Back to Search
Start Over
Outcome of Hemiepiphyseal Stapling for Late-Onset Tibia Vara
- Source :
- The Journal of Bone and Joint Surgery (American). 87:2259
- Publication Year :
- 2005
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2005.
-
Abstract
- Background The results of hemiepiphysiodesis for the treatment of late-onset tibia vara have been reported to be favorable, but the technique requires careful timing and an accurate estimation of skeletal age. Hemiepiphyseal stapling does not require a careful estimation of skeletal age, and it has been reported to yield good results with low morbidity. However, we are not aware of any study evaluating the intermediate-term radiographic results or complications of this procedure. Methods Twenty-six patients with thirty-three extremities with late-onset tibia vara were treated with proximal tibial hemiepiphyseal stapling. Fourteen extremities had substantial concomitant distal femoral varus and also had hemiepiphyseal stapling of the distal part of the femur. Eighteen patients (twenty-three involved extremities) had juvenileonset tibia vara and eight patients (ten involved extremities) had adolescent-onset tibia vara. The mean age at the time of stapling was 11.8 years. The mean duration of follow-up was 3.8 years. We reviewed standardized standing radiographs to determine the mechanical axis deviation, the medial proximal tibial angle, the lateral distal femoral angle, and the zone of the knee through which the mechanical axis passed. Results The mean mechanical axis deviation improved from 58 mm (range, 27 to 157 mm) preoperatively to 22 mm (range, -33 to 117 mm) at the time of the last follow-up, and the mean medial proximal tibial angle improved from 77 degrees (range, 50 degrees to 85 degrees ) to 85 degrees (range, 48 degrees to 95 degrees ). In the fourteen lower extremities in which distal femoral hemiepiphyseal stapling was performed, the mean lateral distal femoral angle improved from 96 degrees (range, 92 degrees to 100 degrees ) to 86 degrees (range, 79 degrees to 97 degrees ). At the time of the final follow-up, seven extremities were considered to be in moderate varus; four, in mild varus; twenty, in normal alignment; and two, in valgus. No differences in radiographic outcome were noted between the juvenile and adolescent forms of tibia vara. Only one of the four extremities with severe preoperative varus was corrected to normal alignment; the remaining three were left with moderate varus. Conclusions Hemiepiphyseal stapling of the lateral aspect of the proximal tibial physis and, as needed, the lateral aspect of the distal femoral physis is safe and effective in children with late-onset tibia vara if the physes are sufficiently open and the varus deformity is mild to moderate. Hemiepiphyseal stapling is particularly effective in patients who are ten years of age or younger. Level of evidence Therapeutic Level IV.
- Subjects :
- musculoskeletal diseases
medicine.medical_specialty
Adolescent
Radiography
Surgical Stapling
Humans
Medicine
Orthopedic Procedures
Orthopedics and Sports Medicine
Femur
Tibia
Age of Onset
Child
Physis
Varus deformity
Bone Diseases, Developmental
biology
business.industry
Bone age
General Medicine
musculoskeletal system
medicine.disease
biology.organism_classification
Surgery
Valgus
Treatment Outcome
Orthopedic surgery
business
Subjects
Details
- ISSN :
- 00219355
- Volume :
- 87
- Database :
- OpenAIRE
- Journal :
- The Journal of Bone and Joint Surgery (American)
- Accession number :
- edsair.doi.dedup.....1ea4d15639defbb01e69a6070a89ac46
- Full Text :
- https://doi.org/10.2106/jbjs.c.01409