PubMed Health⌕ Search

Biomedical subjects

Dror Paley

Publications and source records attributed to Dror Paley.

At least 19 recordsLinked to original sources
PubMed2006

External fixation for the foot and ankle in children.

During the last decade, external fixation for the pediatric foot and ankle has evolved as a result of advances in technology (eg, Taylor spatial frame, hydroxyapatite-coated external fixator pins) and preoperative deformity planning. Although complications are common, most are minor and can be addressed nonoperatively while treatment continues. This article reviews the indications and applications of external fixation for soft tissue contractures, idiopathic and teratologic clubfoot, osteotomies, metatarsal lengthening, tibial lengthening, and foot and ankle trauma.

Bone Lengthening↗
PubMed2006

Treatment of malunion and nonunion at the site of an ankle fusion with the Ilizarov apparatus. Surgical technique.

BACKGROUND: Malunion and nonunion of an ankle fusion site are associated with pain, osteomyelitis, limblength discrepancy, and deformity. The Ilizarov reconstruction has been used to treat these challenging problems. METHODS: We reviewed the results in twenty-one ankles that had undergone a revision of a failed fusion, with simultaneous treatment of coexisting pathologic conditions, with use of the Ilizarov technique. Eight patients had undergone ankle fusion only, eleven had undergone ankle and subtalar fusion, and two had undergone pantalar fusion. Eighteen patients with an average limb-length discrepancy of 4 cm underwent limb lengthening simultaneously with the revision surgery. The average patient age was forty years. Indications for treatment were malunion (eleven patients), aseptic nonunion (eight patients), and infected nonunion (two patients). Clinical, subjective, objective, gait, and radiographic analyses were performed after an average duration of follow-up of 83.4 months. RESULTS: Solid union was achieved in all ankles. The functional result was excellent for fifteen patients, good for three, fair for two, and poor for one. The bone result was excellent for ten ankles, good for nine, fair for one, and poor for one. All eighteen patients who underwent gait analysis had a heel-to-toe progression gait, and twelve achieved normal walking velocity with their shoes on. A plantigrade foot was achieved in each case, and only two patients had >5 degrees of residual deformity. During the Ilizarov treatment, forty-one minor complications (treated conservatively) and twenty major complications (treated surgically) occurred. After removal of the circular frame, seven other complications, which required four additional operations, occurred. CONCLUSIONS: In patients with a failed ankle fusion, infection, limb-length discrepancy, and foot deformity can be addressed simultaneously with use of the Ilizarov apparatus to achieve a solid union and a plantigrade foot, usually with a clinically satisfactory result.

Ankle Joint↗
PubMed2005

The prenatal multiplier method for prediction of limb length discrepancy.

OBJECTIVE: The purpose of this study was to produce a method of predicting limb length discrepancy in utero. METHODS: Using available databases, we divided the femoral and tibial lengths at term by the femoral and tibial lengths at each week of gestation for each percentile. The quotients represent coefficients (multipliers) of limb segment growth at each prenatal age. RESULTS: We found the prenatal multipliers to be independent of race, percentile, and gender from as early as 12 weeks' gestation. The prenatal multipliers are alike for femur and tibia. CONCLUSIONS: The prenatal multiplier method allows for quick prediction of limb length discrepancy at term and at skeletal maturity from as early as 12 weeks' gestation. Future study is needed to validate this method clinically.

Age Determination by Skeleton↗
PubMed2005

Ankle joint distraction.

Ankle joint distraction is a viable alternative to ankle arthrodesis or ankle replacement. A congruent, painful, mobile, and arthritic ankle joint that is treated with this technique can achieve good to excellent results. Attention to the principles (anterior osteophyte resection, equinus contracture release, and ankle joint realignment procedures) is as important for a successful outcome as the accurate application of the hinged ankle joint distraction technique itself.

Animals↗
PubMed2005

Ilizarov hip reconstruction for the late sequelae of infantile hip infection.

BACKGROUND: The late sequelae of infantile hip infection include absence of the femoral head and neck, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. The Ilizarov hip reconstruction includes an acute valgus and extension osteotomy at the proximal part of the femur combined with gradual distraction for realignment and lengthening at a second, more distal, femoral osteotomy. The purpose of this study was to determine whether this technique can successfully treat the sequelae of infantile hip infection. METHODS: We performed a retrospective review of a series of eight consecutive patients with a Type-IV or V hip deformity, according to the classification system of Hunka et al., after an infantile hip infection. The patients' mean age at surgery was 11.2 years. All hips were unstable, with a mean of 3.8 cm of proximal migration. A mean valgus angulation of 44 degrees and a mean extension angulation of 19 degrees were created with the proximal osteotomies. Distal femoral lengthening averaged 5.7 cm, and distal femoral varus angular correction averaged 10 degrees. The mean time in the Ilizarov frame was 4.7 months. Outcomes were evaluated clinically and radiographically. The clinical evaluation included gait analysis and the use of a modified Harris hip score. RESULTS: At the time of follow-up, at a mean of five years, the mean lower-extremity length discrepancy had improved from 4.6 cm preoperatively to 0.7 cm. The mean modified Harris hip score had improved from 51 points to 73 points (p = 0.007). All extremities were well aligned, with a mean pelvic mechanical axis angle of 89 degrees. The mean deviation of the mechanical axis was 2 mm in a lateral direction. The mean stance-time asymmetry improved from 16% to 5.4% (p = 0.0037), and the mean ground-reaction force (second peak) improved from 102% of body weight to 122% of body weight (p = 0.0005). CONCLUSIONS: The Ilizarov hip reconstruction can successfully correct a Trendelenburg gait and simultaneously restore knee alignment and correct lower-extremity length discrepancy. When the procedure is performed on a young patient, remodeling of the proximal osteotomy site and development of lower-extremity length discrepancy should be expected and the procedure may need to be repeated.

Biomechanical Phenomena↗
PubMed2005

Treatment of malunion and nonunion at the site of an ankle fusion with the Ilizarov apparatus.

BACKGROUND: Malunion and nonunion of an ankle fusion site are associated with pain, osteomyelitis, limb-length discrepancy, and deformity. The Ilizarov reconstruction has been used to treat these challenging problems. METHODS: We reviewed the results in twenty-one ankles that had undergone a revision of a failed fusion, with simultaneous treatment of coexisting pathologic conditions, with use of the Ilizarov technique. Eight patients had undergone ankle fusion only, eleven had undergone ankle and subtalar fusion, and two had undergone pantalar fusion. Eighteen patients with an average limb-length discrepancy of 4 cm underwent limb lengthening simultaneously with the revision surgery. The average patient age was forty years. Indications for treatment were malunion (eleven patients), aseptic nonunion (eight patients), and infected nonunion (two patients). Clinical, subjective, objective, gait, and radiographic analyses were performed after an average duration of follow-up of 83.4 months. RESULTS: Solid union was achieved in all ankles. The functional result was excellent for fifteen patients, good for three, fair for two, and poor for one. The bone result was excellent for ten ankles, good for nine, fair for one, and poor for one. All eighteen patients who underwent gait analysis had a heel-to-toe progression gait, and twelve achieved normal walking velocity with their shoes on. A plantigrade foot was achieved in each case, and only two patients had >5 degrees of residual deformity. During the Ilizarov treatment, forty-one minor complications (treated conservatively) and twenty major complications (treated surgically) occurred. After removal of the circular frame, seven other complications, which required four additional operations, occurred. CONCLUSIONS: In patients with a failed ankle fusion, infection, limb-length discrepancy, and foot deformity can be addressed simultaneously with use of the Ilizarov apparatus to achieve a solid union and a plantigrade foot, usually with a clinically satisfactory result.

Adolescent↗
PubMed2004

Deformity correction planning for hindfoot, ankle, and lower limb.

Many patients with foot and ankle deformities have concurrent deformities (osseous and soft tissue), with or without limb length discrepancies. Lower extremity deformities and limb length discrepancies typically result from trauma, congenital abnormality, avascular necrosis, previous surgery, nonunion, and malunion. Limb deformity correction requires extensive surgical experience because many considerations and factors apply to realignment. The considerations and factors regarding realignment are highlighted throughout this article.

Ankle Joint↗
PubMed2004

Correction of the cavus foot using external fixation.

Cavus deformity is of soft tissue, bony, or combined origin and is either static or progressive. The treatment algorithm depends on these factors. Bony deformities are treated by acute osteotomy or gradual distraction osteotomies, whereas soft tissue contractures are treated by soft tissue releases or distraction. External fixation is a powerful tool to obtain correction of the cavus deformity. It must be supplemented with soft tissue balancing procedures, such as tendon transfer and orthotic management, to maintain the correction in progressive cavus deformities.

Algorithms↗
PubMed2004

Calculation and correction of secondary translation deformities and secondary length deformities.

External fixation correction of angular deformities leads to secondary translation deformities when occurring around an axis located proximal or distal to the center of rotation of angulation (CORA); secondary length deformities result when correction occurs around an axis concave or convex to the CORA. With circular fixation, the hinge axis can be matched to the CORA. With monolateral fixation, the level of the hinge/angulator is not easily controlled. Axis of correction of angulation can be plotted graphically and secondary deformities calculated trigonometrically. Location of the hinge/angulator can be accurately planned and adjustments incorporated to compensate for expected secondary deformities.

Bone Malalignment↗
PubMed2004

Different surgical options for monocompartmental osteoarthritis of the knee: high tibial osteotomy versus unicompartmental knee arthroplasty versus total knee arthroplasty: indications, techniques, results, and controversies.

The decision of what procedure to perform for the treatment of monocompartmental osteoarthritis of the knee when nonsurgical treatment methods fail remains controversial. Recent advances using osteotomy, unicompartmental knee replacement, and total knee replacement have been reported. For example, there are new concepts for performing high tibial osteotomies rather than the traditional Coventry method. Many techniques now involve osteotomies below the tibial tubercle. Unicompartmental knee replacement can be done using a standard approach, but less invasive approaches exist, along with minimally invasive approaches for total knee replacement, rather than the standard large incision, that promote decreased soft-tissue destruction.

Arthroplasty, Replacement, Knee↗
PubMed2003

Nerve lesions associated with limb-lengthening.

BACKGROUND: Nerve injury is one of the most serious complications associated with limb-lengthening. We examined the risk, assessment, and treatment of nerve lesions associated with limb-lengthening. METHODS: We retrospectively studied the records on 814 limb-lengthening procedures. Nerve lesions were defined by clinical signs and symptoms of motor function impairment, sensory alterations, referred pain in the distribution of an affected nerve, and/or positive results of quantitative sensory testing with use of a pressure specified sensory device. RESULTS: Seventy-six (9.3%) of the limbs had a nerve lesion. Eighty-four percent of the nerve lesions occurred during gradual distraction, and 16% occurred immediately following surgery. The pressure specified sensory device showed 100% sensitivity and 86% specificity in the detection of nerve injuries. The patients in whom the lesion was diagnosed with this method, or with this method as well as with nerve conduction studies, had significantly faster recovery than did those diagnosed on the basis of clinical symptoms or nerve conduction studies alone (p = 0.02). Patients undergoing double-level tibial lengthening and those with skeletal dysplasia were at higher risk for nerve lesions (77% and 48%, respectively). Nerve decompression was performed in fifty-three cases (70%). The time between the diagnosis and the surgical decompression was strongly associated with the time to recovery (p = 0.0005). Complete clinical recovery was achieved in seventy-four of the seventy-six cases. CONCLUSIONS: Early detection based on signs and symptoms or testing with a pressure specified sensory device improves the prognosis for nerve injury that occurs during limb-lengthening. Of the methods that we used to identify neurologic compromise, testing with the pressure specified sensory device was the most sensitive. Aggressive early treatment (slowing the rate of lengthening and/or performing decompression) allows continued lengthening without incurring permanent nerve injury. When indicated, decompression of the affected nerve should be performed as soon as possible, thereby improving the chances of and shortening the time to complete recovery.

Bone Lengthening↗
PubMed2002

Distraction osteogenesis for nonunion after high tibial osteotomy.

The purpose of this study was to determine whether distraction osteogenesis can be used to treat hypertrophic nonunion associated with angular deformity and shortening after Coventry style high tibial osteotomy. Five consecutive patients were retrospectively reviewed. In all patients the alignment had collapsed into excessive varus or valgus and leg length discrepancy was present. The leg length discrepancy, malalignment, and nonunion were treated simultaneously with distraction. Union was achieved by the time of fixator removal, which averaged 4.4 months. The Hospital for Special Surgery knee score significantly improved from 42 to 89. The mechanical axis deviation significantly improved by 5 cm. The coronal plane deformity significantly improved by 13 degrees, and leg length discrepancy improved significantly from 2.3 to 0.5 cm. Metaphyseal bone stock increased by 43%, and the Insall-Salvati ratio increased from 1.1 to 1.2 and remained within normal limits. All patients were satisfied with the procedure, and none have had or need a total knee replacement at an average followup of 4 years. Distraction osteogenesis of nonunion after high tibial osteotomy is a minimally invasive and successful procedure. It leads to bony union with correction of deformity and leg length discrepancy and prevents the need for total knee replacement at intermediate-term followup. The increase in metaphyseal bone stock may make total knee replacement technically easier.

Adult↗
PubMedDate not supplied

The multiplier method for prediction of adult height.

The authors propose the "height multiplier method," a new, simple, universal method to predict adult height. The authors calculated age- and gender-specific height multiplier values and validated their use for height prediction. Average height multiplier values (M) for boys and girls were calculated by dividing height at skeletal maturity (Htm) by present height (Ht) for each age, gender, and height percentile (M=Htm/Ht) using data published by the Centers for Disease Control and Prevention (CDC). The accuracy of the multiplier method was compared with the CDC growth charts using longitudinal growth data from 52 normal children. No significant differences were noted between predictions made using the CDC growth charts versus the multiplier method. The authors also compared the CDC-derived multiplier values with other growth databases from around the world and from different eras. Height multipliers were independent of height percentile, race, and generation, indicating that the multiplier method is universal.

Adolescent↗
PubMedDate not supplied

Intramedullary infections treated with antibiotic cement rods: preliminary results in nine cases.

The treatment of intramedullary infections after nailing usually includes removal of the rod, debridement of the canal, and, in many cases, insertion of antibiotic-impregnated cement beads. These beads offer no mechanical support and are difficult to remove if left in place for more than 2 weeks. We present an alternative for filling the medullary canal's noncollapsible dead space with an antibiotic-impregnated cement rod. This rod can be custom-made at the time of surgery, using different diameter chest tubes as molds and embedding a 3-mm beaded guidewire within the cement. The smooth molded surface of this nail makes extraction of the cement rod relatively easy. The cement rod also provides some limited temporary support to the fracture or nonunion site while the infection is being treated. After 6 weeks, the rod can be removed and replaced with a definitive metal intramedullary nail, with or without bone grafting to treat the previously infected fracture or nonunion site. We retrospectively reviewed nine cases of intramedullary infection treated with antibiotic-impregnated molded cement rods. These included six femora, two tibiae, and one humerus. The cause of infection was lengthening or transport over nail in six cases, fixator-augmented nailing of osteotomies in two, and fracture fixation in one. The follow-up period after surgery ranged from 38 to 48 months. No recurrent infection occurred during this follow-up period, and no patient required antibiotics after the rod was removed. In all cases, the canal cultures were negative after rod removal. The cement rod was removed between 29 and 753 days after implantation. Fracture of the rod occurred in one case in which the rod was left in place for more than 1 year. We conclude that this method is a relatively simple and inexpensive alternative for the treatment of intramedullary infections.

Adolescent↗
PubMedDate not supplied

Clinical validation of the multiplier method for predicting limb length discrepancy and outcome of epiphysiodesis, part II.

To validate the accuracy of the multiplier method in predicting limb length discrepancy (LLD) and outcome of epiphysiodesis, radiographs of 60 patients treated for LLD were measured. Data generated were used to predict maturity lengths of epiphysiodesed limbs, bone length discrepancies at maturity, and LLD at maturity after epiphysiodesis (residual discrepancy) using the multiplier and Moseley methods. The multiplier method mean error for bone length discrepancies predictions was 0.6 cm (SD = 0.6). Mean error for predicting lengths of epiphysiodesed limbs was 1.6 cm (SD = 1.2) for both methods. Mean errors for predicting residual discrepancies were 0.9 cm for the multiplier method using chronologic age, 1 cm for the multiplier method using skeletal age, and 1.3 cm for the Moseley method. Mean error difference between the methods was significant (P = 0.0008). The multiplier method accurately predicts LLD and outcome of epiphysiodesis and is more accurate than the Moseley method in predicting LLD at maturity after epiphysiodesis.

Child↗
PubMedDate not supplied

Clinical validation of the multiplier method for predicting limb length at maturity, part I.

To validate the accuracy of the multiplier method in predicting bone and limb maturity lengths, radiographs of 60 patients treated for lower limb length discrepancy were measured. Longitudinal limb length data were used to predict maturity lengths of non-epiphysiodesed normal bones and short bones. Mean errors for predictions were 1.1 cm (SD = 0.9) and 1.5 cm (SD = 1.3) for the multiplier method using chronologic age and skeletal age, respectively. Regression correlation values between multiplier method predictions and actual measurements were 0.93 using chronologic age and 0.90 using skeletal age. The multiplier method was more accurate than prediction using the Anderson et al growth charts. Mean error for limb length predictions was 2.5 cm for the multiplier method using chronologic age and 2.6 cm for the Moseley method. Although as accurate as the Moseley method, the multiplier method seems to be quicker and simpler to use and requires only one data point for predicting limb length at maturity.

Adolescent↗