Bridge plating for simple tibial fractures treated by minimally invasive plate osteosynthesis / [Estabilização em ponte de fraturas tibiais simples por osteossíntese minimamente invasiva com placa]

This study aimed to evaluate the effectiveness of bridge plating of simple tibial fractures in dogs by minimally invasive plate osteosynthesis (MIPO). Medical and radiographic records of twenty-nine dogs with simple tibial fractures that underwent bridge fixation by MIPO were retrospectively evaluated. The clinical outcome was classified considering the presence of lameness at the end of the treatment. The tibial mechanical joint angles were measured and compared with the values described in the literature. Additionally, fragment apposition and implant disposition were evaluated. Based on the modified Radiographic Union Scale for Tibial fractures, the moment of clinical union was determined. Clinically, at the end of treatment, only one patient presented lameness at a trot. While there was no significant difference between the bone alignment in the frontal plane values and the values described in the literature (P>0.05), the caudal proximal tibial angle was significantly higher (P=0.001). The median fragment apposition was considered acceptable. The average bridge plate ratio, plate working length, and plate screw density were 0.8, 0.57, and 0.48, respectively. The median time to clinical union was 30 days. Bridge plating in simple tibial fractures resulted in fast healing and low complication rates.(AU)

Objetivou-se avaliar a efetividade da estabilização em ponte de fraturas tibiais simples em cães utilizando-se a técnica de osteossíntese minimamente invasiva com placa (MIPO). Registros médicos e radiográficos de 29 cães com fraturas simples de tíbia, fixadas em ponte por meio da MIPO, foram retrospectivamente avaliados. O resultado clínico foi classificado com base na deambulação ao final do tratamento. Os ângulos articulares mecânicos da tíbia foram aferidos e comparados aos valores descritos na literatura. Adicionalmente, foram avaliadas a aposição dos fragmentos e a disposição dos implantes. Por meio da escala modificada de união radiográfica para fraturas de tíbia, determinou-se o momento de união clínica. Clinicamente, ao final do tratamento, apenas um animal apresentou claudicação ao trote. Não houve diferença significativa entre o alinhamento ósseo no plano frontal quando comparado com dados da literatura (P>0,05), enquanto, no plano sagital, o ângulo mecânico caudal proximal da tíbia foi significativamente maior (P=0,001). A mediana para aposição dos fragmentos foi considerada aceitável. As médias para relação placa em ponte, comprimento de trabalho da placa e densidade de parafusos da placa foram, respectivamente, 0,8; 0,57 e 0,48. A mediana para união clínica foi de 30 dias. A estabilização em ponte de fraturas tibiais simples resultou em rápida consolidação óssea, com baixas taxas de complicação.(AU)

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)

Tratamiento quirúrgico de las dismetrías y deformidades angulares de miembros inferiores mediante epifisiodesis con tornillos transfisarios (técnica de Metaizeau) / Surgical treatment of lower limb length discrepancy and angular deformity by epiphysiodesis with transphyseal screw (Metaizeau technique) / Tratamento cirúrgico das dismetrias e deformidades angulares de membros inferiores mediante epifisiodese com parafusos transfisários (técnica de Metaizeau)

Evaluamos los niños con dismetrías y deformidades angulares operados mediante la Técnica de Metaizeau en el período 2010-2014, mediante un estudio retrospectivo de 11 pacientes, analizados en 2 Grupos. Grupo 1 (Dismetrías), formado por 5 pacientes, de los cuales 3 fueron operados solamente mediante esta técnica, mientras que 2 requirieron adicionalmente procedimientos de alargamiento femoral, valoramos dismetría inicial, dismetría por predicción para el último control y para el final de la madurez, y dismetría final. Grupo 2 (Deformidades Angulares), formado por 6 pacientes, de los cuales 1 presentaba genu varo, 4 genu valgo y 1 valgo de tobillo, valoramos el ángulo femorotibial anatómico, ángulo femoral distal lateral anatómico, ángulo tibial proximal medial, y ángulo tibioastragalino. En ambos Grupos se valoraron las complicaciones. El seguimiento promedio fue de 2 años y 5 meses. En el Grupo 1 obtuvimos dismetría promedio inicial 7,64 cm., dismetría promedio por predicción para el último control 8,54 cm., dismetría promedio final 7,62 cm., corrección promedio lograda 0,91 cm. En el Grupo 2 el promedio de corrección del ángulo femorotibial anatómico 16,85˚, promedio de corrección del ángulo femoral distal lateral anatómico 16,85˚, promedio de corrección del ángulo tibial proximal medial 7,62˚. No detectamos complicaciones en ningún paciente. En 8 (72,72%) pacientes la Técnica fue efectiva, mientras que en 3 (27,27%) los resultados fueron malos por errores técnicos o error en la predicción. La Técnica de Metaizeau, respetando los detalles quirúrgicos y realizando una adecuada predicción, es una buena opción para el tratamiento de dismetrías y deformidades angulares.

We evaluated children with lower limb length discrepancy and angular deformity operated by the Metaizeau technique in the 2010-2014 period through a retrospective study of 11 patients analyzed in 2 groups. Group 1 (Lower limb length discrepancy), consisted of 5 patients, among whom 3 were operated only by Metaizeau technique, whereas the other 2 additionally required procedures for femoral elongation. We evaluated initial discrepancy, predicted discrepancy for ultimate control and at maturity, and final discrepancy. Group 2 (Angular deformity), consisted of 6 patients, among whom 1 had genu varum, 4 genu valgum and, 1 ankle valgus. We evaluated anatomic femorotibial angle, anatomic lateral distal femoral angle, medial proximal tibial angle, and tibio talar angle. In both groups the complications were assessed. The average follow-up was 2 years and 5 months. In Group 1 we obtained the following values: average initial discrepancy, 7.64 cm; average discrepancy predicted for ultimate control, 8.54 cm; average final discrepancy, 7.62 cm and average correction achieved, 0.91 cm. In Group 2 the values were: average correction anatomic femorotibial angle, 16.85˚; average correction anatomic lateral distal femoral angle, 16.85˚ and average correction medial proximal tibial angle, 7.62˚. We found no complications in any patient. In 8 patients (72.72%) the technique was effective, while in 3 (27.27%) the results were poor due to technical errors or prediction errors . Metaizeau Technique, respecting the surgical details and making an accurate prediction is an effective, simple and uncomplicated procedure.

Avaliamos as crianças com dismetrias e deformidades angulares operadas pela técnica de Metaizeau no período de 2010 até 2014, mediante um estudo retrospectivo de 11 pacientes analisados em dois grupos. Grupo 1 (Dismetrias), constituído por cinco pacientes, dos quais 3 foram operados apenas por esta técnica, enquanto que os outros dois precisaram de procedimentos adicionais de alongamento femoral. Avaliamos a dismetria inicial, a dismetria por predição para o último controle e para o final da maturação, e a dismetria final. Grupo 2 (deformidades angulares), constituído por 6 pacientes, entre os quais um apresentava genu varo, 4 genu valgo e um, valgo do tornozelo. Avaliamos o ângulo femorotibial anatômico, o ângulo femoral distal anatômico o ângulo femoral distal lateral anatômico, o ângulo tibial proximal medial, e o ângulo tibioastragalino. Em ambos os grupos foram avaliadas as complicações. O seguimento médio foi de 2 anos e 5 meses. No Grupo 1, obtivemos dismetría inicial média de 7,64 cm, dismetria média por previsão para o último controle de 8,54 cm, dismetría final média de 7,62 cm e correcção média atingida de 0,91 cm. No Grupo 2, a correção de ângulo tibiofemoral anatómica média 16,85˚, correção média do ângulo femoral distal lateral anatómico 16,85˚, e correção média de ângulo tibial proximal medial de 7,62˚. Não detectamos complicações em nenhum paciente. A técnica foi efetiva em 8 (72,72%) pacientes, mas em 3 (27,27%) os resultados foram insatisfatórios por erros técnicos ou na predicção. A técnica de Metaizeau, desde que sejam respeitados os detalhes cirúrgicos e seja feita uma predicção adequada, é uma boa escolha para o tratamento de dismetrías e deformidades angulares.

Resultados funcionales en pacientes adolescentes con corrección de deformidades angulares de los miembros inferiores tratados con osteotomía en cuña abierta / Functional results of open wedge osteotomies in lower limb angular deformities in teenagers

Resumen: Objetivo: Evaluar los resultados funcionales y radiográficos de los pacientes adolescentes con deformidades angulares de los miembros pélvicos tratados con sistema de osteotomía en cuña abierta. Material y métodos: Estudio observacional, prospectivo, analítico y transversal de los pacientes con diagnóstico de deformidad angular de los miembros pélvicos tratados con sistema de osteotomía en cuña abierta. Se valoraron mediante radiografía el ángulo femorotibial, el ángulo de desviación del eje mecánico (MAD), la discrepancia de miembros inferiores y los grados de centro de rotación de la deformidad (CORA) pre- y post­quirúrgico. Se realizó una encuesta telefónica de la escala funcional postquirúrgica IKDC 2000. Resultados: Se valoraron 28 pacientes, 21 femeninos y siete masculinos, con un promedio de edad de intervención quirúrgica de 15.3 años. Sus diagnósticos: genu valgo idiopático, 10 casos; enfermedad de Blount, cuatro; tumoraciones benignas, tres; raquitismo hipofosfatémico, tres y otros como secuelas de artritis séptica de rodilla, hipoplasia femoral y secuelas de fractura. Fueron un total de 29 osteotomías: 17 de tibia y 12 de fémur; 17 osteotomías presentaban desviación lateral del eje mecánico, 11 desviación medial, con una media de ángulo femorotibial de 17 y 7.35 (p < 0.03), respectivamente; la discrepancia inicial promedio tuvo una mejoría de 0.5 cm. El IKDC postquirúrgico en la evaluación subjetiva tuvo una media de 95.3 puntos. Conclusiones: La fijación de osteotomías con placas de cuña abierta es una opción con buenos resultados tanto clínicos como radiográficos.

Abstract: Objective: The aim of this study was to evaluate the functional and radiographic results of adolescent patients with angular deformities of the pelvic limbs treated with an open wedge osteotomy system. Material and methods: Observational, prospective, analytical and cross-sectional study of patients with angular deformity of the pelvic limbs treated with an open wedge osteotomy. We made a radiographic evaluation of the femorotibial angle, MAD angle, lower limb discrepancy, and pre- and postoperative degrees of the rotational center of deformity (CORA), as well as a telephone survey of the postoperative functional evaluation IKDC 2000. Results: It was a sample of 28 patients, 21 female and seven male, with a mean age of 15.3 years. Their diagnoses: idiopathic genu valgo, 10 cases; Blount disease, four; benign tumors (enchondromatosis and osteochondromatosis), three; hypophosphatemic rickets; three, among others, such as sequelae of septic arthritis of the knee, femoral hypoplasia, and fracture sequels. It was a total of 29 osteotomies, 17 of the tibia and 12 of the femur; 17 osteotomies presented deviation to lateral of the mechanical axis, and 11, medial deviation, with a mean femorotibial angle of 17 and 7.35 (p < 0.03), respectively. The mean initial discrepancy had an improvement of 0.5 cm. Postoperative IKDC in the subjective evaluation had an average of 95.3 points. Conclusions: The fixation of osteotomies with open wedge plates is an option with good clinical and radiographic results.

Replantation for complete amputated finger composite lateral tissues / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical therapeutic effect and safety of application of Ilizarov technique combined with flap instant expansion technique in correcting tibia angular deformity combined with skin contracture by one stage.</p><p><b>METHODS</b>From January 2010 to January 2013, 30 cases of tibial deformity with skin contracture were corrected by Ilizarov technique combined with flap instant expansion technique at one stage, including 21 males and 9 females with an average age of(40.2±5.5) years ranging from 25 to 60 years. All patients underwent regular reexamination of X-ray. After removal of the Ilizarov external fixation, knee joint function were assessed by American Hospital for Special Surgery (HSS) scoring criteria, and the pain was evaluated by visual simulation score(VAS).</p><p><b>RESULTS</b>All patients were followed up for 6 to 35 months with an average of 22 months. Among them, the incision of 29 patients were primary healing, 1 patient had wound infection complicated by osteomyelitis, 2 patients complicated with fixed screw loosening, there were no expanded skin flap necrosis and neurovascular injury symptoms. The external fixators were removed at 4 to 7 months after operation with an average of(5.2±1.1) months. Correction angle was 10° to 35° degrees with an average of (25.5±3.5)°. HSS total score was 92.5±6.6 and the result was excellent in 25 cases, good in 4 cases, fair in 1 case; the VAS score was 1.2±1.5.</p><p><b>CONCLUSIONS</b>The application of Ilizarov technique combined with flap instant expansion technique is a good method for correction of tibial angular deformity with skin contracture by one stage, with a shorter time of external fixation frame, without skin necrosis and neurological symptoms, early load exercise and improve the limb function.</p>

Transplantation of a Scaffold-Free Cartilage Tissue Analogue for the Treatment of Physeal Cartilage Injury of the Proximal Tibia in Rabbits

PURPOSE: The purpose of this study was to investigate the effects of transplantation of an in vitro-generated, scaffold-free, tissue-engineered cartilage tissue analogue (CTA) using a suspension chondrocyte culture in a rabbit growth-arrest model. MATERIALS AND METHODS: We harvested cartilage cells from the articular cartilage of the joints of white rabbits and made a CTA using a suspension culture of 2x107 cells/mL. An animal growth plate defect model was made on the medial side of the proximal tibial growth plate of both tibias of 6-week-old New Zealand white rabbits (n=10). The allogenic CTA was then transplanted onto the right proximal tibial defect. As a control, no implantation was performed on the left-side defect. Plain radiographs and the medial proximal tibial angle were obtained at 1-week intervals for evaluation of bone bridge formation and the degree of angular deformity until postoperative week 6. We performed a histological evaluation using hematoxylin-eosin and Alcian blue staining at postoperative weeks 4 and 6. RESULTS: Radiologic study revealed a median medial proximal tibial angle of 59.0degrees in the control group and 80.0degrees in the CTA group at 6 weeks. In the control group, statistically significant angular deformities were seen 3 weeks after transplantation (p<0.05). On histological examination, the transplanted CTA was maintained in the CTA group at 4 and 6 weeks postoperative. Bone bridge formation was observed in the control group. CONCLUSION: In this study, CTA transplantation minimized deformity in the rabbit growth plate injury model, probably via the attenuation of bone bridge formation.

Relación entre deformidad angular y gonartrosis primaria / Relationship between angular deformity and primary osteoarthritis of the knee

Antecedentes: La gonartrosis es una entidad muy frecuente en la actualidad, las deformidades angulares son un hallazgo usual en pacientes con esta entidad y aunque está bien justificada su presencia como causa secundaria, no existen muchos reportes sobre la relación entre deformidad angular y gonartrosis primaria. Objetivo: Profundizar en la relación existente entre gonartrosis primaria y deformidad angular de la articulación de la rodilla. Método: Se realizó una revisión bibliográfica de un total de 300 artículos publicados en PubMed, Hinari y Medline mediante el localizador de información EndNote, de ellos se utilizaron 52 citas seleccionadas para realizar la revisión, 47 de ellas de los últimos cinco años, donde se incluyeron cinco libros. Desarrollo: Se realizó una revisión de los aspectos bioquímicos y biomecánicos más importantes relacionados con las deformidades angulares. Con respecto a la asociación entre deformidad angular y gonartrosis primaria, se plasmaron los elementos relacionados con cada tipo de deformidad tanto en el eje axial, coronal como rotacional. Los factores relacionados con la deformidad pueden ser de tipo óseo y de partes blandas, en especial del aparato capsuloligamentoso de la articulación. Conclusiones: Las deformidades angulares en pacientes con gonartrosis primaria son frecuentes y en su presencia influyen factores relacionados con la arquitectura ósea y de partes blandas.

Background: Osteoarthritis of the knee is a common disease and angular deformities are usually associated to this degenerative affection. Secondary causes of angular deformities are well known in the scientific literature, but there are not many articles about the relationship between angular deformities and primary osteoarthritis. Objective: To deepen in the relationship between angular deformities and primary osteoarthritis of the knee. Method: We conducted a literature review of a total of 300 articles in PubMed, Medline and Hinari locator information by EndNote, 52 of them were used and selected quotes to do the review, 47 of them in the last five years, including five books. Development: A revision of important biochemical and biomechanics aspects were made in regards to the relationship between angular deformities and primary osteoarthritis of the knee. Causes of deformities according to the sagittal, coronal and rotational axis were taken into account. Factors related to deformities could be osseous or soft tissues of the knee joint. Conclusions: Deformities of the knee in patients suffering from primary osteoarthritis are common and there are osseous and soft tissues causes to justified the presence of these deformities.

Clinical efficacy of figure-of-eight steel plate half epiphyseal plate block method in treatment of children with lower limb angular deformity / 中国医师进修杂志

Objective To explore the clinical efficacy of minimally invasive implantation figure-ofeight steel plate in treatment of children with lower limb angular deformity caused by a variety of reasons.Methods The clinical data of 35 lower limb angular deformity children who treated with minimally invasive implantation figure-of-eight steel plate half epiphyseal plate block method were retrospectively analyzed.During pre-operation and post-operation,the X-ray of both lower limb was shoot,the mechanical axis of lower limb and femoral tibial angle (FTA) were measured,and the clinical efficacy combining clinical results was assessed.Results All the children were completed the follow-up,the average follow-up was 15 (13-20)months.The 35 children with lower limb angular deformity achieved satisfactory correction and restored normal the mechanical axis of lower limb.All children were normal,and no complications of epiphyseal plate injury were found,except 1 child appeared incision fat liquefied and healed after secondary wound debridement and suture.Conclusions Minimally invasive implantation figure-of-eight steel plate half epiphyseal plate block method in treatment of the children with lower limb angular deformity is simple,cheap,effective,needless osteotomy,well tolerated and with less complications.It is an easily learned technique for osteology surgeons and to be worth generalization at clinical especially those hospitals without establishing special department of children' s osteology.

Genu valgum postraumático: presentación de un caso / Postraumatic Genu valgum: presentation of a case

Se presentó un caso de deformidad valgo de la rodilla izquierda en un adolescente, masculino, de 15 años de edad, como complicación de un traumatismo aparentemente simple, sin lesión ósea evidente en el estudio radiológico inicial. Se exponen los datos clínicos y radiológicos presentes en la historia clínica del paciente, así como el tratamiento quirúrgico que se realizó. Se señaló la posibilidad de ocurrencia de deformidades angulares de la rodilla por daño traumático de las placas de crecimiento mucho tiempo después del trauma inicial, a pesar de lo infrecuente que esto resulta, destacando la importancia que reviste tener siempre presente la posibilidad de este tipo de complicación, aún ante traumatismos de aparente baja intensidad, así como la importancia de realizar el tratamiento quirúrgico, según las características de cada paciente.

We present the case of a 15-years-old, male adolescent with valgum deformity of the left knee as a complication of an apparently simple trauma without evident bone injury at the initial radiological study. The clinical and radiological data gathered in the patient record and also the applied surgical treatment, are exposed. We point out the possibility of the occurrence of the knee angular deformities due to traumatic injury of the epiphyseal growth plate long time after the initial trauma in spite of the infrequent that it can be, emphasizing how important is to take into account the possibility of this kind of complication, even in the case of a traumatism of apparent low intensity, and the importance of carrying out the surgical treatment according to the characteristics of each patient.

Limb Angular Deformity Correction Using Dyna-ATC: Surgical Technique, Calculation Method, and Clinical Outcome

PURPOSE: Dyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC. MATERIALS AND METHODS: The amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64). RESULTS: All but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0degrees on tibiae and 10.0degrees on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation. CONCLUSION: We believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint.

Change in Effective Leg Length after Angular Deformity Correction by Hemiepiphyseal Stapling

BACKGROUND: The hemiepiphyseal stapling has both positive and negative effects on effective leg length. The purpose of this study was to analyze change in effective leg length after angular correction by hemiepiphyseal stapling, and to validate in clinical cases. METHODS: Mathematical analysis of a hemiepiphyseal stapling model was conducted. The induced formula was validated in 6 cases fulfilling the assumptions of the model. Anatomical parameters involved in this formula were measured in additional 21 cases undergoing hemiepiphyseal stapling or hemiepiphysiodesis. RESULTS: Effective leg length increased or decreased according to three parameters in this model: 1) limb length distal to the operated physis (L), 2) width of the operated physis (d), and 3) the amount of angular deformity to be corrected (theta). Actual change in effective leg length of 6 cases similar to this model coincided with the predicted change at least in its direction. L/d ratio was 4.82 +/- 0.51. CONCLUSIONS: Considering the narrow range of the L/d ratio, hemiepiphyseal stapling is likely to decrease effective leg length if the amount of angular correction is less than 10degrees, whereas to increase it if the amount of angular correction is larger than 16degrees. This should be taken into consideration when selecting the surgical method for angular deformity correction in skeletally immature patients.

Factors Influencing Angular Deformity of Tibia Fracture below Isthmus Treated with Interlocking Nails / 대한정형외과학회잡지

This study analyzed the factors causing the angular deformity as the tibia fracture below isthmus were treated with interlocking nails. For this purpose, we observed 70 cases of tibia fractures in the Gil General Hospital as subjects. Of the 70 cases under the treatment, 32(45.7%) showed the angulation of over one degree, and 11(15.7%) showed that of 5-10 degrees in any plane. According to the outcomes of this studies, the degree of angulation seemed to have close relation to the length of fracture line. Also, if the fracture line reached to the isthmus, angulation was apt to be caused. Even though most angulated cases had concomitant fibular fracture, fibular fracture, itself, seemed to have no direct relation to angulation. In consequence, the intramedullary interlocking nailing needs special carefulness in the case of breakage of cortical buttress such as long fracture line, butterfly fragment and fracture including isthmus.

The Effect of Division of the Periosteum on Enchondral Growth and Angular Deformity of Long Bones: An Experimental Study on Rabbits' Femora / 대한정형외과학회잡지

The purpose of this experiment was to determine the effect of dividing the periosteum circumferentially on the growth of long bones and the effect of partial division of the periosteum on the formation of angular deformity of growing bones and to investigate the tethering effect of the periosteum on the epiphyseal plate as its possible mechanism. One hundred twenty rabbits, one-month old with average weight of 570g, were divided into four groups. In the first group, the periosteum of the right distal femur was completely divided circumfer- entially; in the control group, the medial aspect of the right distal femur was surgically approached but the periosteum was not divided, in the third group, the medial half of the peristeum of the right distal femur was divided transversely; in the fourth group, the medial half of the periosteum was divided and resutured. Following the operation, X-rays were taken every two weeks until twelfth week and then at twentieth week and the length of the femur and the physis-shaft angle were measured. l. After complete circumferential division of the periosteum, the ratios of right over left femoral length before operation, and two, four, six, eight, ten, twelve, and twenty weeks postoperatively, were 100.0±0.0%, 102.1±0.1%, 102.±0.0%, 102.9±0.0%, 103.5±0.0%, 103.6±0.0%, 103.5±0.0%, and 103.5±0.0%, respectively. The overgrowth was most conspicuous during the first two weeks. On the other hand, in the control group there was slight overgrowth, but this was not statistically significant. 2. After partial division of the periosteum, the physisvhaft angles before operation, and two, four, six, eight, ten, twelve, and twenty weeks postoperatively, were 91.0±1.2, 87.8±2.5,84.4±2.4, 83.1±3.2, 84.2±3.5, 86.4±2.3, 86.2±2.3, and 86.8±1.9, respectively. The valgus deformity was induced most conspicuously during the first four weeks, whereas partial correction of the de- formity took place between the eighth and tenth week postoperatively. After repair of the partially divided periosteum, only 0.9 of angular deformity was observed at sixth week, but this became statistically insignificant at tenth week as were in the complete division and control groups. 3. Histologically, no difference was observed in the cartiage cells of the epiphyseal plate and the bony trabeculae of the metaphysis between the control group and other groups. The divided periosteum regenerated at the ninth week, this being same also in the repaired group. There was no statistical difference in the thickness of the epiphyseal plate between the operated femur and the opposite normal femur in the completely divided group, this being same in the control group. Threr was also no statistical difference in the thickness of the epiphyseal plate between the medical and lateral halves in the partially divided group, this being same in the repaired group. Based on these results, the investigator was able to draw following conclusions. 1. In the growing long bone, complete circumferential division of the periosteum near the epiphyseal plate results in stimulation of growth and lengthening of bone. 2. Partial transverse division of the periosteum results in asymmetrical overgrowth, inducing an angular deformity. 3. It is suggested that the mechanism of overgrowth following division of the periosteum lies in the removal of the tethering effect of the periosteum. These findings may bear clinical implications on leg length inequality and angular deformities following certain fractures and epiphyseal injuries during growth period.