Abstract

MARE, Pieter H; THOMPSON, David M  and  MARAIS, Leonard C. Growth modulation may decrease recurrence when used as an adjunct to osteotomy in infantile Blount's disease. SA orthop. j. [online]. 2021, vol.20, n.2, pp.88-92. ISSN 2309-8309.  http://dx.doi.org/10.17159/2309-8309/2021/v20n2a4.

BACKGROUND: This study aimed to determine whether the addition of a lateral proximal tibial tension band plate, combined with proximal tibial dome realignment osteotomy, would decrease the recurrence rate in a group of children younger than 7 years with infantile Blount's disease (IBD) and high recurrence risk, defined as a medial physeal slope >60°METHODS: We reviewed the records of 14 children (22 limbs) under the age of 7 years with IBD and a medial physeal slope >60° that were treated with a combination of tibial osteotomy and tension band plates (group 2) to determine the recurrence rate and time to reoperation. These results were compared with a matched group of eight children (12 limbs) with IBD and a medial physeal slope >60° that were treated previously with tibial osteotomy alone (group 1RESULTS: The two groups were matched in terms of age, sex, obesity, Langenskiöld stage, tibio-femoral angle and medial physeal slope. The recurrence rate was 92% (11/12) in group 1 and 77% (17/22) in group 2 (odds ratio 0.31; 95% CI 0.03-3.01, p=0.312). The mean time to reoperation was 2.4 years in group 1 and 1.9 years in group 2 (p=0.319). There were two implant-related complications: one broken screw and one case of epiphyseal fixation failure in the tension band plate group, both in cases of recurrenceCONCLUSION: The addition of a lateral tension band plate to a proximal tibial realignment osteotomy may be an option to consider in children younger than 7 years with IBD and a high risk of recurrence. Further research is required to determine recurrence risk in IBD and to develop and evaluate surgical strategies to mitigate this risk with well-designed, multicentre controlled trialsLevel of evidence: Level 4

Keywords : Blount's disease; tibia vara; guided growth; tension band plate; osteotomy; recurrence.

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