[Malunited juvenile upper and lower leg fractures. Spontaneous correction, complications, indication for corrective...

If malunion occurs after shaft fractures of the femur or tibia, it often corrects itself spontaneously. If the remaining growth period is +/- 2 years, side to side dislocations, shortening and varus deformities (up to 15 degrees) are equalized. Valgus, recurvation and antecurvation equalize much more slowly and rotation deformities only at the femur. The indication to perform a corrective osteotomy before the end of growth is therefore rare, and the remaining axis deviations have a good long-term prognosis as far as arthritic changes are concerned. Exceptions of this rule are rotation deformities in the lower leg and progressive valgus after high tibial fractures. Contractures instabilities and overuse of neighbouring joints represent another indication for early correction osteotomies. Risk of damage to the growth plate limits the possibilities for performing corrective osteotomies in young children. On the other hand, stable fixation is of less importance. At the end of growth, the procedures are the same as for adults.