Keywords
How to Cite
Abstract
Relevance. Blount's disease and vitamin-D-dependent rickets (VDDR) are nosologically different skeletal diseases in childhood. Considering the similarity of the clinical and radiological picture, orthopedists and pediatricians make mistakes in diagnostics, which leads to wrong treatment tactics.
Objective: to establish clear indications for surgical treatment of Blount's disease and rickets-like diseases.
Materials and Methods. Surgical treatment of 13 patients with varus lower extremity deformities with vitamin-D-dependent rickets and 29 patients with Blount's disease was carried out; 26 and 42 surgical interventions were made, respectively. The patients' age ranged from 6 months to 14 years.
Results. Multilevel osteotomies with blocking and growing intramedullary rods should be performed for the treatment of rickety deformities. Applied plates are used only in single-level corrective osteotomies. The use of eight-shaped plates is indicated in the process of the growth zone functioning. In Blount's disease, we recommend: (1) blocking growth zones in patients with 1-4 degrees of deformity, II-VI stages according to Langenskiöld, and skeletal maturity of 23 to 33 points; (2) semicircular dissection in patients with 1-2 degrees of deformity, I-II stages according to Langenskiöld, and skeletal maturity of 18 to 23 points; (3) corrective osteotomies combined with simultaneous blocking of growth zones in patients with 3-4 degrees of deformity, V-VI stages according to Langenskiöld, and skeletal maturity of 30 to 33 points.
Conclusions. The presented laboratory diagnostics enables differentiate diagnostics of the etiological affiliation of the varus deformity of the lower leg. If rickets is detected, pathogenetic conservative treatment should be performed; in case of Blount's disease, surgical treatment should be started using minimally invasive methods. In the absence of positive dynamics in case of rickets, guided growth should be applied. In case of multiplanar deformities, one should apply the methods of corrective and reinforced surgical treatment: multilevel osteotomies with a blocking intramedullary rod after the closure of the growth zones and osteotomy with a telescopic intramedullary rod in case of preserved growth zone. If Blount's disease is diagnosed early, timely and correctly, growth zone blocking is the method of choice. In case of recurrence, corrective osteotomies with blockage of growth zones should be performed.
References
Голюк ЕЛ, Філіпчук ВВ, Кабацій МС, Немеш ММ. Методика визначення скелетної зрілості у дітей та підлітків за рентгенограмами колінних суглобів. “Літопис Травматології та Ортопедії”. 2014;(1-2):37-40.
Holiuk EL, Filipchuk VV, Kabatsii MS, Nemesh MM. Methods for determining skeletal maturity in children and adolescents by radiographs of the knee joints. “Litopys Travmatolohii ta Ortopedii”. 2014;(1-2):37-40. [in Ukrainian].
Staheli LT. Lower Limb-Fundamentals of Pediatric Orthopedics. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2008. 231 р.
Martsyniak SM. Medical Treatment of Bone Metabolism’s Disorders among Patients with Vitamin-D Dependent Rickets Type 1. Ann Orthop Musculoskelet Disord. 2019;2(1):1022. Available from: http://www.remedypublications.com/open-access/medical-treatment-of-bone-metabolismrsquos-disorders-among-patients-5137.pdf.
Марциняк СМ, Страфун СС. Хірургічне лікування багатоплощинних деформацій нижніх кінцівок до закриття зон росту в дітей із рахітоподібними захворюваннями. Травма. 2020;21(2):17-23.
Martsyniak SM, Strafun SS. Surgical treatment of multiplanar deformities of the lower extremities before closing the growth zones in children with rickets. Travma. 2020;21(2):17-23. [in Ukrainian].
Martsyniak S, Kincha-Polishchuk T. Conservative Management of Metabolic Dysfunction in Osseous Tissue among Patients with Vitamin D-Dependent Rickets Type 2. Springer Medizin, J Mineralstoffwechsel and MuSkuloSkelettale erkrankungen. 2017;24(2):40-45.
Langenskiold A. Tibia vara. A critical review. Clin. Orthop. Relat. Res. 2009;246:195-207.
Khanfour AA. Does Langenskiold staging have a good prognostic value in late-onset tibia vara? Journal of Orthopaedic Surgery and Research. 2012;7:23-30.
Yilmaz G, Oto M, Thabet A, Rogers KJ, Anticevic D, Thacker MM, et al. Correction of lower extremity angular deformities in skeletal dysplasia with hemiepiphysiodesis: A preliminary report. J. Pediatr. Orthop. 2014;34(3):336-345. DOI: 10.1097/BPO.0000000000000089.
Сердюченко СН, Соколовский ОА, Захаров ИА. Метод временного блокирования зон роста при лечении варусной деформаций коленного сустава у детей. ARS Medica. 2016;(17):276-283.
Serdyuchenko SN, Sokolovskiy OA, Zakharov IA. The method of temporarily blocking growth zones in the treatment of varus deformities of the knee joint in children. ARS Medica. 2016;(17):276-283. [in Russian].
This work is licensed under a Creative Commons Attribution 4.0 International License.