Abstract
Planning of surgical correction in sequelae of vitamin D-resistant rickets preliminarily requires the management of the metabolic defect with appropriate measures. In fact, surgery perfomed with the patient in a compensated metabolic condition greatly contributes to the prevention of recurrences.
The deformity most frequently observed is genu varum (where femur, tibia and fibula are usually all deformed), often combined with internal torsion. Compression-distraction systems (or circular external fixators) provide an easy control of the corticotomy fragments and a gradual correction of all kinds of deformity during the operative and post-operative phases. Careful pre-operative planning is necessary, which may require a multi-stage and/or a sequential strategy of management.
Between 1988 and 2002, 16 cases of sequelae of vitamin D-resistant rickets, with combined angular and torsional lower limb deformities, were treated with monofocal or bifocal tibial or femoral corticotomy and gradual correction with compression-distraction devices. There were nine men and seven women, with a mean age of 15 years. The Ilizarov system was used in 14 cases; in two cases the Volkov-Oganesian system was employed. The mean follow-up time was 8 years (range 1 – 15 years).
The anatomical and functional results have been highly satisfactory, with a very low complication rate. These techniques thus represent an excellent option in the management of such complex diseases.
