Gradual on top-of-acute correction of neglected adolescent tibia vara by percutaneous tibial osteotomy and two-ring Ilizarov frame.

OBJECTIVES: This study aims to assess the effect of gradual correction after acute translation of the tibia in tibia vara using a two-ring Ilizarov frame on the correction of mechanical axis deviation (MAD), union time, and the rate of complications. PATIENTS AND METHODS: Between September 2018 and January 2021, a total of 30 patients (25 males, 5 females; mean age: 20±5 years; range, 15 to 25 years) with adolescent tibia vara were included. The patients had a transverse fibular ostectomy and percutaneous tibial osteotomy below the level of the tibial tuberosity. Acute correction of the rotation deformity combined with acute translation was done. A two-ring Ilizarov frame with a medial distractor and two lateral hinges were used to fix the osteotomy and the coronal plane deformity was gradually corrected. RESULTS: The mean follow-up was 24±4 months. All patients had improvement in the mechanical medial proximal tibial angle (mMPTA) and MAD postoperatively. There was an improvement in the Hospital for Special Surgery knee score at one year postoperatively. No neurovascular complications or union complications were observed. CONCLUSION: Acute translation followed by gradual angulation of the proximal tibia in cases with adolescent tibia vara yields better correction of the mechanical axis with good functional and radiological outcomes.

Comparison between Malerba osteotomy and combined Evans/medial displacement calcaneal osteotomies for the management of flexible pes planus in young adults: a prospective randomised control trial, three years follow-up.

PURPOSE: The aim of the current study is to evaluate the functional and radiological outcomes of Malerba osteotomy in comparison to the standardized combined Evans/Medial Displacement Calcaneal Osteotomy (MDCO) in the management of symptomatic flexible pes planus in young adults. METHODS: Prospective randomized control trial included 34 feet (33 patients), 17 cases in each group. Functionally, patients were assessed by AOFAS and FADI scores. Radiographic evaluation included calcaneal pitch, lateral talo-1st metatarsal, AP talo-first metatarsal, AP talo-calcaneal angles, and the talar coverage percentage. RESULTS: Pre-operative and three years follow-up scores and angles were compared between both groups. No statistically significant difference could be detected between both groups (P value 0.87). However, the data showed statistically significant difference in each group when comparing (pre-operative and third year follow-up scores and angles) (P value < 0.001). The mean union rate was eight weeks in Malerba group and nine weeks in Evans/MDCO group. No incidence of nonunion. Complications like calcaneocuboid subluxation, calcaneal anterior process fracture, and lateral column pain were exclusively reported in Evans/MDCO group. CONCLUSION: Malerba osteotomy is a strong valid option for the operative management of flexible pes planus in young adults. Authors recommend Malerba osteotomy in all mild and moderate deformities due to lower complication rate while the combined Evans/MDCO is preferred in severe deformity due to relatively higher corrective power with consideration of possible complications.