Abstract
Background
This study reports on the clinical experience and results of a new surgical technique for single-stage acute correction of the complex proximal tibial deformity in adolescent tibia vara using a minimally invasive surgical approach.
Methods
This prospective study included 19 limbs. The mean age was 14 years. A v-shaped proximal tibial osteotomy was performed such that the first osteotomy limb was used to elevate the depressed medial tibial plateau, while the second limb osteotomy corrected the metaphyseal varum and internal rotation deformity. This acute correction was stabilized by an Ilizarov frame construct.
Results
Follow-up averaged 16.8 ± 4.4 months. Average time in the frame was 11.2 ± 1.2 weeks. All cases reached maturity, maintained their correction, and ultimately achieved union. The angle of depression of the medial tibial plateau improved from a median of 38° preoperatively to 7° postoperatively.
Conclusions
This technique seems to provide satisfactory basis for a dependable method of correction for severe adolescent tibia vara.
Level of Evidence
Level IV, Case series study, Closed Cohort Study.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Blount WP (1937) Tibia Vara. Osteochondrosis deformans tibiae. J Bone Joint Surg Am 19:1–29
Herring JA (2008) Tachdjian’s pediatric orthopaedics, vol 4. Saunders Elsevier, Philadelphia
Langenskiold A, Riska EB (1964) Tibia vara (osteochondrosis deformans tibiae): a survey of seventy-one cases. J Bone Joint Surg Am 46:1405–1420
Loder RT, Johnston CE 2nd (1987) Infantile tibia vara. J Pediatr Orthop 7:639–646
Doyle BS, Volk AG, Smith CF (1996) Infantile Blount disease: long-term follow-up of surgically treated patients at skeletal maturity. J Pediatr Orthop 16:469–476
Cook SD, Lavernia CJ, Burke SW, Skinner HB, Haddad RJ Jr (1983) A biomechanical analysis of the etiology of tibia vara. J Pediatr Orthop 3:449–454
Siffert RS (1982) Intraepiphyseal osteotomy for progressive tibia vara: case report and rationale of management. J Pediatr Orthop 2:81–85
Gregosiewicz A, Wosko I, Kandzierski G, Drabik Z (1989) Double-elevating osteotomy of tibiae in the treatment of severe cases of Blount’s disease. J Pediatr Orthop 9:178–181
Schoenecker PL, Johnston R, Rich MM, Capelli AM (1992) Elevation of the medial plateau of the tibia in the treatment of Blount disease. J Bone Joint Surg Am 74:351–358
Smith SL, Beckish ML, Winters SC, Pugh LI, Bray EW (2000) Treatment of late-onset tibia vara using Afghan percutaneous osteotomy and Orthofix external fixation. J Pediatr Orthop 20(5):606–610
Alekberov C, Shevtsov VI, Karatosun V, Günal I, Alici E (2003) Treatment of tibia vara by the Ilizarov method. Clin Orthop Relat Res 409:199–208
Gordon JE, Heidenreich FP, Carpenter CJ, Kelly-Hahn J, Schoenecker PL (2005) Comprehensive treatment of late-onset tibia vara. J Bone Joint Surg Am 87(7):1561–1570
Jones S, Hosalkar HS, Hill RA, Hartley J (2003) Relapsed infantile Blount’s disease treated by hemiplateau elevation using the Ilizarov frame. J Bone Joint Surg (Br) 85(4):565–571
Hefny H, Shalaby H, El-kawy S, Thakeb M, Elmoatasem E (2006) A new double elevating osteotomy in management of severe neglected infantile tibia vara using the Ilizarov technique. J Pediatr Orthop 26:233–237
McCarthy JJ, MacIntyre NR III, Hooks B, Davidson RS (2009) Double osteotomy for the treatment of severe blount disease. J Pediatr Orthop 29:115–119
Fitoussi F, Ilharreborde B, Lefevre Y, Souchet P, Presedo A, Mazda K, Pennecot GF GF (2011) Fixator-assisted medial tibial plateau elevation to treat severe Blount’s disease: outcomes at maturity. Orthop Traumatol 97:172–178
Kline SC, Bostrum M, Griffin PP (1992) Femoral varus: an important component in late-onset Blount’s disease. J Pediatr Orthop 12:197–206
Schoenecker PL, Rich MM (2001) The lower extremity. In: Morrissy RT, Weinstein SL (eds) Lovell and Winter’s pediatric orthopaedics, 5th edn. Williams and Wilkins, Philadelphia, pp 1059–1104
Laurencin CT, Ferriter PJ, Millis MB (1996) Oblique proximal tibial osteotomy for the correction of tibia vara in the young. Clin Orthop 327:218–224
Kempf I, Grosse A, Abalo C (1986) Locked intramedullary nailing. Its application to femoral and tibial axial, rotational, lengthening, and shortening osteotomies. Clin Orthop 212:165–173
Gkiokas A, Brilakis E (2012) Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation. J Child Orthop 6:411–418
Amer AA, Khanfour AA (2010) Evaluation of treatment of late-onset tibia vara using gradual angulation translation high tibial osteotomy. Acta Orthop Belg 76:360–366
Pinkowski JL, Weiner DS (1995) Complications in proximal tibial osteotomies in children with presentation of technique. J Pediatr Orthop 15:307–312
van Huyssteen AL, Hastings CJ, Olesak M, Hoffman EB (2005) Double-elevating osteotomy for late-presenting infantile Blount’s disease: the importance of concomitant lateral epiphysiodesis. J Bone Joint Surg (Br) 87(5):710–715
Funding
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hegazy, M., Abdelatif, N.M.N., Mahmoud, M. et al. Correction of severe adolescent tibia vara by a single-stage V-shaped osteotomy using Ilizarov fixator. Eur Orthop Traumatol 6, 99–105 (2015). https://doi.org/10.1007/s12570-015-0291-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12570-015-0291-5