title: Proximal tibial derotation osteotomy for torsion of the tibia: a review of 43 cases.
abstract: OBJECTIVE
  Persistent tibial torsion in the older child can be treated with a derotation osteotomy. Distal tibial osteotomy has been recommended due to concerns of peroneal nerve palsy, vascular injury, and compartment syndrome with a proximal tibial osteotomy. However, an osteotomy in the proximal tibia may achieve union more rapidly and skin issues, as described for distal tibial osteotomies, are less likely. This study investigates the safety and efficacy of proximal tibial derotation osteotomies.
  
  
  METHODS
  We retrospectively reviewed 43 tibiae in 25 consecutive children with persistent tibial torsion treated with a proximal tibial derotation osteotomy between 1991 and 2006. Patients with concomitant varus or valgus osteotomies were excluded. Diaphyseal fibular osteotomies were performed in five patients, while all patients had a prophylactic anterior compartment fasciotomy.
  
  
  RESULTS
  The mean age at surgery was 10.4 ± 4.0 years and the mean follow-up was 3.2 ± 3.5 years. Patients with internal tibial torsion had a mean preoperative thigh-foot angle (TFA) of -14° ± 6° and a mean postoperative TFA of 8° ± 4°. Patients with external tibial torsion had a mean preoperative TFA of 38° ± 9° and a mean postoperative TFA of 7° ± 5°. The overall mean correction was 26° ± 9°. Major postoperative complications occurred in 4 patients (9%), including one peroneal nerve palsy which resolved, one delayed union requiring revision surgery, and two patients with mild postoperative valgus deformities.
  
  
  CONCLUSIONS
  Proximal tibial derotation osteotomy with an anterior compartment fasciotomy is a reliable method for treating tibial torsion with an acceptable complication rate. Given the larger bony surface area and improved soft tissue envelope, proximal tibial derotation osteotomy can be considered as an alternative to a distal tibial derotation osteotomy.
authors: Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 201, Chicago, IL 60612 USA.
authors: David M
authors: DM
authors: Walton
authors: Raymond W
authors: RW
authors: Liu
authors: Lutul D
authors: LD
authors: Farrow
authors: George H
authors: GH
authors: Thompson
keywords: Complications; External tibial torsion; Internal tibial torsion; Tibial derotation osteotomy