SS  Vol.6 No.4 , April 2015
Combined Antero-Posterior Inverted-U Metaphyseal and Open-Wedge Medial-Epiphyseal Osteotomy for Advanced Blount Disease
Abstract: Background: Blount disease is frequently associated with deformities that may not be adequately corrected by a single metaphyseal osteotomy. This study evaluated the outcome of a combined metaphyseal and epiphyseal osteotomy in severe cases. Methods: We prospectively evaluated the outcome of combining the antero-posterior inverted-U metaphyseal osteotomy with a medial open-wedge hemi-epiphyseal osteotomy in eighteen patients (27 tibiae) with Stage IV to VI Blount disease. Results: The average age of patients was 9 years (ranging from 5 to 17). The tibio-femoral angle improved from 43° varus (Range: 34° - 78°) to 2° varus (Range: 5° valgus to 8° varus). The metaphyseal-diaphyseal angle improved from 36° to 8° varus. Internal tibial torsion improved from 39° to 2°. All the patients were able to achieve 110° of knee flexion in a year. Conclusion: In conclusion, the combined metaphyseal and epiphyseal osteotomy satisfactorily corrected tibio-femoral and metaphyseal-diaphyseal varus and internal tibial torsion without recurrence in patients with severe Blount disease. Level of Evidence: IV.
Cite this paper: Ogbemudia, A. , Bafor, A. , Ogbemudia, E. and Edomwonyi, E. (2015) Combined Antero-Posterior Inverted-U Metaphyseal and Open-Wedge Medial-Epiphyseal Osteotomy for Advanced Blount Disease. Surgical Science, 6, 162-169. doi: 10.4236/ss.2015.64026.

[1]   Aird, J.J., Hogg, A. and Rollinson, P. (2009) Femoral Torsion in Patients with Blount’s Disease: A Previously Unrecognised Component. Journal of Bone and Joint Surgery, 91, 1388-1393.

[2]   Thompson, G.H. (1988) Angular Deformities of the Lower Extremities. In: Chapman, M.W., Ed., Operative Orthopaedics, 2nd Edition, Lippincott, Philadelphia, 3139-3145.

[3]   Canale, S.T. (1998) Osteochondrosis or Epiphysitis and Other Miscellaneous Affections. In: Canale, S.T., Ed., Campbell’s Operative Orthopaedics, 9th Edition, Mosby, St. Loius, 891-901.

[4]   Stricker, S.J., Edwards, P.M. and Tidwell, M.A. (1994) Langenskiold Classification of Tibia Vara: An Assessment of Interobserver Variability. Journal of Pediatric Orthopaedics (US), 14, 152-155.

[5]   Rab, G.T. (1988) Oblique Tibial Osteotomy for Blount’s Disease (Tibia Vara). Journal of Pediatric Orthopaedics, 8, 715-720.

[6]   Aoki, Y., Yasuda, K., Mikami, S., Ohmoto, H., Majima, T. and Minami, A. (2006) Inverted V-Shaped High Tibial Osteotomy Compared with Closing Wedge High Tibial Osteotomy for Osteoarthritis of the Knee. Ten Year Follow-Up Result. Journal of Bone and Joint Surgery, 88, 1336-1340.

[7]   van Huyssteen, A.L., Hastings, C.J., Olesak, M. and Hoffman, E.B. (2005) Double-Elevating Osteotomy for Late-Presenting Infantile Blount’s Disease: The Importance of Concomitant Lateral Epiphyseodesis. Journal of Bone and Joint Surgery, 87, 710-715.

[8]   Zayer, M. (1992) Hemicondylar Tibial Osteotomy in Blount’s Disease. A Report of 2 Cases. Acta Orthopaedica, 63, 350-352.

[9]   Gregosiewicz, A., Wosko, I., Kandzierski, G. and Drabik, Z. (1989) Double Elevating Osteotomy of Tibiae in the Treatment of Severe Cases of Blount’s Disease. Journal of Pediatric Orthopaedics, 9, 178-181.

[10]   Miller, S., Radomisli, T. and Ulin, R. (2000) Inverted Arcuate Osteotomy and External Fixation for Adolescent Tibia vara. Journal of Pediatric Orthopaedics, 20, 450-454.

[11]   Ogbemudia, A.O., Bafor, A., Edomwonyi, E. and Ogbemudia, P.E. (2008) Sterile Pneumatic Tourniquet Adapted from the Aneroid Sphygmomanometer: Technique and Results. Nigerian Journal of Orthopaedics and Trauma, 7, 45-47.

[12]   Ogbemudia, A.O., Bafor, A. and Ogbemudia, P.E. (2010) Anterior Posterior Inverted-‘U’ Osteotomy for Tibia Vara: Technique and Early Results. Archives of Orthopaedic and Trauma Surgery, 131, 437-442.

[13]   Rupp, R.E., Podeszwa, D. and Ebraheim, N.A. (1994) Danger Zones Associated with Fibular Osteotomy. Journal of Orthopaedic Trauma, 8, 54-58.

[14]   Soejima, O., Ogata, K., Ishinishi, T., Fukahori, Y. and Miyauchi, R. (1994) Anatomic Considerations of the Peroneal Nerve for Division of the Fibula during High Tibial Osteotomy. Orthopedic Reviews, 23, 244-247.

[15]   Hefny, H., Shalaby, H., El-Kawy, S., Thakeb, M. and Elmoatasem, E. (2006) A New Double Elevating Osteotomy in Management of Severe Neglected Infantile Tibia Vara Using the Ilizarov Technique. Journal of Pediatric Orthopaedics, 26, 233-237.

[16]   McCarthy, J.J., MacIntyre, N., Hooks, B. and Davidson, R.S. (2009) Double Osteotomy for the Treatment of Severe Blount Disease. Journal of Pediatric Orthopaedics, 29, 115-119.

[17]   Janoyer, M., Jabbari, H., Rouvillain, J.L., Sommier, J., Py, G., Catonné, Y. and Colombani, J.F. (2007) Infantile Bloun’s Disease Treated by Hemiplateau Elevation and Epiphyseal Distraction Using a Specific External Fixator: Preliminary Report. Journal of Pediatric Orthopaedics B, 16, 273-280.

[18]   Clarke, S., McCarthy, J. and Davidson, R. (2009) Treatment of Blount Disease: A Comparison between the Multiaxial Correction System and Other External Fixators. Journal of Pediatric Orthopaedics, 29, 103-109.

[19]   Bar-On, E., Wiegl, D.M., Becker, T. and Katz, K. (2008) Treatment of Severe Early Onset Blount’s Disease by an Intra-Articular and a Metaphyseal Osteotomy Using the Taylor Spatial Frame. Journal of Children’s Orthopaedics, 2, 457-461.

[20]   Pandya, N.K., Clarke, S.E., McCarthy, J.J., Horn, B.D. and Hosalkar, H.S. (2009) Correction of Blount’s Disease by a Multi-Axial External Fixation System. Journal of Children’s Orthopaedics, 3, 291-299.

[21]   Levin, P.E., Schoen Jr., R.W. and Browner, B.D. (1987) Radiation Exposure to the Surgeon during Closed Interlocking Intramedullary Nailing. Journal of Bone and Joint Surgery, 69, 761-766.