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

1. Administer general anesthesia to the patient.
2. Make a surgical incision over the proximal tibia.
3. Perform an osteotomy by cutting the tibia bone.
4. Realign the bone segments to the desired angle.
5. Secure the new bone alignment with internal fixation devices (plates, screws, or pins).
6. If necessary, perform an osteotomy or resection of a portion of the fibula to accommodate the tibial correction.
7. 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.