Osteotomy, Arthrodesis, and Arthroplasty for Complex Multiapical Deformity of the Leg

Alex C. Lesiak, MD
University of Nebraska Medical Center, Omaha, NE

J. Turner Vosseller, MD
Weill Cornell Medical College, New York, NY


S. Robert Rozbruch, MD

Chief, Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College
President, Limb Lengthening & Reconstruction Society (LLRS.org)

Abstract

Background 
Assessment of diaphyseal deformity in the tibia consists of delineating anatomic axes or cortical lines with resultant apices of deformity. Single-apex deformities have been well described both in terms of assessment and treatment, whereas double-level deformities with metaphyseal and/or juxtacortical involvement are less straightforward. Multiapical deformities of the lower extremity, though uncommon, are the next level of complexity and provide the surgeon with a difficult correctional mission.

Case Description 
We report two cases of multiapical deformity of the tibia, both of which were secondary to a distant history of tibial fracture with resultant knee and ankle joint degeneration and deformity. Both cases had three levels of deformity that were addressed with tibial osteotomy, ankle fusion, and total knee replacement. Initial presentation, problem lists, surgical treatment, and subsequent results are reviewed.

Literature Review 
Treatment of a post-traumatic three-level deformity has never specifically been addressed in the literature, although the principles of treatment are the same as for less complex deformities.

Purposes and Clinical Relevance 
These two cases present a treatment approach for complex, multiapical deformity of the tibia. The same principles of deformity correction used to treat less complex deformities are applied to these patients with an overarching synthesis that takes all aspects of the three deformities into account. Although these cases are complex and difficult, good results in terms of deformity correction and pain relief can be obtained.

This article appears in HSS Journal: Volume 8, Number 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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