Korrektur von meta-epiphysären fehlstellungen der tibia im wachstumsalter nach ilisarov

Objectives Correction of bony deformities at metaphyseo-epiphyseal level of long bones through a corticotomy and gradual distraction. Restoration of shape and function of lower limb. Indications Metaphyseal-epiphyseal angular deformities secondary to infection, trauma, metabolic bone diseases, Blount's disease or epiphyseal or metaphyseal bone dysplasias. Contraindications Unreliable or uncooperative patient. Obesity, particularly in the presence of severe deformity. Angular deformity in the longer limb in the presence of leg length discrepancy. Young age (rarely done under 8 years of age). Surgical Technique Decision of level of frame placement. Assembly of frame. Insertion of wires and half-pins and mounting of construct. Low-energy corticotomy and 1 cm wide resection of fibula. Disconnection of hinges to confirm free movement between fragments. Securing of hinges. Gradual distraction starting 5 days after surgery and correction of alignment. Results Nine patients with 10 proximal metaphyseal-epiphyseal deformities of the tibia underwent this procedure (3 girls, 6 boys). Age at surgery between 9 years and 8 months and 15 years and 8 months. Lengthening achieved varied between 1 and 6 cm. The correction of axial alignment varied between 12° and 25°. One patient had a premature consolidation of the distal translation, one an equinus contracture and one a slight bending of the regenerate. An excellent result was seen in 7 and a satisfactory in 3 tibiae.