Frequency and severity of callus defects. Dorsomedial vs ventrolateral approach for corticotomy in performing callus distraction of the tibia

Background. The purpose of this study was to compare a dorsomedial to the ventrolateral approach for corticotomy in performing callus distraction of the proximal metaphyseal tibia. Patients and methods. A total of 31 callus distractions were performed in 28 humans. The ventrolateral approach was used for 18 and the dorsomedial approach for 13 corticotomies. A scale of four severity grades was used to classify callus defect zones based on their extent as evidenced on serial X-rays. Biopsies were taken from highergrade defects (grades 3-4). Results. A total of 13 radiological evaluations revealed 12 defects using the ventrolateral approach. Seven defects (grades 1 2) healed spontaneously, whereas six defects (grades 3-4) required operative intervention as histological tissue examination showed no osteogenic potential. Conclusion. To prevent callus defects of the proximal tibia in the future and to ensure maximal osteogenic potential in the distraction zone, a minimally invasive dorsomedial approach appears to achieve favorable results.