Proximal tibial derotation osteotomy for torsion of the tibia: A review of 43 cases

Abstract

Purpose Persistent tibial torsion in the older child can be treated with a derotation osteotomy. Distal tibial osteotomy has been recommended due to concerns of peroneal nerve palsy, vascular injury, and compartment syndrome with a proximal tibial osteotomy. However, an osteotomy in the proximal tibia may achieve union more rapidly and skin issues, as described for distal tibial osteotomies, are less likely. This study investigates the safety and efficacy of proximal tibial derotation osteotomies. Methods We retrospectively reviewed 43 tibiae in 25 consecutive children with persistent tibial torsion treated with a proximal tibial derotation osteotomy between 1991 and 2006. Patients with concomitant varus or valgus osteotomies were excluded. Diaphyseal fibular osteotomies were performed in five patients, while all patients had a prophylactic anterior compartment fasciotomy. Results The mean age at surgery was 10.4 ± 4.0 years and the mean follow-up was 3.2 ± 3.5 years. Patients with internal tibial torsion had a mean preoperative thigh-foot angle (TFA) of -14°± 6°and a mean postoperative TFA of 8°± 4°. Patients with external tibial torsion had a mean preoperative TFA of 38°± 9°and a mean postoperative TFA of 7°± 5°. The overall mean correction was 26°± 9°. Major postoperative complications occurred in 4 patients (9%), including one peroneal nerve palsy which resolved, one delayed union requiring revision surgery, and two patients with mild postoperative valgus deformities. Conclusions Proximal tibial derotation osteotomy with an anterior compartment fasciotomy is a reliable method for treating tibial torsion with an acceptable complication rate. Given the larger bony surface area and improved soft tissue envelope, proximal tibial derotation osteotomy can be considered as an alternative to a distal tibial derotation osteotomy.

Minimally invasive plate osteosynthesis for tibial derotation osteotomies in children with cerebral palsy

“…There is a controversy about the level used for a corrective osteotomy in the tibia. 1 , 10 , 14 , 15 , 17 , 22 A tibial osteotomy can be performed at either the proximal tibia, diaphysis, or distally at the supramalleolar region. 15 , 22 The proximal tibia has been used commonly in the treatment of genu valgum or varum.…”

“… 1 , 10 , 14 , 15 , 17 , 22 A tibial osteotomy can be performed at either the proximal tibia, diaphysis, or distally at the supramalleolar region. 15 , 22 The proximal tibia has been used commonly in the treatment of genu valgum or varum. 15 Recent studies have demonstrated high complication rates after proximal osteotomies, including loss of fixation, peroneal nerve injury, and compartment syndrome.…”

Why Do Patellofemoral Stabilization Procedures Fail? Keys to Success

“…This would suggest that in patients with unilateral instability, an excessive external tibial torsion may not be the main underlying factor contributing to PF instability. A small number of complications have been reported, including nerve palsy (49,58), valgus deformity (58), distal physeal closure (59), and delayed/non-union (58)(59)(60). Complications have been typically found in less than 15% of patients which have, in some cases required revision surgery.…”

Rotational deformities of the long bones can be corrected with rotationally guided growth during the growth phase

“… 2006 , Walton et al. 2012 ). Osteotomy has various disadvantages including over or undercorrection, recurrence of the deformity, difficulty in postoperative mobilization, and delayed recovery and return to daily life (Gyr et al.…”