Application of corrective calcaneal osteotomy in treatment of malunited calcaneal fractures / 中华创伤骨科杂志

Malunion is a common complication following a calcaneal fracture which was not treated or treated inappropriately.It is a therapeutic target and a great challenge as well to relieve pain, correct deformity and restore the function of the affected foot in clinical treatment of calcaneal malunion. As a result of researches by scholars at home and abroad focusing on the biomechanical mechanisms underlying the symptoms caused by calcaneal malunion, a variety of corrective calcaneal osteotomy has been widely applied in clinical practice to specifically correct the calcaneal deformity and restore normal calcaneal morphology. This review expounds on the techniques, outcomes, indications and complications of corrective calcaneal osteotomies commonly used in clinic.

Measurements of femoral angles, femur length, and hip width in cat radiographs / Medidas dos ângulos femorais, comprimento do fêmur e largura do quadril em radiografias de gatos

Femoral angle, femur length, and hip width were measured in radiographs of 92 intact domestic cats, males and females of mixed breed from the Center for Zoonosis Control of the Federal District. The animals showed no trauma, orthopedic diseases or angular deformities and had closed physeal lines. Accordingly, we measured aLPFA (anatomical lateral proximal femoral angle, aLDFA (anatomical lateral distal femoral angle), mLPFA (mechanical lateral proximal femoral angle), mLDFA (mechanical lateral distal femoral angle), IA (femoral inclination angle), FL (femur length) and HW (hip width) using ventrodorsal radiographs, with both hindlimbs in a single exposure to an X-ray beam centered on the hip. The mean values of the variables were: mLPFA: 82.5±3.62°; aLPFA: 80.1±4.29°; mLDFA: 96.1±3.51° (males) and 97.3±2.05° (females); aLDFA: 94,3±3.43°; IA: 136.6±3.86°; FL: 12.9±0.55cm (males) and 13.4±0.66cm (females); and HW: 3.1cm±0.23 (males) and 3.5±0.26cm (females). These values will serve as a reference for the diagnosis of angular deformities and as support for planning corrective osteotomies in domestic cats.(AU)

Foram realizadas mensurações radiográficas dos ângulos femorais e medidas lineares do quadril e do fêmur em 92 gatos domésticos, machos e fêmeas, SRD, oriundos do Centro de Controle de Zoonoses do Distrito Federal, livres de traumas, doenças ortopédicas e deformidades angulares em membros pélvicos, portadores de linhas fiseais fechadas, não castrados. Para tanto, foram obtidos os ângulos aLPFA (ângulo anatômico lateral proximal do fêmur), aLDFA (ângulo anatômico lateral distal do fêmur), mLPFA (ângulo mecânico lateral proximal do fêmur), mLDFA (ângulo mecânico lateral distal do fêmur), AI (ângulo de inclinação do fêmur), CF (comprimento femoral) e LQ (largura de quadril), empregando radiografias em projeções ventrodorsais, com ambos os membros em uma única exposição ao feixe de raios-X, centrada no quadril. Após a apuração dos resultados, os valores médios obtidos foram: mLPFA: 82,5°±3,62, aLPFA: 80,1°±4,29; mLDFA: 96,1°±3.51 (machos) e 97,3°±2,05 (fêmeas), aLDFA: 94,3,6°±3,43; AI: 136,6°±3,86; CF: 136,6°±3,86; 12,9cm±0,55 (machos) e 13,4cm±0,66 (fêmeas) e LQ: 3,1cm±0,23 (machos) e 3,5cm±0,26 (fêmeas), respectivamente. Esses valores servem como referenciais para diagnósticos de deformidades angulares e apoio para planejamento de osteotomias corretivas em felinos domésticos.(AU)

A Correction of Malunion or Deformity in the Lower Extremity

The incidence of malunion in the long bone with has been reduced because of the advancements in surgical technique. However, nonunion or malunion are still observed in mechanical axis deformation of the lower limb, resulting in the overload of cartilage and instability of the joint, requiring surgical correction. Preoperative planning for malunion is very important, and accurate evaluation of the deformity is essential. Herein, we describe the indications of corrective osteotomy, choice of patients, and various surgical methods for the treatment of malunion of the long bone.

A Correction of Malunion or Deformity in the Lower Extremity

The incidence of malunion in the long bone with has been reduced because of the advancements in surgical technique. However, nonunion or malunion are still observed in mechanical axis deformation of the lower limb, resulting in the overload of cartilage and instability of the joint, requiring surgical correction. Preoperative planning for malunion is very important, and accurate evaluation of the deformity is essential. Herein, we describe the indications of corrective osteotomy, choice of patients, and various surgical methods for the treatment of malunion of the long bone.

New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months follow-up, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months follow-up, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

The Incidence and Management of Dural Tears and Cerebrospinal Fluid Leakage during Corrective Osteotomy for Ankylosing Spondylitis with Kyphotic Deformity

OBJECTIVE: To present the incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy [Pedicle Subtraction Osteotomy (PSO) or Smith-Petersen Osteotomy (SPO)] for ankylosing spondylitis with kyphotic deformity. METHODS: A retrospective study was performed for ankylosing spondylitis patients with fixed sagittal imbalance, who had undergone corrective osteotomy (PSO or SPO) at lumbar level. 87 patients were included in this study. 55 patients underwent PSO, 32 patients underwent SPO. The mean age of the patients at the time of surgery was 41.7 years (21-70 years). Of the 87 patients, 15 patients had intraoperative dural tears. RESULTS: The overall incidence of dural tears was 17.2%. The incidence of dural tears during PSO was 20.0%, SPO was 12.5%. There was significant difference in the incidence of dural tears based on surgical procedures (PSO vs. SPO) (p<0.05). The dural tears ranged in size from 12 to 221 mm2. A nine of 15 patients had the relatively small dural tears, underwent direct repair via watertight closure. The remaining 6 patients had the large dural tears, consequently direct repair was impossible. The large dural tears were repaired with an on-lay graft of muscle, fascia or fat harvested from the adjacent operation site. All patients had a successful repair with no patient requiring reoperation for the cerebrospinal fluid leak. CONCLUSION: The overall incidence of dural tears during PSO or SPO for ankylosing spondylitis with kyphotic deformity was 17.2%. The risk factor of dural tears was complexity of surgery. All dural tears were repaired primarily using direct suture, muscle, fascia or fat graft.

Treatment of Calcaneal Fracture Malunion Using Lateral Exostectomy and Corrective Osteotomy: A Report of Three Cases / 대한족부족관절학회지

Inappropriate treatment for calcaneus fracture may result in malunion causing long-lasting pain and functional deficits. When such complications occur, the ideal principle of management is preserving congruence and motion of adjacent joints. For three patients with calcaneus fracture malunion, subtalar joint-preserving surgery using exostectomy and corrective osteotomy was performed, and satisfactory outcomes were achieved postoperatively.

Pseudoaneurysm after Proximal Metatarsal Osteotomy for Hallux Valgus Correction: A Case Report / 대한족부족관절학회지

Occurrence of pseudoaneurysm in the foot and ankle is rare, and is usually caused by traumatic injury or by iatrogenic intervention. Iatrogenic pseudoaneurysms in the foot and ankle have been observed after rearfoot and ankle fusions, ankle arthroscopy, endoscopic and open plantar fasciotomy, tibial osteotomy with limb lengthening, midfoot amputation, and Lapidus procedure. We report on a patient who developed a pseudoaneurysm of the dorsal metatarsal artery following correction of hallux valgus. The patient underwent proximal chevron osteotomy and Akin phalangeal osteotomy. The feeding artery was ligated and the pseudoaneurysm was excised.

Corrective Tibial Osteotomy in Young Adults Using an Intramedullary Nail

PURPOSE: The purpose of this study was to document results of a less invasive technique of open wedge proximal tibial osteotomy (PTO) for the varus knee in young adults using an intramedullary tibial nail. MATERIALS AND METHODS: We prospectively studied 24 knees in 16 young patients with varus knee deformity. The mean follow-up was 54 months (range, 36 to 107 months) and the mean age of patients at the time of operation was 25.8 years (range, 18 to 40 years). The open wedge PTO was performed below tibial tuberosity using a percutaneous multiple drill-hole technique. Conventional intramedullary tibial nail was used for fixation without bone graft. Radiographic evaluations were made using mechanical alignment (MA), posterior tibial slope angle, and Insall-Salvati ratio. Union time, loss of correction, implant failure, and associated complications were also investigated.

Effect of the Corrective Osteotomy in Ankylosing Spondylitis to Quality of Life(QOL)

STUDY DESIGN: This is retrospective study. OBJECTIVE: We evaluated the radiologic changes and quality of life after corrective osteotomy in kyphotic deformity of ankylosing spondylitis. SUMMARY OF LITERATURE REVIEW: There is few study about that relationship between corrective osteotomy and quality of life. MATERIALS AND METHODS: Retrospective study about 16 patients who underwent corrective osteotomy from 2005 September to 2007 December was done. Radiologic assessments of sagittal balance were performed on the criteria of thoracic kyphosis, lumbar lordosis, distance between the vertical line on midpoint of C7 and posterosuperior point of S1 pre and postoperatively. Disease specific instruments: the Bath ankylosing spondylitis disease activity index (BASDAI) and the Bath ankylosing spondylitis functional index (BASFI) were applied. Clinical assessments were performed with short form-36 through interview and telephone. RESULTS: The mean thoracic kyphosis was changed from 46.1 degrees to 39.3 degrees. The mean lumbar lordosis was corrected from - 7.4 degrees to - 38.4 degrees, and the mean distance between vertical lines of C7 and S1 was improved from 127.1mm to 30mm. There were significant changes in the subgroup of Physical function, Role physical, Vitality, Social function, Role emotional, Mental health. (p<0.05) The changes of BASDAI, BASFI, Bodily pain and General health were not significant. And similar improvements in the radiological results and SF-36 scores were in the 6 patients with Andersson lesion. CONCLUSION: The parameters of radiographic assessment were improved after corrective osteotomy in the fixed kyphotic deformity of ankylosing spondylitis. General function, social function and mental health were also improved.

Bilateral Malunion and Distal Radioulnar Joint Dislocation after Operative Treatment of Bilateral Galeazzi Fractures in Child: A Case Report

Galeazzi fractures in child is rare and seldom necessary of operative treatment because the result of conservative treatment is good. We present the patient who was a 11-year-old male and fell onto his both hands during a hundred-meter dash. His diagnosis was bilateral Galeazzi fractures and limited open reduction and internal fixation with Kirschner pins was initial treatment at local hospital. After 4 weeks postoperatively, Kirschner pins were removed and rehabilitating exercise was started. After 4 months postoperatively, he was transferred to our hospital due to malunion with severe angular deformities and distal radioulnar joint (DRUJ) dislocation. He was treated with corrective osteotomy. Thus, as in this case, we suggest more careful treatment and observation if conservative method of Galeazzi fracture in child is chosen and consider operative method as treatment according to age and pattern of fracture.

One-stage Corrective Osteotomy for Malunion of Distal Radius Fracture using an Iliac Bone Graft / 대한정형외과학회잡지

PURPOSE: One-stage corrective osteotomy of a symptomatic malunion of a distal radius fracture, is not easy because of the contracture of surrounding soft tissues. We have treated these malunions by a one-stage corrective osteotomy procedure that uses an intraoperative gradual distraction method of the osteotomy site. We have analysed the clinical and radiological results of our procedure, retrospectively. MATERIALS AND METHODS: We have operated on 7 wrists of 7 patients who had malunion of a distal radius fracture who complained of both wrist pain and functional impairment. The distal radius was osteotomized and distracted gradually for 20 to 30 minutes using a lamina spreader. Then the gap was filled with a pre-designed iliac bone graft. The results were analysed functionally using the Cooney's wrist score, cosmetically using Ladd's method, and radiologically using Kreder's method. RESULTS: The Cooney's wrist score improved from an average 44 preoperatively to 91 at the latest follow-up. The clinical results were excellent in 4 patients, good in 2 patients and fair in one patient. CONCLUSION: A one-stage corrective osteotomy with iliac bone graft using a laminar spreader is followed by creep phenomenon is an useful method for the treatment of the malunion of distal radius fracture.

Clinical Results after Corrective Osteotomy of the Kyphotic Deformity in Ankylosing Spondylitis / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of clinical results through questionnaire based instrument and radiologic changes after correction in ankylosing spondylitis. OBJECTIVES: To evaluate the radiographic changes and verify the clinical results of the extension osteotomy through pedicular subtraction and intracorporal decancellization in patients with ankylosing spondylitis who have severely fixed kyphotic deformity. MATERIALS AND METHODS: Total 45 patients were included in this study. In all cases, the deformity was corrected by a onestage pedicle subtraction extension osteotomy. Radiographic assessment for sagittal balance was performed on the criteria of thoracic kyphosis, lumbar lordosis, distance between the vertical line on anterosuperior point of T1 and that of S1 and sacrohorizontal angle. Finally clinical assessment for function, indoor activity, outdoor activity, psychosocial activity, pain and overall subjective satisfaction on the basis of patients' satisfaction(5 grade) were performed. RESULTS: The osteotomy was performed at single level in 43 cases, double levels in 2 cases. The mean follow-up was 36.2 months. The criteriae of radiographic assessment were changed on preoperative, postoperative 3 months and the last follow-up as follows; thoracic kyphosis: 50, 51 and 54 degrees, lumbar lordosis: 10, 46 and 44 degrees, distance between vertical lines of T1 and S1: 94, 15 and 8 mm, sacral inclination: 8, 28 and 24 degrees. At the last follow-up, clinical results were high as 3.2 in function, 2.8 in indoor activity, 3.3 in outdoor activity, 3.3 in psychosocial activity, 3.4 in pain and 3.2 in overall subjective satisfaction. There was no any serious complication, such as death or permanent neurologic deficit. CONCLUSIONS: Nearly all the patients have maintained good correction. Eighty five percent of patients have revealed self-satisfaction to corrective osteotomy. But in connection with the clinical results, the changes of parameters of radiographic assessment didn't revealed any significant correlation and so it should be traced much longer with care.

Effects of Three Dimensional Corrective Osteotomy in Cubitus Varus of Adults / 대한정형외과학회잡지

Cubitus varus is a complex three-dimentsional deformity. In addition to deformity on varus-valgus plane, internal torsion of distal humerus is frequently combined. Also limitation of flexion-extension could be associated in some patients. Surgical correction of the cubitus varus after skeletal maturity, could have some different clinical course from those of growing children. However there have been few papers dealing with the surgical treatment of cubitus varus in adults. From May 1988 to December 1993, 23 patients who were older than 17 years of age, had correc- tive osteotomy for cubitus varus considering its three planes of the deformity at Seoul National University Hospital. To prevent serpentine deformity medial displacement of distal fragment was also combined during operation. The avereage age was 26 years(17-47), and the average follow-up after the operation was 1 year and 6 months(6 months-3 years). The presumed diagnosis of initial injury deduced from history and preoperative radiograms, was supracondylar fracture in 19 cases(86.4%). Others were lateral condylar fracture of humerus in two, and fractures associated with elbow dislocation in two. The average age at the time of initial injury was 8 years(2-14), and average delay from occurrence of deformity to the operation, were 13 years. Tardy ulnar nerve palsy was associated in 3 cases(13.6%). The preoperative average angle of cubitus varus was 26 degrees(16-45), flexion contracture 11 degrees(-5

Surgical Treatment in Congenital Ulnar Drift of Fingers / 대한정형외과학회잡지

The Congenital Ulnar Drift of the fingers is a relatively uncommon and has symmetrical malformations of hand, face and foot characterized by MP joint flexion contracture and ulnarward deviation of the fingers and microstomia, In tarsal deformity, there are clubfoot and congenital vertical talus with rocker bottom deformity. In treatment, the report of the surgical treatment was rare. We experienced congenital ulnar drift of fingers in 2 patients in one family, which were treated by dome resection corrective osteotomy of the metacarpals. Therefore remarkable symptomatic improvement was obtained.

“V” Shape Corrective Osteotomy of the Long Bone / 대한정형외과학회잡지

French method of wedge osteotomy has been widely used to correct the cubitus varus deformity, but it is difficult to correct the rotational deformity, gunstock deformity effectively and to fix the distal fragment rigidly because the supracondylar area of the humerus has an anatomical characteristic of short distance in A-P plane. We can design a new method of “V” shape osteotomy to correct the cubitus varus and apply this method to the deformities of the tibia and femur. Ten cases of “V” shape corrective osteotomy were performed in the Department of orthopedic Surgery, Kyung Hee University. Of these, 5 cases were cubitus varus deformities, 3 cases were deformities of tibia and 2 cases were deformities of femur. The results were obtained as follows. 1. The cubitus varus and gunstock deformities are corrected effectively without unnecessary bony loss. 2. The rotational deformity can be corrected in stable position due to the “V” shape contact surface. 3. The contact area is so wide and oblique that it may be ease to manage the distal fragment and we may expect good union process with early ROM exercise due to rigid fixation. 4. Additional change of the corrective angle can be possible. 5. This method is also effective for the correction of the deformity caused by partial epiphyseal closure of the long boen, using partial open wedge osteotomy.