Hereditary bilateral genu recurvatum: Case report of a family

Correction of Genu Recurvatum Deformity Using a Hexapod Frame: A Case Series and Review of the Literature

Aim and objective

Genu recurvatum is a rare deformity for which minimal literature exists. Non-operative management typically gives unsatisfactory results. This study aims to evaluate the treatment of genu recurvatum with a hexapod frame.

Materials and methods

A single-center retrospective chart review of genu recurvatum cases treated with a hexapod fixator application was performed. Radiographic parameters included the following: leg length discrepancy (LLD), angle of recurvatum, angle of tilt of the tibial plateau, patellar height and anatomic proximal posterior tibial angle (aPPTA). Radiographic and functional results were evaluated.

Results

A total of five patients with six limbs corrected with a hexapod frame were found. Aetiology included post-traumatic (2), post-infectious (1) and idiopathic (3). The mean age at application was 13.36 (5.5–18.0) years. The total mean time in the fixator was 225 (160–412) days. The LLD decreased from a mean of 35.6 mm (0.7–50) preoperatively to a mean of 14.8 (1.0–39.3) postoperatively. The average patellar height remained similar 0.97 (0.69–1.2)–0.97 (0.51–1.6). The angle of the tilt of the tibial plateau improved from a preoperative mean of 66° (58.5–73.5°)–92.5° (80–98.5°). The angle of recurvatum improved from a preoperative mean of 26.4° (18.5–31°)–5.0° (0–9°). The aPTTA improved from (102–118°)–85.5° (77–96°).

Conclusion

Osteotomy distal to the tibial tuberosity and deformity correction using a hexapod frame allows for multiplanar correction. Throughout treatment, soft tissue management with physical therapy remained key to prevent knee contracture.

Clinical significance

A hexapod frame is a safe and accurate technique that allows correction of genu recurvatum along with concomitant deformities with low risk of complications.

How to cite this article

Johnson L, McCammon J, Cooper A. Correction of Genu Recurvatum Deformity Using a Hexapod Frame: A Case Series and Review of the Literature. Strategies Trauma Limb Reconstr 2021;16(2):116–119.

Complications after tibial tubercle traction and femoral neck fractures in children: a case report

Background: Genu recurvatum and femoral neck fracture in children are very rare, and relevant literaturewas reported. However, there were no reports on avascular necrosisafter internal fixation of femoral neck fractures in children, and genu recurvatum and tibial dysplasia after tibial tubercle traction.Case presentation: In this case, a 32-year-old female patient suffered from a femoral neck fracture at the age of 10. The tibial tubercle traction was applied in the conservative treatment, and closed reduction and internal fixationwere adopted after the failure of the conservative treatment. When the patient came to our hospital for the treatment of hip and knee joint pain for 20 years, the doctor discovered that the patient had severe genu recurvatum and avascular necrosis. We adopted staged treatment for the patients. First, the left hip artificial joint replacement was performed due to the femoral head necrosis. After the operation, the pain in the left hip disappeared. Three months later, the patient underwent the combination of tibial osteotomy and tibial tubercle transposition to treat genu recurvatum. One year after the operation, the anterior and lateral radiographs of the knee joint displayed that the osteotomy area healed well, without complications such as fracture nonunion and infection. The appearance of the knee joint returned to normal. According to UCLA Activity Score and WOMAC (The Western Ontario and McMaster Universities) Osteoarthritis Index, the patient's activity and function levels were assessed, and the postoperative scores were significantly improved compared with preoperative scores.Conclusion: Pediatric Femoral Neck Fractures should be treated promptly with surgery and long-term follow-ups. Total hip replacement is an effective method for the treatment of end-stage femoral head necrosis. Meanwhile, tibial traction should be avoided for children with lower extremity fractures, because it may damage the tibial growth plate, thus leading to the early closure of the metaphyseal region in children, and genu recurvatum. The modified surgery for the treatment of genu recurvatum is simple to operate and can avoid patella Baja, so it has a strong healing ability in the osteotomy area. The results of the surgery technique were ideal in this case.P.

Genu Recurvatum After Prolonged Bracing for Drop-Foot in a Patient With History of Guillain-Barre Syndrome

A case of unilateral genu recurvatum (GR) in a 15-year-old boy with a history of Guillain-Barre syndrome (GBS) and subsequent bilateral drop-foot is presented. Muscle imbalance of the lower limb and repetitive pressure from prolonged usage of an orthosis to deal with drop-foot may be the causative factors for early partial physeal arrest of his right proximal tibia. The result was a right GR and a shorter right lower limb. A below the tibial tuberosity anterior opening-wedge oblique proximal tibial osteotomy was performed. The deformity was gradually corrected using an Ilizarof circular frame. The center of rotation and angulation of the procedure was placed at the posterior tibial cortex. The procedure was completed uneventfully within four months. Excellent clinical and radiological improvement of the deformity was obtained.