Combined techniques for the safe correction of very large tibial rotational deformities in adults

• Main Authors: Kevin D Tetsworth, John David Thorsell
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2015-01-01
• Series: Journal of Limb Lengthening & Reconstruction
• Subjects: Corrective osteotomy; deformity correction; external fixation; gradual correction; Ilizarov methods; rotational deformity; tibial deformity
• Online Access: http://www.jlimblengthrecon.org/article.asp?issn=2455-3719;year=2015;volume=1;issue=1;spage=6;epage=13;aulast=Tetsworth

Background: There are few publications specifically discussing the correction of tibial rotational deformities in adults; there are none to our knowledge that address very large deformities, exceeding 45°. We describe here a combination of reliable and predictable techniques for the safe correction of very large tibial rotational deformities. Methods: Retrospective review of a case series of eight adult patients who underwent correction of very large tibial rotational deformities following this surgical treatment protocol, with a minimum 2-year follow-up. These techniques included a formal peroneal nerve release, a subcutaneous anterior fasciotomy, a percutaneous Gigli saw corticotomy, an intramedullary nail, temporary circular external fixation, and gradual correction. The average magnitude of the preoperative rotational deformity measured 54° (45-65°). Seven of the patients had very large external rotation deformities; one had a very large posttraumatic internal rotation deformity (65°). Results: These deformities, all exceeding 45°, were successfully corrected to clinically neutral in eight consecutive cases. For all eight cases, the deformity was fully corrected within 2 weeks, and the patients returned to theater for a planned second minor procedure (locking screw insertion and external fixator removal) at an average of 9.6 (6-14) days after the index procedure. Patients were encouraged to resume full weight bearing by 6 weeks and all were walking unaided by 12 weeks. Clinical and radiographic union was achieved at an average of 15.5 (12-20) weeks. One case was over-corrected 5°; a second procedure was required to revise the deformity correction to clinically neutral. There were no other complications in this series. Conclusions: This combination of surgical techniques has, in this small series, been a consistently safe and effective treatment for this condition.