Posttraumatic tibia valga in children. A long-term follow-up note

We reevaluated seven patients who initially had been managed nonoperatively because of a progressive valgus deformity that had occurred within approximately twelve months after satisfactory healing of a proximal tibial metaphyseal fracture sustained at an average age of four years (range, eleven months to six years and four months). All seven patients were described in a previous report from our institution, published in 1986. In that report, spontaneous improvement of the angulation was documented after an average duration of follow-up of thirty-nine months and nonoperative treatment of the deformity was recommended.

The patients were followed radiographically for an average of fifteen years and three months (range, ten years and four months to nineteen years and eleven months) after the injury. The radiographs were reviewed to determine the metaphyseal-diaphyseal angle, the mechanical tibiofemoral angle, the proximal and distal tibial remodeling angles, the limb-length discrepancy, and the deviation of the mechanical axis of the limb from the center of the knee joint. Knee function was assessed with use of the rating system of the Cincinnati Sportsmedicine and Orthopaedic Center, and ankle function was assessed with use of the rating system of the American Orthopaedic Foot and Ankle Society.

Every patient had spontaneous improvement of the metaphyseal-diaphyseal and mechanical tibiofemoral angles. Most of the correction occurred at the proximal part of the tibia. The mechanical axis of the limb remained lateral to the center of the knee joint in every patient, with an average deviation of fifteen millimeters (range, three to twenty-four millimeters). The affected tibia was longer than the contralateral tibia in every patient, with an average limb-length discrepancy of nine millimeters (range, three to eighteen millimeters). The knee score on the affected side was excellent for five patients and fair for two; one of the patients who had a fair score had had a tibial osteotomy at the age of sixteen years because of pain in the lateral aspect of the knee that was thought to be due to malalignment. The ankle score on the affected side was excellent for three patients and good for four.

Spontaneous improvement of the deformity occurred in all patients and resulted in a clinically well aligned, asymptomatic limb in most. We believe that patients who have posttraumatic tibia valga should be followed through skeletal maturity and that operative intervention should be reserved for patients who have symptoms secondary to malalignment.