Use of Orthofix T-Garche Fixator in Late-Onset Tibia Vara

Abstract

The treatment of late-onset tibia vara has not been well described. High tibial corticotomies and use of the Orthofix T-Garche fixator were performed on 11 children (14 knees) with late-onset tibia vara. The average age at surgery was 12 years, and follow-up was 2 years. Minimum follow-up was until completion of growth. Angular deformities were measured by using the tibiofemoral angle, metaphyseal-diaphyseal angle, and the mechanical axis both preoperatively and on removal of the fixation device. Union was accomplished in 7-12 weeks, and the total time with the appliance averaged 9 weeks. Complications included superficial pin-tract infections (two) and a transient nerve palsy (one). High tibial corticotomy followed by corrective gradual distraction osteosynthesis by using the Orthofix T-Garche fixator is effective in correcting angular deformity and alleviating knee pain. Advantages of this technique include ease of application, immediate weight bearing, and minimal discomfort with hardware removal. Disadvantages include difficulty in obtaining adequate radiographs with the anteriorly based fixation device, pin-tract infections, and the high degree of patient compliance needed.

Comprehensive Treatment of Late-Onset Tibia Vara

“…Price et al demonstrated that monolateral fixation with either acute or gradual correction can effectively correct the tibial varus deformity in the frontal plane 48 . Alignment in the sagittal plane and rotational correction are more difficult to obtain with use of the monolateral fixator 21,50 . A detailed preoperative plan is essential for any surgical procedure.…”

Treatment of Blount Disease

“…The values that we obtained for the PPTA in both groups were slightly lower than those previously reported for circular external fixators 2,7,16 but similar to those previously reported for unilateral fixators. 10,21 In our study, all of the cases which recurred occurred in patients with infantile tibia vara, with 64% occurring in limbs that had previously had surgical correction of tibia vara. 2,7Y9,11,14Y22 In particular, the most common complication that occurred was superficial infection treated with oral antibiotics, which has been reported previously in 7% to 100% of patients treated for Blount with external fixation.…”

“…1Y6 Gradual correction of Blount disease has been described with both unilateral and circular external fixators. 9 Advantages of unilateral fixators include ease of application, 10,11 fewer pin sites, and less restriction of knee motion. 2,7,8 Disadvantages of circular fixators include a steep surgical learning curve and complexity of postoperative correction required by the patient.…”

Magnetic resonance imaging of the growth plate in late-onset tibia vara

“…It is our belief that the abnormal growth plate cannot respond to the surgery and form a bony bridge. Histopathologic changes have been described in the growth plate and the metaphysis in patients with Blount's disease [8,19]. These changes lead to deformity and growth impairment due to disorientation and disorganization of the columnar pattern of the chondrocytes.…”

“…The optimal treatment for patients with late-onset tibia vara is still debated [2,8]. Different types of proximal tibial or distal femoral osteotomy, hemiepiphysiodesis or asymmetric physeal distraction, have been proposed in the literature [1,6,20].…”