engleski

Orthopaedic treatment of metabolic bone disease

Metabolic bone diseases cause a disruption of bone mineralisation and affect the growth plate. These disorders can be congenital like hypophosphatemic rickets and hypophosphatasia, and acquired like vitamin D deficiency rickets and renal osteodystrophy. Treatment by vitamin D and phosphate supplementation is done by pediatric metabolic specialistis. Orthopedic treatment of metabolic bone diseases implies deformity correction of the lower extremity. Patients with these disorders have altered anatomical and mechanical axes of the long bones, most commonly varus and valgus deformations. Long bone axis deviation larger than 15° usually requires operative treatment which was, until now, mostly done by single or multiple corrective osteotomies followed by external or internal fixation. Recently, new techniques of operative treatment were developed, employing special implants set around the growth plate to enable guided growth. We report on 6 patients (1 male, 5 female) with hypophosphatemic rickets and consequential deformity of the lower extremities treated at our Department. All patients had a varus deformation of the lower extremity (femur and tibia). Surgery was performed on 15 lower extremity segments (10 femora, 5 tibiae). Four patients had corrective osteotomies with internal fixation using plates and screws. Two patients were treated by method of guided growth (Stevens „Eight“–plate). The average age at time of surgery was 12, 5 years (range, 8 – 20). All patients were followed until reaching skeletal maturity, which was defined as the end point of treatment. One patient (one segment) treated with the Stevens „Eight“–plate method developed a hemarthros following a fall, the plate was removed and an arthroscopic joint toilet was performed. Three patients (three segments) had a reoperation due to deformity relapse caused by growth.

hypophosphatemic rickets; surgical treatment; bone deformation; Stevens "Eight"-plate; osteosynthesis

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