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 19 recordsLinked to original sources

PubMed1991

Bone malalignment in acute injuries of the wrist.

The purpose of this study was to analyze radiographic signs of carpal bone instability in patients with an acutely injured wrist. There were 80 patients (52 women and 28 men) with a fall on the outstretched hand. Fifty patients had a fracture of the distal radius, and eight had a scaphoid fracture. The patients with a bone fracture showed a larger scapholunate angle than those without a fracture (P less than 0.001, t-test). However, only four of them showed true carpal bone instability: two patients with a scaphoid fracture and one with a radius fracture had dorsiflexion instability of the wrist and one patient with a radius fracture had dorsal subluxation of the wrist. In addition, one patient without any bone fracture had scapholunate dissociation, one form of carpal bone instability. Although carpal bone instability is not frequent in an acutely injured wrist, its signs should be remembered in the radiographic analysis of the traumatic wrist to prevent subsequent articular disorders.

Acute Disease↗

PubMed1985

Congenital skeletal malformations induced by maternal ingestion of Conium maculatum (poison hemlock) in newborn pigs.

Skeletal malformations were induced in newborn pigs from gilts fed Conium maculatum seed or plant during gestation days 43 through 53 and 51 through 61. The teratogenic effects in groups dosed during gestation days 43 through 53 were more severe than those in groups dosed during the later period, with many newborn pigs showing arthrogryposis and twisted and malaligned bones in the limbs and with 1 pig showing scoliosis and deformity of the thoracic cage. The pigs born to gilts given C maculatum during gestation days 51 through 61 had excessive flexure primarily in the carpal joints, without scoliosis or bone malalignment in the limbs. The teratogenicity of poison hemlock depends on the alkaloid concentration and content. Based on the data presented, we speculate that gamma-coniceine is the teratogenic alkaloid in the poison hemlock fed to the gilts.

Abnormalities, Drug-Induced↗

PubMed2000

Correction of lunate malalignment when bone grafting scaphoid nonunion with humpback deformity: rationale and results of a technique revisited.

Patients with scaphoid nonunion with humpback deformity and collapse of the wrist were treated with palmar wedge bone grafting combined with reduction of the lunate to correct the dorsal intercalated segment instability deformity. Union was obtained at an average of 3 months, and patient satisfaction with functional outcome and pain relief was high. Palmar wedge bone grafting combined with correction of lunate malalignment successfully achieved scaphoid union, restored scaphoid length, and avoided the potential complication of scaphoid malunion. This report revisits a technique that facilitates accurate correction of lunate malalignment (dorsal intercalated segment instability) by initial reduction and pin fixation to the radius before insertion of scaphoid bone graft and internal fixation.

Adolescent↗

PubMed2007

Effect of varus/valgus malalignment on bone strains in the proximal tibia after TKR: an explicit finite element study.

Malalignment is the main cause of tibial component loosening. Implants that migrate rapidly in the first two post-operative years are likely to present aseptic loosening. It has been suggested that cancellous bone stresses can be correlated with tibial component migration. A recent study has shown that patient-specific finite element (FE) models have the power to predict the short-term behavior of tibial trays. The stresses generated within the implanted tibia are dependent on the kinematics of the joint; however, previous studies have ignored the kinematics and only applied static loads. Using explicit FE, it is possible to simultaneously predict the kinematics and stresses during a gait cycle. The aim of this study was to examine the cancellous bone strains during the stance phase of the gait cycle, for varying degrees of varus/valgus eccentric loading using explicit FE. A patient-specific model of a proximal tibia was created from CT scan images, including heterogeneous bone properties. The proximal tibia was implanted with a commercial total knee replacement (TKR) model. The stance phase of gait was simulated and the applied loads and boundary conditions were based on those used for the Stanmore knee simulator. Eccentric loading was simulated. As well as examining the tibial bone strains (minimum and maximum principal strain), the kinematics of the bone-implant construct are also reported. The maximum anterior-posterior displacements and internal-external rotations were produced by the model with 20 mm offset. The peak minimum and maximum principal strain values increased as the load was shifted laterally, reaching a maximum magnitude for -20 mm offset. This suggests that when in varus, the load transferred to the bone is shifted medially, and as the bone supporting this load is stiffer, the resulting peak bone strains are lower than when the load is shifted laterally (valgus). For this particular patient, the TKR design analyzed produced the highest cancellous bone strains when in valgus. This study has provided an insight in the variations produced in bone strain distribution when the axial load is applied eccentrically. To the authors' knowledge, this is the first time that the bone strain distribution of a proximal implanted tibia has been examined, also accounting for the kinematics of the tibio-femoral joint as part of the simulation. This approach gives greater insight into the overall performance of TKR.

Arthroplasty, Replacement, Knee↗

PubMed1997

A biomechanical study on five unilateral external fracture fixation devices.

OBJECTIVE: This study examines plastic, slip and fatigue failures in external fixator frames. DESIGN: Failure was examined in five commonly used unilateral external fixators using experimental models that simulated both stable and unstable diaphyseal fractures. BACKGROUND: Plastic failure arises from permanent deformation of a frame initiated by bending of frame components, while slip failure arises from slip at clamping interfaces. Such failure may lead to refracture or to malalignment of the bone (transverse or angular). Fatigue failure arises from the loosening or wear of components under long-term cyclic loading; this can lead to variable interfragmentary displacement and impairment of fracture stability. METHODS: Axial loads were measured at which plastic or slip failure occurred, as were changes in interfragmentary motion due to 10 000 load cycles simulating walking activity. RESULTS: In four fixators, plastic or slip failure initiated bone malalignment at only 50% of average adult weight bearing (650 N). Additionally, in three fixators a third screw at the clamp centre was found to reduce retention of the two adjacent screws, causing premature slip failure. Evidence of fatigue was found in all the fixators after only 10 000 load cycles. In one fixator, the amplitude of elastic interfragmentary motion increased progressively by 30% transversely, 15% angularly and 100% torsionally. In another fixator it increased by 10% in all directions while the column was locked (non-dynamizing), and it increased a further 10% while it was unlocked and able to slide telescopically (dynamizing). Clamp slip occurred at the column of a third fixator almost immediately after commencing the cyclic loading. CONCLUSION: Plastic or slip failure of frames may occur prematurely during routine weight-bearing on unstable fractures, and frame fatigue may affect long-term interfragmentary stability.

Journal Article↗

PubMed1990

Arthroscopy of the wrist: anatomy and classification of carpal instability.

Carpal instability can be defined as the lack of ligamentous and skeletal support adequate to maintain a wrist stable to external forces of pinch and grasp. This instability may be static or dynamic. It has been classified as (a) carpal instability, dissociated (CID), a situation in which one or more of the ligaments are torn, and (b) carpal instability, nondissociative (CIND), a situation in which the ligaments are intact but stretched. Carpal instability can also be the result of carpal bone malalignment from various causes. Arthroscopy can be particularly useful in assessing carpal instability, however arthrography with contrast medium, fluoroscopy, and stress loading should precede this arthroscopic assessment. Arthroscopy allows visualization of the volar radiocarpal and ulnocarpal ligaments of the wrist, and the arthroscopic examination can be combined with manual manipulation of the carpal bones to detect laxity of those ligaments, to examine stability of the scapholunate and lunotriquetral interosseous ligaments, and to show instability of the distal radioulnar joint.

Arthroscopy↗

PubMed1995

Wrist pain in adult athletes.

As more and more adults become physically active, primary care physicians are seeing an increasing number of wrist injuries. Effective treatment is based on (1) accurate diagnosis, (2) maintenance of bone and joint-surface alignment until healing of bone, soft tissue, or both occurs, and (3) institution of an appropriate rehabilitation program. After symptoms have subsided, patients can gradually return to athletic participation. The long-term sequelae of wrist injuries are yet to be determined. If it is assumed that such injury causes a form of joint trauma, then analogies may be drawn to other types of musculoskeletal trauma, in which such factors as joint-surface and bone malalignment can lead to abnormal cartilage wear, predisposing patients to degenerative arthritis. Similarly, untreated ligament injuries may alter joint biomechanics, which can also lead to joint-surface trauma. Further clinical study should clarify the long-term effects of wrist injury.

Adult↗

PubMed2006

Forces and torques during fracture reduction: Intraoperative measurements in the femur.

Reduction is a crucial step in fracture treatment. We determined intraoperative peak forces and torques during fracture reduction in seven patients with eight fractures of the femoral shaft. All fractures were temporarily stabilized by external fixation. Force and torque measurements were performed during the subsequent intramedullary nailing procedure. A three-dimensional load cell was attached to the distal femur fragment using two Schanz screws. All forces and torques were registered on-line during the reduction process. The maximum resulting force was 411 N, the maximum resulting torque 74 N x m. The highest force was observed along the shaft axis with 396 N for distraction. The maximum torque value was measured around the frontal axis, being 74 N x m for antecurvature. These results may assist the development of new reduction techniques and devices.

Adult↗

PubMed2002

[Supracondylar corrective osteotomy in post-traumatic cubitus varus. 3 cases in 2 patients].

Supracondylar fractures of the humerus in childhood frequently result in cubitus varus deformity. Pain, functional impairment and cosmetic problems can request surgical correction. This is a report on an adult and on a mature child with such deformities. The boy had sustained three injuries with following bilateral cubitus varus and lengthening of one lower leg. Planning, surgical technique and outcome of the osteotomies are described. We should recommend the resection of a full wedge with two oblique osteotomies and internal fixation with two plates on either side of the humerus.

Adolescent↗

PubMed2005

[Post-traumatic torsional differences and functional tests following antegrade or retrograde intramedullary nailing of the distal femoral diaphysis].

Previous studies have compared the functional outcome and torsional differences following closed intramedullary nailing of femoral fractures. Rotational deformity following intramedullary nailing may cause symptoms and require surgical correction by osteotomy. Until now studies were designed to evaluate the correct torsional differences by examining every patient following antegrade or retrograde femoral nailing. The series included 13 women and 28 men, average age 44.5 years, who suffered a fracture of the distal femoral diaphysis. Postoperatively we established the diagnosis by three-dimensional determination of the torsion and length of the lower extremities by ultrasound measurement. Furthermore, we performed the clinical examination according to the Tegner and Lysholm score and the Merle d'Aubigne score. There were no significant differences in torsional deformity and length found. The functional outcome showed no significant differences between the two groups. The functional examination exhibited a reduction of flexion in knee motion in the retrograde group. In the antegrade group the motion of the hip was decreased. A correlation between the functional outcome and the torsional deformity was not found. The possible advantage of positioning by using the retrograde femoral nail was not verified.

Adult↗

PubMed2007

[Defect of the femoral condyle in the knee after patellectomy. Long-term results of fresh massive osteochondral allografting].

The presence of a massive full-thickness osteochondral defect in the knee of young and active individuals is an unsolved problem in orthopedic surgery, especially in post-traumatic large bone defects. Fresh massive osteochondral allografts have been used for many years but mostly in oncology but not in post-traumatic cases. This case report describes a 20-year-old right leg-dominant woman, who, at age 19, sustained open Gustilo-Anderson type III comminuted fractures of the left patella and lateral femoral condyle in a motorbike accident. Initial treatment included immediate débridement and patellectomy with lavage. The large defect of the femoral condyle was reconstructed with a massive osteochondral allograft 1 year after the injury. The graft was obtained from our institutional tissue bank. The damaged bearing part of the condyle was resected to bleeding bone to create the nearly rectangular defect. The central condyle wall remained intact. The graft was trimmed to fit the defect and fixed with three cancellous 6.5-mm screws. The meniscus was not damaged. Partial weight bearing was permitted at 8 weeks and full weight bearing at 16 weeks after the surgery. At the last follow-up control 10 years after the surgery, no evidence of tibiofemoral arthrosis was present. The allograft-host interface was not visible. The radiodensity of the graft was nearly identical to the host bone. The Lysholm score and clinical findings were identical (100 points) to those 18 months after the surgery. The patient was extremely satisfied without complaints at 30 years of age.

Adult↗

PubMed1999

[Graphical analysis and operative technique of single-cut osteotomy for complex femur deformities].

The correction of complex long bone deformities with concurrent bending, twisting and shortening is primarily based on complex preoperative planning. Up to now, wedge-shaped cortico-spongiose osteotomy has usually been performed. The single cut osteotomy requires more complex mathematical calculations and was therefore less frequently undertaken. In this paper, we present a graphical approach to define the plane of the single-cut osteotomy without any calculations. The resulting osteotomy allows a simultaneous correction of a deformation in the coronal and sagittal planes, as well as a coexisting torsional error. The advantages of this graphical approach are evident. Preoperative planning is significantly simplified and abbreviated as mathematical calculations are no longer needed. Furthermore, the precision by which the osteotomy plane is defined is not decreased by application of this method. However, the osteotomy should be done preoperatively in a model.

Bone Malalignment↗

PubMed2002

[3D-navigated high energy shockwave therapy and axis correction after failed distraction treatment of congenital tibial pseudarthrosis].

The treatment of congenital tibial pseudarthrosis using a distraction procedure as described by Ilizarov is a standard surgical intervention. Nevertheless, there are problems in achieving bony stability in about 10% of cases even after repeated surgery as reported by Lammens et al. (2000). Traub et al. (1999) found a rate of 50% amputations in 33 cases treated since 1927. To prevent an Ilizarov procedure from resulting in a delayed union or nonunion, Paley et al. (1992) recommended autografting immediately after distraction. Based on the good results in the stimulation of osteogenesis in adults, we started to treat delayed bone union following distraction treatment with high-energy shock wave therapy also in children. In patients suffering from congenital tibial pseudarthrosis with a deviation of the bony axis, we combine this surgery-substituting therapy with fixation of a Taylor spatial frame in order to correct the axis. Using this new method of treatment, we were able to achieve stability in four children who previously had had nonunion even after multiple surgical interventions.

Adolescent↗

PubMed2004

[Knee para-articular focal dome osteotomy].

Focal dome osteotomy (FDO) is a cylindrically shaped osteotomy, with corresponding bone cuts rotating around the central axis of the deformity. Thus, complete correction can be achieved without secondary translation. FDO provides high adjustability of the bone ends, optimal bone contact, and high primary stability. As with straight cut closing, neutral, and opening-wedge osteotomies, FDO allows closing, neutral, and opening corrections. Opening FDO allows preservation of bone contact, whereas closing FDO does not require removal of bone stock. The osteotomy can be modified to tighten the medial collateral ligament. A FDO below the tuberosity does not compromise patellofemoral function and reduces the risk of intra-articular fractures. Sufficient bone stock of the proximal tibial or distal femoral fragment allows intramedullary stabilization. FDO is of high value in the treatment of sagittal plane and frontal plane corrections of the knee even in severe deformities.

Bone Malalignment↗

PubMed2004

[Incomplete, supracondylar femur osteotomy. A minimally invasive compression osteosynthesis with soft implant].

The aim of treatment of a valgus deformity and osteoarthrosis of the lateral compartment of the knee is to obtain axial correction of the misalignment of the extremity. Osteosynthesis of the osteotomized femur using internal fixation and a stiff implant has not been as successful as expected. We evaluated the accuracy of correction and the stability of fixation with a malleable plate after supracondylar osteotomy of the distal aspect of the femur that was performed to correct a valgus deformity of the knee. We performed an incomplete oblique closing-wedge osteotomy of the distal aspect of the femur in 32 consecutive patients (34 knees) and stabilized the osteotomy site with a malleable, semitubular plate, which was bent to form an angled plate, and lag screws. Postoperatively, the patients were immediately encouraged to walk, with partial weight bearing on the affected extremity. The mean age of the patients was 52 years, and the mean follow-up period was 4.4 years. In 32 knees, the osteosynthesis withstood the mechanical loading that occurred during the functional rehabilitation program. Due to pain or incorrect weight bearing, splinting was necessary to maintain the integrity of the osteosynthesis in three knees. The osteosynthesis failed in two knees. The mean deviation of the achieved tibiofemoral axis in the healed bone from the intended tibiofemoral axis was less than 2 degrees, and the maximal deviation less than 5 degrees. The Insall score was 21 points higher 4.4 years postoperatively than it had been preoperatively. Our method allows reliable correction of the tibiofemoral axis using intrinsic stability mechanisms to compress the congruently aligned cut ends of the cortical tubes. We believe that our technique provides an alternative to osteosynthesis using of a stiff implant such as a fixed-angle blade-plate device.

Bone Malalignment↗

PubMed2004

[Knee para-articular flexion and extension osteotomies in adults].

The present review analyzes the rare indications for sagittal knee osteotomies either for some complex cases of capsular and ligamentous laxities in combination with or without bony deformities in the sagittal plane. A thorough clinical and radiological analysis of the patients' knees is mandatory. We routinely recommend lateral standing X-rays to assess not only the bony structures, but also an abnormal knee laxity in the sagittal plane. We present different surgical options and preliminary results of these technically demanding procedures.

Bone Malalignment↗

PubMed2004

[Anterior medial correction the tibial tuberosity].

Anteromedialization of the tibial tubercle (Fulkerson operation) predictably leads to pain reduction and better function in initial and moderate patellofemoral arthritis. This has been shown in the literature and is supported by our own results. The indication is based on symptoms, clinical evaluation, X-rays, and MRI. The Fulkerson operation combines recentering of the patella and reduction of patellofemoral pressure. Aftertreatment together with rehabilitation last for 6-8 months because anteromedialization leads to temporary destabilization of the proximal tibia. Proximal tibial fracture is a complication of Fulkerson operation if the tibia is stressed too early.

Adult↗

PubMed2004

[Open wedge osteotomy of the distal femur in the valgus knee].

This review presents a novel technique for open-wedge varus osteotomies of the distal femur in lateral compartment osteoarthritis in valgus knees. Indications and contraindications are discussed. The technique, its potential pitfalls, and postoperative management are presented. The authors' results with this technique are compared to the data of the literature.

Adult↗