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At least 37 records · Page 2Linked to original sources
PubMed2000

Cubitus varus: problem and solution.

A lateral closing wedge osteotomy was performed in 39 children with cubitus varus deformity resulting from a supracondylar fracture. All had a deformity of 15 degrees or more, with 5 having more than 30 degrees of varus. The osteotomy was fixed by three different methods. In 8 cases the osteotomy was fixed with 2 parallel Kirschner wies (group K). A modified French technique (group TBW) was used in 25 cases and held with a figure-of-8 wire loop tightened over the screw heads. In the last 6 cases the osteotomy was fixed with an external fixator (group EF). The only poor result (i.e. loss of carrying angle of more than 10 degrees and loss of flexion and extension of 20 degrees or more) was in group K due to pin tract infection and loosening of the K-wires. In the TBW group 5 patients lost some degree of correction, and none became infected. In the EF group no patient suffered pin tract infection or loss of correction. Based on our experience and results, we feel that the best age at which to correct cubitus varus deformity was 6-11 years and that the external fixator is a safe, effective and reliable method to fix the osteotomy. We propose this method of fixation as a good alternative method to the modified French technique, especially in cases of severe cubitus varus deformity, where removal of a large wedge can produce a big step at the osteotomy site, increasing the possibility of disengagement of the stainless steel wire from the screw head. In addition, minor postoperative modifications of correction, if required, can also be performed. It also avoids a second operation for implant removal.

Adolescent↗
PubMed2005

Stress fracture of the femoral neck as a complication of total knee arthroplasty.

Stress fracture of the hip is a rare complication of total knee arthroplasty that occurs most often in patients in whom a significant deformity of the knee has been corrected, particularly those with poor mobility before surgery. We report 4 cases of ipsilateral fracture of the femoral neck after total knee arthroplasty.

Aged↗
PubMed2003

Varus/valgus alignment of the tibial component in total knee arthroplasty.

The varus/valgus alignment of the tibial components of 350 total knee arthroplasties was assessed radiologically. All the tibial components were implanted using an extramedullary guide under the supervision of the senior author. Of components, 96.3% were implanted within 2 degrees of the perpendicular to the longitudinal axis of the tibia. In order to validate our X-ray assessment, a subgroup of 40 knees was re-assessed using a CT scanogram. Analysis of this subgroup showed a close correlation between the results using the two different methods (mean difference 0.88 degrees, S.D. 0.75). We believe that with anticipated future advances in robotic and computer assisted surgery it is important to set the benchmark for what can be achieved with current technology.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Retrograde intramedullary nailing in tibiotalocalcaneal arthrodesis: a short-term, prospective study.

In this prospective study, tibiotalocalcaneal arthrodesis was performed in 29 patients with a retrograde femur nail (Interlocking Compression Nail; Stryker Trauma, Schönkirchen, Germany) inserted through a plantar approach. Patients were evaluated by a standardized follow-up examination using the American Foot and Ankle Society ankle-hindfoot scale and the main criteria of the short-form health survey (36 items). Special emphasis was placed on surgical approach, bony consolidation, and postoperative quality of life. Solid fusion was achieved in 90% of the patients after a mean follow-up of 25 months. Twenty-two patients (76%) showed primary bone healing after an average of 5.2 months; a delayed union was observed in 7 patients. In 79% of the patients, pain was reduced effectively and quality of life substantially improved with the intramedullary nail arthrodesis. The average ankle-hindfoot score improved from 46 (range, 41-53) to 71 (range, 49-83) points. Complications occurred in 6 patients (21%), including 2 deep infections, 3 nonunions, and 1 case of postoperative flexion deformity. The authors found retrograde intramedullary nailing in tibiotalocalcaneal arthrodesis to be an effective technique in obtaining solid fusion, an effective relief from pain, and an improvement of quality of life.

Adult↗
PubMed2005

Fixation stability following high tibial osteotomy: a radiostereometric analysis.

Fifteen patients with varus gonarthrosis underwent high tibial osteotomy and internal fixation with an L-shaped rigid plate. In 9 patients, an average wedge size of 7.1 degrees was resected leaving the medial cortex of the proximal tibia intact (group 1). In 6 patients, the medial cortex of the proximal tibia was unintentionally fractured during surgery when an average 10.7 degrees wedge was resected (group 2). Postoperatively, patients were monitored with serial radiostereometric analysis (RSA), conventional radiographs, and clinical evaluation for 1 year. In group 2, RSA revealed a 1.3-mm increase in lateral displacement of the distal tibial segment within 3 weeks following surgery. Twelve weeks after surgery, micromotion between tibial segments was below the precision of the RSA setup in 14 of 15 patients. These findings indicate that in cases with larger wedge sizes (>8 degrees), fracture of the medial cortex of the proximal tibia was frequent and resulted in significant lateral displacement of the distal tibia relative to the tibial plateau. In such cases, prophylactic additional medial fixation rather than lateral L-plate fixation alone is advised to minimize the propensity for lateral displacement of the distal tibia and to avoid subsequent loss of correction.

Bone Malalignment↗
PubMedDate not supplied

[Analysis of two different techniques of osteosynthesis in high tibial osteotomy].

AIM: High tibial osteotomy is an accepted method for varus osteoarthritis. This study intended to compare the technique of plate osteosynthesis with the technique of staple osteosynthesis, as a less invasive procedure. METHOD: 61 patients (65 knees) were included in this retrospective study evaluating the HSS score, patient's satisfaction, non weight bearing period, radiological stage of osteoarthritis, bone healing and complications after a follow up period of 5.7 (5 - 9) years. 26 patients (27 knees) were treated with plates and 37 patients (38 knees) with staples after osteotomy. RESULTS: Patients treated with plates showed 62.2 % excellent and good, 27.8 % moderate and poor results in the HSS score, 77.8 % were very satisfied and satisfied, 22.2 % less or not satisfied. Patients who received staple osteosynthesis showed 80.8% excellent and good, 19.2 % moderate and poor results in the HSS score and were very satisfied and satisfied in 86.9 %, less and nor satisfied in 13.1 %. The periods of non weight bearing and bone healing were slightly longer for patients treated with staples. There was no significant difference in complications. CONCLUSION: The data of the present study suggest that staples as a less invasive osteosynthesis after high tibial osteotomy seem to be justified compared to plate osteosynthesis having no significant difference in clinical results.

Aged↗
PubMedDate not supplied

[Combinations of different cartilage resurfacing techniques].

AIM: The aim of this work was to control the results after simultaneous use of different modern resurfacing techniques. METHODS: We examined the patients who were subjected to different cartilage repair methods using the ICRS score (anterograde drilling, autologous chondrocytes transplantation, OATS, refixation with resorbable pins, spongious bone grafting, HTO). RESULTS: In two cases the combination of different cartilage regenerative methods in a one-step technique produced a good reconstruction of the joint surface with good clinical outcome. With the implantation of carbon plaques, osteolysis of the spongious bone in combination with an incomplete defect filling can be observed. The therapy must be individual and take the clinical, radiological and intraoperative findings into consideration. CONCLUSION: The combination of different resurfacing techniques may have success only if the biomechanical properties of the joint with axial malpositioning and ligament instabilities are considered and treated as well. New prospects are offered particularly for young patients with extensive cartilage damage and without other therapeutic options.

Adult↗
PubMedDate not supplied

[Femoral head epiphyseolysis].

Slipped capital femoral epiphysis could be regarded as exceeding of a physiological process in puberty in which overweight of the patients seems to be the essential factor. Early clinical and radiological diagnosis are important to perform simple surgical procedures stopping further lysis and avoiding later osteoarthritis. Fixation of the femoral epiphysis with K.-wires are emphasized worldwide because of the lower complication rate. In case of severe slip osteotomies for realignment are more problematic. Long term follow-up studies have shown poor results mostly because of chondrolysis and femoral head necrosis in a high percentage. The demand on renunciation of realignment procedures in s.c.f.e. however, can't be supported. In our own patients, recently followed up, realignment osteotomies were without greater problems with no complications like chondrolysis or head necrosis. Stabile fixation of osteotomies allowed early mobilisation just after operation and may be one reason that chondrolysis didn't exist in our patient group. Considering our knowledge today therapeutic procedure of slipped capital femoral epiphysis is described.

Adolescent↗
PubMed2002

Anatomic assessment of the proper insertion site for a tibial intramedullary nail.

OBJECTIVES: To locate the proper insertion point for a tibial intramedullary nail in the coronal plane. DESIGN: Fifty-seven cadaveric lower legs were disarticulated at the knee and ankle and stripped of their soft tissue. Each tibia was nailed in a retrograde fashion through the center of the tibial plafond with a seven-millimeter sharp-tipped rod through the proximal tibia. The exit point of the nail was measured in the coronal plane in relation to the tibial tubercle. RESULTS: Except for one tibia, the intramedullary nail exit point was always located medial to the center of the tibial tubercle with the average being eight millimeters +/- six millimeters medial to the center of the tibial tubercle. Forty-six percent of the nails exited medial to the whole tibial tubercle. CONCLUSIONS: The insertion point of a tibial nail should be over the medial aspect of the tibial tubercle in the coronal plane. Our data supports using a medial or patellar splitting approach for nail insertion. Insertion sites lateral to the tibial tubercle should be avoided.

Aged↗
PubMed2002

Malrotation after locked intramedullary tibial nailing: three case reports and review of the literature.

BACKGROUND: Malrotation after interlocked tibial nailing is rarely documented. METHODS: We report the cases of three patients who incurred symptomatic rotational deformities after closed intramedullary nailing for low-energy spiral fractures of the distal third of the tibia. RESULTS: Two patients elected surgical correction, with excellent clinical results. CONCLUSION: Malrotation may cause functional deficits, but the long-term consequences of rotational deformities in the tibia have not been thoroughly studied. Malrotation after tibial nailing is probably more common than reported. Intraoperative comparison with the uninjured leg may be the best means available for avoiding this postoperative complication.

Accidental Falls↗
PubMed1997

Recurrent rotational deformity of the femur after static locking of intramedullary nails: case reports.

Rotational deformity following intramedullary nailing may cause symptoms and require surgical correction by osteotomy. Reamed, locked intramedullary nailing may be performed, but concern about cortical blood supply and potential pulmonary dysfunction from reaming have led many surgeons to limit this and use smaller diameter nails. Slotted nails are commonly used but are less stiff in torsion than the newer unslotted nails, particularly at the lower diameters. We report two cases of recurrent femoral rotational deformity after using statically interlocked slotted intramedullary nails to correct existing femoral rotational deformities. These patients show that small diameter statically interlocked femoral nails with diminished bone-nail contact must be stiff enough in rotation to avoid potential recurrence.

Adult↗
PubMed1997

A more accurate method of measurement of angulation after fractures of the tibia.

Accurate measurement of the alignment of the tibia is important both clinically and in research. The conventional method of measuring the angle of malunion after a fracture of the shaft of the tibia is potentially inaccurate because the mechanical axis of the normal bone may not pass down the centre of the medullary canal. An alternative method is described in which a radiograph of the opposite tibia is used as a template. A sample of 56 sets of standard radiographs of healed fractures of the shaft of the tibia was evaluated. The 95% limits of agreement between this and the conventional method were wide, being -6.2 degrees to +5.5 degrees for coronal angulation and -6.7 degrees to +8.1 degrees for sagittal angulation. These results suggest that the conventional method is inaccurate. The new method has good inter- and intraobserver reliability.

Bone Malalignment↗
PubMed2004

Supramalleolar derotation osteotomy of the tibia, with T plate fixation. Technique and results in patients with neuromuscular disease.

Torsional deformities of the tibia are common in children, but in the majority both the torsion and the associated disturbance of gait resolve without intervention. There are, however, a significant number of children and adults with neuromuscular disease who present with pathological tibial torsion, which may require surgical correction. We conducted a prospective study in two centres, to investigate the outcome of supramalleolar derotation osteotomy of the tibia, using internal fixation with the AO-ASIF T plate. A range of outcome variables was collected, prospectively, for 57 patients (91 osteotomies), including thigh foot angle, foot progression angle, post-operative complications and serial radiographs. Correction of thigh foot angle and foot progression angle was satisfactory in all patients. Three major complications were recorded; one aseptic nonunion, one fracture through the osteotomy site after removal of the plate and one distal tibial growth arrest. We found that supramalleolar derotation osteotomy of the tibia, with AO-ASIF T plate fixation is an effective method for the correction of torsional deformities of the tibia and the associated disturbances of gait in children and adults with neuromuscular disease, with a 5.3% risk of major complications.

Adolescent↗