Case Report
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World J Orthop. Apr 18, 2013; 4(2): 90-93
Published online Apr 18, 2013. doi: 10.5312/wjo.v4.i2.90
Combined distal tibial rotational osteotomy and proximal growth plate modulation for treatment of infantile Blount’s disease
Amr A Abdelgawad
Amr A Abdelgawad, Department of Orthopedic Surgery, Texas Tech University Health Science Center at El Paso, El Paso, TX 79905, United States
Author contributions: Abdelgawad AA wrote this paper.
Correspondence to: Amr A Abdelgawad, MD, Department of Orthopedic Surgery, Texas Tech University Health Science Center at El Paso, 4801 Alberta Ave, El Paso, TX 79905, United States. amr.abdelgawad@ttuhsc.edu
Telephone: +1-915-5456448 Fax: +1-915-5456704
Received: December 4, 2012
Revised: January 4, 2013
Accepted: January 17, 2013
Published online: April 18, 2013
Abstract

Infantile Blount’s disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone (genu varum) will result in persistence of the internal tibial torsion (the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount’s disease. Both coronal and axial deformities were corrected in this patient. We propose this combination (rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount’s disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.

Keywords: Infantile Blount’s disease, Tibia vara, Growth modulation, Eight plate, Hemi-epiphysiodesis, Rotational osteotomy, Genu varum, Lateral tension plate, Distal tibial osteotomy, External rotation osteotomy, Guided growth