Abstract
Blount's disease is a progressive form of genu varum due to asymmetrical inhibition of the postero medial portion of the proximal tibial epiphysis. The surgical treatments involved in correction of Blount's disease are often technically demanding, complicated procedures. These procedures can lead to prolonged recovery times and poor patient compliance. In such a context we are suggesting "fibulectomy with Z osteotomy" of the proximal tibia, a relatively simple and highly effective technique. This technique is based on correcting the mechanical axis of the lower limb thereby restoring growth from the medial physis of proximal tibia. We have used a new surgical technique, which includes fibulectomy followed by a Z-shaped osteotomy. We have used this simple technique in a 5 year-old boy with unilateral Blount's disease. The femoro-tibial angle was corrected from 18.2° of varus to 4.2° of valgus. The angular correction obtained after operation was 22°. There were no postoperative complications. This technique has the advantages of correcting both angular and rotational deformities simultaneously. The purpose of this case study is to introduce a new surgical technique in the treatment of Blount's disease.
Highlights
Blount’s disease is a progressive form of genu varum due to asymmetrical inhibition of the postero medial portion of the proximal tibial epiphysis
We decided for Z osteotomy which will correct the angular and rotational deformities
For the left tibial varus deformity, the upper horizontal limb of the Z osteotomy starts at the medial border of tibia, one finger breadth below the tibial tuberosity, to the anterior border of the tibia
Summary
Infantile tibia vara or Blount’s disease was the first described by Erlacher in 19221. The results of closing-wedge, proximal tibial osteotomy was published by Laurencin et al.[6] It has many disadvantages like fracture of the medial cortex, which would produce over correction and shortening of the limb. Martin et al.[7] described the result of Opening-wedge-type osteotomy The disadvantages of this technique include undercorrection of the internal tibial torsion and instability at the osteotomy site, which requires rigid internal fixation. The correction achieved following Z osteotomy is based on the principle of correcting mechanical axis of lower limb thereby restoring growth from the medial tibial physis As such this procedure does not have any contraindications or limitations similar to other corrective osteotomies
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