Congenital Posteromedial Bowing of the Tibia (Congenital Tibia Recurvatum)

Hill, Robert A.

doi:10.1007/978-3-319-02767-8_53-1

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“…Congenital posteromedial bowing of the tibia is a rare condition first described by Heyman and Herndon in 1949 1 which has also been termed kyphoscoliosis of the tibia 2 or tibial recurvatum. 3 The literature on this condition is limited; the largest series describing the natural history to date is by Pappas (1984), 4 which describes a group of 33 patients.…”

Section: Introductionmentioning

confidence: 99%

Posteromedial bowing of the tibia: A benign condition or a case for limb reconstruction?

Wright

Hill

Eastwood

et al. 2018

Journal of Children's Orthopaedics

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PurposeTo review the initial deformity and subsequent remodelling in posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition.Patients and MethodsIn all, 38 patients with posteromedial bowing of the tibia presenting between 2000 and 2016 were identified. Mean follow-up from presentation was 78 months. A total of 17 patients underwent lengthening and deformity correction surgery, whilst three further patients are awaiting lengthening and deformity correction procedures.ResultsThe greatest correction of deformity occurred in the first year of life, but after the age of four years, remodelling was limited. The absolute leg-length discrepancy (LLD) increased throughout growth with a mean 14.3% discrepancy in tibial length. In the lengthening group, mean length gained per episode was 45 mm (35 to 60). Mean duration in frame was 192 days, with a mean healing index of 42.4 days/cm. Significantly higher rates of recurrence in LLD were seen in those undergoing lengthening under the age of ten years (p = 0.046). Four contralateral epiphysiodeses were also performed.ConclusionPosteromedial bowing of the tibia improves spontaneously during the first years of life, but in 20/38 (53%) patients, limb reconstruction was indicated for significant residual deformity and/or worsening LLD. For larger discrepancies and persistent deformity, limb reconstruction with a hexapod external fixator should be considered as part of the treatment options.Level of evidenceLevel IV (Case series)

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