Supramalleolar osteotomy for unilateral tibial torsion

Abstract

Surgical correction of unilateral torsional deformity of the tibia is indicated in fewer than 1% of cases. Treatment is limited to those who have a progressive deformity, who are symptomatic and on whom conservative treatment has failed. We present the results of an osteotomy performed at the supramalleolar level leaving the fibula intact and held with staples. In 7 years, 13 children with a mean age of 13.4 years (range 10-16 years) underwent osteotomy. Six osteotomies were performed for internal tibial torsion (mean 25 degrees) and seven for external tibial torsion (mean 25 degrees). Seven participants were female and six male and all cases were idiopathic. One participant required antibiotics for a wound infection and five had the staples removed. All deformities were well corrected and symptoms improved. Numerous methods have been described to correct this deformity but all have been associated with major complications. We describe a supramalleolar osteotomy, leaving the fibula intact, that achieves good correction with minimal complications.

Idiopathic Rotational Abnormalities of the Lower Extremities in Children and Adults

“…With regard to tibial torsion, surgery generally been avoided for patients younger than 8 years of age 3,105,120,121 .…”

Multiplanar supramalleolar osteotomy in the management of complex rigid foot deformities in children

“…Wiltse described closing medial wedge supramalleolar osteotomy to realign the ankle in valgus deformity [28]. Others, such as Lloyd-Roberts, Lichtblau, McNicol, and Goldner, used supramalleolar osteotomy to correct equinus and derotate the tibia in equinovarus deformities [4,5,7,9,11,14,16,20,24,[29][30][31][32]. Abraham utilized the approach to correct ankle valgus in patients with myelomeningocele [2].…”

“…Pearce presented a small series of hemophilic arthropathy patients treated for valgus deformity by supramalleolar osteotomy [18]. Many authors have utilized supramalleolar osteotomies to derotate the tibia alone in torsional deformities [4,5,7,9,11,14,16,20,24]. Percutaneous supramalleolar osteotomies have been performed for rotational deformities in cerebral palsy [9].…”

Differences between Two Methods to Stabilize Supramalleolar Osteotomies in Children—A Retrospective Case Series

“…Our retrospective study proved that the mean time to radiographic consolidation in the WF group was as short as 7.2 weeks. Savva et al reported a mean time to union of 12 weeks after unilateral SMO stabilized with staples [22]. Nevertheless, the authors did not specify their definition of "union," and this was no primary endpoint in their study.…”