Single-stage medial plateau elevation and metaphyseal osteotomies in advanced-stage Blount's disease: A new technique

Abstract

Purpose Surgical treatment in advanced-stage infantile Blount’s disease with medial plateau (MP) depression is challenging. Several osteotomies and fixation methods have been described with no established benchmark. We conducted this study to evaluate the efficacy and safety of a new single-stage technique for acute medial condyle elevation and metaphyseal osteotomies with internal fixation. Methods A prospective case series of 19 consecutive patients (21 knees) with severe infantile Blount’s disease underwent a single-stage MP elevation and metaphyseal osteotomies, with internal fixation. The mean age was 10.3 years (8.2 to 13.6) and the mean follow-up was 5.1 years (3.2 to 8.3). The outcome measures included clinical and radiological parameters and patient-reported pediatric outcomes data collection instrument (PODCI) score. Results The mean PODCI score improved significantly from 50% to 88%. The mean internal tibial torsion improved from -27° to 11°. All cases maintained full knee extension, no limitation in flexion range of movement and no signs of instability or lateral thrust gait. All the radiographic parameters improved significantly; the mean tibiofemoral angle improved from -29° to 7°, the metaphyseal-diaphyseal angle improved from 33.4° to 4.7° and the angle of depressed MP improved from 38.3° to 2.4° (p < 0.001). At the latest follow-up, no cases of deformity recurrence were identified, the final limb-length discrepancy was < 1 cm in all patients. Conclusion Single-stage MP elevation and metaphyseal osteotomies with internal fixation significantly improved the clinical and radiographic parameters and PODCI score in advanced infantile Blount’s disease and precluded the use of external immobilization, with no evidence of deformity recurrence. Level of evidence IV

Osteotomy treatments and post-operative fixations for Blount disease: A systematic review

“…The most featured technique featured in papers reviewed employed proximal tibial osteotomy [ 1 , 4 , 5 , [7] , [8] , [9] , 12 , 13 ] with different location of surgical interventions, namely intra-epiphyseal [ 11 ], metaphyseal [ [14] , [15] , [16] ], and subperiosteal [ 17 ] sites. At least three procedures described were performed as double osteotomy in a single surgery [ 10 , 17 , 18 ], and at least two described grafting fibular fragments into tibial openings [ 17 , 18 ].…”

“…This review saw majority of the reported osteotomies were stabilized using internal fixations, with minimal screws [ 12 ], plates and screws [ 1 , 9 , 13 , 15 , 16 ], and K-wires [ 4 , 17 , 18 ]. The rest of external fixations described mainly used the hexapod rings resembling Ilizarov apparatus [ 5 , 14 ] and one considered using mono-lateral L-shaped pins to achieve gradual correction [ 10 ].…”

Deformity Reconstruction Surgery for Blount’s Disease

“…Children 2021, 8, x FOR PEER REVIEW technique using a gigli saw to perform the osteotomy to avoid the risk of intra fracture and medial condyle displacement [84]. The open-wedge defect is bone and the osteotomy stabilized with internal or external fixation.…”

“…Increased posterior depression can be differentially corrected with rotation in the sagittal plane. Barka et al recently described an "inside-out" technique using a gigli saw to perform the osteotomy to avoid the risk of intra-articular fracture and medial condyle displacement [ 84 ]. The open-wedge defect is bone-grafted, and the osteotomy stabilized with internal or external fixation.…”

An Author’s Guide to Mastering Research Communication Skills: Introduction of a Medical Manuscript

“…However, innovation does not necessary mean a description a new surgical technique or an introduction of a new molecule or drug. This represents one aspect of research novelty only [30].…”