Correction Of Long Bone Deformities Research Articles

Dome versus single-cut osteotomies for correction of long bone deformities—technical considerations

Corrective osteotomy allows to improve joint loading, pain and function. In complex deformities, the biggest challenge is to define the optimal surgical solution, while considering anatomical, technical and biomechanical factors. While the single-cut osteotomy (SCOT) and focal dome osteotomy (FDO) are well-established treatment options, their mathematical relationship remain largely unclear. The aim of the study was (1) to describe the close mathematical relationship between the SCOT and FDO and (2) to analyze and introduce a novel technique—the stepped FDO—as a modification of the classic FDO. The mathematical background and relationship of SCOT and FDO are described for the example of a femoral deformity correction and visualized using a 3D surface model taking into account the benefits for the clinical application. The novel modifications of the stepped FDO are introduced and its technical and clinical feasibility demonstrated. Both, SCOT and FDO, rely on the same deformity axis that defines the rotation axis k for a 3D deformity correction. To achieve the desired correction using a SCOT, the resulting cutting plane is perpendicular to k, while using a FDO will result in a cylindrical cut with a central axis parallel to k. The SCOT and FDO demonstrate a strong mathematical relation, as both methods rely on the same deformity axis, however, resulting in different cutting planes. These characteristics enable a complementary use when defining the optimal type of osteotomy. This understanding enables a more versatile planning approach when considering factors as the surgical approach, biomechanical characteristics of fixation or soft tissue conditions. The newly introduced stepped FDO facilitates an exact reduction of the bone fragments and potentially expands the clinical applicability of the FDO.

A General Pose Recognition Method and Its Accuracy Analysis for 6-Axis External Fixation Mechanism Using Image Markers

The 6-axis external fixation mechanism with Gough-Stewart configuration has been widely applied to the correction of long bone deformities in orthopedics. Pose recognition of the mechanism is essential for trajectory planning of bone correction, but is usually implemented by the surgeons’ experience, resulting in a relatively low level of correction accuracy. This paper proposes a pose recognition method based on novel image markers, and implements accuracy analysis. Firstly, a pose description of the mechanism is established with several freely installed markers, and the layout of the markers is also parametrically described. Then, a pose recognition method is presented by identifying the orientation and position parameters using the markers. The recognition method is general in that it encompasses all possible marker layouts, and the recognition accuracy is investigated by analyzing variations in the marker layout. On this basis, layout principles for markers that achieve a desired recognition accuracy are established, and an error compensation strategy for precision improvement is provided. Finally, experiments were conducted. The results show that volume errors of pose recognition were 0.368 ± 0.130 mm and 0.151 ± 0.045°, and the correction accuracy of the fracture model after taking compensation was 0.214 ± 0.573 mm and −0.031 ± 0.161°, validating the feasibility and accuracy of the proposed methods.

Humerus nail for tibial reconstruction in adolescent with osteogenesis imperfecta – A rare surgical case report

Osteogenesis Imperfecta (OI) is a rare connective tissue disorder known for excessive bone fragility caused by collagen mutations. The common orthopaedic problems related to bone fragility include frequent multiple bone fractures, progressive deformity of long bones leading to impaired ambulation. Surgical correction of long bone deformities in OI is conventionally done using distraction osteogenesis (illizarov fixator), elastic intramedullary nailing, rigid extramedullary fixation using plates, after osteotomy. Intramedullary fixation appears to be an ideal choice for correction of recurrent deformity in the long bone and the devices used previously include telescoping rods, single or dual non-elongating nails (rush nail, TENS). Recently in a case report of 3 individual patients, a humerus nail has been used to reconstruct femur in adolescents with OI. We report a case of humerus nailing for reconstruction of tibia in an adolescent OI male with excellent outcomes which is first of its kind and not reported previously by any other authors.

Computer hexapod-assisted orthopaedic surgery provides a predictable and safe method of femoral deformity correction.

Computer hexapod assisted orthopaedic surgery (CHAOS), is a method to achieve the intra-operative correction of long bone deformities using a hexapod external fixator before definitive internal fixation with minimally invasive stabilisation techniques. The aims of this study were to determine the reliability of this method in a consecutive case series of patients undergoing femoral deformity correction, with a minimum six-month follow-up, to assess the complications and to define the ideal group of patients for whom this treatment is appropriate. The medical records and radiographs of all patients who underwent CHAOS for femoral deformity at our institution between 2005 and 2011 were retrospectively reviewed. Records were available for all 55 consecutive procedures undertaken in 49 patients with a mean age of 35.6 years (10.9 to 75.3) at the time of surgery. Patients were assessed at a mean interval of 44 months (6 to 90) following surgery. The indications were broad; the most common were vitamin D resistant rickets (n = 10), growth plate arrest (n = 6) and post-traumatic deformity (n = 20). Multi-planar correction was required in 33 cases. A single level osteotomy was performed in 43 cases. Locking plates were used to stabilise the osteotomy in 33 cases and intramedullary nails in the remainder. Complications included two nonunions, one death, one below-knee deep vein thrombosis, one deep infection and one revision procedure due to initial under-correction. There were no neurovascular injuries or incidence of compartment syndrome. This is the largest reported series of femoral deformity corrections using the CHAOS technique. This series demonstrates that precise intra-operative realignment is possible with a hexapod external fixator prior to definitive stabilisation with contemporary internal fixation. This combination allows reproducible correction of complex femoral deformity from a wide variety of diagnoses and age range with a low complication rate. Cite this article: Bone Joint J 2017;99-B:283-8.

Сomplications in using different types of intramedullar telescopic fixators in children with osteogenesis imperfecta

Treatment of patients with osteogenesis imperfecta (OI) is a com­plex problem in orthopedics. The most effective method of surgi­cal correction of long bone deformities in OI is the use of Fassi­er-Duval rod. However, a significant number (35 %) of its as­sociated complications (instability, migration and lock eruption, no extension during bone growth, bone deformity and fractures in terms of loading, bone fractures) leads to development of the new approaches. In Sytenko Institute of Spine and Joint Pathol­ogy designed intramedullary telescopic fiction device (ITF), which combines the principles of rotational and axial stability. Objective:to analyze the complications of treatment in OI chil­dren after fixation of long bones by means of rotary ITF stability and without it. Methods: we performed 28 surgeries in 9 patients with combined deformations of the bones of the lower limbs, us­ing ITF (5 rotary unstable, made of stainless steel and 23 rotary-stable — rods in 2 cases made of stainless steel, 21 — with tita­nium alloy). Results: after the use of rotary unstable ITF, eternal immobilization was longer for 10– 14 days, and recovery time range of motion in adjacent joints were longer by 7 days on av­erage compared with the group of patients who used stable rota­ry ITF. There was the following symptoms: violation of blocking wires, deformation and limb segment with ITF migration, ab­sence of ITF lengthening, limb fracture with ITF. Complications from the use of rotary unstable ITF was 60 %, and after rotary-stable — 17.4 %. Conclusions:the use of rotary stable ITF cor­recting deformities of long bones of the extremities in patients with OI is more efficient and leads to less (17.4 %) complica­tions.

Analysis of long-bone deformity correction in adolescents using osteosynthesis by intramedullary interlocking nails: a preliminary report

Aims. The purpose of this study was to analyze the initial experience with adolescents treated for long-bone deformities of the lower extremities of different etiologies using osteotomies and fixation by interlocking nails.Materials and methods. We analyzed the accuracy of long-bone deformity correction using referent lines and angles, the time of consolidation, number of complications, and functional result.Results. We found that the accuracy of femur deformity correction (dependent on the complicity of the deformity), as estimated by different parameters, varied from 77.8% to 91.7%. Simple deformities and deformities of moderate complicity had the most accurate correction; the group of complex multiplanar deformities of the femur had the least accurate correction. This group included five cases of residual deformity, in which three of these had an angle of residual deformity <10°. The accuracy of leg deformity correction was 90%. Evaluation of the functional results using the Lower Extremity Functional Scale indicated the high functionality of the method used.Conclusions. Correction of long-bone deformities using intramedullary osteosynthesis by interlocking nails is an effective treatment of all types of femur and lower leg deformities. When treating complex deformities of the femur, the path to operative treatment should be complex and in most cases the nailing should be accompanied by intraoperative external fixation frame assistance.

Fixator-Assisted Nailing for Correction of Long Bone Deformities

Many surgical options exist for the correction of long bone deformities. The fixator-assisted nailing (FAN) technique developed by Paley et al combines the accuracy, lack of invasiveness, and adjustability of external fixation with the stability and comfort of internal fixation. A temporary external fixator is applied for acute deformity correction. Once the desired alignment is achieved, an intramedullary nail is placed and locked statically, interference screws are inserted for additional stability, and the fixator is removed during the surgery. This combinatory technique may further be combined with lengthening or arthrodesis procedures.

Management Overview of Osteogenesis Imperfecta

The treatment of osteogenesis imperfecta varies with the age of the patients and the severity of disease. Patients with mild disease rarely develop significant deformities; therefore, the care required is mainly limited to periodic fractures or to associated problems, such as erosion of the teeth, decreased hearing, and difficulties in adjustment. It is the patient with severe disease who often requires an unusual amount of attention. Regardless of the immediate problem, the treatment program should be geared toward the long-term function of the patient; in most cases this will be best served by the prevention and/or correction of long bone deformities, and by encouraging maximum intellectual and academic development. The latter requires contact of the child with normal children by placement in regular school classes. The primary basis of a successful treatment program to maintain acceptable skeletal alignment consists of properly timed operations for insertion of extensible intramedullary rods, together with supportive splints and braces. No other method of treatment, such as the use of systemic medications, has yet been shown to benefit the patient clinically. Progressive improvement in bone strength during childhood permits better eventual function for those patients in whom good skeletal alignment has been maintained. Most patients will become productive members of society, so the combination of optimum physical and optimum academic development will offer maximum opportunity to those who enter the competitive job market.

Multiple epiphyseal dysplasia; a report of three cases.

To quote Sir Thomas Fairbank (4), who described multiple epiphyseal dysplasia as a distinct clinical entity in 1935, this disease is “a rare congenital developmental error characterized by mottling or irregularity in density and outline of several of the developing epiphyses, and dwarfism.” Because the deformities of the ossification centers of the carpals and tarsals and of the epiphyses of the long bones may resemble those seen in the Morquio-Brailsford type of osteochondrodystrophy, the condition had been previously classified as atypical Morquio's disease or atypical osteochondrodystrophy. The good prognosis of multiple epiphyseal dysplasia as to crippling, and the fact that no treatment other than osteotomies for correction of long bone deformities is required, make especially important its recognition and differentiation from other growth disturbances presenting superficially similar radiographic findings. Of the cases reported in the literature, some, such as Fairbank's large series, show no definite hereditary or familial tendencies; other reports indicate a definite hereditary and familial distribution (3, 6, 7), particularly one series in which there were 10 cases in a single family (6). The 3 cases to be presented here occurred sporadically; it may be significant, however, that 2 of the patients had parents who were definitely of less than average height. Parents and siblings, all of whom were examined clinically and roentgenographically, showed no demonstrable stigmata of any growth disturbance. Case Reports Case I (Figs. 1–9): H. N., a white boy, was seen first at six and a half years because of difficulty in walking. The parents stated that he had flatfeet and toed in badly at birth, a condition which was treated by a Denis Browne splint. He had always been smaller than normal, walked with a waddling gait, and could not run. The child was of healthy appearance. 43 inches in height, and of normal intelligence. Both feet were extremely flat and pronated, and the gait was waddling. The lower extremities were moderately bowed, with palpable thickening at the epiphyseal regions at both ends of the tibiae and prominent fibular heads. There was internal torsion of both tibiae, so that, with the patellae pointing straight up, the feet were internally rotated. Knees and hips had free mobility. The Trendelenburg test was negative. The spine was straight; posture and body proportions were normal. Roentgenograms showed marked irregularity of all epiphyseal ossification centers and of the tarsals and carpals. Metaphyseal irregularities were present, particularly at the medial tibial condyles. As compared with the tibia, comparative overgrowth of the fibula was present bilaterally. It was decided that the difficulties in walking were due primarily to the flatfoot deformities, and arch supports were prescribed. The child was seen again eight months later because there had been no improvement in his gait and his ability to run.