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العنوان
Low ProfiIe llizarov Frame in Correction of Varus Deformity in Patients With AdoIescent
BIount’s Disease /
المؤلف
Abd Alkader, Mustafa Farouk.
هيئة الاعداد
باحث / Mustafa Farouk Abd Alkader
مشرف / Mootaz Fouad Thakeb
مشرف / Ahmad Saeed Aly
مناقش / Ahmad Saeed Aly
تاريخ النشر
2018.
عدد الصفحات
150 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة العظام والطب الرياضي
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم جراحة العظام
الفهرس
Only 14 pages are availabe for public view

from 150

from 150

Abstract

Summary
Tibia vara was described by Blount in 1937. The 6 radiographic stages classification proposed by Langenskiöld and Riska in 1964 represents the progression of the disease if left untreated.
The etiology of tibia vara remains unknown, however it was proposed that growth arrest of the posteromedial aspect of the proximal tibial physis is due to increased compressive forces on the medial side with tensile forces applied on the lateral aspect.
Early aggressive treatment of tibia vara is recommended before development of complex deformities of the proximal tibia with depression of the tibial plateau. The earlier the management and stage of disease, the less likely the incidence of recurrence. The management of early stages consists mainly of a metaphyseal valgus osteotomy to alter the compressive forces on the medial physis to tensile forces.
In adolescent Blount disease, the radiographic appearance of the tibial physis is relatively normal, there is widening of the proximal medial physeal plate. True bony bridges have rarely been demonstrated. A final mechanical axis of 0 to 5° varus is advised. The preoperative plan must assess the distal femoral deformity.
Several techniques have been proposed for the surgical management of severe cases of tibia vara. Such techniques include metaphyseal valgus osteotomy, hemi-epiphysiodesis, physeal bar resection, asymmetrical physeal distraction.
The use of physeal distraction is limited because of the risk of physeal closure.
Lateral tibial hemiepiphysiodesis may be used, as an alternative to osteotomy ,so prefered in infantile blount but not in adolescent blount , if potential growth remains (more than 1year).
Proximal tibial osteotomy with the use of external fixatorsin late-onset tibia vara is becoming more popular with declining use of internal fixation and casting. The older age and size of the patient make patient mobility highly desirable. External fixators offer rigid fixation allowing early weight bearing in these obese patient population. In addition the difficulties associated with assessing limb alignment either intraoperatively or postoperatively make undercorrection a possibility. Thus postoperative adjustability is highly desirable. However; other authors have their concerns regarding the problems of maintaining function and tolerating longer treatment periods with potential fixation and pin complications.
Corrective osteotomy for tibia vara may be performed with acute correction or gradual correction. Acute correction with an external fixator continues to be seen as an attractive construct because it allows for dynamic compression, minimal postoperative adjustments, and early postoperative weight bearing, less regular follow up visits. Gradual deformity correction of tibia vara, using circular devices, has been advocated to reduce the complications, including peroneal nerve palsy, compartment syndrome, residual deformity, and limb-length inequality.It has its crucial indication in certain situations like addressing severe deformity or a coincident significant anatomical limb length discrepancy,but it requires a high degree of patient compliance and still has its recorded complications. So acute and gradual correction techniques can achieve the same degree of correction. Acute correction offers a shorter time in frame as compared to gradual correction with fewer follow-up visits and exposure to radiation .
In this study we had homogenous group of 10 patients with 14 legs had adolescent Blount disease and patients with severe LLD excluded from this study. All patient were treated with the same strategy acute correction using low profile ilizarov external fixation technique.
Finally, The characteristics of the patient and the deformity dictate the method and type of fixator to be used , so whatever treatment method used, the most important thing is careful preoperative planning, and intraoperative and postoperative assessment with enough attention given to the details of the selected technique.The surgery should be tailored to each patient, based on thorough analysis of each component of the deformity, age, weight and whether unilateral or bilateral affection, also surgeon performance and experience important. .