Post-physeal deformity around the ankle treated by acute or gradual correction

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 (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection. Conclusions: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.

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Acute Versus Gradual Correction of Idiopathic Tibia Vara in Children

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0b013e31819849aa ◽

2009 ◽

Vol 29 (2) ◽

pp. 110-114 ◽

Cited By ~ 27

Author(s):

Julian Gilbody ◽

Gethin Thomas ◽

Kevin Ho

Keyword(s):

Tibia Vara ◽

Gradual Correction

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Impact of abrupt versus gradual correction of mitral and tricuspid regurgitation: a modelling study

EuroIntervention ◽

10.4244/eij-d-19-00598 ◽

2019 ◽

Vol 15 (10) ◽

pp. 902-911

Author(s):

John Walmsley ◽

Pierre Squara ◽

Ulrich Wolfhard ◽

Richard Cornelussen ◽

Joost Lumens

Keyword(s):

Tricuspid Regurgitation ◽

Gradual Correction ◽

Modelling Study

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Intraoperative acute correction versus postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator

10.21203/rs.3.rs-468930/v1 ◽

2021 ◽

Author(s):

Yanshi Liu ◽

Feiyu Cai ◽

Kai Liu ◽

Xingpeng Zhang ◽

Hong Li ◽

...

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Demographic Data ◽

Tibial Shaft ◽

Gradual Correction ◽

Shaft Fractures ◽

Significant Difference ◽

Acute Correction ◽

Operation Duration ◽

Tibial Shaft Fractures

Abstract Background: The purpose of this study was to determine the differences in clinical outcomes, if any, between intraoperative acute correction and postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator.Methods: We retrospectively analyzed 58 consecutive patients with tibial shaft fractures treated by the hexapod external fixator at our institution from January 2015 to April 2019. Twenty-three patients (Group Ⅰ) underwent intraoperative acute correction, from January 2015 to October 2016. Starting in November 2016, the other 35 patients (Group Ⅱ) all underwent postoperative gradual correction. The demographic data, operation duration, original residual deformities before correction, residual deformities after correction, and external fixation time were collected and analyzed. The clinical outcomes were evaluated by the Johner-Wruhs criteria at the last clinical visit.Results: All patients achieved complete bone union with a mean time of 28.7±4.6 weeks (range 21 to 37 weeks) in Group Ⅰ and 27.9±4.8 weeks (range 19 to 38 weeks) in Group Ⅱ (P>0.05). The operation duration in Group Ⅰ (88.9±7.7 minutes) was longer than that in Group Ⅱ (61.9±8.4 minutes), and there was a statistically significant difference (P<0.05). There were no statistically significant differences between the two groups in original residual deformities before correction and residual deformities after correction (P>0.05). The rate of postoperative complication was similar between the two groups. There was no statistical significance in demographic data and clinical outcomes between the two groups (P>0.05). Conclusions: There is no difference in clinical outcomes between intraoperative acute correction and postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator. Postoperative gradual correction may shorten the duration in the operation room and decrease the potential intraoperative risk.

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