Correction of tibial multiplanar deformities using single Taylor external fixator combined with biplanar osteotomy / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities.@*METHODS@#Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table.@*RESULTS@#Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference ( P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant ( P<0.05). The score of lower limb deformity was significantly higher than that before operation ( P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%.@*CONCLUSION@#Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.

Standardization of extramedullary and intramedullary fixations for subtrochanteric fracture / 中国组织工程研究

BACKGROUND:The classification and treatment of subtrochanteric fracture experienced a long process of development. Surgical treatment was currently used popularly, including extramedulary and intramedulary fixation. It should be selected according to the type of fracture and clinical practice, and it is inconclusive in the clinic. OBJECTIVE:To summarize the study and present application of intramedulary and extramedulary fixation in the subtrochanteric fracture in recent years. METHODS:The first author researched two books, and retrieved PubMed, Wanfang Database, and Chinese Journal Ful-text Database for articles about clinical trials on fixation for subtrochanteric fractures, and the safety and efficacy of fixation for subtrochanteric fractures published until March 2014. A total of 42 clinical studies on type, intramedulary and extramedulary fixations were selected. RESULTS AND CONCLUSION:With the progress of fixation methods of subtrochanteric fracture, there was a great progress in improving the rate of fracture healing and reducing hip malunion, and limited mobility. Whether extramedulary fixation, intramedulary fixation or arthroplasty, clinical reports have achieved satisfactory results at present. The intramedulary fixation was stil dominated among various therapeutic methods. However, the type of fracture, age and osteoporosis fractures were different in patients. There was no uniform standard of the specific choice of surgical approach, which stil should be further studied. Authors believed that when fracture line was below the lesser trochanter, interlocking intramedulary nail could be used. High subtrochanteric fracture could utilize proximal femoral nail anti-rotation. However, if the medulary cavity was narrow, the fracture was involved in the greater trochanter or piriformis fossa area, locking proximal femoral plate or less invasive stabilization system could be employed. No matter intramedulary or extramedulary fixation, minimal invasion and biological fixation were the present trend of development. The new minimaly invasive techniques and internal fixation are stil the goal. Although intramedulary fixation has advantages, but cannot completely replace the current extramedulary fixation. It is important to have a perfect surgery plan, standardized surgical approach and long-term postoperative folow-up, in order to achieve better clinical outcomes.

Femoral posterior condylar angle of human knee joint:magnetic resonance imaging measurement / 中国组织工程研究

BACKGROUND:The good rotational alignment of femoral prosthesis was very important in total knee arthroplasty. The research has shown that the posterior condylar angle was important to determine the alignment. The posterior condylar angle is the angle between the posterior condylar axis and the femoral epicondylar axis. MRI can clearly show the condylar cartilage, the projections of lateral epicondyle and the medial epicondyle depression, thus ensuring accuracy of measurement data. OBJECTIVE:To measure the posterior condylar angle of knee joint in the northern part of Baoding City in China, and to provide image evidence for identifying the rotational alignment of femoral prosthesis during total knee arthroplasty. METHODS:The knee was extended on a neutral position when MRI machine was applied to scan knee joint. The scanning plane was perpendicular to the mechanical axis of the knee. The best T1 axial plane of the knee was chosen, and two observers analyzed images independently. Existence rate of femoral medial epicondyle was observed using Bravo viewer 6.0 imaging software. The posterior condylar angle between posterior condylar axis and the femoral condyle axis was measured. RESULTS AND CONCLUSION:The posterior condylar angle was (2.73±1.28)° in males and (2.35±1.37)° in females on average, which did not show significant difference. The results showed that the MRI had great superiority in measuring the posterior condylar angle. The variability of the epicondylar axis was smal in total knee arthroplasty. Posterior condylar angle can be referenced to position femoral prosthesis and to avoid the complications after knee replacement.