Acute correction of proximal tibial coronal plane deformity in small children using a small monolateral external fixator with or without cross-pinning

Abstract

Purpose Surgical correction of proximal tibia deformity in small children can be challenging. We present the surgical technique and outcome of proximal tibia osteotomy fixed with small monolateral external fixator in this patient group. Methods A total of 17 cases in eight patients younger than nine years of age were study subjects. A proximal tibia osteotomy was fixed with a small monolateral external fixator with or without cross-pinning. Outcome was evaluated by changes of radiographic parameters such as medial proximal tibia angle (MPTA), metaphyseal diaphyseal angle (MDA) and clinical findings of complications, time interval until weight bearing and fixator removal time. Results MPTA improved from a preoperative mean of 73° (sd 4°; 66° to 78°) to an immediate postoperative mean of 90° (sd 3°; 85° to 96°) in varus tibiae, and from 104° (sd 1°; 103° to 105°) to 89° (sd 1°; 88° to 89°) in valgus tibiae. In all, 15 of the 17 cases (88.3 %) achieved postoperative MPTA within the normal range (85° to 90°). MDA improved from a preoperative mean of 19° (sd 5°; 11° to 24°) to an immediate postoperative mean of 0° (sd 4°; -6° to 7°) in varus tibiae, and from -25° (sd 2°; -22° to -24°) to 2° (SD 1°; 1° to 3°) in valgus tibiae. Full weight bearing was possible at mean 1.7 months (0.5 to 3.0). Mean follow-up period was 6.5 years (sd 5.4; 1.0 to 16.0). No complications developed during the follow-up. Conclusion Proximal tibia osteotomy fixed with small monolateral external fixator provides accurate, safe and efficient correction in the management of coronal plane angular deformity in small children. Level of Evidence Level IV

Is it possible to achieve multiplanar correction of complex deformities around the knee in children and adolescents using a monolateral external fixator?

“…The authors recommend future studies that focus on one type of deformity. Table 7 summarizes the results of similar studies [ 4 , 16 , 17 , 19 , 20 ].…”

“…The application of the monolateral fixator in deformity correction can be used as a step in the procedures of fixator-assisted nailing or plating; the monolateral fixator is used intraoperatively for planning and deformity correction then the plate or the nail is used to maintain the correction. The fixator is removed at the end of surgery [ 10 , 15 ].…”

“…The monolateral external fixator (MEF) has been used to correct angular deformities, especially coronal plane deformities (genu varum or valgum) [ 10 ]. Also, the use of MEF in complex deformity correction was introduced in the context of fixator-assisted nailing or plating in adults [ 11 ].…”

Proximal Tibial Recurvatum-Valgus: Analysis and Treatment

“…35 Peroneal nerve injury and/or compartment syndrome can result from any acute correction, but particularly at larger magnitudes. 36,37 Finally, in patients with advanced degenerative arthritis of the knee, joint preserving options with osteotomy may not offer satisfactory pain relief and long-term joint preservation. In these patients, total knee arthroplasty (TKA) may be considered.…”

Guided growth for coronal lower limb deformities in skeletal dysplasia

“…The deformities can be treated with different surgical options, including acute or gradual corrective osteotomies. Acute correction with internal fixation is likely associated with a number of complications, including compartment syndromes, nerve palsy, infection, undercorrection or overcorrection and recurrence of deformities [3,4]. Gradual correction with an external fixator has some disadvantages, such as pin site infection and limitation of daily living with a prolonged treatment period [5,6].…”