Congenital postero-medial bowing of the tibia and fibula: is early surgery worthwhile?

Johari, Ashok; Dhawale, Arjun A.; Salaskar, Abhijit; Aroojis, Alaric

doi:10.1097/bpb.0b013e32833ccac2

Cited by 20 publications

(27 citation statements)

References 8 publications

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“…It is accepted that remodelling is not usually complete, and that leg-length discrepancy (LLD) increases with age and may be up to 7 cm at maturity. 4 , 5 , 7 Some authors have suggested that surgery should play a greater role in the management of posteromedial bowing than simple epiphysiodesis, either through the use of osteotomy for deformity correction 7 - 9 and/or limb lengthening techniques. 7 , 10 …”

Section: Introductionmentioning

confidence: 99%

Posteromedial bowing of the tibia: A benign condition or a case for limb reconstruction?

Wright

Hill

Eastwood

et al. 2018

Journal of Children's Orthopaedics

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PurposeTo review the initial deformity and subsequent remodelling in posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition.Patients and MethodsIn all, 38 patients with posteromedial bowing of the tibia presenting between 2000 and 2016 were identified. Mean follow-up from presentation was 78 months. A total of 17 patients underwent lengthening and deformity correction surgery, whilst three further patients are awaiting lengthening and deformity correction procedures.ResultsThe greatest correction of deformity occurred in the first year of life, but after the age of four years, remodelling was limited. The absolute leg-length discrepancy (LLD) increased throughout growth with a mean 14.3% discrepancy in tibial length. In the lengthening group, mean length gained per episode was 45 mm (35 to 60). Mean duration in frame was 192 days, with a mean healing index of 42.4 days/cm. Significantly higher rates of recurrence in LLD were seen in those undergoing lengthening under the age of ten years (p = 0.046). Four contralateral epiphysiodeses were also performed.ConclusionPosteromedial bowing of the tibia improves spontaneously during the first years of life, but in 20/38 (53%) patients, limb reconstruction was indicated for significant residual deformity and/or worsening LLD. For larger discrepancies and persistent deformity, limb reconstruction with a hexapod external fixator should be considered as part of the treatment options.Level of evidenceLevel IV (Case series)

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Section: Introductionmentioning

confidence: 99%

Posteromedial bowing of the tibia: A benign condition or a case for limb reconstruction?

Wright

Hill

Eastwood

et al. 2018

Journal of Children's Orthopaedics

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“…In the second patient, six weeks after complition of lengthening, LCP was inserted and Ilizarov frame was subsequently removed during the same operation (Figure 4). Residual LLD after tibial lengthening in CPMBT has been observed by many authors (2,5,6,12). The first of our patients on the last follow-up visit, five years after lengthening, had no LLD but 0.5 cm of overcorrection have been lost.…”

Section: Figure 2 Progression Of Lld With Growth (Case 4) On Ap X-rmentioning

confidence: 77%

“…Shah et al (6) reported about two patients treated with lengthening. Johari et al (12) performed six lengthening procedures for an average preoperative LLD of 3.93 cm. Finally, Kaufman (2) has recently published the results of treatment of 11 patients whose mean LLD was 3.7 cm.…”

Section: Figure 2 Progression Of Lld With Growth (Case 4) On Ap X-rmentioning

confidence: 99%

Congenital Posteromedial Bowing of the Tibia: A Single Center Experience

Živanović¹,

Slavkovic²,

Marjanović³

et al. 2017

Acta Facultatis Medicae Naissensis

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SU M M A RY Congenital posteromedial bowing of the tibia (CPMBT) is a rare congenital anomaly of the lower limbs.The aim of the present study was to analyze our experience in the treatment of CPMBT.A retrospective study of patients treated for CPMBT in the period January 2000 -June 2016 was performed. In the observed period, six patients were treated (five girls and one boy), with predominance of the right tibia involvement (5:1).The initial treatment included a series of corrective casts (4-9) applied in all patients, followed by removable splints and physiotherapy. Four children with residual angulation of tibia after walking age were prescribed ankle-foot orthosis (AFO) as a prevention of pathological fractures. Both posterior and medial angulation correct over time. Mean initial shortening was 11 mm. At the last follow-up visit, mean shortening was 23.33mm. Three patients had lower limb shortening of more than 2 cm. In two of them, with shortening of 27 mm and 35 mm, Ilizarov lengthening was performed. In one girl, we performed lengthening over titanium elastic nails. In the other girl, after lengthening, circular frame was exchanged with a locking plate to reduce fixator wearing time. There were no major complications of treatment. Patients were followed up for 2-12 years (mean 6.83 years). None of them reached skeletal maturity yet.Primary manifestation of CPMBT -angulation of tibia and fibula as well as calcaneovalgus deformity usually correct spontaneously or with conservative measures. However, limb length inequality, as a consequence of CPMBT, progresses with growth and may require surgical correction in some children. Therefore, all children with CPMBT should be followed up until skeletal maturity.

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“…In this century, only two papers have been published that have described surgical treatment of patients with the congenital posteromedial bowing of the tibia and fibula [5,6]. Shah et al [5] described a total of nine patients who were operated on.…”

Section: Discussionmentioning

confidence: 99%

“…Johari et al [6] described nine cases -three were singlelevel osteotomies, another three were single-level osteotomies with lengthening and the other three were multilevel osteotomies with axis correction at one level and lengthening at the second level. The authors determined the tibia and fibula bowing exceeding 301 as a recommendation to osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Congenital posteromedial bowing of the tibia and fibula

Napiontek¹,

Shadi²

2014

Journal of Pediatric Orthopaedics B

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Few papers have described patients treated surgically with single osteotomy for congenital posteromedial bowing of the tibia and fibula. Only one paper has described two-level osteotomy for deformity correction: the first for deformity correction and the second for bone lengthening. There are no publications describing the surgical correction of deformation only by the method of multilevel tibial and fibular osteotomy. Research material included four children aged between 3.1 and 5.1 years (average age: 3.7 years) who were operated upon for bowing of the tibia and fibula exceeding 35° in the coronal plane. In all cases, tibial osteotomy was carried out at three or two levels accompanied by fibular osteotomy, and with intramedullary stabilization using K-wires (three patients) or Rush pin (one patient). Follow-up ranged from 3 to 7.7 years. In all cases, axis correction and bone healing were achieved. In large congenital posteromedial bowing of the tibia and fibula, a multilevel tibial and fibular osteotomy may be a better solution than an orthosis or a long time waiting for a spontaneous correction of the deformation. Large circumferential periosteal release that accompanied the surgery influenced the stimulation of bone growth. It may induce the process of lower limbs' equalization not to require the application of intensive surgical procedures.

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Congenital postero-medial bowing of the tibia and fibula: is early surgery worthwhile?

Cited by 20 publications

References 8 publications

Posteromedial bowing of the tibia: A benign condition or a case for limb reconstruction?

Posteromedial bowing of the tibia: A benign condition or a case for limb reconstruction?

Congenital Posteromedial Bowing of the Tibia: A Single Center Experience

Congenital posteromedial bowing of the tibia and fibula

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