Abstract
A double osteotomy for correcting tibial deformity in combination with medial plateau elevation is recommended for the management of neglected Blount disease cases. We report our clinical experience with the application of this surgical technique and describe the long-term follow-up of the patients who were operated on. During a 10-year period, eight children (8 boys) with mean age of 12years (range 9-14years) underwent surgery (9 operations) due to neglected infantile tibia vara. All patients suffered from stage V or VI Blount disease according to the Langenskiold and Riska classification. Two simultaneous combined osteotomies were performed for medial plateau elevation and for correction of the tibial deformity. The correction was immediate using K-wires for stabilization and a long-leg cast for immobilization. The mean duration of follow-up was 10years (range 5-15years), and the evaluations were based on clinical and radiological criteria. At the latest follow-up, there was no observable knee flexion or extension restriction and no signs of instability or lateral thrust. All patients had returned to a higher activity level. Leg-lengthening surgery was performed in one child, but the length discrepancy was already present before the double osteotomy was performed. No other complications were noticed. All the angles measured on X-rays had been corrected, and this correction was retained until the latest follow-up. This method results in very good outcomes in patients who suffer from Blount disease of stage V or greater. With this technique, the tibial deformity is corrected, the articular surface is restored, and future recurrence is prevented.
Highlights
Blount published his classical article on what is known as Blount disease in 1937 [1], and it has since become a well-studied entity
Purpose A double osteotomy for correcting tibial deformity in combination with medial plateau elevation is recommended for the management of neglected Blount disease cases
Leg-lengthening surgery was performed in one child, but the length discrepancy was already present before the double osteotomy was performed
Summary
Blount published his classical article on what is known as Blount disease in 1937 [1], and it has since become a well-studied entity This entity has two different types; the infantile or early onset form which appears before the age of 3 years and the adolescence or late onset form which appears in children older than 10 years [2]. In 1964, Langenskiold and Riska proposed elevating the medial plateau for cases of infantile Blount disease that presented late [3] The indication for this additional procedure is the significant incongruity of the joint surface due to depression of the medial part of the tibial plateau [2]. The term ‘‘double elevating osteotomy’’ was proposed by Gregosiewicz et al who used the bony wedge removed from the
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