Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 7 , ISSUE 3 ( November, 2012 ) > List of Articles

Original Article

Limb lengthening in congenital posteromedial bow of the tibia

S. D. Kaufman, J. A. Fagg, S. Jones, M. J. Bell, M. Saleh, J. A. Fernandes

Keywords : Limb lengthening, Posteromedial bow, Deformity correction

Citation Information : Kaufman SD, Fagg JA, Jones S, Bell MJ, Saleh M, Fernandes JA. Limb lengthening in congenital posteromedial bow of the tibia. 2012; 7 (3):147-153.

DOI: 10.1007/s11751-012-0145-4

License: CC BY-NC-SA 4.0

Published Online: 30-11-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Congenital posteromedial bowing of the tibia (PMBT) is a rare condition affecting one lower limb. The bowing of the tibia usually resolves; however, there is associated limb length discrepancy (LLD), which often persists and can cause functional deficits. Advances in limb lengthening techniques allow this issue to be addressed, often with concomitant angular deformity correction. This study examined eleven patients who have had limb lengthening procedures with mean pre-operative LLD of 3.7 cm (range 1.5–5 cm), mean increase in length was 3.9 cm (range 1.5–5.8 cm), and mean LLD at last follow-up was less than 0.6 cm (range 0–2.0 cm). The main complications were minor or moderate grades, such as pin site infection. Greater LLD was found than previously reported, and we believe that the tertiary referrals were those of a severe form of PMBT. The authors conclude that in view of deformity with discrepancy, in select cases, correction and lengthening would be an option rather than only contralateral epiphysiodesis.

PDF Share
  1. Heyman GH, Hendon CH (1949) Congenital posterior angulation of the tibia. J Bone Joint Surg Am 3:571-575
  2. Zollinger PE, Wessels MW, Wladimiroff JW, Diepstraten AFM (2000) Prenatal ultrasonographic diagnosis of posteromedial bowing of the leg: two case e reports. Ultrasound Obstet Gynecol 15:150-153
  3. Yadav SS, Thomas S (1980) Congenital posteromedial bowing of the tibia. Acta Orthop Scand 51:311-313
  4. Pappas AM (1984) Congenital posteromedial bowing of the tibia and fibula. J Paediatr Orthop 4:525-531
  5. Shah HH, Doddabasappa SN, Joseph B (2009) Congenital posteromedial bowing of the tibia: a retrospective analysis of growth abnormalities in the leg. J Pediatr Orthop B 18(3):120-128
  6. Hoffmann A, Wenger DR (1981) Posteromedial bowing of the tibia: progression of discrepancy in limb lengths. J Bone Joint Surg Am 63:3847
  7. Grimes JB, Blair VP, Gilula LA (1986) Roentgen rounds #81. Orthop Rev 15(4):100-106
  8. Paley D (ed) (2002) Oblique plain deformities. In: Principles of deformity correction, Springer, Berlin, pp 175-193
  9. Edwards DJ, Bickerstaff DB, Bell MJ (1994) Periosteal stripping in achondroplastic children. Little effect on limb length in 10 cases. Acta Orthop Scand 65(3):333-334
  10. Saleh M, Scott BW (1992) Pitfalls and complications in leg lengthening: the Sheffield experience. Semin Orthop 7:207-222
  11. Johari AN, Dhawale AA, Salaskar A, Aroojis AJ (2010) Congenital postero-medial bowing of the tibia and fibula: is early surgery worthwhile? J Pediatr Orthop Br 19(6):479-486
  12. Nogami H, oohira A, Kuroyanagi M, Mizutani A (1986) Congenital bowing of long bones: clinical and experimental study. Teratol 33(1):1-7
  13. De Maio F, Corsi A, Roggini M, Riminucci M, Bianco P, Ippolito E (2005) Congenital unilateral posteromedial bowing of the tibia and fibula: insights regarding pathogenesis from prenatal pathology. A case report. J Bone Joint Surg 87-A(7):1601-1605
  14. Dawson GR (1949) Intra-uterine fracture of the tibia and fibula: report of a case with correction by osteotomy and plating. J Bone Joint Surg Am 31:406-409
  15. French SM, Crampton SA, Brandreth DL (1987) Posteromedial bowing of the tibia and fibula: a literature review and case presentation. J Foot Surg 26(1):60-65
  16. Rathgeb JM, Ramsey PL, Cowell HR (1974) Congenital kyphoscoliosis of the tibia. Clin Orthop 103:178-181
  17. Thompson GH (2001) Angular deformities of the lower extremities in children. In: Chapman MW (ed) Orthopaedic surgery, 3rd edn. Lippincott Williams and Wilkins, Philadelphia, pp 4324- 4335
  18. Saleh M, Goonatillake HD (1995) Management of congenital leg length inequality: value of early axis correction. J Paediatr Orthop 4:150-158
  19. Zarzycki D, Tesiorowski M, Zarzycka M, Kacki W, Jasiewicz B (2002) Long-term results of lower limb lengthening by the Wagner Method. J Paediatr Orthop 22:371-374
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.