Infantile Blount's disease treated by hemiplateau elevation and epiphyseal distraction using a specific external fixator: preliminary report

Janoyer, M; Jabbari, Houcine; Rouvillain, J.-L.; Sommier, J.; Py, Gérard; Catonné, Yves; Colombani, J. F.

doi:10.1097/01.bpb.0000210591.35652.84

Cited by 33 publications

(27 citation statements)

References 25 publications

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“…However, because of the absence of pins for external fixation there was no exposure to the risk of pin tract infection in our series. Hemiplateau elevation combined with epiphyseal distraction using an external fixator has also been used with similar satisfactory results [17].…”

Section: Discussionmentioning

confidence: 86%

Combined Antero-Posterior Inverted-U Metaphyseal and Open-Wedge Medial-Epiphyseal Osteotomy for Advanced Blount Disease

Ogbemudia¹,

Bafor²,

Ogbemudia³

et al. 2015

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Background: Blount disease is frequently associated with deformities that may not be adequately corrected by a single metaphyseal osteotomy. This study evaluated the outcome of a combined metaphyseal and epiphyseal osteotomy in severe cases. Methods: We prospectively evaluated the outcome of combining the antero-posterior inverted-U metaphyseal osteotomy with a medial open-wedge hemi-epiphyseal osteotomy in eighteen patients (27 tibiae) with Stage IV to VI Blount disease. Results: The average age of patients was 9 years (ranging from 5 to 17). The tibio-femoral angle improved from 43˚ varus (Range: 34˚ -78˚) to 2˚ varus (Range: 5˚ valgus to 8˚ varus). The metaphyseal-diaphyseal angle improved from 36˚ to 8˚ varus. Internal tibial torsion improved from 39˚ to 2˚. All the patients were able to achieve 110˚ of knee flexion in a year. Conclusion: In conclusion, the combined metaphyseal and epiphyseal osteotomy satisfactorily corrected tibiofemoral and

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Section: Discussionmentioning

confidence: 86%

Combined Antero-Posterior Inverted-U Metaphyseal and Open-Wedge Medial-Epiphyseal Osteotomy for Advanced Blount Disease

Ogbemudia¹,

Bafor²,

Ogbemudia³

et al. 2015

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“…An in-depth research of the ITV literature failed to cite any studies using external fixators with more than 9 patients and or with a mean follow-up greater that 29 months [8, 11, 13]. In one study 6 cases treated with the Taylor Spatial Frame were followed on average of 29 months [8].…”

Section: Discussionmentioning

confidence: 99%

“…There are several reports of single procedures reported to correct these deformities: valgus metaphyseal osteotomy, [7,8] medial tibial plateau elevation, [9–11] and medial epiphysiolysis of the growth plate [12]. Others have combined these procedures in one or two stages [13–18].…”

Section: Introductionmentioning

confidence: 99%

New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach

Abraham

Toby

Welborn

et al. 2019

Journal of Pediatric Orthopaedics

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Background Successful surgical treatment of late presenting infantile tibia vara (ITV) patient requires the correction of oblique deformities. The purpose of this study was to report on a new comprehensive approach to correct and prevent recurrence of these deformities with a single procedure. Methods Medical records of 23 consecutive children (7–18 years) with advanced ITV (29 knees) were retrospectively reviewed after a mean of 7.3 years postoperatively (range: 2–22 years). Indications for the corrective surgery were any child seven year or older with a varus mechanical axis angle (MAA) 10 degrees or greater or a varus anatomical axis angle (AAA) eleven degrees or greater and a medial tibial angle (MTA) slope less than 60 degrees. The deformities were corrected with a dome-shaped osteotomy proximal to the tibial tubercle with a midline vertical extension to the subchondral region of the joint and a lateral hemi-epiphysiodesis. Results At latest follow-up, means and medians of each tibial radiographic axis measurement improved significantly from preoperative values (p<0.001): MAA from 23 degrees to 4 degrees varus, AAA from 25 degrees varus to 1 degree valgus, MTA downward slope from 30 degrees to 78 degrees, posterior medial tibial angle (PMTA) from 59 degrees to 80 degrees. Seventy-nine percent and 74% had good to excellent results based on radiographic criteria and clinical questionnaire for satisfaction, pain and function, respectively. Two abnormal medial tibial plateau types were described. Conclusion This is the first study to use a single stage double osteotomy performed proximal to the tibial tubercle for the late-presenting ITV for children seven years of age or older. In addition to the effective correction of the four major tibial deformities, a lateral proximal tibial hemi-epiphysiodesis minimizes recurrence of tibia vara. A contralateral proximal tibial epiphysiodesis is recommended for treated skeletally immature patients with unilateral disease. Level of Evidence Therapeutic Level IV. See instructions for authors for a complete description of levels of evidence.

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“…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%

“…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%

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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Infantile Blount's disease treated by hemiplateau elevation and epiphyseal distraction using a specific external fixator: preliminary report

Cited by 33 publications

References 25 publications

Combined Antero-Posterior Inverted-U Metaphyseal and Open-Wedge Medial-Epiphyseal Osteotomy for Advanced Blount Disease

Combined Antero-Posterior Inverted-U Metaphyseal and Open-Wedge Medial-Epiphyseal Osteotomy for Advanced Blount Disease

New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach

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

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