Oblique proximal tibial osteotomy for the correction of tibia vara in the young.

Abstract

Proximal tibial osteotomy in the growing patient historically has been associated with a high rate of neurovascular complications and malunion. Here is reported a technique of valgus proximal tibial osteotomy, of the incomplete closing wedge type, that has avoided neurovascular compromise while achieving reliable correction and rapid bony union. Oblique proximal tibial valgus osteotomies with lateral tension plate fixation were performed on 18 tibiae in 14 patients (age range, 5-25 years) with tibia vara. The primary diagnosis was Blount's disease in 13 tibiae, achondroplasia in 2 tibiae, multiple epiphyseal dysplasia in 2 tibiae, and hypochondroplasia in 1 tibia. No postoperative plaster immobilization was necessary. All patients were able to bear weight fully by 8 weeks after surgery. Average angular correction was 18 degrees. One patient had overcorrection because of an unrecognized intraoperative fracture of the media] tibial cortex. There were no neurovascular complications. No growth disturbance of the proximal tibial physis was noted. Oblique proximal tibial osteotomy with tension plate fixation successfully corrected varus deformity of the proximal tibia in the growing patient without damage to the proximal tibial physis or neurovascular compromise.