The Haas procedure for the treatment of tibial torsional deformities

Abstract

This study reviews our 13-year experience with Haas's multiple-longitudinal osteotomy technique for correction of tibial torsion in children. In this procedure, multiple-longitudinal bi-cortical osteotomies are made parallel in the proximal tibia. The deformity is corrected by applying moderate force in the desired plane. Fixation is achieved either with a long cast or with ‘pins-in-plaster’. Forty-six osteotomies were performed in 30 children. In all, there were 35 internal tibial torsion deformities and 11 external tibial torsion deformities. Twenty-one (46%) deformities were associated with spastic cerebral palsy and 15 (33%) were associated with clubfeet. Ten (22%) deformities had no underlying musculoskeletal conditions. Thigh–foot angles were corrected by a mean of 24° for internal tibial torsion and −28° for external tibial torsion. Average anesthesia time for unilateral cases was 46 min. No neurologic or infectious complications, postoperative fractures or physeal damage occurred. There was one case of delayed union and one case of postoperative antecurvatum deformity. All five cases of postoperative recurrent deformities were associated with cerebral palsy. This technique is a simple, safe and efficient method for correcting tibial torsional deformities in both healthy children and those with underlying conditions. It allows accurate alignment of different deformities with a uniform osteotomy technique, which preserves bone continuity and provides inherent stability, thus avoiding the use of internal fixation.