Traumatic Physeal Arrest of the Proximal Tibia with Deformity in All Four Dimensions (Length, Coronal Angulation, Sagittal Angulation, and Rotation)

Abstract

A thirteen-year-old male suffers a fracture to the left proximal tibia involving the physis. He develops a four-dimensional deformity (short, external rotation, valgus, and recurvatum) over time. Simultaneous correction of all four planes of deformity was achieved using the Taylor Spatial Frame. 1 Brief Clinical History A thirteen-year-old male sustains a displaced left proximal tibial Salter-Harris II fracture (Fig. 1a, b). The fracture was immediately fixed with two smooth wires and healed uneventfully. Over the next 3 years, however, the patient slowly developed a noticeable deformity of the left leg. A partial proximal tibial physeal arrest was noted. Evaluation of the limb at that time demonstrates 8 of valgus, 2 cm of shortening, 10 of asymmetric external rotation compared to the opposite side, and 25 of recurvatum (apex posterior). See Fig. 2a, b. 2 Preoperative Clinical Photos and Radiographs See Figs. 1 and 2. 3 Preoperative Problem List 1. Approaching skeletal maturity – guided growth not an option 2. Near-complete arrest of the left proximal tibial physis – resection of the physeal bridge not possible 3. Leg length discrepancy 4. External rotation deformity 5. Genu valgum 6. Proximal tibial slope 25 in the wrong direction *Email: christopher.iobst@nemours.org Limb Lengthening and Reconstruction Surgery Case Atlas DOI 10.1007/978-3-319-02767-8_96-1 # Springer International Publishing Switzerland 2014