Acute versus gradual correction of idiopathic tibia vara in children: a systematic review.

BACKGROUND Idiopathic tibia vara (Blount disease) is an acquired form of tibial deformity found mainly in children who are Afro-Caribbean and obese. It is uncommon. Several methods have been described for the surgical treatment of this condition, which can be categorized as either acute or gradual correction. The aim of this study is to review the evidence comparing the outcome of acute versus gradual correction of childhood tibia vara using accuracy of reduction as the primary outcome measure. METHODS A systematic search was made of the literature across multiple databases to find all studies describing acute or gradual correction of this condition that reported radiographic correction as an outcome measure. RESULTS One retrospective comparative series was found that provided weak evidence of an improvement in mechanical axis deviation using gradual correction with a Taylor Spatial Frame compared with acute correction. Seventeen other case series were found, from which, there was no evidence of an advantage for either form of treatment. CONCLUSIONS There is very little evidence to recommend one form of correction over the other. LEVEL OF EVIDENCE Systematic review of case series (level IV).