Proximal tibial osteotomy osteoclasis in infantile genu-varum: improving the technique and managing potential complications

Abstract

Purpose
Genu-varum is a common problem encountered in pediatric orthopedic. Correction of pathological deformity is mandatory to ensure normal load transfer through the knee. In this study, we describe a new technique of osteotomy osteoclasis in order to evaluate if it is an effective and reliable method in management of infantile genu varum.


Methods
70 children with 122 legs suffering significant infantile genu-varum were treated by percutaneous osteotomy-osteoclasis technique. The mean age was 46 months. Genu-varum was bilateral in 52 children and unilateral in 18 with a mean preoperative proximal medial tibial angle 66.67 ± 2.67°. Under general anesthesia, transverse osteotomy osteoclasis was performed below the tibial tuberosity. Follow-up radiograph was done immediate postoperative, eight weeks postsurgery and at time of the final follow-up to assess alignment and consolidation.


Results
All children were evaluated clinically and radiologically. The mean follow-up was 28.60 ± 4.01 months. The mean operative time was 20 ± 3.96 min. All cases (100%) reported complete consolidation and the cast was removed within 8.69 ± 1.0 weeks (range: 7-11 weeks). The average proximal medial tibial angle improved from a mean 66.67 ± 2.67° (range 60 – 70) preoperatively to 90.15 ± 1.16° (range 88–92) postoperative (P < 0.05) and this was maintained till the end of follow-up. All patients’ caregivers reported their satisfaction by the final end results.


Conclusion
Osteotomy osteoclasis is an effective reliable method in the management of infantile genu-varum.