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At least 667 records · Page 37Linked to original sources

PubMed2006

In vitro evaluation of five canine tibial plateau leveling methods.

OBJECTIVE: To compare application time, accuracy of tibial plateau slope (TPS) correction, presence and magnitude of rotational and angular deformities, and mechanical properties of 5 canine tibial plateau leveling methods. SAMPLE POPULATION: 27 canine tibial replicas created by rapid prototyping methods. PROCEDURE: The application time, accuracy of TPS correction, presence and magnitude of rotational and angular deformation, and construct axial stiffness of 3 internal fixation methods (tibial plateau leveling osteotomy, tibial wedge osteotomy, and chevron wedge osteotomy [CWO]) and 2 external skeletal fixation (ESF) methods (hinged hybrid circular external fixation and wedge osteotomy linear fixation [WOLF]) were assessed. RESULTS: Mean bone model axial stiffness did not differ among methods. Mean application time was more rapid for WOLF than for other methods. Mean TPSs did not differ from our 5 degrees target and were lower for ESF methods, compared with internal fixation methods. Mean postoperative rotational malalignment did not differ from our target or among groups. Mean postoperative medio-lateral angulation did not differ from our target, except for CWO. Internal fixation methods lead to axially stiffer constructs than ESF methods. Reuse of ESF frames did not lead to a decrease in axial stiffness. CONCLUSIONS AND CLINICAL RELEVANCE: The 5 tibial plateau leveling methods had acceptable geometric and mechanical properties. External skeletal fixation methods were more accurate as a result of precise data available for determining the exact magnitude of correction required to achieve a 5 degrees TPS.

Animals↗

PubMed2006

[Subtalar arthrodesis with calcaneal osteotomy].

The amount of postraumatic deformities of the calcaneus after fracture is classified in 5 types (Type I-V). The bony situation includes in the simple group A malunions, in group B the more demanding nonunions and in Group C the worst cases with additional aseptic or septic necrosis of parts of the calcaneus. For type I with posttraumatic arthritis of the subtalar joint and without malalignement, an in situ-arthrodesis is suitable. Type II, with an additional varus- or valgus hind foot deformity, but especially in type III with additional loss of height and dorsal tilting of the talus a bone block distraction arthrodesis is required. Type IV includes, additionally to the pathology of type I to type III, a lateral translation of the calcaneus. This indirectly causes a severe hind foot valgus and an abutment of the posterior facet towards the lateral malleolus. This type needs osteotomy of the calcaneus through the old fracture surfaces, performed using a bilateral approach. Type V is very rare but the most difficult one for reconstructive surgery because the talus is additionally tilted out of the ankle joint. Therefore, in addition to the bilateral approach and calcaneal osteotomy, an anteromedian approach to the ankle joint is necessary. The surgical procedure in group A (malunion) is more or less the same like in group B (nonunion). Group C (aseptic / septic osteonecrosis) needs a preliminary radical necrectomy in a two stage reconstructive procedure.

Adult↗

PubMed2001

Why do ankle arthrodeses fail in patients with rheumatic disease?

Solid and painless fusion was achieved in 117/130 patients (90%) with rheumatic diseases after primary ankle arthrodesis at the authors' institution. Operations were performed using internal fixation according to the Adams technique. Critical retrospective analysis of failures in 13 patients (11 nonunions, one postoperative low-grade infection, and one painful arthrodesis) revealed errors in the primary operative technique in 10/13 ankles (77%), resulting typically from the surgeon's attempt to overcompensate a malaligned ankle while ignoring correction of the hindfoot deformity (subtalar complex). The optimum of 0-5 degrees of valgus was found in only 5/13 patients (38%). All four patients with varus alignment presented with malleolar pain. Bone grafting was adequate even in those patients with failure, whereas immobilization time was suboptimal in one patient (eight weeks). Patient satisfaction was lowered in every case of nonunion. Revision arthrodesis of failed primary fusion was successful in 10/13 patients (77%), however three additional stress fractures, two painful ankles without nonunions, and one superficial wound infection were detected. Ankle arthrodesis is a demanding procedure, and the operation should always be performed by an experienced surgeon, taking into account the alignment, ligament, and muscle balance of the rheumatoid ankle and hindfoot. Correction and rebalancing of these factors and the use of bone grafts are of crucial importance when considering the optimal conditions for fusion. Nonunions, infections, and stress fractures occurring after the primary arthrodesis are severe complications, leading eventually to revision operations and problems with osteoporotic bone, fragile soft tissues, and skin.

Adult↗

PubMed1991

Vascularized full-thickness parietal bone grafts in maxillofacial reconstruction: the role of the galea and superficial temporal vessels.

Reconstruction of bony structures of the face is always a problem as big as the defect and the function that must be replaced. Everything from simple grafts to sophisticated distant bone flaps has been used. Based on the studies of Cutting et al., Psillakis et al., and Casanova et al., we have developed the full-thickness galeoparietal bone flap, initially for mandibular reconstruction, but of great use for all maxillofacial reconstructions. From July of 1987 to December of 1988, 14 patients have been operated on. The experience with this flap is shown in four patients as follows: primary reconstruction of a mandible as a result of ameloblastoma, secondary reconstruction of a mandible with associated old fractures and malalignment of segments, bilateral malar reconstruction in a patient with Treacher Collins syndrome, and severe sequelae of an already treated Romberg case. Small variations could be made to best accommodate the technique used to the defect we were treating. Some technical details, the experience, the results, and possible sequelae or complications are also discussed.

Adult↗

PubMed2005

[Vertebral body replacement with Synex in combined posteroanterior surgery for treatment of thoracolumbar injuries].

OBJECTIVE: Reduction and stabilization of unstable spinal injuries with reconstruction of the anterior column resulting in a permanent restitution of the physiologic spinal alignment, stability and load-bearing capacity. INDICATIONS: Unstable injuries and lesions of the spine from T4 to L5 resulting in a reduced load-bearing capacity of the anterior spinal column caused by vertebral fractures and injury of the intervertebral disks, posttraumatic kyphotic deformities, pathologic fractures, tumors. Relative indications: younger patients with monosegmental injuries; patients with severe osteoporosis. CONTRAINDICATIONS: Concomitant serious thoracic injuries or preexisting cardiopulmonary disease precluding anterior intervention. SURGICAL TECHNIQUE: Combined posteroanterior treatment with (1) posterior reduction and stabilization with an internal fixator and interlaminar fusion with autogenous bone grafts; (2) thoracoscopic anterior approach with reconstruction of the anterior column with a distractible titanium implant for vertebral body replacement (Synex), interbody fusion with autogenous bone grafts and/or beta-tricalciumphosphate. RESULTS: 50 consecutive patients (29 men, 21 women) with an average age of 43 years (20-77 years) were treated with Synex. The most frequent indication was acute injury (n = 36). A bisegmental reconstruction was performed in 30 patients, a monosegmental in 20. Mean follow-up 19.5 months (14-31 months) in 41 patients. 18/33 patients returned to their previous occupation, and 32/41 resumed their recreational activities. At follow-up, 32/41 were free of symptoms or complained of only occasional pain, eight reported marked pain and one severe pain. A VAS spine score (0-100 points, visual analog scale, 19 items) was used for assessment; the preoperative score amounted to 83.1 +/- 20.2 (21-100), the postoperative score to 63.8 +/- 19.5 (25-99). The mean decrease in VAS spine score was 19.3 +/- 22.3. The average degree of correction measured radiologically for patients with fresh injuries or posttraumatic malalignment was 18.6 degrees +/- 10 degrees and the loss of correction 2.1 degrees +/- 2.9 degrees . No implant-related complications were observed.

Adult↗

PubMed2002

The use of external fixators in the immobilization of pediatric fractures.

The use of external fixation in the immobilization of diaphyseal and metaphyseal fractures in children is still controversial, as these fractures are generally managed by immediate plaster casting, by traction followed by casting, by various methods of internal fixation, including the recently developed flexible rods, and by plating. Between 1982 and 1998, we treated 64 children with fractures of the long bones of the lower limb using external fixation, 44 of whom were available for follow-up (46 fractures). Their average age on the day of injury was 8.l years. Average follow-up extended for 4 years. The external fixation used was left in place for an average of 67 days. Full range of movement was achieved in 42 children (44 limbs). The longitudinal axis was anatomically correct (<5 degrees angulation) in 40 children (42 limbs). Due to malalignment of the fracture (15 degrees varus) in one child, tibial osteotomy was performed 4 years after fracture healing. There was no leg length discrepancy in 38 children, and shortening of >2 cm was measured in the fractured limbs of 2 children. We found the use of external fixators to be easy, quick, with a short learning curve, and appropriate for comminuted and closed fractures of the long bones, and especially for children with polytrauma.

Adolescent↗

PubMed2002

Force transmission through the juvenile idiopathic arthritic wrist: a novel approach using a sliding rigid body spring model.

Force transmission across the wrist during a grasping maneuver of the hand was simulated for three children with juvenile idiopathic arthritis (JIA) and for one healthy age-matched child. Joint reaction forces were estimated using a series of springs between articulating bones. This method (i.e., rigid body spring modeling) has proven useful for examining loading profiles for normally aligned wrists. A novel method (i.e., sliding rigid body spring modeling) designed specifically for studying joint reaction forces of the malaligned JIA wrist is presented in this paper. Loading profiles across the wrist for the unimpaired child were similar using both spring modeling methods. However, the traditional fixed-end method failed to converge to a solution for one of the JIA subjects indicating the sliding model may be more suitable for investigating loading profiles of the malaligned wrist. The results of this study suggest that a larger proportion of force is transferred through the ulno-carpal joint of the JIA wrist than for healthy subjects, with a less than normal proportion of force transferred through the radio-carpal joint. In addition, the ulnar directed forces along the shear axis defined in this study were greater for all three JIA children compared to values for the healthy child. These observations are what were hypothesized for an individual with JIA of the wrist.

Arthritis↗

PubMed2001

Minimally invasive selective osteotomy of the knee: A new surgical technique.

We present a simple surgical technique created by the authors to address degenerative chondral lesions of the knee and its application in a limited prospective case series. The technique assumes the concept of beneficial epiphyseal changes caused by disruption of the subchondral bone in improving symptoms, as with drilling, microfracture, periarticular osteotomy, and other invasive procedures. Minimally invasive selective osteotomy (MISO) is an expansion of the arthroscopic treatment of the knee, specifically targeting symptomatic lesions with minimal additional trauma and cost, while avoiding disruption of the articular surface of the subchondral bone. The technique involves a mimimal access approach with selective saw cuts placed with a 1-cm oscillating blade parallel to the joint surface 1 to 1.5 cm deep to identified lesions. The technique does not address malalignment but can address lesions not addressed by classic osteotomies and, as such, may be combined with other corrective alignment procedures as necessary. We present the results of MISO of the knee in a case series of 62 outpatients carried out at the Orthopaedic Division of the Clinical and Surgical Hermanos Ameijeiras Hospital in Havana, Cuba. At 2-year follow-up, there was improvement of symptoms without significant complications.

Adult↗

PubMed1991

Palmar subluxation of the carpus in rheumatoid disease: a radiological evaluation.

The authors present a radiological assessment of palmar subluxation of the carpus in rheumatoid disease. The radiological measurements have been taken with reference to the long axis of the radius, the radiological centres of the lunate and the capitate and expressing their reciprocal distances as a ratio which we have termed the radio-carpal and inter-carpal indices. Using a control group of a 100 serial radiographs of normal wrists it was possible to determine the normal indices and their normal range. A subsequent analysis of 100 rheumatoid wrists enabled them to accurately determine the degree of anterior carpal subluxation, and allowed this form of radio-carpal malalignment to be differentiated from other forms of carpal instability.

Adult↗

PubMed1983

Spondylo-epimetaphyseal dysplasia with joint laxity and severe, progressive kyphoscoliosis. A potentially lethal dwarfing disorder.

A progressive and potentially lethal skeletal dysplasia, spondylo-epimetaphyseal dysplasia with joint laxity (SEMDJL), has been recognized in 18 children from the Afrikaner community of South Africa. This serious disorder, which is inherited as an autosomal recessive trait, warrants diagnostic consideration whenever an infant or child from this population group presents with dwarfism, deformity, articular hypermobility and spinal malalignment. In view of the clinical and genetic implications, diagnostic precision is of great importance.

Bone Diseases, Developmental↗

PubMed2002

Indirect reduction and plating of distal femoral nonunions.

OBJECTIVE: To observe and report the clinical results of indirect reduction and plating in the treatment of distal femoral nonunions. DESIGN: Prospective consecutive study. SETTING: Regional trauma center. PATIENTS: A consecutive series of twenty patients with nonunion of the distal femur, nineteen of whom had undergone operative initial fracture care. INTERVENTION: Surgical treatment with indirect reduction techniques using the 95-degree condylar blade-plate, condylar buttress plate, or locking condylar plate with autologous cancellous bone grafting in 45 percent of patients. Emphasis was placed on preoperative planning, intraoperative attention to soft tissue sparing, and selection of the appropriately applied implant to correct deformity, when present, and obtain union. MAIN OUTCOME MEASUREMENTS: Healing rate and time, operative blood loss and time, incidence of complications including instrumentation failure, loss of fixation, infection, and postoperative malalignment. Both the Böstman and Hospital for Special Surgery knee scores were used to quantify postoperative clinical results at an average follow-up of twenty-three months (range 12 to 60 months). RESULTS: All twenty nonunions healed without further intervention at an average of fourteen weeks (range 12 to 20 weeks) postoperatively. There were no intraoperative complications. Average operative time was 154 minutes (range 90 to 240 minutes), and blood loss was 245 milliliter (range 100 to 400 milliliters). Average Böstman knee score improved from eighteen to twenty-five points, and average Hospital for Special Surgery score improved from fifty-eight to eighty points. Average arc of knee motion improved from 92 to 110 degrees. There was no patient with significant postoperative axial or rotational malalignment (>5 degrees) or limb length discrepancy (more than one centimeter). One patient with a history of osteomyelitis became infected postoperatively and healed without consequence after a debridement procedure. CONCLUSIONS: Contemporary plating techniques are effective in the treatment of distal femoral nonunions. Union occurred reliably with few complications, resulting in a majority of good or excellent clinical results.

Adolescent↗

PubMed1993

Pressure distribution at the knee joint. Influence of varus and valgus deviation without and with ligament dissection.

Traumata or repetitive microtraumata, malalignment with varus or valgus deviation, or chronic joint instability are discussed in the aetiology of osteoarthritis and osteochondritis dissecans of the knee. Biomechanical factors influencing the patterns of pressure distribution at the articular surface and the subchondral bone are suggested to be most important in the pathogenesis. Consequently, the patterns of pressure distribution at the femoral condyles of weight-bearing knee joints were investigated in a cadaveric biostatic model. The pressure in the articular joint space was evaluated with pressure-sensitive films of the knee in different joint positions in the coronal plane (10 degrees varus, 10 degrees valgus, and neutral position) without and with medial collateral ligament (MCL), lateral CL (LCL), MCL + anterior cruciate ligament (ACL) or LCL + ACL ligament division. Results demonstrated that the location of the contact area and the peak pressure depended on the joint position and stage of ligamentous division. Without ligament division, a maximum peak pressure was observed at the medial condyle in the neutral and varus positions. Only in the valgus position did the lateral condyle show a higher peak of pressure than the medial condyle. Ligament division of the LCL and LCL + ACL resulted in an increase of peak pressure at the medial condyle, particularly in the varus position. Division of the MCL and MCL + ACL ligament complex reduced the differences between the medial and lateral condyle. In the valgus position, the peak pressure was significantly higher at the lateral condyle. The absolute maximum peak pressure was measured in the varus position at the medial condyle after division of the LCL and ACL.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadaver↗

PubMedDate not supplied

Radiologic examination and measurement of the wrist and distal radio-ulnar joint. New aspects.

Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulnar head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles.

Adult↗

PubMedDate not supplied

MR imaging of the hip and knee before and after marathon running.

BACKGROUND: Despite its obvious benefits regarding aerobic fitness, the possible deleterious effects of long-distance running remain controversial. The repetitive loading associated with this activity could potentially predispose to the subsequent development of osteoarthritis. Lower extremity malalignment can also result in abnormal joint loading and is another possible contributing factor for premature articular cartilage degeneration. The purpose of this study is to investigate whether external impact loading in marathon runners creates internal stresses on bone and cartilage that are demonstrable on MR images. Participants were separately assessed for static lower extremity alignment, using standard radiographs. METHODS: Six recreational and two semi-professional runners underwent magnetic resonance (MR) imaging of the hip and knee before and after a marathon run using coronal T1-weighted and coronal STIR sequences. RESULTS: The pre-run and post-run scans failed to demonstrate marrow oedema, periosteal stress reactions, or joint effusions in seven runners. One patient who underwent a reconstruction of his anterior cruciate ligament 18 months ago demonstrated a small effusion in the reconstructed knee before and after the race. CONCLUSIONS: Our results suggest that the high impact forces in long-distance running are well tolerated and subsequently do not demonstrate changes on MR images.

Biomechanical Phenomena↗

PubMed1997

Metatarsal stress fractures.

Metatarsal stress fractures, resultant from increases in load due to altered mechanics of the foot, occur most frequently in athletes but also in patients with diminished function of the first metatarsophalangeal joint, neuropathy, metabolic disorders, and hindfoot malalignment. Diagnosis depends on a careful history and physical examination, with select use of imaging techniques. Nonoperative treatment usually is successful, but surgery (partially threaded cancellous screw with overdrilling of the fracture site to stimulate healing) is recommended for the athlete with a fifth metatarsal stress fracture or the nonathlete with a Torg-type-II or III injury. Malalignment or instability of the foot or ankle must be addressed at the time of surgical treatment.

Bone Screws↗

PubMed1978

Post-traumatic ligamentous instabilities of the wrist.

Dorsiflexion, palmar flexion, ulnar translocation, and dorsal carpal subluxation are four, not uncommon, post-traumatic carpal ligamentous instabilities. Palmar carpal subluxation is a theoretical possibility. Dorsiflexion and palmar flexion instabilities are named for the way the distal lunate articular surface dorsally and palmarly, respectively. Ulnar translocation, and dorsal and ventral carpal subluxations are named according to movement of the entire carpus at the radiocarpal joint. Early detection of traumatic carpal instabilities is necessary to encourage optimal treatment of these significant carpal malalignments. These and other patients with disabling wrist problems may be evaluated by a "ligamentous instability series."

Adult↗

PubMed2000

[MacFarland fractures. A series of 24 cases].

PURPOSE OF THE STUDY: MacFarland fracture is a joint fracture of the ankle in children. The fracture line passes through the medial part of the lower epiphyseal disk of the tibia. Prognosis is dominated by later risk of malalignment and osteoarthritis. MacFarland fracture usually occurs subsequent to adduction trauma. The aim of this study was to analyze prognosis in a retrospective series of children with MacFarland fractures. MATERIAL AND METHOD: The series included 24 cases (14 boys and 10 girls, mean age at the time of trauma 12.7 years, age range 10-15 years). The fractures were classed into two groups according to the Salter and Harris classification for epiphyseal detachment: Salter 3 (n=4) and Salter 4 (n=20). Surgical treatment was given in 17 cases (11 screw fixations, 4 pin fixations and 2 other ostheosynthesis combinations). Orthopedic care was given in 7 cases (mean immobilization=40 days). All 24 children were followed for a mean 3 years 2 months (3 months=12 years). Three outcome categories were used: good (no pain, stiffness or malalignment), fair (pain and/or stiffness, no malalignment), and poor (malalignment). RESULTS: Overall results were good in 15 cases, fair in 2 and poor in 7 (29 p. 100). Ankle malalignments (7 cases) required surgical correction: epiphysiodesis for varus<5, supramalleolar tibial valgization osteotomy for varus > 5 degrees. After these procedures, outcome was good with a normally aligned painless ankle at 13 months follow-up. Among factors predictive of malalignment (poor outcome), power of the initial trauma (traffic or sports accident in 5 of the 7 poor outcomes), crush injury (medial metaphyseal comminution in two cases which led to varus ankle despite well conducted treatment), fracture type (7 malalignments among the Salter 4 fractures versus none among the Salter 3 fractures), initially defective reduction or osteosynthesis material passing through the epiphyseal disk leading to epiphysiodesis. DISCUSSION: Careful radiologic and clinical surveillance is needed and should be continued to the end of growth (fusion of the tibial cartilage) in children with high risk fractures in order to detect epiphysiodesis early and avoid secondary malalignment. Surgical correction does remain possible and gives good results.

Accidental Falls↗

PubMed1984

Analyzing forearm fractures in children. The more subtle signs of impending problems.

Poor results with pediatric forearm fractures, while infrequent, do occur. Systematic analysis is required to identify this relatively rare, evolving problem. The purpose of this retrospective study was to identify and organize factors that would help in this process. Sixty-nine patients aged one-17 years with displaced forearm fractures were identified retrospectively. Pre- and postreduction radiographs were analyzed in comparison to standards for displacement, angulation, bow, shortening, and rotation. Those patients who seemed most likely to have problems following treatment were recontacted. Even with the use of stringent criteria in a group weighted toward more severe fractures, 85% of the patients achieved satisfactory results. With careful analysis of fractures for changes in angulation, bow, and disruption of the proximal or distal radioulnar joints, these problems should be avoidable. Analysis relative to standard radiographs aids in the identification of subtle malalignments that would otherwise be easily overlooked.

Adolescent↗