Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 18 , ISSUE 2 ( May-August, 2023 ) > List of Articles


Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator

DP Motta, JLR Faria, A Couto, DP Aguiar, MVG Amaral, LL Kropf, GAVA Motta, FS Cerqueira, BD Leonetti

Keywords : External fixation, Monolateral, Osteotomy, Tibia deformity, Valgus

Citation Information : Motta D, Faria J, Couto A, Aguiar D, Amaral M, Kropf L, Motta G, Cerqueira F, Leonetti B. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. 2023; 18 (2):123-132.

DOI: 10.5005/jp-journals-10080-1585

License: CC BY-NC-SA 4.0

Published Online: 26-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Objective: To present a review of patients subjected to gradual correction of a valgus deformity of the tibia using a monolateral external fixator. Method: This retrospective review included patients from January 2012 to May 2022 who met the following inclusion criteria: deviation of mechanical axis of the limb due to valgus deformity of the tibia; tibial deformity in the coronal plane on radiographic examination; a documented outpatient pre-operative evaluation by an orthopaedic surgeon and age between 10 and 70 years. The following exclusion criteria were applied: the presence of another tibia deformity preventing gradual correction using the proposed assembly; skin conditions incompatible with the surgical procedure; inadequate pre- or post-operative radiological evaluation; and insufficient information in the medical records. Results: The mean age of patients with a valgus deformity of the tibia was 30.8 ± 15.9 years. These patients had a body mass index (BMI) of 26.1 ± 5.5 kg/m2. A congenital or developmental aetiology was attributed to 58.3% of the cases. Most commonly, the deformity was found in the middle third of the tibia with a mean deformity of 14.7 ± 6.6 degrees. The total external fixator time ranged from 73 to 229 days (average 149.7 ± 36.1 days). The mean medial proximal and lateral distal tibial angles differed significantly for pre- and post-operative measurements (p ≤ 0.05). There were complications in eight cases; five cases of pin site infections, two cases of medial cortical fracture and one case of peroneal nerve neuropraxia. Conclusion: The proposed correction technique produces a satisfactory angular correction and with similar outcomes as described in the literature.

  1. Springer B, Bechler U, Waldstein W, et al. The influence of femoral and tibial bony anatomy on valgus OA of the knee. Knee Surg Sports Traumatol Arthrosc 2020;28(9):2998–3006. DOI: 10.1007/s00167-019-05734-6.
  2. Denduluri S, Lu M, Bielski R. Development of genu valgum after removal of osteochondromas from the proximal tibia. J Pediatr Orthop B 2015;25(6):582–586. DOI: 10.1097/BPB.0000000000000221.
  3. Goodier WD, Calder PR. External fixation for the correction of adult post-traumatic deformities. Injury 2019;50 (Suppl 1):S36–S44. DOI: 10.1016/j.injury.2019.03.040.
  4. Cerqueira FDS, Motta GATA, Rocha de Faria JL, et al. Controlled double gradual opening osteotomy for the treatment of severe varus of the knee—Blount's Disease. Arthrosc Tech 2021;10(9):e2199–e2206. DOI: 10.1016/j.eats.2021.05.023.
  5. He A, Mao Y, Zhou Y, et al. Preoperative planning by osteotomy master software helps to improve the accuracy of target limb alignment in high tibial osteotomy. J Orthop Surg Res 2020;15:504. DOI: 10.1186/s13018-020-02033-6.
  6. Sun X, Yang B, Xiao S, et al. Effect of limb rotation on radiographic alignment measurement in mal-aligned knees. Biomed Eng Online 2021;20:119. DOI: 10.1186/s12938-021-00956-7.
  7. Santoso MB, Wu L. Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review. J Orthop Surg Res 2017;12(1):50. DOI: 10.1186/s13018-017-0552-9.
  8. Sherman SL, Thompson SF, Clohisy JCF. Distal femoral varus osteotomy for the management of valgus deformity of the knee. J Am Acad Orthop Surg 2018;26:313–324. DOI: 10.5435/JAAOS-D-16-00179.
  9. van Lieshout WAM, van Ginneken BJT, Kerkhoffs GMMJ, et al. Medial closing wedge high tibial osteotomy for valgus tibial deformities: Good clinical results and survival with a mean 4.5 years of follow-up in 113 patients. Knee Surg Sports Traumatol Arthrosc 2020;28(9):2798–2807. DOI: 10.1007/s00167-019-05480-9.
  10. Peng H, Ou A, Huang X, et al. Osteotomy around the knee: the surgical treatment of osteoarthritis. Orthop Surg 2021;13(5):1465–1473. DOI: 10.1111/os.13021. Epub 2021 Jun 10.
  11. Uboldi FM, Travi M, Tradati D, et al. Medial closure supracondylar femoral osteotomy: An effective solution for long-term treatment of arthritic valgus knee? J Orthop Traumatol 2021;22(1):35. DOI: 10.1186/s10195-021-00600-z.
  12. Paley D, Herzenberg JE, Tetsworth K, et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994;25(3):425–465. DOI: 10.1016/S0030-5898(20)31927-1.
  13. Motta DP da, Faria JLR de, Cruz CM, et al. Lateral gradual opening osteotomy of the tibia with monolateral external fixator for correcting the valgus deformity of the tibia. Arthrosc Tech 2022;11(12):e2271–e2277. DOI: 10.1016/j.eats.2022.08.036.
  14. Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol 2019;20(1):22. DOI: 10.1186/s10195-019-0527-1.
  15. Takata M, Vilensky VA, Tsuchiya H, et al. Foot deformity correction with hexapod external fixator, the Ortho-SUV FrameTM. J Foot Ankle Surg 2013;52(3):324–330. DOI: 10.1053/j.jfas.2013.01.013.
  16. Fürmetz J, Patzler S, Wolf F, et al. Tibial and femoral osteotomies in varus deformities - Radiological and clinical outcome. BMC Musculoskelet Disord 2020;21(1):201. DOI: 10.1186/s12891-020-03232-2.
  17. Warnock AM, Raducanu R, DeHeer PA. Lower extremity pediatric history and physical examination. Clin Podiatr Med Surg 2013;30(4):461–478. DOI: 10.1016/j.cpm.2013.07.008.
  18. Chalopin A, Geffroy L, Pesenti S, et al. Correction of axial deformity during lengthening in fibular hypoplasia: Hexapodal versus monorail external fixation. Orthop Traumatol Surg Res 2017;103(5):755–759. DOI: 10.1016/j.otsr.2017.03.006.
  19. Fragomen AT, Rozbruch SR. Retrograde magnetic internal lengthening nail for acute femoral deformity correction and limb lengthening. Expert Rev Med Devices 2017;14(10):811–820. DOI: 10.1080/17434440.2017.1378092.
  20. Dabash S, Zhang DT, Rozbruch SR, et al. Blocking screw-assisted intramedullary nailing using the reverse-rule-of-thumbs for limb lengthening and deformity correction. Strategies Trauma Limb Reconstr 2019;14(2):77–84. DOI: 10.5005/jp-journals-10080-1430.
  21. Liu X, Chen Z, Gao Y, et al. High tibial osteotomy: Review of techniques and biomechanics. J Healthc Eng 2019;2019:8363128. DOI: 10.1155/2019/8363128.
  22. Kuwashima U, Yonekura A, Itoh M, et al. Tibial condylar valgus osteotomy – indications and technique. J Exp Orthop 2020;7(1):30. DOI: 10.1186/s40634-020-00247-5.
  23. Purcell KF, Russell GV, Graves ML. The clamshell osteotomy for diaphyseal malunion in deformity correction and fracture surgery. Medicina (Kaunas) 2021;57(9):951. DOI: 10.3390/medicina57090951.
  24. Wagner P, Standard SC, Herzenberg JE. Evaluation of a mobile application for multiplier method growth and epiphysiodesis timing predictions. J Pediatr Orthop 2017;37(3):e188–e191. DOI: 10.1097/BPO.0000000000000805.
  25. Wu Z, Ding J, Zhao D, et al. Multiplier method may be unreliable to predict the timing of temporary hemiepiphysiodesis for coronal angular deformity. J Orthop Surg Res 2017;12(1):104. DOI: 10.1186/s13018-017-0604-1.
  26. Sinha R, Weigl D, Mercado E, et al. Eight-plate epiphysiodesis: Are we creating an intra-articular deformity? Bone Joint J 2018;100-B(8):1112–1116. DOI: 10.1302/0301-620X.
  27. Calder PR, Faimali M, Goodier WD. The role of external fixation in paediatric limb lengthening and deformity correction. Injury 2019;50(Suppl 1):S18–S23. DOI: 10.1016/j.injury.2019.03.049.
  28. Puddu G, Cipolla M, Cerullo G, et al. Which osteotomy for a valgus knee? Int Orthop 2010;34(2):239–247. DOI: 10.1007/s00264-009-0820-3.
  29. Al-Saati M, Magnussen R, Demey G, et al. Lateral opening-wedge high tibial osteotomy. Tech Knee Surg 2011;10(3):178–185. DOI:10.1097/BTK.0b013e31822bac0f.
  30. Ceroni D, Grumetz C, Desvachez O, et al. From prevention of pin-tract infection to treatment of osteomyelitis during paediatric external fixation. J Child Orthop 2016;10(6):605–612. DOI: 10.1007/s11832-016-0787-8.
  31. Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: A review of the literature. Strategies Trauma Limb Reconstr 2016;11(2):75–85. DOI: 10.1007/s11751-016-0256-4.
  32. Ktistakis I, Guerado E, Giannoudis PV. Pin-site care: Can we reduce the incidence of infections? Injury 2015;46 (Suppl 3):S35–S39. DOI: 10.1016/S0020-1383(15)30009-7.
  33. Roy A, Pesenti S, Chalopin A, et al. Can the TrueLok Hexapod SystemTM be used to accurately correct lower limb deformity in children? Orthop Traumatol Surg Res 2020;106(7):1361–1366. DOI: 10.1016/j.otsr.2020.06.013.
  34. Saw A, Phang ZH, Alrasheed MK, et al. Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults. J Orthop Surg (Hong Kong) 2019;27(3):2309499019873987. DOI: 10.1177/2309499019873987.
  35. Puijk R, Rassir R, Kok LM, et al. Common peroneal nerve palsy after TKA in valgus deformities; A systematic review. J Exp Orthop 2022;9(1):12. DOI: 10.1186/s40634-021-00443-x.
  36. Ofiram E, Eylon S, Porat S. Correction of knee and ankle valgus in hereditary multiple exostoses using the Ilizarov apparatus. J Orthop Traumatol 2008;9(1):11–15. DOI: 10.1007/s10195-008-0098-z.
  37. Rozbruch SR, Segal K, Ilizarov S, et al. Does the Taylor spatial frame accurately correct tibial deformities? Clinical Orthopaedics & Related Research, 2010;468(5): pp. 1352–1361. DOI: 10.1007/s11999-009-1161-7.
  38. Nogueira MP, Paley D. Prophylactic and therapeutic peroneal nerve decompression for deformity correction and lengthening. Oper Tech Orthop 2011;21:180–183.
  39. Wright JM, Crockett HC, Slawski DP, et al. High tibial osteotomy. J Am Acad Orthop Surg 2005;13(4):279–289. DOI: 10.5435/00124635-200507000-00007.
  40. Da Cunha RJ, Kraszewski AP, Hillstrom HJ, et al. Biomechanical and functional improvements gained by proximal tibia osteotomy correction of genu varum in patients with knee pain. HSS J 2020;16(1):30–38. DOI: 10.1007/s11420-019-09670-6.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.