Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); before epiphyseal closure
CPT4 code
Name of the Procedure:
Osteotomy, Proximal Tibia, Including Fibular Excision or Osteotomy (Includes Correction of Genu Varus [Bowleg] or Genu Valgus [Knock-Knee]); Before Epiphyseal Closure
Summary
An osteotomy of the proximal tibia is a surgical procedure that involves cutting and realigning the upper part of the shinbone (tibia) and possibly removing or resecting a portion of the fibula. This surgery is aimed at correcting abnormal leg alignment, specifically bowlegs (genu varus) or knock-knees (genu valgus), in children whose growth plates are still open.
Purpose
The procedure addresses deformities in leg alignment such as bowlegs and knock-knees. The primary goal is to straighten the legs to improve function, alleviate pain, and prevent future joint problems.
Indications
- Abnormal leg alignment (bowlegs or knock-knees)
- Pain or discomfort due to leg deformity
- Functional impairment in walking or physical activities
- Prevention of future joint damage or arthritis due to misalignment
- Skeletal immaturity with open growth plates (before epiphyseal closure)
Preparation
- Preoperative fasting as instructed by the healthcare team.
- Adjustment or temporary cessation of certain medications, as advised.
- Diagnostic tests such as X-rays or MRI to assess the severity of the deformity and plan the surgery.
Procedure Description
- Administer general anesthesia to the patient.
- Make a surgical incision over the proximal tibia.
- Perform an osteotomy by cutting the tibia bone.
- Realign the bone segments to the desired angle.
- Secure the new bone alignment with internal fixation devices (plates, screws, or pins).
- If necessary, perform an osteotomy or resection of a portion of the fibula to accommodate the tibial correction.
- Close the surgical incision with sutures or staples and apply a sterile dressing.
Duration
The procedure typically takes around 2 to 3 hours, depending on the complexity of the deformity and the surgical technique used.
Setting
The surgery is performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurses
- Surgical technician
Risks and Complications
- Infection
- Blood clots
- Damage to surrounding nerves or blood vessels
- Delayed bone healing or nonunion
- Joint stiffness
- Recurrence of the deformity
- Complications related to anesthesia
Benefits
- Improved leg alignment
- Enhanced walking and physical function
- Alleviation of pain and discomfort
- Prevention of future joint damage or arthritis
Recovery
- Post-operative care includes pain management, physical therapy, and wound care.
- The patient may need to wear a brace or cast for several weeks.
- Most children can return to normal activities within 3 to 6 months.
- Follow-up appointments are necessary to monitor healing and remove any fixation devices.
Alternatives
- Non-surgical options like braces or orthotics to manage mild deformities.
- Physical therapy to improve muscle strength and joint function.
- Growth modulation techniques using guided growth plates in younger children.
- Considerations of pros and cons vary based on the severity of the condition and patient-specific factors.
Patient Experience
Patients will be under anesthesia during the procedure and should not feel pain. Post-operatively, there may be discomfort and swelling, managed with medications. Physical therapy will be crucial for a successful recovery, and some temporary limitations on activities may be necessary as healing progresses.