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Page 49
Volume 13
Journal of Orthopaedics Trauma Surgery & Related Research
Arthroplasty 2018
September 24-25, 2018
Arthroplasty
September 24-25, 2018 London, UK
11
th
International Conference on
Saleh Alsaifi, J Arthroplasty 2018, Volume 13
Guided growth in Blount’s disease
Saleh Alsaifi
Al-Razi Hospital, Kuwait
In 1966, Walter P. Blount describes osteochondrosis deformans tibiae, an epiphyseal and metaphyseal lesion of the proximal tibia.
Blount’s disease is commonly attributed to an intrinsic, idiopathic defect in the posteromedial proximal tibial physis resulting in
progressive bowing of the leg, Intoeing and lateral knee thrust. Not easy to manage and follow. Traditionally treatment depends on
patient’s age and surgeons’ preference. Permanent joint damage and deformity can be sustained if left untreated. Early on the disease
(<4 years), bracing has been utilized, yet the effectiveness is controversial. Majority of cases require surgical intervention in a form of
proximal tibial osteotomy, which is technically challenging with higher potential complications (NV injury, compartment syndrome,
infections). Hemiepiphysiodesis has the advantage of being less invasive procedure with fewer major complications. Lateral tibial
hemiepiphysiodesis in Blount’s disease was previously described in a 1992 in case series. The literature was quite generous discussing
this topic since but it still insufficient in some aspects, minimal invasive procedure, cost effective, pain management, no post-op
immobilization, early weight bearing and limited complications. Hemiepiphysiodesis is safe and effective first line of treatment for
skeletally immature patients. Surgical decision-making must weigh the safety and simplicity of this procedure against the much more
extensive but much more predicable realignment obtained with osteotomy procedures. Technical issues are avoid mechanical failure
by using solid stainless screw, pre-drilling the cortex and avoid wide divergence, initially plate coaptation to the bone (2 plates, 4 holes
plate), and if varus recurs, re-do the procedure. Follow patients till skeletal maturity. Literature lacks proper description of surgical
placement and location of TBP. All modalities of treatment talks about offloading the physis, were non-describes dealing with the
pathology itself.
salsaifi@gmail.com