title: Treatment of severe early onset Blount's disease by an intra-articular and a metaphyseal osteotomy using the Taylor Spatial Frame.
abstract: OBJECTIVE
  Severe Blount's disease results in a multiplanar deformity of the lower limb. The mechanical axis is disrupted, there is a rotational deformity, and also shortening of the limb. A depression of the medial tibial plateau causes joint incongruity and instability. The purpose of this study is to review the results of treatment addressing all the aspects of the deformity.
  
  
  METHODS
  Four patients were treated for severe Blount's disease. The index procedure consisted of a medial tibial plateau elevating osteotomy, a lateral tibial and proximal fibular epiphysiodesis, a proximal tibial metaphyseal osteotomy, and the application of the Taylor Spatial Frame programmed for correction of varus, rotation and shortening, and preemptive lengthening to compensate for growth arrest.
  
  
  RESULTS
  Mechanical axis was corrected from a mean 23 degrees (13 degrees -30 degrees ) to 0 degrees in three patients and 6 degrees valgus in 1. Tibias were lengthened by 1-4 cm. At follow-up, the mechanical axis was 0 degrees in two patients and 7 degrees varus in two. The overlengthening was diminishing as planned.
  
  
  CONCLUSIONS
  The double osteotomy and Taylor Frame correction was found to be accurate, safe, and effective for multiplanar deformity correction in severe Blount's disease.
authors.affiliation: Pediatric Orthopedic Unit, Schneider Children's Medical Center, 14 Kalpan St., 49202, Petah Tikva, Israel, elbar@013.net.
authors.forename: Elhanan
authors.initials: E
authors.lastname: Bar-On
authors.forename: Daniel Martin
authors.initials: DM
authors.lastname: Weigl
authors.forename: Tali
authors.initials: T
authors.lastname: Becker
authors.forename: Kalman
authors.initials: K
authors.lastname: Katz