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Journal of Bone and Joint Surgery - British Volume, Vol 84-B, Issue 2, 263-268.
doi: 10.1302/0301-620X.84B2.11821  
Copyright © 2002 by British Editorial Society of Bone and Joint Surgery
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Natural history of infantile tibia vara

Y. Shinohara, MD, Staff Surgeon; M. Kamegaya, MD, Chief Staff Surgeon; and K. Kuniyoshi, MD, Resident

Chiba Children’s Hospital, 579-1 Heta-chou, Midori-ku, Chiba City, Chiba (266-0007), Japan.

H. Moriya, MD, Professor

School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba (260-0856), Japan.

Correspondence should be sent to Dr Y. Shinohara.

We have observed the natural history without treatment of 46 limbs in 29 patients with infantile tibia vara and a metaphyseal-diaphyseal angle (MDA) of more than 11°. The femorotibial angle (FTA) and MDA were measured, and Langenskiöld’s classification of radiological changes in the proximal medial metaphysis of the tibia was used. In 22 limbs which were not in Langenskiöld stages II to III the condition resolved spontaneously without treatment. Of the remaining 24 which were in stages II to III, in 18 it resolved spontaneously by the age of six years, but six showed little or no improvement at the latest follow-up. It was impossible to differentiate by measuring the FTA or MDA whether spontaneous resolution could be expected before the age of four years. There was no difference in the rate of resolution of the deformity between those patients who had been treated by a brace and those who had received no treatment. We advise no initial treatment but review at six-monthly intervals until the age of four years, even in patients with Langenskiöld stage-II to stage-III deformity. When a deformity persisted or progressed we carried out a corrective osteotomy after the age of four years.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General