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Posteromedial Tibial Bowing: An 11-year monocentricretrospective study on a rare congenitalmusculo-skeletal disorder at a Portuguese University Hospital Center.

Guilherme Ferreira dos Santos1, Mafalda Pires2, Maria José Costa2.

1 - Especialidade de Medicina Física e Reabilitação, Área Músculo-Esquelética, Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa;
2 - Especialidade de Medicina Física e Reabilitação, Pólo de Reabilitação Pediátrica, Área da Mulher, Criança e Adolescente, Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa.

- Apresentação, 13th Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM), Kobe, Japão. 2019;
- Publicação, Conference Paper, edição suplementar, Journal of the International Society of Physical and Rehabilitation Medicine (JISPRM). 2019.

Introduction: Posteromedial bowing is a congenital bowing of the tibia and a calcaneovalgus foot deformity. Both these deformities tend to resolve with little clinical disability; however, a leg-length inequality commonly develops that often requires treatment. Initial treatment of the deformity includes stretching, serial casting, or splinting. Treatment of the leg-length inequality is complex, and options vary depending on the degree of inequality, age of the patient and expected height.
Methods: Retrospective study which included patients treated at our institution from 2008 to 2018. Demographic (age, ethnicity and gender) and clinical data (deformity at diagnosis and follow-up, leg-length inequality at diagnosis and follow-up, surgical procedures underwent, surgical complications and pain and function at follow-up) were extracted from clinical records.
Results: We identified 4 male and 3 female patients (minimum age of 7 months and maximum age of 16 years at last follow-up). Age at diagnosis was <1 month after birth for 6 patients and 10 years of age for 1 patient. Average tibial deformity at diagnosis was 20º (minimum of 16º and maximum of 27º) and residual at last follow-up. 2 out of the 7 patients (1 male, 1 female) underwent surgical correction with a lengthening procedure. Surgical complication rate was 100% (1 pin-site infection, 1 case of chronic postoperative leg pain). Leg-length inequality average at last follow-up was 2,25cm in the operated group and 3,26cm in the non-operated group.
Conclusions: Our study is in accordance with previous series published in the English literature, with the diagnosis made in the first month after birth in a majority of patients. Surgical complication rates of about one per procedure are also to be expected, especially since pin-site infection may occur in nearly every patient, depending on how it is reported. 

KEYWORDS: posteromedial tibial bowing; congenital disorders; retrospective study; pediatric rehabilitation.