Guided Growth for Varus Deformity Following Early Tibial Osteotomy in Infantile Tibia Vara-A Multi-Center Study

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Biomechanical engineering

Background:

• Infantile tibia vara (ITV) often presents with persistent or recurrent varus deformity despite early osteotomy.
• Disordered growth at the medial proximal tibial physis is a common complication in ITV.
• Lateral tibial tension band plating (LTTBP) is hypothesized to guide correction of these deformities.

Purpose of the Study:

• To evaluate the effectiveness of LTTBP in correcting residual varus deformity in patients with infantile tibia vara (ITV) after initial osteotomy.
• To assess the long-term outcomes and potential complications associated with LTTBP in this patient population.

Main Methods:

• Retrospective review of 15 patients (16 extremities) treated with LTTBP across 6 centers.
• Patients diagnosed with ITV at or before 4 years of age.
• Outcome assessment based on digital standing anteroposterior lower extremity radiographs measuring deformity parameters.

Main Results:

• Twenty-two LTTBP procedures were performed at a mean age of 7.5 years, with revisions for implant failure and recurrence.
• Single LTTBP improved the medial proximal tibial angle by a mean of 13.4 degrees.
• Initial correction to MAZone I or valgus was achieved in 81% of limbs, but 56% maintained correction after implant removal.
• Younger patients, those with lower weight and BMI, and those with open triradiate phases showed better improvement.

Conclusions:

• LTTBP is effective in initially correcting residual varus in ITV post-osteotomy, with 81% achieving neutral or valgus alignment.
• Implant removal led to rebound in some cases, reducing the final corrected rate to 56%.
• Ninety-four percent of patients avoided further osteotomy during the study period, highlighting LTTBP's role in limb salvage.