SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The authors have reviewed 32 cases of severe varus deformity following supra-condylar fractures in childhood. The sequellae were mainly cosmetic, the function being preserved. All cases were treated by supra-condylar osteotomy fixed by screwing. The technique is described. The results were satisfactory in 20 cases.
The possibility to correct tibial varus deformity due to Blount disease by epi-metaphyseal distraction was presented. The correction was achieved in 2 patients; in one of them leg length discrepancy was eliminated. The method is not invasive, offers continuous rehabilitation and a possibility of equalization of the extremities.
The authors report their experience in surgical treatment of the arthritic varus knee. After a comparative study of the most commonly used osteotomy techniques, they describe the results of their first cases of metaphyseal tibial corticotomy and angular distraction using an external fixator (25 cases).
High tibial osteotomy is a simple and safe method to correct the varus gonarthritic knee. Numerous follow-up studies have demonstrated that this procedure gives satisfactory functional results for 10-15 years after surgery, above all if a precise valgus hypercorrection of 8 degrees-10 degrees is carried out. The present study attempts to deal with another, less discussed topic: evaluation of the efficacy of external fixation after osteotomy synthesis with respect to the most common plate and screw synthesis as well as to the Insall procedure.
Two cases of humerus varus congenitus have been treated by lengthening of the humerus using an external distraction device. The first was lengthened by about 6 centimetres and the second by about four centimetres. In one case, primary bone union was obtained and in the second, secondary grafting had to be done. The clinical results were satisfactory.
Varus derotational osteotomy (VDRO) was used to treat 69 unstable hips in 38 patients with spastic quadriplegia. After a mean follow-up of 5.3 years, the total rate of failure as judged by either need for revision or persistent radiographic instability or dislocation was 26%. Overall outcomes were better for hips that had been more congruent (preoperative migration index < 60%) than for hips that had experienced more migration (P = .027), and more-congruent hips were 9 times more likely to be stable radiographically at follow-up (P < .001). The failure rate for VDRO combined with femoral shortening or obturator neurectomy was lower than that for VDRO alone (P = .035). VDRO is an appropriate option for treating less advanced hip subluxation and may be more reliable when combined with femoral shortening and/or obturator neurectomy. VDRO alone, however, may be insufficient for treating more advanced instability.
The aim of this study was to examine the peculiarities of femoral proximal epiphysis formation following the early disruption of its blood supply. The experiments were performed using 20 albino rats that were operated at postnatal day 18 having their diaphysis and acetabular arteries cut in one extremity (the other extremity serving as control). Starting at postoperational month 2 and up to month 12, 1-2 animals were sacrificed monthly by ether overdosage. Femoral and pelvic bones were removed from both control and experimental extremities, fixed in neutral formalin, decalcified, dehydrated and embedded in celloidin. The sections were stained with hematoxylin and eosin. It was established that a deceleration of vascular growth compromised the nutrition of the cartilage of the femoral proximal epiphyseal growth plate. This resulted in the delay of chondrocyte differentiation and prevented the timely formation of the bone in the area of femoral collum, causing the development of varus deformity.
The authors have reviewed 250 cases of upper tibial osteotomy for varus deformity of the knee with degenerative arthritis of the medial compartment. Most of the osteotomies (136) were closing osteotomies, the remainder being opening osteotomies using a bone graft. Closing osteotomy is recommended together with an arthrolysis of the upper tibio-fibular joint instead of a fibular osteotomy. Hyper-correction appeared to be beneficial in cases with lateral ligament laxity. The authors do not recommend intra-articular cartilage shaving or meniscectomy. They advocate surgical release of the patella by division of the lateral patellar retinacula or by anterior displacement of the tibial tuberosity.
Total knee arthroplasty was performed in 126 knees of 104 patients, using either the UCI, the Kinematic Anteriorly Joined (K-AJ), or the Kinematic Posterior Cruciate Retention (K-PCR) prosthesis. The average patient age at the time of surgery was 59 years; the average follow-up period was 3.3 years. The UCI device was used in 25 knees, the K-AJ in 75, and the K-PCR in 26. Postoperatively, the femorotibial angle was measured yearly for a period of at least six years on an anteroposterior radiograph of the patient standing on one leg. The cases with the UCI prosthesis, with an average standing FTA of 175 degrees one year postoperatively, showed a gradual change of limb alignment toward varus. In contrast, in the cases with the K-AJ and K-PCR prostheses, with an average standing FTA of 172 degrees one year after surgery, limb alignment remained essentially unchanged throughout a long period of follow-up. The authors recommend that total knee arthroplasty be performed to achieve a postoperative femorotibial angle (standing) as close to 172 degrees as possible, which allows the mechanical axis of the lower extremity to pass through the center of the knee.
The authors report a case of congenital clubfoot in a one-year-old male child, in which an accessory soleus muscle was noted intraoperatively, running anteromedially to the Achilles tendon and with a distinct insertion on the postero-medial aspect of the calcaneus. Correction of the varus and equinus of the hindfoot could only be achieved after cutting the tendon of the accessory soleus muscle at its insertion on the calcaneus.
Because of trauma, metabolic bone disease, congenital deformity, or prior osteotomy, an extraarticular deformity may be present in patients requiring total knee arthroplasty. If the extraarticular deformity is not corrected extraarticularly, it must be corrected by compensatory distal femoral or proximal tibial wedge resection to produce overall limb alignment. Because such a wedge resection between the proximal and distal attachments of the collateral ligaments will produce asymmetrical ligament length, complex instabilities may result. This article, through overlay templates and trigonometric analysis, evaluates all the issues confronting the surgeon deciding whether to pursue intraarticular or extraarticular correction. The conclusions are as follows: (1) the closer a deformity is to the knee, the greater its importance, (2) femoral deformities are more difficult to correct intraarticularly than tibial deformities because femoral compensatory wedge resection produces instability only in extension, and (3) intraarticular correction of varus deformities produces lateral instability that is usually better tolerated than medial instability, and some extraarticular deformities are best treated by extraarticular correct, independent, or total knee arthroplasty.
Authors describe the congenital and acquired forms of the rarely occurring hallux varus on the basis of the material of 14 patients, treated in 1951-87 on the Orthopaedic Department of the Semmelweis University Budapest. In 11 cases the deformity was congenital and in the majority bilateral, multiple, together with other foot deformities.
Varus displacement of the talus in the ankle mortise secondary to a calcaneus fracture was observed in a 33-year-old man. Similar to the calcaneus fracture-dislocation, the mechanism involved inferior and medial displacement of the talus into the body of the calcaneus. The patient's ankle deformity was not corrected by a lateral ankle ligament reconstruction. Correction required a distraction subtalar bone block fusion. Successful reconstruction of the hindfoot after calcaneus fractures requires a careful analysis of the pathologic lesion. In this unusual case, correction required restoration of lost hindfoot bone structure.
An angle within the femoral arch is defined, and its line is described in selecting the osteotomy site and the position of the fixation device in performing a femoral varus osteotomy. This neck metaphyseal angle was measured with varying degrees of rotation on seven pediatric femurs; it was also studied on 283 randomly selected hip radiographs. The angle varied 25-40 degrees in 90% of the patients and was not age related. The angle is stable within 5 degrees as long as the landmarks, base of the great trochanter, and medial metaphysis of the femoral neck are definable (0-30 degrees of rotation).
Reports of corrective procedures for cubitus varus (gunstock deformity) have emphasized the frequency of loss of position and significant complication. Modifications that have been made to the standard supracondylar osteotomy protocol include correction of the angular deformity only, without correction of rotation; an incomplete wedge osteotomy leaving the medial cortex intact by hinging the osteotomy shut on the intact cortex; and immobilization of the elbow in full extension with the forearm supinated. In a review of 16 patients following this protocol, 11 patients had excellent results, three had good results, and two had unsatisfactory results.
The treatment of severe aggravated forms of equino-excavato-varus deformation of the feet of various etiology is rather difficult because the resections performed to eliminate the deformation require the removal of large quantities of the bone tissue and are traumatic, and when accompanied by neurotrophic disturbances they are usually contraindicated. At the Central Institute of Traumatology and Orthopaedics 65 patients with acutely pronounced feet deformations have been treated with Volkov-Organesian-Povarov distraction apparatuses. In 34 patients the deformation was accompanied by various neurotrophic disturbances. The results were good in 61 feet, satisfactory in 18 feet and bad in 4 feet. The experiment has demonstrated the efficacy of apparatus treatment, especially in the cases of aggravated forms of feet deformations, where this method often is the only one available.
This examination is used in cava-adducto-varus feet to determine the primary areas producing the secondary forefoot pathology. Table I is a compilation of the data and shows by means of an asterisk those pathologies possible with an additional primary deformity. The fold face test parts, when indicated in the exact order, are diagnostic. Once the primary areas have been elucidated, the remaining components are secondary, and the prognosis of biochemical and specific surgical treatment can be made. The specific treatment procedures and their rational use will be discussed in a future presentation.
Many methods of fixation have been used after proximal abductory metatarsal osteotomies for the correction of metatarsus primus varus. The methods include external immobilization and the application of devices such as stainless steel wire, Kirschner wires, staples, and compression plates. We have combined external immobilization with compression screw fixation across the osteotomy site. Two different types of screws were used: 1) an AO screw 3.6 mm. wide and 26 to 28 mm. long and 2) a standard Woodruff screw 3.5 mm. wide and 31.8 to 44.4 mm long. Twenty-two procedures were reviewed. When we compared the results, we found the AO screw to be superior in the degree of rigid fixation which it provides, as judged by the extent of postoperative callus formation.