Abstract
BackgroundDespite multiple published reviews, the optimum method of correction and stabilisation of Blount’s disease remains controversial. The purpose of this study is to evaluate the clinical and radiological outcomes of acute correction of late-onset tibial vara by percutaneous proximal tibial osteotomy with circular external fixation using two simple rings. Weighing up the pros and cons and to establish if this method would be the method of choice in similar severe cases especially in a context of limited resources.MethodsThis study was conducted between November 2016 and July 2020. We retrospectively reviewed the clinical notes and radiographs of 30 patients (32 tibiae) who had correction of severe late-onset tibia vara by proximal tibial osteotomy and Ilizarov external fixator. The mean age at the time of the operation was 16.6 (± 2.7) years (range 13–22).ResultsThe mean proximal tibial angle was 65.7° (± 7.8) preoperatively and 89.8° (± 1.7) postoperatively (p < 0.001). The mean mechanical axis deviation improved from 56.2 (± 8.3) preoperatively to 2.8 (± 1.6) mm postoperatively (p < 0.001). The mean femoral-tibial shaft angle was changed from –34.3° (± 6.7) preoperatively to 5.7° (± 2.8) after correction, with degree of correction ranging from 25° to 45°. Complications included overcorrection (three cases 9%) and pin tract infection (eight cases 25%). The mean Hospital for Special Surgery knee scoring system (HSS) improved from 51.03 (± 11.24) preoperatively to 94.2 (± 6.8) postoperatively (p < 0.001). The mean length of follow up period 33.22 (± 6.77) months, (rang: 25–46 months). At final follow up, all patients had full knee range of motion and normal function. All cases progressed to union and there were no cases of recurrence of deformity.ConclusionThis simple procedure provides secure fixation allowing early weight bearing and early return to function. It can be used in the context of health care systems with limited resources. It has a relatively low complication rate. Our results suggest that acute correction and simple circular frame fixation is an excellent treatment choice for cases of late-onset tibia vara, especially in severe deformities.
Highlights
IntroductionThe optimum method of correction and stabilisation of Blount’s disease remains controversial
Despite multiple published reviews, the optimum method of correction and stabilisation of Blount’s disease remains controversial
The right side was affected in 14 patients (44%) and the left sided was affected in 18 patients (56%)
Summary
The optimum method of correction and stabilisation of Blount’s disease remains controversial. Idiopathic tibia vara or Blount’s disease has been categorised into three groups based on age-onset. Blount’s disease results in a complex threedimensional deformity namely varus, internal tibial torsion and procurvatum [2,3,4,5] These deformities result in gait abnormalities, limb-length discrepancy, early onset osteoarthritis and as concomitant deformities in the distal femur and distal tibia [6,7,8]. Addressing these deformities requires very detailed and careful planning in order to achieve satisfactory results and avoid potential complications [9, 10]. The correction main aim is to reduce the abnormal stresses on the knee joint so as to prevent the occurrence of osteoarthritis and any future functional disability [10, 11]
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