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At least 91 records · Page 5Linked to original sources
PubMed2006

Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures?

OBJECTIVE: Evaluate whether supplementary fibular fixation helped maintain axial alignment in distal metaphyseal tibia-fibula fractures treated by locked intramedullary nailing. DESIGN: Retrospective chart and radiographic review. SETTING: Three, level 1, trauma centers. PATIENTS: Distal metaphyseal tibia-fibula fractures were separated into 2 groups based on the presence of adjunctive fibular plating. Group 1 consisted of fractures treated with small fragment plate fixation of the fibula and intramedullary (IM) nailing of the tibia, whereas group 2 consisted of fractures treated with IM nailing of the tibia without fibular fixation. OUTCOME MEASURES: Malalignment of the tibial shaft was defined as 1) >5 degrees of varus/valgus angulation, or 2) >10 degrees anterior/posterior angulation. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 6-month follow-up. Leg length and rotational deformity were not examined. RESULTS: Seventy-two fractures were studied. In 25 cases, the associated fibula fracture was stabilized, and in 47 cases the associated fibula fracture was not stabilized. Cases were more likely to have the associated fibula fracture stabilized where the tibia fracture was very distal. In multivariate adjusted analysis, plating of the fibula fracture was significantly associated with maintenance of reduction 12 weeks or later after surgery (odds ratio = 0.03; P = 0.036). The use of 2 medial-lateral distal locking bolts also was protective against loss of reduction; however, this association was not statistically significant (odds ratio = 0.29; P = 0.275). CONCLUSIONS: In this study, the proportion of fractures that lost alignment was smaller among those receiving stabilization of the fibula in conjunction with IM nailing compared with those receiving IM nailing alone. Adjunctive fibular stabilization was associated significantly with the ability to maintain fracture reduction beyond 12 weeks. At the present time, the authors recommend fibular plating whenever IM nailing is contemplated in the unstable distal tibia-fibular fracture.

Adolescent↗
PubMed2006

Rotational alignment of the finger nails in a normal population.

We measured the alignment of the nails in the hands of 100 normal adults with the interphalangeal joints extended and the metacarpophalangeal (MCP) joints at 0 degrees and 90 degrees. All fingers were naturally supinated (i.e. rotated towards the thumb), the index and little being the most supinated. When examining individual hands in MCP joint extension, only 17% of hands had all nails parallel. With the MCP joints flexed, this improved to 56%. If the little finger was excluded, this improved to 78%. When comparing matching fingers from the two hands, 76% of little, 83% of ring, 77% of middle and 80% of index fingers matched. Thumbnails were assessed in extension and found to match the other side in 95% of individuals. This study identifies that examination of the injured hand alone with all joints extended is an unreliable method of assessing malrotation following fracture, especially in the little finger. Comparing matching fingers in the two hands is more reliable, but there is still substantial variation in approximately 20% of normal individuals.

Adult↗
PubMed1994

Complications of bone lengthening.

Bone lengthening is a surgical method which requires meticulous technique, continuous attention, and satisfactory cooperation on the part of the patient. The absence of common criteria makes it difficult both to classify the complications which arise, and to compare them with those of other authors. We report the complications in a group of 61 patients who were studied prospectively. Disorders of the lengthening callus accounted for 45% of all complications, and a further 33% arose in the joints. The remainder occurred in the bone, the apparatus and the soft tissues, of which the most common were stiffness of the joints, axial deviations and loosening of the pins, while articular subluxation, fractures with angulation and delayed consolidation occurred less frequently. In our study, the overall number of complications per lengthening process was 2.1. In bilateral lengthening, the rate was 1 per segment, while in unilateral cases the mean was 2.7. Problems which we defined as severe, requiring that the lengthening had to be halted, occurred in 1.8% of the total complications. The aetiology of the length discrepancy has an important role in the complications which occur in each segment. Over twice as many problems occur in asymmetrical lengthening procedures as in patients where lengthening is symmetrical.

Bone Lengthening↗
PubMed2004

[Surgical correction of the upper and lower arm of children].

The causes of post-traumatic deformities of the upper and lower arm shafts as well as the complete elbow are 90% iatrogenic, in the area of the proximal humerus and the distal lower arm they are about 90% the result of chance (premature closure of the growth plate). In general, corrections of deformities are possible at any age, dependent on the patient's symptoms, the expected development, the location of the deformity and its changes during development. The correction technique should allow for the removal of all of the components of the deformity, and to retain the results until healing is complete and the patient's motor stability is ensured. Due to the high percentage of iatrogenic deformities, the optimisation of the primary therapy should receive particular attention rather than increasing the indications for a correction.

Ankylosis↗
PubMed2003

Coronal fractures of the proximal scaphoid: the proximal ring sign.

We present two coronal fractures of the proximal scaphoid which were both missed in the acute stage as interpretation of initial radiographs was difficult. In both cases, recognition of the so-called "Proximal Ring Sign" on the PA ulnar deviation radiographs may have helped diagnosis. CT scans were necessary to fully demonstrate the fractures. Open reduction and internal fixation, performed 2 and 4 months after the injury, resulted in union in both cases.

Adult↗
PubMed2002

[Theory and software of the hexapod external fixator].

Using hexapod kinematics (Stewart platform), an external fixator was developed that can be adjusted in all six spatial degrees of freedom by means of six linear adjusting elements. With such a system, any desired three-dimensional bone movements, for example, fracture reduction or deformity correction, can be effected exactly, without having temporarily to compromise any stability already achieved or to rearrange the construction during treatment. Since the introduction of the hexapod principle by Stewart in 1965, computerized control has been deemed necessary for its application. This paper describes the mathematical basis and the software developed for clinical use. Mathematical procedures are needed for the calculation of the inverse and forward kinematics of the hexapod, and for the description of three-dimensional movements.

Biomechanical Phenomena↗
PubMed1989

Clinical and roentgenological studies on malalignment disorders of the patello-femoral joint. Part III: Lesions of the patellar cartilage and subchondral bone associated with patello-femoral malalignment.

This study was aimed at clarifying what mechanism of patello-femoral malalignment causes cartilage lesions and how the lesions are related to the symptoms. The study was composed of a laboratory experiment and clinical observations on 127 joints of 123 patients. In the clinical observations, cartilage lesions on the patella as well as on the groove and condyles of the femur were studied by performing either arthroscopy or open surgery. Changes of the subchondral bone of the patella were also examined through sky-line view roentgenograms to determine their relationship with cartilage lesions. From these observations, it was concluded that cartilage lesions are caused by shearing stresses produced by the abnormal motion of the patella due to malalignment, often accompanied by open or closed (to the joint cavity) subchondral lesions. The experiment showed that various types of cartilage-bone damage could be brought about depending on various combined factors of velocity and energy of the stressing force. Based on our theory, a reasonable treatment is presented.

Animals↗
PubMed1998

Scaphoid malunion. The significance of rotational malalignment.

Three patients with painful malunions of the scaphoid and significant loss of active wrist extension were treated with an opening wedge multiplanar osteotomy that corrected flexion, ulnar deviation, and pronatory rotational malalignment of the distal fragment. After a minimum follow-up of 4 years, all three patients were satisfied with the procedure and were pain-free. The preoperative range of wrist motion had improved, and they had returned to their preoperative occupations.

Adult↗
PubMed2005

Treatment outcome of extensor realignment for patellofemoral dysfunction.

Patellofemoral pain remains one of the most common musculoskeletal disorders encountered in orthopaedic practice. In this retrospective clinical study, 108 knees in 98 patients with patellofemoral pain due to malalignment were treated using a combined proximal and distal realignment technique. The results were evaluated at an average of 29.2 (1-9.2 years) months postoperatively. At final evaluation using the modified Trillat grading scale, good or excellent results were obtained in 88 (81.4%) of the knees treated. Second-look arthroscopy performed in 65 (60.2%) knees demonstrated good patellar tracking and Grade II articular changes were noted in 16 (14.8%) of the patellofemoral joints examined. Complications noted included anterior compartment syndrome with foot drop in one case and arthrofibrosis in another. We conclude that extensor realignment surgery with a combined proximal and distal realignment procedure is a reliable technique for patellofemoral pain secondary to malalignment.

Adolescent↗
PubMed2005

Disorders of the hallucal interphalangeal joint.

Most clinical presentations of the hallux concern the metatarsophalangeal joint; however, interphalangeal joint (IPJ) pathology also may be clinically significant. This article reviews conditions that commonly affect the hallucal IPJ and the appropriate treatment.

Arthritis, Rheumatoid↗
PubMed1995

Carpal malalignment following intra-articular fractures of the distal radius in a working population.

In a review of 52 consecutive intra-articular fractures of the wrist (mean age 41 years), 18 developed one of five carpal malalignment patterns. Seven patients developed a volar intercalated collapse pattern. Although showing some loss of motion and/or grip strength, this group remains relatively pain free on follow-up. Patients who developed dorsal translation (six cases) or a dorsal intercalated collapse pattern (one case) were the most symptomatic, with loss of grip strength, decreased range of motion and pain being prevalent.

Adult↗
PubMedDate not supplied

Surgical correction of miserable malalignment syndrome.

Anterior knee pain is one of the more frustrating problems that orthopaedic surgeons treat. This study investigates the results of surgical correction of miserable malalignment syndrome associated with significant patellofemoral pain. The authors identified and retrospectively reviewed 14 consecutive patients with 27 limbs associated with excessive femoral anteversion, excessive tibial outward rotation, and patellofemoral pain. All of the patients were initially reviewed by the senior author and subsequently treated by ipsilateral outward femoral osteotomy and inward tibial osteotomy. All of the patients had failed nonoperative treatment. No persistent complications were seen. Subjectively and clinically, all of the patients were reviewed at an average of 5.2 (range 2.0-12) years after surgery. All of the patients reported full satisfaction with their surgery and outcomes. Most of the current literature discusses alignment in association with patellofemoral pain in the form of the extensor mechanism alignment. When evaluating patients with patellofemoral pain, it is imperative to assess the rotational profiles of the femur and tibia. The authors recommend that rotational osteotomies be performed in patients with patellofemoral pain and associated excessive femoral and tibial torsion, otherwise known as miserable malalignment syndrome.

Adolescent↗
PubMedDate not supplied

Operative realignment of patellar malalignment in children.

Realignment operations were performed on 57 knees to correct patellar malalignment in children between 1985 and 1991. Three different operative techniques were used: the lateral release, the lateral release and medial reefment, and the Roux-Goldthwait patellar tendon transposition. Roentgenographic values were measured before and after the operation by Laurin's method. The mean follow-up time was 4 years 2 months, after which 20 knees were excellent, 20 good, 11 fair, and six poor, according to Insall's criteria. The effect of the operation on pathological roentgenographic values was obvious, and the malalignment of the patella was in most cases corrected. There are differences in the improvement effected by these three techniques. The lateral release and medial reefment correct the patellar tilt most effectively, and the Roux-Goldthwait operation, the lateral patellar deviation. The lateral release seems to be the appropriate technique for mild malalignment.

Adolescent↗
PubMed1995

[Effects of fibular malunion on contact area and stress distribution at the ankle with six simulated loading conditions].

A shortened, externally rotated malunion in the lateral malleolus following an ankle fracture-dislocation often causes post-traumatic degenerative arthrosis even without talar displacement (occult malunion). The purpose of this study was to examine the effect of malalignment of the fibula on stress distribution in the ankle joint using two grades of pressure sensitive film (super-low and low) as a transducer. The ankles of seven amputated lower legs were mounted in an MTS machine, then loaded in 6 different positions of 3 single leg stance positions at the neutral, abduction and adduction of the foot, and 3 simulated positions in the stance phase of walking. A normal ankle, an ankle with 5 mm shortened fibula only, and an ankle with a shortened fibula plus an additional 20 degrees external rotation of the fibula were tested. Talar shift was examined on X-ray, before and after each test. When the fibula was shortened, and after additional external rotation, there was no talar shift even after loading and the total contact area was not significantly different from normal, however, there was the stress increase on the lateral side of the tibio-talar joint, with the area of higher stress range significantly larger than normal. There was no significant difference between the ankle with a shortened fibula only and that with an additional 20 degrees external rotation. The stress change in the fibular malalignment was concluded to be mainly due to the shortened fibula. It seems that the shortened lateral malleoli affect the ankle joint regardless of the talar shift and may induce degenerative arthrosis.

Aged↗