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PubMed1977

[New results of a modified acetabuloplasty after Lance combined with detorsion-varus-osteotomy (author's transl)].

The results of 254 Lance-acetabuloplasties in a modified technique combined withe detorsion-varus-osteotomy have been analysed. The children were operated upon in the years 1970-1974. Regarding the acetabulum the results were as follow: 1. In children between 1 and 6 years a normal acetabular index (as compared with the Normal Values of Tönnis and Brunken) was achieved in 78.3%, a slightly dysplastic index in 14.8%. In 6.6% a severe dysplasia remained. 2. In children between 6 and 10 years a normal acetabular index was found in 59.4%, a slightly dysplastic index in 24.3% and an index as classifies severe dysplasia in 16.2%. 3. In children older than 10 years and adults in 38.3% a normal Hip Value (Busse et al., Brückl et al.) was achieved, in 19.4% the value classifies a slight dysplasia, in 41.6% a severe dysplasia. These results show, that acetabuloplasty in the technique used here is a very effective method, especially in the first 6 years of life. But even in the older age groups significant improvement has been achieved. There for the indication of different operative techniques should be discussed again.

Acetabulum↗

PubMed1977

[Paresis of the brachial plexus: subcapital varus osteotomy, arthrodesis of shoulder joint and above-elbow amputation (author's transl)].

In brachial plexus paresis with partial sensory sparing in the upper arm and complete motor paralysis we amputate through the humerus at the distal limit of sensation. The remaining proximal humerus is fixed by an arthrodesis of the shoulder joint, combined with a varus-osteotomy below the head. This increases with axillary space, facilitates the fitting of a prosthesis and improves care of the skin in this critical area. It also improves the outline of the shoulder the muscles of which shrink.

Amputation, Surgical↗

PubMed1997

Joint loading with valgus bracing in patients with varus gonarthrosis.

The purpose of this study was to determine whether a brace designed to unload varus degenerative knees actually alters medial compartment loads by decreasing the adduction moment. Eleven patients who had arthrosis confined to the medial compartment were fitted with a valgus brace and tested before and after brace wear with pain and function scoring instruments and by automated gait analysis. The biomechanical data from these patients were compared with those from 11 healthy control subjects. Scores from an analog pain scale decreased 48% with brace wear, and function with activities of daily living increased 79%. Mean adduction moment without the brace measured 4.0 +/- 0.8% body weight times height versus 3.6 +/- 0.8% body weight times height when wearing the brace (10% decrease). The mean adduction moment for control subjects was 3.5 +/- 0.6% body weight times height. Thus, the mean adduction moment decreased from approximately one standard deviation from the normal mean to a value that is similar to the control value. Nine of 11 patients had a decrease in the adduction moment with the brace, five of 11 patients had a reduction higher than 10%, and decreases in this moment were as high as 32%. This study shows that pain, function, and biomechanical knee loading can be altered by a brace designed to unload the medial compartment of the knee.

Arthritis↗

PubMedDate not supplied

[Results of femoral varus osteotomy in the treatment of Legg-Calvé-Perthes disease].

The authors studied a group of 52 patients with Legg-Calvé-Perthes disease who had been treated by femoral varus osteotomy (54 osteotomies) aiming to show the end results and complications of the procedure based on Stulberg et al's evaluation. Regarding this classification of results were found 19 osteotomies (35.1%) with a good result (Stulberg's Groups 1 and 2), 35 (64.8%) with a fair end result (Stulberg's Groups 3 and 4) and none poor result. Few complications were observed in this series: pseudarthrosis occurred in three cases; Trendelemburg was observed in five patients postoperatively and overgrowth of the greater trochanter was observed in seven patients. In nine patients it was observed a significant leg length discrepancy with more than 2.1 cm of difference. However by the end results observed we may say that good results can be obtained with this technique in the treatment of patients with Legg-Calvé-Perthes disease. It is very important the indication criteria adopted based on the prognosis of the individual case studied.

Adolescent↗

PubMed1998

Tibial osteotomy for varus gonarthrosis. A 10- to 21-year followup study.

From 1975 to 1986, 102 high tibial osteotomies for varus gonarthrosis were performed in 99 patients. Fifty-eight patients (60 knees) were reviewed at an average followup of 15 years (range, 10-21 years); of the remaining 41 patients, seven had a knee replacement, 18 had died, and 16 were lost to followup. The results, assessed according to the scoring system of the Hospital for Special Surgery and including the seven patients who underwent a knee replacement, were excellent or good in 37 (55%) knees and fair or poor in 30 (45%). Twenty-six patients of the current study previously were reviewed in 1986, with an average followup of 8 years, using the same clinical and radiographic criteria. In this group of 26 patients, excellent and good results decreased from 73% in 1986 to 46% in 1996. The knees in these 26 patients with a followup greater than 15 years had a statistically significant higher percentage of fair and poor results. No statistically significant differences in the results were found according to the amount of correction. Radiographic controls at followup were available for 45 of the 60 knees; a loss of correction greater than 5 degrees was observed in 11 knees. The results of this long-term followup study show that high tibial osteotomy for gonarthrosis allows a long period (range, 10-15 years) of relief of pain, good range of motion, and function in a large number of patients. Results tend to deteriorate with time, particularly after 15 years.

Adult↗

PubMed1998

Dome osteotomy with T-plate fixation for cubitus varus deformity in an adult patient.

Cubitus varus (gun stock deformity) is the most common long-term complication resulting from a malunion of a supracondylar fracture of the humerus in children. The reported series of complication varies from 9 to 58%. There are many published papers describing corrective supracondylar osteotomy mainly for children. We describe a method of performing supracondylar osteotomy that produced a very satisfactory result in an adult patient.

Adult↗

PubMed1976

Medial subtalar stabilization with posterior medial release in the treatment of varus feet: a preliminary report.

The problem of the varus hindfoot in children ages six to 10 has been discussed. A preliminary follow-up is presented on six patients treated by extensive medial release, multiple tendon lengthenings, and subtalar intra-articular arthrodesis. Two of our patients revealed incomplete correction of the deformity because of technical errors in the medial release. However, there have been no failures of fusion and no progression of the deformity to date. This is a preliminary report and further follow-up is indicated. It should be noted that we have now extended our series to 40 patients.

Child↗

PubMed1998

[Anterior cruciate ligament-plasty and high valgus tibial osteotomy as a combined procedure in anterior instability and varus deviation].

Besides patients having an acute rupture of the ACL with a clear therapeutical strategy there are increasingly young patients with chronical anterior instability and degenerative arthritis of the medial compartment and varus malalignment. This constellation is taxing severely the operative procedure considering that there is not only the instability which has to be treated but that also an improvement of the arthritis symptomatology has to be achieved. In this paper we present a therapeutical concept of high tibial osteotomy combined with an arthroscopic assisted reconstruction of the ACL which is performed as a single procedure since the early 80-ies. The goal is to remove two severe arthrogenic factors correcting the instability and the pathological anatomical axis, to reduce the medial knee pain and to improve the use of the knee in life activities.

Anterior Cruciate Ligament↗

PubMedDate not supplied

Femoral varus osteotomy in Legg-Calvé-Perthes disease: points at operation to prevent residual problems.

We analyzed at skeletal maturity the radiographic results of 46 patients with unilateral Legg-Calvé-Perthes disease (LCPD) who were treated with femoral varus osteotomy (FVO) with special attention to proximal femoral growth. In 30 patients, leg-length discrepancy (LLD) and alignment change in the leg also were examined. The postoperative femoral neck shaft angle (FNSA) was not related to the result on Stulberg's criteria, but the postoperative acetabulum head index (AHI) was. Trochanteric prominence remained on the affected side in spite of an improvement in FNSA. LLD did not depend chiefly on FVO itself. The alignment of the leg on the affected side showed a tendency to valgus, which occurred to correct the mechanical axis displaced medially by the FVO. Along with an FVO for LCPD, some additional operative technique should be performed to prevent trochanteric prominence and medial displacement of the distal fragment to prevent genu valgum.

Adolescent↗

PubMed1950