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PubMed1989

Correction of metatarsus primus varus with the Chevron metatarsal osteotomy. An analysis of corrective factors.

A trigonometric evaluation of the amount of correction of metatarsus primus varus obtainable via lateral displacement of the first metatarsal head in a Chevron osteotomy technique revealed that approximately 1 degree of correction may be obtained for each millimeter of lateral shift. This calculated correction was correlated with the actual correction obtained in ten feet. Narrowing of the metatarsal head associated with removal of the medial eminence was an additional corrective factor.

Adult↗
PubMed1988

High tibial osteotomy in the treatment of arthritic varus knee. A medium term (small) review of 61 cases.

Sixty-one valgizing high tibial osteotomies performed according to the Insall method between 1975 and 1982 were reviewed; follow-up ranged from a minimum of 4 years to a maximum of 11, with an average of 7.5 years. The stage of preoperative osteoarthritis, evaluated according to Ahlbacks's classification, never exceeded Grade 3 (obliteration of the joint space and slight bone erosion). Preoperative varus never exceeded 10 degrees. The clinical results, evaluated on the score-form used at the Hospital for Special Surgery, were satisfactory in 48 cases (79% of the total) and unsatisfactory in 13 (21%). The success rate decreased to 65% in cases with a follow-up exceeding 10 years. There was frequently some loss of radiographic correction between the postoperative and follow-up values, but this was significant in only 9 cases where it exceeded 5 degrees. The arthritis was radiographically progressive in 22 cases, 18 of which were from the satisfactory group (excellent and good) and 4 from the unsatisfactory group (fair and poor). This positive evaluation of the results, even if they tended to deteriorate over a period of time, show that high valgizing tibial osteotomy is an effective operation, particularly when performed in knees without severe deformity.

Adult↗
PubMed1988

Distal femoral varus osteotomy for valgus deformity of the knee.

Twenty-four patients who had degenerative arthritis of the lateral compartment of the knee that was associated with a valgus deformity and a superolateral tilt of the joint line were treated by distal femoral varus osteotomy. A surgical technique that was designed to produce a horizontal joint line and a tibiofemoral angle of zero degrees is described. At an average length of follow-up of four years, twenty-two of twenty-four patients had a successful result as judged by our protocol for evaluation. One osteotomy had to be revised for failure of fixation, and one patient had a pulmonary embolism that had a satisfactory outcome after the administration of anticoagulants. One patient required manipulation of the knee at six months. The simple surgical technique that we used was effective in realigning the femoral with the tibial axis in patients who had a valgus deformity of the knee, a superolateral tilt of the joint line, and osteoarthritis of the lateral compartment.

Adult↗
PubMedDate not supplied

[Long-term results of the tibial head pendulum osteotomy in varus and valgus gonarthrosis in the elderly].

Proximal tibia-head osteotomy is an approved surgical method for the treatment of unilateral knee arthrosis. In a follow-up examination of 44 patients with 56 operated knees the long-term results more than 10 years after surgery are evaluated in older patients with varus and valgus arthrosis. It can be demonstrated that, if the indication is right, excellent long-term results can be expected, also for older patients with unilateral gonarthrosis. A fixation with metal implants seems to be unnecessary, and the complication rate is low.

Aged↗
PubMed1987

Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee.

From 1960 through 1979, a closing-wedge varus osteotomy of the proximal part of the tibia was performed in thirty-one knees (twenty-eight patients) for painful osteoarthritis of the lateral compartment of the knee that was associated with a valgus deformity. The patients were followed for two to seventeen years (average, 9.4 years). Twenty-four knees (77 per cent) had either no pain or only occasional mild pain at the last evaluation. Six knees had moderate pain and one, severe pain. Six knees required a subsequent total knee arthroplasty at an average of 9.8 years after the osteotomy. No patient had an infection or non-union. Osteotomy of the proximal part of the tibia is a reasonable method of treating unicompartmental degenerative arthritis in a knee with a valgus deformity. Although some patients with as much as 20 degrees of anatomical valgus deformity obtained a good result in this series, osteotomy in the supracondylar region of the femur is probably preferable if the valgus angulation exceeds 12 degrees or if the tilt of the tibial articular surface that will result from the surgery will exceed 10 degrees. Correction beyond the normal 5 to 7 degrees of valgus angulation to zero degree of anatomical tibiofemoral alignment is recommended to prevent recurrence of the valgus deformity and to decrease the load on the lateral tibiofemoral compartment.

Adult↗
PubMed1985

Varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip.

We have attempted to define the indications for and limitations of varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip. We studied the cases of thirty-four patients (forty-four hips) who were divided into three groups according to age at operation, and evaluated the influence of femoral remodeling, age, acetabular response, instability, and pre-existing avascular necrosis with respect to the final results. The length of follow-up ranged from five to twenty-two years. Rapid return to a valgus femoral neck-shaft angle by remodeling was not a cause of failure in any age group. There were consistently good results in the patients who were less than four years old at the time of operation. Acetabular correction by remodeling occurred through the age of eight years, but four of thirteen hips in patients who were between the ages of four and eight showed persistent dysplasia despite the operative procedure. The results were less predictable as the patients approached the age of eight years. There was no benefit from isolated femoral osteotomy in ten of eleven hips in patients who were older than eight. Pre-existing avascular necrosis appeared to compromise the results of the procedure in all age groups.

Age Factors↗
PubMed1979

[Spasm of the adductor muscles, pre-dislocations and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part II. The importance of the iliopsoas tendon, its tenotomy, of the coxa valga antetorta, and correction through osteotomy turning the hip into varus (author's transl)].

The following factors besides spasm and contraction of the adductor muscles contribute to the occurrence of dislocations of the hip in spastic paralysis: Spasm and contraction of the iliopsoas muscle and enhanced valgus position and antetorsion. The author holds the opinion that in case of malformation of the proximal end of the femur, it is not only the indirect action of the spastic musculature via the proximal femur-epiphyseal cartilage which is responsible for this phenomen in accordance with the law on functional adaption through longitudinal growth (Pauwels), but also the direct traction of the iliopsoas tendon. A clue in this direction is the often very pronounced elongation or enlargement of the trochanter minor. The author demonstrates the pathogenetic importance of iliopsoas contracture and malpositioning of the neck of the femur by means of analyses of the course in two patients. The following principles of treatment are postulated for spastic dislocation of the hip: Elimination of the pathogenetic factors through myotenotomy of the adductor muscles and complete resection of the obturator nerve, with observation of strict aftertreatment criteria, tenotomy of the iliopsoas, repositioning and osteotomy with turning into varus. Osteotomy without previous elimination of the pathogenetically acting muscular forces does not appear useful. Likewise, permanent re-positioning by means of muscle-relaxing operation cannot be sufficiently safe-guarded without additional osteotomy once the dislocation has taken place. In twelve patients with spastic dislocation of the hip, treated in accordance with these guidelines (two without osteotomy) aged 6 6/12 and 19 5/12 years, a roentgenologically good result was obtained in half of the cases, whereas the functional result was satisfactory not only with these patients but also with part of the other patients. If surgical treatment is instituted early enough, and if the experiences described here are taken into consideration, it is to be expected that the results will be even more satisfactory. The corset supporting the seated patient, developed by us, has been found very useful during the aftertreatment stage. A definite stand is taken against the therapeutic nihilism which leaves treatment of spastic dislocations to physiotherapy. It is also pointed out that indication for treatment is not represented only by the target of learning how to walk, but also by providing an overall improvement of the life situation of the patient, by either enabling him, or improving his ability, to sit or by "merely" improving the care of the perineum.

Adolescent↗
PubMed1984

Poly-syndactyly of hands and feet with talipes equino-varus. An unusual combination.

A case of a fifteen year old male with unusual congenital anomalies of hands and feet (Poly-syndactyly) is presented. There was associated talipes equino-varus deformity of the left foot with bilateral duplication of great toes. Both hands appeared like a cup but the patient was able to carry out his routine activities. The purpose of this report is to document a unique 'isolated' congenital anomaly.

Abnormalities, Multiple↗
PubMed1983

[Congenital metatarsus varus. Value of orthopedic treatment and role of surgery. Apropos of 290 cases].

The authors have reviewed 252 children with congenital metatarsus varus as distinct from club foot with an adequate follow up. They describe fully conservative treatment of the condition and conclude that true correction was obtained in about 80 p. 100 of cases by the age of 3 years and that another 16 p. 100 healed between the ages of 3 and 5 years. There are only about 4 p. 100 of cases which are complex and do not correct. The authors emphasize the fact that among 96 p. 100 of corrections the conservative treatment had no influence whatsoever. When the foot does not correct by the age of 5 years surgery is indicated. Heymann's procedure of correction at Lisfranc's joint seems to give the best results.

Adolescent↗
PubMed1978

Pathology of congenital metatarsus varus and its relationship to other congenital deformities of the foot.

Congenital metatarsus varus may be regarded as a deformity caused by a dislocation and in that respect is similar to congenital clubfoot and vertical talus but not to calcaneovalgus. The dislocation causes adaptive bone changes as well as secondary contracture of the soft tissues. That the dislocation in the forepart of the foot may occur in a maximally dorsiflexed foot also may explain the valgus position of the hindfoot. The secondary changes in bone and soft tissue may explain the lack of spontaneous recovery and the difficulties in effecting correction in severe cases. It is still not possible to explain why the dislocation arises.

Foot Deformities, Congenital↗
PubMed1981

[Varus osteotomy in severe arthrosis of the hip--a long-term study (author's transl)].

141 hips were reviewed more than 10 years after operation. The average follow-up was 13.5 years. A close relationship between the pre-operative functional state and the final result was established. The improvement was due to a decrease of pain in most cases, especially severe ones. Mobility and walking ability were little changed. Some worsening of the condition of patients was noted at about the 10th post-operative year. The aetiology, the degree of dysplasia, or degree of displacement of the osteotomy, had little influence on the final result. The degree of post-operative hip congruence was unimportant. The best results were seen in excentrated hips with severe radiological involvement. It is concluded that varus osteotomy is a valuable procedure in severe arthrosis of the hip. The hazards of the procedure are small, and it is indicated in young or middle-aged patients.

Adult↗
PubMed1984

In vitro strain distribution in the proximal tibia. Effect of varus-valgus loading in the normal and osteoarthritic knee.

Six human cadaver legs were tested with strain-gauge rosettes to determine the effects of varus/valgus loading on the distribution of strain on the cortical bone of the proximal tibia at loads of up to 250 kg. Changes in the femorotibial angle of 1.5 degrees and 3.1 degrees, to create varus/valgus deformities, produced significant unloading of the opposite aspect of the normal leg. A varus deformity of 3.1 degrees in the medial compartment osteoarthritic model virtually unloaded the lateral compartment and, because of the bending effect, placed the whole of the lateral aspect of the leg into axial tension. Under these conditions, the axial strains in almost the whole of the medial aspect of the tibia were doubled, from an initial value of 250 microstrain (compressive) to a value of approximately 500 microstrain (compressive). While a change in load-action, to simulate a 3.1 degrees valgus deformity in the medial compartment osteoarthritic model, did not completely unload the medial plateau of the tibia, it was suggested that such unloading could be achieved with slightly greater valgus loading. Successful clinical results, employing valgus osteotomies in patients with medial compartment osteoarthritis, are obtained by unloading the medial compartment while markedly increasing compressive loads on the whole of the lateral aspect of the leg.

Adolescent↗
PubMed1984

Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity.

Between 1958 and 1983, 45 corrective supracondylar osteotomies of the humerus were performed for post-traumatic cubitus varus deformity in 43 children. The average follow-up period was two and one-half years. Excellent or good results were obtained in 33 patients. Unsatisfactory results were seen in 12. The operation, though deceptively simple, had a significant complication rate (24%), including neuropraxia, sepsis, and cosmetically unacceptable scarring. After these problems were analyzed, the important points of technique that were noted were a comprehensive preoperative plan and a simple lateral closing wedge osteotomy, leaving the medial cortex intact and ignoring rotational deformity.

Bone Nails↗
PubMedDate not supplied

Traumatic hallux varus correction via split extensor tenodesis.

Hallux varus is a deformity, either congenital or acquired, of the first metatarsophalangeal joint. It presents as a medical deviation of the hallux in relation to the longitudinal axis of the first metatarsal shaft. The authors discuss the case history of a patient and the surgical technique--a split width tenodesis--which they used to correct the deformity.

Female↗
PubMed1984

High tibial osteotomy for varus gonarthrosis. A long-term follow-up study.

We evaluated the results in eighty-three patients (ninety-five knees) who had had a high tibial osteotomy for either unicompartmental osteoarthritis or osteonecrosis. The operations were performed between 1965 and 1976. The mean length of follow-up was 8.9 years (range, five to fifteen years). The early results were promising: at two years 97 per cent and at five years 85 per cent of the knees had either an excellent or a good result. At subsequent follow-up, however, only sixty knees (63 per cent) had an excellent or good result, and in the remainder recurrent pain had developed. Twenty-two knees (23 per cent) had been revised to a total knee arthroplasty because of pain. The alignment obtained by the osteotomy was not as important in determining the long-term result as we had previously believed. Although recurrent varus deformity was observed in more than one-quarter of the knees, it was not necessarily associated with an unsatisfactory result. The passage of time was the most important factor in determining the result, as only fifteen (37 per cent) of the knees that had been followed for more than nine years were pain-free. We now believe that total knee arthroplasty is a more suitable operation for patients who are more than sixty years old and that high tibial osteotomy should be reserved for patients who have a strenuous occupation or who wish to continue to participate in sports activities.

Adult↗
PubMed1984

The crooked semantics of valgus and varus.

The meanings of the terms "valgus" and "varus" are clear to orthopedic surgeons but remain confusing to others. The inadequate definitions given in many medical dictionaries and the contradictory meanings listed in Latin lexicons and English dictionaries compound the confusion. Based on a review of the evolution of these terms, standard definitions are offered.

Orthopedics↗
PubMed1984

Varus injury of the knee with common peroneal nerve palsy.

Extensive lateral ligamentous disruption of the knee, otherwise known as severe varus or adduction strain, and common peroneal nerve traction injury (neuropraxia), or complete nerve transection, are rare injury complexes. Six patients with this type of knee injury were studied. Their cases and follow-up, most spanning many years, are reported in detail, with special attention to common peroneal nerve recovery.

Adolescent↗