Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 5-6, Pages: 390-394
https://doi.org/10.2298/SARH1306390V
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Treatment of infantile tibia vara - 18-year follow-up: A case report
Vukašinović Zoran (Medicinski fakultet, Beograd + Institut za ortopedsko-hirurške bolesti „Banjica“, Beograd)
Stefanović Branko (Institut za ortopedsko-hirurške bolesti „Banjica“, Beograd)
Šešlija Igor (Institut za ortopedsko-hirurške bolesti „Banjica“, Beograd)
Pavlović Mladen (Institut za ortopedsko-hirurške bolesti „Banjica“, Beograd)
Živković Zorica (Medicinska akademija US Medical School, Evropski univerzitet, Beograd + Kliničko-bolnički centar „Dr Dragiša Mišović“, Beograd)
Introduction. Blount disease is developmental disorder of the lower leg,
manifested by multiplanar deformity. Surgical treatment includes corrective
osteotomy, lateral hemiepiphisyodesis, distraction of the proximal tibial
physis, physeal bar resection and elevation of the medial tibial plateau.
Case Outline. A case of a 4-year-old girl with bow legs is presented.
Condition was recognized as Blount disease, type five. Both lower legs were
operated by medial methaphyseal semi-osteotomy of the proximal tibia with the
elevation of the medial tibial plateau. Prospectively, bilateral proximal
hemiepiphysiodesis was done. Total follow-up period was eighteen years. The
patient has no disturbances, clinical and radiographic findings are
excellent. Improvement of the femoro-tibial angle is 22° on the right side,
and 21° on the left side. Improvement of the varus angle is 7° on the right
side, and 27° on the left side. Medial plateau depression is completely
bilaterally reduced; improvement on the right side is 46°, and 51° on the
left side. Conclusion. It is known today that multiplanar deformity is a part
of the disease; varus, antecurvatum and internal rotation of the lower leg.
By elevation of the medial plateau varus of the lower and antecurvatum
component of deformity can be solved, while internal torsion cannot be
solved. This deformity has to be either skillfully neglected, or corrected by
an additional osteotomy by the elevation of the medial tibial plateau.
Lateral hemiepiphysiodesis serves as extra stabilisator of the achieved
result, and it is recommended to be done in combination with surgical
elevation of the medial tibial plateau and derotative corrective osteotomy of
the tibia.
Keywords: tibia vara, Blount disease, depression of the medial tibial plateau, elevation of medial tibial plateau
Projekat Ministarstva nauke Republike Srbije, br. 41004