Background: Blount disease is frequently associated with deformities that
may not be adequately corrected by a single metaphyseal osteotomy. This study
evaluated the outcome of a combined metaphyseal and epiphyseal osteotomy in
severe cases. Methods: We prospectively evaluated the outcome of combining the
antero-posterior inverted-U metaphyseal osteotomy with a medial open-wedge
hemi-epiphyseal osteotomy in eighteen patients (27 tibiae) with Stage IV to VI
Blount disease. Results: The average age of patients was 9 years (ranging from
5 to 17). The tibio-femoral angle improved from 43° varus (Range: 34° - 78°) to
2° varus (Range: 5° valgus to 8° varus). The metaphyseal-diaphyseal angle
improved from 36° to 8° varus. Internal tibial torsion improved from 39° to 2°.
All the patients were able to achieve 110°？of knee flexion in a year.
Conclusion: In conclusion, the combined metaphyseal and epiphyseal osteotomy
satisfactorily corrected tibio-femoral and metaphyseal-diaphyseal varus and
internal tibial torsion without recurrence in patients with severe Blount
disease. Level of Evidence: IV.
Vasculitis is one of the less common but important consequence in
patients with Human Immunodeficiency Virus (HIV) infections and presentation
with multiple limb gangrene is rare. We therefore report a novel case of
quadruple limb gangrene in a patient with HIV infection.