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Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction?

PURPOSE: To review the initial deformity and subsequent remodelling in posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition. PATIENTS AND METHODS: In all, 38 patients with posteromedial bowing of the tibia presenting between 2000 and 2016 were identified. Mean f...

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Autores principales: Wright, J., Hill, R. A., Eastwood, D. M., Hashemi-Nejad, A., Calder, P., Tennant, S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902754/
https://www.ncbi.nlm.nih.gov/pubmed/29707059
http://dx.doi.org/10.1302/1863-2548.12.170211
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author Wright, J.
Hill, R. A.
Eastwood, D. M.
Hashemi-Nejad, A.
Calder, P.
Tennant, S.
author_facet Wright, J.
Hill, R. A.
Eastwood, D. M.
Hashemi-Nejad, A.
Calder, P.
Tennant, S.
author_sort Wright, J.
collection PubMed
description PURPOSE: To review the initial deformity and subsequent remodelling in posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition. PATIENTS AND METHODS: In all, 38 patients with posteromedial bowing of the tibia presenting between 2000 and 2016 were identified. Mean follow-up from presentation was 78 months. A total of 17 patients underwent lengthening and deformity correction surgery, whilst three further patients are awaiting lengthening and deformity correction procedures. RESULTS: The greatest correction of deformity occurred in the first year of life, but after the age of four years, remodelling was limited. The absolute leg-length discrepancy (LLD) increased throughout growth with a mean 14.3% discrepancy in tibial length. In the lengthening group, mean length gained per episode was 45 mm (35 to 60). Mean duration in frame was 192 days, with a mean healing index of 42.4 days/cm. Significantly higher rates of recurrence in LLD were seen in those undergoing lengthening under the age of ten years (p = 0.046). Four contralateral epiphysiodeses were also performed. CONCLUSION: Posteromedial bowing of the tibia improves spontaneously during the first years of life, but in 20/38 (53%) patients, limb reconstruction was indicated for significant residual deformity and/or worsening LLD. For larger discrepancies and persistent deformity, limb reconstruction with a hexapod external fixator should be considered as part of the treatment options. LEVEL OF EVIDENCE: Level IV (Case series)
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spelling pubmed-59027542018-04-27 Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction? Wright, J. Hill, R. A. Eastwood, D. M. Hashemi-Nejad, A. Calder, P. Tennant, S. J Child Orthop Original Clinical Article PURPOSE: To review the initial deformity and subsequent remodelling in posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition. PATIENTS AND METHODS: In all, 38 patients with posteromedial bowing of the tibia presenting between 2000 and 2016 were identified. Mean follow-up from presentation was 78 months. A total of 17 patients underwent lengthening and deformity correction surgery, whilst three further patients are awaiting lengthening and deformity correction procedures. RESULTS: The greatest correction of deformity occurred in the first year of life, but after the age of four years, remodelling was limited. The absolute leg-length discrepancy (LLD) increased throughout growth with a mean 14.3% discrepancy in tibial length. In the lengthening group, mean length gained per episode was 45 mm (35 to 60). Mean duration in frame was 192 days, with a mean healing index of 42.4 days/cm. Significantly higher rates of recurrence in LLD were seen in those undergoing lengthening under the age of ten years (p = 0.046). Four contralateral epiphysiodeses were also performed. CONCLUSION: Posteromedial bowing of the tibia improves spontaneously during the first years of life, but in 20/38 (53%) patients, limb reconstruction was indicated for significant residual deformity and/or worsening LLD. For larger discrepancies and persistent deformity, limb reconstruction with a hexapod external fixator should be considered as part of the treatment options. LEVEL OF EVIDENCE: Level IV (Case series) The British Editorial Society of Bone & Joint Surgery 2018-04-01 /pmc/articles/PMC5902754/ /pubmed/29707059 http://dx.doi.org/10.1302/1863-2548.12.170211 Text en Copyright © 2018, The author(s) http://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Original Clinical Article
Wright, J.
Hill, R. A.
Eastwood, D. M.
Hashemi-Nejad, A.
Calder, P.
Tennant, S.
Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction?
title Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction?
title_full Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction?
title_fullStr Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction?
title_full_unstemmed Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction?
title_short Posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction?
title_sort posteromedial bowing of the tibia: a benign condition or a case for limb reconstruction?
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902754/
https://www.ncbi.nlm.nih.gov/pubmed/29707059
http://dx.doi.org/10.1302/1863-2548.12.170211
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