Ilizarov Treatment of Congenital Pseudarthrosis of the Tibia: A Multi-Targeted Approach Using the Ilizarov Technique

Congenital pseudarthrosis of the tibia (CPT) is one of the most challenging problems in pediatric orthopaedics. The treatment goals are osteosynthesis, stabilization of the ankle mortise by fibular stabilization, and lower limb-length equalization. Each of these goals is difficult to accomplish but regardless of the surgical options, the basic biological considerations are the same: pseudarthrosis resection, biological bone bridging of the defect by stable fixation, and the correction of any angular deformity. The Ilizarov method is certainly valuable for the treatment of CPT because it can address not only pseudarthrosis but also all complex deformities associated with this condition. Leg-length discrepancy can be managed by proximal tibial lengthening using distraction osteogenesis combined with or without contralateral epiphysiodesis. However, treatment of CPT is fraught with complications due to the complex nature of the disease, and failure is common. Residual challenges, such as refracture, growth disturbance, and poor foot and ankle function with stiffness, are frequent and perplexing. Refracture is the most common and serious complication after primary healing and might result in the re-establishment of pseudarthrosis. Therefore, an effective, safe and practical treatment method that minimizes the residual challenges after healing and accomplishes the multiple goals of treatment is needed. This review describes a multi-targeted approach for tackling these challenges, which utilizes the Ilizarov technique in atrophic-type CPT.

Posterior Lumbar Interbody Fusion Using New Hydroxyapatite Block: Comparison with Metal and PEEK Cages / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVES: This study compared the clinical outcomes of posterior lumbar interbody fusion (PLIF) using hydroxyapatite blocks with PLIF using a metal or poly-ether-ether-ketone (PEEK) cage. SUMMARY OF THE LITERATURE REVIEW: There are few reports on the clinical outcomes of PLIF using a hydroxyapatite block for treating lumbar degenerative disease. MATERIALS AND METHODS: The 27 PLIF cases (62 units, HA block) that were followed up for 1-year were compared with 13 cases using a metal cage and 13 cases using a PEEK cage. Pedicle screw fixation was performed for all the cases. If the local bone is deficient, then an additional bone graft with autogeous iliac bone or bone substitute was used. The visual analog scale(VAS) for low back pain and radiating pain, the Oswestry disability index (ODI), the intervertebral height and the halo sign around the cages and pedicle screws were comparatively analyzed. RESULTS: The mean VAS score for low back pain before PLIF and using the HA block, the metal cage and the PEEK cage was 7.5, 8.3 and 6.2, respectively, and this was 3.3, 2.9 and 4.8 after PLIF (P0.05, One-way ANOVA). CONCLUSION: PLIF using a HA block showed improvements, including the back pain, and the ODI was satisfactory and this didn't fall below those ODIs of using metal or PEEK cages. Although a HA block may have higher tendency to break, there was no breakage at the 1-year follow up.

Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus Deformity in Patients Aged 50 or Older / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the clinical and radiological results of distal chevron osteotomy in patients aged 50 and older with moderate-to-severe hallux valgus. MATERIALS AND METHODS: The authors reviewed the medical records and radiographs of 19 patients (26 feet). Average age at time of surgery was 58 years and the mean follow-up period was 3 years and 1 month. For radiological evaluation, we analyzed changes in hallux valgus angles and 1st-2nd intermetatarsal angles after index operations. Clinical results were assessed with respect to pain, activities of daily living, and shoe-wear. RESULTS: Hallux valgus angles and 1st-2nd intermetatarsal angles improved, but considerable correction loss occurred with time. This correction loss was found to be significantly correlated with preoperative subluxation of the 1st metatarsophalangeal joint and the 1st-2nd intermetatarsal angle. Clinically, remarkable improvements were achieved in terms of pain and level of activity, but most patients (except 4) still wore comfortable shoes rather than hard shoes at latest follow-ups. CONCLUSION: Distal chevron osteotomy is beneficial for patients aged 50 and older with moderate-to- severe hallux valgus deformity, but correction loss may occur in patients with marked subluxation of the 1st metatarsophalangeal joint or a severe 1st-2nd intermetatarsal angle.