Congenital posteromedial bowing of the tibia: a retrospective analysis of growth abnormalities in the leg

We studied case records and radiographs of 20 children with congenital posteromedial bowing of the tibia (CPMBT) retrospectively to determine the pattern of correction of the bowing, the associated growth abnormalities of the tibia and fibula, and the role of surgical intervention in CPMBT. The magnitude of diaphyseal bowing in two planes and the physeal inclination were measured. Abnormalities of ossification of the distal tibial epiphysis and inclination of the distal articular surface if present were noted and shortening of the tibia was recorded. The rate of resolution of deformity was noted from sequential radiographs and expressed as percentage reduction per month of follow-up. At initial presentation the magnitude of deformity varied; the most severe posterior diaphyseal bow was 70 degrees whereas the most severe medial diaphyseal bow was 64 degrees. Two distinct mechanisms seem to be responsible for resolution of the deformity in CPMBT; one involves physeal realignment and the other involves diaphyseal remodeling. In the first year of life, rapid resolution of angulation was noted; the rate of resolution reduced significantly thereafter. In a proportion of children with CPMBT residual deformity may persist till over 4 years of age. Physeal realignment occurred at a faster rate than diaphyseal remodeling. The degree of shortening was related to the severity of bowing and shortening as great as 40% was noted in a patient. Wedging of the distal tibial epiphysis and fibular hypoplasia with valgus inclination of the distal tibial articular surface occur in some children with CPMBT. Eccentric ossification of the distal tibial epiphysis in early childhood may be a predictor of wedging of the distal tibial epiphysis later on. We recommend all the children with CPMBT to be followed up periodically till skeletal maturity, to identify cases with residual bowing, ankle deformity, muscle weakness, and limb length inequality as active surgical intervention may be needed to correct these problems. J Pediatr Orthop B 18:120-128 (c) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.