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Complications in proximal tibial osteotomies in children with presentation of technique
1Department of Orthopaedic Surgery, Children's Hospital Medical Center of Akron, OH 44308, USA.
Insights
Proximal tibial osteotomies in children can be safe and effective. A specific surgical technique reduced complication rates, including nerve palsies and infections, compared to previous reports.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Surgical Complications
Background:
- Proximal tibial osteotomies in children carry risks such as nerve palsies, infections, and deformity recurrence.
- Previous studies report a significant complication rate associated with this procedure.
Purpose of the Study:
- To evaluate the complication frequency of proximal tibial osteotomies in children at our institution.
- To assess the safety and efficacy of a specific surgical technique in minimizing complications.
Main Methods:
- Retrospective review of 22 children undergoing 30 primary and 7 repeat proximal tibial osteotomies.
- Utilized a technique including prophylactic anterior compartment fasciotomy and distal fibulectomy.
Main Results:
- Observed three superficial wound infections and one delayed union.
- No cases of peroneal nerve palsies, vascular injuries, compartment syndromes, or fixation failures were recorded.
- No long-term sequelae from superficial infections were noted.
Conclusions:
- The employed surgical technique, emphasizing prophylactic measures and attention to detail, appears to significantly lower complication rates for proximal tibial osteotomies in children.
- Proximal tibial osteotomies can be performed safely and successfully in pediatric patients with careful surgical planning and execution.
Abstract:
Proximal tibial osteotomies in children have been associated with a number of complications, including peroneal nerve palsies, compartment syndromes, deep and superficial infections, vascular injuries, iatrogenic fractures, apophyseal or growth plate damage, and recurrence of deformity. A retrospective review of the results of 22 children who had 30 primary and seven repeat proximal tibial osteotomies was performed to assess the frequency of complications at our institution. Using a specified technique that included prophylactic anterior compartment fasciotomy and distal fibulectomy, there were three superficial wound infections and one delayed union but no peroneal nerve palsies, vascular injuries, compartment syndromes, or fixation failures. There were no sequelae from the superficial infections. This is a lower rate of complications than previously reported in the literature and suggests a relationship to our current surgical technique and attention to detail. We believe that proximal tibial osteotomies can be performed successfully and safely in children when the surgeon recognizes the potential problems and takes steps to prevent them.