Denduluri Sahitya K, Lu Min, Bielski Robert J
Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine, Chicago, Illinois, USA.
J Pediatr Orthop B. 2016 Nov;25(6):582-6. doi: 10.1097/BPB.0000000000000221.
Genu valgum is a well-documented deformity secondary to hereditary multiple exostoses about the knee. Post-traumatic tibia valgus is also a well-described phenomenon that occurs in children who sustain an incomplete fracture of the proximal tibia. The finding is considered to be secondary to asymmetric blood flow to the proximal tibial physis. The existing literature only describes genu valgum as a sequela of the hereditary multiple exostoses disorder itself and does not address genu valgum occurring as a postoperative consequence of mass excision. In this paper, we report on three pediatric patients who developed unilateral genu valgum after removal of osteochondromas from the medial proximal tibia. Chart and radiographic data were retrospectively reviewed for a series of three patients. Three patients developed genu valgum after medial proximal tibial osteochondroma excision. The maximum tibiofemoral angle varied from 17 to 23°. One case resolved spontaneously with observation, one was addressed surgically with guided growth correction, and another was advised to undergo operative correction, but declined. We conclude that genu valgum can arise secondary to osteochondroma excision when the mass is resected near the proximal tibial physis. Surgeons should counsel patients on the possibility of postoperative angular growth deformity and monitor closely for its development.
膝外翻是一种有充分文献记载的畸形，继发于膝关节周围的遗传性多发性骨软骨瘤。创伤后胫骨外翻也是一种已被充分描述的现象，发生在近端胫骨不完全骨折的儿童中。这一发现被认为是由于近端胫骨干骺端血流不对称所致。现有文献仅将膝外翻描述为遗传性多发性骨软骨瘤病本身的后遗症，并未提及作为肿块切除术后后果出现的膝外翻。在本文中，我们报告了3例儿童患者，他们在从胫骨近端内侧切除骨软骨瘤后出现了单侧膝外翻。对3例患者的病历和影像学资料进行了回顾性分析。3例患者在胫骨近端内侧骨软骨瘤切除术后出现膝外翻。最大胫股角在17°至23°之间。1例经观察自发缓解，1例接受引导性生长矫正手术治疗，另1例被建议接受手术矫正，但拒绝了。我们得出结论，当在近端胫骨干骺端附近切除骨软骨瘤时，膝外翻可能继发于骨软骨瘤切除。外科医生应告知患者术后出现角状生长畸形的可能性，并密切监测其发展情况。
