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At least 757 records · Page 42Linked to original sources
PubMed2007

Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion.

Fusion of cervical spine in kyphotic alignment has been proven to produce an acceleration of degenerative changes at adjacent levels. Stand-alone cages are reported to have a relatively high incidence of implant subsidence with secondary kyphotic deformity. This malalignment may theoretically lead to adjacent segment disease in the long term. The prospective study analysed possible risk factors leading to cage subsidence with resulting sagittal malalignment of cervical spine. Radiographic data of 100 consecutive patients with compressive radiculo-/myelopathy due to degenerative disc prolapse or osteophyte formation were prospectively collected in those who were treated by anterior cervical discectomy and implantation of single type interbody fusion cage. One hundred and forty four implants were inserted altogether at one or two levels as stand-alone cervical spacers without any bone graft or graft substitute. All patients underwent standard anterior cervical discectomy and the interbody implants were placed under fluoroscopy guidance. Plain radiographs were obtained on postoperative days one and three to verify position of the implant. Clinical and radiographic follow-up data were obtained at 6 weeks, 3 and 6 months and than annually in outpatient clinic. Radiographs were evaluated with respect to existing subsidence of implants. Subsidence was defined as more than 2 mm reduction in segmental height due to implant migration into the adjacent end-plates. Groups of subsided and non-subsided implants were statistically compared with respect to spacer distance to the anterior rim of vertebral body, spacer versus end-plate surface ratio, amount of bone removed from adjacent vertebral bodies during decompression and pre- versus immediate postoperative intervertebral space height ratio. There were 18 (18%) patients with 19 (13.2%) subsided cages in total. No patients experienced any symptoms. At 2 years, there was no radiographic evidence of accelerated adjacent segment degeneration. All cases of subsidence occurred at the anterior portion of the implant: 17 cases into the inferior vertebra, 1 into the superior and 1 into both vertebral bodies. In most cases, the process of implant settling started during the perioperative period and its progression did not exceed three postoperative months. There was an 8.7 degrees average loss of segmental lordosis (measured by Cobb angle). Average distance of subsided intervertebral implants from anterior vertebral rim was found to be 2.59 mm, while that of non-subsided was only 0.82 mm (P < 0.001). Spacer versus end-plate surface ratio was significantly smaller in subsided implants (P < 0.001). Ratio of pre- and immediate postoperative height of the intervertebral space did not show significant difference between the two groups (i.e. subsided cages were not in overdistracted segments). Similarly, comparison of pre- and postoperative amount of bone mass in both adjacent vertebral bodies did not show a significant difference. Appropriate implant selection and placement appear to be the key factors influencing cage subsidence and secondary kyphotisation of box-shaped, stand-alone cages in anterior cervical discectomy and fusion. Mechanical support of the implant by cortical bone of the anterior osteophyte and maximal cage to end-plate surface ratio seem to be crucial in the prevention of postoperative loss of lordosis. Our results were not able to reflect the importance of end-plate integrity maintenance; the authors would, however, caution against mechanical end-plate damage. Intraoperative overdistraction was not shown to be a significant risk factor in this study. The significance of implant subsidence in acceleration of degenerative changes in adjacent segments remains to be evaluated during a longer follow-up.

Adult↗
PubMed2002

Distraction osteogenesis for nonunion after high tibial osteotomy.

The purpose of this study was to determine whether distraction osteogenesis can be used to treat hypertrophic nonunion associated with angular deformity and shortening after Coventry style high tibial osteotomy. Five consecutive patients were retrospectively reviewed. In all patients the alignment had collapsed into excessive varus or valgus and leg length discrepancy was present. The leg length discrepancy, malalignment, and nonunion were treated simultaneously with distraction. Union was achieved by the time of fixator removal, which averaged 4.4 months. The Hospital for Special Surgery knee score significantly improved from 42 to 89. The mechanical axis deviation significantly improved by 5 cm. The coronal plane deformity significantly improved by 13 degrees, and leg length discrepancy improved significantly from 2.3 to 0.5 cm. Metaphyseal bone stock increased by 43%, and the Insall-Salvati ratio increased from 1.1 to 1.2 and remained within normal limits. All patients were satisfied with the procedure, and none have had or need a total knee replacement at an average followup of 4 years. Distraction osteogenesis of nonunion after high tibial osteotomy is a minimally invasive and successful procedure. It leads to bony union with correction of deformity and leg length discrepancy and prevents the need for total knee replacement at intermediate-term followup. The increase in metaphyseal bone stock may make total knee replacement technically easier.

Adult↗
PubMed1981

Experimental observations on the effects of leg lengthening by the Wagner Method.

A proximal tibial epiphysiodesis was successfully performed on the right hind legs of 23 young lambs, producing an average shortening of 12% of the total length of the tibia. A lengthener was attached to stainless steel pins which were then tapped into the shortened tibia prior to osteotomy. In 16 of the 23 animals it was possible to lengthen the shortened bone at a rate of 0.5 mm twice daily until the discrepancy was corrected. The gait was normal in most of the animals, all had full knee motion with no thigh atrophy, and 16 had limited hock (ankle) joint motion. Lengthening of the tibia by more than 11% consistently produced muscle changes in the leg and cartilage damage in the hock (ankle) joint. Any malalignment of the tibial fragments during lengthening intensified these changes.

Animals↗
PubMed1990

Locked intramedullary nailing of fractures of femur and tibia.

The results of 194 consecutive interlocking nailings for 95 fractures in the tibia and 99 fractures in the femur with a median observation time of 22 months are presented. Three fractures were not consolidated radiologically at follow-up; three deep infections were recorded, all of which healed. Shortening greater than 1 cm was recorded in 17 fractures, rotatory malalignment greater than 5 degrees in 21, and angular malalignment greater than 5 degrees occurred in 17. The end result was excellent in 121 fractures, good in 41, fair in 28, and poor in 4.

Adolescent↗
PubMed1990

Patellofemoral pain in children.

The primary inadequacy in the treatment of patellofemoral pain in children has been the inability to translate distinct problems recognized during physical examination into a specific clinical classification. Using a classification system based on etiology rather than symptoms allows the clinician to proceed with treatment based on a specific diagnosis. The majority of patellofemoral pain in children is caused by trauma and malalignment syndromes (or a combination of both) and can usually be managed successfully with nonoperative methods. Success in a rehabilitation program depends on a precise understanding of the original or underlying cause of the child's patellofemoral pain.

Bone Diseases, Developmental↗
PubMed1990

Conservative versus operative treatment of displaced noncomminuted tibial shaft fractures. A retrospective comparative study.

The results of conservative (mainly, functional bracing) and operative treatment (mainly, plate fixation) have been compared in a retrospective study of 170 displaced noncomminutive tibial shaft fractures. The characteristics of the fractures in both treatment groups showed no significant differences. The follow-up analysis revealed no statistical differences in outcome between the two methods. However, because of the many factors analyzed and the restricted number of patients studied, it is impossible to compare all factors independently. Surgical treatment resulted in a higher rate of complications (such as implant failure, osteitis, and refracture) and a longer total hospitalization time. Conservative treatment showed a longer duration of fracture healing and a higher rate of malalignment. Malalignments of up to 10 degrees with no adverse effects have been seen so far. In conservative treatment, two fracture types were identified with a higher rate of malalignment: short oblique isolated tibial fractures and fully dislocated transverse crural fractures. Conservative therapy is favored, because there is less discomfort for the patient and the treatment is cost contained.

Adolescent↗
PubMed2002

[Good long term results with a cemented straight femoral shaft prosthesis made of titanium].

A higher-than-average rate of aseptic loosening has been postulated to be associated with the combination of a titanium stem and bone cement. In this prospective follow-up study we therefore investigated our first consecutive series of 250 implantations of a cemented femoral shaft prosthesis made of titanium alloy (BiCONTACT((R)), Aesculap, Tuttlingen, Germany). Average time of follow-up evaluation was 9.7 years (range 8.7-10.3 years). At follow-up, mean patient age was 81 years; 89 patients with 93 hips have deceased and two could not be located. Follow-up rate was 98.7% for the patients still alive at time of follow-up evaluation. Five patients have been revised, two for infection and one for aseptic loosening of a varus-malaligned stem; two radiologically well-fixed stems had been revised during acetabular revision. Survival estimate showed a calculated cumulative survival rate of 97.5% after 11 years [confidence limits: 99.0% (upper) and 94.1% (lower)]. The average Harris hip score at time of follow-up was 82.25 points.Radiologically, signs of loosening could be detected in 3 stems: in one case varus malalignement deteriorated with time and in 2 cases osteolyses developed together with significant polyethylene wear. All 3 patients experienced only mild pain and revision had not been indicated so far. In conclusion, the long-term follow-up results with this cemented titanium femoral component are encouraging and are comparable to other successful cemented femoral components in primary total hip arthroplasty. No increased risk for aseptical loosening was associated to the combination of titanium and cement in this specific stem. Design parameters seem to play an important role in the development of aseptic loosening in cemented titanium stems.

Adult↗
PubMed2002

[Ultrasound diagnosis of congenital foot deformities].

Assessment of tarsometatarsal skeletal malalignment in congenital foot deformities such as clubfoot and vertical talus is possible with ultrasound. Sonography can be useful in deciding on the therapeutic concept and evaluating therapeutic effects.

Calcaneus↗
PubMed2002

[A case of airway obstruction after posterior occipito-cervical fusion].

A 62-year-old female with rheumatoid arthritis underwent posterior occipito-cervical fusion. Although the operation was successfully performed, airway obstruction developed immediately after the extubation. We succeed in fiberoptic intubation. We consider that airway obstruction was caused by the preexisting reduction of the pharyngeal space and the occipito-cervical fusion malalignment. On the extubation after occipito-cervical fusion, we should always consider the possibility of re-intubation and its difficulty.

Airway Obstruction↗
PubMed2006

[Medial opening-wedge high tibial valgus osteotomy, using a stable TomoFix plate, in genu varum arthritis: surgical technique].

The authors present the technique of high tibial correction osteotomy by the medial opening procedure, with the use of an angle-stable TomoFix plate. The prerequisite for a long-term good outcome of corrective osteotomy in genu varum is to achieve limb alignment permitting transfer of weight-bearing from the affected medial compartment to the healthy lateral compartment of the knee. The development of implants that maintain a stable angle has facilitated corrective osteotomy with an opening wedge on the medial side of the proximal tibia. These implants provide stable fixation even when a high correction of the mechanical axis is needed. The authors present the case of a patient with varus malalignment following a fracture of the tibia. In order to achieve correction of the limb's mechanical axis, it was necessary to open the proximal tibia osteotomy with a wedge that was 2.5 cm on the outer side.

Adult↗
PubMed2003

Spondyloepimetaphyseal dysplasia with joint laxity leptodactylic form: clinical course and phenotypic variations in four patients.

We describe a 5-year-old boy and a 33-year-old woman with spondyloepimetaphyseal dysplasia with joint laxity leptodactylic form (spondyloepimetaphyseal dysplasia with multiple dislocations) (MIM 6003546), and two 12-year-old girls with the disorder who were previously reported as examples of a variant of sponatrime dysplasia. Their clinical manifestations included midface hypoplasia, micromelic short stature, and generalized joint laxity that caused multiple joint problems, including thoracolumbar scoliosis, hip subluxation, progressive genu valgum with knee and patellar subluxation, elbow subluxation, and malalignment of the wrist. Laryngotracheomalacia was present in two individuals, and myopathy was noted in one. The radiological findings in the four individuals included mild platyspondyly most conspicuous in infancy, narrow interpediculate distances of the lumbar spine evident in infancy, retarded epiphyseal ossification that evolved to epiphyseal dysplasia and later to degenerative joint disease, metaphyseal irregularities and striations present in early childhood, and leptodactylic appearance (slender short tubular bones) of the hand.

Adult↗
PubMed1999

Treatment of ipsilateral femoral neck and shaft fractures with the Russell-Taylor reconstructive nail.

Twenty-seven ipsilateral femoral neck and shaft fractures were treated with the Russell-Taylor reconstructive nail. Follow-up ranged from 6-48 months (average: 23.6 months). Femoral neck fractures healed within an average of 3.7 months and femoral shaft fractures healed within an average of 4.8 months. Complications included one case of avascular necrosis of the femoral head, a varus healing of one femoral neck fracture, and a rotational malalignment of the femoral shaft in another case. There were no cases of hardware failure. The Russell-Taylor reconstructive nail allows concomitant hip and shaft fractures to be fixed with a single implant.

Adult↗
PubMed1991

Comparison of absorbable self-reinforced poly-L-lactide screws and metallic screws in the fixation of mandibular condyle osteotomies: an experimental study in sheep.

Nine osteotomies of the neck of the mandibular condylar process in sheep were fixed with self-reinforced poly-L-lactide screws and nine with metallic screws; two osteotomies were left unfixed. Radiographic examination was carried out at 3 weeks. The animals were killed at 6, 12, and 24 weeks. Malalignment was detected at 3 and 12 weeks in both unfixed condyles. The consolidation of the fixed osteotomies seemed to be faster in the polylactide group than in the metallic group. There were no complications in the healing of the fixed osteotomies.

Animals↗
PubMed2005

Management of extensor mechanism disruptions occurring after total knee arthroplasty.

Extensor mechanism disruption from quadriceps tendon rupture, patellar fracture, or patellar tendon rupture is an uncommon complication of total knee arthroplasty. Extensor mechanism disruption can occur either intraoperatively or postoperatively. Common intraoperative causes include avulsion or tendon injury arising from excessive tension during surgical exposure, improper patellar resection, and devascularization due to injudicious lateral retinacular release or multiple prior surgeries. The usual postoperative causes are tissue necrosis arising from infection, component malalignment, and trauma. A wide range of treatment options is available for managing these difficult problems, and recent advances in alternative techniques for reconstruction have yielded promising results.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Fifth metatarsal head resection for correction of tailor's bunions and sub-fifth metatarsal head keratoma: a retrospective analysis.

A variety of surgical procedures traditionally have been employed in the treatment of tailor's bunions and sub-fifth metatarsal head keratomas. The overwhelming majority of literature on this subject evaluates the advantages and disadvantages of various fifth metatarsal osteotomies. The authors have initiated a preliminary investigative study to evaluate the effectiveness of fifth metatarsal head resection and to compare these results with those of other studies that have focused on osteotomy techniques. Subjective and objective analyses of 50 procedures (34 patients) were performed retrospectively. Patients were either satisfied or very satisfied in 84% of the cases reviewed. Symptomatic transfer lesions occurred in only 3% of all feet examined. The most frequent postoperative complication was that of fifth digital malalignment, which presented in nearly 60% of the cases. The procedure possesses advantages and disadvantages, which prior to this study, have been discussed in anecdotal fashion only.

Adult↗
PubMed1996

[Arthrodesis of the ankle joint].

Arthrodesis of the ankle joint is still an important operation in the treatment of painful arthrosis, chronic infection, and malalignment instability when these cases have been treated unsuccessfully with other therapeutic procedures. To date, prosthetic replacement of the ankle joint has been an alternative only in rheumatoid patients. Concerning the long-term results, ankle arthrodesis is much better than alloarthroplasty. Because of the good functional results achievable by arthrodesis when done in the right position, there is less often a need for prosthetic replacement than in the hip or knee joint. A patient with a fused ankle joint is only limited when running. Compression arthrodesis is possible at present with various operative techniques utilizing external fixators, ring fixators and open reduction internal fixation with plates and screws. The last procedure can be carried out arthroscopically. With these techniques, fusion of the ankle joint in the correct position is possible in nearly all situations, e.g., infection, malalignment, osteoporosis, soft tissue damage. The main complication of ankle arthrodesis is pseudarthrosis (up to 35%) and postoperative infection (3%-25%). An important late sequela is arthrosis in the joints adjacent to the fused ankle joint (10-60%).

Ankle Joint↗
PubMed1988

Management of malunited fractures of the metacarpal and phalangeal shafts.

Malunions of the tubular bones of the hand should be carefully studied to understand the original deforming forces at the time of injury. Once a three-dimensional concept of the deformity is embraced, a careful plan for osteotomy can be developed and executed. Surgical approach must afford adequate access with the least possible injury to soft tissues. Technique of osteotomy must be tailored to the configuration, location, and biomechanical requirements for proper realignment of the malunited fracture. Important principles in the management of metacarpal and phalangeal malunions are: 1. Rotatory deformities are most disabling yet frequently not appreciated. A 10-degree rotational malalignment in the metacarpal results in a 2-cm overlap at the finger tip. Alignment should always be checked with the fingers flexed into the palm. 2. Adherence to biomechanical principles of fracture repair is mandatory. 3. The appropriate form of osteotomy and subsequent fixation must be carefully chosen and applied to each individual deformity. Familiarity with the osteotomy techniques and alternative forms of fixation affords flexibility in managing complex deformities. 4. The presence of malunion suggests the presence of fracture disease in the soft tissues. They must be delicately handled and carefully inspected for the presence of scarring, adhesions, and contractures. Careful protection of delicate structures should be complemented by judicious tenolysis and arthrolysis at the time of osteotomy. 5. Appropriate, functional postoperative rehabilitation is mandatory. Without adequate therapy the best surgery will produce suboptimal results. Adherence to these principles can avoid further complications and problems and provide a successful ultimate outcome.

Biomechanical Phenomena↗