Angular Deformity Research Articles

Correction of Angular Limb Deformities in Two Dogs Using a Conformation-Based Surgical Approach and Planning Software

AbstractThe aim of this study is to describe a novel conformation-based approach to surgical planning and execution, as well as novel orthopaedic planning and rehearsal software. This report presents two cases of angular limb deformity correction, utilizing a novel conformation-based technique. A combination of computed tomography and radiographs was used to characterize the deformities for each case. Case 1 presented with a biapical deformity of the left antebrachium. Case 2 presented with deformities affecting the left femur and tibia. Rendering of a three-dimensional (3D) bone model, surgical planning, and production of multistep surgical jigs were executed using a traditional mesh-modeling workflow for case 1, whereas case 2 utilized the described novel software. No intraoperative complications were encountered while using the surgical kits. The multistep surgical jigs facilitated major procedural steps with precision, including application of definitive fixation. The novel software reduced the surgical planning time and the operator's requirement for 3D modeling skill. All osteotomies were stabilized in compression with acceptable alignment and good patient outcomes. This novel conformation-based approach and planning software, developed by the corresponding author, may provide an alternative method of correcting canine angular limb deformities. Further research on this technique and software is indicated before commercial availability.

Updated Blocking Techniques for Lower Extremity Medullary Nailing: Beyond the Concavity of Deformity

Modern blocking techniques are useful to achieve anatomic alignment and stable fixation during end-segment nailing. Whether with screws or drill bits, blocking implants can correct both angular and translational deformities. Understanding the biomechanics of blocking implants allows the surgeon to properly plan their placement based on principles rather than dogma. We use case examples to highlight updates in blocking techniques during acute surgical fixation and chronic deformity correction.

Acute shortening and angulation for complex open fractures: an updated perspective

Summary: Reestablishing an intact, healthy soft tissue envelope is a critical step in managing lower extremity injuries, particularly high-grade open tibia fractures. Acute shortening and angulation can be used independently or together to address complex soft tissue injuries, particularly when bone loss is present. These techniques facilitate management of difficult wounds and can be combined with local soft tissue rearrangement or pedicled flaps as needed, avoiding the need for free tissue transfer. After angular deformity correction, adjacent bone loss can be addressed with bone grafting or distraction histogenesis. This article discusses the indications for, surgical technique for, and limitations of acute shortening and angulation for management of open lower extremity fractures.

Modifiable and non-modifiable risk factors for failure of non-operative treatment of pediatric forearm fractures: Where can we do better?

Distal third forearm fractures are common fractures in children. While outcomes are generally excellent, some patients fail initial non-operative management and require intervention. The purpose of this study is to identify independent risk factors associated with failure of closed reduction. We conducted a retrospective review of distal third forearm fractures in children treated with closed reduction and casting. Patients were divided into two cohorts-those who were successfully closed reduced and those who failed initial non-operative management. Demographic characteristics, cast type, cast index, radiographic fracture, soft tissue characteristics, and quality of reduction were analyzed between groups. A total of 207 children treated for distal third forearm fractures were included for analysis. A total of 190 (91.8%) children maintained their reduction while 17 (8.2%) failed initial non-operative management. Modifiable risk factors associated with loss of reduction on univariate analysis included the use of a long arm cast (p = 0.003), increased post-reduction displacement (p = 0.02), and increased post-reduction angular deformity (p = 0.01). Non-modifiable risk factors included increased body mass index (p = 0.02), increased presenting fracture displacement (p = 0.002), and increased width of the soft tissue envelope at the fracture site (p = 0.0001). The use of long arm casts (13% vs 2%, odds ratio = 6.44) and soft tissue width (60.6 vs 50.4 mm, odds ratio = 1.1) remained significant risk factors for loss of reduction after multivariate analysis. Both larger soft tissue envelope at the site of the fracture and long arm cast immobilization are independently associated with an increased risk of failing initial closed reduction in distal third forearm fractures in the pediatric population. level III Case Control Study.

Impact of telescopic intramedullary rodding on the growth of tibia: Comparative experimental study in dogs

IntroductionThe most commonly accepted method of long bone deformity correction in children with osteogenesis imperfecta is surgical realignment with transphyseal telescopic intramedullary rodding. This approach ensures reinforcement of the bone throughout the growth period. Although longitudinal growth does occur with these implants there has been very little work carried out to calculate the effect of such factors as rod position or implant material on growth. We carried out a prospective comparative study on 12 puppies using titanium alloy telescopic tibial rods with and without hydroxyl-apatite coating. The aim of this non-randomized controlled experimental study was to assess the impact of telescopic intramedullary rodding on spontaneous growth of the tibia. Material and methodsTwelve mongrel puppies aged of 5 months underwent intramedullary transphyseal rodding of the right tibia. In group I (6 dogs) a titanium telescopic rod was used, in group II (6 dogs) a titanium rod with hydroxyapatite (HA)-coated threaded end was used. The following radiological criteria were assessed before surgery and every month until age of 12 months (natural fusion of physes in dogs): length of tibia, amount of superposition of inner (male) rod into external (female) rod; alteration of anatomy in terms of joint angles (mMPTA, mLDTA, mPPTA, mADTA); positioning of threaded ends in proximal and distal epiphyses and evidence of premature growth arrest. Parameters were compared with left tibia serving as control segment. The null hypothesis was that neither rod position nor implant material altered growth. ResultsThe transphyseal rods did not lead to irreversible epiphysiodesis in either group. In group II (HA-coated) some loss of residual length was found in all six dogs, over 7mm (5.9%) in comparison to left intact tibia. In contrast to that, in group I (titanium nail) only one animal (16.7%) demonstrated a tibia length discrepancy of 8mm (4.8%). Eccentric ( posterior) positioning of the rod in the distal epiphysis resulted in a procurvatum deformity (increased anterior distal tibial angle) in both groups. We found no failure of telescoping and no loss of fixation of threaded parts in either epiphyses. DiscussionThe presence of telescopic rods with HA-coated threads parts clearly contributes to inhibition of spontaneous longitudinal growth. We hypothesize that HA stimulates maturation of chondrocytes of growth plate. Our findings regarding the potential adverse effect of thread position in the distal physis demonstrate the importance of attempting to place the rod as central as possible. ConclusionTitanium alloy telescopic rods did not reveal significant effect on physeal growth in puppies in comparison to HA-coated implants. Transphyseal HA-coated implants did however inhibit growth plate function with mean loss of length of 5.2% compared to the other side. Eccentric positioning of rods relative to center of physis resulted in angular deformity due to irregular growth. There were no cases of mechanical failure or loss of telescopic function with either group of titanium implant. Level of evidenceII; prospective comparative experimental study.

TENS in Femoral Shaft Fractures of Children

Background: Pediatric femoral shaft fractures are one of the common fractures that we encounter in the orthopedics outpatient department. These fractures have various treatment options ranging from traction and early hip spica casting to elastic titanium intramedullary nails [titanium elastic nailing system (TENS)] and reamed intramedullary nails. In this study, we are evaluating the functional outcome and results following the use of flexible intramedullary nails and conservative management for femoral shaft fractures in children.
 Methods: This was a prospective observational study which was carried out in a tertiary care hospital from October 2015 to May 2017 for two groups of children who sustained traumatic femoral shaft fractures. A total of 40 patients were taken into consideration with 20 patients each in two groups.
 Results: The male-to-female ratio was 2.6:1 in our study population. The overall post-operative complication rate was more in the TENS group. Besides, we found that the TENS group of patients had a less limb length discrepancy (LLD) (P = 0.004) and a lower degree of angular deformity (P = 0.36).
 Conclusion: TENS demonstrated advantages including sufficient axial stability, early mobilization, and more rapid return to function than spica cast treatment; however, it had the drawback of possible infection and pin site irritation. Overall, TENS offers a minimally invasive method for treatment of the femoral shaft fractures in children which stands superior to traditional spica casting.

The incidence of physeal fractures in the lower limb and the frequency of premature physeal closure: a cohort study of 236 patients.

Physeal fractures represent 15-20% of all pediatric fractures and may lead to premature physeal closure (PPC). The aim of our study was to determine the incidence rates of physeal fractures in the lower limb and the proportion of PPC that lead to limb length discrepancy (LLD), and/or angular deformity (AD). This retrospective study included 236 consecutive children with physeal fracture in the tibia, distal femur, or distal fibula. We estimated incidence rates and reviewed medical records and radiographs to obtain information regarding the development of PPC leading to LLD and AD. Of the 236 children, 100 had planned growth control or were referred for growth control due to symptoms of PPC. The total incidence rate was 35 (95% CI 30-39) per 100,000 person-years, with 1.2 (CI 0.5-23) for distal femur, 5.7 (CI 3.1-7.8) for proximal tibia, 14 (CI 11-17) for distal tibia, and 14 (CI 11-17) for distal fibula. The overall prevalence of PPC was 9.7% (CI 6.3-14), while the prevalence was 38% (CI 8.5-76) for distal femur, 15% (CI 5.9-31) for proximal tibia, 14% (CI 7.4--22) for distal tibia, and 1.1% (CI 0.3--59) for distal fibula. We found a significant higher hazard of PPC in fractures with ≥ 3 mm displacement (hazard ratio: 12, CI 1.5-97). 10% of children with physeal fractures developed PPC that led to LLD or AD. The highest hazard ratio was in children who had an initial fracture displacement. This study highlights the importance of routine and uniform growth evaluation after a physeal fracture.

Accuracy of the hexapod external fixator in treating tibial angular deformities with or without limb length discrepancy: a retrospective study.

Hexapod external fixator systems allow simultaneous deformity correction in multiple planes as well as limb lengthening. The aim of this study is to evaluate the accuracy of a hexapod frame (smart correction frame) in different types of tibial deformities requiring correction with or without lengthening. A total of 54 tibial angular deformities and limb length discrepancies operated with a hexapod frame between January 2015 and January 2021 were classified into four groups: "Group A (n = 13): only lengthening," "Group B (n = 14): lengthening and uniplanar correction," "Group C (n = 16): only uniplanar correction," and "Group D (n = 11): biplanar correction." The accuracy of angular deformity correction/lengthening was calculated by dividing the actual correction/lengthening achieved after frame removal by the preoperative planned lengthening/correction. The lengthening accuracy in Group A and Group B was 96.3 ± 7.1% and 95.7 ± 5.9%, respectively (P = 0.685). The angular deformity correction accuracy was 85.1 ± 9.9% for Group B, 85.2 ± 13.9% for Group C, and 80.2 ± 18.4% for Group D (P = 0.852). A revision program was performed in six cases (1 in Group B, 1 in Group C, and 4 in Group D) for full correction of the deformities. The accuracy of tibial lengthening is high with the hexapod frame and is minimally affected by simultaneous deformity correction; however, the accuracy of angular correction slightly reduces as the deformity becomes more complex. Surgeons should be aware that reprogramming may be required after complex deformity correction.

Early-life limb deformities in Thoroughbred foals and investigation of their associations with mare- and pregnancy-related factors

Angular and flexural limb deformities (LD) are important causes of early-life morbidity and mortality in Thoroughbred foals. There is believed to be an important congenital component however, the exact etiologies remain unknown. We hypothesized that maternal- and pregnancy-level factors, particularly those with potential to influence in-utero growth and development, could play an important role. The aims of this study were to estimate the incidence of early-life LD in foals and to investigate associations with mare- and pregnancy-level factors. A Thoroughbred birth cohort was established on seven farms across the United Kingdom and Ireland and details of veterinary interventions for LD in foals in the first 6-months of life prospectively recorded. Where available, details of dams’ signalment, breeding history and reproductive history in the breeding season(s) of interest were retrospectively retrieved from stud and veterinary records. Analyses were carried out at the pregnancy resulting in the birth of a live foal-level. Incidence risk of LD was estimated as number of new cases requiring veterinary intervention at least once within the first 6-months of life, and associations with mare and pregnancy factors were assessed using mixed effects, multivariable logistic regression modelling. Data were available for 275 pregnancies, in 235 mares sired by 89 stallions over two breeding seasons (2018 and 2019). Records allowed for the evaluation of nine factors as fixed effects (the mares’residing stud farm, age, status and number of previous live foals, month of covering, breeding season, fetal sex, gestation length and whether dystocia was reported). Pregnancies resulted in the birth of 272 live foals (n=3 died during parturition), 21% of which (n=57/272, 95% confidence interval 16-26) required veterinary intervention at least once for LD in the first 6-months of life. Seventy-five percent (n=43/57, 95%CI 63-87) were described as flexural and 25% (n=14/57, 95%CI 15-37) as angular deformities; median age at veterinary intervention was 9 days (inter-quartile range 1-19). Only gestation length was retained in the final model; model fit was not improved by inclusion of farm, mare or stallion as a random effect (likelihood ratio tests P=0.10, P=0.36 and P=0.92, respectively). Odds of LD decreased by 4% per day increase in gestation length between 314-381 days (OR 0.96, 95%CI 0.93-0.99, P=0.01). The main limitations of this work were the retrospective nature of the mare data, which were not recorded specifically for this study, and the use of veterinary records to identify disease, which may underestimate the true incidence of LD in the population. In conclusion, longer gestation length appears to reduce the odds of early-life LD in Thoroughbred foals. Further work is required to elucidate the biological mechanisms behind this association.

The efficacy of hemiepiphysiodesis for idiopathic knee coronal angular deformity by reconstruction plate and screw: A pilot study.

Angular deformities of the lower extremities are among the most common findings in pediatric orthopedics. Alteration of the mechanical axis in the lower extremity affects the cosmetic appearance and may lead to gait disturbances, knee discomfort, patellar maltracking with or without pain, and early joint osteoarthritis. In the current study, we aimed to investigate the efficacy of 3-hole 3.5 mm reconstruction plates in tension-band temporary hemiepiphysiodesis for correcting idiopathic knee coronal angular deformities. The surgical procedure was performed using an extraperiosteal tension band plate (a 3-hole reconstruction plate) and two 3.5 mm cortical screws to treat idiopathic knee coronal angular deformity in children. The location of the hemiepiphysiodesis was determined based on the type of angular deformity present. Postoperative follow-ups were conducted through x-rays to measure the medial proximal tibial angleand lateral distal femoral angleof the limbs. Statistical analysis was then performed to evaluate the efficacy of the surgical treatment based on the rate of alignment change exhibited. The study included 14 patients (25 limbs) with genu valgum deformity who underwent temporary hemiepiphysiodesis on both the distal femur and proximal tibia, with 16 proximal tibias and 15 distal femurs being corrected. The correction rate for genu valgum was found to be 0.59° per month for both proximal tibial and distal femoral hemiepiphysiodesis. Six patients (12 limbs) were also identified with genu varum deformity, and the correction rates for proximal tibial lateral hemiepiphysiodesis and distal femoral lateral hemiepiphysiodesis were 0.85° and 0.15° per month, respectively. During a mean follow-up duration of 11 ± 5.7 months, only one case of physeal plate closure was observed, and there were no other significant complications. Temporary hemiepiphysiodesis with a 3-hole R-plate and two cortical screws takes advantage of physiological physeal growth to successfully treat idiopathic angular deformities with low complication rates.

NEUTRAL WEDGE DISTAL FEMORAL OSTEOTOMY (NWDFO) FOR CORRECTION OF LARGE VALGUS AND VARUS DEFORMITIES: TECHNIQUE AND RESULTS

IntroductionAngular deformities of the distal femur can be corrected by opening, closing and neutral wedge techniques. Opening wedge (OW) and closing wedge (CW) are popular and well described in the literature. CW and OW techniques lead to leg length difference whereas the advantage of neutral wedge (NW) technique has several unique advantages. NW technique maintains limb length, wedge taken from the closing side is utilised on the opening side and since the angular correction is only half of the measured wedge on either side, translation of distal fragment is minimum. Leg lengths are not altered with this technique hence a useful technique in large deformities. We found no reports of clinical outcomes using NW technique. We present a technique of performing external fixator assisted NW correction of large valgus and varus deformities of distal femur and dual plating and discuss the results.Materials & MethodsWe have treated 20 (22 limbs – 2 patients requiring staged bilateral corrections) patients for distal femoral varus and valgus deformities with CWDFO between 2019 and 2022. Out of these 4 patients (5 limbs) requiring large corrections of distal femoral angular deformities were treated with Neutral Wedge (NW) technique. 3 patients (four limbs) had distal femoral valgus deformity and one distal femoral varus deformity. Indication for NW technique is an angular deformity (varus or valgus of distal femur) requiring > 12 mm opening/closing wedge correction. We approached the closing side first and marked out the half of the calculated wedge with K – wires in a uniplanar fashion. Then an external fixator with two Schanz screws is applied on the opposite side, inserting the distal screw parallel to the articular surface and the proximal screw 6–7 cm proximal to the first pin and at right angles to the femoral shaft mechanical axis. Then the measured wedge is removed and carefully saved. External fixator is now used to close the wedge and over correct, creating an appropriate opening wedge on the opposite side. A Tomofix (Depuoy Synthes) plate is applied on the closing side with two screws proximal to osteotomy and two distally (to be completed later). Next the osteotomy on the opposite side is exposed, the graft is inserted. mLDFA is measured under image intensifier to confirm satisfactory correction. Closing wedge side fixation is then completed followed by fixation of opposite side with a Tomofix or a locking plate.Results3 patients (4 limbs) had genu valgum due to constitutional causes and one was a case of distal femoral varus from a fracture. Preoperative mLDFA ranged from 70–75° and in one case of varus deformity it was 103°. We achieved satisfactory correction of mLDFA in (85–90°) in 4 limbs and one measured 91°. Femoral length was not altered. JLCA was not affected post correction. Patients were allowed to weight bear for transfers for the first six weeks and full weight bearing was allowed at six weeks with crutches until healing of osteotomy. All osteotomies healed at 16–18 weeks (average 16.8 weeks). Patients regained full range of movement. We routinely recommend removal of metal work to facilitate future knee replacement if one is needed. Follow up ranged from 4 months to 2 yrs. Irritation from metal work was noted in 2 patients and resolved after removing the plates at 9 months post-surgery.ConclusionsNWDFO is a good option for large corrections. We describe a technique that facilitates accurate correction of deformity in these complex cases. Osteotomy heals predictably with uniplanar osteotomy and dual plate fixation. Metal work might cause irritation like other osteotomy and plating techniques in this location.

Post infective physeal bar sequelae around knee: Natural history and coronal plane deformities

Backgroundand methodology: The presented retrospective study is a report of 17 children (18 limbs) with post infective physeal bars around the knee. Minimum 2 years follow up post sepsis follow up was available. ObservationsThe mean follow up post infection was 6.9 years. The bar formation manifested mean 22.6 months post sepsis. The angular deformity progressed at the mean monthly rate of 0.84, 0.1, 0.26° for peripheral, central and extensive bars respectively. Peripheral bars underwent early intervention. Balancing of physeal growth using contralateral ‘8’ plate was useful for partial bars. For extensive bars and older patients, complete epiphyseodesis and limb length equalization was used. Articular abnormalities (cupping, flattening, small epiphysis) were associated in 80% bars. Neonatal infections were often multifocal and had articular abnormalities. ConclusionsThe 3 bar types presented with different characteristics. Peripheral bars produced most angular deformities and required early intervention. Articular abnormalities were associated with physeal bars in large number of patients especially those with neonatal infections. Overall unhealthy physis beside bar, delayed manifestations, and limb length discrepancy should be accounted for while planning treatment.

Hemiepiphysiodesis for Lower Extremity Coronal Plane Angular Correction in the Distal Femur and Proximal Tibia in Children With Achondroplasia.

Achondroplasia is the most prevalent form of skeletal dysplasia, affecting more than 250,000 individuals. Lower extremity angular deformities, particularly genu varum, are common in children with achondroplasia, often resulting in pain and limitation of function. The authors aim to determine the utility of lower extremity growth modulation with hemiepiphysiodesis in children with achondroplasia for correction of coronal plane deformities about the knee. The authors performed a retrospective chart review of a single center from 1/1/2000 to 12/31/2020 to identify pediatric patients with achondroplasia treated with hemiepiphysiodesis as their initial procedure at the distal femur and/or proximal tibia. Patients with adequate records and who had completed their treatment were included. Data collected included duration of treatment, complications, need for osteotomy, and radiographic measurements including initial and final mechanical axis deviation, knee mechanical axis zone, mechanical lateral distal femoral angle and medial proximal tibia angle. Ten patients with 17 limbs met our criteria. Nine patients (15 limbs) were treated for genu varum and 1 patient (2 limbs) was treated for genu valgum. Prior to treatment, the mechanical axis fell in zone 3 in 59% of limbs and zone 2 in 41%. Average correction in mechanical axis deviation was 26.1mm. Average change in mechanical lateral distal femoral angle was 10.3 degrees per limb, and average change in medial proximal tibia angle was 7.1 degrees per limb. Average treatment duration was 909 days. At final follow up, 81% (14/17) of limbs had the mechanical axis in zone 1, with the remaining 18% (3/17) in zone 2. No patient/limb underwent subsequent distal femur or proximal tibia osteotomy for coronal plane alignment. Children with achondroplasia can successfully be treated with hemiepiphysiodesis to correct coronal plane deformities at the distal femur and proximal tibia. Using this technique, no patient in our series required an osteotomy for genu varum/valgum. Therapeutic level IV, Case series.

FUNCTIONAL OUTCOME OF BOTH BONE FOREARM FRACTURES IN CHILDREN USING TENS NAILING ORTHOPEDICS

Background: Pediatric diaphyseal forearm fractures are treated with closed reduction and an above elbow cast for a varying period of time, depending on the child's age. Because of unacceptable angular deformities, fracture instability, the presence of an open injury, or the failure of conservative management in the form of re-displacement in the cast following manipulation, some forearm diaphyseal fractures require osteosynthesis. The surgical procedure of choice for diaphyseal forearm fractures in children is an intramedullary xation with titanium elastic nails. When there is cortical contact and a healthy soft tissue envelope, stabilisation offers internal elastic support according to the three-point xing principle. to examine the union rates, clinical results, and functional outcome Objectives: s of both TENS-treated paediatric forearm diaphyseal fractures. We come to the conclusion that TENS nailing is a less inva Conclusion- sive approach for xing and uniting misplaced diaphyseal fractures in children while also offering stability and exibility.

Displaced distal tibial Salter-Harris II fractures.

Salter-Harris II fractures of the distal tibia affect children frequently, and when they are displaced present a treatment dilemma. Treatment primarily aims to restore alignment and prevent premature physeal closure, as this can lead to angular deformity, limb length difference, or both. Current literature is of poor methodological quality and is contradictory as to whether conservative or surgical management is superior in avoiding complications and adverse outcomes. A state of clinical equipoise exists regarding whether displaced distal tibial Salter-Harris II fractures in children should be treated with surgery to achieve anatomical reduction, or whether cast treatment alone will lead to a satisfactory outcome. Systematic review and meta-analysis has concluded that high-quality prospective multicentre research is needed to answer this question. The Outcomes of Displaced Distal tibial fractures: Surgery Or Casts in KidS (ODD SOCKS) trial, funded by the National Institute for Health and Care Research, aims to provide this high-quality research in order to answer this question, which has been identified as a top-five research priority by the British Society for Children's Orthopaedic Surgery.

Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients.

Leg length discrepancies (LLD) are frequently associated with coronal malalignment. Temporary hemiepiphysiodesis (HED) is a well-established procedure for the correction of limb malalignment in skeletally immature patients. For treatment of LLD > 2 cm, lengthening with intramedullary devices gains increasing popularity. However, no studies have investigated the combined application of HED and intramedullary lengthening in skeletally immature patients. This retrospective single-center study evaluated the clinical and radiological outcomes of femoral lengthening with an antegrade intramedullary lengthening nail combined with temporary HED performed in 25 patients (14 females) between 2014 and 2019. Temporary HED through the implantation of flexible staples of the distal femur and/or proximal tibia was either performed prior (n = 11), simultaneously (n = 10) or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4). The median initial LLD was 39.0 mm (35.0-45.0). Twenty-one patients (84%) presented valgus and four (16%) showed varus malalignment. Leg length equalization was achieved in 13 of the skeletally mature patients (62%). The median LLD of the eight patients with residual LLD > 10 mm at skeletal maturity was 15.5 mm (12.8-21.8). Limb realignment was observed in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group. Combining antegrade femoral lengthening and temporary HED is a viable option to correct LLD and coronal limb malalignment in skeletally immature patients; however, achieving limb length equalization and realignment may be difficult in cases of severe LLD and angular deformity, in particular.

Some clinical factors of aseptic instability of the knee joint endoprosthesis

Background. Conducting clinical studies to determine the factors determining the aseptic instability of knee joint endoprosthesis components is an urgent issue in modern orthopedics. The aim of the study was to determine some clinical factors of aseptic instability of knee joint endoprosthesis components. Materials and methods. Comprehensive research was conducted on 285 patients who underwent primary knee arthroplasty between 2010 and 2021, including 85 patients with clinical and radiological signs of aseptic instability of knee arthroplasty components (AIKAC). Also, 200 patients made up a control group with no signs of AIKAC instability observed. Clinical research methods included general, and special orthopedic methods of studying local changes in the knee joint. They included measurement of body mass index (BMI), overloading of the knee joint due to work, previous surgical interventions and early postoperative complications of primary arthroplasty, and presence of angular deformities in the knee joint. For the clinical assessment of the knee joint of patients after knee arthroplasty, we used our own point assessment of the state of the knee joint. Results. It was determined that significant factors for the development of instability of components of the knee joint endoprosthesis are both directly related to the patient (increase in BMI, difficult working conditions, the presence of operative interventions on the knee joint), and factors related to errors during the primary total arthroplasty (residual deformities of the knee joint and early postoperative complications). Conclusions. We determined important factors of aseptic instability of the knee joint in the patients after arthroplasty. Taking into account the results of this study will improve the diagnosis and treatment of aseptic instability of the knee joint.

Tibia malunion with angular deformity: Corrective osteotomy and intramedullary fixation

Tibia malunion with angular deformity: Corrective osteotomy and intramedullary fixation

Surgical and Health-related Quality of life Outcomes in Children With Congenital Scoliosis During 5-year Follow-up. Comparison to Age and Sex-matched Healthy Controls.

Congenital spinal anomalies represent a heterogeneous group of spinal deformities, of which only progressive or severe curves warrant surgical management. Only a limited number of studies have investigated the impact of surgery on the health-related quality of life and very limited data exists comparing these outcomes to healthy controls. A single surgeon series of 67 consecutive children with congenital scoliosis (mean age at surgery 8.0 y, range: 1.0 to 18.3 y, 28 girls) undergoing hemivertebrectomy (n = 34), instrumented spinal fusion (n = 20), or vertical expandable prosthetic titanium rib procedure (n = 13) with a mean follow-up of 5.8 years (range: 2 to 13 y). The comparison was made to age and sex-matched healthy controls. Outcome measures included the Scoliosis Research Society questionnaire both pre and postoperatively, radiographic outcomes, and complications. The average major curve correction was significantly better in the hemivertebrectomy (60%) and instrumented spinal fusion (51%) than in the vertical expandable prosthetic titanium rib group (24%), respectively ( P < 0.001). Complications were noted in 8 of 67 (12%) children, but all patients recovered fully during follow-up. Pain, self-image, and function domains improved numerically from preoperative to final follow-up, but the pain score was the only one with a statistically significant change ( P = 0.033). The Scoliosis Research Society pain, self-image, and function domain scores remained at a significantly lower level at the final follow-up than in the healthy controls ( P ≤ 0.05), while activity scores improved to a similar level. Surgery for congenital scoliosis improved angular spinal deformities with a reasonable risk of complications. Health-related quality of life outcomes improved from preoperative to final follow-up, but especially pain and function domains remained at a significantly lower level than in the age and sex-matched healthy controls. Level III, therapeutic.

Correction des déformations angulaires des membres inférieurs chez l’enfant à l’aide d’un nouveau système de plaques flexibles

IntroductionTension band plates (TBP) for guided growth (GG) are the gold standard treatment for angular deformities around the knee. EPIFLEX® is a novel flexible TBP that adjusts to the patient's bone anatomy. HypothesisGG using a flexible TBP produces satisfactory correction rates with minor complications in the pediatric population with angular deformities around the knee. Materials and methodsA retrospective evaluation of 33 patients (60 knees) treated for genu varum and valgum with hemiepiphysiodesis using a flexible TBP between 2017 and 2020 was performed. The study aimed to assess correction and complication rates; patients who completed treatment were included regardless of the follow-up times after implant removal. ResultsThirteen females and 20 males with a median age of 10 years were included. The median treatment duration and follow-up were 10 and 22 months. The median monthly rate of change of mLDFA and mMPTA was 0.67° and 0.57°, respectively. A successful correction was achieved in 90% of the cases. There were no cases of infection or implant failure. Four cases presented overcorrection and two undercorrection; no significant relation with deformity or obesity was found. DiscussionGG using this flexible TBP showed satisfactory correction rates with a low incidence of complications and no implant failure. It provides flexibility through good adaptability to the bone anatomy and mobility of the screws avoiding implant protrusion or breakage. Level of evidenceIV; observational descriptive case series.