Relapsed infantile Blount’s disease treated by hemiplateau elevation using the Ilizarov frame

Jones, Scott; Hosalkar, Harish S.; Hill, Robert A.; Hartley, Jeanne

doi:10.1302/0301-620x.85b4.13602

Cited by 50 publications

(44 citation statements)

References 19 publications

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“…The use of the Ilizarov Frame [15][16][17], the Taylor Spatial Frame [18][19][20], and a Multi-Axial Correction external fixation system [21] are modern therapeutical options, although significantly more expensive than our procedure. These systems enable gradual correction [20], in contrast to our cases, for whom correction was imminent.…”

Section: Discussionmentioning

confidence: 99%

Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation

Gkiokas

Brilakis

2012

Journal of Children's Orthopaedics

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Purpose A double osteotomy for correcting tibial deformity in combination with medial plateau elevation is recommended for the management of neglected Blount disease cases. We report our clinical experience with the application of this surgical technique and describe the longterm follow-up of the patients who were operated on. Methods During a 10-year period, eight children (8 boys) with mean age of 12 years (range 9-14 years) underwent surgery (9 operations) due to neglected infantile tibia vara. All patients suffered from stage V or VI Blount disease according to the Langenskiold and Riska classification. Two simultaneous combined osteotomies were performed for medial plateau elevation and for correction of the tibial deformity. The correction was immediate using K-wires for stabilization and a long-leg cast for immobilization. The mean duration of follow-up was 10 years (range 5-15 years), and the evaluations were based on clinical and radiological criteria. Results At the latest follow-up, there was no observable knee flexion or extension restriction and no signs of instability or lateral thrust. All patients had returned to a higher activity level. Leg-lengthening surgery was performed in one child, but the length discrepancy was already present before the double osteotomy was performed. No other complications were noticed. All the angles measured on X-rays had been corrected, and this correction was retained until the latest follow-up. Conclusions This method results in very good outcomes in patients who suffer from Blount disease of stage V or greater. With this technique, the tibial deformity is corrected, the articular surface is restored, and future recurrence is prevented.

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Section: Discussionmentioning

confidence: 99%

Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation

Gkiokas

Brilakis

2012

Journal of Children's Orthopaedics

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“…These radiological measurements were chosen as they have been used by other authors in studies on Blount's disease. 3,7,14 We documented the time of correction of the deformity in days, the total time in the frame, the time before resuming full activity, and any encountered complications. All patients were followed-up until skeletal maturity.…”

Section: Methodsmentioning

confidence: 99%

“…7 The circular external fixators were used by other surgeons to correct the varus deformity in Tibia Vara using an osteotomy at or below the level of the tibial tuberosity, 8Y13 with only one paper describing the elevation of the depressed medial tibial plateau using a medial hinge osteotomy together with the Ilizarov technique. 14 This article reports elevation of the depressed medial tibial plateau in patients with severe neglected infantile Tibia Vara using a new double elevating tibial osteotomy in conjunction with the Ilizarov technique.…”

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confidence: 99%

A New Double Elevating Osteotomy in Management of Severe Neglected Infantile Tibia Vara using the Ilizarov Technique

Hefny

Shalaby

El-Kawy

et al. 2006

Journal of Pediatric Orthopaedics

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Neglected infantile Tibia Vara is a very challenging clinical problem with many technical problems including distorted joint line secondary to the medial tibial plateau depression, obesity leading to difficulty in exposure, performing osteotomies and difficulty in osteotomy fixation. The aim of this study is to evaluate the clinical and radiological results of treatment of severe neglected infantile Tibia Vara using a new osteotomy to elevate the depressed medial tibial plateau in conjunction with the Ilizarov technique. Seven tibias in five patients were included in this study. These were all Stage V and VI according to Langenskiold and Riska classification. The average age at surgery was 11.6 years (ranging from 8 to 15), and the average follow-up was 6.2 years (ranging from 3 to 10). A new double osteotomy technique was used to elevate the depressed medial tibial plateau and correct the varus deformity. Correction was done gradually using the Ilizarov Frame. The results were assessed clinically and radiologically. The femoral shaft -- tibial shaft angle improved from an average of 36 degrees of varus preoperatively to 4 degrees of varus. The femoral condyle-tibial shaft angle improved from an average of 58 degrees to 83 degrees. The angle of depressed medial tibial plateau improved from an average of 53 degrees to 10 degrees. We believe that our new double elevating osteotomy in conjunction with Ilizarov technique is an excellent modality for patients with stage V and VI according to the Langenskiold and Riska classification. The advantages of this technique include correction of the deformity with simultaneous correction of the joint architecture, immediate weight bearing, and avoidance of excessive dissection needed for internal fixation.

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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%

“…Management includes the restoration of limb alignment, joint congruency, limb length equalization, and careful follow-up to prevent recurrence, which can occur in up to 50% of patients [12][13][14]. Various surgical techniques, including osteotomies, can help to restore alignment of the leg.…”

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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Relapsed infantile Blount’s disease treated by hemiplateau elevation using the Ilizarov frame

Cited by 50 publications

References 19 publications

Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation

Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation

A New Double Elevating Osteotomy in Management of Severe Neglected Infantile Tibia Vara using the Ilizarov Technique

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

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