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PubMed1983

The pathology of congenital metatarsus varus. A post-mortem study of a newborn infant.

A case of congenital metatarsus varus from an autopsy of a newborn infant was explored. Contracture of the anterior tibialis muscle was present as well as alterations in size and shape of the first cuneiform bone. Furthermore, subluxations in the fore- and midfoot were observed, especially round the first cuneiform bone. It is concluded that congenital metatarsus varus may be classified as a subluxation followed by secondary bone changes and contractures in the soft tissues.

Foot Deformities, Congenital↗

PubMed1997

Radiographic analysis of metatarsus primus varus. 45 feet followed 15 months after distal metatarsal osteotomy and lateral soft-tissue release.

We analyzed standardized radiographs of 45 feet in 41 patients with symptomatic hallux valgus and an intermetatarsal angle of 17 (15-23) degrees 15 (9-24) months after distal metatarsal osteotomy and lateral soft-tissue releases. A mean reduction in the II-intermetatarsal angle of 12 degrees and hallux valgus angle of 24 degrees was found. On average, the metatarsus primus varus angle improved by 4 degrees, the I-intermetatarsal angle by 3 degrees and the inclination angle of the first cuneiform by 4 degrees. We conclude that this operation corrects the metatarsus primus varus, without substantially altering the alignment of the long axis of the first metatarsal.

Adult↗

PubMed1989

Correction of hallux valgus and metatarsus primus varus. Using the Cedell technique.

The Cedell procedure consists of: a proximal valgus osteotomy of the first metatarsal bone to correct the metatarsus primus varus, a soft tissue plasty at the first metatarsophalangeal joint with lateral release, and tightening of the medial capsule to correct the hallux valgus. A total of 45 operations in 31 patients (2 men and 29 women) were performed. Forty-one of these operations were followed. The average age at surgery was 24 years (range 16 to 43 years), and the average follow-up time was 23 months (range 8 to 56 months). The postoperative decrease in the intermetatarsal angle averaged 10 degrees, and the average decrease in the metatarsophalangeal angle was 26 degrees. Only a few postoperative complications were observed. At the time of follow up, 75% of the patients had no pain, 23% had only slight pain, and 2% had severe pain. Ninety-five percent were cosmetically satisfied with the operation. The Cedell operative technique has proved to be an effective procedure to correct the combined hallux valgus and metatarsus primus varus in younger patients.

Adolescent↗

PubMed1999

The effect of varus tilt on contact stresses in total knee arthroplasty: a biomechanical study.

The contact stress produced in the tibiofemoral joint from a varus-tilted tibial component was tested in five total knee prostheses. Peak and mean stresses were measured with a digital electronic sensor under compressive load at 15 degrees and 90 degrees flexion. Stresses were measured with the tibial component tilted 0 degrees and 5 degrees in the mediolateral direction. At a 5 degree tilt, the Advantim, the Miller-Galante II, and the Omnifit prostheses, which have a flat configuration on the femoral and tibial surfaces in the coronal plane, had significantly greater stresses than the LCS and the Profix prostheses, which have tibial and femoral components with matching curved surfaces in the coronal plane. These results suggest that the femoral component surface should have a radius of curvature that matches that of the tibial articular surface in the coronal plane to achieve a large contact area even in varus-valgus tilting.

Arthroplasty, Replacement, Knee↗

PubMed2003

Long-term results of derotational femoral varus osteotomy in Legg-Calvé-Perthes disease: 26-year follow-up.

The long-term results of 30 patients (31 hips) who underwent derotational femoral varus osteotomy for Legg-Calvé-Perthes disease are presented. Pain, leg-length discrepancy, Trendelenburg sign, and range of motion at the operated hip were examined clinically. Radiographic analysis included measurement of the Wiberg angle, epiphyseal index, acetabular index, and the Mose index. All were found to be satisfactory for patients in the good/fair category. Good/fair results were obtained in 27 (87%) of 31 hips according to Catterall's postoperative classification. Four patients were classified in the poor category due to severe restriction of movement and constant hip pain. Therefore, derotational femoral varus osteotomy is recommended for the treatment of patients with Legg-Calvé-Perthes disease.

Adult↗

PubMed1991

The myth of running limb varus.

Even though the authors believe that there are many flaws in treadmill-based video analysis, they do believe that this study shows that running limb varus is not as important a concept as previously discussed by many authors. The FootTrak system is the first system available to give biomechanical researchers the ability to document the tibia-to-vertical angle with computerized digitation. The clinician with a knowledge of biomechanics understands that functional orthotic devices are more effective on primary calcaneal motions and positions than motions and positions produced by extrinsic tibial, knee, or hip factors. Thus, functional foot orthoses tend to work better in controlling varus during running that is produced by the calcaneus, rather than the tibia.

Biomechanical Phenomena↗

PubMed1999

Supracondylar humeral osteotomy in children with severe posttraumatic cubitus varus deformity.

The authors report the results of corrective osteotomy of the humerus in 11 children with severe posttraumatic cubitus varus deformity. The average carrying angle on the affected side was -24.4 degrees, and there was an average internal rotation deformity of the distal humerus of 22 degrees. Flexion and extension of the injured elbow were severely limited. A supracondylar lateral wedge osteotomy of the humerus was performed keeping the medial cortex intact. Two K-wires served as levers to correct the angular and rotational deformity of the elbow and then as fixation material to hold the osteotomy fragments. Postoperatively we immobilized the elbows in 90 degrees flexion for 3 to 4 weeks. There was no loss of the postoperative osteotomy alignment in most cases. Recurrence of mild varus deformity (-5 degrees and -7 degrees) occurred in only two patients. At the end of the follow-up we observed excellent results in 9 patients with an average carrying angle of 7.2 degrees (range 5-10 degrees).

Adolescent↗

PubMedDate not supplied

Results of femoral varus osteotomy in children older than 9 years of age with Perthes disease.

We review the results of varus osteotomy in 17 patients older than 9 years of age with 18 hips affected by Perthes disease. Seventeen hips were judged as Catterall 3 or 4, and 14 hips had partial or complete loss of the lateral pillar. At an average follow-up of 10 years (4.2-17.8 years), 3 hips were rated Stulberg 1, 3 were Stulberg 2, 4 were Stulberg 3, and 8 were Stulberg 4 or 5. At follow-up, 7 hips were considered good or fair based on the use of Mose circles. Statistical analysis indicated better results in patients younger than 10 years of age compared with those older than 10 years of age. Varus osteotomy as a method of containment for Perthes disease provides improved results in children older than 9 years compared with natural history studies or studies of noncontainment methods. However, it seems likely that there is an upper age limit for effectiveness of containment treatment.

Adolescent↗

PubMed2000

Distal femoral varus osteotomy in the valgus osteoarthritic knee.

The results of 18 distal femoral varus osteotomies performed in 18 patients between 1982 and 1993 were evaluated. All patients had degenerative arthritis of the lateral compartment of the knee associated with a valgus deformity. At surgery, the average patient age was 54 years (range: 38-75 years). The average follow-up was 9 years (range: 5-16 years). The average tibiofemoral angle was 17.5 degrees of valgus preoperatively and 6 degrees postoperatively. Seventeen patients (1 patient died from an unrelated cause) were evaluated at follow-up according to the Knee Society rating system. At follow-up, 13 (77%) were rated as good or excellent by the Knee Society rating system. The Knee score improved from 54 points preoperatively to 89 points postoperatively. The functional score improved from 65 points preoperatively to 86 points postoperatively. One knee required a subsequent total knee arthroplasty (TKA) 5 years after osteotomy due to severe and persistent pain. No patient had infection or nonunion. Varus osteotomy of the distal femur is a reliable and effective surgical procedure for the treatment of gonarthrosis associated with valgus deformity in both young and older active patients, where it can be an alternative to TKA.

Female↗

PubMed1975

[Revalgisation after intertrochanteric varus osteotomy in infancy].

The causes for revalgisation after varus osteotomies are examined in 153 follow ups. Varus osteotomies which slow an insuffizient fixation due to faulty technic or use of Kirschner wires demonstrate only a slight degree of revalgisation. In contrast, stable fixation leads to post-operative revalgisation directly proportional to the time of rigid fixation, we therefore recommend the removal of the fixation device after osseous consolidation, i.e. after 6 months.

Bone Development↗

PubMed2001

[Corrective French's osteotomy in treatment of cubitus varus].

Cubitus varus is the most common late complication of supracondylar fracture of the humerus in children. The normal carrying angle can be restored by supracondylar osteotomy. This operation using the technique described by French. was done in 10 patients. During follow up examination motion of the cubitus was assessed and compared with an uninjured side. The x-ray examination included evaluation of the carrying angle. Favourite results were confirmed by restoration of carrying angle with minor loss of mobility of the elbow joint with no recurrence of the varus deformity during follow up.

Child↗

PubMed2001

Neck-shaft angle remodelling after derotation varus osteotomy for severe Perthes disease.

Sixteen patients with a severe form of Perthes disease who underwent containment derotation varus osteotomy (DVO) of the proximal femur were studied retrospectively for the neck-shaft angle (NSA) remodelling. Analysis of results after a mean follow-up of 7 years (minimum of 5 years and maximum of 8.7 years) showed mean preoperative, immediate postoperative and the latest follow-up neck-shaft angles (NSA) as 135 degrees, 110 degrees (none had varus less than 90 degrees) and 125 degrees, respectively. A statistically significant relationship between NSA remodelling and the immediate post-op NSA (P = 0.0035) was established. Patients with smaller postoperative NSA showed better remodelling compared with those who had higher degrees of NSA immediately after the surgery. No significant relationship was found between the degree of NSA remodelling and the patient's age at diagnosis, age at surgery, severity of Perthes or the Stulberg grading at maturity. The authors conclude that up to 90 degrees or more varization after DVO for Perthes disease can remodel with time, and the remodelling process is independent of the patient's age at diagnosis, age at surgery, or severity of Perthes or Stulberg grading at maturity.

Age Factors↗

PubMed2001

Varus derotation osteotomy for the treatment of hip subluxation and dislocation in cerebral palsy: statistical analysis in 73 hips.

The purpose of this study is to review the results of varus osteotomy in patients with cerebral palsy and to determine factors that influence the rates of residual hip displacement. A retrospective chart review of 65 patients who underwent 79 varus osteotomies was performed. Preoperative, postoperative and follow-up radiographs were analyzed for routine radiographic measurements, pelvic obliquity, osteonecrosis (avascular necrosis), joint incongruity or degenerative joint disease. The average follow-up was 5.2 years (range, 1.1-18.4 years). At follow-up, 3 hips were dislocated, 19 were subluxated and 57 were stable (72%). Age at surgery and the degree of preoperative hip displacement had significant effects on outcome. The average age at surgery for initially subluxated hips, which were located at follow-up, was 7.2 years. This was significantly younger (P = 0.008) than initially subluxated hips, which were displaced (10 years of age). Subluxated hips at surgery were also more likely to be located at follow-up than dislocated hips.

Adolescent↗

PubMed2003

The short-term outcome of surgical treatment for painful varus arthritis in association with chronic ACL deficiency.

A review of patients with anterior cruciate ligament (ACL) insufficiency, symptomatic medial compartment osteoarthritis, and varus malalignment of the knee was performed. Twenty-six patients met the inclusion criteria. Twelve patients were treated with a valgus closing-wedge high tibial osteotomy (group 1). Fourteen patients were treated with a valgus closing-wedge high tibial osteotomy combined with arthroscopic ACL reconstruction (group 2). Twenty-five patients were available for follow-up at a minimum of 2 years. For group 1 patients, high tibial osteotomy alone had no effect on the Lachman test or pivot shift phenomena. For group 2 patients, combined high tibial osteotomy/ACL reconstruction resulted in a grade 1 Lachman test in 11 of 13 patients, and a negative pivot shift in 12 of 13 patients. No deficits in range of motion were noted in either group. Prior to surgery, 14 (56%) patients participated in recreational sports; 23 (92%) patients were able to participate in recreational sports at follow-up. Radiographs demonstrated osteoarthritic progression in group 1 and 2 patients (P<.05). The results of this study suggest that high tibial osteotomy alone and combined high tibial osteotomy/ACL reconstructions are effective in the surgical treatment of varus, ACL-deficient knees with symptomatic medial compartment arthritis; however, good or excellent results were more often seen after the combined procedure.

Adult↗

PubMed2002

Cubitus varus--correction by distraction osteogenesis.

Cubitus varus deformity in thirty children was corrected by gradual medial opening wedge osteotomy. The osteotomy was stabilized and distracted by simple external fixator-cum-distractor. The patients of both sexes and age from 6 to 14 years, had varus deformity from 17 degrees to 43 degrees. We achieved good to excellent results in 28 cases as regards to correction of deformity and range of motion at elbow joint. None of the cases had neurological deficit or permanent stiffness. One case had fair result due to under-correction and another case had a poor result as osteotomy united before correction. The main complication faced was superficial pin-site infection particularly in summer season and a in fatty children but was managed by good pinsite dressing and care. The technique has been found to be quite effective, technically simple, cosmetically acceptable and with little, if any, lazy S deformity.

Adolescent↗

PubMed1992

[Mathematical model of oblique three-dimensional intertrochanteric detorsion varus-forming osteotomy of the femur by the Bernbeck method in surgical treatment of congenital hip dysplasia in children].

Whenever the conservative procedure fails to bring about congruence of the dysplastic hip joint, an operative procedure becomes indispensable. In Orthopaedic Clinic of the Pomeranian Medical Academy in Szczecin we implement the oblique three-dimensional intertrochanteric detorsion and varus forming osteotomy after Bernbeck in order to correct the proximal end of the femoral bone. Precise determination of the plane to be cut, prior to the operative procedure, simplifies and shortens the operation itself and facilitates the achieving of the planned angular values in all three planes. Mathematical model of osteotomy according to Bernbeck considering required angles of correction as well as angles determining the plane of osteotomy was worked out. In collaboration of the Szczecin Technical University, a simple computer program was elaborated which allowed the presentation of the results in the form of tables. With the help of tables the optimal cutting plane was chosen and created correct biomechanical and anatomical conditions as well as optimal conditions for stable osteosynthesis of dissected fragments of the femoral bone. That type of osteotomy is useful in most operative correcrions of the dysplastic hip joint (not great varus formation connected with relatively extensive detorsion). The achieved congruence in the 22 dysplastic hip joints operated on was the most important condition for their later physiological development. Short post-operative observations confirm the value of described mathematic model.

Acetabulum↗

PubMedDate not supplied

Distal tibial transphyseal osteotomy for ankle varus deformity in an operated case of clubfoot.

Ankle varus deformity arises due to a number of congenital and acquired causes leading to significant functional debility in the patients, especially children. We report a less commonly used technique, the transphyseal osteotomy of distal tibia, for the correction of varus deformity of the ankle joint in a thirteen-year-old boy. Full correction of the deformity could be achieved using this technique. The patient is fully functional with normal gait. No recurrence was detected at follow-up visit 26 months later.

Adolescent↗

PubMed2004

Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty.

Interest in unicompartmental knee arthroplasty (UKA) for the treatment of medial compartment osteoarthritis has increased in recent years with apparent improvement in the long-term results. This is a result of improved surgical technique, patient selection, and implant design. In an effort further to improve patient selection we analysed the relationship between the pre-operative alignment of the knee and the anatomical findings at the time of surgery. We compared these findings with the indications for UKA. From 4021 total knee arthroplasties we compared intra-operative observations with the pre-operative clinical data in order to identify knees with isolated, medial, compartment changes, which would have been ideal candidates for UKA. We found that only 247 of the knees (6.1%) met anatomical qualifications for isolated, medial, unicompartmental osteoarthritis, and of these, only 168 (4.3%) met clinical standards ideal for UKA. Preoperative alignment showed a significant relationship with patterns of disease. Logistic regression revealed a relationship between pre-operative alignment and intraoperative findings resembling a Gaussian distribution. Patients with a pre-operative varus alignment of 7 degrees were slightly more likely to be selected for UKA. But the further the anatomical alignment in either direction varies from 7 degrees of varus, the more unlikely it is for the knee to exhibit a disease pattern of isolated, medial, unicompartmental osteoarthritis.

Adult↗