The Journal of Bone and Joint Surgery, Vol 66, Issue 2 215-223, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Rotational deformities of the lower limb in myelomeningocele. Evaluation and treatment
LS Dias, MJ Jasty and P Collins
We studied the results of surgical treatment for rotational deformities of
the lower extremity in fifty children. The preoperative rotational
deformities were subdivided as follows: (1) external rotation deformity of
the hip (nine hips), (2) external tibial torsion (twenty-nine limbs), and
(3) toeing-in gait (thirty-one limbs). These were further analyzed as to
imbalance between the forces of the medial and lateral hamstrings, that
imbalance associated with fixed internal tibial torsion, and isolated
internal tibial torsion. The average length of follow-up was four years and
six months. For the external rotation deformity of the hip we performed a
derotation osteotomy with internal fixation at the subtrochanteric level.
That procedure led to eight good results and one fair result. The external
tibial torsion was treated by a derotation osteotomy of the tibia and
fibula distally, with correction of the valgus deformity of the ankle if
that was more than 10 degrees. In twenty patients a good result was
obtained. For the toeing-in gait associated with a medial-lateral hamstring
imbalance, the semitendinosus was transferred to the biceps and the head of
the fibula. Good results were seen in ten of the fourteen patients. In
twelve limbs a derotation osteotomy of the distal ends of the tibia and
fibula was done alone, with eight good and fair results. In five patients a
simultaneous semitendinosus transfer and derotation osteotomy was used. All
had a good result. The over-all rate of good and fair results in the entire
series was 79.6 per cent.
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