Outcome of mediolateral dome, chevron and lateral-based proximal tibial closing wedge osteotomy without fixation for bilateral Blount’s disease

Abstract

Background: Studies assessing the outcome of corrective osteotomies without fixation in Blount’s disease are scarce in literature.
Objective: We present our outcome with three types of osteotomies without fixation so as to increase the management options for surgeons especially in resource constrained settings as well as increase the literature on management options in Blount’s disease.
Methods: This was a prospective study in which patients had chevron, mediolateral dome or lateral-based proximal tibial closing wedge osteotomies without fixation. Plaster of Paris back slab was then applied for 2 weeks, full cast for at least 6 weeks and hinged brace for 6 weeks. Measurement of correction and documentation of complications were done after cast removal and recurrence was assessed at one year.
Results: Mean range of varus correction was 22.13±9.94 (p<0.0001). Mean improvement in Drennan’s angle was 24.18±3.94 (p <0.0001). Chevron osteotomy had 6.8% surgical site infection rate (p 0.110) and 9.1% knee stiffness rate (p 0.178). Three cases of nerve palsy were seen with two occurring in the wedge osteotomy group (p 0.206). Recurrence was 14.8% at one year. Statistically significant recurrence was noted in wedge osteotomies (p 0.031). Using Schoenecker’s grading, 87.5% adjudged their surgeries as good, 9.4% as fair and 3% adjudged it poor. Logistic regression showed that no independent osteotomy type was a reliable predictor of good outcome at one year 95% Confidence Interval (CI).
Conclusion: Corrective osteotomies without fixation results in good outcome and patient satisfaction. No osteotomy type is superior to the other however; wedge osteotomy is associated with a significant recurrence rate.

Key words: Blount’s disease, Dome, Chevron, Wedge, Osteotomy, Patients