Case Report: Correcting Deformity at the Center for Children

Figure 1. Preoperative (a) and postoperative
(b) clinical photographs.

A 13-year-old girl presented with untreated Blount’s disease, with a marked varus deformity of her left knee (Figure 2). She had undergone corrective surgery at age 7, but suffered recurrence of her deformity. Radiographic measurements revealed a 35 degree varus deformity of the left proximal tibia, depression of the medial tibial plateau and an 8 degree valgus deformity of the distal femur. Due to damage to the medial growth plate associated with severe Blount’s disease, the left tibia was 3 centimeters shorter than the right.

Figure 2. Preoperative (a) and postoperative
(b) standing lower extremity radiographs.

She underwent correction of her deformity with an osteotomy elevating the medial joint, and another osteotomy at the proximal tibia with gradual correction and lengthening using a Taylor Spatial frame. A distal femoral osteotomy corrected her valgus deformity to obtain a joint line parallel with the floor. In addition she underwent a lateral tibia epiphysiodesis to prevent recurrence, a fibular osteotomy and stabilization of the distal syndesmosis, and a fasciotomy. After surgery she had intensive physical therapy to regain full range of motion. There was a persistent knee flexion deformity. Radiographic parameters revealed that some of this deformity was due to a procurvatum at the proximal tibia. This was addressed with a new program adjusting the Taylor Spatial frame to correct the procurvatum. After 7 months, the Taylor Spatial frame was removed. She has been very happy with the results, and remains pain free.

Correction of severe deformity and limb length discrepancy in children can successfully restore alignment and length, preventing future early arthritis. The process of correction and lengthening with the Taylor Spatial frame is lengthy, complicated and associated with a very high rate of potential minor and major complications that often require close follow up and early treatment. However, for those patients willing to invest time and effort, reliable correction can be obtained with this treatment method.

Patient Testimonial

“ Hi, my name is Natalie Valentine. I’m in 9th grade and before the surgery, I had a disease called Blount’s disease. Thanks to Dr. Frances and Dr. Feldman, the surgery came out perfect. It was a long journey, but it was worth it!”