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At least 937 records · Page 52Linked to original sources

PubMed2005

[Ankle arthrodesis using the cable technique].

OBJECTIVE: Arthrodesis of the ankle with a cable technique for restitution of pain-free gait with the foot in functional alignment. INDICATIONS: Painful osteoarthritis of the ankle unresponsive to conservative and surgical treatment or in instances where these treatments do not seem sensible. CONTRAINDICATIONS: Osteomyelitis, acute arthritis, neuropathic arthropathy. SURGICAL TECHNIQUE: Exposure of the ankle through bilateral longitudinal incisions. Resection of malleoli and of articular surfaces of tibia and talus correcting at the same time any malalignment. Insertion of two cortical screws into the lateral aspect of the tibia and one each into talar body and neck. All four screws must protrude the opposite cortex. Around the neck of each anterior and posterior pair of screws as well as around the tips of the protruding screws cables are placed, tensioned, and tightened in a crimp. RESULTS: An arthrodesis of the ankle was performed in 25 patients (25 ankles). The goal of surgery was reached in 21 patients at 6-8 weeks postoperatively. Two patients had to undergo a revision using the same method to secure a bony fusion. In another two the failure was due to a wrong indication; in both a bony fusion occurred after external fixation. Using the Mazur Score the patients reached an average of 74 points and with the MHH Score ("Medizinische Hochschule Hannover" [Hanover Medical School]) an average of 78 points, both attesting to a good result.

Adult↗

PubMedDate not supplied

Biomechanical comparison of a circular external skeletal fixator construct to pin and tension band wire fixation for the stabilization of olecranon osteotomies in dogs: a cadaveric study.

OBJECTIVE: To compare anatomic reduction and the biomechanical properties of a circular external skeletal fixator (CESF) construct to pin and tension band wire (PTBW) fixation for the stabilization of olecranon osteotomies in dogs. STUDY DESIGN: Cadaveric study. ANIMALS: Forelimbs from 12 skeletally mature mixed-breed dogs, weighing 23 to 28 kg. METHODS: An olecranon osteotomy was stabilized with either a CESF construct or PTBW fixation. A single distractive load to failure was applied to each specimen through the triceps tendon. Osteotomy reduction and biomechanical properties were compared between fixation groups. RESULTS: Reduction was not significantly different (gap: P =.171; malalignment: P =.558) between fixation groups. Osteotomies stabilized with the CESF had greater stiffness (P <.0001) and maximum load sustained (P <.0001) compared to PTBW fixation. There was no significant difference for yield load (P =.318) or for load at 1 mm of axial displacement (P =.997) between fixation groups. Failure of fixation occurred by bending of the intramedullary Steinmann pin and the fixation wires in the CESF specimens and by untwisting of the tension band wire knot with pullout and bending of the Kirschner wires in the PTBW specimens. CONCLUSIONS: Specimens stabilized with the CESF construct had similar reduction and yield load, greater stiffness and maximum load sustained, and less elastic deformation than specimens stabilized with PTBW fixation. CLINICAL RELEVANCE: The CESF construct may provide a biomechanically favorable alternative to PTBW fixation for stabilization of olecranon osteotomies in dogs, and its application warrants clinical investigation.

Animals↗

PubMed2005

[Ankle arthrodesis with four cancellous lag screws].

OBJECTIVE: Arthrodesis of the ankle at 90 degrees and perfect axial alignment for restoration of a painless function. Early functional postoperative care. INDICATIONS: Painful posttraumatic or idiopathic osteoarthritis of the ankle either unresponsive to conservative measures or where these measures are not expected to be successful. Posttraumatic malalignment of the ankle, paralysis or instability, that cannot be improved or eliminated by joint-preserving measures. Joint destruction after infection. Failure of total joint replacement. CONTRAINDICATIONS: Acute osteitis. Poor skin or soft-tissue conditions. Severe peripheral arterial occlusive disease. SURGICAL TECHNIQUE: Anterior approach, judicious resection of the remaining articular cartilage. Freshening of the zones of sclerosis. Preservation of the anatomic shape of the mortise. Correction of malalignments in the sagittal and frontal planes and placement of the talus in line with the tibial axis. Tibiotalar stabilization with four 7.3-mm self-cutting cannulated cancellous lag screws or with four 6.5-mm cancellous lag screws. RESULTS: Between January 1, 1994 and December 31, 1998 this technique was performed in 50 ankles of 48 patients. 40 patients could be followed up for an average of 5.6 years (4.8-7.6 years). No serious complications. The average compensatory movement of the Chopart joint amounted to 26 degrees . Osteoarthritis of the subtalar joint was seen in 13%, and of the talonavicular joint in 12.5% of patients. Preexisting osteoarthritis of these joints remained in general unchanged. The AOFAS Score was assessed pre- and postoperatively. Preoperatively, 17.5% of patients showed a satisfactory and 82.5% a poor score. Postoperatively, 52.5% had an excellent, 30% a good, 10% a satisfactory, and 7.5% a poor outcome.

Adult↗

PubMedDate not supplied

Effects of isolated Weber B fibular fractures on the tibiotalar contact area.

Fractures of the lateral malleolus can occur without rupture of the deltoid ligament or fracture of the medial malleolus. Controversy exists regarding the necessity of surgery on supination-external rotation stage II ankle fractures. Theoretically, as long as the medial structures are intact, the talus cannot displace enough to cause degenerative arthritis of the ankle joint. The purpose of this study was to measure changes in contact area between the tibial plafond and the talar dome with serial displacement of the distal fibula in both a lateral and a superolateral direction. Twelve cadaver lower extremities were used. Distal fibular fractures were replicated by creating an osteotomy. Displacement was accomplished with a customized apparatus that displaced and held the distal fibula in a malaligned position. Tibiotalar contact area was measured with pressure sensitive film at the following intervals of fibular displacement: 0 mm, laterally 2 mm and 4 mm, and then posteriorly and superiorly 2 mm and 4 mm. A servohydraulic testing apparatus was used to apply the same physiologic load to all limbs while measuring contact area. Key independent variables included the direction and amount of displacement of the distal fibula. Mean tibiotalar contact area decreased from baseline (no displacement) 361.1 mm2 (SD +/- 49.0) to 162.2 mm2 (SD +/- 81.3) and 82.6 mm2 (SD +/- 30.6) for 2 mm and 4 mm lateral displacement of the distal fibula respectively. With posterior/superior displacement of 2 mm and 4 mm mean tibiotalar contact decreased to 219.3 mm2 (SD +/- 56.7) and 109.2 mm2 (SD +/- 39.0), respectively. Statistical significance was found (P <.001) when comparing normal ankle alignment with displaced fractures at all levels of displacement.

Aged↗

PubMed2001

A minimally invasive medial approach for proximal tibial fractures.

Numerous techniques have been described for MIPPO (minimally invasive percutaneous plate osteosynthesis) for metaphyseal or combined metaphyseal-articular fractures of the proximal tibia. Surgical management is often complicated by the initial soft tissue damage, malalignment, remaining instability, or infection. In this prospective cohort study, we describe the diagnostic procedures vital for preoperative planning. These include plain radiographs and CT scans in case of articular fracture components. The techniques for temporary stabilization and definitive fracture care using 4.5 mm DCP, LC-DCP, and LISS (Less Invasive Stabilization System) by limited medial incisions are described in a stepwise protocol. From 1996 to 1998, six fractures in six patients were studied. According to the AO classification, there were four type 41 fractures and two type 42 fractures. One patient died of ARDS. All patients had an intact medial soft tissue coverage allowing a medial approach. One patient developed a compartment syndrome, which was addressed by lateral dermato-fasciotomy prior to osteosynthesis. A LISS was used in three patients. The only complication related to surgery was in a patient with a four-part fracture with lateral comminution and a dislocated postero-medial fragment, which was reduced and buttressed with a short posteromedial 3.5 mm small fragment plate. This patient developed a deep, intraarticular infection, which was successfully treated with revision surgery; the implants were left in situ. At her latest follow-up at 18 months, she had a range of motion of 0/10/110, was back at work, and able to participate in recreational sports. The average time to healing was between 12 and 20 weeks postoperatively. There was no delayed healing, pseudarthrosis, recurrent fracture or late infection. None of the cases needed bone grafting. At the most recent follow-up, all patients were bearing full weight without walking aids. All cases achieved a neutral alignment and satisfactory range of movement. Though further data are needed we have sound reason to propagate a single medial approach and minimally invasive osteosynthesis as a sufficient and subtle technique for stabilization of these complicated fractures.

Adult↗

PubMed2002

Idiopathic cavovarus and lateral ankle instability: recognition and treatment implications relating to ankle arthritis.

Hindfoot malalignment and chronic lateral ankle instability may lead to degenerative ankle arthritis. We retrospectively analyzed 10 patients with 13 cavovarus feet. None of the patients had underlying neurologic disorders. All patients presented with a history consistent with chronic lateral ankle instability, clinically with cavovarus feet, and radiographically with varying degrees of varus talar tilt and ankle arthritis. Ankles with severe degenerative change were fused. The ankles with mild or moderate change underwent calcaneal osteotomy with lateral ligament reconstruction and/or dorsiflexion osteotomy of the first metatarsal. A quantitative radiographic Coleman block test was utilized to aid in the preoperative planning of the calcaneal and metatarsal osteotomies. All patients had correction of preoperative deformity and resolution of pain and instability. Recognition of the association between cavovarus and chronic ankle instability and degenerative ankle arthritis may be important in developing the appropriate treatment strategy in this patient population.

Adult↗

PubMedDate not supplied

Kinematic and kinetic analysis of distal derotational osteotomy of the leg in children with cerebral palsy.

Patients with cerebral palsy often develop rotational deformities of the lower extremities. These deformities may be caused by abnormal muscle tone, soft-tissue contractures, or bony malalignment. When rotational deformity persists after correction of the soft-tissue components, bony-realignment procedures are warranted to improve gait in ambulatory patients. We performed a retrospective review of 10 ambulatory children with cerebral palsy and tibial torsion who underwent 13 distal tibial and fibular derotation osteotomies. Preoperative and postoperative three-dimensional gait analysis were used to determine the effect of distal tibial and fibular derotation osteotomy on tibial rotation, foot-progression angle, gait velocity, and moments about the ankle. Mean tibial rotation and foot-progression angle were significantly improved by the procedure. Gait velocity improved but not significantly. Moment data demonstrated a trend toward normal. This study demonstrates that the derotational distal tibial and fibular osteotomy stabilized with percutaneous crossed Kirschner wires is a safe, reliable, and effective procedure for correcting rotational deformities of the leg in patients with cerebral palsy.

Adolescent↗

PubMed2005

Operative treatment of femoral shaft fractures in children and adolescents.

Although femoral shaft fractures constitute fewer than 2% of all fractures in children and adolescents, their treatment has produced many pieces of literature and years of controversy. Prevailing opinion has favored nonoperative and operative treatment, and a variety of techniques have been advocated to avoid complications such as nonunion, limb-length discrepancy, malalignment, osteonecrosis, and growth disturbance. Currently, operative methods of treatment generally are favored to allow early ambulation and shorter hospital stays and to avoid detrimental psychological and social effects often associated with prolonged nonoperative treatment, and to avoid complications. Options for operative fixation include external fixators, flexible and locked intramedullary nails, and compression and bridge plating. Although all of these can obtain good results in particular situations, there is no clear consensus of the indications for each. My choice for fixation of each fracture is based on consideration of a number of factors, including the age and size of the child, associated injuries, the location and pattern of the fracture, and the social situation of the child. In general, I prefer flexible nailing for younger children (6-10 years old) and locked nailing for adolescents at or near skeletal maturity. Bridge plating may be chosen for segmental, grossly comminuted fractures, whereas external fixation usually is reserved for severely comminuted or severe open fractures for which internal fixation is not appropriate.

Adolescent↗

PubMed2003

Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures. A retrospective review of 25 cases, with a follow-up of 36-150 months.

INTRODUCTION: Complex femoral fractures pose considerable therapeutic challenges to orthopedic surgeons. We present a retrospective review of 25 patients with complex femoral fractures treated with intramedullary locked nailing and supplemental screw fixation. MATERIALS AND METHODS: Fifteen patients with ipsilateral femoral neck and shaft fractures (group 1) and 10 patients with ipsilateral femoral shaft and distal femur fractures (group 2) were treated from 1990 to 1998. High-energy injuries occurred in all patients. There were 4 open fractures. Antegrade, locked nailing of diaphyseal fractures was performed in all cases. Supplemental screws for the neck were used in all patients in group 1 and in 3 patients in group 2. RESULTS: All of the fractures united during the follow-up. Five patients in group 1 underwent reoperation (33.3%): one due to a delayed union, the second due to an implant failure, the third due to a nonunion of a neck fracture, and the last two because of an initially missed femoral neck fracture. None of the patients in group 2 underwent reoperation. Angular malalignment of the shaft was found in 6 fractures in group 1 (average 4.8 degree, range 3 degree-11 degree) and in 4 fractures in group 2 (average 6 degree, range 3 degree-12 degree). Shortening of the limb occurred in 3 patients in group 1 (average 1.4 cm, range 1-1.8) and in 1 patient in group 2 (2 cm). Loss of fixation was seen in 1 patient in each group. Avascular necrosis and infection were not seen in any case in both groups. CONCLUSION: Femoral intramedullary nails with antegrade or retrograde options for insertion and different locking possibilities have extended the indications to include both diaphyseal and metaphyseal fractures. New nail designs, usually more expensive than the conventional nails, have been introduced into the market for this purpose. One has to keep in mind that antegrade, locked nailing of femoral shaft fractures combined with neck or distal femur fractures is a technically demanding but efficacious procedure. The success rate is high when the technique is meticulously implemented.

Adolescent↗

PubMed1992

Oblique sliding metatarsal osteotomy for pressure metatarsalgia.

The transverse arch of the foot is formed by metatarsals which heads lie in a straight line to endure most of the loading of the forefoot. Malalignment of one or more metatarsal heads will result in increased loading and produce local tender plantar callosity. The treatment of pressure metatarsalgia must aim for it's pathomechanic cause, that is, hyper-extension of metatarsophalangeal joint. We have modified the distal metatarsal osteotomy to treat 40 toes in 22 cases. Follow up for an average of 21.3 months (ranging from 18 months to 31 months) indicated 19 cases (86.4%) with satisfactory results. The 3 cases with unsatisfied results were all due to early removal of the pin. Maximum oblige sloping of the osteotomy makes the osteotomy slide more easily and ensures union. Intramedullary pinning and early weight bearing maintain the osteotomic alignment, prevent foot stiffness and allow the distal fragment telescopes to be adequately positioned to prevent over correction which leads to transfer lesion. Compared to other methods, modified metatarsal osteotomy is less invasive, preserves natural structure, is easily performed and easy cared for which leads to effective and stable results.

Adult↗

PubMed2006

Long-term maintenance of cervical alignment after occipitocervical and atlantoaxial screw fixation in young children.

OBJECT: Despite decades of surgical experience, the long-term consequences of occipitocervical (OC) and atlantoaxial (C1-2) fusions in children are unknown. The purpose of this study was to determine the long-term effects of these fusions on growth and alignment of the maturing cervical spine. METHODS: A retrospective chart review was conducted for patients 6 years of age or younger (mean 4.7 years, range 1.7-6.8 years) who underwent OC or C1-2 fusion at the Primary Children's Medical Center at the University of Utah within the last 10 years. Immediate postoperative plain radiographs and computed tomography (CT) scans were compared with the most recent plain and dynamic radiographs to assess changes in spinal growth and alignment. Seventeen children met entry criteria for the study. All patients had fusion documented on follow-up radiography or CT scans. At a mean follow up of 28 months, there were no cases of sagittal malalignment (kyphotic or swan-neck deformity), subaxial instability (osteophyte formation or subluxation), or unintended fusion of adjacent levels. The lordotic curvature of the cervical spine increased from a mean of 15 degrees postoperatively to 27 degrees at follow up (p = 0.06). A mean of 34% of the vertical growth of the cervical spine occurred within the fusion segment. When data were analyzed pertaining to a subgroup of five patients who underwent follow-up periods for longer than 48 months (mean 50.2 months, range 48-54 months), similar results were seen. CONCLUSIONS: Preliminary follow-up results indicate that, compared with older children, children 6 years of age or younger undergoing OC or C1-2 fusion are not at an increased risk of spinal deformity or subaxial instability. Longer follow-up periods, during which measurements of the spinal canal are taken, will be necessary to determine precisely how children's spines grow and remodel after an upper cervical spine fusion.

Age Factors↗

PubMed1992

[Clinical experience with recently produced devices for use in spinal surgery].

The authors reported their clinical experience with devices, which have been recently introduced for spinal surgery. The main roles of such devices are to correct malalignment of the spine and stabilize the spinal instability. Although Harrington's device has been widely used since 1962, its use is gradually decreasing due to its having several weak points, such as its low resistance to distorting forces and its imperfect ability to correct malalignment of the spine. In the present manuscript, the authors describe clinical experience with three kinds of spinal devices. They are Steffee's transpedicular screw for 5 cases of lumbar spondylolisthesis, Roosen-Trauschel compression clamp for 2 cases of atlanto-axial dislocation and Kaneda's device for one case of metastatic T-11 tumor. Good fixation was obtained in 4 cases using Steffee's devices. The injury of the nerve root is one of the most serious disadvantages in this device. Although Roosen-Trauschel compression clamp needs improvement in some aspect, it was able to bring about good stabilization without using sublaminar wiring, which may be a dangerous procedure in the cervical region. Kaneda's device seemed to be useful for the thoracolumbar lesion. Although it needs a relatively radical approach, such as thoracotomy, Kaneda's device brought about good stabilization and corrected the kyphosis. The devices, which are described in the present manuscript, will probably play important roles in spinal surgery in the future.

Adult↗

PubMed2006

Prediction of instability in distal radial fractures.

BACKGROUND: Effective methods of treating an unstable distal radial fracture are described in the literature, but there is no reliable method of identifying an unstable fracture in time to initiate appropriate treatment. The purposes of this study were to identify the predictors of fracture instability and to construct a method of prospectively predicting the radiographic outcome. METHODS: Data on approximately 4000 distal radial fractures were prospectively recorded over a 5.5-year period. The database was validated by reexamining a sample of it. Demographic data on the patients and mode of injury, as well as the fracture classification and measurements, were recorded at the time of presentation. Outcome measures consisted of radiographic measurements made at one week and six weeks and assessment of carpal alignment at six weeks. Univariate and multiple logistic regression analyses were performed to identify the significance of the data obtained at presentation in the prediction of early and late instability as well as the risk of malunion and carpal malalignment. RESULTS: The predictors of early and late instability and malunion differed according to the displacement of the fracture at presentation. Patient age, metaphyseal comminution of the fracture, and ulnar variance were the most consistent predictors of radiographic outcome. Dorsal angulation was not found to be significant in the prediction of radiographic outcome for displaced fractures. The degree to which the patient was independent was predictive of malunion in minimally displaced and displaced fractures. Formulas that are predictive of each of the seven radiographic outcome measurements were constructed. CONCLUSIONS: The study succeeded in identifying the factors that are prognostic of the radiographic outcome for distal radial fractures. Formulas to predict the radiographic outcome were constructed as the independent prognostic significance of these factors was quantified. These formulas can be used to inform the surgeon's decision about the nature of primary treatment of fractures of the distal aspect of the radius. However, they must be validated by further studies before they are used to impact the management of distal radial fractures. LEVEL OF EVIDENCE: Prognostic Level I.

Carpal Bones↗

PubMed1982

A new orthopedic fixation method in the treatment of bladder extrophy.

Extreme diastasis of the pubis and malalignment of both ilium and hip joints are always associated with the absence of infraumbilical structures and with the failure of the anterior bladder wall to close. Therefore, for a successful cure of extrophy, the pelvic ring has to be repaired, at the time of or a few days prior to the surgical cure of the bladder. The repair of the pelvis, when executed in poor aseptic conditions, results in difficult nursing problems, and fails due to the lack of convenient fixation. For these reasons, we transformed Bartons tongues into an external fixator which enhanced and improved the controlled contention of the "vertical bilateral posterior osteotomy" of the pelvis. When a two stage procedure is decided on, the modified Bartons tongues do not interfere with the urologic surgery, and in addition, the nursing problems are alleviated. Although we have used our modified Bartons tongues in only three cases, our methodology is of low enough risk for it to be reported at this time.

Bladder Exstrophy↗

PubMed1993

Influences of some design parameters on the biomechanics of the unreamed tibial intramedullary nail.

Several questions relating to the biomechanics of the AO unreamed tibial nail were addressed in this study. These included the effects of the location of the nail bend on the reduction of a high proximal fracture, and the relation of proximal locking screw hole orientation and fracture component cortical contact to the mechanical stiffness of the construct. To measure fracture site malalignment with nail insertion, a motion transducer mounted on the distal tibial shaft was used to track the position of the proximal component during and after insertion of the nail. For studying the effect of screw hole orientation, the intramedullary (IM) nail was modified by drilling a second set of proximal screw holes with oblique instead of parallel alignment. The axial, torsional, and varus-valgus stiffnesses of the constructs with parallel or oblique screws and with or without fracture site contact were determined. In an experimental model with an osteotomy located proximal to the position of the bend in the nail when fully inserted, anterior displacement of the proximal fracture component (or posterior displacement of the distal component) of up to 1 cm was measured. Oblique proximal locking screws significantly decreased both varus/valgus angulation and medial/lateral translation under load, compared with the parallel screws. Constructs were 117% and 55% as rigid as the intact tibia in axial loading with and without cortical contact, and 6.5% and 3.1% as stiff in torsion.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗

PubMedDate not supplied

Determination of tibial torsion by computed tomography.

Torsional malalignment of the lower extremity, especially during childhood, is a common concern and even an anxiety to the parents. Torsional deformity may be seen at one or more sites, and tibial torsion is a frequent cause of this problem. Medial femoral torsion and metatarsus adductus also affects the alignment of the extremity. Although a corrective osteotomy for tibial torsion is performed very rarely, the precise determination is mandatory. Tibial torsion and the torsion of the leg was measured in 25 adults by computed tomography. The inclination between the dorsal tangent to the tibial condyles and the distal reference line was considered as tibial torsion. The distal reference line was formed with intersection of centers of medial and lateral malleoli. While measuring the torsion of the leg, tangent dorsal to the femoral condyles was used for proximal reference line. In the females, the average of tibial torsion was 31.07 degrees for the right side and 30.02 degrees for the left. For the males, the averages were 32.7 and 35.26 degrees for the right and left sides, respectively.

Adolescent↗

PubMed2000

[Fractures of the pelvis--a survey of "nonunion" and "malunion" surgical results].

UNLABELLED: Nonunion (NU) and malunion (MU) of the pelvis are conditions of absent and malaligned healing of a previous pelvis fracture causing severe disabling symptoms. Reconstructive surgery of the pelvis is more demanding than treatment of the acute fracture. Ten cases of NU and/or MU of the pelvis were treated. Average time from injury to referral was 33 months. Initial treatment was conservative (seven patients), internal fixation (two patients) or combined internal and external fixation (one patient). Complaints were pain (ten patients), limp (eight patients), leg length difference (five patients) and sitting problems (seven patients). RESULTS: All patients showed radiological union. Nine patients had less or no pain at all. All eight with a preoperative limp showed improvement or no limp after surgery. Two of five still had minor leg length difference. All seven patients with sitting problems claimed relief or complete removal of sitting problems. It is concluded that patients with severe disabling symptoms from NU and/or MU can expect relief of symptoms by late correction of the pelvic deformity.

Adolescent↗

PubMed1991

[Malalignment following injuries of the distal tibia and epiphysis of the fibula].

If the correct treatment is applied, growth disturbances following epiphyseal fractures of the distal tibia are rare. Even if the prognosis is good after the correct treatment of epiphyseal fractures of the distal tibia, the parents and child may have to be informed about growth disturbances. Most frequent is a varus deformity after asymmetric closure of the medial growth plate. If at least 2 years of growth can be expected, a callus resection according to Langenskjöld is indicated. If this procedure fails, the ideal timing for a correction is the end of the growth. Imminent contractures can be an indication for early correction even if a recurrent deformity can be expected. An open-wedge osteotomy permits all three procedures to be carried out: callus resection, axis correction and leg-length correction. If an incongruence of the joint is present, the closed wedge technique using an external fixator is indicated; correction of the leg length can be postponed. Joint incongruence reacts well to axis alignment. The pre-arthrotic joint can remain free of symptoms for years. We never encountered epiphyseal fractures of the distal fibula, but we did see one case of deformity of the ankle joint as a result of closure of the proximal fibular growth plate.

Adolescent↗