Acute Correction and Plate Fixation for the Management of Severe Infantile Blount’s Disease: Short-term Results

Abstract

Purpose: The purpose of this study is to evaluate the short-term results of lateral closing wedge osteotomy with medial hemiplateau elevation for the management of severe infantile Blount’s disease. Materials and methods: In this prospective study, 11 cases of severe Blount’s disease (Langenskiold stages five and six) were managed in the period between January 2017 and January 2020. Double osteotomy technique was applied, namely a metaphyseal closing wedge and a medial hemiplateau elevation, through a single midline incision. Fixation was achieved by a medial anatomical locked plate. Patients were evaluated clinically according to a modified version of paediatric outcomes data collection Instrument (PODCI) and radiologically by measuring the angle between the tibial and the femoral shaft, the mechanical axis deviation (MAD) and the angle of the medial tibial plateau (MTP) depression. Results: The average follow-up period was 2 years. Healing of the osteotomies was achieved in all cases after the index operation within an average of 3 months. Based on our modification of the PODCI score, five cases had an excellent outcome, five were good, and one case ended with a fair outcome. No major complications were encountered in this study. Conclusion: The management of severe Blount’s disease by acute correction using the aforementioned technique has been proven to achieve acceptable clinical and radiological outcomes without significant complications. Level of evidence: Level IV case series study.