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Tibial derotational osteotomy to correct for internal tibial torsion
2%
37/1988
Femoral derotational osteotomy to correct for femoral retroversion
40%
800/1988
Tibial derotational osteotomy (with/without femoral derotational osteotomy) to correct for internal tibial torsion and femoral anteversion
6%
123/1988
Tibial derotational osteotomy (with/without femoral derotational osteotomy) to correct for external tibial torsion and femoral retroversion
28%
555/1988
Tibial derotational osteotomy (with/without femoral derotational osteotomy) to correct for external tibial torsion and femoral anteversion
22%
442/1988
Select Answer to see Preferred Response
This patient has right external tibial torsion and femoral (neck) retroversion. The calculation for femoral neck rotational alignment is right (29.7-8.29=21.41°) and left (9.38-1.11=8.27°) of femoral retroversion. The calculation for distal tibia rotation alignment is right (66.2-25.3=40.9°) and left (44.0-8.43=35.57°) of external tibial torsion. Single bone (tibia) correction is more common, although both-bone correction (tibia and femur) will correct for a greater degree of deformity. Internal tibial torsion (ITT) is a result of intrauterine positioning and most correct with activity. External tibial torsion (ETT) is commonly progressive and more patients require surgical treatment. Normal thigh foot angle (TFA) is between -5° and 20°. Surgery is indicated for cosmetic or functional reasons if the TFA <-15° or >30° in a child aged 9 years or older. Anterior fasciotomy is necessary with proximal osteotomies to reduce risk of peroneal nerve palsy from the tight anterior compartment, especially if there is both angular and rotational correction. Distal tibial osteotomies have the advantages of easier dissection, easier rotation, less risk of compartment syndrome and easier stabilization with only K-wires, making soft tissue coverage less of an issue, and less risk of neurovascular compromise. On the other hand, proximal tibia osteotomy may provide greater contact area and thicker soft tissue envelope for vascularity (see below), but may have a higher risk of neurovascular compromise. Walton et al. retrospectively reviewed 43 tibiae treated with proximal tibial derotation osteotomy. All had prophylactic anterior compartment fasciotomy. Mean age was 10 years. Mean preoperative and postoperative TFA in ITT was -14° and 8° respectively. Mean preoperative and postoperative TFA in ETT was 38° and 7° respectively. They recommend proximal tibial derotation osteotomy because of the larger bony surface area and soft tissue envelope for treating tibial torsion. Incorrect Answers: Answers 1: The patient has EXTERNAL tibial torsion (not internal) Answers 2: Femoral osteotomy alone for both sides is less desirable as the majority of the deformity lies in the tibia. Answers 3, 5: The patient has femoral RETROversion and not anteversion.
1.1
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