Orthopaedics

Osteoplasty and Epiphysiodesis of Tibia and Fibula 

DIAGNOSIS:  Right valgus distal tibia deformity secondary to congenital clubfoot.

PROCEDURE:  Osteoplasty right tibia and fibula, epiphysiodesis right distal tibia and fibula, application Ilizarov ring external fixator for deformity correction.

SURGEON:  M, MD

ASSISTANT SURGEON:  C, MD

INDICATIONS FOR THE PROCEDURE:  This is a 15-year-old boy with a 15-degree valgus deformity of his foot, secondary to a congenital clubfoot deformity.  He was noted to have a distal tibial epiphyseal deformity.  He was taken to the Operating Room for treatment.

DESCRIPTION OF THE PROCEDURE:  With the patient under general anesthetic, the right leg was prepped and draped in the usual manner.  First, the epiphysiodesis were performed. The fibula was performed first.  A 1 cm transverse incision was made over the distal tibial physis.  Fluoroscopy was used to permit drilling of the physis with a 4.5 mm drill.  A curette was then used to complete the epiphysiodesis.  The incision was irrigated and closed with staples.

The identical procedure was then performed on the distal tibial side.  Using fluoroscopy, the location of the physis was identified.  A 1 cm incision was made, and the physis was drilled along its entire width with a 4.5 mm drill.  The epiphysiodesis was completed with a curette.

A fibula osteotomy was then performed.  The location for the osteotomy was identified with fluoroscopy.  A 1 cm longitudinal incision was made at this location.  A 4.5 mm drill was used to make multiple drill holes.  Using fluoroscopy, the osteotomy was completed with an osteotome.

The ring fixator was then applied.  The frame had been preconstructed to an x-ray template.  It consisted of 2 proximal rings, a juxtaarticular hinge, and a motor to perform the correction.  The fixator was slid over the tibia, and its location was determined with fluoroscopy.  The first wire inserted was the distal reference wire.  This was inserted parallel to the articular surface, just proximal to the physis.  The wire was fixed to the frame, and the wire was tensioned.  Next, the proximal reference wire was inserted.  This was done parallel to the knee, and with the frame well-aligned with the tibia in the AP and lateral views.  The wire was fixed to the frame and tensioned.  Additional points of fixation were then achieved with a half-pin fixed to the proximal ring, and two half-pins fixed to the middle ring.  Additional points of fixation of the distal ring were done with an additional wire and a half-pin.

The distal tibial osteoplasty was then performed.  A 1.5 cm incision was made over the anteromedial aspect of the tibia.  The periosteum was displaced.  Multiple drill holes were made through the distal tibia, and the osteotomy was completed with an osteotome.  Completeness of the osteotomy was confirmed with fluoroscopy.

All connections were then tightened.  The position of the hinges was confirmed.  All incisions were then closed and dressed, and sponges were placed on the wires.

The patient tolerated the procedure well without complications.

ESTIMATED BLOOD LOSS:  100 cc.

The patient was transferred to the Recovery Room in stable condition.

Medical Transcription Terms Home Page * Orthopaedics Home Page