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At least 361 records · Page 20Linked to original sources
PubMed2007

Factors affecting femoral varus osteotomy in cerebral palsy: a long-term result over 10 years.

The present study was conducted to review the long-term results of femoral varus osteotomy with/without pelvic osteotomy of spastic cerebral palsy. We also evaluated the spastic hip score with following factors: migration index of Reimer's, Shenton's line, shape of the femoral head, shape of the roof of the acetabulum, and presence of windblown effect. Of the 31 children (61 hips) reviewed, 49 hips (80%) had satisfactory outcomes after 10 years of follow-up. Twelve hips showed unsatisfactory outcomes with recurrent dislocation or significant osteoarthritis. A low preoperative spastic hip score was more indicative of a better outcome.

Adolescent↗
PubMed1997

Magnetic resonance imaging and early remodeling of the femoral head after femoral varus osteotomy in Legg-Calvé-Perthes disease.

We studied 21 children with Legg-Calvé-Perthes Disease with a prognostically poor development, including lateralization, poor containment, anterolateral flattering, and deformation of the femoral head, as evaluated on serial magnetic resonance (MR) imaging. These children were treated with proximal femoral varus derotation osteotomy. The sphericity of the cartilaginous and bony femoral epiphysis was evaluated postoperatively on serial radiography and MR imaging. There was an early postoperative continuous spherical remodeling over a follow-up period of 3.0 years (1.0-5.1; SD, 1.3).

Bone Remodeling↗
PubMedDate not supplied

Intertrochanteric varus osteotomy in Legg-Calvé-Perthes disease: a report of 112 hips.

The results of 112 intertrochanteric femoral varus osteotomies performed on 102 children with Legg-Calvé-Perthes disease were analyzed. The result worsened with the increasing age of the patient at operation. It was seldom good when the patients age was greater than or equal to 9 years. Catterall grouping and the concept of head at risk were of prognostic significance in patients operated on before 9 years of age and before the disease had reached the healing phase. No correlation was observed between the result and the femoral neck-shaft angle measured preoperatively and after consolidation of the osteotomy.

Age Factors↗
PubMedDate not supplied

Humeral torsional deformity after supracondylar osteotomy for cubitus varus: its influence on the postosteotomy carrying angle.

Humeral torsion was measured in 23 patients by computed tomography (CT) scan after supracondylar osteotomy for cubitus varus. The opposite unoperated humerus was used as the control. The mean torsion in the unoperated humerus was 70 degrees. Patients who did not have "derotation" of the distal fragment during osteotomy had approximately 30 degrees more internal torsion on the operated side than on the opposite side. The carrying angle after osteotomy was not influenced by lack of correction of torsional deformity in the humerus, and correction of torsion during osteotomy was not essential for correction of the carrying angle.

Adolescent↗
PubMedDate not supplied

Uniplanar supracondylar humeral osteotomy with preset Kirschner wires for posttraumatic cubitus varus.

Between 1974 and 1989, a lateral closing wedge osteotomy was used to correct posttraumatic cubitus varus in 36 patients. In 35 (97%) of the patients, the deformity was corrected to within 5 degrees of the contralateral elbow, and the patient was satisfied with the result. There were no nerve palsies or infections. Of the nine patients treated before age six years, seven had a minimum 2-year follow-up (average 9 years), and there was no evidence of recurrent deformity. This technique allows good correction of deformity with minimal complications.

Adolescent↗
PubMed1984

Dynamic EMG findings in varus hindfoot deformity and spastic cerebral palsy.

Dynamic electromyography was used to examine the activity of muscles of 26 children with varus hindfoot deformities as a result of spastic cerebral palsy. Four different patterns of inappropriate muscle activity involving the tibialis anterior, tibialis posterior, gastrocnemius and soleus were seen during walking. Dynamic electromyographic techniques can be very helpful in identifying the specific muscular aberrations which contribute to this deformity.

Adolescent↗
PubMed1988

A comparison of foot-switch and EMG analysis of varus deformities of the feet of children with cerebral palsy.

Fifty-one children with cerebral palsy who were candidates for surgery for equinovarus deformities of the foot had their gait evaluated by means of foot-switches and electromyography to determine the contribution of the anterior tibialis and posterior tibialis muscles to the deformity. Seven EMG patterns and five foot-switch patterns were identified, but there was no correlation between the EMG and foot-switch patterns. Foot-switch data alone could not identify the deforming muscles or their patterns, so are not adequate for planning surgical correction of varus feet of children with cerebral palsy.

Cerebral Palsy↗
PubMedDate not supplied

Corrective osteotomy for pes varus in the dachshund.

Five dachshunds were treated for a distal varus deformity of one tibia. Angulations of 20 degrees to 30 degrees resulted from shortening of the medial tibial length with the maximum curvature at the distal metaphysis. Comparison with the contralateral limbs was required to determine the amount of correction necessary for functional and cosmetic results. Open wedge osteotomies stabilized with a modified type II external fixator resulted in correction of the deformities, early return of limb function, and healing of the osteotomies.

Animals↗
PubMedDate not supplied

Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust.

BACKGROUND: The purpose of this study was to assess the functional outcome of opening wedge high tibial osteotomy (HTO) in a young, active group of patients with instability rather than osteoarthritis. METHODS: The results of 17 opening wedge HTOs in 16 patients with a symptomatic hyperextension-varus thrust were evaluated. Functional results were evaluated according to the activity scoring system of Tegner and Lysholm and using a 5-point visual analogue scale to assess change in knee stability and satisfaction. Radiographs were analyzed to determine changes in femorotibial and mechanical axis alignment, tibial slope, and patellar height. RESULTS: Patients were followed for a mean of 56 months. All patients had an increase in their activity score postoperatively. Nine patients rated their symptoms as significantly better and seven as somewhat better. All but one were satisfied with the surgery. Femorotibial axis alignment was changed to a mean of 6 degrees valgus, mechanical axis alignment was corrected to a mean of 46% toward the lateral compartment, posterior tibial slope was increased a mean of 8 degrees, and the ratio of patellar height was decreased a mean of 0.17. CONCLUSION: Opening wedge HTO can produce good functional and radiographic results in selected patients with a symptomatic thrust.

Adolescent↗
PubMed2006

Radiographic measures of knee alignment in patients with varus gonarthrosis: effect of weightbearing status and associations with dynamic joint load.

BACKGROUND: Radiographic measures of lower limb malalignment are used to indicate abnormal loading of the knee and to plan corrective procedures. HYPOTHESES: Weightbearing status during hip-to-ankle radiographs will significantly affect malalignment measures; malalignment in single-limb standing will be most highly correlated to the external knee adduction moment during gait, a proposed dynamic measure of functional knee joint load. STUDY DESIGN: Controlled laboratory study. METHODS: Mechanical axis angle was measured in 40 patients with varus gonarthrosis from hip-to-ankle radiographs taken with patients in single-limb standing, double-limb standing, and supine positions. Kinematic and kinetic data were collected during walking and used to calculate the peak adduction moment about the knee. RESULTS: Repeated-measures analysis of variance and Scheffé post hoc tests indicated that mechanical axis angle measured on single-limb standing radiographs (-8.7 degrees +/- 4.0 degrees) was significantly greater than on double-limb standing radiographs (-7.1 degrees +/- 3.8 degrees), which was significantly greater than on supine radiographs (-5.5 degrees +/- 2.8 degrees). The peak knee adduction moment (2.8 +/- 0.8 percentage body weight x height) was only moderately correlated with mechanical axis angle on single-limb standing (r = -0.46), double-limb standing (r = -0.45), and supine (r = -0.43) radiographs. CONCLUSION: Patient position significantly affects frontal plane knee alignment. However, the peak knee adduction moment is only moderately correlated to mechanical axis angle, regardless of weightbearing status. CLINICAL RELEVANCE: These findings are inconsistent with the hypothesis that mechanical axis angle measured in single-limb standing is more representative of dynamic joint load and further highlight the differences between static and dynamic measures. Results also underscore the importance of reporting patient position during radiographs and keeping positions consistent when evaluating patients over time.

Adult↗
PubMedDate not supplied

High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two- to seven-year follow-up study.

We assessed short-term treatment results of younger patients with varus malalignment and chronic anterior cruciate ligament deficiency. Forty-one patients (mean, 32 years; range, 16 to 47) underwent a high tibial osteotomy. Because of giving way symptoms, 14 also had a lateral iliotibial band extraarticular procedure at the time of the osteotomy and 16 had an intraarticular anterior cruciate ligament allograft reconstruction after the osteotomy. All returned for followup (mean, 58 months; range, 23 to 86), which included KT-1000 arthrometer testing and evaluation by our knee rating system. Statistically significant (P < 0.05) improvements were found in the mean overall rating scores for pain, swelling, and giving way. Preoperatively, 30 (73%) had pain with activities of daily living or with any sports activity; 11 (27%) could perform only light sports activities without pain. At followup, 32 patients (78%) had no pain with activities of daily living or light sports. Ten of 15 patients with advanced medial tibiofemoral arthrosis (subchondral bone exposure) had significant improvements in symptoms. Patient satisfaction was high: 88% stated they would undergo the procedure again and 78% felt their knee condition was improved. Patients who had the allograft reconstruction had significantly lower (P < 0.05) anterior-posterior displacements at followup than those who had the extraarticular procedure. We concluded that osteotomy should be performed early in the disease process for younger athletes who experience symptoms with activity. It may be unrealistic, however, to expect continuation of sports beyond light recreational, given the joint arthrosis that is usually present and the high in vivo joint loadings with athletes. Anterior cruciate ligament reconstruction should be considered when giving way previously occurred and the patient plans to resume athletics. However, patients with advanced arthrosis can avoid anterior cruciate ligament surgery by reducing athletic activities.

Adolescent↗
PubMedDate not supplied

Roentgenographic and mathematical analysis of first metatarsal osteotomies for metatarsus primus varus: a comparative study.

The operative effectiveness of five different first metatarsal osteotomies for nonarthritic hallux valgus and metatarsus primus varus were objectively evaluated roentgenographically. The series consisted of 120 feet (75 patients) seen over a 5-year period. The osteotomies were biplanar neck, Chevron, biplanar basilar, basilar concentric, and basilar concentric combined with a lateral closing wedge. All the osteotomies except for the Chevron had varying degrees of plantar displacement of the distal fragment and crossed Kirschner wire fixation. The operative techniques and failures are discussed. Special x-ray studies confirmed misleading pseudocorrections caused by bandage compression and intraoperative and early postoperative roentgenographic distortion. The Chevron gave the least correction, 2 degrees, and did not permit plantar displacement to obviate late metatarsal transfer lesions. The biplanar neck osteotomies were technically the simplest, giving 86% satisfactory corrections, averaging 4.3 degrees. The biplanar basilar osteotomies yielded the most erratic results. The poor results were due to medial tilt during fixation, thereby negating any correction. The technical difficulties with the basilar concentric osteotomy were overcome by the addition of a small lateral closing wedge. This procedure gave by far the most consistently good results with corrections of up to 12 degrees, averaging 7.9 degrees.

Adolescent↗
PubMedDate not supplied

A method of predicting the degree of functional correction of the metatarsus primus varus with a distal lateral displacement osteotomy in hallux valgus.

Metatarsus primus varus may be an important pathologic component in hallux valgus deformity. The correction of the pathologic intermetatarsal angle M1 M2 is essential for providing an acceptable alignment of the hallux. The distal lateral displacement osteotomy of the first metatarsal (Chevron or Mitchell) provides correction of the intermetatarsal angle M1 M2. The present paper describes a simple method of calculating preoperatively the maximum possible correction through such osteotomies. This method, based on the measurement of the length of the first metatarsal and the width at the osteotomy site, projects the amount of correction and, furthermore, provides the limits of angular correction through such osteotomies performed distally.

Foot Deformities, Acquired↗
PubMed1988

Basal osteotomy of the first metatarsal for the correction of metatarsus primus varus associated with hallux valgus.

At the University of Vienna Department of Orthopaedics, 26 feet in 21 patients were treated with a basal osteotomy for hallux valgus associated with metatarsus primus varus. In 85% of the cases, a satisfactory result was achieved. Critical analysis revealed shortening of the first metatarsal and elevation of its head, which resulted in excess lateral straining of the foot and metatarsalgia. In 15 cases, osteoarthritis in the metatarsocuneiform joint was also increased. Given these results, an osteotomy that prevents shortening of the first metatarsal and elevation of the head of the first metatarsal, or one that takes these facts into account, seems ideal.

Adolescent↗
PubMedDate not supplied

Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus.

Sixty-seven closing wedge arthrodesis procedures of the first metatarsocuneiform joint were performed in 41 females and 12 males. Follow-up averaged 28 months (range 16-49 months) and was performed in 51 of 53 patients with a questionnaire, clinical examination, and comparison of pre- and postoperative weightbearing radiographs. The average hallux valgus angle was 34.5 degrees (range 20 degrees-75 degrees) and was corrected to 13.0 degrees (range-10 degrees-22 degrees) postoperatively. The average intermetatarsal angle was 14.3 degrees (range 9.5 degrees-34 degrees) and was corrected to an average of 5.8 degrees (range 0 degrees-12 degrees) postoperatively. Complications included seven superficial pin tract infections, three symptomatic dorsal bunions, one of which required repeat surgery, seven nonunions, one of which was symptomatic, one hallux varus, and three neuromas of the deep peroneal nerve. The range of motion of the hallux metatarsophalangeal joint was 85% of normal postoperatively. A total of 77% of the patients were totally relieved, 15% partially relieved, and 8% not relieved with respect to pain, comfort, appearance of the foot, and shoewear following surgery. The specific indications for performing this operation are discussed.

Adolescent↗
PubMed1994

Asymmetric bifurcation of the extensor digitorum longus tendon in a case of congenital digitus minimus varus.

Congenital digitus minimus varus (overlapping of the fifth toe) is often bilateral and may result from an anatomic deformity of the extensor digitorum longus tendon. Although bifurcation of the tendinous slip to the fifth toe has been reported as an anatomical variant, in those patients affected with overlapping fifth toe, a pronounced asymmetry between the medial and lateral components may occur. Not only do the two slips to the fifth toe differ in girth, but the morphology of the separate tissues reflects a dissimilar level of organization. Surgical techniques for correction of secondary overlap should consider the possibility of altered gross and histologic anatomy of the extensor tendon when attempting to preserve function.

Child↗
PubMed1997

Action of the peroneus longus tendon on the first metatarsal against metatarsus primus varus force.

A medially directed force was applied to the first metatarsal in 10 cadaver feet. The peroneus longus tendon was subjected to a pull of 5 pounds. The soft tissues between the first and second metatarsals were cut sequentially, starting with the skin on the dorsal and plantar aspect, followed by the intermetatarsal ligament and adductor hallucis tendon, and, finally, the peroneus longus tendon at its distal insertion. Dorsoplantar radiographs while weightbearing were taken after each sectioning. A statistically significant varus displacement of the first metatarsal was observed only after transection of the peroneus longus tendon. It was concluded that the peroneus longus tendon is a strong retaining mechanism of the first metatarsal.

Biomechanical Phenomena↗