Correction of major humeral deformity from acquired ricket using a 3D personalized osteotomy guide

Objective The present study aims to evaluate the ability of triple arthrodesis in eliminating the main complaints presented by patients with adult acquired flatfoot deformity (AAFD): 1) disabling hindfoot pain; 2) major deformities, such as medial arch collapse, valgus, abduction, and supination. Methods A total of 17 patients (20 feet) with advanced AAFD who underwent surgical correction by triple arthrodesis were evaluated after a mean follow-up period of 43 months (range: 18–84 months). The average age of the patients at surgery was 62 years old (range: 38–79 years old). The visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were used to assess the final results. Results According to the VAS, the average residual pain was 3 points; the AOFAS hindfoot score points increased 23% after the surgery; and the correction of deformities was considered satisfactory in 10 out of 20 feet; partially satisfactory in 4 out of 20 feet; partially unsatisfactory in 5 out of 20 feet; and unsatisfactory in 1 out of 20 feet. Conclusion Despite the high index of bone fusion after triple arthrodesis, which is the gold standard treatment in advanced AAFD, the incomplete correction of major deformities and the persistence of residual pain contributed to a high disappointment rate of the patients with the surgical results.

During the period 1975–1981, 18 cases of Crouzon syndrome and seven cases of other craniosynostosis syndromes underwent surgical correction of major craniofacial deformities. It is still too soon to give a statistical picture of the benefits of these procedures. It can be said that functional symptoms have responded well. Raised intracranial pressure was demonstrated in five and has been relieved in all. Orbitostenosis severe enough to cause ocular dislocation was present in two, and this has never recurred since operation. The symptoms of faciostenosis have often benefited; though snorers still snore, the upper airway is usually less obstructed and dental occlusion is improved. We cannot yet say that these good functional results will be permanent, though we believe that they will be. Nor can we yet present meaningful figures of aesthetic improvement, although corrections of deformity appear so far to be well maintained. It is also too soon to report statistically on our studies of the psychosocial benefits of these procedures. We can however report objectively on the adverse complications. These include many predictable misfortunes, familiar from earlier surgical experience, and also some which were not anticipated by us. There are special hazards in this new surgical discipline. Craniofacial surgery is more than maxillofacial surgery with an occasional neurosurgical component. The very innovative techniques which make possible the spectacular successes of craniofacial surgery are also the causes of occasional terrible disasters.

Background: Deformity of long bones of lower limb leads to frequent gait and joint problems, in addition to the esthetic problems. Correction of such deformities proves to be a challenge due to spatial and soft-tissue considerations. Taylor Spatial Frame (TSF) and Ortho-SUV Frame (SUV) are two six axis correction devices which utilize the Ilizarov methods and allow easier correction of complex deformities. This study was performed to compare the efficacy of TSF and SUV for correction of lower limb long bone deformities. Materials and Methods: The Study was held at Sir Ganga Ram Hospital, New Delhi between January 2015 and November 2019. Twenty patients were included for each correction group. Assessment of correction was done in terms of rate and accuracy of deformity correction, lengthening index, total lengthening achieved, time in frame, assessment of ability to perform Activities of Daily Living, functional outcome using Association for the Study and Application of the Method of Ilizarov (ASAMI) score, and complications during treatment. Results: Both groups showed excellent correction of deformity in all planes and good functional outcomes. TSF group showed lesser incidence of joint stiffness as well as a shorter time in Frame. Pin site infection was the most common complication followed by major residual deformity. Conclusion: Both TSF and SUV provide excellent outcome in correction of complex spatial deformities of lower limb with high accuracy and good functional outcome. The TSF provides an advantage over SUV with reduced time in Frame, lesser joint stiffness and increased patient compatibility due to smaller frame size and reduced bulk as compared to SUV.

Correction of major saddle nose deformities is one of the greatest challenges in nasal surgery. Here, a new approach for the correction of major saddle nose deformities in which the missing parts of the nasal skeleton are replaced with their anatomic replicas sculptured from an autogenous osteocartilagineous rib graft is presented. Since 1998, this new technique has been used in 17 patients (11 females and 6 males) with major saddle nose deformities. The age range was between 19 and 37 years. The etiology of saddle nose deformity was iatrogenic in 11 and traumatic in 2 patients. In the remaining 4 patients, saddle nose was a part of ethnic facial features. During a mean follow-up of 2 years, the sculptured nasal frame maintained its form and resistance. There was no patient with recurrent nasal collapse or airway obstruction. The nasal tip was naturally mobile in all patients. Replacing the missing parts of the nasal skeleton with their anatomic replicas created from autogenous tissues, this new technique restores all anatomic and functional features of the nose. It efficiently corrects saddle nose deformity and eliminates associated functional deficiencies.

Background: Congenital kyphosis and acquired kyphoscoliotic deformities are uncommon but are potentially serious because of the risk of progressive deformity and possible paraplegia with growth. Our current approach for the treatment of these deformities is to use a single posterior incision and costotransversectomy to provide access for simultaneous anterior and posterior resection of a hemivertebra or spinal osteotomy, followed by anterior and/or posterior instrumentation and arthrodesis. To our knowledge, this approach has not been reported previously. Methods: The medical records and radiographs for sixteen patients who had been managed at our institution for the treatment of congenital kyphosis and acquired kyphoscoliosis between 1988 and 2002 were analyzed. The mean age at the time of surgery was twelve years. The diagnosis was congenital kyphosis for fourteen patients and acquired kyphoscoliotic deformities following failed previous surgery for two. The mean preoperative kyphotic deformity was 65° (range, 25° to 160°), and the mean scoliotic deformity was 47° (range, 7° to 160°). Fifteen patients were managed with vertebral resection or osteotomy through a single posterior approach and costotransversectomy, anterior and posterior arthrodesis, and posterior segmental spinal instrumentation. The other patient was too small for spinal instrumentation at the time of vertebral resection. A simplified outcome score was created to evaluate the results. Results: The mean duration of follow-up was 60.1 months. The mean correction of the major kyphotic deformity was 31° (range, 0° to 82°), and the mean correction of the major scoliotic deformity was 25° (range, 0° to 68°). Complications occurred in four patients; the complications included failure of posterior fixation requiring revision (one patient), lower extremity dysesthesias (one patient), and late progressive pelvic obliquity caudad to the fusion (two patients). The outcome, which was determined with use of a simplified outcomes score on the basis of patient satisfaction, was rated as satisfactory for thirteen patients, fair for two patients, and poor for one patient. Conclusions: A simultaneous anterior and posterior approach through a costotransversectomy is a challenging but safe, versatile, and effective approach for the treatment of complex kyphotic deformities of the thoracic spine, and it minimizes the risk of neurologic injury. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Nasomaxillary depression, which may be seen with major saddle nose deformities, especially as a sequel to childhood nasal trauma, generally is overlooked during management of the saddle nose. To handle both the saddle nose deformity and nasomaxillary depression, the authors used a one-stage intraoral and external open rhinoplasty approach for 12 patients. Lateral nasal osteotomies and correction of midface retrusion with crescent-shaped autogenous rib cartilage grafts were performed through two bilateral intraoral gingivobuccal incisions. The external open rhinoplasty approach was used for the correction of the saddle nose deformities. The mean follow-up period after the surgery was 2years (range, 1-3.5years). The correction of nasal tip depression resulting from midface retrusion was evaluated by lateral cephalometric radiographs. The mean movement of the nasal tip anteriorly in the sagittal plane 1year after the operation was 5.5mm (range, 4-7mm). The functional and aesthetic results were satisfactory for all the patients. As the findings show, the intraoral part of the approach provides a route for the placement of cartilage grafts to correct the depressed nasal tip, augment the paranasal area, and provide support to the lateral alar bases and the controlled low-to-low lateral osteotomies. The external part of the approach provides correction of the saddle nose deformity.

Congenital kyphosis and acquired kyphoscoliotic deformities are uncommon but are potentially serious because of the risk of progressive deformity and possible paraplegia with growth. Our current approach for the treatment of these deformities is to use a single posterior incision and costotransversectomy to provide access for simultaneous anterior and posterior resection of a hemivertebra or spinal osteotomy, followed by anterior and/or posterior instrumentation and arthrodesis. To our knowledge, this approach has not been reported previously. The medical records and radiographs for sixteen patients who had been managed at our institution for the treatment of congenital kyphosis and acquired kyphoscoliosis between 1988 and 2002 were analyzed. The mean age at the time of surgery was twelve years. The diagnosis was congenital kyphosis for fourteen patients and acquired kyphoscoliotic deformities following failed previous surgery for two. The mean preoperative kyphotic deformity was 65 degrees (range, 25 degrees to 160 degrees ), and the mean scoliotic deformity was 47 degrees (range, 7 degrees to 160 degrees ). Fifteen patients were managed with vertebral resection or osteotomy through a single posterior approach and costotransversectomy, anterior and posterior arthrodesis, and posterior segmental spinal instrumentation. The other patient was too small for spinal instrumentation at the time of vertebral resection. A simplified outcome score was created to evaluate the results. The mean duration of follow-up was 60.1 months. The mean correction of the major kyphotic deformity was 31 degrees (range, 0 degrees to 82 degrees ), and the mean correction of the major scoliotic deformity was 25 degrees (range, 0 degrees to 68 degrees ). Complications occurred in four patients; the complications included failure of posterior fixation requiring revision (one patient), lower extremity dysesthesias (one patient), and late progressive pelvic obliquity caudad to the fusion (two patients). The outcome, which was determined with use of a simplified outcomes score on the basis of patient satisfaction, was rated as satisfactory for thirteen patients, fair for two patients, and poor for one patient. A simultaneous anterior and posterior approach through a costotransversectomy is a challenging but safe, versatile, and effective approach for the treatment of complex kyphotic deformities of the thoracic spine, and it minimizes the risk of neurologic injury. Therapeutic Level IV.

Osteoporotic vertebral compression fractures (OVCFs) are an important health issue for which minimally invasive techniques are a feasible treatment. The SpineJack® (Vexim) is an intravertebral expandable system designed to improve the correction of the structural modifications caused by OVCFs. Its ability to stabilise and reduce OVCFs at the acute phase being already well established, we sought to evaluate the feasibility of vertebral augmentation with the SpineJack® in chronic kyphotic OVCFs. All consecutive patients treated with the SpineJack® were prospectively included if they met the following criteria: (1) OVCF considered unstable (grade A3 according to Magerl's classification). (2) Local kyphotic angle ≥ 20°. (3) OVCF older than 6 weeks. (4) Back pain with visual analogue scale (VAS) ≥ 4. Nineteen consecutive patients (16 women [84.2%] and 3 men [15.8%]; mean age 73.2 ± 8.2 years) were included. Treatment was performed after a mean delay of 5.8 months ± 2.9 (range 1.5-12). Median visual analogue scale significantly improved from 7 preoperatively (IQR 6-9) to 2 (IQR 1-5) at 6 months (p < 0.01). Significant kyphosis reduction (i.e. ≥ 30%) was obtained in 94.7% of cases. Secondary adjacent level fractures (SALFs) were noted in 21.1% of cases and were correlated with the importance of the kyphosis reduction. Vertebral augmentation with the SpineJack® is feasible and seems able to correct major structural deformities in chronic OVCFs. SALFs were noted in a substantial amount of cases. Preventive adjacent vertebroplasty might be useful in patients with several risk factors for SALFs. • Vertebral augmentation with SpineJack® is effective to correct major structural deformities e.g. height loss and kyphosis. • Successful reduction is reachable with SpineJack® in chronic (older than 6 weeks) OVCFs. • Aggressive reduction of major kyphosis might promote SALFs and complementary adjacent vertebroplasties prevent their occurrence.

Surgical interventions for congenital kyphosis (CK) in the growing child include posterior spinal fusions (PSF) with instrumentation and growth-friendly (GF) procedures. While GF approaches aim to preserve spinal growth, they may increase complications and unplanned reoperations (UPRORs). This study compares complications, UPRORs, and radiographic and patient-reported outcomes between PSF and GF approaches for CK. An international, multicenter database for early-onset spinal deformity was queried to identify patients with CK who underwent primary operative management of the spinal deformity. The inclusion criteria were patients 9-years of age and younger with a preintervention sagittal kyphosis greater than their major coronal deformity, with the major coronal deformity being <35 degrees, and were followed up for at least 2-years postoperatively. A total of 54 patients (27 PSF; 27 GF) met the inclusion criteria with similar ages and follow-up periods. Preoperative and postoperative sagittal deformity was similar between groups. Both corrected sagittal deformity (PSF: -12 degrees, P=0.0182; GF: -25 degrees, P=0.0003) similarly postoperatively and at final follow-up. Preoperative and postoperative coronal deformity was also similar between groups, but PSF saw better corrections postoperatively (PSF: -6 degrees, GF: 1 degrees, P=0.0343). Coronal deformity correction was similar at final follow-up. T1-S1 length increased similarly for both groups at postoperative and final follow-up. Thirteen patients (41%) of the PSF group experienced complications compared with 36 patients (63%) in the GF group (P=0.0048). Five patients (19%) in the PSF group experienced a UPROR compared with 14 patients (33%) in the GF group (P=0.0470). The PSF group saw greater improvements in the EOSQ-24 general health domain (PSF: +23, GF: -6, P=0.0336), with all other scores being similar. In this study, PSF patients had similar deformity correction and EOSQ-24 scores with fewer complications and UPRORs than GF patients. In addition, though GF aims to preserve spinal growth, T1-S1 growth overtime was similar between groups. Clinicians should weigh the risk and benefits of both approaches for each patient's unique CK deformity to optimize shared surgical decision-making. Level III.

IntroductionTitanium elastic nailing (TENS) with wedge osteotomy for the management of monostotic fibrous dysplasia (FD) of tibia is done in a 6-year-old male patient.Case ReportThis is a case describing monostotic FD of right tibia in a 6-year-old male patient. The patient’s parents noticed a diffuse swelling in the right leg a few days after birth. It was managed conservatively till 3 years of age when the patient started complaining of pain in his right leg and difficulty in walking and running. The patient developed gradual and progressive anterior bowing in the right leg in the next 3 years. The patient was diagnosed with monostotic FD of the right tibia based on clinical and radiological findings. Wedge osteotomies were done in the tibia and fibula with TENS nailing as a definitive procedure for this patient.DiscussionManagement of monostotic FD of the right tibia with TENS nailing and wedge osteotomy can be a possible modality of definitive management with complete pain relief and deformity correction.ConclusionCorrection of deformities secondary to FD requires meticulous pre-operative planning and execution. But with proper planning, even major deformities as in our case, procedures as simple as wedge osteotomy and TENS nailing can give excellent outcomes.

Background: Forward head posture is a major postural deformity in the head and neck area. Considering the importance and secondary consequences of this deformity, current study aims at investigating this deformity among boys and girls of different educational levels of Tehran universities. Methods: This is a cross-sectional descriptive and field study (causal-comparative). A total of 1017 students, 511 girls (age: 23.74±3.91, height: 162.42±7.14, weight: 57.33±8.87) and 506 boys (age: 23.82±3.57, height: 174.70±7.97, weight: 69.19±12.18) were selected. Their forward head angle was measured 3 times by a specific goniometer and the subjects' final angle was considered as the average of three measurements. Data were analyzed using SPSS V.22 software and the two-way ANOVA, Tukey and one-way ANOVA tests. Results: The results of one-way ANOVA analysis showed a significant difference in the head angle of the students at different educational levels (p 0.05). Conclusion: According to the results of this study, educational level and gender were the major factors in the development of forward head posture, so considering these two variables could be effective in prevention, control, and correction of related deformities. Background: Forward head posture is a major postural deformity in the head and neck area. Considering the importance and secondary consequences of this deformity, current study aims at investigating this deformity among boys and girls of different educational levels of Tehran universities.

The purpose of this study was to evaluate the alignment and functional outcome after surgical augmentation of the tibialis posterior by tendon transfer and lateral column lengthening by osteotomy of the os calcis, calcaneo-cuboidal arthrodesis or reorientating triple arthrodesis. From 1991 to 1999 41 patients with the clinical and radiological diagnosis of dysfunction of the tibialis posterior tendon underwent surgical exploration and repair. These 41 patients (22 women, 19 men) had an average age of 44.3 years (range, 19-69 years) and had been symptomatic for an average of 2.3 years (range, 6 months to 6 years). All patients had the symptoms of a painful flatfoot deformity without dynamic support along the medioplantar aspect. Flexor digitorum longus (FDL) tendon transfer as reconstruction of the tibialis posterior tendon was performed in the cases without major deformity (n = 77). Patients underwent FDL transfer and lengthening osteotomy (n = 15) of the os calcis or calcaneocuboidal (c-c) arthrodesis (n = 12) if passive correction of the foot deformity was still possible and reorientating triple arthrodesis (n = 7) when a fixed flatfoot deformity had developed. AOFAS score and radiological examination were used preoperatively and in the follow-up. The AOFAS score improved for stage 1 patients after a mean follow-up of 43 months with FDL transfer from a preoperative mean of 54 to 84 points, for stage II patients with FDL transfer and lengthening osteotomy (mean follow-up 36 m) from 47 to 92 points, with c-c arthrodesis (follow-up 66 m) from 48 to 86 points, and for stage III patients with triple arthrodesis from 42 to 72 points. In two patients, the deformity failed to improve (stage I) necessitating a revision surgery with a calceneo-cuboidal lengthening arthrodesis for relapsing deformity. In order to correct deformity and provide substantial relief of foot pain and dysfunction, we recommend the transfer of the FDL tendon in flexible flat foot deformity together with lengthening osteotomy. This treatment will provide optimal restoration of a dynamic support along the medioplantar aspect of the foot and is functionally superior to a c-c arthrodesis. Reorientating triple arthrodesis showed fair functional results and is recommended--for fixed flatfoot deformity.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Septoplasty is among the most common procedure in nasal surgery, and it has some difficulties, especially at the beginning of the surgical training.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study including 154 patients underwent septoplasty surgery in Zahrawi Private Hospital using our surgical technique from October 2015 to June 2017, preoperative examination using zero degrees 3 mm sinuscope, anterior active rhinometry (AAR), and computed tomography of paranasal sinuses was done. Operative time and postoperative AAR was calculated. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A significant reduction in nasal breathing resistance was found in 146 patients (95%), there are two patients with postoperative bleeding, and one patient develops synechiae. No septal perforation or other major deformities. The mean septoplasty operation time was 15.34±3.66 min (range 10-35 min).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our surgical technique is an effective and rapid procedure for the correction of septal deformities. It is reproducible and easily learned.&lt;/p&gt;

The gluteal concave deformity, a complication of repeated intragluteal injections in childhood, is a relatively common complaint of many young women in China. This issue could be addressed by lipofilling, as the method could produce aesthetically acceptable results in correcting soft tissue contour defects. Twelve patients with bilateral gluteal concave deformities associated with repeated intragluteal injections were operated on from June 2006 to June 2010. The deformities were classified as major or minor. Overall satisfaction with body appearance after gluteal fat grafting and liposculpture was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). The evaluation was performed at 3-44months after surgery. The average volume of fat injected was 196.9±41.4ml. No serious adverse events occurred. One patient with major deformity had one additional fat grafting procedure. One patient developed cellulitis in the feet and lower legs, upon which the grafted areas were incised and drained on suspicion of infection but with negative cultures. The patient recovered uneventfully with intravenous antibiotic application for 7days. At the office visit nine cases judged that their appearance after the operation as "very good" (4) to "excellent" (5) and three cases responded that their contour was "good." Improvement in skin texture and alleviation of the pigmentation in the concave area were observed in all cases during the 3-44-month follow-up intervals after the fat grafting, and softening of the hypertrophic scar was also observed as early as 1month after the fat grafting and continuously improved during the 12-month follow-up. Autologous lipografting for gluteal concave deformity, combining a liposculpture procedure adjacent to the defects, accomplishes good aesthetic results with high patient satisfaction. The key to success is complete release of fibrosis adhesion, meticulous manipulation of fat grafts, and multitunnel and multiplane injections to ensure maximum take of the grafts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correction of post-traumatic orbital deformities: operative techniques and review of 26 patients