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PubMedDate not supplied

A literature review of the Ilizarov technique and some applications for treating foot pathology.

The Ilizarov technique is a method of stimulating new bone and/or soft tissue growth at the rate of 1 mm per day. This technique was developed in the former Soviet Union in the early 1950s to stimulate limb lengthening, correct malaligned appendicular skeletal deformities, heal nonunions and close soft tissue defects. This procedure has been used in the United States less than 10 years. While Professor Ilizarov recognized that his technique could be used to treat foot pathology such as clubfoot, physicians continue to expand the applications for the Ilizarov procedure in treating complex foot pathologies.

Bone Lengthening↗

PubMedDate not supplied

Anteromedialization of the tibial tuberosity for patellofemoral malalignment.

Anteromedialization of the tibial tuberosity is a new and highly effective technique for transferring the tibial tuberosity when anteriorization is desired in addition to medial shift of the patellar tendon insertion. Prompt primary bone healing can be achieved, allowing rapid rehabilitation with substantially improved patellofemoral mechanics. No bone grafting is necessary to achieve anteriorization, although only slight to moderate anteriorization is possible in most cases. Realignment of the patellofemoral mechanism and relief of patellofemoral contact stress can be achieved in one procedure.

Adolescent↗

PubMedDate not supplied

Early experience with titanium elastic nails in a trauma unit.

The Titanium Elastic Nail (TEN) offers a number of potential advantages over traditional ways of treating long bone fractures particularly in the paediatric population. These advantages include earlier mobilisation and shorter hospital stay and less risk of loss of fracture position. These advantages are most apparent and significant when treating femoral fractures in children where the length of hospital stay is reduced from several weeks to a typical period of 5 to 8 days. We have reviewed our early experience of using these implants over the past 2 years. Patients were assessed clinically and radiologically. 13 patients were treated using the TEN during this period. There were 2 femoral fractures, 4 humeral fractures, 1 tibial and 6 forearm fractures treated using the Titanium Elastic Nail. All fractures united during the study period. However 1 humeral fracture required a secondary bone grafting and plating for delayed union and 1 fracture lost position during follow-up. Insertion point pain was a problem in 4 patients but this resolved after nail removal in all. There was 1 superficial wound infection which resolved with antibiotics and 1 superficial wound infection of an open fracture wound which resolved following nail removal and antibiotics. There were no cases of deep infection. There were no limb length discrepancy or rotational or angular malalignment problems. Biomechanical principles and technical aspects of this type of fixation are discussed.

Adult↗

PubMed2004

Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures.

OBJECTIVE: To summarize the surgical experience and clinical results of the first 89 fractures of the proximal tibia treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA). DESIGN: Retrospective analysis of prospectively enrolled patients into a database. SETTING: Academic level I trauma center. SUBJECTS/PARTICIPANTS: Eighty-seven consecutive patients with 89 proximal tibia fractures (AO/OTA type 41 and proximal type 42 fractures) treated by 2 surgeons. Seventy-five patients with 77 fractures were followed until union. The mean follow-up was 14 months (range: 3-35 months). There were 55 closed fractures and 22 open fractures. INTERVENTION: Surgical reduction and fixation of fractures, followed by rehabilitation. MAIN OUTCOME MEASUREMENTS: Perioperative and postoperative complications, postoperative alignment, loss of fixation, time to full weight bearing, radiographic union, and range of motion. RESULTS: Seventy of 77 fractures healed without major complications (91%). There were 2 early losses of proximal fixation, 2 nonunions, 2 deep delayed infections, and 1 deep peroneal nerve palsy. Other complications included a superficial wound infection and 3 seromas. Postoperative malalignment occurred in 7 patients with 6 degrees to 10 degrees of angular deformity (6 flexion/extension and 1 varus/valgus malalignments), and an eighth patient had a 15 degrees flexion deformity. In 4 patients, the hardware was removed at an average of 13 months because of irritation (5%). The mean time for allowance of full weight bearing was 12.6 weeks (range: 6-21 weeks), and the mean range of final knee motion was 1 degrees to 122 degrees . CONCLUSIONS: The LISS provides stable fixation (97%), a high rate of union (97%), and a low (4%) rate of infection for proximal tibial fractures. The technique requires the successful use of new and unfamiliar surgical principles to effect an accurate reduction and acceptable rate of malalignment.

Adolescent↗

PubMed1988

Modified technique for tibial tubercle elevation with realignment for patellofemoral pain. A preliminary report.

Malalignment of the quadriceps mechanism was corrected and the tibial tuberosity elevated in 17 knees in 16 patients without the use of a free bone graft. The indications for operation were patellofemoral pain unresponsive to conservative treatment, recurrent subluxation or dislocation of the patella, and patients who had had a previous patellectomy with subsequent lateral subluxation of the patella tendon associated with pain. A bone block including the attachment of the patellar tendon is transposed medially to correct the quadriceps angle (Q-angle), elevate the tibial tuberosity, and thereby decrease patellofemoral pressure. A prerequisite for this procedure is a Q-angle of 20 degrees or more. The average age of the patients was 29 years. The follow-up period was one to four years. Eighty-five percent of the patients had an excellent or good result. The only complication was a stress fracture, which developed in one bone block.

Adolescent↗

PubMed2004

Long gamma nail in the treatment of subtrochanteric fractures.

INTRODUCTION: The purpose of our study was to retrospectively evaluate the clinical and radiological results of subtrochanteric fractures treated with a long gamma nail (LGN). The LGN has been the implant of choice at our level-1 trauma center since 1992. MATERIALS AND METHODS: Over a period of 7 years, we have treated 90 consecutive patients with subtrochanteric fractures. In order to evaluate the clinical and radiological outcomes, we reviewed the clinical and radiographic charts of these patients followed for a mean time of 2 years (range 13-36 months). RESULTS: We found no intra- or perioperative complications nor early or late infection. Clinical and radiological union was achieved at a mean of 4.3 months in all of the patients (range 3-9 months); in 24 cases (30%) the distal locking bolts were retrieved in order to enhance callus formation and remodeling as a planned secondary surgery. Three patients (3.3%) needed unplanned secondary surgery for problems related to the nailing technique. Two mechanical failures with breakage of the nail were encountered due to proximal varus malalignment, of which one was treated with exchange nailing and grafting and the other one by removal of the broken hardware, blade-plating, and bone grafting. One fracture below a short LGN was treated by exchange nailing. CONCLUSIONS: The minimally invasive technique and simple application of the LGN lead to a low percentage of complications in these difficult fractures after a relatively short learning curve. The biomechanical properties of this implant allow early mobilization and partial weight-bearing even in patients with advanced osteoporosis.

Adult↗

PubMedDate not supplied

Use of a double hook plate for treatment of a distal radial fracture in a dog.

Attempted stabilization of open, distal radius and ulnar fractures in a 3-year-old German shepherd dog using intramedullary pins and a Schroeder-Thomas splint resulted in malalignment of the limb and osteomyelitis. A double hook plate was used to rigidly stabilize the distal radial fracture after anatomical realignment. An autogenous cancellous bone graft was used where a lateral architectural defect remained after reduction. Culture of the fracture site showed Staphylococcus sp., which responded to chloramphenicol therapy. Fracture union and resolution of osteomyelitis occurred by 9 weeks after surgery, and the dog had no lameness and a normal muscle mass 22 weeks after surgery. The double hook plate provided rigid internal fixation of the radial fracture, allowed a rapid return to function during osteosynthesis, and minimal interference of antebrachiocarpal joint function occurred.

Animals↗

PubMed2003

Revision of ankle arthrodesis.

From 1989 to 1996, we treated 18 cases (10 males, eight females; average age 48.2 years) of failed ankle arthrodesis by revision of ankle arthrodesis and followed their progress for at least two years. The average time interval between original surgery and revision was 17.3 months. Revisions were needed due to infection in one case, nonunion in 10 cases, and malalignment in seven cases. The salvage operations included debridement in the infected case, refreshed pseudoarthrosis in nonunion cases, and corrective osteotomy in malalignment cases. Sixteen cases were fixed by crossed screws with internal compression, one infected case was fixed by an external fixator, and one case with bone loss was fixed with buttress plate. The average follow-up period was 40.4 months. There was one nonunion and two delayed unions, with an ultimate fusion rate of 94%. The average AOFAS ankle-hindfoot score was 70.9 at final follow up. There was one excellent result (5.6%), five good results (27.8%), 11 fair results (61%), and one poor result (5.6%), and the overall results were poorer compared with our series of primary arthrodesis. The time to fusion also took longer in the revision cases (average 2.7 months in primary cases and 4.8 months in revision cases). Fusion techniques that ensure solid union in a functional position are essential. If an ankle arthrodesis fails, however, revision is a salvage procedure that can achieve an acceptable result.

Adult↗

PubMed1991

[Post-traumatic hindfoot reconstruction--principles and selected examples].

Besides rheumatoid diseases, fractures are the most frequent cause of painful static problems about the hindfoot. Even when the ankle, the subtalar or the midtarsal joints are not involved directly in the fracture, they likely degenerate secondarily because of the malalignment. The aim is to restore normal morphology of the foot with reorienting arthrodeses using stable internal fixation by screws and cortico-cancellous autologous bone grafts which allow early partial weight bearing. There are three surgical approaches which can be used alone or in combination: antero-medial along the medial column, lateral (Ollier), and postero-lateral along the heel cord.

Adult↗

PubMed2001

Scapular neck fracture--the influence of permanent malalignment of the glenoid neck on clinical outcome.

A scapular neck fracture is considered unstable if it is associated with an ipsilateral clavicular fracture or an acromioclavicular (AC) joint dislocation. Currently, it is recommended that stabilization of a disrupted shoulder girdle must be achieved through open reduction and internal fixation of the clavicular fracture or by reduction of the AC joint, without addressing the scapular neck. However, if the displaced glenoid neck is not simultaneously reduced, malalignment of the glenoid neck may persist. The purpose of this retrospective study was to analyze the effect of associated shoulder girdle injury on glenoid displacement and the influence of glenoid malalignment on clinical outcome. Nineteen patients with scapular neck fractures were reviewed clinically and radiologically at a mean of 8 years (range 2-21 years) after injury. None of them has developed nonunion of the scapular neck, and only one showed radiological signs of mild degenerative joint disease. The glenopolar angle (GPA), which assesses the rotational malalignment of the glenoid about an anteroposterior axis perpendicular to the scapular plane on plain X-rays was measured less than 20 degrees in six patients. Three of them had sustained an associated clavicular fracture or AC joint dislocation. The other 3 patients had permanent severe malalignment of the glenoid neck in the absence of an associated shoulder girdle injury. Five patients with GPA less than 20 degrees complained of moderate or severe pain, whereas of the 13 patients with mild or no glenoid rotational displacement or medial displacement alone, 11 patients had no or mild pain, and only 2 had moderate or severe pain (P = 0.0095). Five patients presented with reduced activities of daily living, 4 of them had severe glenoid rotational displacement (P = 0.0173). Loss of motion was found in only 2 patients, and both had a severely displaced glenoid neck (P = 0.088). In conclusion, severe displacement of the glenoid neck may occur with or without associated fracture of the clavicle or dislocation of the AC joint and can be identified as a GPA less than 20 degrees. Scapular neck fractures with such malalignment have a less favorable long-term outcome compared with otherwise comparable cases with absence of glenoid malalignment as measured with the glenopolar angle.

Adult↗

PubMed1999

Resection of the distal scaphoid for scaphotrapeziotrapezoid osteoarthritis.

Twenty-one patients with symptomatic scaphotrapeziotrapezoid osteoarthritis were treated with partial distal scaphoid excision. In 12 wrists the joint defect was filled with either capsular or tendinous tissue, while in nine no fibrous interposition was done. At an average follow-up time of 29 (range, 12-61) months, 13 wrists were painfree, while eight had occasional mild discomfort. Mean wrist flexion-extension was 119 degrees. Grip and pinch strength improved by an average of 26% and 40% respectively compared with their preoperative status. Fifteen patients returned to their original jobs, while six, who were unemployed, felt unrestricted for activities of daily living. Although patient satisfaction was comparable for both types of treatment, the wrists without fibrous interposition showed significantly greater wrist flexion-extension than patients with soft-tissue interposition. Removal of the distal scaphoid resulted in a DISI pattern of carpal malalignment in 12 wrists. At follow-up, none of these wrists showed further joint deterioration due to residual malalignment.

Adult↗

PubMed1999

[Results of therapy after primary conservative management of distal radius fractures in patients over 65 years of age].

BACKGROUND: In the clinical routine of our City Hospital Triemli, Zürich, Switzerland, we prefer to treat old patients with fractures of the distal radius conservatively. It was our aim to examine the long-term effects of this treatment on anatomical position, mobility, strength, and patient satisfaction. PATIENTS AND METHODS: We reviewed the data of 102 consecutive patients over 65 years of age. 95 were treated with a plaster cast and controlled weekly in our outpatient department, finally discharged after 50 days. After an average time of eight months, 79 patients could be controlled clinically and radiologically. RESULTS: Although a significant (p < 0.001) reduction of joint mobility and grip strength was found in all cases, we documented no loss of independence in every-day life. Radiological malalignment of the distal radius with a dorsal or palmar angle of more than 20 degrees in the lateral view or a radio-ulnar angle of less than 15 degrees in the dorsopalmar view was associated with increased complaints and patients dissatisfaction. CONCLUSION: In old-aged patients with distal radius fractures, the indication for surgical treatment should be made very carefully, since certain degrees of radiological malalignment are tolerated well.

Aged↗

PubMed1987

Angular deformities of the lower limbs in children.

Bowlegs and knock-knees are common concerns in the early years of life. For the majority of children, these problems represent normal physiologic development and they correct spontaneously. A few children will have pathologic malalignment, which may lead to functional or cosmetic problems that may require treatment, usually bracing and occasionally surgery. Physiologic varus and valgus and the common causes of pathologic malalignment, including Blount's disease, rickets, hereditary conditions, infection, and trauma are discussed.

Adolescent↗

PubMed1986

Anteromedial displacement of the tibial tubercle for patellofemoral arthralgia.

Anterior and medial repositioning of the tibial tubercle (anteromedialization) reduces patellofemoral pressure and corrects patellar malalignment. Over the last 6 years this simple procedure was carried out on 53 knees in patients who had no athletic inclinations. The average age was 40.4 years. Follow-up was at least 1 year. A rating system was developed and overall the results were 65.9% excellent, 15.9% good, 11.4% fair and 6.8% poor. In the over-45 age group, the results were 57.1% excellent, 28.6% good, 14.3% fair and none poor. The complication rate was relatively low (18.7%). This procedure appears to be satisfactory for patellofemoral arthralgia when malalignment is present, particularly in the elderly.

Adult↗

PubMed2006

[Arthrodesis of the talonavicular joint].

The talonavicular joint as part of the coxa pedis plays a pivotal role in the overall motion of the foot. The necessity for talonavicular fusion arises from isolated arthritis of posttraumatic, rheumatoid, degenerative, or idiopathic etiology. Posttraumatic arthritis is seen after malunited mid-tarsal (Chopart) fracture-dislocations and is frequently accompanied by malalignment due to an imbalance between the medial and lateral columns of the foot. In these cases a corrective arthrodesis becomes necessary. In cases of poor bone stock or arthritis of the calcaneocuboid joint, a double arthrodesis is preferred over isolated talonavicular fusion. Fusion with mini-plates is biomechanically superior to fusion with screws and especially staples, the latter being associated with non-union rates of up to 37%. Talonavicular fusion allows reproducible pain reduction in isolated arthritis with subjective patient satisfaction of between 86% and 100% in a literature review. The substantial reduction of movement in the triple joint complex leads to overload of the adjacent joints with development of arthritis in about 30% in the medium term.

Ankle Injuries↗

PubMed1988

Laminectomy for relief of atlantoaxial subluxation in four horses.

Malalignment of the atlas and axis was seen in 4 horses with an idiopathic form of atlantoaxial subluxation characterized by spinal cord compression on extension. The bone structure and density of the atlas and axis were radiographically normal in 3 of the 4 horses. Clinical signs appeared when the horses were 6 to 30 months old, and 3 of the 4 horses had a history of trauma. Although a congenital anomaly could not be ruled out, the cause was thought to be trauma. The horses were moderately to severely ataxic at the time of examination. Myelography revealed compression of the spinal cord at the atlantoaxial junction on extension. Flexion completely relieved the compression. In each horse, subtotal laminectomy of the caudal two thirds of the dorsal arch of the atlas was used to relieve the spinal cord compression. Two horses recovered fully, one had residual grade-1 neurologic deficits, and a fourth was euthanatized after it fractured a limb 6 weeks after surgery.

Animals↗

PubMed1990

Vascularized fibular grafts in the treatment of congenital pseudarthrosis of the tibia.

Free vascularized fibular bone grafts were used in nineteen children, seen consecutively, who had congenital pseudarthrosis of the tibia. The average age was 5.1 years (range, 1.4 to 11.4 years). Sixteen of the patients had been treated with electrical stimulation for at least one year, and the tibia had not united. All but four patients had had at least one previous operative procedure. At an average follow-up of 6.3 years (range, 2.0 to 11.0 years), eighteen (95 per cent) of the nineteen pseudarthroses had healed. The leg-length discrepancy averaged 1.6 centimeters (range, 0 to 4.0 centimeters), but ten tibiae had residual or progressive valgus or anteroposterior malalignment despite bracing. There was minimum morbidity at the donor site.

Bone Transplantation↗

PubMed1990

Preoperative planning for the treatment of nonunions and the correction of malunions of the long bones.

A detailed analysis of the steps of preoperative planning as employed in our clinic has been presented. We have found these techniques to be of great value in anticipating the requirements that must be fulfilled to correct malalignments and obtain healing when the malalignments occur alone or are associated with nonunion. Besides helping one to decide where a malalignment is best corrected to anatomically match the normal extremity, tracings aid in allowing the surgeon to appreciate the kinetics of the operative procedure, as well as to define the best methods of stabilizing the resulting correction.

Adult↗