Treatment of Severe Early Onset Blount's Disease by an Intra-articular and a Metaphyseal Osteotomy Using the Taylor Spatial Frame

Overview

Journal J Child Orthop

Publisher Sage Publications

Specialty Pediatrics

Date 2009 Mar 25

PMID 19308542

Citations 9

Authors

Elhanan Bar-On

Daniel Martin Weigl

Tali Becker

Kalman Katz

Affiliations

Soon will be listed here.

Abstract

Purpose: Severe Blount's disease results in a multiplanar deformity of the lower limb. The mechanical axis is disrupted, there is a rotational deformity, and also shortening of the limb. A depression of the medial tibial plateau causes joint incongruity and instability. The purpose of this study is to review the results of treatment addressing all the aspects of the deformity.

Methods: Four patients were treated for severe Blount's disease. The index procedure consisted of a medial tibial plateau elevating osteotomy, a lateral tibial and proximal fibular epiphysiodesis, a proximal tibial metaphyseal osteotomy, and the application of the Taylor Spatial Frame programmed for correction of varus, rotation and shortening, and preemptive lengthening to compensate for growth arrest.

Results: Mechanical axis was corrected from a mean 23 degrees (13 degrees -30 degrees ) to 0 degrees in three patients and 6 degrees valgus in 1. Tibias were lengthened by 1-4 cm. At follow-up, the mechanical axis was 0 degrees in two patients and 7 degrees varus in two. The overlengthening was diminishing as planned.

Conclusions: The double osteotomy and Taylor Frame correction was found to be accurate, safe, and effective for multiplanar deformity correction in severe Blount's disease.

Citing Articles

Recurrence and Complication Rates of Surgical Treatment for Blount's Disease in Children: A Systematic Review and Meta-Analysis.

Ramella M, Depaoli A, Menozzi G, Gallone G, Cerasoli T, Rocca G J Clin Med. 2023; 12(20).

PMID: 37892633 PMC: 10607610. DOI: 10.3390/jcm12206495.

Can acute correction with simultaneous hemiepiphysiodesis of lateral proximal tibia physis prevent recurrence in neglected infantile Blount's disease?.

Miraj F, Karda I, Erwin U, Pratama I Eur J Orthop Surg Traumatol. 2023; 34(1):529-537.

PMID: 37642701 DOI: 10.1007/s00590-023-03699-4.

Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease.

Mare P, Marais L Strategies Trauma Limb Reconstr. 2022; 17(1):32-37.

PMID: 35734039 PMC: 9166260. DOI: 10.5005/jp-journals-10080-1549.

Acute "three-in-one" surgery for the treatment of severe Blount's disease: Surgical technique and report of two cases.

Abak A, Khoshhal K J Taibah Univ Med Sci. 2020; 15(5):422-430.

PMID: 33132813 PMC: 7565016. DOI: 10.1016/j.jtumed.2020.08.002.

Blount's disease successfully treated with intraepiphyseal osteotomy with elevation of the medial plateau of the tibia-a case report with 65 years' follow-up.

Terjesen T, Anticevic D Acta Orthop. 2018; 89(6):699-701.

PMID: 30328743 PMC: 6300735. DOI: 10.1080/17453674.2018.1516179.

References

Sasaki T, Yagi T, Monji J, Yasuda K, Kanno Y . Transepiphyseal plate osteotomy for severe tibia vara in children: follow-up study of four cases. J Pediatr Orthop. 1986; 6(1):61-5. View

Payman K, Patenall V, Borden P, Green T, Otsuka N . Complications of tibial osteotomies in children with comorbidities. J Pediatr Orthop. 2002; 22(5):642-4. View

Slawski D, Schoenecker P, Rich M . Peroneal nerve injury as a complication of pediatric tibial osteotomies: a review of 255 osteotomies. J Pediatr Orthop. 1994; 14(2):166-72. DOI: 10.1097/01241398-199403000-00007. View

Schoenecker P, Johnston R, Rich M, Capelli A . Elevation of the medical plateau of the tibia in the treatment of Blount disease. J Bone Joint Surg Am. 1992; 74(3):351-8. View

Jones S, Hosalkar H, Hill R, Hartley J . Relapsed infantile Blount's disease treated by hemiplateau elevation using the Ilizarov frame. J Bone Joint Surg Br. 2003; 85(4):565-71. DOI: 10.1302/0301-620x.85b4.13602. View

LANGENSKIOLD A . Tibia vara: osteochondrosis deformans tibiae. Blount's disease. Clin Orthop Relat Res. 1981; (158):77-82. View

Pinkowski J, Weiner D . Complications in proximal tibial osteotomies in children with presentation of technique. J Pediatr Orthop. 1995; 15(3):307-12. DOI: 10.1097/01241398-199505000-00009. View

Martin S, Moran M, Martin T, Burke S . Proximal tibial osteotomy with compression plate fixation for tibia vara. J Pediatr Orthop. 1994; 14(5):619-22. DOI: 10.1097/01241398-199409000-00013. View

Feldman D, Madan S, Koval K, van Bosse H, Bazzi J, Lehman W . Correction of tibia vara with six-axis deformity analysis and the Taylor Spatial Frame. J Pediatr Orthop. 2003; 23(3):387-91. View

10.

Beck C, Burke S, Roberts J, Johnston 2nd C . Physeal bridge resection in infantile Blount disease. J Pediatr Orthop. 1987; 7(2):161-3. DOI: 10.1097/01241398-198703000-00009. View

11.

Hefny H, Shalaby H, El-Kawy S, Thakeb M, Elmoatasem E . A new double elevating osteotomy in management of severe neglected infantile tibia vara using the Ilizarov technique. J Pediatr Orthop. 2006; 26(2):233-7. DOI: 10.1097/01.bpo.0000218530.59233.ab. View

12.

Rab G . Oblique tibial osteotomy for Blount's disease (tibia vara). J Pediatr Orthop. 1988; 8(6):715-20. DOI: 10.1097/01241398-198811000-00018. View

13.

Accadbled F, Laville J, Harper L . One-step treatment for evolved Blount's disease: four cases and review of the literature. J Pediatr Orthop. 2003; 23(6):747-52. View

14.

Gregosiewicz A, WOSKO I, Kandzierski G, Drabik Z . Double-elevating osteotomy of tibiae in the treatment of severe cases of Blount's disease. J Pediatr Orthop. 1989; 9(2):178-81. View

15.

Janoyer M, Jabbari H, Rouvillain J, Sommier J, Py G, Catonne Y . Infantile Blount's disease treated by hemiplateau elevation and epiphyseal distraction using a specific external fixator: preliminary report. J Pediatr Orthop B. 2007; 16(4):273-80. DOI: 10.1097/01.bpb.0000210591.35652.84. View

16.

van Huyssteen A, Hastings C, Olesak M, Hoffman E . Double-elevating osteotomy for late-presenting infantile Blount's disease: the importance of concomitant lateral epiphysiodesis. J Bone Joint Surg Br. 2005; 87(5):710-5. DOI: 10.1302/0301-620X.87B5.15473. View

17.

Feldman D, Madan S, Ruchelsman D, Sala D, Lehman W . Accuracy of correction of tibia vara: acute versus gradual correction. J Pediatr Orthop. 2006; 26(6):794-8. DOI: 10.1097/01.bpo.0000242375.64854.3d. View