Bamboo Osteotomy for Blount’s Disease

Abstract

Blount disease is a common childhood condition that requires surgical correction. The conventional method of osteotomy and acute correction is associated with risk of neurovascular complications and occasionally displacement of the intra operative alignment. This case report describes a new technique that involves multiple longitudinal osteotomies over the proximal tibia without loss of cortical continuity between the proximal and distal tibia. It simulates an incomplete (greenstick) fracture that allows plastic deformation at the site of correction. This correction is more stable, and can be expected to heal more rapidly than conventional treatments. Blount disease is a developmental condition characterized by disordered endochondral ossification of the medial area of the proximal tibial physis resulting in multiplanar deformities of the lower limb(1). Secondary to asymmetrical growth with relative inhibition of the posteromedial portion of the proximal tibial growth plate, a three-dimensional deformity of the tibia with varus, procurvatum (apex anterior), and internal rotation develops, along with possible limb shortening in unilateral cases(2). The management of Blount disease must be customized for each patient on the basis of the patient's age, severity of deformity and the level of treatment facilities available. Acute correction of angular and rotational deformity can be accomplished with a proximal tibial osteotomy. However, neurovascular complications and displacement of bony alignment achieved during surgery are possible problems with such treatment(3). We have developed an innovative osteotomy technique to minimize these problems and describe such a case here.