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PubMed1998

Mechanical comparison of biplanar proximal closing wedge osteotomy with plantar plate fixation versus crescentic osteotomy with screw fixation for the correction of metatarsus primus varus.

Proximal crescentic metatarsal osteotomy is a clinically successful technique for correcting metatarsus primus varus in hallux valgus surgery. However, there have been instances of dorsal elevation of the metatarsal head with this technique. Mechanical testing on 10 matched pairs of cadaver feet was performed to evaluate a new technique combining a biplanar closing wedge osteotomy and plantar plate fixation versus crescentic metatarsal osteotomy. The specimens were tested in cantilever-bending mode on an MTS Mini Bionix test frame. The mean load-to-failure values were 127.2 +/- 81.9 N (SD) for biplanar osteotomy with plate fixation and 44.9 +/- 43.3 N for crescentic osteotomy (P = 0.019); the mean stiffness values at the initial portion of the load-deflection curve were 83.11 +/- 73.76 N/mm and 31.95 +/- 43.00 N/mm, respectively (P = 0.012). The biplanar wedge osteotomy with plantar plate fixation demonstrated significantly stronger fixation than the crescentic osteotomy, with higher mean load-to-failure and stiffness values. This newly described technique may provide an acceptable alternative for patients at risk for dorsal elevation of the metatarsal, particularly those who are noncompliant or have osteopenia. Clinical study will determine whether this new technique offers satisfactory long-term results.

Biomechanical Phenomena↗

PubMed1999

Unilateral tibial hemimelia with leg length inequality and varus foot: external fixator treatment.

A 15-year-old girl with type II unilateral hemimelia presented with a 13.5-cm shortening of her right leg, absence of the distal half of the tibia, tibiofibular synostosis, and medial dislocation of a cavus and varus foot. She was treated by means of an external fixator. The shortening was significantly corrected, and realignment of the foot with the limb was achieved. An arthrodesis of the talus and lower end of the fibula was carried out operatively and stabilized with an external fixator. In the same surgical procedure, we performed an osteotomy of the tibiofibular synostosis, and progressive distraction was done with another external fixator. We emphasize the advantages of progressive distraction for the correction of congenital deformities of the limbs.

Adolescent↗

PubMed2004

Valgus and varus deformity after wide-local excision, brachytherapy and external beam irradiation in two children with lower extremity synovial cell sarcoma: case report.

BACKGROUND: Limb-salvage is a primary objective in the management of extremity soft-tissue sarcoma in adults and children. Wide-local excision combined with radiation therapy is effective in achieving local tumor control with acceptable morbidity and good functional outcomes for most patients. CASE PRESENTATION: Two cases of deformity after wide-local excision, brachytherapy and external beam irradiation for lower-extremity synovial cell sarcoma are presented and discussed to highlight contributing factors, time course of radiation effects and orthopedic management. In an effort to spare normal tissues from the long-term effects of radiation therapy, more focal irradiation techniques have been applied to patients with musculoskeletal tumors including brachytherapy and conformal radiation therapy. As illustrated in this report, the use of these techniques results in the asymmetric irradiation of growth plates and contributes to the development of valgus or varus deformity and leg-length discrepancies. CONCLUSIONS: Despite good functional outcomes, progressive deformity in both patients required epiphysiodesis more than 3 years after initial management. There is a dearth of information related to the effects of radiation therapy on the musculoskeletal system in children. Because limb-sparing approaches are to be highlighted in the next generation of cooperative group protocols for children with musculoskeletal tumors, documentation of the effects of surgery and radiation therapy will lead to improved decision making in the selection of the best treatment approach and in the follow-up of these patients.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1979

Anomalous insertion of the tibialis posterior tendon in congenital metatarsus varus.

Congenital metatarsus varus is a common deformity that usually responds to conservative treatment. In fifteen feet operated on for resistant deformity, an anomalous insertion of the tibialis posterior tendon was found in fourteen. Six cadaveric infant feet were dissected to confirm the normal insertion. The dynamic component of the deformity is stressed.

Foot Deformities, Congenital↗

PubMed1981

The surgical management of varus deformity in haemophilic arthropathy of the knee.

Five patients severely affected by haemophilia, in whom six knees showed advanced haemophilic arthropathy, have been studied. The patients presented with painful limitation of movement and increasingly frequent episodes of spontaneous bleeding in the affected knees. These all showed secondary degenerative changes and varus deformity. A Corrective osteotomy of the proximal tibia was performed under full haematological cover without complications. Follow-up ranged from 6 to 36 months, with a mean of 18 months. At follow-up all patients were free of pain and had retained their range of movement. In the three patients with a longer follow-up there was radiological improvement. The most significant feature was that there was almost complete cessation of bleeding episodes into the knee in all patients and no progression of the arthropathy. The cost benefit implications of this corrective procedure are discussed.

Adult↗

PubMed1984

Supracondylar osteotomy of the humerus for correction of cubitus varus.

Cubitus varus is the most common complication of supracondylar fracture of the humerus in children. Although function of the elbow is not greatly impaired, the deformity is unsightly. It usually results from malunion, since growth disturbance of the humerus after this fracture is uncommon. The normal carrying angle can be restored by supracondylar osteotomy. This operation was done in 32 patients over a ten-year period, 16 of them using the technique described by French (1959). The results in 27 patients are reviewed in the light of previous reports. French's method proved safe and satisfactory.

Child↗

PubMed1988

Supracondylar osteotomy for cubitus varus. The value of the straight arm position.

Supracondylar osteotomy for traumatic cubitus varus is usually considered to be difficult, and to have a significant incidence of complications. Most difficulty is in maintaining correction after operation. We report 20 osteotomies performed by a modification of French's technique and managed postoperatively with the elbow extended. When a plaster splint was used only three of seven cases had good or satisfactory results, two requiring revision. Postoperative management by straight arm traction maintained correction and achieved a good or satisfactory result in all 13 cases. This new technique is recommended.

Adolescent↗

PubMed1989

Hallux varus.

We reviewed 12 patients with congenital hallux varus who had had operations on 20 feet to enable them to wear normal shoes and to improve the appearance. After an average follow-up of 12.7 years the results of soft tissue procedures were satisfactory in 12 of 17 feet. Arthrodesis of the first metatarsophalangeal joint, performed primarily in one foot and secondarily in two others was also satisfactory, but metatarsal osteotomy in two feet gave unsatisfactory results leading to local amputation. The unsatisfactory results were generally due to the appearance of shortness of the first metatarsal and rarely because of symptoms or recurrent deformity.

Child↗

PubMed1989

Surgical implications of varus deformity of the knee with obliquity of joint surfaces.

Some arthritic knees with varus deformity show excessive valgus angulation of the femoral joint surface with proximal tibia vara. This causes a downward and medial inclination of the articular surfaces in the coronal plane. The patients we studied had a medial shift of the standing load-bearing axis, and arthritic changes mainly in the medial compartment. Some also had lateral tibial subluxation with twisting of the distal femur and proximal tibia in opposite directions. We assessed the articular geometry by precise radiographic analysis, and compared the results with those in normal volunteers and a group of osteoarthritic patients. The prevalence of this type of deformity in our osteoarthritic patients was 11.5%; its recognition allows the use of specific operative correction that may include double osteotomy or the precise orientation of prosthetic components.

Adolescent↗

PubMed1990

A simple technique for varus supracondylar osteotomy in genu valgum.

Varus osteotomy of the distal femur is recommended for osteoarthritis of the knee with significant valgus deformity, but the operation is difficult to plan and perform. A simple technique involving a jig referenced to the line of the tibia is described. This allows accurate overcorrection by a few degrees, with impaction and secure fixation at the osteotomy. It has been successful, with no complications, in 12 consecutive knees.

Femur↗

PubMed1990

The lateral condylar prominence. A complication of supracondylar osteotomy for cubitus varus.

We reviewed 27 patients who had supracondylar closing wedge osteotomy for cubitus varus. There were 10 excellent and 12 good results. However, of these 22 patients, 14 had a significant bony prominence over the lateral condylar region caused by lateral displacement of the elbow when closing the osteotomy. This prominence was less obvious in patients who had their osteotomy at a young age, but worse after operations near or after skeletal maturity. This difference appeared to be due to remodelling.

Adolescent↗

PubMed1991

Metatarsus primus varus. A statistical study.

A survey of 6000 schoolchildren discovered 36 cases of unilateral and 60 cases of bilateral hallux valgus, defined as a metatarsophalangeal angle of more than 14.5 degrees, measured on standing radiographs. Metatarsus primus varus was found not only in the early stages of hallux valgus but in the unaffected feet of children with unilateral hallux valgus. Adduction of the first metatarsal is not due to differential growth of the cortices of the first metatarsal nor is it a consequence of malalignment of the metatarsocuneiform joint. The intermetatarsal angle did not correlate with the angle of metatarsus adductus nor with the intercuneiform angle.

Anthropometry↗

PubMed2000

Treatment of cubitus varus using the Ilizarov technique of distraction osteogenesis.

Seven children with a post-traumatic cubitus varus deformity were treated using the Ilizarov technique of distraction osteogenesis. The outcome was rated as excellent in each case and all were satisfied with the cosmetic appearance. No complications had been encountered by the latest follow-up at a mean of 66.7 months. This technique seems reliable for the treatment of such deformities, provided that it achieves full correction by gradual distraction. Nerve palsy and unsightly scars are avoided, and the range of movement of adjacent joints is preserved.

Adolescent↗

PubMed2002

Failure of active extension after traumatic cubitus varus. A case report.

In children cubitus varus is common after malunion of a supracondylar fracture of the humerus. Later problems such as tardy ulnar nerve palsy, snapping of the lateral triceps tendon or ulnar nerve and posterolateral rotatory instability are well documented. We present a case of anteromedial dislocation of the entire triceps tendon with loss of extensor power and describe the method of treatment.

Athletic Injuries↗

PubMed1996

Varus osteotomy of the distal part of the femur. A survivorship analysis.

Varus osteotomy of the distal part of the femur is often the procedure of choice for the treatment of osteoarthrosis of the lateral compartment associated with genu valgum. We followed twenty-one knees (twenty patients) long term or until failure. At the most recent evaluation (average, 133 months; range, ninety-seven to 240 months), thirteen osteotomies were still successful, seven had failed, and one patient (in whom the knee had remained functional) had died. Of the seven failures, three occurred early (at twelve or twenty-four months) and four occurred late (between seventy-two and ninety-eight months). The probability of survival at ten years was 64 per cent (95 per cent confidence interval, 48 to 80 per cent), as determined with use of the Kaplan-Meier method. We concluded that, with proper selection of patients, this procedure is effective for the treatment of gonarthrosis of the lateral compartment associated with valgus deformity.

Adult↗

PubMed1996

Pemberton pelvic osteotomy and varus rotational osteotomy in the treatment of acetabular dysplasia in patients who have static encephalopathy.

Forty-four patients (fifty-two hips) who had static encephalopathy and acetabular dysplasia were managed with a Pemberton osteotomy as part of a comprehensive operative approach. Thirty-three patients had quadriplegia and were unable to walk; the remaining eleven patients had diplegia and could walk. The age at the time of the operation ranged from four years and five months to sixteen years and five months, as an open triradiate cartilage is a prerequisite for the Pemberton procedure. Concomitant operative procedures included a varus rotational osteotomy in fifty of the involved hips, a soft-tissue release in thirty-seven hips, and an open reduction in thirteen hips. The mean center-edge angle preoperatively was -11 degrees (range, -80 to 17 degrees), which improved to a mean of 27 degrees (range, 5 to 62 degrees) at the time of the latest follow-up. The mean duration of follow-up was four years (range, two years to eight years and eight months). At the time of writing, none of the hips had redislocated but one hip had subluxated. Eight of the hips had been painful preoperatively, but none of these was painful at the time of the most recent follow-up. One patient who had not had pain in the hip preoperatively had pain at the time of the follow-up evaluation. There were no complications attributable to posterior uncovering of the hip. The age of the patient at the time of the operation had no discernible effect on the result.

Acetabulum↗

PubMed1998

Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle.

We performed a one-stage opening-wedge valgus osteotomy in nine patients to correct a post-traumatic progressive varus deformity of the ankle. The osteotomy site was stabilized with two, three, or four Kirschner wires or with a plate and screws (in one patient). The site of the osteotomy united within two months after the operation in eight patients and at six months in one patient who was fifty-nine years old. The average duration of follow-up was seven years and four months (range, two years and four months to thirteen years and two months). Postoperatively, the range of motion of the ankle was decreased in six patients and remained unchanged in three. However, none of the patients reported any limitation in the activities of daily living, and the four adolescent patients were able to participate in sports activities. The result was graded as excellent for four ankles, good for two, and fair for three.

Activities of Daily Living↗

PubMed1975

Congenital metatarsus varus. On the advantages of early treatment.

Among 212 infants with congenital metatarsus varus 84 (39.6 per cent) of the infants were treated. Only the treated group is considered in the analysis. Daily manipulative therapy was given followed by fixation in elastic bandage or splint. The manipulations aimed at correcting the adduction of the fore part of the foot, as well as the increased valgus of the heel. In 68 infants treatment was instituted before one year of age. The results were good in 65 of these patients and correspondingly good results were obtained in 15 out of 16 patients treated at more than one year of age. Subluxation in the fore- and midfoot and bony incongruity present at birth are offered as a possible explanation for lack of spontaneous recovery before weightbearing as well as the occurrence of resistant cases. Spontaneous improvement may take place during childhood and may be explained by the influence of the position of the heel during weightbearing.

Child, Preschool↗