Modifies Oblique Proximal Tibial Osteotomy for Deformity Correction of Tibia Vara (Blount Disease)

Abstract

Background: In Blount's disease, there is a complex three-dimensional deformity which typically includes varus, internal rotation, and (sometimes) procurvatum. The best way to obtain correction is with simple procedure carried out as high in the tibia as possible to promote rapid union, quick remodeling, and with minimal proximal shaft deformity. Patients and methods: 17 patients with tibia vara underwent corrections of deformity associated with tibia vara by modified Rab proximal tibial oblique osteotomy at our hospital. In twelve patients the deformity was bilateral and it was unilateral in the other five patients, with a total of 29 tibiae. They were ten boys and seven girls with a mean age at surgery of 3 years 6 months (range, 3 years 2 months to 4 years 11 months). The patients were in stage III of the Langenskiöld classification (1952) of the disease. Results: According to Schoenecker's criteria, 100% of the patients in this study had a good result. Radiologically healing was achieved in all osteotomies with the desired correction of deformity within twelve weeks in all the 17 patients with no complication. Conclusion: The modified Rab oblique proximal tibial has the advantage of allowing both angular and rotational correction with a high degree of success.

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

“…Acute correction with internal fixation has been widely used in correction of proximal tibial deformity in small children and successful correction has been reported. 3 , 4 However, some studies reported inaccurate correction and malunion. Aly 19 reported that only 67% to 75% of cases achieved accurate correction, which was within 5° of normal value (MPTA 87°), by acute correction with Kirschner-wire cross pinning in children of two to four years of age.…”

“…There are several surgical options, including asymmetric physeal suppression, 1 gradual correction using an external fixator 2 and acute correction with internal fixation. 3 , 4 Asymmetric physeal suppression by temporary hemiepiphysiodesis or guided growth is a less invasive procedure, with fewer complications. 5 , 6 However, in small children with genetic or metabolic skeletal disorders, it could be technically demanding for hypoplastic or dysplastic epiphysis.…”

Oblique tibial osteotomy with elevation of medial tibial plateau for treatment of tibia vara (Blount`s disease) in 8 year old girl: (case report)

“…The limited internal fixation with crossed screws provided satisfactory control of the osteotomy position. 12 Elzohairy et al 2 described 17 patients with tibia vara. A total of 29 tibiae underwent corrections of the deformity associated with tibia vara by modified Rab proximal tibial oblique osteotomy.…”

“…According to Schoenecker's criteria, 100% of the patients in this study had a good result. 2 Zayer et al 8 published a case report of two neglected cases of Blount's disease with severe sloping of the medial tibial condyle and excessive ligamentous laxity. They did elevation of the medial tibial condyle with good results.…”

“…In this condition which was first described by Erlancher in 1922 and later reviewed by Blount in 1937, 1 there is a complex three-dimensional deformity, which typically includes varus, internal rotation, and possible procurvatum. 2 It results from repeated compressive loading injury of proximal medial tibial physis with overgrowth of lateral tibial physis leading to varus deformity. 3 Surgical correction of Blount disease can be achieved by number of methods, which includes asymmetric temporary physeal stapling, hemiepiphysiodesis, or osteotomy.…”