Abstract
We reviewed the results in 24 children (34 knees) following double-elevating osteotomy for late presenting infantile Blount’s disease.
The mean age of our seven male and 17 female patients was 9.1 years (7 to 13.5). Obesity was noted in 15 (above the 95th percentile). Previous valgus osteotomy had been performed on nine knees.
Ten knees were Langenskîld stages IV, six stage V and 18 stage VI. The surgical technique addressed the medial joint line depression with an elevating osteotomy, which was maintained by insertion of a tricortical wedge from the iliac crest and the excised fibula. The tibial varus and internal torsion was corrected with an osteotomy proximal to the apophysis. In the more recent patients, a proximal lateral tibial and fibular epiphysiodesis was done concomitantly.
The mean preoperative mechanical varus of 30.6( (14( to 60() was corrected to 0( to 4( mechanical valgus in 29 knees. In five knees there was under-correction to 2( to 4( mechanical varus. At follow-up a further eight knees developed varus owing to late epiphysiodesis. The tibial varus angle (the angle subtended by the mechanical axis of the tibia and a line along the lateral tibial joint line) increased at a mean of 1( a month due to inevitable medial growth plate fusion.
The mean preoperative joint depression angle of 49( (40( to 60() was corrected to 26( (20( to 30(), which was maintained at follow-up. There was no noteworthy femoral valgus or varus present preoperatively to warrant femoral osteotomy.
The abstracts were edited by Prof. M.B.E. Sweet. Correspondence should be addressed to him at the Department of Orthopaedic Surgery, Medical School, University of the Witwatersrand, 7 York Road, Parktown, 2193 South Africa
