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Double-elevating osteotomy for late-presenting infantile Blount's disease: the importance of concomitant lateral
A L van Huyssteen1, C J Hastings, M Olesak
1University of Cape Town, 7 Marne Avenue, Newlands 7700, Cape Town, South Africa.
Insights
Double-elevating osteotomy effectively corrects medial tibial plateau depression and tibial varus in children with late-presenting infantile Blount
Area of Science:
- Pediatric Orthopedics
- Pediatric Limb Deformity Correction
- Pediatric Bone Surgery
Background:
- Late-presenting infantile Blount's disease often involves significant tibial deformity.
- Surgical correction is necessary to restore normal knee alignment and function.
- Double-elevating osteotomy is a surgical technique used to address these deformities.
Purpose of the Study:
- To evaluate the efficacy of double-elevating osteotomy in treating late-presenting infantile Blount's disease.
- To assess the correction of medial tibial plateau depression and tibial varus.
- To determine the outcomes of concurrent proximal lateral tibial epiphysiodesis.
Main Methods:
- Review of 34 knees in 24 children (ages 7-13.5) with Langenskiöld stages IV-VI Blount's disease.
- Surgical technique involved double-elevating osteotomy to correct joint line depression, tibial varus, and internal torsion.
- Proximal lateral tibial epiphysiodesis was performed concurrently in 19 recent cases.
Main Results:
- Mean medial tibial plateau depression corrected from 49 to 26 degrees, with sustained correction at follow-up.
- Mean pre-operative mechanical varus of 30.6 degrees corrected to 0-5 degrees of valgus in 29 knees.
- Eight knees with delayed epiphysiodesis showed recurrent varus due to physeal fusion.
Conclusions:
- Double-elevating osteotomy is an effective surgical option for correcting deformities in late-presenting infantile Blount's disease.
- Concurrent proximal lateral tibial epiphysiodesis is crucial for maintaining correction and preventing recurrence.
- Delayed epiphysiodesis can lead to adverse outcomes, including recurrent tibial varus.
Abstract:
We reviewed 34 knees in 24 children after a double-elevating osteotomy for late-presenting infantile Blount's disease. The mean age of patients was 9.1 years (7 to 13.5). All knees were in Langenskiöld stages IV to VI. The operative technique corrected the depression of the medial joint line by an elevating osteotomy, and the remaining tibial varus and internal torsion by an osteotomy just below the apophysis. In the more recent patients (19 knees), a proximal lateral tibial epiphysiodesis was performed at the same time. The mean pre-operative angle of depression of the medial tibial plateau of 49 degrees (40 degrees to 60 degrees ) was corrected to a mean of 26 degrees (20 degrees to 30 degrees ), which was maintained at follow-up. The femoral deformity was too small to warrant femoral osteotomy in any of our patients. The mean pre-operative mechanical varus of 30.6 degrees (14 degrees to 66 degrees ) was corrected to 0 degrees to 5 degrees of mechanical valgus in 29 knees. In five knees, there was an undercorrection of 2 degrees to 5 degrees of mechanical varus. At follow-up a further eight knees, in which lateral epiphysiodesis was delayed beyond five months, developed recurrent tibial varus associated with fusion of the medial proximal tibial physis.