Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 19 , ISSUE 2 ( May-August, 2024 ) > List of Articles

CASE SERIES

The Outcome of Corrective Transverse Osteotomy in Paediatric Tibia Vara

MA Irwan, WH Chan, M Anuar Ramdhan I, IP Faris

Keywords : Blount's disease, Corrective osteotomy, Tibia vara, Transverse osteotomy

Citation Information : Irwan M, Chan W, Ramdhan I MA, Faris I. The Outcome of Corrective Transverse Osteotomy in Paediatric Tibia Vara. 2024; 19 (2):111-117.

DOI: 10.5005/jp-journals-10080-1617

License: CC BY-NC 4.0

Published Online: 14-08-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Tibia vara is a three-dimensional deformity of the proximal tibia, varus, internal tibial torsion and procurvatum. It is an uncommon deformity with the surgical management varied. This study describes the outcomes of tibia vara management using a corrective transverse osteotomy in one centre. Materials and methods: A retrospective cohort study was conducted involving eight patients with tibia vara (ten tibias). Consent was obtained for treatment using an acute corrective osteotomy. Measurements of Drennan's angle, the tibiofemoral angle (TFA) and the procurvatum angle were measured preoperatively and postoperatively both just after surgery and at 1 year. A validated questionnaire—the Knee Outcome Survey of Activity Daily Living (KOS-ADL)—was utilised to assess clinical function and outcome. Also recorded were the intraoperative and postoperative complications, the radiological lower limb alignments, the union rate and the recurrence of deformity. Results: There were eight patients involved in this study with a total of ten tibias (six with unilateral tibias and two with bilateral tibias). The mean age of the patients was 11.3 years old (ranging from 8 to 15 years old) with most males (five males and three females). The affected tibias were 6 right sided and 4 left sided. Measurements of Drennan's angle, the TFA and the procurvatum angle were used to determine lower limb alignment preoperatively, postoperatively (immediate post-surgery) and at 1-year follow-up. Functional parameters were measured using the KOS-ADL. A descriptive analysis between the preoperative and postoperative variables was done. The mean for Drennan's angle was 21.6 (±5.2) preoperatively, 3.6 (± 2.3) postoperatively and 4.9 (±2.8) at 1-year follow-up. The TFA was improved from 22.6 (±6.1) preoperatively to 3.5 (±2.8) postoperatively and 4.4 (±2.0) at 1-year follow-up. The procurvatum angle was improved preoperatively from 8.20 (±7.5) to 2.40 (±2.5) postoperatively and 2.20 (±2.5) at 1-year follow-up. At the latest follow-up, the ADLS mean score was 98.5 (±2.6) while the SAS mean score was 97.5 (±3.3). The mean length follow-up period was 2 years (ranging from 1 year to 3 years). None of the patients developed postoperative complications with all achieving union without deformity recurrence in the period of observation. Conclusion: This study revealed that acute correction via a corrective transverse osteotomy of the tibia is a safe and effective method in treating tibia vara.


PDF Share
  1. Phedy P, Siregar PU. Osteotomy for deformities in Blount disease: A systematic review. J Orthop 2016;13(3):207–209. DOI: 10.1016/j.jor.2015.03.003.
  2. Langenskiöld A. Tibia vara. A critical review. Clin Orthop Relat Res 1989;(246):195–207. PMID: 2670387.
  3. Edwards TA, Hughes R, Monsell F. The challenges of a comprehensive surgical approach to Blount's disease. J Child Orthop 2017;11(6): 479–487. DOI: 10.1302/1863-2548.11.170082.
  4. Feldman DS, Madan SS, Ruchelsman DE, et al. Accuracy of correction of tibia vara: Acute versus gradual correction. J Pediatr Orthop 2006;26(6):794–798. DOI: 10.1097/01.bpo.0000242375.64854.3d.
  5. Stanitski DF, Dahl M, Louie K, et al. Management of late-onset tibia vara in the obese patient by using circular external fixation. J Pediatr Orthop 1997;17(5):691–694. DOI: 10.1097/00004694-199709000-00021.
  6. Laurencin CT, Ferriter PJ, Millis MB. Oblique proximal tibial osteotomy for the correction of tibia vara in the young. Clin Orthop Relat Res 1996;(327):218–224. DOI: 10.1097/00003086-199606000-00027.
  7. Hayek S, Segev E, Ezra E, et al. Serrated W/M osteotomy. Results using a new technique for the correction of infantile tibia vara. J Bone Joint Surg Br 2000;82(7):1026–1029. DOI: 10.1302/0301-620x.82b7.10507.
  8. Thompson GH, Carter JR. Late-onset tibia vara (Blount's disease). Current concepts. Clin Orthop Relat Res 1990;(255):24–35. PMID: 2189629.
  9. Hegazy M, Bassiouni H, Hammady AE, et al. Osteotomy methods for treatment of Blount's Disease a systematic review. Behna Med J 2020;37(2):13. DOI: 10.21608/bmfj.2020.79643.
  10. Giwa OG, Anetor JI, Alonge TO, et al. Biochemical observations in Blount's disease (infantile tibia vara). J Natl Med Assoc 2004;96(9): 1203–1207. PMID: 15481748.
  11. Thompson GH, Carter JR, Smith CW. Late-onset tibia vara: A comparative analysis. J Pediatr Orthop 1984;4(2):185–194. DOI: 10.1097/01241398-198403000-00007.
  12. Salenius P, Vankka E. The development of the tibiofemoral angle in children. The Journal of Bone and Joint Surgery. American Volume 1975;57(2):259–261. PMID: 1112851.
  13. Langenskiöld A, Riska EB. Tibia vara (osteochondrosis deformans tibiae): A survey of seventy-one cases. The Journal of Bone & Joint Surgery. American Volume 1964;46(7):1405–1420. PMID: 14213402.
  14. Zein AB, Elhalawany AS, Ali M, et al. Acute correction of severe complex adolescent late-onset tibia vara by minimally invasive osteotomy and simple circular fixation: a case series with 2-year minimum follow-up. BMC Musculoskelet Disord 2021;22(1):681. DOI: 10.1186/s12891-021-04496-y.
  15. Miraj F, Ajiantoro, Arya Mahendra Karda IW. Step cut “V” osteotomy for acute correction in Blount's disease treatment: A case series. Int J Surg Case Rep 2019;58:57–62. DOI: 10.1016/j.ijscr.2019.03.044.
  16. Zionts LE, Shean CJ. Brace treatment of early infantile tibia vara. J Pediatr Orthop 1998;18(1):102–109. PMID: 9449110.
  17. Gilbody J, Thomas G, Ho K. Acute versus gradual correction of idiopathic tibia vara in children: A systematic review. J Pediatr Orthop 2009;29(2):110–114. DOI: 10.1097/BPO.0b013e31819849aa.
  18. Kim SJ, Sabharwal S. Is there a difference in sagittal alignment of Blount's disease between radiographic and clinical evaluation? Clin Orthop Relat Res 2014;472(12):3807–3813. DOI: 10.1007/s11999-014-3473-5.
  19. Ogbemudia AO, Bafor A, Ogbemudia PE. Anterior posterior inverted-‘U’ osteotomy for tibia vara: Technique and early results. Arch Orthop Trauma Surg 2011;131(4):437442. DOI: 10.1007/s00402-010-1139-7.
  20. Ferriter P, Shapiro F. Infantile tibia vara: Factors affecting outcome following proximal tibial osteotomy. J Pediatr Orthop 1987;7(1):1–7. PMID: 3793900.
  21. Van Greunen E, Firth GB. Recurrence in infantile tibia vara (Blount disease) after high tibia and fibula osteotomy. J Pediatr Orthop B 2022;31(2):134–138. DOI: 10.1097/BPB.0000000000000901.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.