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continued observation until skeletal maturity.
3%
17/508
fitting for a valgus-producing hinged knee-ankle-foot orthosis.
18%
90/508
lateral proximal tibial hemiepiphysiodesis.
20%
103/508
proximal tibiofibular osteotomy and acute correction.
52%
265/508
proximal tibiofibular epiphysiodesis and osteotomy with lengthening.
5%
25/508
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The clinical scenario describes infantile tibia vara (Blount’s disease). The radiograph shows severe deformity with the characteristic Langenskiold stage 3 changes of the medial proximal tibial metaphysis that distinguish it from physiologic bowing. The preferred treatment is proximal tibiofibular osteotomy with acute correction into slight valgus to unload the damaged area of the physis. This method provides the best results in patients younger than age 4 years. Continued observation would result in progressive deformity. Bracing is most effective in younger children with less severe deformity. Lateral proximal tibial hemiepiphysiodesis relies on growth of the injured medial physis for correction and would result in severe tibial shortening in this young child. Complete epiphysiodesis also produces severe shortening and requires multiple lengthening procedures.
2.8
(12)
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