SEARCH · PubMed Health

Results for “Bone Malalignment”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources

PubMed2002

[Clinical evaluation of the distal femoral nail].

METHOD: The clinical results after DFN-osteosynthesis of n=56 AO-classification 33A-fractures (32%), 33C-fractures (43%), 32X-fractures (21%) and pseudarthrosis treatment (4%) are presented. RESULTS: Follow up was available for 54 fractures (96%) after a mean of 1.2 years (range 0.2-2.8 years). 95% of patients showed full-weight-bearing with a knee flexion of 120 (60-140) degrees. Extension-deficit >10 degrees was observed in 5.4%. All fractures were consolidated. One soft-tissue infection, one partial loss of reduction and one implant failure were observed. A significant axial malalignment was found radiologically in 17%, a loosened spiralblade or locking screw in 7.4%. In 91% of cases the result was judged as good to excellent by patients and surgeons. CONCLUSION: The mechanical stability of the implant allows a save osteosynthesis of unstable supracondylar and complete articular femoral fractures without additional bone grafting. Mechanical stability and minimal invasive operative technique permit a safe bone healing without major complications.

Adolescent↗

PubMed2001

Angular malalignment after intramedullary nailing of femoral shaft fractures.

OBJECTIVES: To determine factors associated with angular malalignment of femoral shaft fractures treated with intramedullary nails and to determine differences in the incidence of angular malalignment based on fracture location, fracture comminution, and method of treatment (i.e., antegrade or retrograde). DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS: Three hundred sixty patients with 374 femoral shaft fractures were identified from a prospectively obtained orthopaedic trauma database. Complete sets of immediate postoperative anteroposterior and lateral radiographs were available for 355 (95 percent) of the 374 fractures. INTERVENTION: Patients were treated with antegrade (183 cases) or retrograde (174 cases) intramedullary femoral nailing. MAIN OUTCOME MEASURE: Goniometric measurements were made on all immediate postoperative radiographs to determine the coronal plane and sagittal plane angular alignments. A multiple linear regression statistical analysis was used to determine factors associated with increasing angular malalignment. The incidence of malalignment was determined using more than 5 degrees of deformity in any plane as the definition of malalignment. RESULTS: Proximal fracture location, distal fracture location, and unstable fracture pattern were associated with increasing fracture angulation (p < 0.001). Fracture location in the middle third, stable fracture pattern, method of treatment (i.e., antegrade or retrograde), and nail diameter were not associated with increasing fracture angulation (p > 0.05). The incidence of malalignment was 9 percent for the entire group of patients, 30 percent when the fracture was of the proximal third of the femoral shaft, 2 percent when the fracture was of the middle third, and 10 percent when the fracture was of the distal third. The incidence of malreduction was 7 percent for patients with stable fracture patterns and 12 percent for those with unstable fracture patterns. CONCLUSIONS: Patients with fractures of the proximal third of the femoral shaft treated with intramedullary nails are at highest risk for malalignment. Proximal fracture location, distal fracture location, and unstable fracture pattern are associated with increasing fracture angulation.

Adolescent↗

PubMed1997

External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study.

We report the outcome of 19 children aged 5.2 to 13.2 years with 20 fractures of the femoral shaft requiring surgery, who were randomly assigned to have external fixation (EF) or flexible intramedullary nailing (FIN) (10 fractures each). The duration of the operation averaged 56 minutes for the EF group with 1.4 minutes of fluoroscopy, compared with 74 minutes and 2.6 minutes, respectively, for the FIN group. The early postoperative course was similar, but the FIN [corrected] group showed much more callus formation. The time to full weight-bearing, full range of movement and return to school were all shorter in the FIN group. The FIN complications included one transitory foot drop and two cases of bursitis at an insertion site. In the EF group there was one refracture, one rotatory malunion requiring remanipulation and two pin-track infections. At an average follow-up of 14 months two patients in the EF group had mild pain, four had quadriceps wasting, one had leg-length discrepancy of over 1 cm, four had malalignment of over 5 degrees, and one had limited hip rotation. In the FIN group, one patient had mild pain and one had quadriceps wasting; there were no length discrepancies, malalignment or limitation of movement. Parents of the FIN group were more satisfied. We recommend the use of flexible intramedullary nailing for fractures of the femoral shaft which require surgery, and reserve external fixation for open or severely comminuted fractures.

Absenteeism↗

PubMed1998

[Supramalleolar corrective osteotomy].

The general aspects for the analysis of malalignment of the low tibial region in the three-dimensional space are discussed. Recommendations of clinical and radiological diagnostics prior to low tibial osteotomies are given. Closing wedge, opening wedge, dome-shaped, distraction, rotational and step-shaped osteotomies as well as combined procedures are described. The possibilities of these techniques are pointed out for malalignment after lower leg, pilon and ankle fractures, as well as after trauma of the distal epiphysis of the tibia. Arthroscopy of the ankle is an additional tool for detailed planning of the adequate surgical procedure. The importance of determining an early correction cannot be underestimated.

Ankle Injuries↗

PubMed1998

[Single corrective osteotomy after knee para-articular fractures].

Post-traumatic malalignment can occur on one or several planes following fractures in close proximity to the knee joint. In a clinical and radiological analysis of deformities, the frontal, sagittal and longitudinal alignment, as well as differences in femoral or tibial length and torsion, must be taken into account. The location of the correctional osteotomy is usually defined by the center of the angular and torsional deformity. Of decisive importance when choosing the site of the osteotomy are the local quality of bone and the soft tissue envelope, the condition of the articular cartilage in the different compartments of the knee, the stability of ligamentocapsular structures and preexistent deformities of the distal femur and proximal tibia. Therefore, the location of correctional osteotomies must be modified, depending on the individual situation. The appropriate approach and technique must be chosen from the different available operative techniques. Inaccurate planning and inappropriate operative techniques pose severe risks. Specific postoperative complications are compartment syndromes, nerve irritation and infection.

Bone Malalignment↗

PubMed2004

Rotational malalignment after intramedullary nailing of femoral fractures.

OBJECTIVES: Intramedullary nailing has been accepted as the treatment of choice for femoral shaft fractures. The aim of our study was to determine the incidence and implications of rotational malalignment after intramedullary nailing using computed tomography measurements. DESIGN: Cohort study. SETTING: Patients who postoperatively visited the orthopaedic outpatient and radiology clinics. PATIENTS: Seventy-six patients, 59 men and 17 women, with a mean age of 28.4 years (15-88). INTERVENTION: Patients treated on a fracture table with an antegrade reamed AO nail (n = 46) or Grosse Kempf nail (n = 30) for a unilateral femoral shaft fracture between 1988 and 1998 were included in the study. MAIN OUTCOME MEASUREMENTS: Patients filled out a questionnaire concerning pain, daily activities, and sport. Oxford, Western Ontario and McMaster University osteoarthritis index, and Harris Hip and Knee Society scores were obtained. Physical exams and computed tomography measurements were established. RESULTS: Twenty-one patients (28%) were found to have a rotational malalignment of 15degrees or more. There was no significant difference in rotational deformity with either the AO or Grosse Kempf nail. The incidence of malrotation was independent of the fracture level. Patients with a torsional deformity had difficulties with more demanding activities like running, sports, and climbing stairs. Patients with an external rotational malalignment (n = 12) have more functional problems than patients with an internal rotational malalignment (n = 9). Clinically determined rotation differences are not accurate (+/-20degrees) compared with the established computed tomography measurements. CONCLUSIONS: Rotational malalignment after intramedullary nailing for femoral fractures is found in 28% of the patients in this study. These patients have difficulties with more demanding activities, especially when they have an external torsional deformity.

Adolescent↗

PubMed2004

[Closing wedge osteotomy of the tibial head in treatment of single compartment arthrosis].

Closing wedge high tibial osteotomy is an efficient method for the treatment of medial osteoarthritis of the knee. Prerequisites of successful surgery are proper indication and planning as well as the understanding of biomechanics and pathophysiology. The technique of osteotomy to choose (opening or closing wedge) depends on the type of malalignment and on additional pathologies. The surgical technique demands high precision to realize the planned correction and to avoid complications. Implants with angular stability provide advantages compared to traditional implants. Correct indication and surgical technique results in a desirable follow-up, which often lasts for at least 10 years. The effect on the prognosis of the young patient with cartilage damage is still unclear.

Bone Malalignment↗

PubMed1999

[Correction of malalignment of the ring finger after Kirschner wire infection of the phalangeal-interphalangeal joint].

After a tractus-intermedius rupture of the extensor aponeurosis of the ring finger, a Kirschner wire infection developed following an initially uncomplicated course after surgical care and PIP-joint transfixation. In spite of adequate therapy, destruction of the PIP-joint subsequently developed with an ulnar dislocation of the distal ring finger. With an unicondylar corrective osteotomy it was possible to achieve a normal position and an improvement in mobility.

Adult↗

PubMed1996

Impending malunions of the hand. Treatment of subacute, malaligned fractures.

Malunions of the hand present a challenging problem to the orthopaedic surgeon. Angular and rotational deformities, and shortening and articular incongruity, can lead to significant functional impairment or dysesthetic appearance. The prevention of malunion should remain a primary goal. When displaced fractures of the metacarpals or phalanges present within the first or second weeks, properly performed closed or open reduction with percutaneous pinning or internal fixation are excellent options with predictable results. Malaligned fractures that present later frequently cannot be readily reduced. Once fully united, treatment options have included corrective osteotomy if function is significantly impaired or if appearance is objectionable; for patients who are not suitable for surgery for medical or other reasons, or for whom appearance is acceptable, intensive occupational therapy to maximize function may yield sufficiently serviceable clinical results. During the past several years, the senior author (BL) has chosen to be more proactive in the prevention of malunions of the hand. In the authors' experience, results of aggressive surgical treatment of subacute, malaligned fractures in selected patients have produced results comparable with or superior to those reported for later reconstructive procedures. With the proliferation of managed care, there has been an increasing frequency of delayed referral patterns for fracture treatment by hand specialists. Definitive treatment of these "impending malunions" is preferable to passive treatment delay and secondary reconstructive procedures, offering both earlier correction of alignment and earlier opportunity for return of function.

Adolescent↗

PubMed2004

[Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator].

High tibial osteotomy (HTO) is an established technique for the treatment of the symptomatic varus malaligned knee. Correction is usually achieved by closed wedge osteotomy from a lateral exposure. This procedure has a certain risk potential regarding peroneal nerve injuries, instability of the osteotomy and secondary loss of correction. We present four technical modifications of HTO which improve safety and reproducibility of this operation. 1) Open wedge osteotomy from a medial exposure avoids lateral muscle detachment, dissection of the peroneal nerve, proximal fibula osteotomy and leg shortening. Only one osteotomy needs to be performed and the correction can be adapted intraoperatively. 2) A biplanar osteotomy provides improved rotational stability of the osteotomy and creates an anterior buttress against sagittal tilting. 3) An incomplete osteotomy with plastic deformation of the intact lateral bone bridge avoids fractures of the lateral cortex and instabilities and promotes bone healing. 4) Rigid fixation with a medial plate-fixator (Tomofix) allows for early mobilisation and avoids loss-of-correction. 262 patients were consecutively operated using the described modified technique until now. No loss-of-correction occurred in this group, two patients with delayed healing received secondary cancellous bone grafts.

Adult↗

PubMed2005

Treatment of the neglected distal radius fracture.

Operative treatment of inadequately or imperfectly treated fractures of the distal radius can improve wrist and hand function substantially, but rarely restores the limb to normal. Patients with malunion of the distal radius present either with poor radiographic alignment before complete healing of the fracture (nascent malunion) or with functional problems that may be related to inadequate alignment of a healed fracture (mature malunion). Corrective osteotomy is offered to patients who have sufficient malalignment that the surgeon thinks problems are inevitable or to patients in whom the functional deficit can be related clearly to the malunion. Ununited fractures are associated with painful instability of the wrist and very poor hand function. Operative treatment has proved successful even when the distal fragment is small. Operative treatment for reconstruction of the distal radius has been facilitated by the introduction of plates with angular stable screws (screws that lock into the plate). Painful arthritis is salvaged with arthrodesis.

Arthritis↗

PubMed2002

[Intramedullary nail placement with percutaneous Kirschner wires. Illustration of method and clinical examples].

Unreamed nailing is an established method for internal fixation of femoral und tibial shaft fractures. The interlocking technique allows the stabilization of metaphyseal fractures, too, but the risk of malalignment increases. The "palisade method" presented here allows the precise positioning of the nail in the marrow cavity and works as a tool for successful minimally invasive nailing in the meta/epiphyseal region. The method is easy to use and suited particularly in combination with the UFN and UTN, but is in principal applicable to other nails, too. In contrast to the "Poller Screw" method developed by Krettek et al., no biomechanical augmentation of the osteosynthesis remains.

Adult↗

PubMed1999

Salvage of contaminated fractures of the distal humerus with thin wire external fixation.

Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.

Adolescent↗

PubMed2001

Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws.

OBJECTIVES: To describe the technique and results of using blocking screws and intramedullary nails to treat patients with fractures of the proximal third of the tibial shaft. DESIGN: Prospective. SETTING: Level I trauma centers. PATIENTS: Twelve consecutive patients treated with intramedullary nailing and blocking screws for fractures of the proximal third of the tibial shaft. INTERVENTION: Patients were treated with intramedullary nails and blocking screws. MAIN OUTCOME MEASURE: The alignment of fractures was determined using standard anteroposterior and lateral radiographs after surgery and at each follow-up examination. One patient was lost to follow-up. All other patients were followed at regular intervals until union or establishment of a nonunion. Changes in alignment and complications were noted. RESULTS: Postoperatively, all patients had less than 5 degrees of angular deformity in the planes in which blocking screws were used to control alignment. One patient had postoperative malalignment (6 degrees of valgus), but a lateral blocking screw to control valgus deformity was not used in this patient. One patient was lost to follow-up. Eleven patients were followed up to union (n = 10) or establishment of a nonunion (n = 1). Ten of eleven patients maintained their postoperative fracture alignment at their last follow-up examination (average follow-up of thirty-three weeks). One patient progressed from 6 degrees of valgus immediately after surgery to 10 degrees of valgus at union. This patient did not have a blocking screw to control valgus angulation. CONCLUSIONS: Blocking screws are effective to help obtain and maintain alignment of fractures of the proximal third of the tibial shaft treated with intramedullary nails.

Adolescent↗

PubMedDate not supplied

Use of a modified Elmslie-Trillat procedure to improve abnormal patellar congruence angle.

Forty patients underwent 45 modified Elmslie-Trillat realignment procedures (mean followup, 2 years) for refractory patellar instability (34 knees) or painful patellofemoral syndrome with malalignment (11 knees). The postoperative congruence angle (mean, +3.4 degrees) was significantly improved compared with the preoperative value (mean, +21.5 degrees). We considered the "normal" congruence angle average as -8 degrees (range, -20 degrees to +4 degrees). Over time postoperatively, we detected no statistical difference in the congruence angle (5 months, 3.4 degrees; 24 months, 6.3 degrees). There were no patellar dislocations postoperatively. Nine knees (20%) had some postoperative subluxation. Ninety-four percent of the patients without subluxation had congruence angles less than 15 degrees, whereas 54% of patients with postoperative subluxation had postoperative congruence angles greater than 15 degrees. The evidence in this study population indicates that the modified Elmslie-Trillat procedure can predictably improve the patellar congruence angle. Adequate correction may eliminate patellar dislocation. Correction of the congruence angle to less than +15 degrees will result in a decreased incidence of postoperative patellar instability. Early full activity postoperatively did not affect the modified Elmslie-Trillat correction of the congruence angle being maintained over time.

Adolescent↗

PubMedDate not supplied

[Knee instability and varus malangulation - Simultaneous cruciate ligament reconstruction and osteotomy (Indication, planning and operative technique, results)].

AIM: Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malangulated knees. We present the indication, planning of the osteotomy as well as the operative technique and the results of our patients with simultaneous osteotomy and cruciate ligament reconstruction. MATERIALS/METHODS: From 4/96 until 12/00 58 patients ( 33 years) received simultaneous osteotomy (r = 57 correcting valgus, r = 1 varus malalignement) and cruciate ligament plasty (e = 49 ACL, n = 7 PCL, n = 2 ACL & PCL which routinely was performed in the arthroscopic technique after completion of the osteotomy (closed-wedge technique). Average correction angle of the osteotomy was 7 (4 - 10) degrees with a mean malalignement of 5 (0 - 10) degrees. 13 patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), 2 patients received an implanted Collagen Meniscus (CMI) at the same time. RESULTS: Preoperatively the Lysholm score was 66 (35 - 81) points and increased to 81 (74 - 95), 87 (79 - 99) and 93 (88 - 99) points at 3, 6, and 12 months after surgery, respectively. Subjectively all patients reported an improvement of preoperative swelling, pain and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications were noted in 4 patients. CONCLUSIONS: Unstable varus malangulated knees can be sufficiently treated by osteotomy and cruciate ligament plasty at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost effective therapy delaying the progression of osteoarthritis and minimising clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and return of these patients to the activities of daily living and sports.

Adolescent↗

PubMed2004

Compensation for rotational malalignment after intramedullary nailing for femoral shaft fractures. An analysis by plantar pressure measurements during gait.

INTRODUCTION: Even though rotational malalignment due to a femoral shaft fracture leads to clinical complaints, a large number of patients may have none of significance. The ability to compensate may play a role. The purpose of this study is to give insight into aspects of compensatory gait of patients with a femoral malrotation and the relation with clinical complaints. METHODS: In a cross-sectional laboratory setting, foot-progression angles (FPA) during gait were measured using a foot scan device. Results were related to CT determined femoral torsion and clinical complaints. RESULTS: Patients with external (EMR) or internal malrotation (IMR) showed differences in foot-progression angles (DeltaFPA) in the same direction of their malrotation. Compared to IMR patients, EMR patients appeared to compensate less for their malrotation. No statistically significant differences were detected between these groups for absolute and relative compensation. EMR patients scored worse at the Oxford 12-item and WOMAC score and experienced more problems executing demanding activities than do patients without malrotation. Correlations were found between Oxford 12-item and WOMAC score and relative compensation. CONCLUSIONS: Femoral torsion and the FPA are strongly related. All patients compensate towards normal values of FPA at their fractured side. Patients who are less able to compensate have more physical complaints. EMR patients tend to have more complaints and difficulty compensating.

Adaptation, Physiological↗

PubMed2004

Rotational malalignment of the tibia following reamed intramedullary nail fixation.

OBJECTIVE: To determine the incidence and severity of tibial malrotation following reamed intramedullary nail fixation as measured by computerized tomography and to determine the repeatability of computed tomography measurement in the assessment of rotational malreduction. DESIGN: Prospective cohort. SETTINGS: Level 1 trauma center. PARTICIPANTS: Twenty-five consecutive patients with 25 tibial shaft fractures. INTERVENTION: All patients were treated with reamed intramedullary nailing. Appropriate radiographs and a postoperative lower extremity computed tomography scan were obtained for each patient who consented to the study. MAIN OUTCOME MEASURE: Rotational alignment of affected tibia as compared to a version of the normal contralateral limb. Malrotation was defined as an internal/external rotation deformity greater than 10degrees. RESULTS: Malrotation, comparing the fractured limb to normal limb, was determined using a similar measurement method previously described in the literature. Two patients declined inclusion, and in one case, the computed tomography was not acceptable for analysis. Malrotation, comparing the fractured limb to the normal limb, was determined using the measurements from axial computed tomography images. Results revealed a mean absolute rotational difference of 6.7degrees (SD +/-6.3degrees). Rotational malreduction ranged from 15degrees of internal rotation to 22degrees of external rotation. Five of the 22 tibia (22%) were malrotated greater than 10degrees. A larger degree of deformity was seen with certain injury patterns. The intraobserver and interobserver repeatability testing revealed a mean absolute difference between paired malrotation calculations of 3.4degrees and 3.9degrees, respectively, and a repeatability coefficient of 8degrees for both. CONCLUSION: Computed tomography measurement is a repeatable method of assessing tibial torsion and in this study revealed a significantly higher incidence of rotational malreduction than that previously reported in the literature.

Adolescent↗