PMC7429768_01
Supramalleolar derotational osteotomy in a 3-year-old male fixed with percutaneous 0.062-inch Kirschner wires. (a) Anteroposterior and lateral radiographs at 9-week postoperative time point demonstrating delayed healing of the tibial osteotomy site. (b) Six-month postoperative radiographs demonstrating no interval evidence healing at the tibial osteotomy site. (c) Immediate postoperative radiographs following revision open reduction with internal fixation of tibial nonunion. (d) Three-month postoperative radiographs showing union of the tibial osteotomy site.
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Postoperatively, the patient was maintained in a cast with wires in place for 9 weeks, at which point, radiographs demonstrated complete consolidation of the fibular osteotomy with evidence of scant bridging callus at the tibial osteotomy site (Figure 1(a)). The child was managed conservatively for a total of 6 months, and at the time of the 6-month follow-up, nonunion was diagnosed, as there had been no radiographic progression of healing during this period (Figure 1(b)). The patient was taken back for revision open reduction with internal fixation, utilizing a 6-hole 2.7 mm plate in compression mode with supplemental demineralized bone matrix (Figure 1(c)). Following revision surgery, the patient was immobilized in a cast for one month after which he was progressed to weight-bearing and went on to an uneventful union by the 3-month postoperative time point (Figure 1(d)).
PMC7429768_02
Supramalleolar derotational osteotomy in an 8-year-old male fixed with a 2.7 mm plate. (a) Postoperative anteroposterior and lateral radiographs. (b) Radiographs obtained at the 2-month postoperative visit demonstrating procurvatum and valgus angulation through the tibial osteotomy site. (c) Imaging obtained 14 weeks postrevision with perpendicular plating showing healing of osteotomy site with some residual valgus deformity.
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Fixation was achieved with a 6-hole 2.7 mm plate in compression (Figure 2(a)). At the 2-month postoperative visit, it was noted that the patient had been very active in her cast including jumping off the bed onto the ground resulting in procurvatum and valgus displacement at her osteotomy site (Figure 2(b)). At her most recent follow-up 14 weeks status postrevision fixation, the patient had completely healed her osteotomy site, was asymptomatic, and had no activity restrictions (Figure 2(c)).
PMC7429768_03
18-year-old female with achondroplasia who underwent a varus-producing diaphyseal osteotomy for valgus deformity of the tibia. (a) Anteroposterior and lateral radiographs demonstrating nonunion of diaphyseal osteotomy following Taylor spatial frame application for gradual corrective program. (b) Coronal and sagittal computed tomography reconstructions confirming nonunion of diaphyseal osteotomy despite completion of the program. (c) Revision open reduction and internal fixation with 3.5 mm plate 6 months following index frame application. (d) Radiographs obtained at 3 months following revision demonstrating union of the tibial osteotomy with no residual deformity.
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Radiographs demonstrated nonunion of the diaphyseal osteotomy (Figure 3(a)). This was confirmed by computed tomography (Figure 3(b)). Following debridement of the nonunion site, fixation was achieved with a 6-hole 3.5 mm plate in compression mode with supplementary demineralized bone matrix (Figure 3(c)). She returned to regular activities by 3 months, at which time radiographs demonstrated complete consolidation of the osteotomy site (Figure 3(d)).