Center Of Rotation Of Angulation Research Articles

Comparative digital study of two cranial rotation methods of the proximal fragment on the center of rotation of angulation-based leveling osteotomy planning with different tibial distal anatomical axes

The center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) technique was developed for cranial cruciate ligament (CrCL) rupture treatment, aiming to modify the mechanical-anatomical angle (AMA), which is described as a predictive risk factor for the disease and is recommended to be taken into consideration when one is choosing a surgical procedure for tibial plateau slope alteration. Identifying a tibial distal anatomical axis (DAA) is essential in CBLO surgical planning and measuring AMA amplitude. The aim of this study was: to evaluate two methods of cranial rotation of the proximal fragment using four different tibial distal anatomical axes for digital planning on the CBLO technique, comparing its effectiveness in achieving the desired tibial plateau angle (TPAd) and closing the AMA angle. Tibial measurements were made with the vPOP pro software using 30 mediolateral radiographs of canine stifles. The DAA described by four authors was used based on the amount of Rotation completed (Rc) for each. The rotation methods evaluated were: 1) commercial CBLO table (RT) and 2) overlapping the tip of the intercondylar eminence with the corresponding DAA line (RE). The TPAd to be obtained was fixed at 10°, and the final AMA to be achieved at 0°. The mean values and standard deviations of the final TPA and final AMA with the rotation method were TPA(RT)f(%TPAd), TPA(RE)f(%TPAd), AMA(RT)f(%AMAzero), AMA(RE)f(%AMAzero). The results of each author were Hulse 10.0 ± 0.3(46.6%), 9.9 ± 0.1(60%), 0.3 ± 0.3(33.3%), 0.3 ± 0.3(13.3%), Osmond 10.1 ± 0.2(75%), 10,1 ± 0.2(83.3%), 0.4 ± 0.4(33.3%), 0.4 ± 0.3(8,3%), Miles 10.0 ± 0.1(66.6%), 10.0 ± 0.1(75%), 0.2 ± 0.1(16.6%), 0.2 ± 0.1(8.3%), Tudury 9.6 ± 0.6(31.2%), 9.5 ± 0.2(31.2%), 1.0 ± 0.7(18.7%), 1.0 ± 0.6(12.5%), respectively. The initially described RT obtained a higher percentage of AMA at zero degrees. Therefore, the RE method is discarded for use as an alternative to CBLO planning.

Morphologic impact of four surgical techniques to correct excessive tibial plateau angle in dogs: A theoretical radiographic analysis.

To determine morphologic differences between four tibial osteotomy techniques used to correct excessive tibial plateau angle (eTPA). Retrospective radiographic analysis. Sixteen dogs (27 tibias) with eTPA. Virtual corrections of eTPA were performed on sagittal plane radiographs of canine tibia using four tibial osteotomy techniques and categorized into respective groups. Group A represented the center of rotation of angulation (CORA)-based leveling osteotomy (CBLO) and coplanar cranial closing wedge ostectomy (CCWO), Group B the tibial plateau leveling osteotomy (TPLO) and CCWO, Group C the modified CCWO (mCCWO), and Group D the proximal tibial neutral wedge osteotomy (PTNWO). Pre- and post-correction TPA, tibial length and mechanical cranial distal tibial angle (mCrDTA) were measured and compared. Mean TPA prior to correction was 42.67 ± 6.1°. Post-correction mean TPAs were 10.47 ± 2.1°, 6.77 ± 1.6°, 4.76 ± 1.5°, and 7.09 ± 1.3° for Groups A, B, C, and D, respectively. TPA correction accuracy in Groups A and D varied least from target TPAs. Tibial shortening was documented in Group B in contrast to other groups. The greatest mechanical axis shift was identified in Group A. Each technique achieved TPA < 14° despite having different effects on tibial morphology including alteration of tibial length, mechanical axis shift and variation in correctional accuracy. Despite all methods being able to correct eTPA, the choice of technique will affect morphology in unique ways and should be considered prior to surgery to consider the implications in a given patient.

Apex posterior angulation of the humerus: A characterization of normal sagittal plane anatomy with implications for surgical fixation

IntroductionAn understanding of the sagittal plane morphology of the humerus is relevant during surgical fixation of humeral fractures but is not well described in the literature. The purpose of this study was to better characterize the native sagittal plane morphology of the humerus. Materials and methods170 patients with uninjured full length lateral humerus radiographs were retrospectively evaluated. The angle between the proximal humeral diaphyseal axis and the distal humeral diaphyseal axis was identified and measured. The proximal axis was defined by two points equidistant from the anterior and posterior cortex 10 mm and 100 mm distal to the metaphyseal flare, and the distal axis by two points at 10 mm and 50 mm proximal to the capitellum/trochlea. The relative location of the center of rotation of angulation (CORA) was calculated as a percentage of humeral length. Results114 radiographs were included in the analysis (66 right humeri, 48 left humeri). The average apex posterior angulation was 6.5 +/- 2.9°. The CORA occurred at an average of 80% (SD+/-13%) of the length of the humerus (proximal to distal). Total humeral length and absolute distance to CORA were greater in males compared to females (364 ± 50 mm versus 326 ± 30 mm; p<0.001; 290 ± 68 mm versus 260 ± 48 mm; p=0.003), but there were no significant sex differences with respect to magnitude of the apex posterior angulation (p=0.077) or location of CORA as a percentage of total humeral length (p=0.916). There were no statistically significant associations between age and total humeral length (p=0.056), distance to CORA (p=0.130), location of CORA as percentage of total humeral length (p=0.753), or magnitude of angulation (p=0.075). ConclusionAn apex posterior bow consistently exists in the distal one-quarter of the humerus that is consistent across ages and between sexes. This normal anatomic bow is important to recognize to avoid an extension malreduction and has implications for implant fit and contouring.

Identification of the Apex of the Medial Longitudinal Arch Break in Progressive Collapsing Foot Disorder

Category: Midfoot/Forefoot Introduction/Purpose: Progressive Collapsing Foot Disorder (PCFD) is caused by failure of both dynamic and static structures. The aim of this study was to identify the anatomical location of the medial longitudinal arch break in symptomatic flat foot deformity and analyze its relationship with Meary's angle. Methods: We analyzed weight-bearing radiographs of 81 patients [mean age 53.7 years (range, 18-81) with 101 flat feet. The apex of the medial arch break was determined on the lateral foot radiographs as the intersection of the anatomical axis of the talus and the first metatarsal. Therefore, the overall centre of rotation of angulation (CORA) of the medial arch break was documented as the angle at its apex (Meary's angle). Each separate joint angulation was then calculated to determine if the overall CORA was made of separate CORAs. Correlations between the apex location, and the number of apices, with Meary's angle were conducted. Results: There was an isolated apex of deformity in 50.4% (51/101) of cases. These were localised at talonavicular joint (TNJ) in 47% (24/51), the naviculocuneiform joint (NCJ) in 52.9% (27/51) and none at the cuneiform-first metatarsal joint (C-1MTJ). The remaining 49.5% (50/101) had combination apices with the primary deformity being at TNJ in 58% (29/50), the NCJ in 40% (20/50), and 2% (1/50) at the C-1MTJ. The mean Meary's angle was -17.9° for isolated and -18° for combination which was not statistically significant (p=0.92). There was no statistical difference in the talonavicular uncoverage angle between the single and combination apices group (p= 0.99). Conclusion: The apex of the medial arch break occurs distal to the talonavicular joint in the majority of cases, and thereby the main insertion points of the posterior tibial tendon and spring ligament. In 52.9% (27/51) of cases, the deformity occurs solely distal to the TNJ and in 58% (29/50) cases, it involves joints in addition to the TNJ. These will involve pathology of other structures, including the naviculocuneiform ligament. Surgical strategies in successfully correcting Progressive Collapsing Foot Disorder will therefore need to address joints distal to the TNJ in the majority of cases.

Distal Tibia Apex Posterior Angulation: A Normal Anatomic Variant with Side-To-Side Symmetry

Category: Trauma; Ankle Introduction/Purpose: The native sagittal plane alignment of the distal tibia has not been well-described and has implications during the fixation of tibia fractures. Cavovarus foot alignment has been previously thought to influence gastrocsoleus tightness and the potential for anterior talar escape in the setting of an osseous injury in this region. However, the relationship between midfoot alignment and sagittal distal tibia morphology is undescribed. Characterization of this osseous anatomy may be helpful to achieve adequate sagittal alignment during the reduction of distal tibia fractures. The purpose of this study was primarily to characterize distal tibia sagittal morphology and ankle radiographic parameters, determine whether symmetry exists from side-to- side, and secondarily to identify any differences based on midfoot alignment. Methods: 112 patients (60 females, mean age 45.8 years) with bilateral lateral weight-bearing ankle radiographs were retrospectively evaluated (224 ankles). Midfoot morphology was classified as normal, planus, or cavus using Meary's angle (MA) (Planus: MA &lt;-4°, Normal: MA -4°≤x≤4°, Cavus: MA&gt;4°). The angle between the proximal diaphyseal (Line 1) and distal tibia (Line 2) axes was measured, and the location of the center of rotation of angulation (CORA) relative to the plafond was recorded (Figure 1). The horizontal distance (via a line parallel to the floor) from the distal tibia axis (Line 2) to the lateral talar process was measured, as well as the anterior distal tibial angle, and the plafond radius of curvature (ROC). Bilateral ankles and midfoot morphologies were compared using a Mann-Whitney U test and ANOVA, respectively. Correlation was assessed using linear regression. Results: The average distal tibia had 2° of apex posterior angulation with the CORA located 8.0 cm proximal to the plafond. There was no difference by laterality in magnitude of the angulation (p=.358) or distance from the plafond to the CORA (p=.901). The angulation increased as foot alignment transitioned from cavus (1.25°), to normal (1.89°), to planus (3.05°) alignment (r=.32; R2=.102; p&lt;.001). The angulation was larger in men (2.8°) than in women (1.4°) (p&lt;.001) and decreased with increasing patient age (r=.279, R2=.078, p&lt;.001). The lateral talar process was on average 5.9 mm anterior to the distal tibia axis (Line 2), more anterior with cavus versus planus alignment (6.7mm vs. 4.8mm) (p&lt;.001). The average anterior distal tibial angle and plafond ROC were 83.6° and 22.9 mm, respectively, with no significant differences by laterality or midfoot morphology (p&gt;.05 for both). Conclusion: The distal tibia has a consistent apex posterior bow that is symmetric from side-to-side, but variable from patient- to-patient. Distal tibia osseous morphology is related to midfoot alignment, sex, and age. Cavus alignment is additionally correlated with anterior translation of the lateral talar process relative to the distal tibia axis. Surgeons treating distal tibia fractures may consider the use of contralateral imaging as a reduction template to help restore patient-specific sagittal alignment. A tibial nail that ends anterior in the distal segment of a distal tibia fracture should prompt the surgeon to carefully evaluate whether sagittal alignment has been restored.

Neural wedge osteotomy method of correction for cubitus varus deformity in children.

In this study, we evaluated the clinical outcome of neutral wedge osteotomy assisted with the center of rotation of angulation (CORA) method of distal humerus anatomical axis for the treatment of cubitus varus deformity in children. From 2016 to 2019, 20 children with cubitus varus deformity after supracondylar fracture of the humerus were enrolled. Standard anteroposterior radiograph of the humerus was taken preoperatively. The CORA point and angulation angles were obtained by measuring the proximal and distal humerus anatomical axis. During the operation, neutral wedge osteotomy was performed to correct the varus deformity. The Baumann angle and the carrying angle were used to evaluate the correction effect of the distal humeral varus deformity. The average age of the patients was 7.8 years. Patients were followed up for an average of 29.3 months (range, 24–36 months). The average interval between surgery and injury was 12 months. The mean preoperative Baumann angle and carrying angle were 99° (90°–115°) and –14° (range, –10° to –30°), respectively. At the last follow-up, the mean Baumann angle and carrying angle was 76° (70°–80°) and 13.6° (10°–18°), respectively, with 16 cases showing excellent outcome and 4 cases showing good outcome. Our results indicated that the neutral wedge osteotomy assisted with CORA method of distal humerus anatomical axis showed good clinical outcomes in the treatment of cubitus varus deformity in children and is worthy of clinical application. The level of evidence is IV.

Effect of center of rotation of angulation-based leveling osteotomy on ex vivo stifle joint stability following cranial cruciate ligament transection and medial meniscal release with and without a hamstring load.

ObjectiveTo evaluate the effect of center of rotation of angulation (CORA)‐based leveling osteotomy (CBLO) and hamstring load on stifle stability following cranial cruciate ligament transection (CCLx) and medial meniscal release (MMR).Study designEx vivo experimental study.Sample populationCadaver hind limb preparations (n = 7).MethodsAfter instrumentation, constant quadriceps and gastrocnemius loads with an optional hamstring load in a 3:1:0.6 ratio were applied, and stifles were extended from fully flexed using an electrical motor during fluoroscopic recording. The recording process was repeated after each of CCLx, MMR and CBLO and the extracted landmark coordinates were used for calculation of cranial tibial translation (CTT) and patellar ligament angle (PTA).ResultsMean initial tibial plateau angle was 28.1°: post‐CBLO the mean was 9.7°. Cranial tibial translation developed from 50° and 75° with CCLx and MMR respectively (p < .04, < .02) without hamstring loading. Hamstring loading mitigated CTT due to CCLx and delayed CTT until 120° for MMR (P < .02) in this model. CBLO prevented CTT, except at 140° without hamstring loading (P = .01). Similar results were seen for PTA, but CBLO curves were parallel to and lower than intact values at all tested angles (P < .04), consistent with induced effective joint flexion.ConclusionCBLO to a target tibial plateau angle of 10° largely eliminated CTT induced by CCLx and MMR. Hamstring loads of 20% quadriceps load improved stifle stability in this model.ImpactStifle stability following CBLO appears to be multifactorial and depends on meniscal integrity, joint angle, and hamstring strength.

Native tibia valga: a potential source of varus malreduction during intramedullary tibial nail fixation of tibial shaft fractures.

To determine the effect of native tibia valga on intramedullary nail (IMN) fixation of tibial shaft fractures. Retrospective comparative cohort analysis of 110 consecutive patients with tibial shaft fractures undergoing IMN fixation at an urban level one trauma centrewas performed. Medical records and radiographs were reviewed for demographics, tibia centre of rotation of angulation (CORA), nail starting point, incidence of varus malreduction, and nail/canal proportional fit. Tibia valga (CORA of ≥ 3 degrees) was present in 37 (33.6%) patients. The anatomic nail starting point distance (in relation to the lateral tibial spine) was significantly greater in the tibia valga group (12.0mm vs. 5.0mm, mean difference: 7.1mm, 95% CI: 5.8 to 8.3mm, p < 0.0001). Varus malreduction was more common in the tibia valga group (10.8% vs. 1.4%, proportional difference: 9.4%, 95% CI: - 1.0 to 21.3%, p = 0.04). Varus malreduction in the tibia valga group was associated with a decreased nail width/inner canal width proportion on multivariate analysis (OR = 0.683, 95% CI: 0.468 to 0.995, p = 0.0004). Native tibia valga is common, and the use of a standard coronal IMN starting point with poor nail fit can lead to iatrogenic varus malreduction. In patients with tibia valga, maximizing nail fit or utilization of a medial starting point should be considered.

Automatic Femoral Deformity Analysis Based on the Constrained Local Models and Hough Forest.

Clinically, Taylor spatial frame (TSF) is usually used to correct femoral deformity. The first step in correction is to analyze skeletal deformities and measure the center of rotation of angulation (CORA). Since the above work needs to be done manually, the doctor's workload is heavy. Therefore, an automatic femoral deformity analysis system was proposed. Firstly, the Hough forest and constrained local models were trained on the femur image set. Then, the position and size of the femur in the X-ray image were detected by the trained Hough forest. Furthermore, the position and size were served as the initial values of the trained constrained local models to fit the femoral contour. Finally, the anatomical axis line of the proximal femur and the anatomical axis line of the distal femur could be drawn according to the fitting results. According to these lines, CORA can be found. Compared with manual measurement by doctors, the average error of the hip joint orientation line was 1.7°, the standard deviation was 1.75, the average error of the anatomic axis line of the proximal femur was 2.9°, and the standard deviation was 3.57. The automatic femoral deformity analysis system meets the accuracy requirements of orthopedics and can significantly reduce the workload of doctors.

Evaluation of the Radial Procurvatum Using the Center of Rotation of Angulation Methodology in Chondrodystrophic Dogs.

The radial joint orientation angles were calculated using the center of rotation of angulation (CORA) methodology within the frontal and sagittal planes in chondrodystrophic dog breeds, including Welsh Corgi, Dachshund, Pekinese, Poodle, Beagle and Maltese, and it was compared whether there is a statistically significant difference between the breeds. Radial joint orientation angles were obtained in eighty-eight dogs, including 23 Welsh Corgis, 16 Dachshunds, 14 Pekinese, 13 Maltese, 12 Poodles and 10 Beagles. Using the CORA methodology, the cranial proximal radial angle (CrPRA) and caudal distal radial angle (CdDRA) in the sagittal plane and medial proximal radial angle (MPRA) and lateral distal radial angle (LDRA) in the frontal plane were measured for the six breeds studied. The mean values of joint angles for each breed were compared statistically were observed. The CrPRA, CdDRA, and LDRA mean values of Dachshund and Welsh Corgi breeds were significantly smaller than other breeds, and in MPRA, Pekingese showed significantly smaller values than other breeds. This study confirms that the mean values of radial joint orientation angles can be significantly different among chondrodystrophic breeds. To accurately evaluate the degree of angular deformity of the radius, it may be helpful to refer to the average value for each breed with chondrodystrophy.

Geometric modelling of CORA-based levelling osteotomy in the dog

Centre of rotation of angulation (CORA)-based levelling osteotomy (CBLO) is a recent addition to surgical procedures for stabilization of the cranial cruciate ligament-deficient canine stifle joint. Careful identification of the CORA location preoperatively and use of this location intraoperatively are required to ensure accurate correction of the tibial plateau angle. Limited data are available regarding the magnitude and source of potential errors during planning and execution of CBLO. A geometric model enabling isolation of various error sources is described.Landmarks were derived from tibial radiographs (n = 50) by 5 observers and used to define proximal and distal anatomical axes for simulation of CBLO. Observer-specific CORA locations with mean landmark data were used to assess planning errors, and simulated malpositioning of the CORA at 10 mm from the ideal location was used to assess surgical errors.Planning errors result mainly from tibial plateau misidentification, with CORA locations dispersed up to ±10 mm proximodistally from ideal (95% confidence). Malpositioning of the CORA during surgery causes equal and opposite changes in tibial plateau angle (TPA) and anatomical-mechanical axis angles, and varying degrees of translation and limb length changes. The magnitude of these changes is dependent on initial TPA and limb length, with smaller dogs and steeper tibial plateaus resulting in larger errors.Optimal planning and execution are required to achieve the planned outcome of CBLO. The main source of error in our simulation is identification of the tibial plateau. While both pre- and intraoperative errors influenced TPA, based on our geometric model the effect in larger dogs may not be clinically significant. If distalisation of the CORA is required during surgery, compensation of the CORA angle to maintain the target TPA is possible.

An Easy and Economical Way to Produce a Three-Dimensional Bone Phantom in a Dog with Antebrachial Deformities.

Simple SummaryAccurate planning, for corrective surgeries in case of bone cutting, is necessary to obtain a precise coordination of the skeleton and to achieve the owner’s satisfaction. The present experiment displays a simple and cost-effective technique for surgical planning, utilizing a 3-D bone phantom model in a dog with foreleg deformity. 3-D surgical planning for restorative osteotomy is costly and time-consuming because surgeons need to be helped from commercial companies to get 3-D printed bones. However, practitioners can save time and keep the cost to a minimum by utilizing free software and establishing their 3-D printers locally. Surgical planning for the corrective osteotomy of antebrachial growth deformities (AGD) is challenging for several reasons (the nature of the biapical or multiapical conformational abnormalities and lack of a reference value for the specific breed). Pre-operative planning challenges include: a definite description of the position of the center of rotation of angulation (CORA) and proper positioning of the osteotomies applicable to the CORA. In the present study, we demonstrated an accurate and reproducible bone-cutting technique using patient-specific instrumentations (PSI) 3-D technology. The results of the location precision showed that, by using PSIs, the surgeons were able to accurately replicate preoperative resection planning. PSI results also indicate that PSI technology provides a smaller standard deviation than the freehand method. PSI technology performed in the distal radial angular deformity may provide good cutting accuracy. In conclusion, the PSI technology may improve bone-cutting accuracy during corrective osteotomy by providing clinically acceptable margins.

Effect of proximal abducting ulnar osteotomy (PAUL) on frontal plane thoracic limb alignment: An ex vivo canine study.

To determine the effect of proximal abducting ulnar osteotomy (PAUL) on frontal plane thoracic limb alignment in standing and recumbent positions. Ex vivo cadaveric study. Canine thoracic limbs (n = 15 limb pairs). Limbs were acquired from healthy Labrador retrievers that had been euthanized for reasons unrelated to this study. A limb press was used to obtain standing and recumbent caudocranial radiographs before and after PAUL. Foot lateralization and rotation were directly measured in standing position. Mechanical joint angles were determined using full limb radiographic montages and the center of rotation of angulation (CORA) method for pre-PAUL (Pre), 2-mm PAUL (PAUL2), and 3-mm PAUL (PAUL3). Data are reported as mean ± SD and 95% CI. Mixed linear modeling was used to identify differences in limb alignment values and foot position, with significance established at P ≤ .004. There were differences in five of 12 limb alignment values pre-PAUL and post-PAUL in standing and recumbent positions. In the standing position, there was an increase in mechanical medial proximal radioulnar angle (Pre, 80.6° ± 2.5°; PAUL2, 82.6° ± 2.4°; PAUL3, 84° ± 2.4°) and a decrease in elbow compression angle (Pre, 1.4° ± 1.3°; PAUL2, 1° ± 0.9°; PAUL3, 0.8° ± 1°). There was a movement of mechanical humeral radioulnar angle (Pre, -8.9° ± 2.8°; PAUL2, -6.1° ± 2.7°; PAUL3, -5.2 ± 2.7°), mechanical thoracic humeral angle (Pre, 3.9° ± 1.7°; PAUL2, 2.4° ± 1.4°; PAUL3, 2.6° ± 1.5°), and elbow mechanical axis deviation (Pre, 1.9% ± 1.1%; PAUL2, 0.9% ± 1.1%; PAUL3, 0.4% ± 1.4%) toward a value of "0" representing coaxial alignment of the limb. The foot underwent lateralization (Pre, 1.4 ± 0.6 cm; PAUL2, 1.8 ± 0.7 cm; PAUL3, 2.3 ± 0.7 cm) and external rotation (Pre, 10.5° ± 4.7°; PAUL2, 13.7° ± 5.1°; PAUL3, 16° ± 6.6°). In the ex vivo setting, PAUL resulted in translation of the mechanical axis of the thoracic limb from a medial to lateral direction through alterations in limb alignment values associated with the elbow, humerus, and proximal radius/ulna. Additional studies are required to determine whether PAUL alters thoracic limb alignment in client-owned dogs.

Outcome of Dome Osteotomy With Plate Osteosynthesis for Genu Valgum in Late Adolescents and Young Adults.

AimTo evaluate the degree of correction and outcomes after correction of genu valgum deformity using dome osteotomy with plate osteosynthesis in late adolescents and young adults.MethodsA total of 27 knees in 21 patients underwent correction using dome osteotomy fixed with 3.5-mm low-profile proximal humeral locking system (PHILOS) plate. The functional, clinical, and radiological assessments were performed preoperatively and at six months postoperatively. Functional assessment was performed using the Bostman score, while clinical and radiological assessments were performed by measuring intermalleolar distance, tibiofemoral angle, mechanical lateral distal femoral angle, and mechanical axis deviation. All values were compared preoperatively and postoperatively using the paired t-test and Wilcoxon’s test.ResultsThe comparison between preoperative and postoperative data was statistically significant (P<0.0001). Twenty patients had an excellent knee score, and one patient had a good score. None had an unsatisfactory score.ConclusionsDome osteotomy fixed with well-contoured, 3.5-mm low-profile PHILOS plate allows deformity correction at the CORA (center of rotation of angulation) of the knee and permits early knee mobilization without significant procedure or implant-related complications with excellent outcomes.

Clinical comparison between two stabilization methods in distal tibial angular deviation corrected by the CORA method

Background: Angular deformity is characterized by the deviation of part of the bone that can occur in three different planes, frontal, sagittal and transverse. Trauma on physeal plates is the most common cause of angular deviations of the limbs in dogs. Currently the CORA (Center of Rotation of Angulation) methodology is the best way to evaluate and surgically correct these deformities. The objective of this study is to describe the surgical procedures performed to treat the uniapical valgus deviation affecting both tibial bones in a dog, comparing the outcomes of hybrid external skeletal fixator used in the right pelvic limb in relation to the locking plate used in the left pelvic limb.Case: A 10-month old Border Collie dog was attended at the University Veterinary Hospital with history of lameness and deviation of both pelvic limbs. In the orthopedic examination, it was possible to identify bilateral valgus deviation in the region of the tibio-tarsal joints and moderate lameness, with absence of pain or joint crepitation. Radiographic examination showed that the deformity was only uniapical in the frontal plane, affecting both tibial bones of the dog. Signs of osteoarthrosis were not observed and the preoperative examinations were within the normal limits for the species. The deformities were corrected in two surgical times starting with the procedure in the right tibia, which appeared to be clinically worse. Due to the fact that it was a bilateral affection and there was not a healthy pelvic limb to obtain the normal angles values of this dog, for planning according to the CORA methodology, the values of the tibial mechanical angles for dogs of similar size were taken from the literature. For surgical correction of the right tibia, a closed wedge osteotomy was performed following the second rule of Paley, with bone stabilization using type IB hybrid external skeletal fixator (ESF). The radiographic follow-up was done every 30 days postoperatively, however at 60 days the dog presented with severe lameness and the ESF had to be removed due to the breaking of one of the wires that composed the ring of the hybrid system. The limb continued to be treated by external bandages and total bone healing occurred at 210 days after surgery. Only after the complete recovery of the right limb, the left pelvic limb was operated and was also corrected by closed wedge osteotomy from the second Paley's rule. However, the bone stabilization was achieved with the use of a T-shaped locking plate. Radiographic follow-up was performed every 30 days postoperatively and at 60 days the osteotomy gap was already consolidated and the dog showed good weight bearing in the pelvic limbs without signs of lameness or pain.Discussion: Currently, it is indicated that bone deformities in small animals should be corrected using the CORA methodology. The hybrid ESF is one of the most commonly used fixation systems for bone stabilization after corrective osteotomies due to great versatility, however, the reported complication rates are relatively high. The locking plates with special shapes, such as the "T" plate used in this study, provide the stable fixation of osteotomies with limited bone stock, as they allow the introduction of larger number of screws per area. Thus, this latter type of implant becomes advantageous for the correction of bone deformities close to the joints. It is concluded that CORA methodology is really effective in the planning of corrective surgeries of angular deviations in dogs. In this case report, the resulting tibial angles after the surgical corrections were within the normal range for healthy dogs of similar size. However, the use of locking plate provided better results with early bone healing and fewer complications than the type IB hybrid ESF.

Comparative study of early functional outcome between cruciate retaining knee and 3D knee: who is more satisfied?

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; With growing demand on quality of life, there is drastic increase in total knee arthroplasty (TKA) surgeries and accordingly there is increase in research on TKA design to get the best possible outcome. Commonly known TKA designs are PCL substituting or retaining, fixed bearing or mobile bearing. Now the scientific research shifted to center of rotation of angulation (CORA) of knee i.e. medial or lateral pivot. 3D knee is based on lateral pivot system and designed to match the natural knee. The purpose of this study is to compare 3D knee with cruciate retaining (CR) knee functionally and also to assess the patient’s level of satisfaction.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 20 patients each included in 3D knee and CR knee group from June 2016 to June 2018 who satisfied the inclusion and exclusion criteria. Patients were followed up for 1 year. Their functional outcome assessed using knee society score (KSS) part 1 and 2. Also patient’s knee range of motion documented separately.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Postoperatively there is improvement in knee society score in both the groups. 3D knee showed significant better KSS score than CR knee groups in first 3 months but as the patients followed up for 1 year both groups reached similar KSS score and also similar knee range of motion.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 3D knee showed satisfactory outcome when compared with CR knee and definitely provides a step ahead in search of natural knee.&lt;/p&gt;

Correction of Biapical Tibial Deformity by True Spherical Osteotomy, Modified Circular External Skeletal Fixation and Distraction Osteogenesis

Objectives The aim of this study was to describe a case of biapical tibial deformity as a result of premature distal physeal closure corrected by true spherical osteotomy, circular external skeletal fixation and distraction osteogenesis. Methods A 6-month-old male Labrador Retriever was presented for the evaluation and treatment of angular limb deformity of the left pelvic limb, with radiography and computed tomography revealing a multiplanar, biapical, compensatory tibial growth deformity, with marked distal tibial recurvatum and varus. A true spherical osteotomy was performed at the distal tibial centre of rotation of angulation (CORA), allowing for correction of the deformity in three planes, with a transverse osteotomy performed at the most proximal CORA. A circular external skeletal fixator was applied and distraction osteogenesis performed at the transverse osteotomy. Latency, distraction osteogenesis, and consolidation were performed over a 113-day period. Results At frame removal, tibial length discrepancy improved from 16.8% to 0.6% and frontal plane varus angulation improvement from 20° to 5°, when compared with the contralateral limb. Long-term evaluation revealed a satisfactory clinical and cosmetic outcome, judged by the clinician and owners, with force plate analysed symmetry index of the pelvic limb within reported normal limits. Clinical significance To our knowledge this is the first case report illustrating the value of true spherical osteotomy for the treatment of an angular limb deformity when performed in combination with distraction osteogenesis in a canine pelvic limb.

Znaczenie kryteriów biomechanicznych w prawidłowym planowaniu leczenia choroby zwyrodnieniowej stawu kolanowego

Following the established and unequivocal criteria when choosing the treatment of knee osteoarthritis, despite possibility of precise imaging, is still very problematic. This is partly because doctors of different disciplines: general practitioners, orthopaedic surgeons, rheumatologists, physiotherapists, are involved in the treatment of this disease. For most of them the basic criteria to implement the treatment are: pain and assessment of X -ray in the supine position. As a result of that, despite slight and doubtful improvement, treatment is improperly targeted and extended. The aim of the study was to prove that the correct diagnosis, including biomechanical characteristics of the affected limb, choice of correct treatment, and observance of indications, can shorten treatment, make it more efficient and less expensive. We analyzed of 103 patients qualified for total knee arthroplasty between 2006 and 2011. The indication was primary and advanced knee osteoarthritis in phases III and IV according to Ahlbäcka scale medial displacement of mechanical axis deviation in the lower limb with club- -foot (I to IV degrees) and with centre of rotation of angulation (CORA) in the proximal part of the tibia. Only subjects with body mass index under 25 were included in the study. Surveys were used to assess the pre -operative duration of illness, non-surgical methods of treatment and their effects. Final evaluation was made using the Visual Analogue Scale (10 -degrees) of pain (during the effort and rest) and gait efficiency 30 days after completed treatment. The 66.5% of patients showed no significant improvement in all assessed parameters, which would justify to continuation of the therapy as described above.

Proximal tibial anterior open-wedge oblique osteotomy: A novel technique to correct genu recurvatum

BackgroundFor successful acute correction of genu recurvatum, accurate correction of plateau angle, restoration of anatomical axis, rigid fixation, and preservation of patellar height are essential. However, a surgical treatment that satisfies all these conditions has not yet been established. The purpose of this study was to evaluate the novel technique of proximal tibial anterior open-wedge oblique osteotomy (PT-AOWOO) for the treatment of genu recurvatum. MethodsFive patients with genu recurvatum underwent PT-AOWOO from 2008 to 2013. The open-wedge center of rotation of angulation (CORA) was determined by the intersection of transverse bisector line and tibial posterior cortex to prevent secondary translational deformity. An osteotomy was performed from the distal margin of the tibial tuberosity to the planned CORA to maintain patellar height and provide sufficient space for fixation. The opening gap was calculated by the picture-archiving and communications system (PACS)–Photoshop method. ResultsThe mean angle of recurvatum was 17° (range, 14 to 25°) preoperatively and −0.4° (range, −5° to 5°) postoperatively. The mean angle of the tibial plateau was 79.8° (range, 67 to 85°) preoperatively and 98.4° (range, 95 to 105°) postoperatively. Tibial anatomical axis was restored and the patellar height was maintained in all patients. The overall results were excellent in three patients and good in two patients. ConclusionsThe PT-AOWOO and its unique osteotomy level corrected the tibial plateau angle accurately, restored the sagittal tibial axis without translation, maintained patellar height, and enabled rigid fixation. This technique showed satisfactory radiologic and clinical outcomes without any complications.

The Effect of Sliding Humeral Osteotomy (SHO) on Frontal Plane Thoracic Limb Alignment: An Ex Vivo Canine Cadaveric Study.

To determine the effect of sliding humeral osteotomy (SHO) on frontal plane thoracic limb alignment in standing and recumbent limb positions. Canine cadaveric study. Canine thoracic limbs (n=15 limb pairs). Limbs acquired from healthy Labrador Retrievers euthanatized for reasons unrelated to this study were mounted in a limb press and aligned in a standing position followed by axial loading at 30% body weight. Frontal plane radiography was performed in standing and recumbent positions pre- and post-SHO. In the standing position, lateralization of the foot was measured pre- and post-SHO using a textured grid secured to the limb press base plate. Twelve thoracic limb alignment values (mean ± SD and 95% CI) were determined using the center of rotation of angulation (CORA) method were compared using linear mixed models to determine if significant differences existed between limb alignment values pre- or post-SHO, controlling for dog, limb, and limb position. Six of 12 standing or recumbent alignment values were significantly different pre- and post-SHO. SHO resulted in decreased mechanical lateral distal humeral angle and movement of the mechanical humeral radio-ulnar angle, radio-ulnar metacarpal angle, thoracic humeral angle, and elbow mechanical axis deviation toward coaxial limb alignment. In the standing position, the foot underwent significant lateralization post-SHO. SHO resulted in significant alteration in frontal plane thoracic limb alignment. Additional studies are necessary to determine if the changes reported using our ex vivo model occur following SHO in vivo.