Abstract
Severe Blount's disease results in a multiplanar deformity of the lower limb. The mechanical axis is disrupted, there is a rotational deformity, and also shortening of the limb. A depression of the medial tibial plateau causes joint incongruity and instability. The purpose of this study is to review the results of treatment addressing all the aspects of the deformity. Four patients were treated for severe Blount's disease. The index procedure consisted of a medial tibial plateau elevating osteotomy, a lateral tibial and proximal fibular epiphysiodesis, a proximal tibial metaphyseal osteotomy, and the application of the Taylor Spatial Frame programmed for correction of varus, rotation and shortening, and preemptive lengthening to compensate for growth arrest. Mechanical axis was corrected from a mean 23 degrees (13 degrees -30 degrees ) to 0 degrees in three patients and 6 degrees valgus in 1. Tibias were lengthened by 1-4 cm. At follow-up, the mechanical axis was 0 degrees in two patients and 7 degrees varus in two. The overlengthening was diminishing as planned. The double osteotomy and Taylor Frame correction was found to be accurate, safe, and effective for multiplanar deformity correction in severe Blount's disease.
Highlights
The treatment of Blount’s disease varies with the age of the patient as well as the stage of the disease
In the advanced stage of the disease, there is a bony bridge formation with medial plateau depression, joint instability, and leg length inequality, all of which have to be addressed by the proposed treatment
We present our experience in the treatment of four cases of severe early onset Blount’s disease by an elevation of the medial tibial plateau to restore joint congruity, a lateral hemiepiphysiodesis to prevent recurrence and a proximal tibial metaphyseal osteotomy using the Taylor Spatial FrameTM (Smith and Nephew Richards, Memphis TN, USA) to correct the mechanical axis of the limb and address future leg length discrepancy
Summary
The treatment of Blount’s disease varies with the age of the patient as well as the stage of the disease. In the early stage of the disease, the process is reversible and a correction of the mechanical axis by a metaphyseal osteotomy can restore normal physeal growth. In the advanced stage of the disease, there is a bony bridge formation with medial plateau depression, joint instability, and leg length inequality, all of which have to be addressed by the proposed treatment. We present our experience in the treatment of four cases of severe early onset Blount’s disease by an elevation of the medial tibial plateau to restore joint congruity, a lateral hemiepiphysiodesis to prevent recurrence and a proximal tibial metaphyseal osteotomy using the Taylor Spatial FrameTM (Smith and Nephew Richards, Memphis TN, USA) to correct the mechanical axis of the limb and address future leg length discrepancy
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