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.