Blounts Genu Varus Case for small group discussion
Blount’s Genu Varus Case for small group discussion: Bone deformity AOTrauma External Fixation
• 9 -year-old girl • Progressive genu varus • Height 122 cm • Weight 57 kg
Learning objectives • Discuss diagnosis and evaluation of severe childhood genu varus • Discuss timing of and staging of surgical intervention in bilateral cases • Understand how to correct this deformity with external fixation
Where is the deformity? a) Femur? b) Tibia? c) Both? What is your diagnosis?
Where is the deformity? a) Femur? b) Tibia? c) Both? Blount disease Deformity is in the tibia in this case
Treatment options? 9 -year-old girl 1. Continued observation 2. Lateral closing wedge osteotomy with plate fixation? 3. Medial opening wedge osteotomy with plate fixation? 4. Dome osteotomy with plate fixation? 5. Ilizarov frame with hinge and osteotomy? 6. Hexapod frame with osteotomy?
Treatment options? 9 -year-old girl 1. Continued observation 2. Lateral closing wedge osteotomy with plate fixation? 3. Medial opening wedge osteotomy with plate fixation? 4. Dome osteotomy with plate fixation? 5. Ilizarov frame with hinge and osteotomy? 6. Hexapod frame with osteotomy?
• CORA very close to the joint • Can this be managed with a hinged Ilizarov fixator?
Preoperative planning
Ilizarov frame with hinge and osteotomy
Good execution of preoperative plan
How do we decide how fast to move the motor unit?
3 weeks
3 months
4 months When to perform surgery on the other side?
Right side
Compare two sides
Consolidation 3 months
10 -years-old Weight: 72 kg Height: 145 cm
Take-home messages • CORA very near a joint can still be managed by a hinge • Can be difficult to create stability in the short metaphyseal segment (two wires and half pin) • Ilizarov technique excellent for Blount disease
- Slides: 27