Correction Of Angulation Research Articles

Limb Angular Deformity Correction Using Dyna-ATC: Surgical Technique, Calculation Method, and Clinical Outcome

PurposeDyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC.Materials and MethodsThe amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64).ResultsAll but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0° on tibiae and 10.0° on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation.ConclusionWe believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint.

Angulasi Gigi Pasca Perawatan Ortodonti dengan Pencabutan dan Tanpa Pencabutan (Kajian Foto Rontgen Panoramik di Klinik Ortodonti FKG UI)

At the end of treatment with extraction, it is often found root paralleling problem on upper second insicive, lower premolar and adjacent teeth of extraction. This caused by failure of angulation correction on finishing stage. Objective : To describe whether any differences in angulation of teeth after treatment with extraction and without extraction of patients treated in Orthodontic Clinic, RSGM FKGUI. Material and methods : The angulation measurement is done by using Ursi methode on panoramic radigraphic. Result : Based on independent t test analysis, there were a significant differences (p<0.05) between tooth angulation after orthodontic treatment with extraction and without extraction on upper right second premolar and upper left canine, also on lower right canine and lower left second premolar, whereas there are no difference. Conclusion : It appeared that, tooth angulation after orthodontic treatment has a significant differences between extraction case and non extraction case (adjacent teeth of extraction). Panoramic radiograph required before finishing stage to evaluate tooth angulation and root parallelism for increase stability after orthodontic treatment. DOI: 10.14693/jdi.v16i1.16

Treatment of angulation and shortening deformity of the lower extremity after trauma in children with Ilizarov apparatus.

Objective To evaluate the treatment of angulation and shortening deformity after trauma of the lower extremity in children with Ilizamv apparatus and discuss how to place the hinges at the right position according to the state of deformity. Methods From March 2005 to September 2007, 6 children with the sequelae of angulation and shortening deformity after trauma of the lower extremity were treated with Ilizarov apparatus gradually during one stage. The extent of shortening and angulation deformity were measured according to the full length X-ray film which were taken at the standing position. The center of rotation of angulation (CORA) was identified on the film, and during operation, the hinges of the Ilizarov apparatus were placed at the level of CORA. The apparatus were adjusted to correct the angulation and shortening deformity simuhaneouly 7 days after operation. The X-ray film was taken once 2 weeks during the period of adjustment. After the realignment of mechanical axis and recovery of leg length were confirmed on the full length film, the X-ray film was taken once a month. The apparatus were removed after consolidation of the new bone was enough. During follow-up, the leg length and range of motion were recorded clinically, the mechanical axis and articular angle as well as the remolding of the new bone were observed radiographically. Results The angulation was corrected at the deformity site and bone lengthening was performed at the adjacent segment in one case, all other 5 cases completed the deformity correction at the osteotomy site. The extent of angulation correction averaged 34.8° and bone elongation averaged 5.3 cm. The mechanical axis was realigned in all cases, articular angle was within the normal range and the leg length was equal. X-ray film at the latest follow-up showed good healing of the newborn bone, no fracture was observed. Conclusion It is a good and safe method to treat the angulation and shortening deformity in children simultaneously with llizarov apparatus. But the correct position of the hinges according to the deformity is mandatory. Key words: Child; Bone lengthening; Lower extremity

USE OF LOCKING COMPRESSION PLATES FOR DEFORMITY CORRECTION OF THE FOREARM BONES IN CHILDREN

The aim of our study was to assess treatment results of angular deformities in distal radius by a system of the locking compression plates (LCP) at our clinic. Our source data was collected prospectively from the records of patients where the locking compression plate was used for angulation correction of distal forearm between 2006 and 2007. The patients were divided by sex, the age range was defined and two groups were formed based on the initial diagnosis: the group of posttraumatic deformities (2 patients; 29 %) and the group of no traumatic deformities (3 patients with congenital shortening of ulna, valgus deformity and overgrowth of radius and 2 patients with exostoses multiplices with shortening of ulna and overgrowth of radius with ulnar angulation). The following parameters were set: radial articular angle and carpal slip prior to and after angulation correction, the healing period, the range of movement of the surrounding joints and occurrence of complications. We recorded only one case of delayed healing which was subsequently sustained by autospongioplastics and adjusted to normal. In the rest of the cases deformity correction occurred and the defined parameters were then corrected to normal. We observed no postoperative complications or permanent consequences. A two-year follow-up period monitoring treatment and therapeutic results of deformities in the forearm bones at our clinic, confirmed a minimal incidence of complications and a high percentage of successfully treated cases.

Operative Behandlung von Knochendeformitäten bei einem Patienten mit Vitamin-D-resistenter Rachitis

Surgical treatment of patients with vitamin D-resistant rickets is reserved for management of severe deformities or pathological fractures of the lower limbs. This case report describes the operative management of a child with vitamin D-resistant rickets suffering from a pathological fracture and a bending deformity of the right femoral bone. A modified technique of fragmentation and realignment by intramedullary fixation was performed using an unreamed humerus nail. We corrected the anatomical proximal femoral shaft angle (aMPFA) from 68 degrees to 84 degrees and achieved three more centimetres of femoral length. The same procedure was performed on the left femur and corrected the aMPFA from 108 degrees to 89 degrees and gained 2.5 more centimetres of femoral length. Thus the legs were almost equal in length. We preferred the modified technique of multiple osteotomies and intramedullary fixation by nailing (originally described by Sofield and Millar) because the correction of angulation and rotation of the femoral shaft in one step appeared to be much easier than with plate fixation. Moreover, this method seems to reduce the number of refractures and enables the patients to approach the normal activities of growing children.

Extra-Articular Osteotomy for Malunited Unicondylar Fractures of the Proximal Phalanx

To evaluate an extra-articular osteotomy rather than an intra-articular osteotomy in the treatment of malunited unicondylar fractures of the proximal phalanx. An extra-articular osteotomy was used to correct the deformity resulting from a malunion of a unicondylar fracture of the proximal phalanx in 5 patients. A closing wedge osteotomy that was stabilized with tension band fixation accomplished realignment of the joint. Each patient was evaluated at a minimum of 1 year after surgery for radiographic healing, correction of angulation, digital motion, postoperative complications, current level of pain with motion, and overall satisfaction with the procedure. All of the osteotomies healed by 10 to 12 weeks after surgery with an average angular correction from 25 degrees to 1 degrees . The average proximal interphalangeal joint motion improved to 86 degrees from the preoperative average of 40 degrees , whereas the average total digital motion improved from 154 degrees before surgery to 204 degrees at follow-up evaluation. This method of extra-articular osteotomy for malunited unicondylar fractures of the proximal phalanx is highly reproducible, avoids the risks of intra-articular surgery, and leads to a predictable outcome.

Biomechanical testing of anterior and posterior thoracolumbar instrumentation in the cadaveric spine. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

Thoracolumbar burst fractures frequently require surgical intervention. Although the use of either anterior or posterior instrumentation has advantages and disadvantages, there have been few studies in which these two approaches have been compared biomechanically. Ten human cadaveric spines were subjected to subtotal L-3 corpectomy. In five spines placement of L-3 wooden strut grafts with lateral L2-4 dual rod and screw instrumentation was performed. Five other spines underwent L1-5 pedicle screw fixation. The spines were fatigued between steps of the experiment. The spines were load tested with pure moments of 1.5, 3, 4.5, and 6 Nm in the intact state and after placement of instrumentation in six degrees of freedom (flexion, extension, right and left lateral bending, and right and left axial rotation). In axial rotation posterior instrumentation significantly increased spinal rigidity compared with that of the intact state, whereas anterior instrumentation did not. Combined anterior-posterior instrumentation did not significantly increase the rigidity of the spine when compared with anterior or posterior instrumentation alone. Posterior instrumentation alone provided a greater reduction in angular rotation compared with anterior instrumentation alone in all degrees of freedom; however, statistical significance was achieved only in extension at 6 Nm. The increased rigidity provided by pedicle screw instrumentation compared with the intact state or with anterior instrumentation is due to the longer construct spanning five levels and the three-column engagement of the pedicle screws. The decision to use anterior or posterior instrumentation should be based on the clinical necessity of canal decompression and correction of angulation.

Calculation and correction of secondary translation deformities and secondary length deformities.

External fixation correction of angular deformities leads to secondary translation deformities when occurring around an axis located proximal or distal to the center of rotation of angulation (CORA); secondary length deformities result when correction occurs around an axis concave or convex to the CORA. With circular fixation, the hinge axis can be matched to the CORA. With monolateral fixation, the level of the hinge/angulator is not easily controlled. Axis of correction of angulation can be plotted graphically and secondary deformities calculated trigonometrically. Location of the hinge/angulator can be accurately planned and adjustments incorporated to compensate for expected secondary deformities.

Comparison between Operative and Conservative Treatment of the 5th Metacarpal Neck Fracture

Purpose: To evaluate the clinical results between conservative and operative treatments and to give guidelines in the treatment of angulated fifth metacarpal neck fracture. Materials and Methods: The 43 cases of fifth metacarpal neck fracture (25 operative cases, 18 conservative case) were reviewed. The functional and radiologic results between two groups were evaluated. Results: Both the operative group (preop.: ) and the conservative group (preop.: ) showed satisfactory results(operative group: , conservative group: ) immediately after the correction. The maintenance of angulation correction was superior in operative group () than in conservative group (), and patients’ subjective satisfactions were superior in operative group too. Depressed knuckle on dorsum of hand was more frequently observed in conservative group (38.9%) than operative group (4%). Functional result in both groups was good. Conclusion: Because the correction of angulation was not maintained well in conservative group and a large portion of complications often occurred in cases of angulation more than , operative treatment is needed in cases of angulation of fractured site more than in the fifth metacarpal neck fracture.

EXTRACORPOREAL SHOCKWAVE THERAPY FOR PEYRONIE DISEASE

While surgery is the mainstay of therapy for Peyronie disease requiring correction of angulation, interest has grown in the application of extracorporeal shockwave therapy (ESWT) as a minimally invasive approach. This article reviews the current literature reporting the use of ESWT for Pey ronie disease.

Extracorporeal shockwave therapy for peyronie disease.

While surgery is the mainstay of therapy for Peyronie disease requiring correction of angulation, interest has grown in the application of extracorporeal shockwave therapy (ESWT) as a minimally invasive approach. This article reviews the current literature reporting the use of ESWT for Peyronie disease.

Correction of leg deformities. Definition, estimation and realignment of axis deviation and misalignment

The operative realignment of mechanical axis deviations (MAD) is necessary to prevent early joint degeneration and to reach normal load-bearing. Modern types of external fixation systems allow an alignment of the mechanical axis to exact degrees. Predominantly this are corrections of angular deformities. In some cases the analysis of the MAD does not show any angular deformity, but a parallel staggering of the mechanical axis lines of a bone. Such parallel staggering of the mechanical axis lines is defined as a translation deformity of the bone. In combined deformities with angulation and translation the centre of deformity can be established proximal or distal out of the limit of the bone. In translation deformities the realignment of the mechanical axis requires a parallel re-staggering made by a translation-osteotomy or by a counter-angulated double osteotomy. In complex deformities with angulation and translation, the translation requires a separate corrective planning. By using external fixator systems to perform acute or progressive corrective osteotomies the position of the Axis of Correction of Angulation (ACA) in relation to the n-CORA of the deformity has to be considered. If ACA position is not conform with the n-CORA position relevant geometric effects in relation of length and translation occur. These geometric effects to corrective osteotomies can be calculated by using simple trigonometric formulas or graphical methods. Possibilities to compensate translation and length effects are shown by using unilateral external fixator systems.

Femoral Lengthening After Type IVB Septic Arthritis of the Hip in Children

Summary Septic arthritis of the hip in the newborn baby can result in severe long-term sequelae in the form of dislocation of the hip, loss of movement, and growth disturbance with leg-length discrepancy. For more severe discrepancies often with concomitant hip dislocation, no good solutions are readily available. This series comprised four patients with Choi's type IVB septic hip sequelae. They all had associated multiple-joint sepsis and resultant major leg-length discrepancies ranging from 6.9 to 14 cm. All underwent distraction lengthening with simultaneous correction of angulation and other deformities of the femur, three with the Ilizarov and one with the Orthofix system. The age at operation ranged from 9 to 13 years, with an average follow-up of 3 years. The overall lengthening achieved ranged from 4.5, 6.8, 12, to 13 cm, with the lengthening index from 24 to 51 days/cm. All hips remained stable, and the loss of range of hip and knee motion was not significant. Other complications included one deep pin-tract infection and one fracture of the callus.

Femoral lengthening after type IVB septic arthritis of the hip in children.

Septic arthritis of the hip in the newborn baby can result in severe long-term sequelae in the form of dislocation of the hip, loss of movement, and growth disturbance with leg-length discrepancy. For more severe discrepancies often with concomitant hip dislocation, no good solutions are readily available. This series comprised four patients with Choi's type IVB septic hip sequelae. They all had associated multiple-joint sepsis and resultant major leg-length discrepancies ranging from 6.9 to 14 cm. All underwent distraction lengthening with simultaneous correction of angulation and other deformities of the femur, three with the Ilizarov and one with the Orthofix system. The age at operation ranged from 9 to 13 years, with an average follow-up of 3 years. The overall lengthening achieved ranged from 4.5, 6.8, 12, to 13 cm, with the lengthening index from 24 to 51 days/cm. All hips remained stable, and the loss of range of hip and knee motion was not significant. Other complications included one deep pin-tract infection and one fracture of the callus.

The small pin circular fixator for distal tibial pilon fractures with soft tissue compromise.

A Monticelli-Spinelli small pin circular external fixator was used in combination with closed reduction or a limited open reduction internal fixation in five cases in an attempt to salvage a satisfactory result in distal tibia pilon fractures when associated soft tissue compromise prevented standard fixation with plates and screws. The small pin fixator enhances the ability to perform a closed reduction through a technique that uses distraction with pins in the tibia and calcaneus, combined with correction of angulation by tensioning wires with a stop nut. Small pin stabilization of these comminuted fractures allows early patient mobilization. The small diameter pins support the soft cancellous bone fragments. This technique attempts to combine the benefits of traction, external fixation, and limited internal fixation. We recommend this technique as a salvage procedure when plates and screws are contraindicated because of poor bone and soft tissue conditions.

Tibial fractures in children: follow-up study.

One hundred seventeen children with tibial shaft fractures were treated by above knee cast with or without traction depending on stability. All fractures united in an average period of 37 days. Reevaluation after 3-10 years showed that initial shortening, fracture type, fracture location, and age of the patient affected growth acceleration, whereas the initial angular magnitude, direction, and planes, as well as the type of the fracture, the age of the patient, and length of follow-up period, affected correction of angulation. We concluded that: shortening can be compensated by growth acceleration; varus deformities can undergo spontaneous correlation whereas valgus deformity and posterior angulation partially persist and rotational deformities persist.

Remodeling after femoral shaft fractures in children treated by the modified blount method.

One hundred forty-one children with femoral shaft fractures in the 1-12-year age range were treated by simple skin traction without spica cast immobilization. All fractures united in an average traction period of 28 days. Clinical and radiological reevaluation 2-10 years after treatment showed that fracture location, age, and overriding significantly affected overgrowth, whereas the length of the follow-up period and the direction of angular deformity affected correction of angulation. The following conclusions were reached: Distraction should be avoided, and overriding of up to 15 mm can be compensated for by growth acceleration. Initial angular deformities of up to 20 degrees in the coronal plane and up to 30 degrees in the sagittal plane will end in a satisfactory outcome. Rotational deformity was not a problem following this method of treatment.

Experimental epiphysial distraction producing and correcting angular deformities.

Angular deformities of the distal radius of 15 sheep were induced by asymmetrical epiphysial distraction. Eleven sheep were between 10 and 20 weeks old; four were older than 24 weeks. Gradual distraction on the medial side of the limb caused partial separation of the epiphysis from the metaphysis, resulting in a valgus deformity. The distraction device was removed three to six weeks after insertion. Spontaneous correction of angulation with growth occurred in the younger sheep; but when the induced valgus angle exceeded 20 degrees correction was poor. In two sheep further distraction was applied on the lateral side and this produced complete correction. Premature closure of epiphyses did not occur after distraction and longitudinal growth of the bone remained normal. In the older sheep asymmetrical distraction succeeded in inducing angulation in only one case, and correction was poor.

A segmental approach to mandibular molar uprighting

Diagnosis and treatment in molar uprighting are discussed. The over-all objective in molar uprighting is ideal positioning of the molar which will eventually become an abutment tooth for a fixed prosthesis. The ideal position will provide an optimal periodontal environment for the molar(s). The specific objectives concerning protection against inflammatory periodontal diseases and occlusal traumatism, which together determine the optimal periodontal environment, are explained. Emphasis is placed on the biomechanics of molar uprighting which will achieve the desired periodontal treatment result. The specific technique recommended for the instances in which the molar is considerably angulated involves a segmental approach which utilizes a modification of the Burstone root spring. Proper application results in the dissociation of the correction of angulation and the extrusion of the molar tooth. It is explained that molar extrusion is, for the most part, an undesirable side effect of molar uprighting. When extrusion of the periodontally involved molar is required, then it should follow the correction of molar angulation. Other advantages of this approach involve the precision and ease of symmetrical preactivation, favorable load/deflection considerations, the low level of patient discomfort, and the reduced tendency of normal function distorting or dislodging the spring. This technique is compared by these parameters to other popular molar-uprighting techniques. It is recognized that a multidisciplinary approach to this type of dental therapy is ideal and that since treatment planning in individual cases varies greatly, each malocclusion and associated periodontal involvement should be evaluated on an individual case basis.

Advanced Peyronie’s Disease Treated With the Inflatable Penile Prosthesis

Nineteen patients with significant advanced Peyronie’s disease (that is severe angulation, erectile impotence and/or intractable pain) that had not responded to conservative medical therapy were treated surgically with insertion of the inflatable penile prosthesis. Of the patients 10 had correction of angulation and/or erectile impotence by instillation of the prosthesis alone and needed no additional operation, while 8 required incisions of the tunica albuginea distal to the plaques in addition to the prosthesis to correct the deformity. One patient required a monofilament knitted polypropylene velour graft to cover the defect in the tunica albuginea. Satisfactory results were obtained in 18 of 19 patients.