Improving the Accuracy of Corrective Osteotomy for Congenital Radio Ulnar Synostosis using the Axis of Rotation of the Forearm as a Guide

@#Introduction: Despite several techniques for corrective osteotomy in congenital radioulnar synostosis (CRUS) the published literature lacks a guide for radiographic planning and rationale for the site and level of the osteotomy. The primary objective of this study is to report a technique of radiographically controlled corrective osteotomy using the axis of rotation of the forearm in CRUS. Materials and methods: Children with CRUS underwent corrective osteotomy based on radiographic planning; the extent of rotational correction and functional outcomes were assessed at a mean of 27 months after the operation. Results: Seven forearms in six children of an average of 6.25 years were assessed for correction and functional outcomes. The average pre-operative pronation deformity was 71.5°. The average correction achieved was 64°. At follow-up, there were five excellent and two good functional outcomes. All children could perform daily tasks besides eating with hand and personal hygiene. Conclusion: Radiographic determination of the osteotomy sites by the method described is effective, consistent, and reproducible in achieving optimal functional outcomes in congenital radioulnar synostosis.

Angulo Q extendido: un nuevo signo clínico para decidir técnica de realineación distal de aparato extensor / Extended Q angle: a new sign for the physical exam for deciding distal realignement

Los trastornos patelofemorales son una de las causas más frecuentes de consulta en ortopedia, y múltiples son los factores etiológicos descriptos en la fisiopatogenia. Un examen físico completo es imprescindible para detectar él o los factores influyentes en cada paciente para realizar un tratamiento “a la carta”. En la bibliografía se suele considerar a la realineación distal del aparato extensor como sinónimo de transposición de la TAT, sin embargo este concepto no contempla el factor rotacional generador de grandes fuerzas desestabilizantes en esta articulación. En este trabajo se describe un signo semiológico muy útil para decidir la realineación distal del aparato extensor, donde se agrega un vector más al ángulo Q clásico, desde el polo inferior de la rótula y paralelo a la diáfisis tibial y su relación con la posición del pie. Este signo se mide con rodilla en 30° de flexión, rótulas al cenit. Se describen 2 tipos de ángulo Q aumentado, contemplando la posición del pie que es fundamental para detectar trastorno rotacional con intrarotación de rodilla durante la marcha. También se describe y fundamenta la necesidad de diferenciar los 2 tipos de ángulo Q extendido para un tratamiento de realineación distal que respeta la biomecánica patelofemoral.

Patellofemoral problems are one of the most common cause of consult in orthopaedic practice. Multiple etiologic factors have been described in the genesis of the pathology. A complete physical exam is very important for the detection of factors that affect each patient, so that we can make a “a la carte” treatment. In the literature the distal realignement is consider as sinonym of transfer of the tibial tuberosity, but this concept not consider the rotational influence that generate grate forces at the articulation. Here we describe a new sign for the physical exam, useful for deciding distal realignement, where we add and other vector from the distal pole of the patella and paralel to the tibial diafisis and the relantionship with the foot. The sign must be taken in 30° of knee flexion, patellas facing straight to the cenit . We find that there is two types of extended Q angles considering the position of the foot and the presence of a rotational problem wich produce an inward knee. We describe the importance of different type of treatment for each extended Q angles in distal realignement procedures considering more physiological and anatomic treatment for patellofemoral problems.

Bilateral Femoral Derotatioal Osteotomy in Spastic Diplegia: Outcome Assessment of Single Stage Multilevel Surgery / 대한정형외과학회잡지

PURPOSE: To evaluate the outcome of multilevel surgery including femoral derotational osteotomy, and analyze the effect of bilateral femoral derotational osteotomy on the gait of spastic diplegia. MATERIALS AND METHODS: The medical records of 26 spastic diplegics, who had undergone a bilateral intertrochanteric femoral derotational osteotomy, bilateral distal hamstring lengthening, bilateral rectus femoris transfer, and bilateral heel cord lengthening, were evaluated. There were 16 boys and 10 girls with a mean age of 7.6 years. The pre- and post-operative gait analysis, functional assessment score, and physical examination were archived and analyzed. RESULTS: In the physical examination, the femoral anteversion, hip flexion contracture, and popliteal angle decreased significantly, while the ankle range of dorsiflexion increased significantly. In three dimensional gait analysis, the cadence remained constant while the walking speed improved significantly. In transverse plane kinematics, the mean pelvic rotation did not show any difference but foot progression angle fell into the normal range after surgery. In the sagittal plane, the maximal hip extension and H3 power generation improved significantly, while the mean anterior pelvic tilt decreased significantly. The functional assessment score improved from 7 to 9, which was significant. CONCLUSION: The walking ability of spastic diplegia with in-toeing, stiff knee and tip toeing gait improved after single stage multilevel surgery including a femoral derotational osteotomy. Femoral derotation osteotomy without psoas lengthening improved the anterior pelvic tilt despite the distal hamstring lengthening

Derotational Osteotomy and External Fixation for Increased Femoral Anteversion / 대한정형외과학회잡지

PURPOSE: To describe a method of femoral derotational osteotomy using an external fixator. MATERIALS AND METHODS: A retrospective review was conducted of 6 patients with 12 femora treated by derotational osteotomy with a semicircular modified Ilizarov external fixator and Schanz screws. The mean follow-up period was 17 months (in the range 12-28 months). There were two boys and four girls of mean age 11 years (in the range 10 to 13 years). The deformities were all idiopathic and there was no combined disease. Mean preoperative femoral anteversion was 38 degrees (in the range 31-50 degrees) and mean internal and external hip rotation were 76 degrees (in the range 70-85 degrees) and 23 degrees (in the range 20-30 degrees), respectively. RESULTS: After operation, the mean internal rotation at the hip diminished to 47 degrees (in the range 40-50 degrees) and the mean external rotation increased to 52 degrees (in the range 45-55 degrees). In all cases, the mean varus angle 6 degrees (3-9 degrees) was made with conical washers on the osteotomy site to correct combined genu valgum. Mean clutch ambulation was started at 5 days postoperatively. The Ilizarov external fixator was removed at a mean 9 weeks after the operation and there was no refracture. No significant complication occured in any cases excepting 3 cases of superficial pin tract infection. CONCLUSION: Femoral derotational osteotomy using a semicircular modified Ilizarov external fixator with Schanz screws has the advantages of simplicity, an exact correction of deformity, early ambulation, and the freedom to alter the alignment postoperatively.