Posttraumatic tibia valga in children - A long-term follow-up note

Background: We reevaluated seven patients who initially had been managed no noperatively because of a progressive valgus deformity that had occurred wi thin approximately twelve, months after satisfactory healing of a proximal tibial metaphyseal fracture sustained at an average age of four years (rang e, eleven months to six years and four months). All seven patients were des cribed in a previous report from our institution, published in 1986, In tha t report, spontaneous improvement of the angulation was documented after an average duration of follow-up of thirty-nine months and nonoperative treat ment of the deformity was recommended. Methods: The patients were followed radiographically for an average of fift een years and three months (range, ten years and four months to nineteen ye ars and eleven months) after the injury. The radiographs were reviewed to d etermine the metaphyseal-diaphyseal angle, the mechanical tibiofemoral angl e, the proximal and distal tibial remodeling angles, the limb-length discre pancy, and the deviation of the mechanical ards of the limb from the center of the knee joint, Knee function was assessed with use of the rating syste m of the Cincinnati Sportsmedicine and Orthopaedic Center, and ankle functi on,vas assessed with use of the rating system of the American Orthopaedic F oot and Ankle Society. Results: Every patient had spontaneous improvement of the metaphyseal-diaph yseal and mechanical tibiofemoral angles. Most of the correction occurred a t the proximal part of the tibia, The mechanical axis of the limb remained lateral to the center of the knee joint in every patient, with an average d eviation of fifteen millimeters (range, three to twenty-four millimeters). The affected tibia was longer than the contralateral tibia in every patient , with an average limb-length discrepancy of nine millimeters (range, three to eighteen millimeters), The knee score on the affected side was excellen t for five patients and fair for two; one of the patients who had a fair sc ore had had a tibial osteotomy at the age of sixteen years because of pain in the lateral aspect of the knee that was thought to be due to malalignmen t. The ankle score on the affected side was excellent for three patients an d good for four. Conclusions: Spontaneous improvement of the deformity occurred in all patie nts and resulted in a clinically well aligned, asymptomatic limb in most. W e believe that patients who have posttraumatic tibia valga should be follow ed through skeletal maturity and that operative intervention should be rese rved for patients who have symptoms secondary to malalignment.