Comparison of Pediatric and General Orthopedic Surgeons’ Approaches in Management of Blount’s Disease and Torsional Malalignment Syndrome

[Background]Orthopedic disorders of children are regularly managed by both general and pediatric orthopedists, practically, with various diagnostic and therapeutic approaches.[Objectives]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.[Methods]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.[Results]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.[Conclusions]Disagreements among orthopedic surgeons imply inadequacy of level-1 evidence. More comprehensive investigations are necessary to elucidate the situation.