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 901 records · Page 50Linked to original sources

PubMedDate not supplied

Upper tibial osteotomy.

Arthritis of the knee usually produces a change in the coronal plane of the normal femorotibial axial alignment. This change occurs if the arthritis is mostly unicompartmental. Most unicompartmental degenerative arthritis involves the medial compartment, producing a varus deformity. In rheumatoid patients, however, a valgus deformity is commonly produced. For at least the last 25 years, upper tibial osteotomy has been used to correct this malalignment. The rationale is to unload the more involved compartment and transfer the load to the less involved side. While the vast majority of upper tibial osteotomies are done for degenerative arthritis, the procedure is occasionally indicated in the inactive stage of rheumatoid arthritis. A study of 213 knees with a 16-year follow-up period showed that, even before total knee arthroplasty (TKA) was available as an alternative, 61% of the knees were satisfactory after ten years. With the additional choice of either unicompartmental or bicompartmental TKA during the past decade, the selection for upper tibial osteotomy can be more specific. The need to overcorrect to about 10 degrees of valgus in a varus knee has been established. In addition, technical aspects have been improved. With the more specific selection of patients and improvement in the exactness of the technique, an even higher incidence of long-term excellent and good results can be anticipated. Finally, it has been clearly demonstrated that when the bone and articular cartilage are relieved from the overloaded state, the cartilage will regenerate. Thus, upper tibial osteotomy not only relieves pain and improves function but also allows for healing of the articular cartilage.

Age Factors↗

PubMed2006

[Radiographic analysis of rotational malalignment between tibial component and femoral component in total knee arthroplasty].

OBJECTIVE: To identify possible reasons of rotational mismatch between tibial component and femoral component in total knee arthroplasty and choose a right reference axis for placing the components in the operation and to decrease the complications. METHODS: Forty normal Chinese knees were studied. There were 20 men and 20 women, and average age was 34 years (range, 18 - 42 years). The images of cross sections of the distal femur were obtained by spiral CT scanning (0.5 mm thickness). Scan direction was aligned to be in the plane perpendicular to the mechanical axis of the tibia. On the images of the distal femur and the proximal tibia, three baselines for the anteroposterior axis of the femoral component were drawn based on the clinical epicondylar axis and the surgical epicondylar axis and 3 degrees lateral rotated to the posterior condylar surfaces of the femur separately, and a baseline for the anteroposterior axis of the tibial component was drawn based on the medial 1/3 of the tibial tuberosity. The rotational mismatch angles were measured between each component by using the Autocad software. RESULTS: The mean rotational mismatch angle between tibial component and femoral component is 2.94 degrees for the clinical epicondylar axis, 6.50 degrees for the surgical epicondylar axis and 6.83 degrees for 3 degrees lateral rotation of the femoral component referenced to the posterior condylar axis separately. CONCLUSIONS: Landmarks of each bone were the intrinsic cause of the rotational mismatch in total knee arthroplasty. The clinical epicondylar axis can be chosen for the ideal reference to rotational alignment of the femoral component because of its minimal rotational mismatch between each component.

Adolescent↗

PubMed2005

[Osteoarthritis from long-distance running?].

Long distance running has become a fashionable recreational activity. This study investigated the effects of external impact loading on bone and cartilage introduced by performing a marathon race. Seven beginners were compared to six experienced recreational long distance runners and two professional athletes. All participants underwent magnetic resonance imaging of the hip and knee before and after a marathon run. Coronal T1 weighted and STIR sequences were used. The pre MRI served as a baseline investigation and monitored the training effect. All athletes demonstrated normal findings in the pre run scan. All but one athlete in the beginner group demonstrated joint effusions after the race. The experienced and professional runners failed to demonstrate pathology in the post run scans. Recreational and professional long distance runners tolerate high impact forces well. Beginners demonstrate significant changes on the post run scans. Whether those findings are a result of inadequate training (miles and duration) warrant further studies. We conclude that adequate endurance training results in adaptation mechanisms that allow the athlete to compensate for the stresses introduced by long distance running and do not predispose to the onset of osteoarthritis. Significant malalignment of the lower extremity may cause increased focal loading of joint and cartilage.

Adult↗

PubMed2002

Treatment of distal femoral nonunions by external fixation with simultaneous length and alignment correction.

The use of external fixation for management of distal femoral nonunions may minimise some of the problems frequently encountered in these patients. Fifteen patients treated by external fixation for distal femoral nonunions between 1987 and 1997 were reviewed. There were nine males and six females. The average age was 35.4 years (17-53) with an average follow up of 4.6 years (2-8). Nine followed an open fracture, five a closed fracture and one a femoral osteotomy. Five of the cases were infected nonunions. In all cases an internal fixation device was used as the initial method of treatment. All patients had the nonunion site stabilised with an external fixator. In 12 cases the knee joint was crossed with the fixator to further stabilise the fracture site. All patients had some degree of leg length discrepancy or malalignment that required correction. Fourteen cases united. The other patient united following intramedullary nailing. The average time to union was 10.4 months (4-24). The average range of movement was 80 degrees after treatment. Up to 9 cm of lengthening was achieved using the external fixation system (mean 5.0 cm). The mean angular correction was 15 degrees. One patient had persistent pain despite union at the time of the last follow up. The advantages of preservation of soft tissue, immobilisation of the fracture site by crossing the knee joint and the facility for proximal lengthening make external fixation a definite option in the management of distal femoral nonunions.

Adolescent↗

PubMed1986

The correlation between arthroscopic findings and the patellofemoral pain syndrome.

For this study, 1,784 arthroscopies were analysed. Abnormalities of the patellofemoral joint consisting of patellar malalignment and/or patellar chondral damage were present in 175 (10%). Two types of lesion were identified, distinguished by the alignment of the patellofemoral joint, namely, subluxation with or without chondral damage (group I) and chondral damage without subluxation (group II). Group I (mean age, 25 years) included a greater proportion of women than group II; in 72%, the predominant clinical feature was patellofemoral pain syndrome (PFPS). Group II (mean age, 43 years) included fewer women; PFPS was found in only 32%, but in 82% there were signs of degenerative joint disease, which could explain the symptoms. Patellar subluxation was correlated to the PFPS, whereas chondral damage alone was not.

Adult↗

PubMed1994

Immediate interlocking nailing of fractures of the femur caused by low- to mid-velocity gunshots.

A retrospective review of 39 fractures of the femur in 37 patients caused by low- and mid-velocity handgun missiles treated with static interlocking nailing within 18 h of injury was conducted to evaluate the efficacy, safety, and cost savings of immediate intramedullary nailing in these injuries. Patients were followed through union of the fracture with an average follow-up of 12.5 months. The average hospitalization was 8.5 days. All but two fractures healed in an average of 14 weeks (range 8-28). One delayed union was treated with exchange intramedullary nailing with reaming 5 months postinjury and progressed uneventfully to fracture union. One nonunion occurred, presenting with broken distal interlocking screws 18 months after injury, which was treated with an exchange intramedullary nailing with reaming. The nonunion healed within 4 months of this secondary procedure. There were no malunions of > 5 degrees angulation, no leg length discrepancies of > 1.0 cm, and no rotational malalignments noted. There was one (2.5%) infection that was successfully treated with nail removal, reaming of the canal, and reinsertion of a larger diameter nail. We conclude that immediate interlocking nailing of low- and mid-velocity gunshot fractures of the femur is an effective and safe treatment. Compared with previously published data on intramedullary nailing of femoral gunshot fractures, immediate intramedullary nailing resulted in a shorter hospital stay with a significant decrease in hospital expenses. Because the findings of this study indicate that early fixation in these injuries had no detrimental effect on the clinical results, we recommend immediate intramedullary nailing of gunshot fractures of the femur.

Adolescent↗

PubMed1986

Early surgical intervention in Apert's syndactyly.

The hand deformities in Apert's syndrome are among the most complex congenital hand problems to reconstruct due to the skeletal malalignment, symphalangism, and progressive functional deficits with growth. Ten children with Apert's syndactyly underwent early surgical intervention (mean age 8.4 months) as part of a staged program of digital separation leading to completion of both hands by the age of 2 years. The incidence of major complications was low, rate of revision (18 percent) acceptable, and the aesthetic result very satisfactory. Long-term functional results tend to reflect the effect of progressive intrinsic disease despite preservation of skeletal alignment and digital form with growth. However, the aesthetic improvement and potential for greater functional gains at a young age support the concept of early surgical intervention in this syndrome.

Acrocephalosyndactylia↗

PubMed2005

State-of-the-art treatment of forearm shaft fractures.

As the treatment of pediatric forearm shaft fractures has changed extensively over the past 30 years, it is worth discussing the current treatment modalities in these fractures. The recommendations are based on an ongoing evaluation of treatment procedures, problems, complications, and final results going back to 1976. Between 1976 and 1985, the 95.9% of fractures that were treated conservatively were tainted with bad functional results because a significant proportion healed with malalignment. The introduction of elastic-stable intramedullary nailing (ESIN) initiated a definitive change and the opportunity to stabilize unstable fractures with a less invasive method. Apart from some technical problems, the functional results of ESIN are very satisfactory. The external fixator is a good treatment for open, comminuted, or special distal dia-metaphyseal fractures in older children and adolescents. Therefore, we currently have a variety of methods to treat forearm shaft fractures in children using primary definitive fracture care (PDFC). The differentiated use of conservative and surgical measures should minimize final functional sequelae. A well-tried algorithm for this fracture region is outlined.

Adolescent↗

PubMed2006

Sleep disordered breathing in children with achondroplasia. Part 2. Relationship with craniofacial and airway morphology.

We evaluated the craniofacial and airway morphology in children with achondroplasia complicated by snoring and apnea during sleep (AP group) in comparison with children with snoring and apnea during sleep without chromosomal aberrations (adenoid group) and healthy children without sleep disordered breathing or malalignment (healthy group). Lateral cephalograms in 10 children each (four males and six females) in the three groups were analyzed. When the AP and healthy groups were compared, the AP group showed significantly lower values for facial depth, nasal floor length, point A, point pog, and saddle angle (p<0.01) and significantly higher values for mandibular plane angle and gonial angle (p<0.01) regarding craniofacial morphology and significantly lower values for D-AD1, D-AD2, and upper pharynx (p<0.01) regarding airway morphology. When the AP and adenoid groups were compared, the AP group showed significantly lower values for facial depth, nasal floor length, point A, point pog, and saddle angle (p<0.01) and significantly higher values for mandibular plane angle and gonial angle (p<0.01) regarding craniofacial morphology and significantly lower values for D-AD1, D-AD2, and upper pharynx (p<0.05) regarding airway morphology. Thus, the craniofacial/airway morphology in the AP group was characterized by upper airway stenosis, a retruded position of the chin, and an increased mandibular plane angle due to partial early ossification of cranial bones, and an increased lower facial height due to an increased mandibular angle, which may tend to induce sleep snoring and apnea.

Achondroplasia↗

PubMedDate not supplied

Hemiepiphysiodesis for posttraumatic tibial valgus.

Posttraumatic tibial valgus is a recognized complication of proximal tibial metaphyseal fractures in children. There is no consensus regarding management of this malalignment; approaches range from repeated osteotomy to therapeutic nihilism. The authors present 12 patients with an average age at fracture of 4 years 11 months, each of whom who was successfully managed by temporary hemiepiphysiodesis. An additional patient (age 33 years) is included to illustrate the potential long-term outcome of "benign neglect."Using staples or, more recently, a 2-hole plate for guided growth, we have demonstrated correction of posttraumatic tibial valgus by all criteria; including mechanical axis deviation, lateral tibial metaphyseal-diaphyseal angle, tibiofemoral angle, and tibial length. We conclude that hemiepiphysiodesis is a safe and effective method of treatment with a high degree of patient/parent satisfaction. There have been no permanent growth arrests.

Bone Plates↗

PubMed2000

Results of an uncemented straight femoral shaft prosthesis after 9 years of follow-up.

The first consecutive 250 implantations of an uncemented, proximally anchored straight femoral shaft prosthesis (BiCONTACT) in 236 patients are included in this prospective follow-up study. Average time of follow-up evaluation was 8.9 years (range, 7.4-10.7 years). At follow-up, 27 patients had died, and 2 could not be located. Seven patients underwent revision-2 for infection, 1 for recurrent dislocation, 2 for component undersizing with rapid subsidence, and 1 for aseptic loosening of a varus-malaligned stem; 1 radiologically well-fixed stem had been revised during acetabular revision. Overall survival was 97.1% after 11 years (confidence limits, 98.7% [upper] and 93.6% [lower]). The average Harris Hip score at time of follow-up was 84.3 points. Radiologically, tiny reactive lines (<2 mm) were present in the distal zones of the femoral shaft, but no radiolucencies could be found in the proximal anchoring zone. The midterm to long-term follow-up results with the evaluated femoral component are encouraging and are comparable to those of modern techniques of cementing in primary total hip arthroplasty.

Adult↗

PubMed1998

[Solution to the problem of extra-articular, femoral hip fracture by the "sliding screw-nail principle". Results of 2 different systems (classical nail and gamma nail)].

Between January 1993 and December 1995 we treated 109 patients (median age: 75 years) with 112 extraarticular hip fractures including combined trochanteric and shaft fractures using two different "sliding-screw-nail implants" (intramedullary hip screw = classic nail: n = 61; gamma nail: n = 51). Comparing the two systems in detail certain advantages and disadvantages were seen, with both being equivalent. We encountered the following complications: secondary varus malalignment of the collum femoris with "cut out" of the sliding-screw (1.8%) and without "cut out" (1.8%), fissure of the femoral shaft occurring intraoperatively and being treated conservatively (1.8%), femoral perforation by the nail (0.9%), infection (2.7%). Thus, 5 reoperations (4.5%) were necessary. None of these complications were attributable to the principle itself or to the different implants used. Each patient was followed-up for a minimum of 12 months postoperatively. In 59% of all patients the pre-trauma range of mobility could be fully restored. Intramedullary hip screw and gamma nail are excellent and equivalent systems, which fully satisfy the biomechanical needs of above mentioned fractures.

Adolescent↗

PubMed1985

The operative stabilization and grafting of thoracic and lumbar spinal fractures.

In this paper several concepts of surgical treatment of thoracic and lumbar fractures are reviewed. Most classifications of these fractures are primarily radiologic, but pathomechanical aspects are very important as these guide the insight into and the rationale of the different modes of treatment. The segment of movement can be considered biomechanically as a three-dimensional system, built up from two rings, linked together at five functional points of support. Our principal mode of surgical therapy after closed reduction by halo-femoral traction is anterolateral decompression, stabilization and grafting to induce fusion. In suitable cases, a dorsal or posterolateral approach and instrumentation can be combined with ventral methods. By using the primary anterolateral approach, one can reduce malalignment at the site where it is needed. Decompression can be carried out where it is truly necessary. One can give support within the segment of movement at the logical place from a biomechanical point of view: the weight bearing part, i.e., the anterior ring. By excision of the injured bony and ligamentous tissue, motion in the damaged segment of movement is eliminated, the original height is restored by grafting, and at the same time the load-bearing capacity of the fractured area is repaired. By applying Zielke instrumentation one can compress the grafts in accordance with modern views on fracture treatment. This "philosophy" is illustrated with case histories and a decision making flow chart.

Adolescent↗

PubMed1990

[Treatment results and indications for surgery in subtrochanteric femur fractures during growth].

A series of 29 subtrochanteric femoral fractures in children and adolescents treated during the last twenty years is presented. Primary osteosynthesis was done in five, secondary osteosynthesis in eleven patients. Ten patients were treated by an unilateral external fixator, two by a DC-plate, two by intramedullary nails, one by a Rushpin and one by cerclage wires. There were no deep infections. 13 patients were treated conservatively. Axial deviations resulted from conservative therapy in 9 of 11 patients, from osteosynthesis in one of 15 patients. One third of both series showed rotatory malalignment. Spontaneous corrections of axial deviations during growth can only be expected in small children to a small amount. In the average, operatively treated children had a positive leg length difference of one to two centimeters, whereas conservative treatment mostly resulted in equal leg lengths, but few patients showed differences from -4cm to +1 cm. Rotation and leg length seem to be more important for the clinical outcome than axial deviations of less than 20 degrees. Except in cases of severe concomitant injuries subtrochanteric fractures of the femur do not present an indication for primary osteosynthesis. If fracture reduction is not achieved by conservative means during the first four days osteosynthesis by DC-plates is recommended.

Adolescent↗

PubMed2006

Three-year results of proximal tibia fractures treated with the LISS.

UNLABELLED: Proximal tibia fractures present a difficult treatment challenge with historically high complication rates. In a prospective study, we asked whether the Less Invasive Stabilization System (LISS) plate can adequately treat extraarticular and complex intraarticular proximal tibia fractures and provide low complication rates and acceptable long-term functional outcomes. We prospectively observed 25 patients with 26 proximal tibia fractures (AO type A2, A3, C1, C2, or C3) treated with the LISS. Consecutive 3-year followup included radiographs and clinical examinations using Knee Society scores and Hospital for Special Surgery scores for extraarticular and intraarticular fractures. No loss of reduction occurred in patients with extraarticular fractures, whereas varus malalignment occurred in one patient with an intraarticular fracture. Two patients with AO 41 C 3.3 fractures had severe knee arthrosis develop and had total knee replacements. The mean Knee Society scores and final average Hospital for Special Surgery scores were similar for extraarticular and intraarticular fractures. Complications related to the surgery included one delayed union and implant removal in two patients. The LISS provided stable fixation of extraarticular and intraarticular proximal tibia fractures and good functional outcomes with a low complication rate. In complex articular fractures additional screws should be used. LEVEL OF EVIDENCE: Therapeutic study, Level II (lesser quality randomized controlled trial [eg, < 80% followup, no blinding, or improper randomization]).

Adult↗

PubMed2003

Overview of injuries in the young athlete.

It is estimated that 30 million children in the US participate in organised sports programmes. As more and more children participate in sports and recreational activities, there has been an increase in acute and overuse injuries. Emergency department visits are highest among the school-age to young adult population. Over one-third of school-age children will sustain an injury severe enough to be treated by a doctor or nurse. The yearly costs have been estimated to be as high as 1.8 billion US dollars. There are physical and physiological differences between children and adults that may cause children to be more vulnerable to injury. Factors that contribute to this difference in vulnerability include: children have a larger surface area to mass ratio, children have larger heads proportionately, children may be too small for protective equipment, growing cartilage may be more vulnerable to stresses and children may not have the complex motor skills needed for certain sports until after puberty. The most commonly injured areas of the body include the ankle and knee followed by the hand, wrist, elbow, shin and calf, head, neck and clavicle. Contusions and strains are the most common injuries sustained by young athletes. In early adolescence, apophysitis or strains at the apophyses are common. The most common sites are at the knee (Osgood-Schlatter disease), at the heel (Sever's disease) and at the elbow (Little League Elbow). Non-traumatic knee pain is one of the most common complaints in the young athlete. Patellar Femoral Pain Syndrome (PFPS) has a constellation of causes that include overuse, poor tracking of the patellar, malalignment problems of the legs and foot problems, such as pes planus. In the child, hip pathology can present as knee pain so a careful hip exam is important in the child presenting with an insidious onset of knee pain. Other common injuries in young athletes discussed include anterior cruciate ligament injuries, ankle sprains and ankle fractures. Prevention of sports and recreation-related injuries is the ideal. There are six potential ways to prevent injuries in general: (i) the pre-season physical examination; (ii) medical coverage at sporting events; (iii) proper coaching; (iv) adequate hydration; (v) proper officiating; and (vi) proper equipment and field/surface playing conditions.

Adolescent↗

PubMed1990

[Dorsal plate osteosynthesis of the tibial shaft. Results of a collective study of the German section of the International AO (Study Group for Osteosynthesis Problems)].

This collective study was conducted by the German section of AO International to work out the indications for fixation of the tibial shaft by means of dorsal plating. Primary dorsal plating was done in 70 cases. Most of the patients had second- or third-degree open fractures with severe ventral soft tissue injuries or closed fractures that could not be reduced and fixed conservatively. In 72 patients, secondary dorsal plate fixation was performed. The main reason for the dorsally positioned plate was persistent instability or axial malalignment after previous external or internal fixation, but failed conservative treatment constituted a further reason. Most of these patients had such severe damage following fractures that dorsal plating was the last chance of avoiding amputation. The high rate of complications (12 infections and 7 non-unions and breakages of implants after primary dorsal plating; 20 infections and 11 non-unions and breakages of implants after secondary dorsal plating) has to be considered in the light of the extraordinary indications for the dorsal plating of the tibial shaft in especially severe fractures or disastrous sequelae. In cases with extremely severe conditions before fixation, dorsal plating of the tibial shaft for secondary operative treatment yields adequate results.

Adult↗

PubMed1987

Epiphyseal injuries of the foot and ankle.

A thorough knowledge of functional growth plate anatomy and physiology is essential to proper management of epiphyseal foot and ankle injuries. The ability to classify foot and ankle fractures according to the Salter-Harris anatomic and radiographic classification provides useful prognostic information that may affect treatment. The Dias-Tachdjian mechanistic classification system for pediatric ankle fractures provides useful information about the extent of osseous and soft tissue injury and the best method of closed reduction and correlates well with the Lauge-Hansen system, which is widely used for adult ankle fractures. Most epiphyseal foot fractures involve the metatarsals or phalanges and can usually be managed with closed reduction. Considerable spontaneous correction of deformity can be expected in the younger child (under age 10 years), but one should be aware that sagittal plane and rotational malalignment of the metatarsal heads may cause significant problems. Salter-Harris type I and II fractures of the ankle can usually be managed with closed reduction. Salter-Harris type III and IV ankle fractures with greater than 2 mm of displacement require open reduction and internal fixation. One must also have a high index of suspicion for juvenile Tillaux and triplane transitional fractures that may not be obvious on plain radiographs. Although these fractures usually do not produce significant limb-length discrepancies, they are intra-articular fractures and ankle joint arthritis can result. Finally, younger children (under age 10 years) have a better prognosis for spontaneous correction of nongrowth arrest-induced deformities but a much poorer prognosis with growth arrest injuries than do older children, in whom growth arrest does not usually cause a significant problem. All children with growth plate injuries should be followed at regular intervals for at least 2 years or to skeletal maturity in the case of physeal disturbance. Treatment of epiphyseal fractures of the foot and ankle must be individualized but should always be based upon a thorough knowledge of anatomy, bone growth physiology, classification, potential pitfalls, and prognosis.

Adolescent↗