Comprehensive Treatment of Late-Onset Tibia Vara

Gordon, Joel; Heidenreich, Fred P; CARPENTER, CHRIS J.; Kelly-Hahn, Jill; Schoenecker, Perry L.

doi:10.2106/jbjs.02276

Cited by 43 publications

(44 citation statements)

References 48 publications

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“…This allows for a comparison between the results obtained with the MAC system and those of the Ilizarov fixator in terms of radiographic correction, wear time, operative time, and complications. First, looking at radiographic correction, Gordon et al examined 15 patients with late-onset tibia vara who were corrected using tibial osteotomy and an Ilizarov circular fixator [15]. Their preoperative MAD (108 mm) was more severe than our patient population, yet, their pre-operative MPTA (71°) Fig.…”

Section: Discussionmentioning

confidence: 88%

“…The MAC system was developed as a possible alternative to the Ilizarov circular fixator. The surgical treatment of Blount's disease has centered around the use of tibial osteotomies with varying forms of internal or external fixation [11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Due to the fact that the two institutions involved in this study are large referral centers for Blount's disease, we felt that choosing to analyze this deformity (with its combination of angulation, rotation, and medial column shortening) would be the ideal manner to analyze the MAC system [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Utilizing the Ilizarov fixator as the 'gold standard' in the treatment of Blount's disease [15][16][17][18][19][20][21], there have been several studies that have investigated correction using this method. This allows for a comparison between the results obtained with the MAC system and those of the Ilizarov fixator in terms of radiographic correction, wear time, operative time, and complications.…”

Section: Discussionmentioning

confidence: 99%

“…Various surgical techniques, including osteotomies, can help to restore alignment of the leg. Reports include the use of circular Ilizarov external fixation [15][16][17][18][19][20][21], non-circular external fixation [22,23], internal fixation [11,24], hemiplateau elevation with/ without epiphyseal distraction [25,26], double elevating osteotomies [27], serrated W/M osteotomies [28], epiphyseal stapling [29], Taylor Spatial Frame correction [30], and hemiepiphysiodesis by guided growth [31]. All of these techniques vary in their ease of application/performance, achievement of (and time to) deformity correction (both clinically and radiographically), prevention of recurrence, and complications (i.e., nerve damage, infection, non-union, mal-union) [12, 14, 16, 17, 22-26, 28, 29, 32, 33].…”

Section: Introductionmentioning

confidence: 99%

“…The use of the Ilizarov circular fixator in combination with tibial osteotomy has been widely used for the correction of Blount's disease [15][16][17][18][19][20][21]. Advantages of this method include early weight-bearing, early motion, and, most importantly, multi-planar deformity correction (including rotation, angulation, and translation) [17,18].…”

Section: Introductionmentioning

confidence: 99%

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Correction of Blount's disease by a multi-axial external fixation system

Pandya

Clarke

McCarthy

et al. 2009

Journal of Children's Orthopaedics

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Background Blount's disease is a multi-planar deformity affecting the pediatric population which leads to varus alignment of the lower extremities. The Multi-Axial Correction (MAC) monolateral external fixation system (Biomet, Parsippany, NJ, USA) is a non-circular fixator that was developed as a response to the technical difficulty for both patients and physicians of placing, managing, and tolerating a circular fixator. The purpose of this study was to determine the efficacy of the MAC system for the treatment of pediatric patients with Blount's disease. Methods A retrospective analysis of 17 consecutive patients with surgically corrected Blount's disease using the MAC system with tibial and fibular osteotomies was identified. Patient charts and radiographs at three different time points (pre-operative, fixator removal, and final follow-up) were reviewed. The mechanical axis deviation (MAD), tibial-femoral angle (TFA), medial proximal tibial angle (MPTA), and posterior proximal tibial angle (PPTA) were measured in the MAC group at the three time points mentioned previously. The total wear time, total operative time, and post-operative complications were noted. Results The MAC system was able to correct the deformity of Blount's disease as measured by a decrease in the MAD (40.2 ± 29.3 mm; P B 0.001) and TFA (15.9 ± 13.7°; P B 0.001), as well as an increase in the MPTA (15.7 ± 14.6°; P = 0.001) at the time of fixator removal. The correction was maintained for these parameters at the time of final follow-up (P B 0.025). The absolute values obtained at final follow-up for MAD (20.5 ± 12.7 mm medial), TFA (8.0 ± 4.1°varus), and MPTA (83.7 ± 8.1°) after correction with the MAC system were close to what is considered as normal for these indices. The most common complications noted were superficial pin tract infections and/or cellulitis, with no patients having nerve palsy, compartment syndrome, non-union, or leg length discrepancies. The total time that the fixator was on the patients prior to removal was 130.6 days (standard deviation [SD] = 44.8). The mean operative time was 120.6 min (SD = 21.2). Conclusions Correction of Blount's disease with osteotomy of the tibia and fibula as well as dynamic fixation with the MAC system achieved deformity correction as

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Section: Discussionmentioning

confidence: 88%