Spatial frame correction of anterior growth arrest of the proximal tibia: report of three cases

Abstract

We report three cases of anterior growth arrest of the tibia in adolescent boys. Two of the three cases had a clear history of trauma and although there was a history of trauma in the third case, the patient also had human leukocyte antigen-B27 negative enthesitis that had not previously affected the knee. In all cases, a slowly deteriorating hyperextension of the knee developed that in the two posttraumatic cases was initially misinterpreted as a posterior cruciate ligament injury. Radiographs demonstrated an abnormal relationship between the tibial plateau and the long axis of the tibia on the lateral view--anatomical posterior proximal tibial angle. All patients were successfully treated by the Taylor spatial frame with correction of the anatomical posterior proximal tibial angle to normal, equalization of the legs and correction of any concomitant coronal deformity. Hyperextension of the knee developing after an injury in adolescents should raise the suspicion of anterior growth arrest prompting careful analysis of the lateral radiograph.

Correction of Proximal Tibia Varus with External Fixation

“…The accuracy of measurement and correction varies greatly in the literature. [32][33][34] Certainly there are limitations to the present study. A minimum follow-up period of 6 months does not allow us to draw conclusions about the further clinical course of our patients, including the necessity of performing total knee arthroplasty in the future.…”

Does the Taylor Spatial Frame Accurately Correct Tibial Deformities?

“…We did use different and the most relevant radiographic measurements [25,27,36] for proximal, middle, and distal groups, and we evaluated the groups separately for alignment (Tables 2-4) [12,17,31,34,41,43]. The TSF has been used for fracture treatment [4] and reconstruction of the tibia [8,10,11,14,23,24,28,40,44,45,47], ankle [22], femur [8,21,29], and upper extremity [38] in children and adults. Precise deformity correction and ease of use have been cited as advantages of the TSF [20,23,49].…”

“…The associated webbased software has simplified planning and performance of deformity correction for patients and physicians and has been used to treat all aspects of deformities in the lower extremities. Use of the TSF is associated with few complications [4,10,14,33,34,40,41,44,47] and corrects complex tibial deformities in adults and children.…”

Accuracy of a hexapod parallel robot kinematics based external fixator

“…In some of these studies, the authors define the achieved clinical accuracy as the amount of remaining bone deformity (angulation and torsion in degrees, and translation in millimeters or percentage of dislocation) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). In other studies, the standard joint angle system established by Paley and colleagues (2,3) is used as the reference to report clinical accuracy (9,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). For the Precision Hexapod® system, median values are between 1 mm and 3 mm remaining translational deformity and 1°to 3°remaining angulation deformity, with maximum values of 5 mm to 14 mm and 3°to 18°, respectively (22)(23)(24).…”

“…For the TSF system, mean values are between 1.3 mm and 2 mm or 0% to 9% remaining translational deformity/dislocation and 0.5°to 3°remaining angulation deformity, with maximum values ranging from 3 mm to 5 mm or 6% to 40% and 2.5°t o 30°, respectively (9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Furthermore, maximum values exceeding 5°of remaining angulation deformity only occur very rarely (9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)…”