Acute correction of proximal tibial coronal plane deformity in small children using a small monolateral external fixator with or without cross-pinning

PurposeSurgical correction of proximal tibia deformity in small children can be challenging. We present the surgical technique and outcome of proximal tibia osteotomy fixed with small monolateral external fixator in this patient group.MethodsA total of 17 cases in eight patients younger than nine years of age were study subjects. A proximal tibia osteotomy was fixed with a small monolateral external fixator with or without cross-pinning. Outcome was evaluated by changes of radiographic parameters such as medial proximal tibia angle (MPTA), metaphyseal diaphyseal angle (MDA) and clinical findings of complications, time interval until weight bearing and fixator removal time.ResultsMPTA improved from a preoperative mean of 73° (sd 4°; 66° to 78°) to an immediate postoperative mean of 90° (sd 3°; 85° to 96°) in varus tibiae, and from 104° (sd 1°; 103° to 105°) to 89° (sd 1°; 88° to 89°) in valgus tibiae. In all, 15 of the 17 cases (88.3 %) achieved postoperative MPTA within the normal range (85° to 90°). MDA improved from a preoperative mean of 19° (sd 5°; 11° to 24°) to an immediate postoperative mean of 0° (sd 4°; -6° to 7°) in varus tibiae, and from -25° (sd 2°; -22° to -24°) to 2° (SD 1°; 1° to 3°) in valgus tibiae. Full weight bearing was possible at mean 1.7 months (0.5 to 3.0). Mean follow-up period was 6.5 years (sd 5.4; 1.0 to 16.0). No complications developed during the follow-up.ConclusionProximal tibia osteotomy fixed with small monolateral external fixator provides accurate, safe and efficient correction in the management of coronal plane angular deformity in small children.Level of EvidenceLevel IV

Osteotomies for the Management of Medial Compartment Defects of the Knee

For nearly three-quarters of a century the proximal tibia osteotomy has been used as an effective treatment for cartilage injuries of the knee. Over this same timeframe several advancements have been made in our diagnostic, preoperative planning, and technical execution of this procedure. As such, good-to-excellent short-, mid-, and long-term outcomes have been reported. Since its inception, the most important step in deciding on this procedure is identifying the ideal candidate. This candidate should be a young patient (<55 years old), active, with isolated medial compartment arthrosis without significant comorbidities. With appropriate patient selection and careful preoperative planning, the patient should achieve excellent results and high satisfaction.

BLOUNT DISEASE EVALUATION OF THE OPERATIVE TREATMENT WITHIN 2006-2014 IN DR. SOETOMO GENERAL HOSPITAL SURABAYA

Background: Blount disease is a growth disturbance of the medial side of the proximal physeal of the tibia, epiphyseal and metaphyseal. Clinically this disease marked by varus angulation and internal rotation of the tibia on the metaphyseal area below knee.Method: This paper evaluating 2 cases of blount disease treated surgically in Soetomo general hospital within 2006 – 2014. The evaluation based on MDA (meta-diaphyseal angle) pre and post operatively.Result: Showed significant and satisfactory to patients and parents who have carried out the operation. A reduction in the angle of MDA, in first patients the MDA angle before surgery was 18 degrees on the right 40 degrees on the left, after surgery MDA was 24 degrees on the right, 10 degrees on the left. The second patient MDA before surgery was 32 degrees on the right and 33 degrees on the left, after the surgery MDA was 12 degrees on the left side, for the right side hasn’t operated yet.Discussion and Conclusion: There is hope for correction on severe form of blount disease. Correction by performing a proximal tibia osteotomy on the affected bone.