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Abstract

Tibial osteotomies in children have been associated with a number of complications. A retrospective review of 116 children who had 129 tibial osteotomies was performed to assess these complications at our institution. Results showed that there were 35 cases of wound problems, 6 cases of recurrence/reoperation, 5 cases of delayed union, 2 cases with transient peroneal nerve palsy, 1 case of nonunion, and 1 case of mal-union. Patients having certain comorbidities had a higher frequency of complications. There were no significant differences between the location of the tibial osteotomy (proximal or distal) and the incidence of complication. External fixation was associated with a lower incidence of complications than the use of pins and casting. Although our results demonstrate an overall low complication rate, there is a significant association between complications and comorbid conditions. This highlights the need to recognize comorbidities preoperatively and the potential of increased postoperative complications.

Treatment of severe early onset Blount's disease by an intra-articular and a metaphyseal osteotomy using the Taylor Spatial Frame

“…Considering a proximal tibial growth of 0.6 cm/year, one can expect an equalization of leg lengths in our patients 4-5 years postoperatively-at age 13-14 years at which time a decision can be made for either a contralateral epiphysiodesis or an ipsilateral relengthening. Regarding the need for a peroneal nerve release, peroneal neuropathy has been shown to occur after both varus and valgus osteotomies [14][15][16]. The planned lengthening in the present procedure further necessitates a release and the neuropathy encountered in the one patient on whom it was not performed leads us to recommend a peroneal release for all patients undergoing the procedure.…”

Minimally invasive plate osteosynthesis for tibial derotation osteotomies in children with cerebral palsy

“…Although the conventional internal fixation technique may result in wound healing problems or infections, we did not experience any superficial or deep wound infections or healing problems. 9 , 14 , 19 While keeping in mind the future possibility of needing a revision after any corrective procedure in a growing child, our surgical experience suggests that this technique provides stable fixation with no loss of correction and less damage to the surrounding tissues.…”

“… 10 , 12 , 13 Several reports have shown that TDO is an effective treatment option for the correction of rotational deformities of the tibia in children with CP, but significant complications have been reported. 8 , 9 We achieved an average of 22.3° improvement in the thigh-foot angle (TFA) through supramalleolar osteotomy with minimally invasive plate osteosynthesis, without any significant complication.…”

“… 4 , 5 , 6 , 7 Several surgical techniques had been defined in the literature for TDO, with varying success rates, but significant complications can occur, such as loss of reduction, nonunion, malunion, compartment syndrome, nerve palsy, pin tract infections, and pressure sores in the cast. 1 , 8 , 9 , 10 Therefore, we began to perform supramalleolar osteotomy and fixation of the correction with minimally invasive plating, to prevent these complications.…”

The challenges of a comprehensive surgical approach to Blount's disease

“… 40 , 35 - 37 In this report, one patient had mild paraesthesia lasting weeks, while one patient had a long episode of sensory and motor deficit of the peroneal nerve. A retrospective review of 116 children with 129 tibial osteotomies performed by Payman et al 41 noted 35 cases of delayed union, two cases with transient peroneal nerve palsy, one case of nonunion and one case of malunion. More recently, Wilson et al 42 reported a complication rate of 153% following 38 high tibial osteotomies with external fixation in patients with Blount’s disease; both studies highlighted Blount’s disease and obesity as factors increasing the complication rate.…”