title: Correction of proximal tibia varus with external fixation.
abstract: Correction of proximal tibia varus deformity has been used with success. Our Protocol is to use monolateral frame to correct varus of less than 10 degrees and to use the Taylor spatial frame for deformities greater than 10 degrees and for multiplanar deformities. Is this protocol successful? Ninety-one limbs in 68 patients with proximal tibia varus were treated with percutaneous proximal tibial osteotomy and external fixation. The monolateral and spatial frames were used for 36 and 55 limbs, respectively. Each group was further subdivided into neutral or intentionally overcorrected subgroups. Monolateral group time of correction and time in frame was 15 days (8 to 20) and 101 days (81 to 133), respectively. The preoperative mechanical axis deviation (MAD) was 22 mm medial (10 to 44). Postoperative MAD in the neutral subgroup was 5 mm lateral (2 to 10) and 3 mm medial (0 to 7). Postoperative MAD in the overcorrected subgroup was 10 mm lateral (4 to 20) and one patient was 5 mm medial. Medial proximal tibial angle (MPTA) improved from 85 degrees (79 to 89) to 90 degrees (85 to 96) in the neutral group and to 92 degrees (85 to 98) in the overcorrected group. Spatial frame group time of correction and time in frame was 34 days (7 to 99) and 130 days (95 to 177), respectively. The preoperative MAD was 40 mm medial (range 5 to 155). This improved to 5 mm medial (0 to 30) and 4 mm lateral (0 to 7) in the neutral group, and 17 mm medial (0 to 35) and 11 mm lateral (4 to 28) in the overcorrection group. MPTA improved from 80 degrees (40 to 87) to 88 degrees (83 to 96) in the neutral group and to 84 degrees (89 to 97) in the overcorrected group. In both groups, there was no significant change in the ankle or knee range of motion. There was one refracture in both groups. Our algorithm for treating proximal tibial varus deformities is safe and effective. For simple varus deformities, we recommend use of the monolateral frame. We reserve the use of the spatial frame for large or complex deformity correction.
authors.affiliation: Limb Lengthening and Complex Reconstruction Service (LLCRS), Hospital for Special Surgery, New York, NY, USA.
authors.forename: Kashif
authors.initials: K
authors.lastname: Ashfaq
authors.forename: Austin T
authors.initials: AT
authors.lastname: Fragomen
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.forename: S Robert
authors.initials: SR
authors.lastname: Rozbruch
mesh_terms: D000328:Adult; D000368:Aged; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation*; D006801:Humans; D016916:Joint Deformities, Acquired / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult