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PubMedDate not supplied

Reverse Austin osteotomy for correction of hallux varus.

A case of hallux varus and extensus of unusual etiology and treatment is presented. Special emphasis is directed toward the angle formed between the first metatarsal base and medial cuneiform, which these investigators believe has not been previously described. The procedure performed is a reverse Austin bunionectomy with a step-by-step outline of soft tissue procedures attempted before osteotomy. The cartilage at the first metatarsal head was medially adapted and of normal structure and function preoperatively; therefore, the decision was made to perform a joint preservation procedure.

Female↗
PubMed2000

Humerus varus deformity in Roman period burials from Kellis 2, Dakhleh, Egypt.

Humerus varus deformity (HVD) occurs unilaterally in a female (#85) skeleton and bilaterally in a male (#124) from Kellis 2, a Roman period cemetery (circa 300-450 AD) from Dakhleh, Egypt. The affected humeri were shortened, their glenohumeral joints deformed, and their upper diaphyses were angulated. The skeletons were otherwise normal. The severity of the changes suggests that the underlying growth disturbances occurred early in postnatal development. The differential diagnosis considers the mucopolysaccharidoses, thalassemia, infection, and birth trauma, with the latter being favored. Clinical data show limited morbidity or functional impairment in individuals with HVD, although radiographic analysis suggests that #85 may have favored her dominant arm. Ortner and Putschar (1981), and Hershkovitz et al (1991) describe the only other archaeological cases of HVD. These authors provide useful, though limited, information on the differential diagnosis of HVD in archaeological specimens. Future research should focus on documenting the prevalence and expressivity of HVD in Mediterranean population samples where thalassemia evolved. HVD is relatively common in thalassemics and this approach would be valuable for documenting the range of osseous responses characteristic of HVD.

Animals↗
PubMed2006

Evaluation of bone healing enhancement by lyophilized bone grafts supplemented with platelet gel: a standardized methodology in patients with tibial osteotomy for genu varus.

Orthopedic practice may be adversely affected by an inadequate bone repair that might compromise the success of surgery. In recent years, new approaches have been sought to improve bone healing by accelerating the rate of new bone formation and the maturation of the matrix. There is currently great interest in procedures involving the use of platelet gel (PG) to improve tissue healing, with satisfactory results both in vitro and in maxillofacial surgery. Otherwise, to our knowledge, only a preliminary clinical study was undertaken in the orthopedic field [Kitoh et al., Bone 2004;35:892-898] and the efficacy of PG is still controversial. Our paper focuses on the effect on bone regeneration by adding PG to lyophilized bone chips used for orthopedic applications. The clinical model and the laboratory methodology were standardized. As a clinical model, we employed the first series of patients of a randomized case-control study undergoing high tibial osteotomy (HTO) for genu varus. Ten subjects were enrolled: in 5 patients lyophilized bone chips supplemented with PG were inserted during tibial osteotomy (group A); 5 patients were used as a control (group B) and lyophilized bone chips without gel were applied. Forty-five days after surgery, computed tomography scan guided biopsies of grafted areas were obtained and the bone maturation was evaluated by a standardized methodology: the osteogenic and angiogenic processes were semi-quantitatively characterized by using histomorphometry, and the mineral component of the lyophilized and host bone was analyzed by using X-ray diffraction technique with sample microfocusing and microradiography. Lyophilized bone with PG seems to accelerate the healing process, as shown by new vessel formation and deposition of newly formed bone, with no evidence of inflammatory cell infiltrate, when compared with lyophilized bone without gel. On the contrary, lyophilized bone undergo a resorption process, and a fibrous tissue often fills the spaces between chips. A histiocytic/giant-cell reaction is sometimes present. Otherwise, no differences have been found concerning microstructure. Our findings show the reliability of the methodology used to monitor early bone repair. The completion of the study and the evaluation of the ultimate clinical outcome are necessary in order to verify PG in vivo effects in orthopedic surgery.

Adult↗
PubMed1990

Bone and cartilage changes following experimental varus or valgus tibial angulation.

The purpose of this work was to determine whether subchondral bone changes are an integral part of the development of osteoarthrosis of the knee following experimentally created tibial angulation. Thirty degree varus or valgus proximal tibial osteotomies were created in female New Zealand white rabbits. Bone and cartilage changes were assessed grossly, radiologically, and histologically. Thirty-four weeks following osteotomy, severe cartilage changes, including osteophytes, fibrillation, derangement of cell columns, and cloning, were evident on the overloaded condyle, accompanied by increased subchondral bone density. The pattern of cartilage deterioration was different from that found in other experimental, mechanically induced arthroses. We conclude that osteoarthrosis is a final common pathway for mechanically induced joint failure, and that progressive cartilage change is associated with increased subchondral bone density.

Animals↗
PubMed1990

Oblique tibial osteotomy for rotational and varus deformities in children.

A technique of oblique tibial osteotomy is described which is effective in correcting varus and medial rotational deformities in young children. The oblique cut in one plane corrects both elements of the deformity at the same time. We have used the method on both legs in four children and satisfactory results were obtained.

Child, Preschool↗
PubMed1997

External rotational positioning of the leg after intertrochanteric combined varus-derotational osteotomy in Perthes' disease.

A 13-year-old boy underwent an intertrochanteric combined varus derotational osteotomy (VDO) for Perthes' disease of his right hip. After surgery he walked with his right leg externally rotated. Computed tomography scans of both knees and hips were obtained with the legs in their spontaneous position to evaluate rotation and anteversion. The femoral condyles were in 28 degrees of external rotation on the operated side compared with 2 degrees on the non-operated side. The angle between the femoral neck and the horizontal plane was 32 degrees on both sides. We conclude that there may be a risk that a derotational osteotomy may produce an external rotational position of the leg instead of altering the angle between the femoral neck and the horizontal plane.

Adolescent↗
PubMed1995

False-positive sonographic hip examinations in newborns with congenital varus deformity of the proximal femur.

In cases of congenital varus deformity of the proximal femur, the screening of hip dysplasia can lead to misinterpretations. The false-positive ultrasound result is caused by the superiorly displaced greater trochanter in hips with coxa vara, which narrows the scan window. In this paper three typical patients are presented to demonstrate that the use of additional non-standard views cannot exclude hip dysplasia in all cases. Hence, such patients with femoral abnormalities and doubtful sonographic findings should be further evaluated by arthrography or magnetic resonance imaging to rule out additional hip dysplasia.

False Positive Reactions↗
PubMed1989

The surgical treatment of metatarsus primus varus in the adult.

As a surgical treatment of metatarsus primus varus in the adult, metatarsal osteotomy toward valgus near the base with internal fixation using a 40-mm AO small-fragment cancellous screw, in which a medical cortical console has a stabilizing function for the support of the screw head, has proved successful in 31 cases.

Bone Screws↗
PubMed1990

Hand-foot-genital syndrome: the importance of hallux varus.

The hand-foot-genital syndrome is an autosomal dominant disorder previously reported in six families. This report of the seventh family identified with this syndrome is presented to emphasize the frequent occurrence of medial deviation of the first toes (hallux varus).

Abnormalities, Multiple↗
PubMed2005

[Soft tissue management in knees with varus deformity. Computer-assisted sequential medial ligament release].

BACKGROUND: Knees with severe varus deformities and contractures of the medial and lateral collateral ligaments and the posterior capsule require special soft tissue management to gain a stable knee over the full range of movement. The introduction of navigation systems into knee surgery has now made precise measurement of the leg axis and gap size possible. METHODS: Ten knee joints received a computer-assisted total knee replacement (Ci navigation system DePuy) I-Orthopaedics, Munich). The change of the leg axis and the size of the mediolateral gaps were measured and documented when performing a standardized medial ligament release sequence. RESULTS: We found a significant effect after each release step regarding the change of the leg axis as well as the gap width (p<0.001). The highest effect was seen for the 6-cm capsule release in extension and the release of the medial collateral ligament in 90 degrees flexion. CONCLUSION: Implementation of computer-assisted navigation facilitates visualization and quantification of the effect of the sequential medial soft tissue release in total knee arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed2006

Bilateral varus osteotomies in hip deformities: are early interventions superior? A long-term follow-up.

Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26 patients with a symmetrical hip deformity for which we performed a therapeutic osteotomy on the symptomatic hip. The contralateral hip had the same anatomical predisposition to develop an OA, but there were only minor to no complaints. We advised and performed an early osteotomy on these hips. On radiological evaluation, an average Sharp angle of 42.2 degrees and an average CCD of 142 degrees was present. During an average follow-up period of 19.9 years (range 15.0-25.9), 14 hips were converted to THR after the primary osteotomy, whereas there were only 6 after the early osteotomy (chi-square P<0.05). Using a Pearson correlation analysis, the age, preoperative grade of OA, preoperative Merle d'Aubigne score and excessive femoral anteversion were significantly correlated with the outcome. Our results show that the effect of an early, more prophylactic varus osteotomy in patients with a coxa valga with excessive femoral anteversion and acetabular dysplasia can be superior to the results achieved when surgery is postponed until the complaints and arthrosis have become more severe.

Adult↗
PubMed1996

Combined acetabuloplasty and varus derotation osteotomy in congenital dislocation of the hip. Long-term results.

Twenty-two patients (33 hips) with congenital dislocation of the hip were examined at an average of 26 years after combined acetabuloplasty and intertrochanteric varus derotation osteotomy. Seventeen patients had no problems despite physically demanding jobs and sporting activities in some cases. The CE angle was improved to the lower end of the normal range. The shaft-neck angle was corrected by 31 degrees to 120 degrees. Restoration to the normal valgus subsequently occurred and we found no evidence of subcapital coxa valga. Although there was an increase in the neck epiphysis angle 5 years after operation indicating a horizontal shift in the epiphyseal plate, most cases had normal hip joints. The incidence of postoperative avascular necrosis of the femoral head was 6%, and we found no increase in femoral deformities. Our long-term results show that the combination of acetabuloplasty and femoral osteotomy has no disadvantages, and is the best way of achieving optimal centring of the femoral head and stabilisation of the hip.

Acetabulum↗
PubMed2005

Curved varus femoral osteotomy for minimal dysplastic hip in patients older than 45 years of age: comparison with rotational acetabular osteotomy.

Periacetabular osteotomies, such as rotational acetabular osteotomy (RAO) for osteoarthritis (OA) secondary to hip dysplasia, have produced satisfactory medium- and long-term results in early OA. However, as the degree of surgical invasion of these procedures is comparatively major and long-term postoperative rehabilitation is required, this procedure is generally not indicated for those in the fifth and sixth decades of life. Curved varus femoral osteotomy (CVO), which is a less invasive procedure, is considered a worthwhile option, although to the best of our knowledge no comparative study has been reported on these two procedures in older patients. We performed a comparative study on the outcomes of CVO for minimal dysplasia of the hip with a center-edge (CE) angle greater than 5 degrees in 15 patients (15 joints) older than 45 years of age at a mean period of 8 years after surgery and on the outcomes of RAO in 16 patients (18 joints) performed during the same period. No significant difference was observed between the two groups regarding the Merle d'Aubigne score during follow-up. Progression of osteoarthritis was radiologically observed during follow-up in three hips in the CVO group and in one hip in the RAO group. Kaplan-Meier survivorship analysis, with radiological progression of osteoarthritis as the endpoint, predicted a survival rate of 75% at 10 years in the CVO group. In the RAO group the predicted 10-year survival rate was 94%, demonstrating no significant difference between the two groups. CVO is a less invasive surgical technique than RAO, requires a comparatively shorter period of postoperative rehabilitation, and is useful as a joint-preserving procedure in older patients with minimal dysplasia of the hip with unilateral involvement. CVO should be selected for elderly patients with a CE angle greater than 5 degrees .

Acetabulum↗
PubMed1991

Prevention of cubitus varus deformity in supracondylar fractures of the humerus.

Based on cadaveric experiments, peroperative observations and clinical study, an exact mechanism is described by which full pronation of the forearm prevents cubitus varus deformity in supracondylar fractures of the humerus. The significance of the position of the upper limb in relation to the chest is described, and it has been demonstrated that even the posterolaterally displaced supracondylar fractures are better reduced and maintained in pronation.

Adolescent↗
PubMed2004

Total knee arthroplasty in patients with angular varus or valgus deformities of > or = 20 degrees.

Of 8,014 surgeries between January 1986 and August 2000, 82 primary total knee arthroplasties (TKAs) were performed on 75 patients with severe preoperative varus or valgus deformity of greater than or equal to 20 degrees with a minimum 2-year follow-up time and a posterior cruciate retaining prosthesis. This study was designed to determine whether these patients (group A) could be as successful, using a Knee Society score (KSS) and alignment, as a matched control group (group B). There was no statistical difference in knee score, alignment, or revision. One revision was performed among the severely deformed. Knees that had severe angular deformities performed as well as deformity-free TKAs. Patients with excessive deformity should not be excluded from surgical correction solely based on this deformity.

Aged↗
PubMed2006

Chronic ankle instability: management of chronic lateral ligamentous dysfunction and the varus tibiotalar joint.

Many techniques have been described in acute and chronic lateral ligament insufficiency in the ankle. At present, the Bostrom-Gould and Chrisman-Snook procedures and their variations remain the "gold standard". Recent assessment of important etiologic factors has shed some light on the relationship between the original injury or injuries and the subsequent development of the varus tibiotalar joint with or without secondary osteoarthritis. The development of Taylor Spatial Frame may well revolutionize its management. In the meantime, further consideration should be given to well-designed and evaluated randomized controlled trials, improved understanding of the biomechanics, and function of the ligaments, for example, proprioceptive function and their healing. Newer and less invasive arthroscopic and percutaneous techniques are being developed.

Ankle Joint↗
PubMed2005

Varus impacted intracapsular hip fractures.

We describe a distinct variant of an impacted intracapsular hip fracture that is difficult to classify within any of the current fracture classification systems. Instead of impaction occurring laterally, as generally occurs with a Garden grade I fracture, there is medial impaction. We have termed this a varus impacted fracture. Nineteen such fractures were identified. The majority of these patients presented with a history of progressive hip pain over several days without a definite history of trauma. For the 16 fractures treated by internal fixation without any attempt at fracture reduction, fracture healing occurred in 11 cases.

Aged↗