D Kolp1, K Ziebarth2, T Slongo2. 1. Dept. für Kinder-Traumatologie und -Orthopädie, Universitäts Kinderklinik Bern, 3010, Bern, Schweiz. Dagmar.Kolp@insel.ch. 2. Dept. für Kinder-Traumatologie und -Orthopädie, Universitäts Kinderklinik Bern, 3010, Bern, Schweiz.
Abstract
OBJECTIVE: Corrections for congenital or posttraumatic malrotation of the lower leg, considering alignment of the contralateral leg, with an osteotomy and fixation using locking compression plates (LCP). INDICATIONS: Posttraumatic deformity due to malunion. Increased tibial torsion in residual clubfoot deformity as long as the foot has been realigned. Idiopathic internal or external rotational deformity if the child is regularly tripping and falling, has psychological problems (other children making fun of the child because of the unusual gait), or is bothered by the deformity (age > 10 years, relative indication). CONTRAINDICATIONS: Rotational deformities at other levels, mainly the hip. Children under the age of 3 years due to the remodeling potential during growth. SURGICAL TECHNIQUE: Osteotomy at supramalleolar level and fixation with 3.5 mm 90° locking plate. Perpendicular osteotomy at the intersection of midshaft to distal shaft. After achieving the desired correction, fixation by a straight four-hole 3.5-mm locking plate. POSTOPERATIVE MANAGEMENT: Following fixation of the osteotomy with the four hole 3.5 mm LCP, a lower leg cast is recommended for 4-5 weeks. Applying the 3.5 mm 90° LCP allows immediate postoperative full weight bearing. Osteotomy material should be removed 1 year postoperatively. RESULTS: Assuming an uneventful postoperative course, consolidation of the fracture can be expected within 4-6 weeks. The stable fixation with locking plates provides stability without loss of correction at follow-up.
OBJECTIVE: Corrections for congenital or posttraumatic malrotation of the lower leg, considering alignment of the contralateral leg, with an osteotomy and fixation using locking compression plates (LCP). INDICATIONS: Posttraumatic deformity due to malunion. Increased tibial torsion in residual clubfoot deformity as long as the foot has been realigned. Idiopathic internal or external rotational deformity if the child is regularly tripping and falling, has psychological problems (other children making fun of the child because of the unusual gait), or is bothered by the deformity (age > 10 years, relative indication). CONTRAINDICATIONS: Rotational deformities at other levels, mainly the hip. Children under the age of 3 years due to the remodeling potential during growth. SURGICAL TECHNIQUE: Osteotomy at supramalleolar level and fixation with 3.5 mm 90° locking plate. Perpendicular osteotomy at the intersection of midshaft to distal shaft. After achieving the desired correction, fixation by a straight four-hole 3.5-mm locking plate. POSTOPERATIVE MANAGEMENT: Following fixation of the osteotomy with the four hole 3.5 mm LCP, a lower leg cast is recommended for 4-5 weeks. Applying the 3.5 mm 90° LCP allows immediate postoperative full weight bearing. Osteotomy material should be removed 1 year postoperatively. RESULTS: Assuming an uneventful postoperative course, consolidation of the fracture can be expected within 4-6 weeks. The stable fixation with locking plates provides stability without loss of correction at follow-up.
Entities:
Keywords:
Bone malposition; Bone plate; Children; Lower leg; Tibial osteotomy