Comparison of Pediatric and General Orthopedic Surgeon's Approaches in Management of Blount's Disease and Torsional Malalignment Syndrome

Orthopedic disorders of children are regularly managed by both general and pediatric orthopedists, practically, with various diagnostic and therapeutic approaches.
The purpose of this study was to compare these two groups of surgeons regarding consensus and viewpoint variety on Blount’s disease and malalignment syndrome.
A nine-item questionnaire was designed and different choices were provided for each question to cover the main management strategies. Forty surgeons in two groups of general orthopedic surgeons (GOS) (n = 20) and pediatric orthopedic surgeons (POS) (n = 20) participated in the study and they were asked to choose answers by an electronic keypad. Statistical analysis was performed with Chi-square and Fisher’s exact tests.
For unimproved Blount’s disease after one-year application of leg brace, 85% of POS vs. 31% of GOS tended to perform osteotomy, mostly with pin and cast fixation. In case of recurrence, re-osteotomy and temporary hemiepiphysiodesis were most popular. For further work-up of typical Blount lesion in X-ray, 73% of POS and 36% of GOS would perform an MRI. For a child with asymptomatic torsional malalignment syndrome, 75% of POS and 78% of GOS voted against surgery; while, for a symptomatic patient, femoral and tibial osteotomy was the choice.
Disagreements among orthopedic surgeons imply inadequacy of level-1 evidence. More comprehensive investigations are necessary to elucidate the situation.