Combined Antero-Posterior Inverted-U Metaphyseal and Open-Wedge Medial-Epiphyseal Osteotomy for Advanced Blount Disease

Alfred O Ogbemudia,Anirejuoritse Bafor,Ehimwenma J Ogbemudia,Edwin Edomwonyi

doi:10.4236/ss.2015.64026

Abstract

Background: Blount disease is frequently associated with deformities that may not be adequately corrected by a single metaphyseal osteotomy. This study evaluated the outcome of a combined metaphyseal and epiphyseal osteotomy in severe cases. Methods: We prospectively evaluated the outcome of combining the antero-posterior inverted-U metaphyseal osteotomy with a medial open-wedge hemi-epiphyseal osteotomy in eighteen patients (27 tibiae) with Stage IV to VI Blount disease. Results: The average age of patients was 9 years (ranging from 5 to 17). The tibio-femoral angle improved from 43° varus (Range: 34° - 78°) to 2° varus (Range: 5° valgus to 8° varus). The metaphyseal-diaphyseal angle improved from 36° to 8° varus. Internal tibial torsion improved from 39° to 2°. All the patients were able to achieve 110° of knee flexion in a year. Conclusion: In conclusion, the combined metaphyseal and epiphyseal osteotomy satisfactorily corrected tibio-femoral and metaphyseal-diaphyseal varus and internal tibial torsion without recurrence in patients with severe Blount disease. Level of Evidence: IV.

Highlights

Severe Blount disease is a complex of deformities which include: internal torsion and procurvatum of the tibia; shortening of the leg, genu varum, distal femoral torsion [1], medial condyle overgrowth and depression of the medial tibial plateau
The goals of operative treatment include the restoration of the mechanical axis of the limb at the knee to about 5 ̊ of valgus, correction of limb length discrepancy, varus deformity and internal tibial torsion [2]
Lateral hemi-epiphyseodesis of the proximal tibia is only consistent in correcting genu varum and not the depression of the medial tibial plateau

Summary

Introduction

Severe Blount disease is a complex of deformities which include: internal torsion and procurvatum of the tibia; shortening of the leg, genu varum, distal femoral torsion [1], medial condyle overgrowth and depression of the medial tibial plateau. Lateral hemi-epiphyseodesis of the proximal tibia is only consistent in correcting genu varum and not the depression of the medial tibial plateau. To meet the goals of operative treatment and address the instability associated with osteotomy of the tibia and fibula at the same level, fibular osteotomy at the junction between its middle and distal third, proximal tibial metaphyseal osteotomy in the shape of an inverted-U in the antero-posterior plane were done alongside a medial hemicondylar open-wedge osteotomy of the epiphysis and reefing of the lateral collateral ligament. The procedures were done without image intensifier guide and the outcome and complications form the focus of this article

Patients and Method

Results

Discussion