HSS Journal ®

, Volume 8, Issue 3, pp 304–308 | Cite as

Osteotomy, Arthrodesis, and Arthroplasty for Complex Multiapical Deformity of the Leg

  • Alex C. Lesiak
  • J. Turner Vosseller
  • S. Robert Rozbruch
Case Report

Abstract

Background

Assessment of diaphyseal deformity in the tibia consists of delineating anatomic axes or cortical lines with resultant apices of deformity. Single-apex deformities have been well described both in terms of assessment and treatment, whereas double-level deformities with metaphyseal and/or juxtacortical involvement are less straightforward. Multiapical deformities of the lower extremity, though uncommon, are the next level of complexity and provide the surgeon with a difficult correctional mission.

Case Description

We report two cases of multiapical deformity of the tibia, both of which were secondary to a distant history of tibial fracture with resultant knee and ankle joint degeneration and deformity. Both cases had three levels of deformity that were addressed with tibial osteotomy, ankle fusion, and total knee replacement. Initial presentation, problem lists, surgical treatment, and subsequent results are reviewed.

Literature Review

Treatment of a post-traumatic three-level deformity has never specifically been addressed in the literature, although the principles of treatment are the same as for less complex deformities.

Purposes and Clinical Relevance

These two cases present a treatment approach for complex, multiapical deformity of the tibia. The same principles of deformity correction used to treat less complex deformities are applied to these patients with an overarching synthesis that takes all aspects of the three deformities into account. Although these cases are complex and difficult, good results in terms of deformity correction and pain relief can be obtained.

References

  1. 1.
    Harman MK, Markovich GD, Banks SA, Hodge WA. Wear patterns on tibial plateaus from varus and valgus osteoarthritic knees. Clin Orthop Relat Res. 1998;352:149–158PubMedGoogle Scholar
  2. 2.
    Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. Clin Orthop Relat Res. 1992;280:65–71PubMedGoogle Scholar
  3. 3.
    Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res. 1992;280:48–64PubMedGoogle Scholar
  4. 4.
    Paley D. Principles of deformity correction. Herzenberg JE, ed. Berlin, Heidelberg: Springer-Verlag, 2002Google Scholar
  5. 5.
    Probe RA. Lower extremity angular malunion: evaluation and surgical correction. J Am Acad Orthop Surg. 2003;5:302–311.Google Scholar
  6. 6.
    Rozbruch SR, Segal K, Ilizarov S, Fragomen AT, Ilizarov G. Does the taylor spatial frame accurately correct tibial deformities? Clin Orthop Relat Res. 2010;5:1352–1361CrossRefGoogle Scholar
  7. 7.
    Russell GV, Graves ML, Archdeacon, MT, Barel DP, Brien GA Jr, Porter SE. The clamshell osteotomy: a new technique to correct complex diaphyseal malunions. J Bone Joint Surg Am. 2009; 91(2): 314–324PubMedCrossRefGoogle Scholar
  8. 8.
    Saithna A. The influence of hydroxyapatite coating of external fixator pins on pin loosening and pin track infection: a systematic review. Injury. 2010; 41: 128–132PubMedCrossRefGoogle Scholar
  9. 9.
    Stuermer EK, Stuermer KM. Tibial shaft fracture and ankle joint injury. J Orthop Trauma. 2008;2:107–112CrossRefGoogle Scholar
  10. 10.
    Takakura Y, Tanaka Y, Kumai T, Tamai S. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J. Bone Joint Surg. Br. 1995;77:50–54PubMedGoogle Scholar
  11. 11.
    Tang SC, Leong JC, Hsu LC. Lambrinudi triple arthrodesis for correction of severe rigid drop-foot. J Bone Joint Surg. Br. 1984;66:66–70PubMedGoogle Scholar
  12. 12.
    Thonse R, Conway JD. Antibiotic cement-coated nails for the treatment of infected nonunions and segmental bone defects. J Bone Joint Surg, Am. 2008;90 Suppl 4:163–174CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2012

Authors and Affiliations

  • Alex C. Lesiak
    • 1
  • J. Turner Vosseller
    • 2
  • S. Robert Rozbruch
    • 2
    • 3
  1. 1.University of Nebraska Medical CenterOmahaUSA
  2. 2.Weill Cornell Medical CollegeNew YorkUSA
  3. 3.Limb Lengthening and Deformity Service, Hospital for Special SurgeryNew YorkUSA

Personalised recommendations