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At least 415 records · Page 23Linked to original sources
PubMed1997

Restoration of limb alignment in total knee arthroplasty: evaluation and methods.

Obtaining adequate alignment is critical in the proper performance of total knee arthroplasty (TKA). This study prospectively evaluates 350 patients who had previous TKA. Its goals are to establish the best method of measuring limb alignment as well as the best method of restoring ideal alignment. Intramedullary alignment techniques were compared with extramedullary, and alignment of each limb was evaluated by both long (scanogram) and short films (14 inches x 17 inches). Conclusions reached were (1) that only data obtained from full limb radiographs are accurate for determining and reporting limb alignment in TKA, (2) that alignment values should be reported relative to the mechanical axis of the limb because of the variability of the femoral anatomic angle, (3) that intramedullary femoral guides are required to make accurate femoral bone cuts, (4) that extramedullary tibial guides permit accurate cuts of the proximal end of the tibia, and (5) that tibial intramedullary guides are not only unnecessary but also potentially misleading.

Biomechanical Phenomena↗
PubMed1998

[Intraoperative computer-assisted measurement of stimulation threshold of the common peroneal nerve in osteotomy of the head of the tibia].

Using a computer-assisted threshold hunting paradigm the motoric threshold of the common peroneal nerve was monitored in 18 patients during a high tibial osteotomy (HTO). The exposed nerve (lateral approach) was stimulated proximal to the osteotomy area and the surface EMG of the M. tibialis anterior was used to guide a threshold hunting device. Motoric threshold as a sensitive indicator of nerve function was found to be almost unaffected by several surgical steps of HTO. Only forceful rotation of a subperiostal Hohmann device during high peroneal osteotomy evoked a slight threshold shift that was fully reversible with device repositioning. The tourniquet, however, affected the threshold significantly. In 10 of the 18 patients the nerve became completely inexcitable after an average time of 59 min. The inexcitability was reversible after opening of the tourniquet. On the other hand, the eight patients maintaining an excitability throughout the entire ischemic period had tourniquet times that did not exceed 60 min. There are several factors that may be responsible for the observed inexcitability after long ischemic periods and we conclude that tourniquet time minimization appears appropriate to avoid neurological deficits during a high tibial osteotomy.

Adult↗
PubMed1998

[Analysis of leg geometry].

Analysis of bony geometry of the lower limb comprises frontal, sagittal and longitudinal alignment, as well as length and torsion, including at first the whole leg and finally the femur and tibia separately. Clinical examination assesses the bony geometry, functional aspects, ligamentous and soft tissue conditions, etc. Frontal and sagittal radiographs indicate axial alignment and angles of the hip, knee and upper ankle joint. Apex and size of deformities are defined simultaneously. CT and ultrasound techniques allow the measurement of length and torsion of the whole leg, as well as of the femur and tibia separately, provided those techniques are standardized with proven reproducibility.

Bone Malalignment↗
PubMed2005

Biomechanical stability of intramedullary nailed high proximal third tibial fractures with cement augmented proximal screws.

OBJECTIVE: Intramedullary nailing of nonarticular proximal tibia fractures can be affected by bone density resulting in loss of stability, fixation, and malalignment in osteopenic bone. This study was designed to quantify the biomechanical effects of augmenting proximal screws with cement in intramedullary nailing of high proximal third tibial fractures. DESIGN: In vitro biomechanical study using anatomic specimens. METHODS: Reamed nails were inserted into seven pairs of fresh-frozen cadaveric proximal tibiae and secured using two oblique and two transverse proximal screws. Paired tibiae were randomly assigned into two groups: cemented and noncemented proximal screw-holes. Bone cement was injected into the screw-holes before screw insertion in the cemented tibiae. Specimens were then tested in flexion/extension and varus/valgus to 12 Nm and in torsion to 7 Nm. Physical measurements of bone density were obtained to determine the effect of density on stability. MAIN OUTCOME MEASURES: Stability of the construct in both groups was analyzed and compared statistically using paired t tests. RESULTS: Cement augmentation of the proximal screws significantly increased mechanical stability in torsion and varus/valgus load configurations, with average decreases in rotational motion of 5.4 degrees +/- 1.6 degrees and 5.1 degrees +/- 5 degrees respectively. No change in stability was observed in flexion/extension loading. A trend toward decreased stability was seen in the uncemented construct in varus/valgus; cement augmentation of the proximal screws eliminated this effect. CONCLUSIONS: Lower bone density decreased the stability of the uncemented construct; however, cement augmentation of the proximal screws showed a trend to eliminate this effect in the varus/valgus loading configuration and should be considered when nailing proximal third tibial fractures in osteoporotic patients.

Aged↗
PubMed2003

Bone marrow edema and its relation to progression of knee osteoarthritis.

BACKGROUND: While factors affecting the course of knee osteoarthritis are mostly unknown, lesions on bone scan and mechanical malalignment increase risk for radiographic deterioration. Bone marrow edema lesions on magnetic resonance imaging correspond to bone scan lesions. OBJECTIVE: To determine whether edema lesions in the subarticular bone in patients with knee osteoarthritis identify knees at high risk for radiographic progression and whether these lesions are associated with limb malalignment. DESIGN: Natural history study. SETTING: A Veterans Administration hospital in Boston, Massachusetts. PATIENTS: Persons 45 years of age and older with symptomatic knee osteoarthritis. MEASUREMENTS: Baseline assessments included magnetic resonance imaging of the knee and fluoroscopically positioned radiography. During follow-up at 15 and 30 months, patients underwent repeated radiography; at 15 months, long-limb films were obtained to assess mechanical alignment. Progression was defined as an increase over follow-up in medial or lateral joint space narrowing, based on a semi-quantitative grading. Generalized estimating equations were used to evaluate the relation of medial bone marrow edema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment. RESULTS: Of 256 patients, 223 (87.1%) participated in at least one follow-up examination. Medial bone marrow lesions were seen mostly in patients with varus limbs, and lateral lesions were seen mostly in those with valgus limbs. Twenty-seven of 75 knees with medial lesions (36.0%) showed medial progression versus 12 of 148 knees without lesions (8.1%) (odds ratio for progression, 6.5 [95% CI, 3.0 to 14.0]). Approximately 69% of knees that progressed medially had medial lesions, and lateral lesions conferred a marked risk for lateral progression. These increased risks were attenuated by 37% to 53% after adjustment for limb alignment. CONCLUSION: Bone marrow edema is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment.

Aged↗
PubMed2003

Surgical reconstruction of late pelvic post-traumatic nonunion and malalignment.

We have retrospectively reviewed the clinical and radiological results in 204 consecutive adult patients who had surgical correction of 70 late post-traumatic pelvic nonunions and 134 malalignments. The deformed pelvises were subdivided into united (true), unstable, ununited, and partially stable malalignments with heterotopic bone. The principal complaints were of pain, pelvic instability, sitting imbalance, and apparent limb-length discrepancy. After surgery, 195 patients (96%) achieved a primary union and 144 (71%) had slight, intermittent or no pelvic pain, while pelvic instability was entirely eliminated. Overall, 131 patients (64.2%) were extremely satisfied, 58 (28.4%) were satisfied and 15 (7.4%) were unsatisfied. After reconstruction of the malaligned pelvises, 67 results (50%) were anatomical, 47 (35%) were satisfactory and 20 (15%) were unsatisfactory. For a pelvic nonunion with local osteopenia and malalignment, stabilisation of all three pelvic columns is recommended. True pelvic (united) malunions were the most satisfactorily realigned and had the fewest complications. Ununited and unstable malalignments, especially those with heterotopic bone, had the poorest corrections and the most neurological complications. A therapeutic alternative, by the local resection of a symptomatic bony prominence, and fixation in situ of a posterior pelvic nonunion, gives highly effective symptomatic relief with fewer complications. Despite this, many patients had persistent low back pain.

Adult↗
PubMed1995

An intramedullary aligned bone cutting jig for elbow replacement.

One of the main post operative complications of total elbow replacement has been dislocation and fracture of the olecranon. This has been associated with rotational malalignment of the bone cuts of the proximal ulna caused by the current free hand cutting method. This paper presents an intramedullary aligned bone cutting jig which gives rotational location on the ulna for the bone cuts, without notching the olecranon.

Biomedical Engineering↗
PubMed2000

Ilizarov treatment of tibial nonunions results in 16 cases.

Treatment with the Ilizarov technique was performed in 16 patients with complex tibial nonunions. Two years post treatment the functional stage and patient satisfaction were recorded. There were 4 hypertrophic, 3 atrophic and 9 infected nonunions. Eleven patients had segmental bone loss. Fifteen nonunions united, and limb length discrepancy was reduced within 1.5 cm of the contralateral leg. Average time in the frame was 182 days. Fifteen of the 16 patients were satisfied with the treatment. One patient demanded an amputation after 3 months of treatment, despite good signs of healing. There were no refractures or recurrent infections. In conclusion the Ilizarov technique for complex nonunions has a high rate of success in achieving union and eradicating infection, bone loss and malalignment. The treatment is demanding both to the surgeon and to the patient, but we strongly recommend the Ilizarov treatment for tibial nonunion, especially in cases with chronic infection and severe bone loss.

Adolescent↗
PubMed1975

[Correction osteotomy of tibia for malalignment at the knee and the bone-suture (author's transl)].

Correction osteotomy of the tibia in genu valgum and varum is discussed on the basis of the literature and two cases. After considering critically the well-known techniques of fixation, the almost forgotten bone-suture with silk or Perlon is recalled which may replace osteosynthesis. The advantages of the plaster cast of the leg which permits much earlier weightbearing then osteosynthesis and adds to bony union are emphasized. The author warns against too early mobilization.

Adolescent↗
PubMed1997

A method of examining the magnitude and origin of "soft" and "hard" tissue forces resisting limb lengthening.

Complications arising from limb-lengthening procedures such as muscle contracture, axial malalignment of the bone and traction injuries to the nerves and vessels, are often severe. Often complications arise from the build-up of forces in the biological tissues which are resisting lengthening. Little is known about the origin and magnitude of these forces, although three studies have identified the regenerate (new bone tissue) as the dominant resisting tissue. This study describes the development of a method to examine these forces. It employs load measurement devices in the structural columns of Ilizarov fixators which measure the compressive load on the frame exerted by the biological tissues. The distribution of this load between the columns of the frame, in conjunction with a transverse radiograph of the limb at the regenerate site, is used to examine the origin of the resisting force. Accuracy was determined by a laboratory simulation which found the predicted position of the force to be within 5 mm of the actual position in all four cases tested. Mean error in the total measured force was 2 N (SD, 1 N). A pilot study on a patient undergoing a 60 mm femoral lengthening revealed a peak force of 717 N originating in the Vastus Lateralis or the illiotibial tract. Negligible contribution to resistance was provided by the regenerate, contrary to that found with other studies.

Adult↗
PubMed2001

Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology.

The purposes of this study were to determine the prevalence of posttreatment open gingival embrasures in adult orthodontic patients and to examine the association of pretreatment maxillary incisor malalignment, posttreatment alveolar bone height, interproximal contact position, root angulation, crown shape, and embrasure area with open gingival embrasures. Posttreatment intraoral photographs of 337 adult orthodontic patients were evaluated to determine the prevalence of open gingival embrasures. A subsample of 119 patients was identified for measurement and divided into 2 groups: normal gingival embrasures and open gingival embrasures. Digital images of the pretreatment maxillary models and posttreatment maxillary central incisor periapical radiographs were made to measure the pretreatment and posttreatment variables. The prevalence of posttreatment open gingival embrasures in adult orthodontic patients was 38%. Pretreatment maxillary central incisor rotation and overlap were not statistically associated with posttreatment open gingival embrasures. A posttreatment alveolar bone-interproximal contact distance greater than 5.5 mm was associated with open gingival embrasures. Short and more incisally positioned posttreatment interproximal contacts were associated with open gingival embrasures. Open gingival embrasures were found to have more divergent root angulations and more divergent or triangular-shaped crown forms than normal gingival embrasures. Embrasure areas larger than 5.09 mm(2) were also correlated with open gingival embrasures. Increased alveolar bone-interproximal contact distance and increased root angulation demonstrated the greatest increase in the odds of an association with an open gingival embrasure. This investigation indicates that open gingival embrasures are common in adults who have undergone orthodontic treatment and that posttreatment variables are significant factors in open gingival embrasures.

Adult↗
PubMed1995

Lower quarter screening for skeletal malalignment--suggestions for orthotics and shoewear.

Skeletal malalignments of the lower quarter, deformities within a bone or at a joint, may be the primary cause of musculoskeletal patient problems. Skeletal malalignments also may sustain the presence of a musculoskeletal patient problem that has some other causal mechanism. A screening exam for skeletal alignment of the lower quarter may assist clinicians in identifying skeletal malalignments that are associated with a musculoskeletal complaint. The purposes of this paper are to: 1) describe components for a skeletal alignment screening exam, 2) analyze how lower quarter malalignments may influence lower quarter function and contribute to the development of musculoskeletal pathology, and 3) suggest general characteristics of foot orthoses and shoes that may assist in the management of musculoskeletal patient problems of the lower quarter.

Biomechanical Phenomena↗
PubMed2003

[Soft tissue balancing in total condylar knee arthroplasty].

Soft tissue balancing and correct bone cuts are an entity in correcting malalignment in total knee arthroplasty, and cannot be considered isolated. Distinct bony deformations/deviations need enlarged soft tissue management. The extent of resection of the bone stock has to be planned exactly before the operation. Exact soft tissue balancing is necessary to stabilize the corrected knee. Soft tissue balancing has to be done primarily on the side of the contracture by lengthening of the shortened and contracted structures. After balancing the ligaments should have the same tension in extension and flexion together with the same height of the extension and flexion gap. Because of the classic resection of the tibial head, the femoral resection must follow the Insall-Line, that means 3 degrees to 5 degrees outer rotation in relation to the condyles. Only in this way a symmetric flexion gap can be achieved in combination with ligamentous stability in extension and flexion.

Arthroplasty, Replacement, Knee↗
PubMed2006

Hemilaterally symptomatic bipartite patella associated with bone erosions arising from a gouty tophus: a case report.

Symptomatic bipartite patella in adults is rare. We have treated an unusual case of a bipartite patella in an adult, which became symptomatic in association with cystic degeneration localized to the patella and a gouty tophus. Although the patient had bilateral bipartite patellae, multiplanar reformation with computed tomography (CT-MPR) clearly demonstrated that the bipartite portion of the patella was malaligned at the junction of the accessory bone and patella in the symptomatic knee. Bone erosions were present both in the bipartite fragment and adjacent portion of the patella. After surgical excision of the bipartite fragment, the patient's symptoms have improved. This case illustrates that cyst formation associated with inflammatory arthritis may be a rare cause for a bipartite patella in an adult to become symptomatic.

Adult↗
PubMed1979

[Corrective osteotomy in malalignment of healed fractures of the metacarpal and phalangeal bones].

As a result of improper immobilization in extension following phalangeal and metacarpal fractures, rotation and deviation deformities can occur. The functional disturbance and aesthetic deformities can be corrected with an osteotomy through the proximal phalanx of the metacarpal. The technique and results of this correction osteotomy are described. Prevention of these malunions by proper positioning at the time of primary treatment is emphasized.

Finger Injuries↗
PubMed1997

Open reduction and bone plate stabilization, compared with closed reduction and external fixation, for treatment of comminuted tibial fractures: 47 cases (1980-1995) in dogs.

OBJECTIVE: To compare open reduction and bone plate fixation with closed reduction and external skeletal fixation as treatment for severely comminuted fractures of the tibia. Limb alignment, fracture reduction, operating time, hospitalization time, postoperative care, time to unrestricted activity, bone healing, complications, and number of surgical procedures were considered. DESIGN: Retrospective case series. ANIMALS: 47 dogs with severely comminuted fractures of the tibia treated with open reduction and bone plate application (22 dogs) or closed reduction and external fixation (25 dogs). PROCEDURE: Medical records of all dogs included in this study were reviewed. Postoperative and follow-up radiographs were evaluated by 2 independent observers. RESULTS: Differences were not found in hospitalization time, time to unrestricted activity, or time to earliest radiographic evidence of bone healing between dogs with fractures treated with a bone plate and dogs with fractures treated with an external fixator. Fractures treated with an external fixator had more caudal malalignment, and fractures treated with a bone plate had more valgus malalignment. Malalignments were determined not to be related to clinical problems. Dogs with fractures treated with an external fixator had shorter surgery times and more recheck examinations. Dogs with fractures treated with a bone plate had more complications. CLINICAL IMPLICATIONS: Open reduction with bone plate fixation and closed reduction with external fixation were both effective for treatment of comminuted tibial fractures. External fixation was associated with shorter surgery time, but dogs required more extensive postoperative care. Bone plate fixation was associated with more complications.

Animals↗
PubMed2005

Derotation of post-traumatic femoral deformities by closed intramedullary sawing.

Different techniques and devices have been used for correction osteotomies of bones in patients with malalignments. The most frequently used technique for rotational deformities of the femur and tibia is open osteotomy with an oscillating saw and pre-drilled holes with all well-known drawbacks of open surgery. An intramedullary device with an adapted minimal-invasive surgical technique allows intramedullary osteotomy of the bone preserving the surrounding soft tissue. We performed femoral osteotomies with an intramedullary saw followed by static interlocking nailing in 14 patients with post-traumatic rotational deformity in the femur. Twelve patients had an external rotational deformity of the femur ranging between 26 and 63 degrees , one had an additional leg-shortening of about 4 cm. Two patients had internal rotational deformities. In two patients with delayed fracture healing union was achieved within one year without secondary surgery. Post-operative clinical assessment and CT-scans revealed good derotation results with deformities of less than 4 degrees in all cases. No device-related complications were observed. Therefore, we conclude that "closed" osteotomy with an intramedullary saw is a minimal-invasive, safe and reliable option for derotation procedures in the femur.

Adolescent↗