DOS Kongressen 2014 ·
233
Supramelleolar tibial osteotomy without fibular
osteotomy, allowing immediate weightbearing,
is safe.
Ida Marie Rahbek, Gert Rahbek Andersen
Ortopaedic dept. U, Rigshospitalet
Background:
Children with cerebral palsy have a risk of developing external
tibial torsion secondary to a persisting fetal femoral anteversion. External tibial
torsion can lead to gait disturbances, patello- femoral instability and pain. This
can be corrected by surgery, which can be performed with different procedures.
These vary in terms of level of the osteotomy, the treatment regimen, the
method of fixation, and whether concomitant fibular osteotomy is performed.
Purpose / Aim of Study:
The purpose of this study is primarily to examine
the results of supramalleolar tibial osteotomy with plate fixation and immedi-
ate weight bearing, including rate of complications and course of mobilization.
Secondarily to compare this study to previous studies in terms of fixation meth-
ods and treatment regimens.
Materials and Methods:
Data is collected retrospectively from medical charts
at the Children’s Orthopedic Department of Rigshospitalet. The included pa-
tients were diagnosed with cerebral palsy, and received surgery in the period
1999-2013. The osteotomies were fixated with a plate, and full weightbearing
was allowed. Forty patients were included, with a total of 65 osteotomies.
Findings / Results:
In the 65 osteotomies, 5 complications was reported
(7.7%), including 3 major complications and 2 minor. There were no cases of
malunion or non-union. Median age at surgery was 14.8 years. Surgery to re-
move the plate was performed in 22 of the 65 osteotomies and median follow-
up was 2.6 years.
Conclusions:
This study shows that supramalleolar tibial osteotomy with pri-
mary weight bearing is a safe method, that doesn’t result in more frequent or
severe complications, than observed with 4 weeks of immobilization without
weight bearing. Primary mobilization leads to less loss of muscle mass, which is
essential to the target group.
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