title: Double tibial osteotomy for bow leg patients: A case series.
abstract: BACKGROUND
  High tibia osteotomy (HTO) is a common surgical operation for correction of genu varum deformity. In some patients, there are concurrent tibia vara and genu varum (bow leg). This study aimed to consider the possibility of better correction of bow leg deformity after double level tibial osteotomy (DLTO).
  
  
  METHODS
  A case series of 10 patients of genu varum in addition to tibia vara (bow leg) deformity who were referred to orthopedic ward of an academic hospital of Isfahan- Iran during 2009-2011 were included in the study. The mean age was 17.3 ± 3.1 years and all of them underwent DLTO. The results of treatment have been assessed based on clinical and radiological parameters before and after surgery.
  
  
  RESULTS
  The mean pre- and post operative values for Tibia-Femoral Angle, Medial Proximal of Tibia Angle (MPTA), and Lateral Distal of Tibia Angle (LDTA) were 18.13 ± 3.05° vs. 3.93 ± 0.66°, 79.13 ± 3.4° vs. 89.7 ± 1.8° and 96.40 ± 1.8° vs. 88.73 ± 3.0° respectively (P < 0.05). Improvement of all radiological parameters was meaningful. Seventy three percent of patients had normal mechanical axis of limb after surgery. The remaining cases had varus deformity in distal femur that was corrected by valgus supracondylar osteotomy in an additional operation. Limited range of motion (ROM) near knee and ankle was not observed.
  
  
  CONCLUSIONS
  DLTO correct bow leg deformity in the point of alignment of limb and paralleling of knee and ankle joint more effectively. This method can be used in metabolic and congenital bow leg which deformities are present in throughout of the lower limb. We described this technique for the first time.
authors: Department of Orthopedics, Isfahan Medical University, Isfahan, Iran.
authors: Khalilollah
authors: K
authors: Nazem
authors: Department of Orthopedics, Isfahan Medical University, Isfahan, Iran.
authors: Arash
authors: A
authors: Fouladi
authors: Department of Orthopedics, Isfahan Medical University, Isfahan, Iran.
authors: Mozhdeh
authors: M
authors: Chinigarzadeh
keywords: Bow leg; double tibial osteotomy; genu varum; limb alignment; osteotomy; tibia