Treatment of Tibia Vara by the Ilizarov Method

Abstract

Sixty-nine lower extremities of 45 patients (mean age, 10 years 8 months) with tibia vara were treated with the Ilizarov circular external fixator and distraction osteogenesis. Twenty-four of the patients had bilateral involvement, six of whom had simultaneous surgery and the remaining 18 had staged operations 8 to 12 months apart. In 11 limbs with femoral valgus deformity greater than 10 degrees simultaneous corrections were done. Active movements of the joints of the extremity were encouraged the day after surgery and partial weightbearing began 2 days later. All patients were followed up 27 to 178 months (mean, 80 months) after surgery. No neurovascular complications, delayed union, or nonunions were observed. The mean 28.6 degrees varus tibiofemoral angle preoperatively (range, 15 degrees -45 degrees ) improved to 7.5 degrees valgus (range, 0 degrees -18 degrees ) postoperatively. The preoperative internal torsion angle also improved from 20.7 degrees (range, 0 degrees -48 degrees ) to 3.5 degrees external torsion (range, 0 degrees -9 degrees ) postoperatively. Residual deformity was seen in six patients, and they had successful revision surgery using the same technique. The Ilizarov method allows early weightbearing and motion and allows all components of the deformity to be corrected.

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

“…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].…”

“…Utilizing the Ilizarov fixator as the 'gold standard' in the treatment of Blount's disease [15][16][17][18][19][20][21], there have been several studies that have investigated correction using this method. This allows for a comparison between the results obtained with the MAC system and those of the Ilizarov fixator in terms of radiographic correction, wear time, operative time, and complications.…”

“…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].…”

“…The use of the Ilizarov circular fixator in combination with tibial osteotomy has been widely used for the correction of Blount's disease [15][16][17][18][19][20][21]. Advantages of this method include early weight-bearing, early motion, and, most importantly, multi-planar deformity correction (including rotation, angulation, and translation) [17,18].…”

Femoral Deformity in Tibia Vara

“…Femoral deformity has long been noted in patients with tibia vara, and this has complicated the treatment 13,23,[28][29][30][31][32][33][34] . Infantile tibia vara has been associated with overgrowth of the medial condyle of the femur, resulting in a valgus deformity of the distal part of the femur 13,23,29,30,[33][34][35] . Late-onset tibia vara has been associated with both varus and valgus deformity of the distal part of the femur 13,29,33,35,36 .…”