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PubMedDate not supplied

Supracondylar corrective osteotomy for cubitus varus--the internal rotation component and its importance. An unique bone experiment.

In 20 patients with cubitus varus, a clinical test suggested by Yamamoto et al (1985) was carried out to measure the internal rotation. Average internal rotation was found to be 37.5 +/- 9.390. A correction for internal rotation was carried out for all the patients having angle more than 20 degrees. Following osteotomy, post-operative Yamamoto's angle was measured and was found to be 8.85 +/- 6.5. An experiment was carried out on postmortem human humerus with cubitus varus. The internal rotation was measured with Kirschner wires and was found to be 30 degrees. Osteotomy was carried out to eliminate varus and correct internal rotation. Radiographs taken before and after the osteotomy confirmed the correction. We conclude that this derotation has to be corrected and Yamamoto's test should be used to assess the correction.

Adolescent↗

PubMed2006

High tibial osteotomy for osteoarthritis of the knee with varus deformity utilizing the hemicallotasis method.

INTRODUCTION: A hemicallotasis method has been developed utilizing an external fixator as high tibial osteotomy (HTO), and satisfactory results of this method with the external fixator have been reported. This external fixator has a universal joint that moves in all directions. We have recently designed a hemicallotasis device for this operation. METHODS: HTO for the knee with varus deformity utilizing the hemicallotasis method was performed on 44 knees. The patients had a mean age at operation of 65 years (range 49-82 years), a mean follow-up period of 68 months (range 36-119 months), and a mean preoperative knee score of 66 points (range 27-90 points). RESULTS: The operated knees had a mean knee score at the final follow-up of 86 points (range 51-98 points), but the mean range of knee motion was not changed as follows. Before surgery, the mean flexion was 129 degrees (range 90-150 degrees) and the mean extension was -5 degrees (range -30 to 0 degrees), whereas at the final follow-up, the corresponding values were 127 degrees (range 85-150 degrees) and -4 degrees (range -25 to 0 degrees), respectively. Radiographically, the femorotibial joint was classified as grade 2 in 9 knees, grade 3 in 21 knees, and grade 4 in 14 knees according to the classification of osteoarthritis (Kellgren and Laurence). The patellofemoral joint was also classified as grade 1 in 39 knees, grade 2 in 2 knees, and grade 3 in 3 knees. The mean femorotibial angle was 184 degrees (4 degrees varus) before surgery, 169 degrees (11 degrees valgus) after pin extraction, and was maintained at the final follow-up. The complications of this method were relatively few and consisted of pin-tract infection (8 knees), deep vein thrombosis (3 knees), and delayed union (2 knees). No peroneal nerve palsy or compartment syndrome was encountered. No knee was converted to total arthroplasty. However, administration of analgesics was necessary in ten knees at the final follow-up. CONCLUSION: The hemicallotasis method easily determined the angle of correction even in the knees with ligamentous laxity. Nevertheless, one of the major demerits of this method was a longer period of application of the external fixator. The level of evidence was level IV (case series).

Aged↗

PubMed2000

Post-burn hallux varus: a case report and management of a rare deformity.

Post-burn hallux varus is an extremely rare condition. A 22-year-old male, with a history of campfire burns in childhood, presented with secondary hallux varus of the left great toe. Surgical correction included medial soft tissue release, metatarsophalangeal joint arthrodesis, two-pin fixation of bones, metatarsophalangeal joint capsulorrhaphy, and coverage of the skin defect with a "Z" plasty of the skin and split thickness skin grafting. Follow up 20 months later showed satisfactory results.

Adult↗

PubMed1975

Acquired hallux varus: a preventable and correctable disorder.

Acquired hallux varus deformity of either the static or the dynamic type results from surgery to correct hallux valgus deformity and the accompanying bunion. The dynamic type is disfiguring, uncomfortable, and disappointing to the patient and surgeon alike. Linear as well as rotational forces are at work to produce the deformity. When recognized early, before fixation of the first digit has occurred in the deviated and clawed position, resection of the base of the proximal phalanx will correct the deformity. More radical treatment is required in the patient who is treated late. The experience with seven feet of five patients with acquired hallux varus deformity is presented here.

Adult↗

PubMed1991

Iatrogenically induced hallux varus.

Hallux varus is not uncommon after hallux valgus surgery. Through understanding of its cause, this deformity may be easily avoided with thorough preoperative evaluation, meticulous and deliberate intraoperative technique, and early postoperative diagnosis. By recognizing these factors, one can significantly reduce the predilection toward hallux varus. Once the diagnosis has been made, aggressive treatment is warranted, in the hope of minimizing the complexity of joint disorientation and surgical repair.

Hallux↗

PubMedDate not supplied

Hallux varus--surgical correction and review of the literature.

Acquired hallux varus may follow correction of hallux abducto valgus by the modified McBride procedure. The authors discuss correction of both acquired and congenital hallux varus and show pre- and postoperative illustrations of both types.

Foot Deformities, Acquired↗

PubMed1984

Extensor hallucis longus transfer for hallux varus deformity.

The hallux varus deformity results from a dynamic imbalance of the tendons that cross the first metatarsophalangeal joint. This condition most frequently occurs after McBride-type operative treatment for hallux valgus. A new procedure, developed to correct this imbalance, involves transferring the extensor hallucis longus beneath the first intermetatarsal ligament into the base of the proximal phalanx, along with an arthrodesis of the first interphalangeal joint. This procedure in fifteen affected great toes gave over-all satisfactory correction of the hallux varus deformity.

Adult↗

PubMed1990

The effect of marginal osteophytes on reduction of varus-valgus instability in osteoarthritic knees.

The varus-valgus stability of 20 knees with unicompartmental osteoarthritis was studied in vivo at the time of total knee replacement. Intact osteoarthritic knees had an average of 11.0 degrees of varus-valgus motion. Removal of osteophytes from the osteoarthritic compartment significantly increased the motion to 13.1 degrees (P less than 0.05), while subsequent removal of osteophytes from the nonosteoarthritic compartment further increased motion to 14.7 degrees (P less than 0.025). In primarily unicompartmental osteoarthritis, marginal osteophytes appear to stabilize osteoarthritic knees, but can cause fixed deformity.

Aged↗

PubMed2004

A six-month followup of a randomized trial comparing the efficacy of a lateral-wedge insole with subtalar strapping and an in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee.

OBJECTIVE: To assess the effect of a lateral-wedge insole with elastic strapping of the subtalar joint on the femorotibial angle in patients with varus deformity of the knee. METHODS: The efficacy of a wedged insole with subtalar straps and that of a traditional wedged insole shoe insert were compared. Sixty-six female outpatients with knee osteoarthritis (OA) were randomized (according to birth date) to be treated with either the strapped or the traditional inserted insole. Standing radiographs with unilateral insole use were used to analyze the femorotibial angles for each patient. In both groups, the baseline and 6-month visual analog scale (VAS) scores for subjective knee pain and the Lequesne index scores for knee OA were compared. RESULTS: The 61 patients who completed the 6-month study were evaluated. At baseline, there was no significant difference in the femorotibial angle (P = 0.66) and the VAS score (P = 0.75) between the 2 groups. At the 6-month assessment, the 29 subjects wearing the subtalar-strapped insole demonstrated a significantly decreased femorotibial angle (P < 0.0001) and significantly improved VAS scores (P = 0.001) and Lequesne index scores (P = 0.033) compared with their baseline assessments. These significant differences were not observed in the 32 subjects assigned to the traditional shoe-inserted wedged insole. CONCLUSION: These results suggest that an insole with a subtalar strap maintained the valgus correction of the femorotibial angle in patients with varus knee OA for 6 months, indicating longer-term clinical improvement with the strapped insert compared with the traditional insert.

Aged↗

PubMed1980

Abductor hallucis release in congenital metatarsus varus.

Adduction of the forefoot diagnosed in the young child generally corrects spontaneously. Resistant forefoot adduction is usually combined with a degree of supination of the forefoot and described as congenital metatarsus varus. In true congenital metatarsus varus there is a contraction or shortening of the abductor hallucis muscle and tendon which is considered to be the primary deforming factor. In the early severe or resistant deformity correction can be achieved by either division of the tendon with release of its capsular attachment, or, in the more severe deformity, by complete release of the abductor hallucis muscle from its extensive attachment to bone and soft tissues.

Child↗

PubMed1995

Long-term results of intertrochanteric varus osteotomy for arthrosis of the dysplastic hip (over 10 years' follow-up).

We performed a retrospective clinical and radiographic review of the long-term results of 64 hips in 53 patients who underwent intertrochanteric varus osteotomy for arthrosis of the hip at the pre- or early stage with acetabular dysplasia. Their average age at operation was 26 years. The average duration of follow-up was 18 years and 10 months. The mean Harris hip score was 77 +/- 9 points pre-operatively, and improved significantly to 84 +/- 13 points at the final follow-up. The acetabular coverage influenced the final outcome, and the postoperative prognosis was predictable from the acetabular head index (AHI) on a pre-operatively done hip maximum abduction radiograph (abd XP). We conclude that varus osteotomy for a dysplastic hip should be considered when the acetabular coverage is sufficient, and that a good prognosis can be expected when AHI on abd XP is greater than 60%.

Adolescent↗

PubMed1994

Varus deformity of the distal end of the femur secondary to a focal fibrous lesion.

Severe unilateral varus deformity of the distal end of the femur secondary to a focal fibrous lesion is reported. It is a malformative process rare at this level, this being the first report of it in the radiological literature. The conventional radiograph is pathognomonic and CT is useful in the confirmation of the fibrous tissue. Osteotomy is indicated only if the deformity progresses or the angle of varus is severe.

Bone Neoplasms↗

PubMed2005

[Proximal tibial osteotomy for osteoarthritis of the knee with varus deformity].

OBJECTIVE: Correction of the axial malalignment to slow down wear and tear of the medial compartment of the knee in instances of medial compartment osteoarthritis with varus deformity. Return to nearly normal weight-bearing ability of the knee. INDICATIONS: Patients up to a biologic age of 65 years with medial compartment osteoarthritis with varus malalignment. CONTRAINDICATIONS: Morbid obesity, circulatory disturbances, gait disorders neurologic in origin, osteoarthritis of all three compartments. SURGICAL TECHNIQUE: 1st step: oblique fibular osteotomy between proximal and middle third without internal fixation. 2nd step: anterolateral approach to the proximal tibia from distal-lateral to medial-proximal and resection of a bony wedge leaving the medial cortex intact. Internal fixation with a six-hole semitubular plate using a tensioner for compression of the fragments. RESULTS: In 113 patients 121 valgus realignment tibial osteotomies for medial compartment osteoarthritis were performed by three surgeons. Minimal postoperative follow-up period 10 years. 86% of the osteotomies required no further treatment even after 10 years, a total knee replacement was done in only three patients between the 7th and 10th postoperative year.

Female↗

PubMed2002

[Supracondylar corrective osteotomy in post-traumatic cubitus varus. 3 cases in 2 patients].

Supracondylar fractures of the humerus in childhood frequently result in cubitus varus deformity. Pain, functional impairment and cosmetic problems can request surgical correction. This is a report on an adult and on a mature child with such deformities. The boy had sustained three injuries with following bilateral cubitus varus and lengthening of one lower leg. Planning, surgical technique and outcome of the osteotomies are described. We should recommend the resection of a full wedge with two oblique osteotomies and internal fixation with two plates on either side of the humerus.

Adolescent↗

PubMed2005

[An open wedge tibial head osteotomy using continuous callus distraction. An alternative method for the treatment of of varus arthrosis].

High tibial osteotomy is an accepted method for treatment of medial osteoarthritis. An alternative technique is an open-wedge osteotomy and consecutive callotasis (CO) using an external fixator. The purpose of this study was to evaluate the clinical and radiological results and the efficiency of this technique for precise correction. This prospective study included 41 patients (44 knees) evaluated by the HSS score, radiological stage of osteoarthritis, bone healing, and complications after a follow-up period of 49 (36-61) months. The HSS score increased from median 67 preoperatively to 82 points at the time of follow-up (p<0.001). Of 44 knees, excellent/good results were found in 70.5% and fair/poor in 29.5%. The median preoperative femorotibial anatomical angle was 3.6 degrees varus and 9.4 degrees valgus at the latest follow-up examination. The total time in external fixation was median 80 (61-125) days. We observed one early collapse of the new bone wedge, one complete corticotomy, and pin tract infections in ten cases. Furthermore, two hematomas required revision surgery. Hemicallotasis with external fixators allows constant manipulation of alignment during the healing process to optimize alignment. The disadvantage of the external fixation is the risk of pin track infection. Therefore, CO may constitute an important contribution to our algorithm in the treatment of varus gonarthrosis.

Adult↗

PubMed2006

The oblique high tibial osteotomy technique without bone removal and with rigid blade plate fixation for the treatment of medial osteoarthritis of the varus knee: medium and long-term results.

Several high tibial osteotomy (HTO) surgical techniques for the treatment of medial osteoarthritis of the varus knee have been reported. Their main objectives are the achievement of the precise correction that is necessary for the lower limb mechanical axis realignment and the alleviation of the medial joint space. Early or late recurrence of the varus deformity must be avoided and various methods of fixation have been proposed to obtain this. We present a method of single level oblique HTO with no bone removal and with blade plate fixation for the treatment of medial osteoarthritis of the knee. One hundred seventeen patients (136 knees) were operated using this technique during a 12.2-year period. In 4.5 years follow-up there were 73.8% satisfactory results while in 8.4 years follow-up there were 61.1% satisfactory results. There were 11 complications: five patients with deep vein thrombosis, four with superficial wound infection and two with temporary peroneal nerve dysfunction. This study presents the operative technique in details, evaluates the results and assesses the advantages and disadvantages of the method in relation to other techniques described in the literature.

Aged↗

PubMed2006

High tibial osteotomy that does not cause recurrence of varus deformity for medial gonarthrosis.

It is widely accepted that high tibial osteotomy (HTO) is an effective surgical treatment for medial gonarthrosis. However, long-term follow-up studies have revealed that the clinical results deteriorate over time and varus deformity often recurs. We performed barrel-vault osteotomy in HTO with a correction angle that did not cause arthritic progression in the medial compartment of the knee or recurrence of varus deformity. Thirty patients (44 knees) were followed clinically and radiographically for a minimum of 10 years (average, 11.4 years). We aimed for an average postoperative femorotibial angle (FTA) of 165.3 degrees (range, 162-169 degrees ) according to our method using a correction angle chosen on the basis of the so-called Mikulicz's mechanical axis. The clinical results were good in 30 (68.2%) knees, fair in 7 (15.9%) and poor in 7 (15.9%). Arthritic progression in the medial compartment was only found in 1 (2.3%) knee, while in the lateral compartment it was found in 17 (38.6%) knees. Of the knees with arthritic progression in the lateral compartment, six (35.3%) were classified as poor. The average postoperative FTAs were 164.3 degrees at 1 year, 164.0 degrees at 5 years and 163.5 degrees at 10 years after the operation, indicating that the knees tended to become slightly valgus over time. The clinical results were not poor after slightly overcorrected osteotomy was performed. Since overcorrection tended to occur, when the preoperative lateral tibial thrust was severe, HTO is not a good indication for such cases.

Adult↗

PubMed2006

Isolated varus intertrochanteric osteotomy for hip dysplasia in 52 patients: long-term results.

Great strides have been made in the field of total hip arthroplasty, but the issue of wear and osteolysis continue to be a problem, mostly for young adults. For this population varus rotational osteotomy still remains a viable alternative to total hip arthroplasty. The purpose of this prospective study was to describe the indications, the technique and the functional outcome of an isolated varus femoral osteotomy in 52 patients with hip dysplasia. We obtained very good results with a significant improvement of hip function and pain relief. We conclude that with appropriate selection of the patient the procedure may prevent or postpone the development of secondary osteoarthritis.

Adult↗