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Congenital Posteromedial Bowing of Tibia: Comparison of Early and Late Lengthening
Bhushan Sagade1, Naeem Jagani2, Ishani Chaudhary3
1Centre for Ilizarov Techniques, Chaudhary Hospital, Akola.
Insights
Lengthening in congenital posteromedial bowing of tibia (CPMBT) is safe and effective in younger children. Early intervention leads to significantly fewer complications and shorter external fixator duration compared to older children.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Limb reconstruction
Background:
- Congenital posteromedial bowing of tibia (CPMBT) is a rare anomaly causing progressive limb shortening.
- Lengthening procedures for CPMBT have not been extensively studied.
- This study compares outcomes of tibial lengthening in younger versus older children.
Purpose of the Study:
- To evaluate the safety and efficacy of early tibial lengthening in children with CPMBT.
- To compare the duration and complication rates of limb lengthening between younger (≤5 years) and older (>5 years) children with CPMBT.
- To determine the benefits of early intervention for CPMBT.
Main Methods:
- A retrospective study of 28 tibial lengthenings in 23 patients, divided into two groups: ≤5 years (Group A) and >5 years (Group B).
- All lengthenings were performed using circular external fixators, with 3 cases using an internal nail.
- Outcomes measured included deformity, limb length discrepancy (LLD), amount and percentage of lengthening, external fixator duration (EFD), external fixator index (EFI), and complication grading.
Main Results:
- Younger children (Group A) presented with greater preoperative deformities but similar LLD compared to older children (Group B).
- Group A showed significantly higher percentage of lengthening (%L), shorter EFD, and lower EFI than Group B.
- Complication rates were lower in Group A, with 11/14 achieving the "triple contract" compared to 3/14 in Group B. Bone scores were excellent in both groups.
Conclusions:
- Early tibial lengthening in children with CPMBT is safe and associated with reduced external fixator duration and fewer complications.
- Younger children with CPMBT, despite presenting with greater deformities, benefit from early lengthening procedures.
- This study supports early intervention for CPMBT to improve outcomes and minimize treatment burden.
Background:
Congenital posteromedial bowing of tibia (CPMBT), a rare anomaly, is characterized by a decreasing deformity and a gradually increasing limb shortening. Lengthening in CPMBT has not been studied extensively. Our series compares the duration and complications of lengthening in younger versus older children to determine early lengthening safety and benefits.
Methods:
We studied 28 tibial lengthenings performed by a single surgeon in 23 patients, divided into 2 equal groups of 14 segments: group A 5 years or younger (preschool) and group B above 5 years. All were lengthened with circular external fixators, of which 3 were lengthened over a nail. We measured preoperative (bo) and postoperative (po) sagittal, coronal, and oblique plane deformities, initial limb length discrepancy (LLD), percentage LLD (% LLD), amount of lengthening (AmtL), percentage lengthening (%L), external fixator duration (EFD), and external fixator index (EFI). We graded complications by Lascombes' criteria, results by Association for the Study and Application of the Methods of Ilizarov bone score.
Results:
The mean age was 8.8±7.1 years; the mean follow-up was 7.9 years. Group A had significantly greater bo-sagittal, coronal, and oblique plane deformities. Mean LLD (3.4 cm in group A vs. 4.1 cm in group B) was similar in both. Expected LLD at maturity (LLDM) using the multiplier method was greater than previously reported (mean, range in group A: 7.2 cm, 4.4 to 9.5 cm; group B: 5 cm, 2.5 to 9.7 cm). Though AmtL (3.5 and 4.1 cm) was similar in both, %L was 24% in group A and 15.7% in group B (P=0.002). EFD (116.6 days) and EFI (33.7 days/cm) were lesser in group A compared with group B (200.3 days, P=0.001; 50.2 days/cm, P=0.01). Lascombes' triple contract was fulfilled in 11/14 lengthenings in group A versus 3/14 in group B. Association for the Study and Application of the Methods of Ilizarov bone score was good and excellent in both groups (P=0.44).
Conclusions:
In a large series of lengthenings in CPMBT, we found younger children presenting with large deformities and large projected length discrepancies could be safely lengthened with significantly lesser EFD and complications than in older children.
Level Of Evidence:
Level IV-therapeutic study.
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