2. Introduction
Overview of Blount’s disease
Principles of osteotomies
Osteotomies for Blount’s disease
complications
3. Disorder of endochondral ossification of
proximal tibia
Aetiology
◦ Autosomal dominant
◦ Early ambulation: Heuter-Volkmann’s law
◦ Developmental disorder-Langenskiold
◦ Multi-factorial – infection, trauma, osteonecrosis,
latent form of ricket
4.
5. Deformities
◦ Tibia vara
◦ Internal tibial torsion
◦ LLD
◦ Recurvatum
◦ Dislocation/subluxati
on
◦ Sharp medial
angulation of tibia
metaphysis
6. Type I:
◦ 2-3 years
◦ Metaphyseal beaking
Type II:
◦ 2.5-4 years
◦ Saucer shape defect
Type III
◦ 4-6 years
◦ Step
7. Type IV:
◦ 5-10 years
◦ Epiphysis bend
Type V:
◦ 9-11 years
◦ Double epiphysis
Type VI:
◦ 10-13 years
◦ Bony bar
8. All stages can occur earlier than described
Is inaccurate for prognosis when applied to
predominately non white population
There can be a rapid progression from one
stage to the other despite treatment
9. I and II
◦ Common
III and IV
◦ Possible
V and VI
◦ High rate of recurrence
10. Non operetive
◦ < 3 years
◦ Stage I and II
◦ Especially unilateral
Operative
◦ Failed non operative
◦ > 3 years
◦ Stage III-IV
11. Level of osteotomy
◦ ? At the apex of the deformity (NO)
◦ At metaphysis
◦ Open-wedge; easier, more precise, intra op fine-
tunning
◦ Purely rotational deformity correction – osteotomy
in transverse plane
◦ Purely valgus/varus correction – osteotomy in the
coronal plane
12. Tibio-femoral angle
◦ 0 – 18 months 15 degrees of varus
◦ 1.5 – 2 years neutral
◦ 3 – 4 years 8-10 degrees (max valgus)
◦ 6 – 7 years 5 – 7 valgus
30. Opening-closing osteotomy described by
Greene
Greater stability, minimal changes in leg
length
Longer immobilization, loss of correction
31. Sand bag
Prep from the toes to the proximal thigh
Fibulectomy at mid shaft
Hockey-stick incision 4-5cm distal to the
tibial tubercle, extending to the Gerdy
tubercle
32. Incise periosteum
just distal to the
tubercle transversely
Apex of the
osteotomy is just
distal to the tubercle
Drill a hole from
anterior to posterior
Complete osteotomy
with an oscillating
saw, remove the
lateral wedge
33. Swing tibia to
desired position of
valgus and external
rotation
Insert lateral wedge
medially
Fixation with a
single pin/two
crossed pins
Release tourniquet
34. Bury end of pins
Subcutaneous
fasciotomy
Long leg cast knee
flexed at 45
degrees
36. Determine amount
of wedge
Longitudinal
incision to expose
the physis
Protect the
collateral ligaments
Perform
fibulectomy in the
proximal third
37. Bony bar resection through the physis
Elevate the medial tibial plateau
Perform metaphyseal closing wedge
osteotomy
Place the wedge/fibula beneath the elevated
tibial plateau
38. Cross steinmann pins through the epiphysis
and the proximal tibial graft
Long leg cast
39. Correct intraarticular deformity
Knee in extension
Incision-medial femoral condyle to 2cm
medial and distal to the tibial tuberosity
Capsulotomy anterior to the medial collateral
ligament
40. Circumferential
incision through the
epiphysis
¾-inch (18mm)
curved osteotome
Apply small cortical
bone graft
Correct recurvatum
