One-step treatment for evolved Blount's disease: four cases and review of the literature.

In infantile tibia vara, the presence of superomedial bridge and sloped plateau requires several problems to be addressed: correction of varus deformity and internal tibial torsion, prevention of recurrences, restoration of normal joint congruity, and prevention and correction of limb length discrepancy. Four patients were treated as follows: percutaneous epiphysiodesis of the superolateral tibia and proximal fibula, elevation osteotomy of the medial tibial plateau, osteotomy of the fibula, and dome-shaped metaphyseal osteotomy of the tibia, followed by progressive lengthening. Osteosynthesis was achieved by an Ilizarov frame (average 6 months). Latest follow-up (average 6 years 10 months) showed that all patients were satisfied, with normal limb length and alignment and correct articular surface congruence. Correction of limb alignment, restoration of joint surface congruity, prevention of recurrence, and treatment of limb length discrepancy are all dealt with in the same procedure.