Bifocal tibial corrective osteotomy with lengthening in achondroplasia: An analysis of results and complications

Sandeep V. Vaidya, Hae Ryong Song, Seok Hyun Lee, Seung-Woo Suh, Swapnil M. Keny, Shailendra S. Telang

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

The results and complications of bifocal tibial osteotomies with gradual correction and lengthening by Ilizarov ring fixator performed in 47 tibiae in 24 achondroplastic patients were analyzed. Comparison was made between the parameters of angular and torsional deformities of the tibia preoperatively, at fixator removal, and at last follow-up. Of these parameters, statistically significant change was seen postoperatively in the values of medial proximal tibial angle, lateral distal tibial angle, mechanical axis deviation, and tibial torsion, which changed from 78.8 ± 7.05 degrees, 103.2 ± 11.8 degrees, 25.1 ± 14.6 mm (medial), and 22.7 ± 10 degrees (internal) preoperatively to 87.3 ± 6.3 degrees, 90.9 ± 5.4 degrees, 5.3 ± 10 cm (medial), and 15.8 ± 4.2 degrees (external), respectively, at the time of fixator removal; and this correction was maintained during the follow-up period. Mean total tibial lengthening was 6.84 ± 1.3 cm. Average healing index was 26.06 days/cm. Complications observed were 15 pin tract infections, 1 residual varus, 1 overcorrection into valgus, 2 recurrence of varus, 22 equinus contractures, 2 premature consolidations, and 3 fibula malalignments. Recurrence of varus was observed in limbs with a residual abnormal medial mechanical axis deviation due to femoral deformity. A hundred percent incidence of equinus was observed in limbs with tibial lengthening of more than 40%, with distal tibial lengthening of more than 15%. To minimize the risk for occurrence of equinus, we recommend restriction of distal tibial lengthening in achondroplasia to less than 15%, although total tibial lengthening may exceed 40%. Fibula malalignment was not observed after double fibula osteotomy. This procedure is safe and efficacious if performed with strict adherence to prescribed technique.

Original languageEnglish
Pages (from-to)788-793
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume26
Issue number6
DOIs
Publication statusPublished - 2006 Nov 1

Fingerprint

Achondroplasia
Fibula
Osteotomy
Tibia
Equinus Deformity
Extremities
Recurrence
Thigh
Incidence
Infection

Keywords

  • Achondroplasia
  • Bifocal tibial osteotomy
  • Complications
  • Ilizarov ring fixator

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Bifocal tibial corrective osteotomy with lengthening in achondroplasia : An analysis of results and complications. / Vaidya, Sandeep V.; Song, Hae Ryong; Lee, Seok Hyun; Suh, Seung-Woo; Keny, Swapnil M.; Telang, Shailendra S.

In: Journal of Pediatric Orthopaedics, Vol. 26, No. 6, 01.11.2006, p. 788-793.

Research output: Contribution to journalArticle

Vaidya, Sandeep V. ; Song, Hae Ryong ; Lee, Seok Hyun ; Suh, Seung-Woo ; Keny, Swapnil M. ; Telang, Shailendra S. / Bifocal tibial corrective osteotomy with lengthening in achondroplasia : An analysis of results and complications. In: Journal of Pediatric Orthopaedics. 2006 ; Vol. 26, No. 6. pp. 788-793.
@article{b9a813b717074c3391b342b97cefedba,
title = "Bifocal tibial corrective osteotomy with lengthening in achondroplasia: An analysis of results and complications",
abstract = "The results and complications of bifocal tibial osteotomies with gradual correction and lengthening by Ilizarov ring fixator performed in 47 tibiae in 24 achondroplastic patients were analyzed. Comparison was made between the parameters of angular and torsional deformities of the tibia preoperatively, at fixator removal, and at last follow-up. Of these parameters, statistically significant change was seen postoperatively in the values of medial proximal tibial angle, lateral distal tibial angle, mechanical axis deviation, and tibial torsion, which changed from 78.8 ± 7.05 degrees, 103.2 ± 11.8 degrees, 25.1 ± 14.6 mm (medial), and 22.7 ± 10 degrees (internal) preoperatively to 87.3 ± 6.3 degrees, 90.9 ± 5.4 degrees, 5.3 ± 10 cm (medial), and 15.8 ± 4.2 degrees (external), respectively, at the time of fixator removal; and this correction was maintained during the follow-up period. Mean total tibial lengthening was 6.84 ± 1.3 cm. Average healing index was 26.06 days/cm. Complications observed were 15 pin tract infections, 1 residual varus, 1 overcorrection into valgus, 2 recurrence of varus, 22 equinus contractures, 2 premature consolidations, and 3 fibula malalignments. Recurrence of varus was observed in limbs with a residual abnormal medial mechanical axis deviation due to femoral deformity. A hundred percent incidence of equinus was observed in limbs with tibial lengthening of more than 40{\%}, with distal tibial lengthening of more than 15{\%}. To minimize the risk for occurrence of equinus, we recommend restriction of distal tibial lengthening in achondroplasia to less than 15{\%}, although total tibial lengthening may exceed 40{\%}. Fibula malalignment was not observed after double fibula osteotomy. This procedure is safe and efficacious if performed with strict adherence to prescribed technique.",
keywords = "Achondroplasia, Bifocal tibial osteotomy, Complications, Ilizarov ring fixator",
author = "Vaidya, {Sandeep V.} and Song, {Hae Ryong} and Lee, {Seok Hyun} and Seung-Woo Suh and Keny, {Swapnil M.} and Telang, {Shailendra S.}",
year = "2006",
month = "11",
day = "1",
doi = "10.1097/01.bpo.0000242429.83866.97",
language = "English",
volume = "26",
pages = "788--793",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Bifocal tibial corrective osteotomy with lengthening in achondroplasia

T2 - An analysis of results and complications

AU - Vaidya, Sandeep V.

AU - Song, Hae Ryong

AU - Lee, Seok Hyun

AU - Suh, Seung-Woo

AU - Keny, Swapnil M.

AU - Telang, Shailendra S.

PY - 2006/11/1

Y1 - 2006/11/1

N2 - The results and complications of bifocal tibial osteotomies with gradual correction and lengthening by Ilizarov ring fixator performed in 47 tibiae in 24 achondroplastic patients were analyzed. Comparison was made between the parameters of angular and torsional deformities of the tibia preoperatively, at fixator removal, and at last follow-up. Of these parameters, statistically significant change was seen postoperatively in the values of medial proximal tibial angle, lateral distal tibial angle, mechanical axis deviation, and tibial torsion, which changed from 78.8 ± 7.05 degrees, 103.2 ± 11.8 degrees, 25.1 ± 14.6 mm (medial), and 22.7 ± 10 degrees (internal) preoperatively to 87.3 ± 6.3 degrees, 90.9 ± 5.4 degrees, 5.3 ± 10 cm (medial), and 15.8 ± 4.2 degrees (external), respectively, at the time of fixator removal; and this correction was maintained during the follow-up period. Mean total tibial lengthening was 6.84 ± 1.3 cm. Average healing index was 26.06 days/cm. Complications observed were 15 pin tract infections, 1 residual varus, 1 overcorrection into valgus, 2 recurrence of varus, 22 equinus contractures, 2 premature consolidations, and 3 fibula malalignments. Recurrence of varus was observed in limbs with a residual abnormal medial mechanical axis deviation due to femoral deformity. A hundred percent incidence of equinus was observed in limbs with tibial lengthening of more than 40%, with distal tibial lengthening of more than 15%. To minimize the risk for occurrence of equinus, we recommend restriction of distal tibial lengthening in achondroplasia to less than 15%, although total tibial lengthening may exceed 40%. Fibula malalignment was not observed after double fibula osteotomy. This procedure is safe and efficacious if performed with strict adherence to prescribed technique.

AB - The results and complications of bifocal tibial osteotomies with gradual correction and lengthening by Ilizarov ring fixator performed in 47 tibiae in 24 achondroplastic patients were analyzed. Comparison was made between the parameters of angular and torsional deformities of the tibia preoperatively, at fixator removal, and at last follow-up. Of these parameters, statistically significant change was seen postoperatively in the values of medial proximal tibial angle, lateral distal tibial angle, mechanical axis deviation, and tibial torsion, which changed from 78.8 ± 7.05 degrees, 103.2 ± 11.8 degrees, 25.1 ± 14.6 mm (medial), and 22.7 ± 10 degrees (internal) preoperatively to 87.3 ± 6.3 degrees, 90.9 ± 5.4 degrees, 5.3 ± 10 cm (medial), and 15.8 ± 4.2 degrees (external), respectively, at the time of fixator removal; and this correction was maintained during the follow-up period. Mean total tibial lengthening was 6.84 ± 1.3 cm. Average healing index was 26.06 days/cm. Complications observed were 15 pin tract infections, 1 residual varus, 1 overcorrection into valgus, 2 recurrence of varus, 22 equinus contractures, 2 premature consolidations, and 3 fibula malalignments. Recurrence of varus was observed in limbs with a residual abnormal medial mechanical axis deviation due to femoral deformity. A hundred percent incidence of equinus was observed in limbs with tibial lengthening of more than 40%, with distal tibial lengthening of more than 15%. To minimize the risk for occurrence of equinus, we recommend restriction of distal tibial lengthening in achondroplasia to less than 15%, although total tibial lengthening may exceed 40%. Fibula malalignment was not observed after double fibula osteotomy. This procedure is safe and efficacious if performed with strict adherence to prescribed technique.

KW - Achondroplasia

KW - Bifocal tibial osteotomy

KW - Complications

KW - Ilizarov ring fixator

UR - http://www.scopus.com/inward/record.url?scp=33750471948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750471948&partnerID=8YFLogxK

U2 - 10.1097/01.bpo.0000242429.83866.97

DO - 10.1097/01.bpo.0000242429.83866.97

M3 - Article

C2 - 17065948

AN - SCOPUS:33750471948

VL - 26

SP - 788

EP - 793

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

IS - 6

ER -