Acute correction of proximal tibial coronal plane deformity in small children using a small monolateral external fixator with or without cross-pinning

Purpose: Surgical correction of proximal tibia deformity in small children can be challenging. We present the surgical technique and outcome of proximal tibia osteotomy fixed with small monolateral external fixator in this patient group. Methods: A total of 17 cases in eight patients younger than nine years of age were study subjects. A proximal tibia osteotomy was fixed with a small monolateral external fixator with or without cross-pinning. Outcome was evaluated by changes of radiographic parameters such as medial proximal tibia angle (MPTA), metaphyseal diaphyseal angle (MDA) and clinical findings of complications, time interval until weight bearing and fixator removal time. Results: MPTA improved from a preoperative mean of 73 degrees (sD 4 degrees; 66 degrees to 78 degrees) to an immediate postoperative mean of 90 degrees (SD 3 degrees; 85 degrees to 96 degrees) in varus tibiae, and from 104 degrees (SD 1 degrees; 103 degrees to 105 degrees) to 89 degrees (SD 1 degrees; 88 degrees to 89 degrees) in valgus tibiae. In all, 15 of the 17 cases (88.3 %) achieved postoperative MPTA within the normal range (85 degrees to 90 degrees). MDA improved from a preoperative mean of 19 degrees (SD 5 degrees; 11 degrees to 24 degrees) to an immediate postoperative mean of 0 degrees (SD4 degrees; -6 degrees to 7 degrees) in varus tibiae, and from -25 degrees (SD 2 degrees; -22 degrees to -24 degrees) to 2 degrees (SD 1 degrees; 1 degrees to 3 degrees) in valgus tibiae. Full weight bearing was possible at mean 1.7 months (0.5 to 3.0). Mean follow-up period was 6.5 years (SD 5.4; 1.0 to 16.0). No complications developed during the follow-up. Conclusion: Proximal tibia osteotomy fixed with small monolateral external fixator provides accurate, safe and efficient correction in the management of coronal plane angular deformity in small children.

Automated summary

Surgical correction of proximal tibia deformity in small children using small monolateral external fixator provides accurate, safe, and efficient correction in the management of coronal plane angular deformity, with a high rate of achieving postoperative normal range of radiographic parameters. No complications were observed during the follow-up period, indicating a successful and reliable surgical technique for this patient group.