Cargando…

Anterolateral congenital tibial bowing: case report

BACKGROUND: The treatment of congenital curvatures (bowing) of the tibia still represents a challenging problem for all pediatric orthopedic surgeons because of its unpredictable course, especially if pseudoarthrosis occurs after a pathologic fracture of the tibia. CASE PRESENTATION: We describe the...

Descripción completa

Detalles Bibliográficos
Autores principales: Mastantuoni, Giuseppe, Aulisa, Angelo Gabriele, Giordano, Marco, Savignoni, Pietro, Toniolo, Renato Maria, Falciglia, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166803/
https://www.ncbi.nlm.nih.gov/pubmed/37181425
http://dx.doi.org/10.3389/fped.2023.966358
_version_ 1785038520389206016
author Mastantuoni, Giuseppe
Aulisa, Angelo Gabriele
Giordano, Marco
Savignoni, Pietro
Toniolo, Renato Maria
Falciglia, Francesco
author_facet Mastantuoni, Giuseppe
Aulisa, Angelo Gabriele
Giordano, Marco
Savignoni, Pietro
Toniolo, Renato Maria
Falciglia, Francesco
author_sort Mastantuoni, Giuseppe
collection PubMed
description BACKGROUND: The treatment of congenital curvatures (bowing) of the tibia still represents a challenging problem for all pediatric orthopedic surgeons because of its unpredictable course, especially if pseudoarthrosis occurs after a pathologic fracture of the tibia. CASE PRESENTATION: We describe the case of a child affected by an isolated curvature of his left leg. The congenital malformation was discovered at birth and no other pathological clinical finding was present. The first x-ray showed the presence of a congenital curvature of the tibia of the antero-lateral type. He was born in another country (Romania) and when he first came to our clinical observation at the Orthopedic and Traumatology Department, Pediatric Hospital “Bambino Gesu’”, Rome, the child was 14 months of age and had already started walking. Only a leg discrepancy of about 2 cm was present with consequent pelvis obliquity. At the beginning, we prescribed external lower limb orthoses and a simple shoe rise to prevent a tibial pathologic fracture and reduce pelvic obliquity. At periodical clinical follow-up visits and despite the external lower limb orthoses prescribed, a progressive worsening of the severe congenital tibial curvature was observed together with signs and symptoms, such as pain and limping, that suggested an objective “pre-fracture stage” of the tibial curvature; we decided to perform surgery. At the time of surgery, the child was three and a half years old. Surgery consisted of a double osteotomy, both of the fibula and of the tibia. Subtraction of the distal meta-diaphyseal portion of the fibula and tibial osteotomy in Correspondence: of the major anterolateral curvature. The tibial osteotomy was then stabilized by an internal Rush rod inserted proximally to the tibia under the cartilage growth plate and made it end inside the distal tibial epiphysis, crossing the distal tibial cartilage growth plate, preserving the ankle joint. RESULTS: The patient had an immediately excellent outcome. The tibial osteotomy site healed perfectly. At periodical orthopedic follow-up visits, the child was found to be always better. No clinical significative evidence of growth disturbances, due to the Rush rod that crossed the distal tibial cartilage growth plate, were noted. X-rays showed that the Rush rod progressively migrated with tibial growth together with the tibial bone growth, always getting further away from the distal tibial cartilage growth plate. Moreover, even the leg-length discrepancy and the pelvic obliquity improved. After an eight-year follow up, the patient, now a young boy of 11 and a half years, has an excellent outcome. CONCLUSIONS: Our case report undoubtedly provides further important information for the treatment of these rare congenital disorders. In particular, it highlights the management of the “pre-fracture stage” in a severe congenital tibial antero-lateral curvature in a very young child and describes the surgical technique performed.
format Online
Article
Text
id pubmed-10166803
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-101668032023-05-10 Anterolateral congenital tibial bowing: case report Mastantuoni, Giuseppe Aulisa, Angelo Gabriele Giordano, Marco Savignoni, Pietro Toniolo, Renato Maria Falciglia, Francesco Front Pediatr Pediatrics BACKGROUND: The treatment of congenital curvatures (bowing) of the tibia still represents a challenging problem for all pediatric orthopedic surgeons because of its unpredictable course, especially if pseudoarthrosis occurs after a pathologic fracture of the tibia. CASE PRESENTATION: We describe the case of a child affected by an isolated curvature of his left leg. The congenital malformation was discovered at birth and no other pathological clinical finding was present. The first x-ray showed the presence of a congenital curvature of the tibia of the antero-lateral type. He was born in another country (Romania) and when he first came to our clinical observation at the Orthopedic and Traumatology Department, Pediatric Hospital “Bambino Gesu’”, Rome, the child was 14 months of age and had already started walking. Only a leg discrepancy of about 2 cm was present with consequent pelvis obliquity. At the beginning, we prescribed external lower limb orthoses and a simple shoe rise to prevent a tibial pathologic fracture and reduce pelvic obliquity. At periodical clinical follow-up visits and despite the external lower limb orthoses prescribed, a progressive worsening of the severe congenital tibial curvature was observed together with signs and symptoms, such as pain and limping, that suggested an objective “pre-fracture stage” of the tibial curvature; we decided to perform surgery. At the time of surgery, the child was three and a half years old. Surgery consisted of a double osteotomy, both of the fibula and of the tibia. Subtraction of the distal meta-diaphyseal portion of the fibula and tibial osteotomy in Correspondence: of the major anterolateral curvature. The tibial osteotomy was then stabilized by an internal Rush rod inserted proximally to the tibia under the cartilage growth plate and made it end inside the distal tibial epiphysis, crossing the distal tibial cartilage growth plate, preserving the ankle joint. RESULTS: The patient had an immediately excellent outcome. The tibial osteotomy site healed perfectly. At periodical orthopedic follow-up visits, the child was found to be always better. No clinical significative evidence of growth disturbances, due to the Rush rod that crossed the distal tibial cartilage growth plate, were noted. X-rays showed that the Rush rod progressively migrated with tibial growth together with the tibial bone growth, always getting further away from the distal tibial cartilage growth plate. Moreover, even the leg-length discrepancy and the pelvic obliquity improved. After an eight-year follow up, the patient, now a young boy of 11 and a half years, has an excellent outcome. CONCLUSIONS: Our case report undoubtedly provides further important information for the treatment of these rare congenital disorders. In particular, it highlights the management of the “pre-fracture stage” in a severe congenital tibial antero-lateral curvature in a very young child and describes the surgical technique performed. Frontiers Media S.A. 2023-04-25 /pmc/articles/PMC10166803/ /pubmed/37181425 http://dx.doi.org/10.3389/fped.2023.966358 Text en © 2023 Mastantuoni, Aulisa, Giordano, Savignoni, Toniolo and Falciglia. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Mastantuoni, Giuseppe
Aulisa, Angelo Gabriele
Giordano, Marco
Savignoni, Pietro
Toniolo, Renato Maria
Falciglia, Francesco
Anterolateral congenital tibial bowing: case report
title Anterolateral congenital tibial bowing: case report
title_full Anterolateral congenital tibial bowing: case report
title_fullStr Anterolateral congenital tibial bowing: case report
title_full_unstemmed Anterolateral congenital tibial bowing: case report
title_short Anterolateral congenital tibial bowing: case report
title_sort anterolateral congenital tibial bowing: case report
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166803/
https://www.ncbi.nlm.nih.gov/pubmed/37181425
http://dx.doi.org/10.3389/fped.2023.966358
work_keys_str_mv AT mastantuonigiuseppe anterolateralcongenitaltibialbowingcasereport
AT aulisaangelogabriele anterolateralcongenitaltibialbowingcasereport
AT giordanomarco anterolateralcongenitaltibialbowingcasereport
AT savignonipietro anterolateralcongenitaltibialbowingcasereport
AT toniolorenatomaria anterolateralcongenitaltibialbowingcasereport
AT falcigliafrancesco anterolateralcongenitaltibialbowingcasereport