Evaluation of complications of treatment of severe Blount's disease by circular external fixation using a novel classification scheme

Alexander M. Cherkashin, Mikhail L. Samchukov, John G. Birch, Ana L Munhoz Da Cunha

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Corrective osteotomy for recalcitrant varus deformity secondary to adolescent and infantile Blount's disease can be challenging because of a combination of severity of deformity, complexity of deformity, and frequent association with patient obesity. We present here the outcome of treatment by osteotomy and gradual deformity correction by circular external fixation in 31 patients with either infantile or adolescent Blount's disease. We used a unique classification scheme to quantify and qualify complications in this patient group: category I, complications not requiring an alteration in the treatment plan, not involving unplanned return to surgery, and not influencing outcome; category II, complications requiring an alteration in the treatment plan, including unplanned returns to surgery, but that did not influence outcome; category IIIA, complications that resulted in a failure to achieve treatment goals; and category IIIB, complications that resulted in a failure to achieve treatment goals and the development of a new pathology or worsening of patient condition. All but one patient in this group incurred at least one complication. However, despite the complex nature of this patient population, 88% achieved satisfactory correction without developing category IIIA or IIIB complications. Careful selection of patients and vigilant postoperative management can result in excellent outcomes with circular external fixation and gradual correction in this challenging patient population.

Original languageEnglish (US)
Pages (from-to)123-130
Number of pages8
JournalJournal of Pediatric Orthopaedics Part B
Volume24
Issue number2
DOIs
StatePublished - Mar 6 2015

Fingerprint

Osteotomy
Therapeutics
Blount disease
Patient Selection
Population
Obesity
Pathology

Keywords

  • adolescent Blount's disease
  • circular fixation
  • complications
  • infantile Blount's disease

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

@article{77407530b6eb456c8ada99ba28c04aab,
title = "Evaluation of complications of treatment of severe Blount's disease by circular external fixation using a novel classification scheme",
abstract = "Corrective osteotomy for recalcitrant varus deformity secondary to adolescent and infantile Blount's disease can be challenging because of a combination of severity of deformity, complexity of deformity, and frequent association with patient obesity. We present here the outcome of treatment by osteotomy and gradual deformity correction by circular external fixation in 31 patients with either infantile or adolescent Blount's disease. We used a unique classification scheme to quantify and qualify complications in this patient group: category I, complications not requiring an alteration in the treatment plan, not involving unplanned return to surgery, and not influencing outcome; category II, complications requiring an alteration in the treatment plan, including unplanned returns to surgery, but that did not influence outcome; category IIIA, complications that resulted in a failure to achieve treatment goals; and category IIIB, complications that resulted in a failure to achieve treatment goals and the development of a new pathology or worsening of patient condition. All but one patient in this group incurred at least one complication. However, despite the complex nature of this patient population, 88{\%} achieved satisfactory correction without developing category IIIA or IIIB complications. Careful selection of patients and vigilant postoperative management can result in excellent outcomes with circular external fixation and gradual correction in this challenging patient population.",
keywords = "adolescent Blount's disease, circular fixation, complications, infantile Blount's disease",
author = "Cherkashin, {Alexander M.} and Samchukov, {Mikhail L.} and Birch, {John G.} and {Da Cunha}, {Ana L Munhoz}",
year = "2015",
month = "3",
day = "6",
doi = "10.1097/BPB.0000000000000138",
language = "English (US)",
volume = "24",
pages = "123--130",
journal = "Journal of Pediatric Orthopaedics Part B",
issn = "1060-152X",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Evaluation of complications of treatment of severe Blount's disease by circular external fixation using a novel classification scheme

AU - Cherkashin, Alexander M.

AU - Samchukov, Mikhail L.

AU - Birch, John G.

AU - Da Cunha, Ana L Munhoz

PY - 2015/3/6

Y1 - 2015/3/6

N2 - Corrective osteotomy for recalcitrant varus deformity secondary to adolescent and infantile Blount's disease can be challenging because of a combination of severity of deformity, complexity of deformity, and frequent association with patient obesity. We present here the outcome of treatment by osteotomy and gradual deformity correction by circular external fixation in 31 patients with either infantile or adolescent Blount's disease. We used a unique classification scheme to quantify and qualify complications in this patient group: category I, complications not requiring an alteration in the treatment plan, not involving unplanned return to surgery, and not influencing outcome; category II, complications requiring an alteration in the treatment plan, including unplanned returns to surgery, but that did not influence outcome; category IIIA, complications that resulted in a failure to achieve treatment goals; and category IIIB, complications that resulted in a failure to achieve treatment goals and the development of a new pathology or worsening of patient condition. All but one patient in this group incurred at least one complication. However, despite the complex nature of this patient population, 88% achieved satisfactory correction without developing category IIIA or IIIB complications. Careful selection of patients and vigilant postoperative management can result in excellent outcomes with circular external fixation and gradual correction in this challenging patient population.

AB - Corrective osteotomy for recalcitrant varus deformity secondary to adolescent and infantile Blount's disease can be challenging because of a combination of severity of deformity, complexity of deformity, and frequent association with patient obesity. We present here the outcome of treatment by osteotomy and gradual deformity correction by circular external fixation in 31 patients with either infantile or adolescent Blount's disease. We used a unique classification scheme to quantify and qualify complications in this patient group: category I, complications not requiring an alteration in the treatment plan, not involving unplanned return to surgery, and not influencing outcome; category II, complications requiring an alteration in the treatment plan, including unplanned returns to surgery, but that did not influence outcome; category IIIA, complications that resulted in a failure to achieve treatment goals; and category IIIB, complications that resulted in a failure to achieve treatment goals and the development of a new pathology or worsening of patient condition. All but one patient in this group incurred at least one complication. However, despite the complex nature of this patient population, 88% achieved satisfactory correction without developing category IIIA or IIIB complications. Careful selection of patients and vigilant postoperative management can result in excellent outcomes with circular external fixation and gradual correction in this challenging patient population.

KW - adolescent Blount's disease

KW - circular fixation

KW - complications

KW - infantile Blount's disease

UR - http://www.scopus.com/inward/record.url?scp=84922402860&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922402860&partnerID=8YFLogxK

U2 - 10.1097/BPB.0000000000000138

DO - 10.1097/BPB.0000000000000138

M3 - Article

C2 - 25588049

AN - SCOPUS:84922402860

VL - 24

SP - 123

EP - 130

JO - Journal of Pediatric Orthopaedics Part B

JF - Journal of Pediatric Orthopaedics Part B

SN - 1060-152X

IS - 2

ER -