Deformity correction in children with hereditary hypophosphatemic rickets.
X-linked hereditary hypophosphatemic rickets can induce various multiplanar deformities of the lower limb. We evaluated our ability to correct these deformities and assessed complications and recurrence rates in 10 children (eight girls and a pair of twin boys) followed from early childhood to skeletal maturity. We performed 37 corrective operations in 10 children. Depending on the patient's age, external fixation was used in 53 segments: Kirschner wires in 18, DynaFix in three, the Taylor Spatial Frame device in 13, and the Ilizarov device in 19. Internal fixation with intramedullary nailing was performed in 12. After bone consolidation, we radiographically determined the mechanical axis at an average distance of 0.5 cm medial to the center of the knee. The average mechanical lateral distal femoral angle was 85 degrees (range, 83 degrees-92 degrees) and the average mechanical medial proximal tibial angle was 91 degrees (range, 85 degrees-92 degrees). Deviation of the mechanical axis and knee orientation lines was increased at the followups conducted during a period of 5 to 12 months. Additional followups revealed a recurrence rate of 90% after the first corrective procedure and 60% after a second procedure.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Department of Pediatric Orthopedics, Orthopedic Hospital Vienna-Speising, Speisinger Strasse 109, 1130, Vienna, Austria. gert.petje@oss.at
Gert
G
Petje
Roland
R
Meizer
Christof
C
Radler
Nicolas
N
Aigner
Franz
F
Grill
D000293:Adolescent; D000328:Adult; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D053098:Familial Hypophosphatemic Rickets / Q000150:complications*; D005260:Female; D005360:Fibula / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D005684:Gait; D040181:Genetic Diseases, X-Linked; D006801:Humans; D038061:Lower Extremity Deformities, Congenital / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010027:Osteotomy; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery; D055815:Young Adult