Oblique tibial osteotomy revisited

Abstract

Purpose: Oblique proximal tibial osteotomy is a useful option for correcting deformity associated with Blount's disease (tibia vara). Safe, adequate correction depends on technical issues that have evolved since the original description of the procedure.

Methods: Retrospective review of surgical experience.

Results: The refinement of osteotomy plane orientation, based on the distal rather than the proximal tibia, reduces the likelihood of procurvatum after surgery. The stability of the osteotomy is enhanced by an improved screw fixation technique. The risk of compartment syndrome is low if prophylactic partial fasciotomy is performed concurrently. Avoidance of spinal or regional block anesthesia minimizes the possibility of failure to detect post-operative compartment syndrome.

Conclusions: Improvements in the technical execution of oblique proximal tibial osteotomy enhances the correction and predictability of the procedure.

Keywords: Blount’s disease; Oblique osteotomy; Tibial osteotomy.

Figures

Fig. 1

As the distal fragment of the osteotomy slides along the cut surface, the center of frontal rotation is in the proximal tibia, and external rotation of the distal fragment occurs

Fig. 2

The incision currently favored for oblique proximal tibial osteotomy allows access to the medial tibial physis and lateral exposure for fibular osteotomy and partial fasciotomy

Fig. 3

a Starting the oblique cut from the anterior surface of the upper tibia can lead to procurvatum with higher angles of correction. b This can be improved by orienting the starting plane to correspond with the distal, internally rotated tibial surface

Fig. 4

a Previously used fixation screw technique, while allowing positional adjustment, could allow shortening or instability. b Orienting fixation screws perpendicular to long axis of the tibia enhances stability and prevents shortening