SEARCH · PubMed Health

Results for “Varus”

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 1,045 records · Page 58Linked to original sources

PubMed1996

Dega acetabuloplasty combined with intertrochanteric osteotomies.

Between 1973 and 1984, 70 modified Dega acetabuloplasties done simultaneously with intertrochanteric osteotomies in 51 patients with developmental dysplasia of the hip were reviewed for long-term results and analyzed for causes of failure. Mean patient age at operation was 2.9 years (range, 8 months-8 years), and mean followup time was 15.2 years (range, 10-19 years). Topical investigations were based on clinical criteria of the Severin classification and radiologic criteria of the Commission for the Study of Hip Dysplasia of the German Society of Orthopaedics and Traumatology. The review of clinical documents and investigations very good and good results in 80% of the hips. The Trendelenburg sign was a useful clinical indicator for problematic cases. Measurements on radiographs were classified into deviation grades from the normal range. Values of the acetabulum and the acetabulum to head relation were normal or slightly abnormal in >80% of hips. Measurements of the femoral head and neck were in the low normal range. The lowest percentage of normal values was in 24 cases with coxa valga after acetabuloplasty combined with derotational varus osteotomy. Poor clinical and radiologic outcome usually was the result of avascular necrosis of the femoral head or recurring valgus deformity after derotational varus osteotomy. The rate of avascular necrosis as a consequence of the operation was 5.7%. The risk of avascular necrosis caused by derotational varus osteotomy is lower than the risk of later development of deformities in the proximal femur.

Acetabulum↗

PubMed1997

Meniscal allograft transplantation for unicompartmental arthritis of the knee.

Sixty-seven meniscal allografts were transplanted in the knees of 63 patients between 1988 and 1994. Before surgery, all patients experienced refractory disabling knee pain secondary to a prior total meniscectomy with advanced unicompartmental osteoarthritic changes as verified by arthroscopy. At a mean followup of 31 months (range, 1.0-5.5 years), 58 knees (86.6%) attained a good to excellent results-Twenty-one knees received isolated meniscal allografts, with 19 achieving good to excellent results (90.5%). Five knees received a medial or lateral meniscal allograft with an anterior cruciate ligament reconstruction, and 4 (80.0%) obtained good to excellent results. Thirty-four knees received a meniscal allograft in combination with either a valgus high tibial osteotomy, varus high tibial osteotomy, or varus distal femoral osteotomy to correct for preoperative varus or valgus deformities, with 29 (85.3%) attaining good to excellent results. The remaining 7 knees underwent a combined medial meniscal allograft, valgus high tibial osteotomy, and anterior cruciate ligament reconstruction with 6 (85.7%) attaining good to excellent results. The most frequent complication was a traumatic posterior horn tear in 6 knees at a mean of 21 months after surgery (range, 9-43 months), most likely the consequence of unsuccessful healing of the posterior horn of the graft.

Activities of Daily Living↗

PubMedDate not supplied

A dynamic biomechanical analysis of the etiology of adolescent tibia vara.

Biomechanical overload of the proximal tibial physis due to static varus alignment and excessive body weight has been implicated in the etiology of infantile tibia vara. Whether a similar pathophysiologic process applies to adolescent tibia vara is controversial, with poor consensus concerning the nature and significance of static knee alignment early in the course of the disease. This study examines the hypothesis that dynamic gait deviations to compensate for increased thigh girth associated with obesity (fat-thigh gait) could result in increased loading of the medial compartment of the knee during the gait cycle. Three-dimensional motion analysis was used to identify the kinematic/kinetic profile associated with fat-thigh gait. Gait deviations identified were dynamic stance-limb knee varus, increased stance-limb knee rotation, and swing-limb circumduction. Pathologic compressive forces were generated in an anthropometric model by using recorded fat-thigh gait deviations and clinically appropriate excessive body weight. This analysis supports the clinical observation that underlying static varus malalignment of the knee is not a prerequisite for the development of adolescent tibia vara and illustrates the significance of dynamic gait deviations when considering knee-joint loading.

Adolescent↗

PubMed2004

Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3).

OBJECTIVES: Historically, mechanically unstable fractures of the distal femur have been difficult to treat. Problems such as varus collapse, malunion, and nonunion frequently resulted before fixed-angle plates and indirect reduction techniques were popularized. More recently, the Less Invasive Stabilization System, or LISS (Synthes, Paoli, PA), has been designed to combine these 2 approaches with the intended goals of achieving adequate stable fixation and early healing. Early clinical results for the femoral Less Invasive Stabilization System have been promising. The purpose of this study is to evaluate the clinical results of patients with high energy, mechanically unstable fractures of the distal femur treated with the Less Invasive Stabilization System. DESIGN: Retrospective analysis of a treatment protocol, consecutive patient series. SETTING: Busy level II trauma center. PATIENTS /PARTICIPANTS: Twenty-six patients with 27 high-energy AO/OTA types A2, A3, C2, and C3 fractures of the distal femur. INTERVENTION: Treatment with indirect fracture reduction and internal distal femoral fixation using the Less Invasive Stabilization System. MAIN OUTCOME MEASUREMENTS: Clinical and radiographic assessment. RESULTS: Twenty-one patients with 22 fractures were available for evaluation at an average 19 months postinjury (range 12-35 months). The mechanism of injury included 12 motor vehicle collisions, 4 high falls, 5 motorcycle crashes, and 1 bicyclist struck by a car. Twenty patients had associated injuries. Six fractures were open. All fractures were comminuted; according to the AO/OTA fracture classification there were 4 A2, 3 A3, 12 C2, and 3 C3 fractures. All fractures healed without secondary surgeries at a mean of 13 weeks (range 7-16 weeks). There were no cases of failed fixation, implant breakage, or infection. Average joint line orientation relative to the femoral shaft axis (valgus) measured 99 degrees on postoperative radiographs and 99 degrees on final radiographs. A comparison of postoperative to healed final radiographs for each femur demonstrated no case with greater than a 3 degrees difference in either varus or valgus. Complications included 1 mal-union where the fracture was fixed in 8 degrees of valgus and 2 cases of external rotation between 10 degrees and 15 degrees. Painful hardware occurred in 4 patients, of which 3 underwent implant removal. The average knee range of motion was 5 degrees to 114 degrees. CONCLUSIONS: The Less Invasive Stabilization System allows for stable fixation and facilitates early healing in mechanically unstable high-energy fractures of the distal femur. There were no patients with fixation failure, varus collapse, or nonunion in this "at-risk" population. This treatment safely allows for immediate postoperative initiation of joint mobility and the progression of weight bearing with early radiographic signs of healing.

Adolescent↗

PubMed2002

Frontal plane knee angle affects dynamic postural control strategy during unilateral stance.

PURPOSE: Center of plantar pressure (COPP) location moves toward the forefoot as ankle plantar flexor muscles attempt to maintain postural control during single leg stance. This study evaluated relationships between frontal plane tibiofemoral joint angulation during relaxed bilateral stance and mean COPP locations during vision-denied single leg stance at 20 degrees knee flexion. METHODS: Fifty-six nonimpaired athletes (29 female, 27 male) were evaluated for frontal plane tibiofemoral joint angulation and standing foot angle by using two-dimensional videography (30 Hz). Mean anterior-posterior and mediolateral COPP locations were assessed during single leg stance on a mat (25 Hz, 15 s). One-way ANOVA and Tukey HSD tests evaluated group differences (P < or = 0.05) based on frontal plane tibiofemoral joint angulation. RESULTS: Group 1 (genu varus or genu valgus < 5 degrees ) displayed a mean anterior-posterior COPP location of 54.2 +/- 6% from the (0,0) coordinate starting point at the anterolateral foot (10.3 +/- 2 cm from the posterior sensor edge). Group 2 (genu varus angulation > or = 5 degrees ) and group 3 subjects (genu valgus angulation > or = 5 degrees ) displayed mean anterior-posterior COPP locations of 60.6 +/- 8% and 60.7 +/- 7% (8.8 +/- 2 cm and 8.7 +/- 2 cm from the posterior sensor edges), respectively. Group 2 (12.5 +/- 3 N x kg(-1)) and group 3 (12.4 +/- 3.1 N x kg(-1)) subjects also displayed greater mean plantar force magnitude/body weight than group 1 (10.3 +/- 2 N x kg(-1)) subjects. Mean ankle plantar flexor moment magnitudes did not differ between groups. CONCLUSIONS: Rearfoot directed mean anterior-posterior COPP locations and greater plantar force magnitudes/body weight suggests that subjects with genu varus or genu valgus relied more on the subtalar and midtarsal joint control function of the ankle plantar flexor muscle group for lower extremity dynamic postural control.

Adolescent↗

PubMed1987

Treatment of preaxial polydactyly of the foot.

Fourteen patients with preaxial polydactyly are classified into four types according to their morphologic configuration: type 1--ray duplication; type 2--completely duplicated phalanges; type 3--incompletely duplicated metatarsals; and type 4--incompletely duplicated phalanges. The surgical treatment and timing thereof appropriate for each group are discussed. Three cases of congenital hallux varus deformity are analyzed, focusing on the pathomechanism of this disorder. Based on our experience, two main factors are noticed in the etiology of congenital hallux varus deformity: inadequacy of the adductor hallucis and tightening of the fibrous band pulling the big toe into the varus.

Abnormalities, Multiple↗

PubMed2003

A comparison of rotational landmarks in the distal femur and the tibial shaft.

The relationship among three anatomic landmarks and the mechanical axis of the tibia was evaluated using magnetic resonance imaging in 30 normal knees in 15 healthy volunteers. These three relationships are calculated for flexion and extension. The angles between the tibial mechanical axis and a line perpendicular to the surgical epicondylar axis, a line perpendicular to the clinical epicondylar axis, and the anteroposterior axis were 3.9 degrees varus, 0.6 degrees varus, and 0.2 degrees valgus, respectively. The mechanical axis of the femur was 3.0 degrees varus relative to the mechanical axis of the tibia. The results of the current study suggest that the surgical epicondylar axis rather than the clinical epicondylar axis or the anteroposterior axis can maintain a more predictable orientation with respect to the mechanical axis of the tibia when moving from flexion into extension.

Adult↗

PubMed2004

Effect of tibial slope or posterior cruciate ligament release on knee kinematics.

An experimental study using fresh human cadaver knees was designed to evaluate the effect of partial posterior cruciate ligament release or posterior tibial slope on knee kinematics after total knee arthroplasty. Varus and valgus laxity, rotational laxity, anteroposterior laxity, femoral rollback, and maximum flexion angle were evaluated in a normal knee, an ideal total knee arthroplasty, and a total knee arthroplasty in which the ligaments were made to be too tight in flexion. The total knee arthroplasty specimens then were subjected to either partial posterior cruciate ligament release or increased posterior tibial slope, and the tests were repeated. Posterior tibial slope increased varus and valgus laxity, anteroposterior laxity, and rotational laxity in the knee that had flexion tightness. Posterior cruciate ligament release corrected only anteroposterior tightness, and had no effect on the abnormal collateral ligament tightness. Increased posterior tibial slope significantly improved varus and valgus laxity and rotational laxity in the knee that was tight in flexion more than with release of the posterior cruciate ligament. Therefore increasing posterior tibial slope is preferable for a knee that is tight in flexion during total knee arthroplasty.

Arthroplasty, Replacement, Knee↗

PubMedDate not supplied

Leg length discrepancy in Legg-Calve-Perthes disease.

The purpose of this study was to determine the incidence of the leg length discrepancy (LLD) in Legg-Calve-Perthes disease and whether there is any correlation between LLD and age at onset, gender, type of treatment, and severity of disease. The study population consisted of 261 patients with unilateral involvement who had reached skeletal maturity at last follow-up. All hips were treated by containment methods (bed rest and traction in abduction, Petri cast, brace, varus osteotomy, Salter osteotomy, and shelf acetabuloplasty). The late results were classified according to the Stulberg classification. LLD was found in 33 patients and ranged from 1 to 5.2 cm (average 2.51 cm). The limb shortening was observed in Herring group B (average 2.18 cm) and C (average 2.82 cm) and was statistically significant more common in group C. The statistical analysis revealed no statistical difference between the age at onset, sex, and type of treatment with regard to LLD; nevertheless, patients in Herring group C with LLD were younger than patients in group B, and LLD was seen more often after varus osteotomy. The amount of residual shortening of the affected limb in Legg-Calve-Perthes disease at the end of skeletal growth seems to depend on the extent of involvement and the presence of a growth arrest. A varus osteotomy produces more significant shortening than other methods of treatments. The age at the onset of symptoms and sex do not influence the amount of LLD, but early onset of the disease can result in more severe limb shortening.

Adolescent↗

PubMedDate not supplied

A new double elevating osteotomy in management of severe neglected infantile tibia vara using the Ilizarov technique.

Neglected infantile Tibia Vara is a very challenging clinical problem with many technical problems including distorted joint line secondary to the medial tibial plateau depression, obesity leading to difficulty in exposure, performing osteotomies and difficulty in osteotomy fixation. The aim of this study is to evaluate the clinical and radiological results of treatment of severe neglected infantile Tibia Vara using a new osteotomy to elevate the depressed medial tibial plateau in conjunction with the Ilizarov technique. Seven tibias in five patients were included in this study. These were all Stage V and VI according to Langenskiold and Riska classification. The average age at surgery was 11.6 years (ranging from 8 to 15), and the average follow-up was 6.2 years (ranging from 3 to 10). A new double osteotomy technique was used to elevate the depressed medial tibial plateau and correct the varus deformity. Correction was done gradually using the Ilizarov Frame. The results were assessed clinically and radiologically. The femoral shaft -- tibial shaft angle improved from an average of 36 degrees of varus preoperatively to 4 degrees of varus. The femoral condyle-tibial shaft angle improved from an average of 58 degrees to 83 degrees. The angle of depressed medial tibial plateau improved from an average of 53 degrees to 10 degrees. We believe that our new double elevating osteotomy in conjunction with Ilizarov technique is an excellent modality for patients with stage V and VI according to the Langenskiold and Riska classification. The advantages of this technique include correction of the deformity with simultaneous correction of the joint architecture, immediate weight bearing, and avoidance of excessive dissection needed for internal fixation.

Adolescent↗

PubMedDate not supplied

The use of dynamic EMG in predicting the outcome of split posterior tibial tendon transfers in spastic hemiplegia.

The purpose of this study was to assess the outcome of split posterior tibial tendon transfers in patients with spastic cerebral palsy to determine whether the use of preoperative dynamic electromyography was predictive of surgical success. The study is a consecutive case series of 25 children with spastic hemiplegia who underwent unilateral split posterior tibial tendon transfers for varus foot deformities. Three patients were considered failures because of residual varus, which required further surgery. An additional 5 patients had mild residual varus. Preoperative dynamic electromyographic data were evaluated to determine the etiology of postoperative undercorrection. Undercorrection seems to be related to unrecognized anterior tibial muscle overactivity and advanced age at surgery. Overcorrection did not occur. Dropfoot was noted postoperatively in 52% of patients and was related to early cessation of anterior tibial muscle activity in swing. Split posterior tibial tendon transfer is a successful surgery on those patients with increased posterior tibial muscle activity. Undercorrection can be avoided by assessing the activity of the anterior tibial muscle before surgery. These results are expected to assist in surgical decision making for the equinovarus foot in cerebral palsy.

Adolescent↗

PubMedDate not supplied

Bifocal tibial corrective osteotomy with lengthening in achondroplasia: an analysis of results and complications.

The results and complications of bifocal tibial osteotomies with gradual correction and lengthening by Ilizarov ring fixator performed in 47 tibiae in 24 achondroplastic patients were analyzed. Comparison was made between the parameters of angular and torsional deformities of the tibia preoperatively, at fixator removal, and at last follow-up. Of these parameters, statistically significant change was seen postoperatively in the values of medial proximal tibial angle, lateral distal tibial angle, mechanical axis deviation, and tibial torsion, which changed from 78.8 +/- 7.05 degrees, 103.2 +/- 11.8 degrees, 25.1 +/- 14.6 mm (medial), and 22.7 +/- 10 degrees (internal) preoperatively to 87.3 +/- 6.3 degrees, 90.9 +/- 5.4 degrees, 5.3 +/- 10 cm (medial), and 15.8 +/- 4.2 degrees (external), respectively, at the time of fixator removal; and this correction was maintained during the follow-up period. Mean total tibial lengthening was 6.84 +/- 1.3 cm. Average healing index was 26.06 days/cm. Complications observed were 15 pin tract infections, 1 residual varus, 1 overcorrection into valgus, 2 recurrence of varus, 22 equinus contractures, 2 premature consolidations, and 3 fibula malalignments. Recurrence of varus was observed in limbs with a residual abnormal medial mechanical axis deviation due to femoral deformity. A hundred percent incidence of equinus was observed in limbs with tibial lengthening of more than 40%, with distal tibial lengthening of more than 15%. To minimize the risk for occurrence of equinus, we recommend restriction of distal tibial lengthening in achondroplasia to less than 15%, although total tibial lengthening may exceed 40%. Fibula malalignment was not observed after double fibula osteotomy. This procedure is safe and efficacious if performed with strict adherence to prescribed technique.

Achondroplasia↗

PubMed2006

Prevalence of bowlegs among child and adolescent soccer players.

OBJECTIVE: Little is known about the interactions of sports-related demands and human body, in particular on musculoskeletal features, during growth. Focusing on the relationship between soccer and lower limb alignment, we examined the hypothesis that varus knee deviation is more prevalent among high-performance pediatric and adolescent soccer players. DESIGN: Cross-sectional study with focused sampling. SETTING: First league sports clubs. PARTICIPANTS: 106 male child/adolescent soccer players aged 10 to 21 years and 68 age-matched tennis players. INTERVENTIONS: All athletes completed a demographic questionnaire and underwent physical examinations, which included height, weight, generalized laxity, knee, ankle, foot and spine axis, hip range of motion, tibial torsion, Q angle, foot navicular height, and progression angle. MAIN OUTCOME MEASUREMENT: Varus/valgus axis was determined by the intercondylar intermalleolar distance while standing. Soccer and tennis players were compared on knee axis and other outcome variables by analysis of covariance, adjusting for age and by t-tests within age groups. RESULTS: A significantly higher prevalence of knee varus was found among the soccer players compared to that among the tennis players. The difference in intracondylar distance was statistically significant after the age of 13 years (P < 0.001). In addition, compared to tennis players, soccer players had higher foot arches, decreased hip external rotation and increased external tibial torsion. CONCLUSIONS: Varus knee axis deviation was more common among children and adolescent soccer players than among tennis players. The prevalence was more pronounced among players aged 13 years or older. Further research is needed to explore the rationale of this phenomenon.

Adolescent↗

PubMed2003

Locked-nail treatment of humeral surgical neck nonunions.

OBJECTIVE: The authors' purpose was to report their experience with the use of locked nails in treating humeral surgical neck nonunions. Locked nailing has the advantages of minimal soft tissue trauma, automatic fracture reduction, and stable fracture fixation. METHODS: Excluding 3 patients with severe medical illness, a total of 15 consecutive patients with 15 nonunions were treated by humeral locked nailing and bone grafting. Delay from trauma to surgery averaged 13.8 months, and 10 patients had previous operations. The average age of patients was 55.1 years; average follow-up time was 22.4 months. There were two hypertrophic and 13 atrophic nonunions. The average preoperative Neer score for shoulder joints was 53.5. All but three cases had varus deformity, with an average angle of 32.3 degrees. RESULTS: Seven nonunions were nailed with 8-mm nails and eight with 7-mm nails. With a single operation, all but one patient achieved osseous union in an average of 5.4 months. This one patient, who had a Neer score of 72, refused further surgery. At follow-up, 13 of the 15 patients had excellent or good functional recovery of shoulder joints, with an average Neer score of 86.7. Four patients had residual varus angulation averaging 15.5 degrees. For patients with solid union, the average range of shoulder motion was 152.3 degrees in flexion and 146.4 degrees in abduction. No patients had significant limitation of elbow motion. Three patients had occasional shoulder pain and no patients had evident shoulder impingement. CONCLUSION: For humeral surgical neck nonunions in which the head fragment still preserves the greater tuberosity, locked nailing with transfixing screws appeared to be a useful alternative, especially in fractures with osteoporosis, severe varus deformity, or severe soft tissue scarring.

Adult↗

PubMed1984

Surgical treatment of pathological subtrochanteric fractures due to benign lesions in children and adolescents.

Twelve children and adolescents with pathological subtrochanteric fractures due to benign tumors or tumorlike lesions were treated by curettage, autologous cancellous bone graft, and internal fixation. The healing of the lesion and the fracture in nine patients was without complications. In the remaining three, the healing was complicated. In one, with nonunion and shortening due to 35 degrees varus deformity following conservative treatment, a 1-cm shortening due to 15 degrees varus deformity remained after surgery. In the same patient, a small recurrence was curetted when removing the plate and the screws. In the second, a stress fracture with varus deformity and shortening followed surgical treatment. These were corrected by valgus osteotomy. In both patients the final result was good. In the third, a femoral head collapse occurred. It was due to a lesion in the head that was overlooked on the initial roentgenogram. Although the fracture and the lesion were healed, the final result was poor. It was concluded that internal fixation of these fractures allows thorough curettage and bone grafting and results in the least amount of immobilization and the most rapid resolution of the lesion and the fracture.

Adolescent↗

PubMedDate not supplied

Behavior of the proximal femur during the treatment of congenital dysplasia of the hip: a clinical long-term study.

The influence of the acetabular cover on the development of the proximal femur during the treatment of congenital dysplasia of the hip was studied in 47 children (58 hips) with a follow-up of 22 years. Varus osteotomy failed to correct hip dysplasia in 33 hips of 27 children. Chiari osteotomy was followed by a positive anti-Chiari effect (oval shaped acetabulum with proximal migration of the femoral head) in 15 children (20 hips). In five children (five hips) with coxa vara due to avascular necrosis, the anti-Chiari effect was negative. The combination of Chiari and varus osteotomy before the age of 8 years was followed by a positive anti-Chiari effect and recurrence of valgus deformity in seven of eight hips. The long-term failure of the varus and Chiari osteotomy, together with a review of clinical and experimental surveys, led us to prefer the acetabular redirectional osteotomy.

Adolescent↗

PubMedDate not supplied

Metatarsal epiphyseal bracket: treatment by central physiolysis.

Longitudinal epiphyseal bracket (LEB) is a rare ossification anomaly in which an epiphysis brackets the diaphysis of a phalanx, metacarpal, or metatarsal. This abnormal epiphysis tethers longitudinal growth, resulting in a shortened and oval-shaped bone. Four patients with five LEBs were treated by central physiolysis and followed for a mean of 6 years. The patients had significant hallux varus deformity. Three patients had duplicated great toes, and two had tibia hemimelia significant enough to require epiphysiodesis as they neared adolescence. Resection of the LEB allowed the proximal and distal epiphysis to resume untethered growth. Silastic or methyl methacrylate was placed over the resected physis to prevent bony rebridging. The associated hallux varus deformity was corrected by capsulorrhaphy and K-wire fixation. In all patients, the metatarsal resumed longitudinal growth and correction of the hallux varus was maintained.

Child↗

PubMedDate not supplied

Supracondylar elbow fractures with impaction of the medial condyle in children.

We reviewed the cases of 13 children with supracondylar elbow fractures with impaction of the medial wall. The displacement was underestimated in two patients and treated as a minimally displaced fracture by simple immobilization without reduction, resulting in a cubitus varus deformity. In one patient, the correct diagnosis was made, but treatment by reduction was refused by the parents. A loss of carrying angle of 10 degrees resulted from this. Two patients referred for treatment of cubitus varus were treated elsewhere for the initial injury: one by reduction and plaster cast immobilization and the other by simple immobilization without reduction. Two children with a supracondylar fracture with buckling of the medial condyle without prominent deformity were not reduced and showed no deformity at follow-up. Six children with collapse of the medial condyle, treated by closed reduction and percutaneous pinning, all had a normal carrying angle at follow-up. We believe that this method is safe to prevent varus angulation.

Child↗