Complications and Perioperative Course After Distal Tibial/Fibular Derotation Osteotomy for Idiopathic Tibial Torsion: A Retrospective Case Series Across a Pediatric Health System (2012-2022).

Background: Distal tibial derotational osteotomy (DTDO) with or without fibular osteotomy (FO) is used to treat persistent idiopathic tibial torsion in children; however, complication severity in isolated idiopathic cases has not been well characterized using standardized grading systems. Methods: A retrospective case series was conducted across 4 pediatric hospitals within a single health system. Patients younger than 18 ​years who underwent DTDO with or without FO for isolated idiopathic tibial torsion between 2012 and 2022 were included in the study. Postoperative complications were graded using the Clavien-Dindo classification (CDC). Associations were evaluated using univariate statistical testing; body mass index (BMI) was analyzed at the patient level, and, because 5 patients underwent bilateral procedures, limb-level subgroup comparisons were reassessed using an exhaustive 1-limb-per-patient sensitivity analysis across all 32 possible limb selections. Results: Thirty-four limbs in 29 patients met inclusion criteria. Eleven of 34 limbs (32.4%) experienced at least 1 postoperative complication, accounting for 15 total events. Ten events were grade I, 1 event was grade II, and 4 events were grade IIIb. Four limbs (11.8%) required unplanned reoperation. Patients who experienced complications had a higher mean BMI ​(25.3) than those without complications (22.5); however, this difference was not statistically significant ( Conclusions: In this cohort, DTDO with or without FO was associated with substantial postoperative complication and reoperation rates when graded using the CDC. Findings of this study emphasize the importance of transparent preoperative counseling regarding surgical risks and underscore the need for careful patient selection. While patients with complications demonstrated higher BMI values, this difference was not statistically significant; other subgroup findings were sensitive to bilateral-limb selection and should not be interpreted as established risk factors. Key Concepts: (1)Distal tibial derotational osteotomy with or without fibular osteotomy for isolated idiopathic tibial torsion carries meaningful perioperative morbidity and should not be considered a benign procedure.(2)Preoperative counseling should include transparent discussion of postoperative complications, possible unplanned reoperation, and the limited evidence regarding objective correction, functional improvement, and long-term outcomes.(3)Children undergoing surgery for isolated idiopathic tibial torsion represent a distinct clinical population; outcomes from mixed neuromuscular, syndromic, or multideformity cohorts may not generalize to this group. Level of Evidence: III.