Bamboo Osteotomy for Blount’s Disease

Cureus

Genu varum is a common finding in the pediatric population with a large differential, including but not limited to Blount's disease, rickets, and physiologic bowing of the legs. Here we report a case of a 12-yearold Caucasian male who presented for an atraumatic stress fracture of the fifth metatarsal after an athletic event. Further evaluation showed significant genu varum with a Q angle of 9 degrees and medial knee joint space narrowing. The patient was unable to undergo conservative management due to early completion of puberty with relatively premature skeletal maturity. A bilateral tibial and fibular osteotomy with external spatial frame placement was performed successfully followed by six months of minor activity complicated by subclinical enoxaparin-induced purpura. The unique presentation of a stress fracture caused by compensatory mechanisms for the severe varus deformity, as well as the rarity of this procedure being performed on both legs simultaneously with good outcomes was the primary reason for the publication of this paper.

Orthopedic & Muscular System, 2012

Background: In Blount's disease, there is a complex three-dimensional deformity which typically includes varus, internal rotation, and (sometimes) procurvatum. The best way to obtain correction is with simple procedure carried out as high in the tibia as possible to promote rapid union, quick remodeling, and with minimal proximal shaft deformity. Patients and methods: 17 patients with tibia vara underwent corrections of deformity associated with tibia vara by modified Rab proximal tibial oblique osteotomy at our hospital. In twelve patients the deformity was bilateral and it was unilateral in the other five patients, with a total of 29 tibiae. They were ten boys and seven girls with a mean age at surgery of 3 years 6 months (range, 3 years 2 months to 4 years 11 months). The patients were in stage III of the Langenskiöld classification (1952) of the disease. Results: According to Schoenecker's criteria, 100% of the patients in this study had a good result. Radiologically healing was achieved in all osteotomies with the desired correction of deformity within twelve weeks in all the 17 patients with no complication. Conclusion: The modified Rab oblique proximal tibial has the advantage of allowing both angular and rotational correction with a high degree of success.

BMC Musculoskeletal Disorders

Background Despite multiple published reviews, the optimum method of correction and stabilisation of Blount’s disease remains controversial. The purpose of this study is to evaluate the clinical and radiological outcomes of acute correction of late-onset tibial vara by percutaneous proximal tibial osteotomy with circular external fixation using two simple rings. Weighing up the pros and cons and to establish if this method would be the method of choice in similar severe cases especially in a context of limited resources. Methods This study was conducted between November 2016 and July 2020. We retrospectively reviewed the clinical notes and radiographs of 30 patients (32 tibiae) who had correction of severe late-onset tibia vara by proximal tibial osteotomy and Ilizarov external fixator. The mean age at the time of the operation was 16.6 (± 2.7) years (range 13–22). Results The mean proximal tibial angle was 65.7° (± 7.8) preoperatively and 89.8° (± 1.7) postoperatively (p

2000

he conventional osteotomies used to treat infantile tibia vara (Blount's disease) may require internal fixation and its subsequent removal. These techniques, which carry the risk of traction injury, and potential problems of stability and consolidation, do not always succeed in correcting the rotational deformity which accompanies the angular deformity. We have used a new surgical approach, the serrated W/M osteotomy

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.

Acta orthopaedica Belgica, 2010

Late-onset tibia vara or Blount's disease is the most common cause of pathologic genu varum in children and adolescents. Treatment remains controversial. Many studies in the past have shown that an osteotomy with acute correction is the most appropriate treatment. More recently however, there has been a growing interest, especially in severe cases, in using gradual correction with the Ilizarov technique after a single high tibial osteotomy. A retrospective study in 20 children with late-onset tibia vara, who were treated by gradual angulation translation high tibial osteotomy using the Ilizarov technique, was performed. The mean follow-up period was 2.9 years (range: 2-4 years; SD 0.75). Recurrence of varus deformity to various degrees was noted in 10 of 22 cases (45.5%). Recurrence of deformity was found to be significantly related to both the degree of pre-operative deviation and the duration of follow-up. No statistically significant relationship was found between recurrence ...

Children, 2021

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...

Limb Lengthening and Reconstruction Surgery Case Atlas, 2015

Developmental Medicine & Child Neurology, 2008

2012

determinado en que sintieron que su vida estaba en peligro. Para Piglia, en estas historias se perciben y se hallan muchos de los procedimientos que están en Chejov, que están en Tolstoi, pues muchas veces, de un modo directo, se reproduce esta suerte de artimañas o estrategias que la narración literaria emplea.