Corrective Osteotomy for Residual Lower Extremity Deformities Following Healed Rickets: A Retrospective Study in a Rural Hospital among Nigerian Children

Abstract

Background: Rickets is the clinical manifestation of a failure of calcification of bone matrix in growing children. Although treatment of rickets is medical, residual deformities following healed/ burnt out rickets may exist requiring surgical correction. Objective: To determine the pattern of presentation and outcome of corrective osteotomy in children with residual lower extremity deformities following healed rickets in a rural hospital. Methods: Retrospective data was obtained over a 5 year period from January 2010 to December 2015. All patients 0-18 years who presented in Nongu u Krestu u i ser u Sha Tar (NKST) rehabilitation hospital Mkar, North- Central Nigeria with residual lower extremity deformities following healed rickets who had corrective osteotomy were included. Thirty eight patients met the inclusion criteria. Data was analysed using SPSS version 21. Results: The mean age was 8.5±3.1 years. There were 21(55.3%) males and 17(44.7%) females with a male to female ratio of 1.2:1. The commonest pattern of presentation of residual deformity following healed rickets was knock knee deformity occurring in 21 (55.3%) patients. Corrective osteotomy was the main form of treatment. Sixteen (41.0%) patients commenced full weight bearing at 9-12 weeks. The commonest post op complications encountered was recurrence in 2(5.3%) and delayed union in another 2(5.3%) patients. Conclusion: Knock knee deformity was the commonest residual lower extremity angular deformities following healed rickets in our environment. Recurrence and delayed union were the commonest complications encountered following corrective osteotomy. It was therefore recommended that careful patient selection, proper preoperative planning and meticulous surgical technique are vital in order to achieve satisfactory lower limb alignment, restore lower extremity function and ameliorate morbidity.