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At least 55 records · Page 3Linked to original sources
PubMed2003

Hydroxyapatite coating of external fixation pins to decrease axial deformity during tibial lengthening for short stature.

BACKGROUND: Tibial valgus, a known complication of leg lengthening with external fixation techniques, has been related to the stability of the bone-fixator system and, in particular, to pin loosening. A hydroxyapatite coating has been reported to enhance the quality of the bone-pin interface. The aim of this study was to compare the prevalence of axial deformity after tibial lengthening with hydroxyapatite-coated external fixation pins with the prevalence after tibial lengthening with uncoated pins. METHODS: We conducted a prospective study of thirty-four symmetrical tibial lengthening procedures in seventeen pathologically short patients. One limb of each patient was lengthened with use of hydroxyapatite-coated pins and the other, with standard uncoated pins; the sides of the operations were randomly selected. The bone angle in the frontal plane was measured before the operation and at the end of the fixation period, and the difference between these measurements was compared between the lengthening procedures performed with coated pins and those performed with uncoated pins. RESULTS: The mean valgus deviation of the tibia was 6.5 degrees in the group treated with hydroxyapatite-coated pins and 12.5 degrees in the group treated with uncoated pins (p = 0.023). With the numbers available, other factors previously related to the development of valgus deformity did not differ significantly between the two groups. CONCLUSION: Tibiae that are lengthened with the use of hydroxyapatite-coated external fixation pins are less prone to axial deviation in the frontal plane than are those treated with uncoated pins. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2002

[Growth prognosis after para-epiphyseal tangential epiphysial injuries of the lower extremity exemplified by the distal femur: outcome after injuries of epiphyses of the distal femur].

Fractures of the distal end of the femur are rare. Premature partial closure of the physis may occur after metaphyseal fractures. After epiphyseal fractures it has a high incidence of occurrence. The cause of physeal arrest is not known. Stimulation of the physes ends in leg length discrepancy and was seen in 50% of all cases. Spontaneous correction of an axis deviation is possible after antecurvation up to an age of 5 years. But this should be only accepted during therapy of metaphyseal fractures of the distal femur. Side-to-Side deviations remodel in all cases. Aim of therapy in distal epiphyseal fractures should be an anatomical reduction and a definitive retention. Screw osteosynthesis seems to have an advantage.

Adolescent↗
PubMed2004

Computer-assisted revision total knee replacement.

A technique for performing allograft-augmented revision total knee replacement (TKR) using computer assistance is described, on the basis of the results in 14 patients. Bone deficits were made up with impaction grafting. Femoral grafting was made possible by the construction of a retaining wall or dam which allowed pressurisation and retention of the graft. Tibial grafting used a mixture of corticocancellous and morsellised allograft. The position of the implants was monitored by the computer system and adjusted while the cement was setting. The outcome was determined using a six-parameter, quantitative technique (the Perth CT protocol) which measured the alignment of the prosthesis and provided an objective score. The final outcomes were not perfect with errors being made in femoral rotation and in producing a mismatch between the femoral and tibial components. In spite of the shortcomings the alignments were comparable in accuracy with those after primary TKR. Computer assistance shows considerable promise in producing accurate alignment in revision TKR with bone deficits.

Aged↗
PubMed1993

Closed intramedullary osteotomy for the correction of deformities of the femur.

Over the period 1986-1990, an intramedullary saw was used to correct length inequality, rotational and axial deformities and malunions of 17 femora in 15 patients. Interlocking intramedullary nails were inserted after the osteotomies were performed. No postoperative complications were encountered. Quadriceps function returned within 2-8 days and all osteotomies healed radiographically within 3 months. All deformities were satisfactorily corrected and all patients were pleased with the outcome. The intramedullary nails were removed in the majority one year following surgery. The authors conclude that closed intramedullary osteotomy of the femur is a safe and effective technique to correct deformities of the femur, although demanding in terms of experience and equipment.

Adolescent↗
PubMed1995

A 13-month-old boy with progressive genu valgum.

The following case illustrates the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are indicated below. The final clinical and differential diagnoses are presented on the following pages.

Bone Malalignment↗
PubMed1994

Perforation of the small intestine caused by fixation plate penetration into the abdomen.

The authors report a case of intestinal loop penetration and peritonitis caused by penetration of the tip of the fixation into the abdominal cavity after internal fixation of an unstable intertrochanteric fracture. Complete regression of acute infection was achieved by suturing the intestinal wound, removing the internal fixation device and administering systemic and local antibiotic therapy.

Aged↗
PubMed1994

Rotational deformity and remodeling after fracture of the femur in children.

The remodeling potential of angular deformities in the coronal and sagittal planes in children is widely appreciated, and has been studied extensively. The short-term clinical consequences and remodeling potential of torsional deformity after fracture of the femur are less well understood. Computerized axial tomography (CT) was used to identify and follow children with torsional malunion after standard treatment (traction/spica cast) of a closed femur fracture. Seven fracture patients with torsional differences greater than 10 degrees were selected and observed. Computed axial tomography scans were performed at the time of spica cast removal and at the one-year follow-up examination. Four cases showed diminished femoral torsion (one case retroversion), and three cases showed increased femoral torsion. The deformity ranged from 13 degrees to 38 degrees. Follow-up CTs one year later showed no significant correction of deformity. Clinically, deformity of up to 25 degrees was well tolerated. The only symptomatic patient (38 degrees malunion) had a third CT done 28 months after injury, which showed no further correction of deformity. This study confirms the poor remodeling potential of significant posttraumatic torsional deformity of the femur in children.

Bone Malalignment↗
PubMed1993

Lengthening and spatial correction of limbs.

Limb inequality, axial deformity and other problems of reconstructive bone and joint surgery are discussed. Limb length equalisation and correction of axial deformities are complex surgical and rehabilitation procedures associated with a high incidence (0-50%) of complications and side effects requiring prompt remedial measures. The basic principles of limb lengthening by the Wagner method and the essential features of the Ilizarov method for elongation and spatial correction of congenital and acquired limb deformities are described. Further indications for the use of the Ilizarov method in the management of posttraumatic and congenital anomalies of the bone and joint system are presented. The results of operative treatment of these anomalies obtained by the Wagner and Ilizarov techniques over the period from 1979 to 1992 in a total of 274 patients are presented. Attention was focused on the problem of complications or rather side effects arising during such treatment procedures, their prevention and management.

Adolescent↗
PubMed1993

Derotation osteotomy to correct rotational deformities of the lower extremities in children. A comparison of three methods.

Twenty-one supracondylar femoral and 11 tibial derotation osteotomies were performed in 17 patients to correct rotational deformities. Three different methods were used to fix the fragments after derotation: pins incorporated in plaster, plate and screws, and the Ilizarov external fixator. A retrospective review showed no difference in accuracy of derotation between the three methods. However, we recommend the use of the external fixator because it gives less malunion and permits early mobilization and (partial) weight bearing.

Adolescent↗
PubMed1996

[Role of intramedullary nailing in pseudarthrosis and malalignment].

Intramedullary stabilization can provide fast bone consolidation in cases of delayed fracture healing and hypertrophic non-unions. The indication for intramedullary nailing must be exactly adapted to the individual situation. An analysis of our own cases revealed bony healing in hypertrophic non-unions of femoral shaft fractures in 93% and in 94% of tibial shaft fractures after reamed intramedullary nailing. In selected cases of axial or rotational deformities or length discrepancy of the femur and the tibia, a correction osteotomy can be performed with intramedullary nailing. If it is necessary to expose the non-union and in axial or rotational deformities a rotation-stabilizing plate can be applied in addition to the intramedullary nail.

Adult↗
PubMed2001

The nail-insertion point in unreamed tibial nailing and its influence on the axial malalignment in proximal tibial fractures.

The consequence of choosing a point of insertion for the nail (i.e. medial or lateral of the lig. patellae) in unreamed tibial nailing (AO unreamed tibial nail, UTN) was studied in 22 formaldhyde-fixed tibiae. A lateral osteotomy at the transition from the first to the second fifth of the tibia was used as a model for the fracture. A nail insertion point medial of the lig. patellae caused a valgus deformity, combined with a shift of the distal fragment to the medial side. A lateral point of entry resulted in a varus deformity, together with a lateral shift of the distal fragment. Our results show that the insertion point of the nail is important for the alignment of the axis. Choosing a different point for the insertion of the nail can be useful in operative correction of malalignment of the tibia.

Biomechanical Phenomena↗
PubMed2005

First metatarsal osteotomy nonunion and malunion.

The purpose of this article is to review our experience with malunion and nonunion of proximal and distal first metatarsal osteotomies and to outline the treatment options when such complications occur.

Biomechanical Phenomena↗
PubMed2006

Circular external fixation in knee arthrodesis following septic trauma sequelae: preliminary report.

Deep infection is one of the most devastating complications after knee fractures. It may be related to the initial fracture status or, more commonly, the surgical intervention. From 1991 to 2003, 12 patients underwent knee fusion to treat resistant infection after complex knee fractures or arthrodesis fractures using the Ilizarov method and frame. There were 9 men and 3 women (mean age, 39.7 years). Two-thirds of the patients had long-standing infection and 5 patients had undergone earlier attempts at knee arthrodesis. Correction of concurrent malalignment was achieved in 2 patients. Bone transport using the same arthrodesis frame was necessary in 2 patients to overcome large bony defects. Solid fusion was achieved in all patients by the end of treatment. The average duration of external fixation was 22 weeks (range: 11-44 weeks). No patients required secondary bone grafting to achieve union. Complications occurred in 6 (50%) patients. The most common problem seen was pin tract infection, but only 2 patients required surgical intervention for its treatment. The study emphasizes the clinical success of the Ilizarov method in knee arthrodesis after infected fractures.

Adult↗
PubMed2004

Loss of alignment after surgical treatment of posterior Monteggia fractures: salvage with dorsal contoured plating.

PURPOSE: To review the results of internal fixation with a dorsal contoured plate in patients with malalignment after internal fixation of a posterior Monteggia fracture. METHODS: Seventeen patients with malalignment after surgical treatment of a posterior Monteggia fracture were treated with realignment of the ulna and fixation with a contoured dorsal plate. Fifteen patients had loose fixation and 12 patients had subluxation or dislocation of the ulnohumeral joint. Sixteen patients had fracture of the radial head and 9 patients had fracture of the coronoid process. Nine patients had ancillary procedures on the radial head, 4 had ancillary procedures on the coronoid, 5 had hinged external fixation, and one had fascial arthroplasty. Seven patients had another surgery before the final evaluation related to a complication in 6 patients and a to subsequent injury in 1 patient. RESULTS: At the final evaluation at an average of 59 months the fracture was healed and the ulnohumeral joint was reduced concentrically in all 17 patients. The average arc of elbow flexion was 108 degrees and the average arc of forearm rotation was 134 degrees. The average American Shoulder and Elbow Surgeons Elbow Evaluation Score was 88. According to the system of Broberg and Morrey, the final result was rated excellent for 5 patients, good for 9, fair for 2, and poor for 1. One patient had fascial arthroplasty as part of the index procedure and 9 patients had radiographic signs of ulnohumeral arthrosis. CONCLUSIONS: Malalignment after surgical treatment of posterior Monteggia fractures often is associated with unstable fixation. Dorsal contoured plating of the ulna in combination with other procedures can help salvage a malaligned posterior Monteggia fracture with satisfactory function restored in the majority of patients.

Adult↗