Modified dome shaped proximal tibial osteotomy for treatment of infantile tibia vara


  • Mohammed A. A. Geith Department of orthopedic surgery, Faculty of human Medicine, Zagazig University, Egypt
  • Ahmed M. El. Naggar Department of orthopedic surgery, Faculty of human Medicine, Zagazig University, Egypt



Tibia, Vara, Dome, Osteotomy, Infantile


Background: Tibial deformity in childhood is not always one plane deformity, but often combines torsional and angular malalignment.

Methods: In this prospective study, dome shaped osteotomy was performed in 36 tibiae in 24 patients. The osteotomy was held with K-wires and a plaster cast. The mean age at surgery was 5.5 years and the mean follow-up time was 30 months, range (24-42) months.

Results: All osteotomies united and no compartment syndrome occurred. Postoperatively, one leg (2.7%) had temporary weakness of external hallucis longus muscle. Thirty five of thirty six legs had good clinical and radiological correction of alignment. Recurrent deformity was seen in one leg. ‎ 

Conclusions: Dome shaped osteotomy of the tibia is a simple, safe and effective method for correction of uni-planar varus deformity. For bi-planar deformities in childhood with infantile tibia vara we may need to step cut the lateral cortex to allow good bone contact to help in union with minimum morbidity.


Author Biographies

Mohammed A. A. Geith, Department of orthopedic surgery, Faculty of human Medicine, Zagazig University, Egypt

sharqya, zagazig

Ahmed M. El. Naggar, Department of orthopedic surgery, Faculty of human Medicine, Zagazig University, Egypt



Brooks CW, Gross HR. Genu varum in children: diagnosis and treatment. J Am Acad Orthop Surg. 1995;3;326-35.

Mielke CH, Stevens PM. Hemi-epiphyseal stapling for knee deformities in children younger than 10 years; a preliminary report. J Pediatr Orthop. 1996;16:423-9.

Wagner H. The displacement osteotomy as a correction principle, in Hierholzer G, Muller KH (editors): corrective osteotomies of the lower extremity after trauma. Berlin: Springer; 1985: 141-150.

Laurencin CT, Ferriter PJ, Millis MB. Oblique proximal tibial osteotomy for the correction of tibia vara in the young. Clin Orthop. 1996;327:218-24.

Zayer M. Hemi-condylar tibial osteotomy in Blount's disease, a report of 2 cases. Acta Orthop Scand. 1992;63:350-2.

Sasaki T. Trans-epiphyseal plate osteotomy for severe tibia vara in children; follow up of 4 cases. J Pediatr Orthop. 1986;6:61-5.

Ponseti I, Tapia J, Stearin G. Vitamin D resistant rickets. J Bone Joint Surg. 1964:46:935.

Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A: Deformity planning for frontal plane corrective osteotomies. Orthop Clin North Am. 1992;25:425-65.

Nadeem RD, Thomas JQ, Deborah ME. Focal dome osteotomy for the correction of tibial deformity in children. J of Pediatr Orthop B. 2005;14:340-6.

Staheli LT, Corbett M, Wyss C, King H. Lower extremity rotational problems in children. J Bone Joint Surg (Am). 1985;67:39-47.

Levine AM, Drennan JC. Physiological bowing and tibia vara. J Bone Joint Surg (Am). 1982;64:1158-63.

Elgafy H, Ebraheim NA, Shaheen PE, Yeating RA. Extensor hallucis longus innervations an anatomic study. Clin Orthop. 2002;398:245-51.

Kirgis A, Albrecht S. Palsy of peroneal nerve after proximal tibia osteotomy: an anatomical study. J Bone Joint Surg (Am). 1992;74:1180-5.

Miller S, Radomisli T, Ulin R. Inverted arcuate osteotomy and external fixation for adolescent tibia vara. J Pediatr Orthop. 2000;20:450-4.

Henderson RC, Kemp GJ, Greene WB. Adolescent tibia vara: alternative for operative treatment. J Bone Joint Surg (Am). 1992;74:342-50.

Thompson GH, Carter GR. Late onset tibia vara (Blount disease): Current concepts. Clin Orthop. 1990;255:24-35.

Rab GT. Oblique tibial osteotomy for Blount′s disease (tibia vara). J Pediatr Orthop. 1988;8:715-20.

Slawski DP, Schoenecker PL, and Rich MM: Peroneal nerve injury as a complication of pediatric tibial osteotomies: A review of 255 osteotomies. J Pediatr Orthop 1994;14:166-72.

Steel HH, Sandrow RE, Sullivan PD. Complications of tibial osteotomy in children with genu varum and genu valgum. Evidence that neurological change due to ischemia. J Bone Joint Surg (Am). 1971;53:1629-35.

Schrock RD. Peroneal nerve palsy following de-rotation osteotomies for tibial torsion. Clin Ortop. 1969;62:172-7.

Pamyan KR, Patenal V, Borden P, Green T, Otsuka NY. Complications of tibial osteotomies in children with co-morbidities. J Pediatr Orthop. 2002;22:642-4.

Mueller KL, Farley FA. Superficial and deep posterior compartment syndrome following high tibial osteotomy for tibia vara in a child. Orthopaedics. 2003;26(5):513-4.






Original Research Articles