ABSTRACT
Objective:To explore the effects of 3 osteotomy methods on the bone healing in Ilizarov tibial bone transport.Methods:The data of 93 patients were retrospectively reviewed who had been treated by Ilizarov single-segment tibial bone transport at Department of Hand Surgery, The Second Hospital of Tangshan from December 2003 to April 2019. Minimally invasive osteotomy was performed in 16 patients [group A: 16 males with an age of (37.1±8.3) years; 5 cases of type Ⅱ and 11 ones of type Ⅲ by Gustilo classification], subperiosteal saw osteotomy in 57 patients [group B: 47 males and 10 females with an age of (39.1±11.8) years; 17 cases of type Ⅱ and 40 ones of type Ⅲ by Gustilo classification] and extraperiosteal wire saw osteotomy in 20 patients [group C: 19 males and one female with an age of (37.7±11.2) years; 18 cases of type Ⅱ and 2 cases of type Ⅲ by Gustilo classification]. The 3 groups were compared in terms of the bone healing index and the Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores.Results:The 3 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). All the patients were followed up for 19 to 50 months (average, 27.4 months). All patients achieved bony healing, and their associated complications were cured after corresponding treatments. There were no significant differences in the bone healing index between the 3 groups [(53.09±21.88) d/cm for group A, (59.97±33.29) d/cm for group B and (46.20±14.11) d/cm for group C] ( P>0.05). There were no significant differences either in the good to excellent rate by the ASAMI functional scores between the 3 groups (87.5% for group A, 89.5% for group B and 90.0% for group C) ( P> 0.05). Conclusion:All the 3 osteotomy methods may achieve good bony union, leading to similar bone healing indexes and postoperative functional scores.
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RESUMEN Fundamento: la rodilla es una de las articulaciones más afectadas por el proceso degenerativo articular, se asocia a deformidades angulares en especial el varo, lo que hace más difícil su tratamiento. Objetivo: presentar el caso clínico de una paciente con artrosis de la rodilla y deformidad en varo tratada mediante artroscopia y ostectomía proximal del peroné de forma combinada y simultánea. Caso clínico: paciente de 64 años de edad, blanca, femenina sin antecedentes mórbidos de salud, la cual sufre de dolor de tipo mecánico a nivel de la rodilla izquierda alrededor de un año de evolución, que aumenta con la actividad física, se alivia con el reposo y la administración de analgésicos y antiinflamatorios no esteroideos. El examen radiográfico simple de ambas rodillas mostró la desviación en varo evidenciado en la medición de los ángulos tibial y femorotibial, esta deformidad fue más acentuada en la rodilla izquierda. Para dar respuesta a esta situación, la paciente fue intervenida quirúrgicamente donde se le realizó artroscopia y ostectomía proximal del peroné de forma combinada y simultánea. Conclusiones: la técnica propuesta es ventajosa al combinar dos procedimientos en uno, es factible y reproducible en instituciones que cuenten con servicio de artroscopia.
ABSTRACT Background: knee is one of the joints most affected by osteoarthritis, associated to angular deformities especially the varus, which makes treatment even more difficult. Objective: to show a case report of a patient with knee osteoarthritis and varus deformity treated by simultaneous arthroscopy and proximal fibular ostectomy. Clinical case: a 64 year-old, white woman, without health morbid antecedents, was taken to the outpatient department complaining of left knee pain for a year, the pain gets worse with physical activities and reliefs with rest, pain killers and non steroidal anti-inflammatory drugs. Simple X Rays showed varus deformity of both knees more accentuated in the left one. Because of patient condition, she underwent surgery where it was performed a combined and simultaneous arthroscopy and proximal fibular ostectomy. Conclusions: the technique is a useful, while combining two procedures in one, and it is feasible and reproducible in institutions with arthroscopic service training.
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ABSTRACT An open fracture of the calcaneus with loss of substance is a challenging injury and requires specialized care, involves high costs, and demands attention despite its lower incidence. The main complications are osteomyelitis, pressure ulcers, and fistulas, as well as pain conditions in the lateral, medial, and plantar regions. This is due to the wide loss of tissue and the change in anatomical conformation of the calcaneus in some cases. However, in cases of flattening of the calcaneus bone, these complications may be prevented or treated successfully. This technical note describes the resection osteotomy technique for calcaneus flattening to prevent and treat complications after micro-surgical flap in cases of open fracture or loss of substance.
RESUMO A fratura exposta do calcâneo com perda de substância é uma lesão desafiadora, demanda cuidados especializados, envolve elevados custos e exige atenção, apesar de sua menor incidência. As principais complicações são osteomielite, úlceras de pressão, fistulas, além de quadros álgicos nas regiões lateral, medial e plantar. Essa relação se deve à grande perda de tecido e à mudança da conformação anatômica do calcâneo em alguns casos. Porém, quando ocorre uma modelação do formato ósseo do calcâneo com seu aplainamento, essas complicações podem ser prevenidas ou tratadas com sucesso. O objetivo desta nota técnica é descrever a técnica de osteotomia de ressecção para aplainamento do calcâneo na prevenção e no tratamento de complicações após retalho microcirúrgico em casos de fratura exposta ou perda de substância.
Subject(s)
Humans , Calcaneus , Fractures, Open , Orthopedic Procedures , Osteotomy , Surgical FlapsABSTRACT
ABSTRACT Objectives: To present a simplified calculation for the measurement of osteotomy wedges used for the correction of angular uniplanar deformities of long bones and to compare the simplified calculation proposed (circumferential calculation) with the classical trigonometric calculations, as well as with the exact calculation performed by computer software AutoCADtm. Methods: The software AutoCADtm was used to calculate the bone wedges, for mathematical comparison of the three main groups, each one of them containing 18 hypothetical bone deformities which angles ranging from 5 to 90 degrees, with 5 degrees intervals between them. Results: In the analysis of 18 deformities, the hypothetical angular bone, the average lengths of the corrective wedges obtained by the trigonometric, circumferential and the exact metods were, respectively, 32.21 ± 16.81 mm, 33.16 ± 18.63 mm and 35.22 ± 23.52 mm. There was no statistically significant difference between the three calculation methods (p>0.05). Conclusion: The circumferential calculation proposed in this study is useful for being accurate and simple, not requiring any trigonometric knowledge. Level of Evidence II, Experimental Study.