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Patients with severe early-onset Blount disease (Langenskiold III or greater) often have the radiographic appearance of depression of the medial tibial plateau and delayed ossification of the epiphysis, adjacent physis, and metaphysis. Schoenecker and other authors recommended elevation of the medial plateau of the tibia for correction of this deformity. The purpose of this study was to assess the nature of the medial proximal tibia in these severe cases. Eight girls and two boys (17 tibiae) with severe early-onset Blount disease had standing radiographs and magnetic resonance imaging (MRI) evaluation. Average patient age was 5.8 years (range, 3-8 years). Eleven knees in eight patients underwent arthrography at the time of surgical correction of deformity. No tibia had MRI or arthrographic evidence of medial tibial joint "depression." The "empty" radiographic space was occupied by cartilage-density material. A smooth dye contour without pooling parallel to the femoral condyles was noted arthrographically in all instances. These findings do not support the concept of routine joint elevation in the correction of severe deformity associated with early-onset Blount disease.

Frontal-plane deformity of the proximal tibia in children has a variety of etiologies. There are also a number of described surgical techniques for correction of these deformities. The authors reviewed their early experience with the use of the Orthofix T-Garches external fixator for correction of 16 proximal tibial deformities in 14 patients. Mean age at surgery was 14.2 years. The most common diagnosis was adolescent Blount's disease. Average deformity was 12 degrees. Total treatment time averaged 13 weeks for those requiring lengthening and 10.8 weeks for those without. Complications included one ring sequestrum treated by curettage, and two patients with subsequent development of femoral deformity. Tibial anatomic axis averaged 1 degree of varus. This device can achieve excellent correction of deformity isolated to the frontal plane with few complications. It allows functional weight bearing and use of adjacent joints during treatment.

Externally rotated gait is a hallmark of slipped capital femoral epiphysis (SCFE) attributed to the change of proximal femur structure. This study investigated the potential role of abnormal tibial torsion in 44 patients with chronic, stable SCFE. Comparison of the tibiae of the involved side with the uninvolved side and with previously published normal values showed no evidence of tibial torsional abnormalities in these patients.