A Child with Severe Bilateral Tibia Vara: Treatment with Computer-Assisted Gradual Correction Utilizing Hexapod External Fixator A 7-year-old obese boy presented to the Paediatric Orthopaedic clinic with a complaint of worsening bilateral knee bowing. He was initially seen for the same problem in another hospital at the age of 3. The bowing of the leg was associated with pain over the lateral aspect of both knees. He was able to walk but unable to run or participate in sports due to the deformity and knee pain. On examination, the child had a waddling gait and lateral thrust due to severe bilateral genu varus. The range of motion of bilateral knee joints was 0 to 110 degrees. The knee intercondylar distance was markedly increased and there was bilateral tibial torsion. No limb length discrepancy and neurovascular examination was normal. The radiograph revealed features of infantile tibia vara (Blount disease). Bilateral proximal tibia temporary hemiepiphysiodesis was attempted but no correction of the deformity was achieved due to implant failure. His parents were then counseled to let him undergo gradual deformity correction surgery using a ring external fixator (hexapod system). The bilateral varus deformity was corrected after 4 months, and the patient was able to walk normally.

The cases of nine patients with unicameral bone cysts were reviewed from two orthopaedic centres. In one hospital, five patients received serial steroid injections, and at the other hospital four patients were treated conservatively following fractures. In the steroid injection group, three cases were in the proximal femur and two in the proximal humerus. The five steroid injection patients showed radiological evidence of cyst healing within six months of treatment. Subsequently four of the patients showed a satisfactory radiological outcome after a year and complete resolution after 2 years. In the conservative group, all four cases were in the proximal humerus. Persistent cystic lesions were observed in all four patients and two was complicated by another fracture within six months.