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Osteotomy around the knee in children.when and why?
1. Osteotomy around the knee
in children: when and why?
F. Moungondo ,R. Elbaum
Service d’orthopédie
Hôpital Erasme
2. Introduction
• In young children or
adolescent,most of frontal
knee defformity can be
correct without osteotomy
only by simple epiphysiodesis
(staple,scews or growth plate).
• In some cases when the
deformity is too complex or
when the patient is too old ,
knee osteotomy is the only
solution to restaure anatomy.
3. Just a little remind
The variation of the normal pattern
7. Axe diaphysaire F et T en
charge
Use of the metaphyseal-diaphyseal angle in the evaluation
of bowed legs.
J Bone and Joint surg. 1993 Nov;75(11):1602-9.
Feldman MD1, Schoenecker PL.
8. - 5°
0°
+ 5°
2 Y 4 Y 12 Y 15
G. Varum
G. Valgum
M
EVOLUTION OF THE TF ANGLE IN THE FRONTAL PLANE
F
9. Normal femoral and tibial torsion
Torsion :
Is the turning of a
bone on its longitudinal axes.
As a result the upper and
the lower epiphysis are not
in the same plane
10. Femoral anteversion
angle :
Fabry (1973)
Tibial torsion angle :
Dupuis ( 1951)
Jend (1981)
ROTATIONAL NORMS IN HEALTHY CHILDREN
Rotational angles vary with age
11. 5 Y 1O Y 15 Y
30°
15°
10°
5°
40°
20°
10°
FA
Lat. T.T.
EVOLUTION
OF THE NORMAL FEMORAL AND TIBIAL TORSION / AGE
12. Consequences of constitutional
angular deformities
Do severe angular deformities induce
osteoarthritis of the knee ?
Modifications of TF angle
Alteration of distribution of loads on the
knee
Osteoarthritis
14. Consequences of constitutional
rotational deformities
Do severe rotational deformities induce
osteoarthritis of the knee and hip ?
Exaggerated torsion
Alteration of the loads on hip or knee
osteoarthritis
15. No prospective and longitudinal study
on the long term of rotational deformities
However
22. « Pathological » constitutional
frontal deformities
« Pathological » constitutional angular deformities :
Should be related to the natural history
Frequently found in other members of family
They can be corrected in late chilhood
They must be differentiated from secondary deformities
TF angle exceeding 2 SD around the mean for age and sex
24. Boy 16 years old
Bilat genu varum
Girl 12 years old
Genu valgum I M D : 12 cm
Constitutional angular deformities in
preadolescents
25. Rickets :
Nutritional
Vitamin D resistant
Hypophosphatasia
Infantile tibia vara (Blount)
Metaphyseal chondrodysplasia
Focal fibrocartilaginous dysplasia
Secondary angular deformities in
patients less than 3 Y
31. Secondary to :
Trauma
Infection
M.. l. 15 Y
Femoral Epiphysiodesis
Unilateral genu valgum or varum
Secondary angular deformities in
patients more than 10 Y
36. Relationships between
rotational malalignment and the patella
Eckhoff (1997) : « the patellar tracking pattern is determined
by the femoral and tibial torsion ».
The patella is subjected to increased stress
due to malalignment syndrome.
Anterior knee pain is associated with triple deformity sd :
Delgado (1996)
Bruce (2004)
Patella instability is related to torsional problems :
Turner ( 1994)
Cameron (1996)
41. Extension deformity (genu recurvatum)
Iatrogenic (post épiphysiodèse TTA)
Post trauma
Post septic
42. Technique de l’ostéotomie tibiale de flexion
pour le recurvatum d’origine tibiale
LECUIRE F, LERAT JL et al.
Le genu recurvatum et son traitement par ostéotomie tibiale
Revue de Chirurgie Orthopédique, 198O
43. Complications of osteotomies about
the knee in children.
“On Sixty-five procedures were performed by a variety of
techniques with the majority being on the proximal tibia.
Postoperative complications were numerous with 63% of
the patients having one or more. These complications
included loss of alignment, vascular complications,
pathologic fractures, wound infection, anterior and
posterior angulation at the osteotomy site, tibial tubercle
prominence and patellofemoral malalignment.”
Myckosie J.P. Orthopedics 1981 Sep 1;4(9):1005-15.
44. CONCLUSION
• In children ,most of pathological knee deformity
can be corrected by simple procedure if some
principles are respect
• If a knee osteotomy is planned ,it has to be
decide after a good explanation to the child and
his parents.
• Type of procedure depends on the surgeon habits
• Be very carefull because complications rate are
not so rare.