Tibial lengthening in congenital posteromedial bowing of tibia: A scoping review

Congenital posteromedial bowing of tibia is a very rare congenital deformity. The tibia is angulated in posterior and medial direction. This deformity is seen at birth. The angluation can also be seen in fibula. The classical presentation of the disease is short leg, bowed leg, and the foot is touching the shin of tibia with a skin dimple. The characteristic deformity is posterior and medial bowing with calcaneovalgus foot with foot in extreme dorsiflexion. It is most seen unilaterally on the left side. The angular deformity gradually improves within 2 to 4 years because of remodeling, but leg length discrepancy persists because of inhibition of tibial growth. The cause is still unclear but can be because of intrauterine mechanical factors like amniotic band constriction which causes a focal growth arrest. Most of the cases are managed by conservative management with good prognosis but may require lengthening procedures for leg length discrepancy. The initial management is by serial manipulation and casting to correct the calcaneovalgus foot. Leg length discrepancy less than 2 cm is managed by shoe lift or orthoses. If the estimated leg length discrepancy is 2 to 5 cm at maturity, epiphysiodesis of the contralateral side can be done. If the expected leg length discrepancy is more than 5 cm, then lengthening procedures with Taylor spatial frame or with Illizarov fixator is preferred. Sofield ostetotomy is done for children in whom deformity is not corrected. Generally, congenital posteromedial bowing of tibia presents with shortening of the affected limb. Lengthening associated with congenital posteromedial bowing of tibia is not very common. Hence, this study is being undertaken to answer this question. A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis was conducted and no current or underway systematic reviews or scoping reviews on the topic were identified. Review question: What are the indications, timing and patient selection criteria for limb lengthening in congenital posteromedial bowing of tibia? Which lengthening technique gives a good regenerate with a good healing index? What are the outcomes of lengthening ankle range of motion and function at skeletal maturity? What are the complications related to procedures used for limb lengthening? Keywords