THE MANAGEMENT OF TIBIAL TORSION IN PATIENTS WITH SPINA-BIFIDA

We reviewed 20 patients with spina bifida who had had surgical managem ent of tibial torsion. Eight had had bilateral procedures and 12 a uni lateral procedure, giving a total of 28 limbs for analysis. We perform ed closed osteoclasis on seven limbs and tibial osteotomy on 21. In th e closed osteoclasis group six limbs (85%) had a good result after an average follow-up of nine years (2 to 22). All limbs developed postope rative anteromedial bowing of the tibia which later remodelled. In the tibial osteotomy group 19 (90%) had a good result. The average follow -up was nine years (2 to 28). Complications occurred in seven limbs (3 3%). We recommend closed osteoclasis of the tibia for the young patien t with spina bifida in whom walking is impeded by excessive internal t ibial torsion, and supramalleolar tibial osteotomy in the older patien t with excessive external tibial torsion and a planovalgus foot.