Supramalleolar Derotation Osteotomy of the Tibia with Locking Compression Plate Fixation
and Minimal Incisions, in Patients with Idiopathic Internal Tibial Torsion.
Galbán G, Miguel Ángel *; Villanueva, Roceli;** Santana, Adolfredo***
*Pediatric Orthopaedic Surgery and Limb Reconstruction Surgery, Caracas, Venezuela
**Resident of Pediatric Orthopaedic Surgery, Hospital Ortopédico Infantil, Caracas, Venezuela
***Fellowship of Limb Reconstruction Surgery, Caracas, Venezuela
Key Words: tibial torsion, LCP, supramalleolar osteotomy.
In spite of a tendency for rotational deformities of the tibia in children to improve spontaneously over
time, some persist and require corrective derotation osteotomy. Internal tibial torsion is frequent in
patients with cerebral palsy, clubfoot and neurological injuries. The idiopathic internal tibial torsion is
a frequent cause of gait disturbance in normal children. To treat this deformity has been proposed the
supramalleolar osteotomy of the tibia with or without concomitant fibular osteotomy. The method of
fixation has been described with cast, kirschner wires, steinmann pins, staples, intramedular nails,
dynamic compression plates (DCP) and external fixation. This is a description of a series of
Supramalleolar Derotation Osteotomy fixed with locking compression plate (LCP) in combination with
minimal incisions (MIPO). We evaluated 29 patients, 54 tibias with idiopathic internal tibial torsion
treated between February 2008 and January 2010. The mean age at the time of surgery was 12.9 years
(5 to 68). All osteotomies were fixed with straits LCP and 4 locking screws (2 proximal and 2 distal),
3.5 mm or 5 mm systems. The LCP was placed distal and laterally. We used three minimal incisions,
two laterals of 3 centimeters for proximal and distal screws and a third antero-medial incision of 5
millimeters for percutaneous osteotomy. 62% were male. 4 Cases unilateral, 25 cases bilateral. 61%
needed casting for three weeks in those cases where lengthening of the Achilles tendon was done. The
remaining patients did not use any immobilization and were free to move. All patients were aloud to
full weight bearing at three weeks and they started to walk. Bone healing was obtained in all patients
except two in a mean period of seven weeks (5 to 12). No loss of reduction at the site of the osteotomy
developed. Supramalleolar osteotomy of the tibia without fibular osteotomy and fixed with lateral strait
LCP and minimal incisions is a safe and simple surgical procedure, and more important it is a more
comfortable method.
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