Management of Blount’s Disease in adolescent using hexapod system
Nazri Yusof2021
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Blount’s disease produce varus, procurvatum and rotational deformity. We reported 2 cases of Blount’s disease who presented late during their adolescent. Both presented at early adolescent with severe deformity of more than 20 degrees angulation. The first case was a boy presented early at of 3 years with genu varus of both knee. At the age of 5 corrective osteotomy and fixation of K wire was done. However he come again at the age of 9 with recurrence. At the age of 10 we did bilateral open wedge osteotomy, fibula graft and plating. He return to us again at the age of 15 with recurrence. This time, the right side we treat him with Truelok circular fixator 11 month. The left side we treat him with hexapod (TL Hex) for 11 month. The second case is a 14 year old boy who had genu varus at both knee. We perform gradual correction using TL Hex for 4 month of his left tibia. Currently he is waiting for correction his right knee during the next school holiday. Hexapod allows correction of s...
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Correction of Adolescent Blount’s Disease Deformity Using Hinged Ilizarov Frame
Orthopedic Research Online Journal, 2020
Background: Adolescent Blount disease is the commonest cause of genu varum in old children. It is a multiplanar deformity consisting of varus, procurvatum and internal tibial torsion. Ilizarov frame can be used for both acute and gradual correction. Acute correction has the benefit of shorter time to healing and more comfortable to the patient. Gradual correction needs more patient compliance but is more forgiving. Objective: the aim of this work to evaluate the results of acute correction of adolescent Blount's disease using a hinged Ilizarov frame constructed for gradual correction taking the benefits of acute correction and using a hinged frame making it possible to correct any overcorrection or under correction in the clinic. Patients and Methods: It was a prospective study for 23 boys with adolescent Blount disease treated by acute correction using a hinged Ilizarov frame. The average age at presentation was 14 years (range 11-17 years), 3 patients (13%) had bilateral affection. 6 patients had limb length discrepancy. Results: Average preoperative to postoperative changes of MPTA from 70º (range 60-80) improved to 90º (range 85-95), Average preoperative to postoperative changes of PPTA from 72 (range 64-80) improved to 80º (range 78-82), Average preoperative to postoperative changes of MAD from 35 mm (range 20-50mm) improved to 5mm (range 0-10mm). Average preoperative to postoperative changes of TFA from-25 (range-30-20) of internal tibial torsion improved to 5.36 (range 0-10) of external tibial torsion. Conclusion: Acute correction of adolescent Blount's disease using a hinged two rings Ilizarov frame constructed for gradual correction is a safe technique combining the benefits of acute and gradual correction, allows the surgeon to correct any error at the clinic and decreasing the need for operative fluoroscopy.
A Study of Blount’s Disease
Journal of Evidence Based Medicine and Healthcare, 2018
BACKGROUND In the year 1937, Walter Blount from Milwaukee gave description of this condition called tibia vara in his classic article. Blount described tibia vara as "an osteochondrosis of the medial side of the proximal tibial epiphysis." However, currently, tibia vara is considered an acquired disease of the proximal tibial metaphysis, rather than an epiphyseal dysplasia or osteochondrosis. This disease is characterized by an abrupt angulation of the proximal end of tibia into a progressive varus deformity. The objectives of this study were to evaluate the clinical and radiological aspects of Blount's disease and to study various treatment options available and their results. MATERIAL AND METHODS This is retrospective study conducted in department of Orthopaedics, King George Hospital, Visakhapatnam, in patients who had been diagnosed with unilateral or bilateral Blount's disease during the period of 2012 to 2017, after obtaining permission from institutional ethics committee. Twenty-one patients were included in the sample. There were 13 females and 8 males. All the cases in the sample were radiological confirmed cases of Blount disease with a progressive bowing and a metaphysealdiaphyseal angle of more than eleven degrees and were graded with Langenskiold types. The adolescent group was further separated with early onset (8-13 years) and late onset (above 13 years). RESULTS Incidence of Blount's is more common in females left tibia was involved in eleven children. Internal torsion was same before and after osteotomies. Range of varus was 15 degrees to 50 degrees. Average m-d angle was 26 degrees. Grading of result was done on basis of femorotibial mechanical axis. CONCLUSION Langenskiold grading has no prognostic effect. Metaphyseal-diaphyseal angle was useful in making diagnosis. There is no correlation between recurrence of varus deformity and preoperative deformity angle. Fixation with pins or staples is not a factor. Metaphyseal osteotomies have high incidence for recurrence, limb length discrepancy and subluxation of knee joint.
Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults
Journal of Orthopaedic Surgery
Purpose: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy. Methods: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA). Results: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm ...
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Blount’s disease is an idiopathic developmental abnormality affecting the medial proximal tibia physis resulting in a multi-planar deformity with pronounced tibia varus. A single cause is unknown, and it is currently thought to result from a multifactorial combination of hereditary, mechanical, and developmental factors. Relationships with vitamin D deficiency, early walking, and obesity have been documented. Regardless of the etiology, the clinical and radiographic findings are consistent within the two main groups. Early-onset Blount’s disease is often bilateral and affects children in the first few years of life. Late-onset Blount’s disease is often unilateral and can be sub-categorized as juvenile tibia vara (ages 4–10), and adolescent tibia vara (ages 11 and older). Early-onset Blount’s disease progresses to more severe deformities, including depression of the medial tibial plateau. Additional deformities in both groups include proximal tibial procurvatum, internal tibial torsi...
Recurrence and Complication Rates of Surgical Treatment for Blount’s Disease in Children: A Systematic Review and Meta-Analysis
Journal of Clinical Medicine
Background: Blount’s disease is a growth disorder of the proximal tibia that causes progressive genu varum in children. Surgical treatment is recommended if the deformity worsens, but which intervention is best remains controversial. This study aims to identify factors influencing outcomes and determine the most effective surgical approach. Methods: A systematic review was conducted of studies published before January 2022. Results: In total, 63 retrospective studies with CEBM IIIb/IV levels were included (1672 knees in 1234 patients). The most commonly reported treatment was acute correction via osteotomy (47%), followed by hemiepiphysiodesis (22%) and gradual correction (18%). Combined procedures were reported in 13% of cases. The overall recurrence rate was 18%, with a significant difference when comparing the recurrence rates after gradual correction with those after hemiepiphysiodesis (7% and 29%, respectively). Major complications beyond recurrence were observed in 5% of cases...
Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients
Journal of Orthopaedics, 2021
Background: There are no comparative study between guided growth and tibial osteotomy in early stage of Blount disease (BD) to our knowledge. The aim of this work was to compare the results of patients treated by these two techniques. Method: This was a retrospective, descriptive, and analytical study over a period of 5 years in including 17 children (24 Knees) with an early stage of infantile BD in two centers. Patient were classified in two groups: group 1(treated by guided growth), group 2 (treated by Tibial Osteotomy). Preoperative alignment analysis using the tibial femoral angle (HKA) and the proximal medial tibial mechanical angle (mMPTA) were compared with three measurements taken postoperatively in each of the groups. The mean variations of the angles were compared between the two groups. Results: Socio-demographic characteristics were similar for the two groups. Median age at surgery was 6.5 ± 2.5 [3-9 years] in group 1 and 6.8 ± 2.9 years [3-9 years]. At a follow-up of 24 ± 3.5 months, the limb alignment was significantly corrected (1,03 • /month) in group 1 (median HKA 144 •-171 • ; p = 0,001; median MMPTA 78 •-87 • , p = 0,018), and in group 2 we observed at a follow-up of 23 ± 15 months a progressive loss (0,52 • / month) of the correction obtained immediately postoperatively (median HKA 160 •-176 • (immediate post operative) to 165,5 • ; p = 0,31; median MMPTA = 78 •-86 • (immediate post operative) to 80,5 • ; p = 0,37). There was a statistically significant difference between the mean variation in HKA between the two groups (group 1 = 22,5; group 2 = 4,5, p = 0.00), as well as for MMPTA; (group 1 = 7; group 2 = 2,5, p = 0,023). The rate of correction was 78% in group 1 with no rebound at a median follow-up after removal of the material of 10 ± 2.4 months. Within group 2, the rate of correction was 10% with a recurrence rate of 60%. Conclusion: Guided growth appears to be the best treatment for early stage of BD in squelletically immature patients.
Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation
Journal of Children's Orthopaedics, 2012
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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UNDER
PATRONAGE OF
GRAND IMAM OF AL-AZHAR
PROF. AHMED AL TAYEB
PRESIDENT OF AL AZHAR UNIVERSITY
VICE PRESIDENT OF AL AZHAR UNIVERSITY
(ASSIUT)
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PROF. MOHAMED ABDELMALIK
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PROF. IBRAHIM ABUOMIRA
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Department of Orthopedic Surgery, Al-Azhar University
in Collaboration with the Egyptian Orthopaedic Association
29 SEPTEMBER, 2021
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WEDENSDAY
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ADANAN SABAY, ISMAIL YASSIN, HANY ALMWAFY, AHMED AKR
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BAHAAELDIN IBRAHIM, EGYPT
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DANEILE P, ESAM ALSHERIF, NABIL EL MOGHAZY, WAEL ELADLY
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in Alnoor specialized hospital Saudi Arabia
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4:00-4:05
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DAY
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THURSDAY
30 SEPTEMBER, 2021
04:05 PM - 05:20 PM
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HESHAM ELKADY, EGYPT
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MICHAL WALCZAK, POLAND
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HOSAM ABO-BEIH, EGYPT
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MOHAMMED FADEL, YASSER ELBATRAWY, MOSTAFA ELSHERBINI, KHALED EMARA
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Proximal humeral non union
ABDELHAKEM ABDELLAH, EGYPT
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Neglected complex dysplastic hip deformities
BAHAA KORNAH, EGYPT
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KHALED EMARA, EGYPT
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IBRAHIM ABUOMIRA, EGYPT
Paralytic hip dislocation
6:00-6:15
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30 SEPTEMBER, 2021
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MOHAMED ABDELAAL, EGYPT
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Shoulder trauma
FAISAL ZAYED, EGYPT
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Humeral Non-union
CATAGNI MAURIZIO DANEILE P, ITALY
6:50-7:00
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SAUHAIL B.MASADEH, U.S.A
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ABD-ELKHALEK HAFEZ, EGYPT
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Articular knee case discussion
ALAA EL-ZOHEIRY, EGYPT
9:15-9:25
DISCUSSION
9:25-9:35
11
DAY
3
FRIDAY
1 OCTOBER, 2021
09:35 AM- 10:20 AM
SESSION 3: (SPINE)
CHAIRPERSONS:
HESHAM FARHOOD, MOHAMMED ELSHARKAWY, SAMIR ELSHORA, MOHAMED NEGM
Role of Surgery in Treating Spinal Infections
MOAHMED ELSHARKAWY, EGYPT
9:35-9:45
Tandum spinal stenosis
MOHAMED ABD-ELWANIS, EGYPT
9:45-9:55
Low back pain
HESHAM FARHOOD, EGYPT
9:55-10:05
Early onset scoliosis
MOHAMMAD NEGM, EGYPT
10:05-10:15
DISCUSSION
10:15-10:20
10:20 AM - 11:05 AM
SESSION 4: (SPINE)
CHAIRPERSONS:
MOHAMMED ABDELWANIS, SALAH ELKHATEEB, MOHAMED ELMESHTAWY, HASSAN ELBARBARY
Challenging spine cases , in Azhar Assiut orthopedic department
AMER ALKOT, EGYPT
10:20-10:25
Cervical disc prolapse in young patients, are we have a golden choice??
SALAH SENOSY, EGYPT
10:25-10:30
Correction of ankylosing spondylitis.
MOHAMED ELBESHBESHY, EGYPT
10:30-10:35
Post traumatic kyphosis
MOATAZ ABDELRAHEEM ALI AHMED, EGYPT
10:35-10:40
Minimal invasive surgery in pediatric spine deformity(recorded)
ALAA AZMY, PALASTINE
10:40-10:50
Biofilms and Musculoskeletal infections: What surgeons should know ???
CARLO ROMANO, ITALY
DISCUSSION
12
(recorded)
10:50-11:00
11:00-11:05
DAY
3
FRIDAY
1 OCTOBER, 2021
04:00 PM - 05:00 PM
WORKSHOPS
CHAIRPERSONS:
DANEILE P, YASSER ELBATRAWY, AHMED KHASHABA, MOHAMMED ABDELLAL
Bone transport and non union
CHAIRPERSONS:
IBRAHIM ABUOMIRA, MOSTAFA ELSHERBAINI, BARAKAT ELALFY, NABIL ALMOGHAZY, AHMED KHASHABA, KHAMIS MOHAMMED
Interlocked canulated blade plate
13
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COMPANIES
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CONFERENCE
2022
17
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