[ results of high tibial open wedge osteotomy in patients with varus deformity]

High tibial open wedg osteotomy is one of the most important modality for treatment of varus deformity in order to correct deformity and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with varus deformities. This retrospective study conducted on twenty nine patients [36 knees] undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from2004 to 2010. Inclusion criteria were: age less than 60 years, high physical activity, varus deformity and involvement of medical compartment of knee. Patients with obesity, smoking, patelofemoral pain, lateral compartment lesion, deformity degree more than20 degree, extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation. Fourteen patients were females. All of them were younger than 50 years, with mean [ +/- SD] 27.64 [ +/- 10.88]. The mean [ +/- SD] of follow up time was 4.33 [ +/- 1.7]. All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graft were used, in15 cases [42.5%] casting and in the rest T. Buttress plate were used for fixation of fractures. In both groups of primary and double varus the International knee documentation committee [IKDC] and modified Larson indices were improved after operation, but there was no significant difference between two groups. High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the deformity and improves the radiologic parameters of the patients.

[Assessment of clinical and radiologic manifestations of Larsen syndrome]

Larsen syndrome has complex clinical manifestations accompanying different congenital joint dislocations. Therefore, early diagnosis, correct treatment and prevention of complications are essential. This study was performed on 10 cases of Larsen syndrome and their clinical / radiological aspects were assessed. In our review, there were 6 male [cases 1 to 6] and 4 female patients. The youngest and oldest patients at the time of referral were 3 and 51 years old, respectively. An interesting aspect is that hypertelorism and nose widening were detected in all cases. In spine, six patients had Spina bifida, whereas hip dislocation was also detected in eight cases. The significant points were high riding DDH in a 46- year old female patient and bilateral femoral head subluxation in a 51- year old male patient. Knee dislocation was seen in 9 patients. The above two cases had neglected knee dislocation, but acceptable knee function was reported. In upper extremities of eight patients, radial head posterior dislocation was seen. A 5- year old male patient had distal humerus physical deformity. All patients had 2nd metacarpal base deformity [double epiphysis in 2nd metacarpal bone]. Concerning multiple joints involvement in the syndrome, accurate physical examination is essential. Prioritization and staged management of the involvements is recommended.