Tarsal abductory osteotomy in the treatment of residual adduction deformity after clubfoot surgery

Adduction of the forefoot is the most common deformity after clubfoot surgery. Surgical correction is often required for the moderate and severe deformities. Deformity correction at its apex provides the best correction with no translational deformity. Tarsal bones osteotomy should allow good healing with less stiffness of the foot than metatarsal base osteotomy. The present study included 18 patients. In 14 patients the deformity was bilateral and it was unilateral in the other four with a total of 32 feet. The youngest patient at the time of surgery was four years and the oldest was ten years. The procedure included osteotomy of the cuboid and the third and second cuneiforms, a closing wedge of the cuboid bone was removed and used for an opening wedge of the medial cuneiform. Fixation was achieved by Kirschner wires or staples and below knee cast. Clinical and radiological improvement of deformity was achieved in all patients and no complications were seen. Lesser tarsal abductory osteotomy allows deformity correction at its apex, little technical difficulty and better osteotomy healing

Upper tibial coronal plane - oblique osteotomy for deformity correction in Blount's disease

Correction of tibia vara deformity entails correction of varus and internal rotation deformities. In small children, the use of internal fixation is not desirable to avoid physeal violation; also, external fixator may not be applicable. Then, the osteotomy should be inherently stable, corrects all elements of deformity and allows post-operative adjustments of position. Oblique osteotomy has been described to perform varus derotation of the proximal femur and to correct varus internal rotation of the tibia in Blount's disease. The present study included 16 children. In ten patients the deformity was bilateral and it was unilateral in the other six patients, with a total of 26 tibiae. The youngest child was three years old and the oldest was 12 years old. The procedure included coronal plane oblique osteotomy starting distal to the tibial tubercle and runs up to the posterior tibial metaphysis just distal to the epiphyseal plate. A single fixation screw was used for limited internal fixation in the sagittal plane to allow post-operative position correction by cast wedging. All osteotomies healed within 12 weeks. The deformities were corrected with ten degrees of over-correction of varus deformity. In two patients post-operative weakness of extensor hallucis longus occurred which resolved within one week. Upper tibial oblique osteotomy in the coronal plane has the advantages of correction of all deformity elements with minimal internal fixation, at the same time allows post-operative adjustments which are desirable in small children

Treatment of trochanteric fractures by external fixator in patients with high unacceptable operative risk

External fixation has been used for the management of fractures since a long period of time. Good fixation, mild blood loss and early ambulation are always the main advantages for this technique. Other advantages include: it is simple, quick, inexpensive and causes minimal surgical trauma. The goal of this study was to report and evaluate the place of external fixation in the treatment of trochanteric fractures in patients with high unacceptable operative risk to withstand conventional osteosynthesis and to obviate the many disadvantages of traction and prolonged rest in bed. From January 1998 to December 2000, 22 patients, 6 males and 16 female, mean age 65.03 years, suffering from trochanteric fracture and considered preoperatively as "poor medical status"; were treated by external fixation and early mobilization. Technique was prescribed. All fractures except one were united at approximately 12.2 weeks [range 11.4-12.85 weeks]. Soft tissue interposition led to non-union in one patient. Deep screws-track infection was found in one case. Two cases had DVT. The use of the external fixator in these patients reduced their time in the hospital and facilitated their postoperative rehabilitation by allowing uncomplicated healing of a complicated fracture

Lumbar pedicle screw fixation to improve correction of idiopathic scoliosis

Twenty-three consecutive patients with King-Moe type-I [thoracolumbar and lumbar] adolescent idiopathic scoliosis were treated with posterior spinal instrumentation using lumbar pedicle screw constructs. From the plain radiographs, the Cobb angles of the major curves and their correction were noted. Apical vertebral rotational angle and its correction were estimated from a single CT scan through the apical vertebra of the curve. A balance was also assessed on the posteroanterior [PA] radiographs by measuring a deviation from the median sacral line off C7. The average time of follow up examination was 28.8 months after surgery [range, 19-34 months]. The study concluded that using lumbar pedicle screw constructs for King-Moe type-I curve, idiopathic scoliosis was effectively derotating the scoliotic curve with no evidence of decompensation or imbalance within the coronal plane. Segmental pedicle screw fixation is a safe and effective method for correcting the triplanar deformity of the idiopathic thoracolumbar and lumbar scoliosis