Evaluation of tenotomy in the hip subluxation treatment of children with zika syndrome / Avaliação da tenotomia no tratamento da subluxação do quadril de crianças com zika

ABSTRACT Objectives: Evaluate the efficacy and effects of releasing the muscles of subluxated hips of patients with SCZ. Methods: This is a retrospective study with 29 patients with subluxation of the hip, corresponding to 55 hips operated in a public hospital in Recife, Brazil. Preoperative femoral head migration (PM) percentages were evaluated and compared with 6- and 12-month postoperative results. Results: Twenty-nine patients were eligible, representing 55 hips evaluated. 19 were female (65.5%), with a mean age of 31.45 months (ranging from 23 to 42 years). 19 patients were GMFCS level V (65.5%), 34.5% were level IV, and 20 of the 29 patients (69%) had no complications. The PM had an absolute reduction of 11.6% (GMFCS IV) and 13.31% (GMFCS V) in the first six months. After 12 months, there was a regression of MP of 7.14% (GMFCS V) and 11.25% (GMFCS IV) compared to preoperative values, with no significant statistical difference among MP values presented between 6 and 12 months after surgery. Conclusions: The surgery was effective in PM regression during the analyzed period and presented a low complication rate. Level of Evidence III; Comparative retrospective study.

RESUMO Objetivos: Avaliar a eficácia e os efeitos da liberação das musculaturas de quadris subluxados de pacientes com SCZ. Métodos: Trata-se de um estudo do tipo retrospectivo com 29 pacientes CZS com subluxação do quadril, correspondendo a 55 quadris operados em um hospital público de Recife, Brasil. Foram avaliados os percentuais migratórios da cabeça femoral (PM) no pré-operatório e comparados com os resultados pós-operatórios de 6 e 12 meses. Resultados: Foram elegíveis 29 pacientes, representando 55 quadris avaliados. 19 eram do sexo feminino (65,5%), com média de idade de 31,45 meses (variando de 23 a 42 anos). 19 pacientes eram GMFCS nível V (65,5%), 34,5% eram nível IV e 20 dos 29 pacientes (69%) não apresentaram complicações. O PM teve redução absoluta de 11,6% (GMFCS IV) e de 13,31% (GMFCS V), nos primeiros seis meses. Após 12 meses, houve regressão do PM de 7,14% (GMFCS V) e de 11,25% (GMFCS IV) em relação aos valores pré-operatórios, sem diferença estatística entre os valores do PM apresentados entre 6 e 12 meses da cirurgia. Conclusões: A cirurgia foi eficaz em regredir o PM no período analisado e apresentou uma baixa taxa de complicações. Nível de Evidência III; Estudo retrospectivo comparativo.

Scarf osteotomy combined with soft tissue balance release for severe hallux valgus / 中国骨伤

OBJECTIVE@#To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus.@*METHODS@#Totally 38 patients(50 feet) with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed, aged from 29 to 64 years old with an average of(54.7±6.8) years old; 26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of (12.4±3.9) years. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and after operation, and postoperative complications was observed. American orthopedic foot ankle society(AOFAS) score before operation and final follow-up was used to evaluate recovery of forefoot function, and visual analogue scale (VAS) was used to evaluate pain relief.@*RESULTS@#Thirty-eight patients (50 feet) were followed up from 15 to 23 months with an average of (18.3±3.2) months. Preoperative HVA, IMA and DMAA were (44.61±3.92)°, (18.74±2.51)°, (12.85±2.11)°, and improved to (13.45±2.13)°, (7.83±1.36)°, (7.03±1.39)°at final follow-up, which had statistical differneces(P<0.05). No delayed union or nonunion of osteotomy end, fracture or loosening of internal fixation, hallux varus occurred. VAS and AOFAS score improved from (6.81±2.14), (43.6±8.4)points before operation to (1.97±0.78), (87.6±5.2) points at final follow-up, which had statistical difference(P<0.01). According to AOFAS at final follow-up, 20 feet got excellent result, 28 feet good and 2 feet moderate.@*CONCLUSION@#Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect, but learning curve and postoperative complications should be paid attention.

Comparative Study Of Surgical Correction Of Congenital Talipes Equino Varus Deformity With And Without Internal Fixation (using K-wires)

Congenital Talipes Equino Varus is one of the most common congenital deformity which occurs in 1/1000 live birth worldwide. Regarding management of this clubfoot ,most orthopaedic surgeons agree that approach management of children with congenital talipes equino varus deformity of foot should begin with conservative measures i.e, manipulation and serial casting in position of correction. One or more surgical procedures are often required in patients who had incomplete correction , recurrent deformity , syndromic correction and after repeated manipulation and casts. Recurrence is a common problem following the club foot surgery one of the reason for recurrence can be redisplacement of tarsal bones .This study aims to compare prospectively the functional and cosmetic outcome of two groups of club foot-one in whom tarsal joint were fixed with k-wires after doing posteromedial soft tissue release and one in whom tarsal joint were not fixed after soft tissue release .To know the incidence of congenital talipes equino varus with respect to age and sex predilection over a period of two years which were admitted between October 2017 to October 2019, 28 idiopathic club foot in 20 children range from 4 months to 3 years were treated out of 20 cases 12 were males,8 were females.8 patients had bilateral deformity out of 12 unilateral deformities 8 were on right side and 4 were on the left side. Male and female ratio 1.5:1 and unilateral to bilateral 1.5 :1.In 12 feet turco's posteromedial soft tissue release and internal fixation of tarsal joints with k-wires was done in 16 feet only turco's posteromedial soft tissue release was done. The period of follow up ranges from 6 months to 2 years

Treatment of rigid congenital clubfoot with Ilizarov technique in older children / 中国修复重建外科杂志

Objective: To investigate the effectiveness of Ilizarov technique in treatment of rigid congenital clubfoot in older children. Methods: A clinical data of 55 patients (69 feet) with rigid congenital clubfoot (Diméglio grade Ⅳ) between September 2005 and September 2015 were retrospectively analyzed. There were 33 boys and 22 girls with an average age of 11 years (range, 6-14 years). There were 41 cases of unilateral clubfoot and 14 cases of bilateral clubfeet. The degree of foot deformity was rated as fair in 24 feet and as poor in 45 feet according to International Clubfoot Study Group (ICFSG) score before operation. Sixty-nine feet were treated by Ilizarov external fixator combined with limited soft tissue release, and 21 feet were combined with individualized V-shaped osteotomies. Results: All patients were followed up 2-10 years ( mean, 4.2 years). The incisions healed well after operation. Five cases of needle tract infection occurred and were cured by local dressing change. The effectiveness was excellent in 39 feet, good in 21 feet, and fair in 9 feet according to ICFSG score, with the excellent and good rate of 87.0%. During the follow-up, X-ray films showed that no blood supply disorder or necrosis of talus, scaphoid, cuneiform, metatarsal, calcaneus, and cuboid occurred. No osteomyelitis occurred. Conclusion: Ilizarov technique combined with limited soft tissue release or V-shaped osteotomy for the older children with rigid congenital clubfeet is safe and can obtain significant orthopedic effectiveness.

Total hip arthroplasty with soft tissue release for patients with severe development dysplasia of the hip / 中南大学学报(医学版)

Objective:To explore the clinical effect of total hip replacement with soft tissue release and true acetabulum reconstruction on treating osteoarthritis secondary to severe development dysplasia of the hip.Methods:From January 2005 to January 2011,23 hips in 21 patients with osteoarthritis secondary to Crowe Ⅲ development dysplasia of the hip underwent total hip arthroplasty with soft tissue release and true acetabulum reconstruction.There were 18 females and 3 males.The age was (45.1±13.2) years.Two patients underwent bilateral total hip arthroplasty (THA) and 19 cases underwent unilateral hip.The Harris hip score was 39.7±5.6.Results:The duration of follow up was (110±46) months.The symptoms of patients were relieved,and all the patients' femur head recovered to the true acetabulum after soft tissue released.Sciatic nerve paralysis occurred in one patient,who recovered after 3 months.All patients showed restoration of limb length,while the limb-length discrepancy was (11.0±3.5) mm.The postoperation Harris hip score was 87.2±5.9.Conclusion:Total hip arthroplasty with soft tissue release and true acetabulum reconstruction was an effective method in treating osteoarthritis secondary to Crowe Ⅲ development dysplasia of the hip and was a challenging work to the orthopedic surgeon.It was critical the surgeon to plan the operative intervention carefully.

Soft-tissue release for hip subluxation and dislocation in cerebral palsy / Journal of Rural Medicine

<p><b>Objective:</b> This study aimed to evaluate the effectiveness of soft-tissue release on hip subluxation and dislocation in cerebral palsy as well as activities of daily living after surgery.</p><p><b>Patients and Methods:</b> Soft-tissue release was performed in 13 patients (19 hips) with cerebral palsy. Of them, 10 had spastic quadriplegia and three had spastic diplegia. Mean ages were 8.6 years at surgery and 13.8 years at the last investigation. The mean follow-up period was 5.2 years. Hip subluxation and dislocation severities were analyzed before and after surgery and at the final investigation as migration percentage on radiographs. Postoperative activities of daily living were also evaluated in 12 patients.</p><p><b>Results:</b> Seven hips classified as mild and moderate preoperatively were classified as good, mild, and moderate at the last investigation. Nine of 12 hips classified as severe preoperatively continued to be severe at the last investigation. However, three of 12 hips classified as severe preoperatively improved at the last investigation. There was a positive correlation between preoperative migration percentage and that at the last investigation. Daily activities improved postoperatively in 12 patients.</p><p><b>Conclusions:</b> Early treatment is necessary to prevent hip dislocation and improve hip subluxation. However, several patients with severe subluxation might experience improvement with soft-tissue release alone. Soft-tissue release is effective for treating hip dislocation and subluxation in cerebral palsy and improving daily activities.</p>

Tratamiento quirúrgico del Hallux Valgus moderado y severo: osteotomía metatarsiana proximal y liberación distal de partes blandas / Surgical Treatment of Moderate to Severe Hallux Valgus: Proximal Metatarsal Osteotomy and Distal Soft Tissue Release

Objetivo: evaluar los resultados clínicos y radiológicos obtenidos con la combinación de la osteotomía proximal del primer metatarsiano y la liberación distal de las partes blandas según técnica de Mann-Coughlin en el tratamiento del hallux valgus moderado y severo. Métodos: estudio retrospectivo en 16 pacientes (30 pies) con hallux valgus moderados y severo, operados en dos Centros Diagnóstico Integral del Estado Apure, en la República Bolivariana de Venezuela, todos por el mismo cirujano, en el período comprendido desde marzo 2009 hasta diciembre 2012. Solo 4 pacientes no continuaron en el seguimiento. Se evaluaron los resultados clínicos y radiográficos. Resultados: se encontró una mejoría promedio de 87,5 puntos según la Escala de la Sociedad Americana de Ortopédicos de Tobillo y Pie (AOFAS por sus siglas en inglés). El ángulo del hallux valgus mejoró de 34,8° promedio a 16,6° y el ángulo intermetatarsiano mejoró de 16,2° a 8,8° después de la cirugía. No hubo hallux varus y solo 2 pacientes tuvieron deshicencia de la herida quirúrgica y un paciente aflojamiento de la aguja Kirschner. Conclusiones: la osteotomía proximal del primer metatarsiano combinada con la liberación distal de partes blandas es una buena opción para la corrección quirúrgica en el tratamiento del hallux valgus moderado y severo, es sencilla para reproducir y presenta similares complicaciones que otras técnicas(AU)

Objective: Evaluate clinical and radiological results obtained with the combination of the first metatarsal osteotomy proximal and distal soft release according Mann-Coughlin technique in the treatment of moderate to severe hallux valgus parts. Methods: A retrospective study was conducted on 16 patients (30 feet) with hallux moderate and severe valgus. They underwent surgery at two Comprehensive Diagnostic Centers in Apure State, in the Bolivarian Republic of Venezuela, by the same surgeon from March 2009 to December 2012. Only four patients did not continue to follow up. Clinical and radiographic results were evaluated. Results: an average of 87.5 points improvement was found according to the scale of the American Society of Orthopaedic Foot and Ankle (AOFAS for its acronym in English). The hallux valgus angle improved from 34.8° to 16.6° and average intermetatarsal angle improved from 16.2° to 8.8° after surgery. There were no hallux varus. Only two patients had dehiscence of the surgical wound, and a patient had loosening of the Kirschner needle. Conclusions: the proximal osteotomy of the first metatarsal combined with distal soft tissue release is a good choice for surgical correction in the treatment of moderate to severe hallux valgus, it is easy to reproduce and it has similar complications than other techniques(AU)

Soft Tissue Balancing of Varus Arthritic Knee in Minimally Invasive Surgery Total Knee Arthroplasty: Comparison between Posterior Oblique Ligament Release and Superficial MCL Release

PURPOSE: To assess proper soft tissue balancing of the varus arthritic knee between posterior oblique ligament (POL) release group and superficial medial collateral ligament (SMCL) release group. MATERIALS AND METHODS: This retrospective study was performed on 186 patients who underwent minimally invasive surgery (MIS) total knee arthroplasty (TKA) from January 2011 to December 2011. Eighty-three patients were in the group of SMCL release and 103 patients were in the POL release group. We intended to use a 10 mm polyethylene insert (PE) during TKA, and retrospectively compared the actual thickness of PE between POL release group and SMCL release group. RESULTS: The mean PE thickness was 10.59+/-1.3 mm (range, 8 to 15 mm) in POL group and 11.88+/-1.8 mm (range, 10 to 18 mm) in SMCL group (p=0.001). We found a significant difference in the mean PE thickness between POL release group and SMCL release group. CONCLUSIONS: POL and deep MCL releases in MIS-TKA would be beneficial for varus deformity correction in the osteoarthritic knee.

Treatment of Calcaneovalgus Deformity Following Operative Treatment of Diplegic Equinovarus Deformity in Cerebral Palsy Patient: A Case Report / 대한족부족관절학회지

Calcaneal or calcaneovalgus deformity can occur after surgical treatment of equinus or eguinovarus deformity in cerebral palsy patient. It is a serious complication and the results of many conservative and operative treatments are reported unsatisfactory. We experienced one case of both calcaneovalgus deformity following operative treatment of diplegic equinovarus deformity in a spastic cerebral palsy patient and report about the result of the treatment.

The Results of Distal Chevron Osteotomy with Lateral Soft Tissue Release for Hallux Valgus Deformity / 대한족부족관절학회지

PURPOSE: To evaluate the results and effectiveness of distal chevron osteotomy combined with lateral soft tissue release for the correction of hallux valgus deformity. MATERIALS AND METHODS: 31 patients who underwent distal chevron osteotomy with lateral soft tissue release between July 2002 and June 2003, were analyzed in terms of hallux valgus angle, intermetatarsal angle, subluxation of sesamoid, AOFAS score and the occurrence of avascular necrosis of the first metatarsal head. RESULTS: The mean amount of the correction of hallux valgus angle was 26.3 degrees . The mean amount of the correction of intermetatarsal angle was 6.6 degrees. The mean amount of the correction of sesamoid subluxation was 1.2 points. The mean improvement of AOFAS score was 25.8 points. Avascular necrosis of the first metatarsal head was not found in any cases. CONCLUSION: For correction of hallux valgus deformity, distal chevron osteotomy with lateral soft tissue release showed improvement of hallux valgus angle, sesamoid subluxation and AOFAS score with no evidence of avascular necrosis of the first metatarsal head.

Effect of Both Limited Selective Posterior Rhizotomy and Limited Selective Soft Tissue Release Treating Spasmo-Cerebral Palsy in Both Legs / 实用儿科临床杂志

Objective To analyze the effect of both limited selective posterior rhizotomy(LSPR)and limited selective soft tissue release(LSTR)on healing motor function related to spasmo-cerebral palsy in both legs.Methods Thirty-eight cases CP with LSPR and LSTR were collected in the past 3 years;21 males,17 females;aged 3.0-8.11 years old,on the average of 5.11 years old.Perioperative motor function were evaluated according to motor function scores.Results LSPR and LSTR played a role in improving motor function obviously,and had little difference in orthomorphia after SPR for 6 months.Conclusion LSPR and LSTR may improve cramp and abnormality in both legs,and enhance motor function,so the secondary operation agony can be avoided,and the family economic burden relived.

Significance of Soft Tissue Release in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

Legg-Calve-Perthes disease is a hip disorder of undetermined etiology, occurring in children and characterized by necrosis and repair of the proximal femoral epiphysis. Many methods of the treatment were reported with good result and the goals of them were prevention of deformity of femoral head and secondary osteoarthritis of femoral head with concept of containment. The purpose of this study is to determine the significance of soft tissue release operation in patient of Legg-Calve-Perthes disease, whose prognosis will be poor by clinical and rsdiological evaluation at diagnosis. Soft tissue release operation was carried out 21 hips of 19 patients of Legg-Calve-Perthes disease at Severance Hospital from January 1986 to October 1987 and satisfactory result was obtained. We consider our method as new, effective treatment modality and its significance is to reduce abnormal pressure to femoral head, to restore normal range of motion, to avoid recurrent ischemia, and, finally, to avoid progression of deformity by soft tissue release operation.