Recurrence in infantile tibia vara (Blount disease) after high tibia and fibula osteotomy.

Infantile Tibia Vara (ITV or Blount disease) often recurs after surgical correction of the deformity. Vastly different recurrence rates have been reported in the literature. The main objective of this study was to identify any risk factors for the recurrence of ITV following high tibia and fibula valgus osteotomy. This was a retrospective cohort comparative study of 44 patients with ITV (16 with bilateral involvement) who underwent a total of 60 high tibia and fibula osteotomies. Demographics, family history, BMI, walking age and age at surgery were recorded. Pre-, post- and follow-up weight-bearing anatomic femorotibial angles, were measured from X-rays. The limbs were divided into Langenskiöld stages based on preoperative X-rays. The study found an overall recurrence rate of 63.3% for children who had a high tibia and fibula osteotomy for ITV. Surgery after the age of 4 years, advanced Langenskiöld stages (stages 3-5) and overcorrection of less than 15 degrees of valgus were identified as risk factors for recurrence. This study recommends performing a high tibia and fibula valgus osteotomy before the age of 4 years in ITV to avoid recurrence. Overcorrection of the high tibia and fibula osteotomy to 15 degrees of valgus should be considered in older patients with high Langenskiöld stages at time of presentation.

The femoral deformity in Blount's disease: a comparative study of infantile, juvenile and adolescent Blount's disease.

An associated femoral deformity in patients with Blount's disease is not commonly described in the literature. The objective of this study is to establish the presence and magnitude of deformity in the coronal plane of the distal femur in children of all ages with Blount's disease and compare this to a matched cohort of children from the same population. This was a retrospective review of patients from an academic hospital. A control group was established by matching for age and gender from a group of unaffected patients with mid to proximal third femur fractures or controls at the same hospital. Study participants were categorized by age at onset of deformity as follows: infantile (<4 years), juvenile (4-10 years) and adolescent (>10 years). The measurements of the anatomic lateral distal femoral angle (aLDFA) were recorded and the Wilcoxon rank-sum test was used to determine statistically significant differences in the LFDA between children with Blount's disease and those without. Seventy-two Black African children were included in the study with 118 affected limbs (27 infantile, 55 juvenile and 36 adolescent). The overall average aLDFA for all patients with Blount's disease was 87° (range 73-100°). Overall, children with Blount's disease had a higher aLDFA than children without (87° vs. 82°). There was a significant association between LDFA in the control group and children with Blount's disease in each of the three groups. This study found distal femoral varus deformity to be present in all groups of children with Blount's disease. In this study population, it was most significant in the infantile and adolescent groups when compared to a control group from the same population. Although further studies are required, the surgeon must always assess the distal femoral component in treating children with Blount's disease.

Transtibial Ertl amputation for children and adolescents: a case series and literature review.

PURPOSE: Despite advances in limb reconstruction, there are still a number of young patients who require trans-tibial amputation. Amputation osteoplasty is a technique first described by Ertl to enhance rehabilitation after trans-tibial amputation. The purpose of the study reported here was to evaluate the results of the original Ertl procedure in skeletally immature patients and to assess whether use of this procedure would result in a diminished incidence of bony overgrowth. METHODS: The cases of four consecutive patients (five amputations) treated between January 2005 and June 2008 were reviewed. Clinical evaluation consisted of the completion of the prosthesis evaluation questionnaire (PEQ) and physical examination. Radiographic analysis was performed to evaluate bone-bridge healing, bone overgrowth, and the development of genu varum as measured by the medial proximal tibial angle (MPTA). RESULTS: The best mean PEQ score in the question section was 91.8 (range 74-100) for 'well being' and the worst mean score was 66.6 (range 50-78) for 'residual limb health'. Examination of the residual limbs revealed no bursae, and all knees were stable with full range of movement. All bony bridges united at an average age of 1.7 (range 1-2) months. One case required stump revision for bony overgrowth, and one case developed asymptomatic mild genu varum. CONCLUSIONS: The original Ertl osteomyoplasty may serve as one of the options for treatment of trans-tibial amputation in older children. CLINICAL RELEVANCE: Our results suggest that the Ertl osteomyoplasty is a feasible option in this challenging patient population.