CORRECTION OF BOW LEGS IN CHILDREN (BLOUNT DISEASE)
Blount disease, a deformity of the knee in children, characterized by varus and internal torsion of the tibial and knee recurvature. There are 2 types of Blount disease according to the age of onset:
- INFANTILE – which begins before 8 years of age.
- ADOLESCENT – which begins after 8 years of age.
The infantile form is difficult to differentiate from physiological bowing common in this age group, especially before the age of 2years. It is bilateral and symmetrical in approximately 60% of affected children. In Blount diseases, varus deformity increases progressively while physiological bowing tends to resolve with growth.
ADOLESCENT BLOUNT DISEASE is divided into 2 types:
- One occurring between the ages of 8 and 13years, caused by partial closure of the growth plate after trauma or infection
- Late-onset: which occurs in obese children, between the ages of 8 and13years, without a distinct cause.
Osteotomy is indicated for significant deformity in an older child when spontaneous correction can no longer be expected. Valgus osteotomies of both the proximal tibia and fibular with mild overcorrection is advised.
CORRECTION OF BOW-LEGS AND K-LEGS IN ADULTS
Osteoarthritis is a major cause of bow-leg and K-leg in adults. Arthritis is a reaction of a joint to a condition which produces incongruity in its surfaces (mechanical derangement, pyogenic infection, congenital anomaly, physeal separation, ligamentous instability and fracture into a joint).
Osteoarthritis of the knee may cause symptoms ranging from mild to disabling. Because of the progressive nature of the disease, patients with osteoarthritis of the knee eventually require operative treatment, ranging from arthroscopic lavage and debridement to total knee arthroplasty. The choice of procedure depends on the patient’s age and activity expectations, the severity of the disease and the number of knee compartment involved. In osteoarthritis of the knee, VARUS and VALGUS deformities are fairly common and cause an abnormal distribution of stresses of weight-bearing within the joint.
We perform proximal tibial osteotomy in patients with varusuni-compartmental osteoarthritis of the knee, which biomechanical rationale is ‘’unlocking’’ of the involved joint compartment by correcting the mal-alignment and redistributing the stresses on the knee joint.”
The use of Ilizarov circular external fixation after tibial osteotomy allows correction to be accurately adjusted postoperatively, its ability to translate the distal fragment to restore mechanical adjustment, improved stability of fixation, and immediate weight-bearing and knee motion in the circular frame.
Distal femoral osteotomy is done in valgus knee deformities.