Indications for Osteotomy of the Tibia in Children

Dietz, Frederick R.; Merchant, Thomas C.

doi:10.1097/01241398-199010040-00011

Cited by 20 publications

(2 citation statements)

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“…LOTV is also linked with obesity [6,19]. A relationship with vitamin D deficiency exists in all types [19][20][21][22][23]. Wenger et al proposed that age-related differences in osseous physiology lead to the clinically and radiologically distinct entities of early-and late-onset disease [24].…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

Deformity Reconstruction Surgery for Blount’s Disease

Robbins¹

2021

Children

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Blount’s disease is an idiopathic developmental abnormality affecting the medial proximal tibia physis resulting in a multi-planar deformity with pronounced tibia varus. A single cause is unknown, and it is currently thought to result from a multifactorial combination of hereditary, mechanical, and developmental factors. Relationships with vitamin D deficiency, early walking, and obesity have been documented. Regardless of the etiology, the clinical and radiographic findings are consistent within the two main groups. Early-onset Blount’s disease is often bilateral and affects children in the first few years of life. Late-onset Blount’s disease is often unilateral and can be sub-categorized as juvenile tibia vara (ages 4–10), and adolescent tibia vara (ages 11 and older). Early-onset Blount’s disease progresses to more severe deformities, including depression of the medial tibial plateau. Additional deformities in both groups include proximal tibial procurvatum, internal tibial torsion, and limb length discrepancy. Compensatory deformities in the distal femur and distal tibia may occur. When non-operative treatment fails the deformities progress through skeletal maturity and can result in pain, gait abnormalities, premature medial compartment knee arthritis, and limb length discrepancy. Surgical options depend on the patient’s age, weight, extent of physeal involvement, severity, and number of deformities. They include growth modulation procedures such as guided growth for gradual correction with hemi-epiphysiodesis and physeal closure to prevent recurrence and equalize limb lengths, physeal bar resection, physeal distraction, osteotomies with acute correction and stabilization, gradual correction with multi-planar dynamic external fixation, and various combinations of all modalities. The goals of surgery are to restore normal joint and limb alignment, equalize limb lengths at skeletal maturity, and prevent recurrence. The purpose of this literature review is to delineate basic concepts and reconstructive surgical treatment strategies for patients with Blount’s disease.

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Section: Etiology and Pathophysiologymentioning

confidence: 99%

Deformity Reconstruction Surgery for Blount’s Disease

Robbins¹

2021

Children

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“…By consensus, proximal tibial osteotomies are contraindicated due to the high rate of complications including neurovascular injury, compartment syndrome, and a high rate of recurrence [4, 12, 13]. If spontaneous correction of the deformity is not observed and there is sufficient growth remaining, hemi-epiphysiodesis can offer the optimal solution [10, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

Cozen\'s deformity: resolved by guided growth

Morin¹,

Klatt²,

Stevens³

2018

Strategies in Trauma and Limb Reconstruction

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Proximal tibial metaphyseal fractures in children can lead to progressive and symptomatic tibial valgus. Corrective osteotomy has been abandoned, due to frequent complications, including recurrent valgus deformity. While spontaneous remodelling has been reported, this is not predictable. For children with persistent deformities, we have resorted to guided growth of the tibia. We present 19 patients who were successfully treated with guided growth, tethering the proximal medial physis. There were ten boys and nine girls, ranging in age from two to 13.6 years at the time of intervention. The mean follow-up from injury was 7.3 years. We documented the intermalleolar distance, mechanical axis deviation (by zone), medial proximal tibial angle (MPTA), and leg length discrepancy. Removal of the plate, or more recently, the metaphyseal screw, was undertaken upon normalization of the mechanical axis. Including the four patients who have undergone repeat tethering for recurrent valgus (one patient—twice), we are effectively reviewing 24 Cozen’s phenomena, making this the largest series reported in the literature. Correction of the mechanical axis and the proximal medial tibial angle was achieved in all but one patient. Limb length inequality at follow-up ranged from 0.1 to 1.5 cm, with a mean of 0.5 cm. There have been five recurrences in four patients to date; four corrected with repeat tethering and one is pending. Two patients developed significant over correction because of parental failure to pursue timely follow-up. Both have corrected to neutral with lateral tibial physeal tethering. Ten patients have attained skeletal maturity and required no further treatment. The remaining nine patients will be followed until maturity. Guided growth is an excellent choice for the management of post-traumatic tibial valgus. Our rationale for restricting medial overgrowth is twofold: (1) to restore the MPTA and (2) to reduce the length discrepancy due to tibial overgrowth caused by the fracture. Recognizing the potential for recurrent deformity following implant removal, our standard practice now includes removal of just the metaphyseal screw and subsequent reinsertion, in the event of rebound valgus deformity.Level of evidence Therapeutic IV, retrospective series/no control cohort.

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Die operative Korrektur fehlverheilter kindlicher Frakturen an der unteren Extremität

Müller-Färber¹

1997

Posttraumatische Beindeformitäten

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Indications for Osteotomy of the Tibia in Children

Cited by 20 publications

References 0 publications

Deformity Reconstruction Surgery for Blount’s Disease

Deformity Reconstruction Surgery for Blount’s Disease

Cozen\'s deformity: resolved by guided growth

Die operative Korrektur fehlverheilter kindlicher Frakturen an der unteren Extremität

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