Amount of Correction of Torsional Deformity in Blount's Disease After Coronal Plane Deformity Correction by 8 Plate Hemiepiphysiodesis

Study Overview
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Brief Summary
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This study is to evaluate the amount of correction of torsional deformity in Blount's disease after coronal plane deformity correction by 8 plate hemiepiphysiodesis.

Detailed Description
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Blount disease, also known as pathologic tibia vara , is an acquired growth disorder of the medial proximal tibial physis and epiphysis that results in a three-dimentional deformity of the lower limb (a progressive varus ,procurvatum and internal rotaion deformity of the tibia). Blount disease can be classified as infantile, or early onset form, which appears before the age of four years, juvenile, which appears between four and ten years and adolescent, or late onset form, which appears in children older than ten years. Surgical treatment options include tibial osteotomies with either acute or gradual correction and proximal lateral tibial hemiepiphysiodesis (guided growth) the latter being less invasive and with significantly lower rate of major complications. Guided growth by 8 plate hemiepiphysiodesis is commonly used to correct coronal plane deformity around the knee. Since its introduction by Stevens in 2007 many studies have demonstrated the efficacy, safety and advantages of tension band plating in the paediatric age group as an alternative to corrective osteotomy. The marked intoeing seen in Blount disease may be caused by internal tibial torsion, femoral anteversion or metatarsus adductus ..yet, there is no enough available literature studies evaluating the amount of correction of tortional deformity after coronal plane deformity correction by 8 plate hemiepiphysiodesis. This is the question of this study and we are trying to answer it by measuring the torsional plane deformity after achieving full correction of coronal plane deformity by 8 plate hemiepiphysiodesis.

Official Title
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Amount of Correction of Torsional Deformity in Blount's Disease After Coronal Plane Deformity Correction by 8 Plate Hemiepiphysiodesis

Conditions
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Blount Disease

Intervention / Treatment
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* Procedure: 8 plate hemiepiphysiodesis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Skeletally immature patients over 2.5 years of age and less than 12 years of age who presented with pathologic tibia vara.( Langenskiöld type 1,2and 3) associated with intoeing. Exclusion Criteria: Skeletal maturity. Epiphyseal dysplasia. Metabolic and neurologic disorders. previous trauma. Patients younger than 2.5 years and older than 12 years old

Ages Eligible for Study
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Minimum Age: 18 Months
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Skeletally immature patients over 2.5 years of age and less than 12 years of age who presented with pathologic tibia vara.( Langenskiöld type 1,2and 3) associated with intoeing.
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: 8 plate hemiepiphysiodesis|surgical procedure by lateral incision in proximal tibia and fixation by usuing 8 plate and screws.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The amount of correction of torsional deformity in patients with Blount's disease after coronal plane deformity correction by 8 plate hemiepiphysiodesis. | Measuring in postoperative long film x-rays and CT axial profile. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Site of torsional correction (foot-tibia-femur) in each part. | Measuring in postoperative long film x-rays and CT axial profile. | 1 year | 
| Any complications detected | Follow up of the patient postoperatively and clinical examination. | 1 year |