Objective To delineate the surgical methodology and therapeutic paradigm of proximal tibial notch retro-grade interlocking intramedullary nailing for ameliorating deformities due to osteofibrous dysplasia(OFD)in a pediatric popula-tion.Methods A retrospective assessment was conducted on the medical records of individuals undergoing orthopedic osteotomy complemented by retrograde interlocking intramedullary nailing for OFD of the tibia from January 2016 to December 2019.The co-hort comprised 15 patients,with a follow-up exceeding three years,documenting complete data sets.The patient profile included 8 males and 7 females,with 8 left-side and 7 right-side afflictions.The mean age at the time of surgery was 10.1±2.5 years,ranging from 7.1 to 12.6 years.Parameters measured were preoperative and postoperative imaging findings,which encompassed the scope of the lesion(longitudinal lesion length relative to tibial length),coronal and sagittal limb alignments,and lower limb length dis-crepancies.Results The mean follow-up duration was 3.4±1.3 years,ranging from 3 to 6.6 years.Preoperatively,prominent ante-rior tibial arch deformities and limping were present,with 7 cases reporting fatigue-induced pain and 3 instances of pathological fractures.Post-surgery,pain symptoms were resolved,gait disturbances were improved in 9 patients,and completely resolved in 6.Tibial osteotomy or fracture healing of 15 patients averaged 3.9±0.7 months(range 3-5 months).The lesion range before surgery was 0.41±0.17,immediately after surgery was 0.38±0.17,and at the last follow-up was 0.30±0.16,with no statistical significance(F=0.101,P=0.904).Lesion range showed no significant change throughout treatment,but radiographic density within the lesion notably increased post-surgery,suggesting bone improvement.The anterior tibial arch Angle was 28.30°±6.62°(range 20°-45°)be-fore surgery,4.73°±1.53° immediately after surgery,and 6.87°±1.36° at the last follow-up,with statistical significance(F=159.739,P＜0.001).A significant correction in the anterior tibial arch deformity was achieved and maintained postoperatively.There was no significant angular deformity of the tibia in the coronal plane before operation,and the medial proximal tibial angle(MPTA)and lateral distal tibial angle(LDTA)were 87.50°±1.46° and 88.30°±1.62°,88.40°±1.46° and 88.70°±1.45° immediately after surgery,and 88.00°±1.39° and 89.10°±1.53° at the last follow-up,the differences were statistically significant(F=1.741,P=0.188;F=1.016,P=0.371),there was no coronal deformity of tibia.The limb length discrepancy(LLD)was 0.60±0.98 cm before surgery,0.18±0.93 cm at the last follow-up,with statistical significance(t=0.096,P=0.761).There were no incidents of postopera-tive complications such as infection.Conclusion In pediatric cases of tibial deformities attributed to osteofibrous dysplasia,a therapeutic strategy involving osteotomy for lower limb realignment,sans curettage or bone grafting of the lesion,followed by retro-grade interlocking intramedullary nailing,yields favorable outcomes.Importantly,this implantation technique does not compro-mise the integrity of the proximal tibial epiphyseal plate in children and adolescents.
维普
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