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Year : 2015  |  Volume : 1  |  Issue : 1  |  Page : 6-13

Combined techniques for the safe correction of very large tibial rotational deformities in adults

1 Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital; Division of Surgery, School of Medicine, University of Queensland, Herston, Queensland; Orthopaedic Research Centre of Australia, Brisbane, 4029, Australia
2 Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia

Correspondence Address:
Kevin D Tetsworth
Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-3719.168743

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Background: There are few publications specifically discussing the correction of tibial rotational deformities in adults; there are none to our knowledge that address very large deformities, exceeding 45°. We describe here a combination of reliable and predictable techniques for the safe correction of very large tibial rotational deformities. Methods: Retrospective review of a case series of eight adult patients who underwent correction of very large tibial rotational deformities following this surgical treatment protocol, with a minimum 2-year follow-up. These techniques included a formal peroneal nerve release, a subcutaneous anterior fasciotomy, a percutaneous Gigli saw corticotomy, an intramedullary nail, temporary circular external fixation, and gradual correction. The average magnitude of the preoperative rotational deformity measured 54° (45-65°). Seven of the patients had very large external rotation deformities; one had a very large posttraumatic internal rotation deformity (65°). Results: These deformities, all exceeding 45°, were successfully corrected to clinically neutral in eight consecutive cases. For all eight cases, the deformity was fully corrected within 2 weeks, and the patients returned to theater for a planned second minor procedure (locking screw insertion and external fixator removal) at an average of 9.6 (6-14) days after the index procedure. Patients were encouraged to resume full weight bearing by 6 weeks and all were walking unaided by 12 weeks. Clinical and radiographic union was achieved at an average of 15.5 (12-20) weeks. One case was over-corrected 5°; a second procedure was required to revise the deformity correction to clinically neutral. There were no other complications in this series. Conclusions: This combination of surgical techniques has, in this small series, been a consistently safe and effective treatment for this condition.

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