Closing Wedge Osteotomy Research Articles

Patellar medial closing-wedge osteotomy in patello-femoral instability: Indications and outcomes

BackgroundPatellofemoral (PF) instability is a syndrome involving several factors and conditions. Trochlear dysplasia (TD) has been shown to be the feature most frequently diagnosed in patients with OPI (Objective Patellar Instability). Even the patella might have an altered shape. Articulating during growth with an abnormal trochlea might lead the patellar posterior surface to modify accordingly, becoming congruent with the trochlear shape. A mismatch between the two articulating surfaces has a role in patellofemoral dislocations.Rarely and in case of a highly dysplastic patella, reshaping only the trochlear groove might lead subsequently to an incongruence between the two bones.When isolated sulcus-deepening trochleoplasty does not restore a congruent patellofemoral tracking tested perioperatively, further surgical procedures might be required. MethodsA medial closing wedge patellar osteotomy (MCWPO) added to sulcus deepening trochleoplasty should be performed to create a congruent patellofemoral joint.Indications for this procedure are Wiberg type III or IV patella with an intraoperative abnormal patellar tracking after the sulcus deepening trochleoplasty procedure has been concluded. ResultsFrom January 2012 to August 2020, 21 (6 right and 15 left knees) sulcus deepening trochleoplasties with a concomitant medial closing wedge patellar osteotomy have been performed. The mean follow up was 35,25 months (ranging from 10 to 60 months). The average Kujala, IKDC and Lysholm score were respectively 70,14 ± 15,51; 55,75 ± 7,12 and 77,12 ± 14,80. No further patellar dislocation has been assessed in those patients during follow up. ConclusionThis technique has shown good and promising clinical outcomes and should be considered when treating patients with a still unsatistactory patellofemoral tracking after the sulcus deepening trochleoplasty has been performed due to a patella-trochlea shape mismatch.

Valgus Second Toe Deformity Treated With a Percutaneous Extracapsular Closing-Wedge Osteotomy of the Proximal Phalanx.

Coronal and sagittal plane deformities of the lesser toes are common yet challenging to treat. Traditional open releases and translational Weil osteotomies can be unpredictable and lead to postoperative stiffness. We present the results of a percutaneous closing wedge extracapsular osteotomy of the proximal phalanx to treat valgus deformity of the second toe. Thirty-one patients underwent 40 percutaneous osteotomies at a median age of 58.6±9.4 years. Using a small dorsomedial incision, a percutaneous proximal metaphyseal medial closing-wedge extracapsular osteotomy of the second toe is performed, leaving the dorsolateral cortex intact. An irrigated low-speed, high-torque 2- × 8-mm burr is used under image guidance. The osteotomy is then closed to correct deformity and taped for 2 weeks. Patient-reported outcomes and weightbearing radiographs were obtained. Questionnaire data was available for 89.7% (n=35) of cases. Most cases (91.4%) were either satisfied or extremely satisfied with the procedure. Radiographs were available for 90.0% of osteotomies, with a median length from surgery to radiographic follow-up of 1.6 years (range 0.5-6.3; SD ±1.5). Median second-toe valgus angle (STVA) decreased from 16.2±10.7 degrees to 5.0±7.0 degrees (P < .001) at final follow-up. All osteotomies united with no delayed union. There were no wound complications or infections. We found 2 cases of radiographic recurrence. Percutaneous proximal phalanx base metaphyseal closing wedge extracapsular osteotomies of lesser toes to correct coronal plane deformity is useful adjunct to first-ray corrective surgery and is associated with high levels of patient satisfaction. Level IV, retrospective case series.

Long-Term Outcome of Valgus Osteotomy and Fixation with Double Angled Dynamic Hip Screw for Nonunion Fracture of the Neck of the Femur in Young Adults.

Objective To evaluate the long-term results of valgus intertrochanteric osteotomy fixed with double angled dynamic hip screw for nonunion fracture of the neck of the femur in young adults. This implant allows more freedom of fixation in the sagittal plane. Very few studies have evaluated the long-term outcome for treatment of nonunion in fractures of the neck of the femur. Methods This is a prospective interventional study that included 20 patients with nonunion of the fracture of the neck of the femur aged < 60 years old without avascular necrosis of the head and significant resorption of the neck of the femur. A lateral closing wedge osteotomy was performed just above the lesser trochanter after inserting the Richard screw across the nonunion site, and it was fixed with a double-angle 120° barrel plate. The outcome was evaluated using union rate and the Harris Hip Score for functional outcome. Results The average postoperative decrease in the Pauwels angle was of 28.9°. A total of 80% of the cases progressed to union within a mean duration of 7.53 months. The mean Harris Hip Score at the final follow-up was 86.45. Conclusion Valgus intertrochanteric osteotomy and fixation with a double angled dynamic hip screw is a reliable and effective method for preservation of head and promoting union in an ununited fractured neck of the femur in young patients.

Hemi-high tibial osteotomy: technical note and case report

High tibial osteotomy (HTO) is a widely performed procedure, with several surgical techniques described to treat varus mal-alignment and medial compartment arthrosis of the knee. In our case report, we present a new surgical technique for performing a medial open wedge HTO in a young patient with proximal varus deformity of the right knee to avoid the clinical complications of HTO. A longitudinal medial incision was made medially over the proximal tibia, the medial collateral ligament (MCL) split, and an osteotomy was made from the medial cortex exiting into the “lateral tibial spine”. The osteotomy was then opened. A wedge measured 12.5 mm, and a bone graft harvested from the right iliac crest was used to fill the defect, followed by a Puddu plate placement. We had planned to have the osteotomy exit in the centre of the knee. Two years postoperatively, complete osteotomy healing and full range of right knee movement with no pain were observed. Radiographs confirmed deformity correction. Many surgical techniques have been described for HTO, including closing wedge osteotomy, opening wedge osteotomy, dome osteotomy, progressive callus distraction, and chevron osteotomy. We believe that in this technique, the risk of nonunion is less, the construct is more stable, and the patient will have a faster rehabilitation program with early weight-bearing. Hemi-HTO is a new surgical technique that can be used to treat proximal varus deformity of the knee, especially if the lateral tibial plateau appears radiologically normal.

Clinical study of outcomes of supracondylar osteotomy in correcting cubitus varus deformities

Background: It is the most frequent complication of treatment for supracondylar humeral fractures in children. Although cubitus varus has been conventionally described as a cosmetic deformity with little functional significance, Supracondylar fracture of humerus is one of the commonest fractures sustained by children. It is one of the difficult fractures to treat due complications like malunion, neurovascular injury, ischemic contracture. Much attention paid to prevention of malunion by anatomical reduction either by closed or open method. The present study evaluates a technique of correction of post-traumatic cubitus varus in children with a laterally based closing-wedge osteotomy of the distal humerus with medial displacement of distal fragment, through a lateral approach and fixation with percutaneous Kirschner wires. Material and Methods: A Retrospective study, which was conducted in department of Orthopaedics of Maharaja Agrasen Medical College, Agroha, Haryana, India, in 42 children with cubitus varus deformity following supracondylar fracture of humerus, were treated by lateral closing wedge osteotomy with medial displacement of distal fragment and fixation with percutaneous K-wires. Out of these, 36 children who satisfied the inclusion and exclusion criteria, and were available for assessment of final outcome were included in this study.

Metatarsal osteotomies in Hallux Rigidus

This work presents the objectives and indications of the three distal osteotomies of the first metatarsal most frequently used in Hallux Rigidus surgery: Weil-Barouk oblique osteotomy, Youngswick (modified Chevron) osteotomy, and Watermann dorsal closed wedge osteotomy. The surgical technique, indications, advantages, and disadvantages of each of them are described. Level of Evidence V; Therapeutic Studies; Expert Opinion.

3D-printed model and osteotomy template technique compared with conventional closing-wedge osteotomy in cubitus varus deformity

Cubitus varus deformity is the most common late complication of malunited supracondylar fracture that requires corrective osteotomy and fixation. From 2009 to 2017, 40 consecutive patients with cubitus varus deformity were included. Twenty patients underwent the conventional closing-wedge osteotomy (conventional group), while the other twenty patients underwent the 3D-printed model and osteotomy template osteotomy (3D-printed template group). The functional outcome was evaluated using the Mayo Elbow Performance Index (MEPI) Score and Flynn criteria. There were no statistically significant differences were observed regarding the humerus-elbow-wrist angle and tilting angle between the two groups, both preoperatively and postoperatively at 24 months. No statistically significant differences were observed regarding the elbow ROM (127.0 ± 4.7° VS 128.9 ± 3.8°) and MEPI score (93.5 ± 3.3 VS 94.3 ± 4.1) between the groups. All patients were satisfied both cosmetically and functionally as per the Flynn criteria and MEPI score. The conventional osteotomy and 3D-printed model and osteotomy template techniques both met the treatment requirements of cubitus varus deformity. The 3D-printed template technique showed better osteotomy accuracy, but no significant advantage regarding the functional and cosmetic results than conventional osteotomy.

Genetics, Clinical Presentation, Radiological Features, and Midterm Outcome of Closing Wedge Osteotomy in Children With Brachydactyly Type C.

Brachydactyly (BD) type C is a rare form of familial BD caused by GDF5 mutations. Some of the affected children have severe clinodactyly requiring surgery. The literature is limited to case reports. The current retrospective study included 15 Saudi Arabian families with 42 affected children seen by the author for 25 years. A total of 23 digits (in 23 hands) underwent surgical correction of clinodactyly using a closing wedge osteotomy. The current study reports on the genetics, clinical presentation, radiological features, and midterm outcome of surgery. Genetic analysis was done in 6 families and confirmed the presence of 2 novel missense mutations (p.Met173Val in 3 families and p.Thr203Asn in 3 families) in the GDF5 gene. All cases in the study group demonstrated the classical clinical and radiographic features of BD type C. However, only 1 hand showed all the features of angel-shaped bony defect. The clinodactyly defect was mostly observed in the index or middle fingers. Surgery for the clinodactyly defect was only done if there was finger overlap. Closing wedge osteotomy was done in a total of 23 digits with a satisfactory outcome. This study represents the largest reported series of children undergoing surgery for correction of BD type C clinodactyly with a uniform technique performed by a single surgeon. The closing wedge osteotomy used resulted in good midterm outcomes, although long-term follow-up is lacking.

Excessive hypercorrection after an open wedge high tibial osteotomy: a clinical case

Background: Currently, there is a tendency to increasing the proportion of knee joint organ-preserving surgeries. High tibial osteotomy (HTO) has proven itself a good method for the treatment of the knee joint varus deformity in extra-articular deformity cases. The question of the perfect angle of correction, which will not significantly impair the biomechanics of the knee and adjacent joints, remains controversial, as well as the issue of preventing excessive hypercorrection as an osteotomy complication.&#x0D; Clinical case description: A clinical case of a 59-year-old patient who underwent primary and revision HTOs is analyzed in this article. The patient had a varus deformity of the left lower limb with isolated medial knee osteoarthritis. The patients body mass index (BMI) was 28 kg/m2. The patient complained only of pain and a limited range of motion in the knee joint. According to the arthroscopy and magnetic resonance imaging (MRI) data, there was a cartilage damage classified as Outerbridge 4 stage of the medial compartment. There were no signs of a lateral compartment cartilage damage and patellofemoral joint arthritis. The varus deformity of the knee joint was 10. The patient underwent a medial high tibial open wedge osteotomy. During the preoperative planning, topograms of the lower limb with weight bearing were used. The clinical status before the operation, according to the used scales, was as follows: Knee injury and Osteoarthritis Outcome Score (KOOS) 46 points, Visual Analogue Scale (VAS) 7 cm, American Orthopaedic Foot and Ankle Society (AOFAS) 92 points. 6 months after the initial surgery, the clinical status was as follows: knee joint VAS 1 cm, ankle joint VAS 5 cm, KOOS 88 points, AOFAS 63 points. During the clinical examination and according to the instrumental studies, excessive valgus hypercorrection of 11.2 was noted. Also, the tibial plafond inclination (TPI) and the talar inclination (TI) were significantly increased. 1.5 years after the primary osteotomy, a revision closed wedge osteotomy was performed. The valgus deformity of the knee joint became 3, the axis of the ankle joint changed to the normal values. The clinical and functional results 6 months after the revision osteotomy were the following: KOOS 92 points, AOFAS 99 points, pain in the knee and ankle joint 1 cm by the VAS scale.&#x0D; Conclusions: The case showed that the careful preoperative planning and the use of additional methods for monitoring the intraoperative correction were important. Excessive valgus hypercorrection promotes good regeneration of the medial compartment cartilage; however, it overloads a lateral compartment and adversely affects the ankle joint and foot.

Precision of the Wilson corrective osteotomy of the first metacarpal base using specific planning and instruments for treatment of basal thumb arthritis

IntroductionArthritis of the basal thumb is a relatively common condition also affecting younger patients. Wilson et al. described a 20°–30° closing wedge osteotomy of the first metacarpal bone to unload the trapeziometacarpal joint. It was the purpose of this study to analyze the clinical and radiographic outcome of patients who underwent proximal extension osteotomy of the first metacarpal bone using patient-specific planning and instruments (PSI).MethodsAll patients who underwent proximal metacarpal osteotomy for basal thumb arthritis at our tertiary referral center were retrospectively included. The patients underwent preoperative planning using computed tomography and 3D segmentation to build patient-specific guides and instruments for the operative treatment. Stable fixation of the osteotomy was achieved by internal plating. The inclusion criterion was a minimum follow-up of 1 year with clinical examination, including the Michigan Hand Outcomes Questionnaire (MHQ), and computed tomography to validate the correction. Complications and reinterventions were recorded.ResultsA total of eight Wilson osteotomies in six patients could be included at a mean follow-up duration of 33±16 months (range, 12 to 55 months). The patients were 49±8 years (range, 36 to 58 years) at the surgery and 88% were female. The postoperative MHQ for general hand function was 77±8 (range, 45 to 100) and the MHQ for satisfaction was 77±28 (range, 17 to 100). The working status was unchanged in 7/8 hands (6/7 patients). Radiographic analysis revealed successful correction in all cases with unchanged Eaton–Littler stage in 7/8 hands. No complications were recorded.ConclusionThe combined extending and ulnar adducting osteotomy using patient-specific guides and instrumentation provides an accurate treatment for early-stage thumb arthritis.Level of evidenceType IV—retrospective, therapeutic study.

Application of Patient-Specific Instrumentation in a Dog Model with Antebrachial Growth Deformity Using a 3-D Phantom Bone Model.

One of the most frequent bone deformities in dogs is antebrachial growth deformity (AGD), which results from malunion of the distal growth plates. The objective of the present study was to re-align the limbs, which can correct the length mismatch and reset the coherence of the joint with the aid of a 3-D phantom model for surgical preplanning. A 14-month-old, intact female Golden Retriever with an angular deformity of the left radius and ulna was selected for the study. The diagnosis was confirmed by orthogonal radiographs. Moreover, computed tomography (CT) scans revealed a multiplane deformity with valgus, procurator, and external rotation of the left radius. The pre-surgical planning started with the quantification of the angular deformity, followed by a simulated virtual osteotomy, and concluded with an in vitro rehearsal surgery on 3-D printed phantom bone models. In the operating room, prefabricated patient-specific instrumentation (PSI) was attached at the planned site of the radial bone surface for a precise closing wedge osteotomy. Then two locking plates were fixed routinely. Post-operative radiographs showed accurate correction of the deformity as we had planned. At 12 weeks post-operatively, the follow-up surveys revealed improved gait, weight-bearing, and progression of bone healing. Our PSI design, based on novel surgical planning, was steady yet straightforward during the osteotomy. The osteotomy was performed without difficulty since the PSI that pre-determined the sites and angles let the surgeon perform the antebrachial malformation surgery. This method of operation reduces stress on the operator and helps to improve accuracy, repeatability, and surgery time.

Percutaneous, implantless basal closing wedge osteotomy for hallux valgus: Surgical technique and preliminary results in 114 patients

BackgroundPercutaneous, implantless basal closing wedge osteotomy (PIBCO) is a new technique for hallux valgus (HV) deformity correction that does not need internal fixation. We present this technique and its short-term clinical outcomes for moderate-to-severe HV deformities. MethodsA retrospective review of 162 feet in 114 patients who underwent PIBCO of the first metatarsal (MT1) was conducted. Follow-up averaged 18.5 months. Outcomes were assessed using the visual analog scale (VAS), hallux valgus angle (HVA), intermetatarsal angle (IMA), and radiologic union. Complications were also assessed. ResultsAverage VAS score improved from 6.2 to 1.0 (P < 0.001). HVA improved from 29.8° to 7.6° (P < 0.001). IMA improved from 14.5° to 6.3° (P < 0.001). A total of 8 major complications were noted (4.9%). ConclusionsSatisfactory HV deformity correction was achieved. However, some instances may require internal fixation in order to avoid complications related to instability and noncompliance of postoperative rehabilitation protocols.

Management of Insertional Achilles Tendinopathy.

Insertional Achilles tendinopathy is a common condition that can lead to chronic, debilitating heel pain in athletes and nonathletes alike. Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy. When nonsurgical treatment fails, surgical treatment is recommended. Although there are options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, others are aimed at detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment. Additional or alternate procedures may include a calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer. Recent advances in suture anchor techniques further add to the complexity of available options. This review discusses the relevant anatomy, biomechanics, and pathophysiology as well as the recent available evidence for nonsurgical and surgical management of this condition to guide surgeons in selecting the most appropriate treatment for their patients.

Pediatric neglected distal femoral fracture with growth arrest.

Introduction and importanceDistal femoral growth plate fracture is one of the most common growth plate fractures in the pediatric age, and associated with growth disturbance risk. Consequences that may arise are hindered growth, irreversible decrease in range of motion, instability, angular deformity and neurovascular issues. Fractures of the lateral condyle show a higher risk of developing sequelae compared to the medial side.Case presentationCorrective osteotomy of the distal femur was performed in patient with history of femoral fracture which undergone an ORIF procedure for the shaft at the previous hospital, while the lateral condyle fracture was treated conservatively. We did close wedge osteotomy medially and transferred the bone fragment to the lateral side as an open wedge to lengthen the lateral cortex. The leg-length discrepancy was reduced from 5 to 2 cm even though subsequent deformities may possibly occur.Clinical discussionThe management approach for fracture of distal femoral physis can be done conservatively or surgically. Unfavorable outcomes from the conservative approach gave more reasons to opt for a surgical approach. The growth plate location should be considered when deciding which level of osteotomy is best and the fixation points in younger patients. When physeal bars are formed due to the fracture stress on the growth plate, the treatment is based on the patient's age and the bar's size.ConclusionFractures of the distal femur involving a growth plate in children should not be considered a trivial case, and a comprehensive treatment plan should be coordinated.

Minimally Invasive Procedure for Correcting Extra-Articular Malunions of Metacarpals and Phalanges

Extra-articular malunions of metacarpals and phalanges may cause palmar pain, finger scissoring, and splaying, and interfere with function. Current treatment involves open osteotomy and fixation with plates and screws. We present a minimally invasive method using cannulated headless screws for correction of malunions and examine the outcomes in a series of patients. Twenty malunions were operated on in 17 patients. In 16 cases, the malunion involved the metacarpal and in 4 it involved the proximal phalanx. All proximal phalanx and 3 metacarpal malunions were malrotation types, while the rest of the metacarpal malunions were dorsal angulations. The operation consisted of an opening wedge osteotomy in 8 patients; closing wedge osteotomy in 5; and a transverse osteotomy and derotation in the rest. Concomitant surgery to release tendon adhesions or contracted joints or to perform adipofascial flaps was performed in 8 cases. Fixation was achieved by means of a cannulated headless screw. Immediate range of motion was permitted in all cases. Correction of the malunion and osteotomy union was achieved in all cases. One patient required manipulation of a digit that was found rotated at the first follow-up visit. Eleven fingers achieved more than 280° of total active motion. In 9 digits, the total active motion was less than 280° after the operation, yet improved 76° (range, 140°-30°) from their preoperative total active motion. The mean single-assessment numeric evaluation score for the whole group was 9.1. The fixation provided by the cannulated headless screw is sufficient to permit immediate range of motion. Due to the minimal tissue disruption, this approach may be a reasonable alternative to the standard approach. Therapeutic IV.

Lateral Patellar Luxation and Ehlers Danlos Syndrome (EDS) in a Dog

Background: Ehlers Danlos Syndrome (EDS) is a rare genetic disease characterized by a deficiency in collagen synthesis, which can result in joint laxity. Patellar luxation is one of the main orthopedic conditions that affect the canine knee joint, with limited descriptions of its association with EDS in dogs. The purpose of this report is to describe the surgical management and postoperative evolution of a 1-year-old Chow Chow dog with grade II patellar luxation, tibial valgus and EDS.Case: A 1-year-old Chow Chow dog was referred to the University Veterinary Hospital due to lameness of the left pelvic for 3 months. At the orthopedic examination were verified severe lameness and lateral deviation of the left stifle joint during the ambulation of the animal. Additionally, it was verified bilateral hyperextension of the tibiotarsal joint and grade II patellar luxation of both pelvic limbs with painful hyperextension of the left stifle joint. Radiographic evaluation showed lateral displacement of the patella from both femoral trochlear groove, and a valgus deviation of the proximal left tibial shaft. In addition, it was verified cutaneous hyperextensibility and an extensibility index suggestive of EDS. The animal was submitted to trochlear block resection technique and medial imbrication, followed by corrective tibial osteotomy. Furthermore, skin biopsies of the scapular and lumbar folds were performed during the corrective tibial osteotomy. The samples were sent for histopathological examination, which revealed fragmented and unorganized collagen fibers in the dermis. Histopathological findings were compatible with EDS. The absence of lameness and correct positioning of the patella in the trochlear sulcus were verified in the post-surgical follow-up. Complete bone consolidation of the closing wedge osteotomy to correct the tibial valgus was verified at 90 days postoperatively.Discussion: The clinical signs, cutaneous extensibility index, and histopathological abnormalities in the present case were consistent with EDS. In the present study, this congenital collagen abnormality syndrome may have been a contributing factor of patellar luxation as EDS can result in hypermobility of ligaments and joints, due to metabolic and structural abnormalities of the collagen in connective tissues, and consequently may promote patellar luxation and other orthopedic abnormalities. A variant of EDS in humans has been implicated in the development of skeletal abnormalities such as short stature and bone deformities. This corroborates the possibility that EDS is correlated with valgus angulation of the proximal portion of the tibia in the present case. However, in-depth genetic studies are required to confirm this correlation. Corrective osteotomy in conjunction with block recession sulcoplasty and medial imbrication seem to have enabled patellofemoral stability and alignment of the quadriceps mechanism, ensuring that the patella remained in the trochlear sulcus, even in the presence of EDS. In addition, this syndrome does not seem to affect the surgical outcome of the treatment of patellar luxation associated with closed wedge osteotomy for tibial valgus correction. Medium-term follow-up can be considered excellent in this case report since there was a rapid resolution of lameness and adequate corrective osteotomy healing despite persistent hyperextension of the tibiotarsal joint. Ehlers Danlos Syndrome did not contraindicate the surgical treatment of patellar luxation. However, further studies are needed to assess the influence of the syndrome on long-term patellar luxation. The findings of this case report can help in the diagnosis and treatment of other animals affected by this rare syndrome and associated orthopedic diseases.Keywords: patellar luxation, bone, collagen diseases.

Complications of Calcaneal Osteotomy: Are They Equal Between Different Osteotomy Types?

Category:Hindfoot; OtherIntroduction/Purpose:Calcaneal osteotomy is regularly performed as part of the surgical management of a number of conditions. Complication rates are thought to be low, however are these risks the same for different osteotomy types? In our institution a Lateralising Closing wedge osteotomy is performed for Cavus foot correction and Varus alignment with instability, whilst Lateral Column Lengthening Osteotomy and Medialising Displacement Calcaneal Osteotomy (MDCO) are performed for Pes Planus with and without forefoot abduction respectively. In severe Pes Planus deformities both may be utilised. The purpose of this study was to examine complication rates in each group.Methods:This is a retrospective case series of consecutive calcaneal osteotomies performed at our institution between January 2010 and December 2019. The primary outcome measures were healing of the osteotomy, metalwork removal and any other reported complications related to the calcaneal osteotomy including infection and wound problems. Patient demographics, associated procedures, indication for surgery, incision, and fixation method were also recorded.Results:There were 141 patients in the series. 77 patients underwent a lateralising osteotomy, 55 underwent MDCO and 12 Lateral column lengthening (LCL) with opening wedge osteotomy of the anterior process of the Calcaneus. Fixation was with cannulated screws, or specific purpose locking plates. Patients were followed up for a minimum of three months and discharged from follow-up once a satisfactory level of recovery was reached..One non-union was seen in each of the Lateralising, MDCO and LCL groups. Delayed union was seen in 3 lateralising osteotomies, and 1 MDCO. Metalwork irritation requiring surgery for metalwork removal was 6.5% (4 with screws, 1 plate), 9.1% (all screws) and 0% for Lateralising, MDCO and LCL osteotomies respectively. Wound problems or sural nerve irritation were noted in 11.7%, 3.6% and 8.3% of Lateralising and MDCO and LCL osteotomy respectively. 1 superficial infection was seen in the Lateralising osteotomy groupConclusion:One non-union was seen in all groups, with a trend for bone healing to be slower in those having lateralising procedures. Patients should be advised of this possibility if undergoing calcaneal osteotomy. Wound problems and sural nerve irritation were also more common with lateralising procedures. Metalwork removal due to hardware irritation was common (7% overall), and fixation method rather than osteotomy type appears to influence this with 9 cases following cannulated screws and 1 following lateral locking plate fixation. Screw fixation is associated with higher hardware removal rates.

A simple method to predict postoperative relative first metatarsal length after proximal closing-wedge osteotomy

Optimal relative first metatarsal length is one of the keys to achieving sufficient results after osteotomy of the first metatarsal. An excessive shortening of the first metatarsal was associated with postoperative metatarsalgia, whereas a long first metatarsal has been implicated as a cause of hallux valgus. To adjust the relative first metatarsal length to the optimal range during surgery, a predictive tool would be beneficial for preoperative planning. However, there is no established tool for predicting relative first metatarsal length. Here, we report a simple method to predict postoperative relative first metatarsal length after proximal rotational closing-wedge osteotomy for rheumatoid forefoot deformities. Two board-certified orthopedic surgeons performed relative first metatarsal length prediction retrospectively on a computed radiography system in nine consecutive cases. Most of them underwent simultaneous modified shortening oblique osteotomy of the second metatarsal (7/9 cases). The interclass correlation coefficients of intraobserver and interobserver reliability for relative first metatarsal length prediction were 0.96 and 0.94, respectively. The mean absolute error on relative first metatarsal length prediction was 1.5 mm at 3-month postoperatively in the same case series. The average time required to perform the relative first metatarsal length prediction was 44.1 s (standard deviation 9.0). Predicting relative first metatarsal length preoperatively in a simple manner, which takes less than a minute to complete, has the potential to improve the surgical outcome of rheumatoid forefoot surgery.

Ulnar nerve injury post Cubitus varus correction by lateral closing wedge osteotomy: Lessons learnt

Ulnar nerve injury post Cubitus varus correction by lateral closing wedge osteotomy: Lessons learnt

Radiographic Evaluation of Isolated Continuous Compression Staples for Akin Osteotomy Fixation

Category:Bunion; OtherIntroduction/Purpose:The use of continuous compression implants (nitinol staples) in orthopaedic surgery has increased secondary to advances in metal alloy engineering. Biomechanical studies provide useful data supporting the theoretical use of nitinol staples in the foot and ankle. However, clinical data is limited. The purpose of this study was to determine the overall effectiveness, both clinically and radiographically, of continuous compression implants (nitinol staples) to achieve bony healing in the medially based, closing-wedge osteotomy of the proximal phalanx of the great toe (Akin osteotomy).Methods:A retrospective chart review was performed on 104 patients (107 feet) who underwent an Akin osteotomy using nitinol staples between January 1st, 2018 and February 20th, 2020. The primary outcome variable was radiographic evidence of healing on x-ray. X-rays were independently reviewed by three board-certified foot and ankle surgeons. All investigators were blinded towards the x-rays, and x-rays were randomized in terms of timing from surgery. Each investigator reviewed digital radiographs independently and recorded their radiographic finding responses. Osteotomies were deemed healed if greater than 50% of the osteotomy contained bridging bone. A partially healed osteotomy was defined as some bridging bone, but less than 50% of the overall osteotomy site, and a nonunion was defined as no healing seen radiographically, broken hardware, or loss of reduction.Results:Radiographic union (partial or full) was seen in 95% of Akin osteotomies (96/101) based on our parameters, with no loss of initial reduction. Only 2.8% (3/107) of the patient population had unplanned return to the operating room for reasons associated with the Akin osteotomy: one infection (0.9%), one irritable hardware removal (0.9%), and one traumatic disruption of fixation (0.9%). None of the eligible staples (0/106) were found to be fractured upon radiographic analysis. Smokers and diabetics represented 4.8 and 8.7 percent of the patient population, respectively.Conclusion:Since its inception in 1925, the Akin osteotomy has been described using several types of fixation methods. The results of this retrospective study show that continuous compression implants (nitinol staples) are a viable option for Akin osteotomy fixation, with low rates of complications (2.8%, 3/107) and high healing rates (95%, 96/101). Staples are lower profile, eliminating hardware irritation and potential secondary surgeries, are technically less demanding, and time of application is decreased when compared to other fixation methods. They offer the benefit of continuous compression of the fusion site, as well, and are rigid enough to maintain reduction.