Correction Of Lower Extremity Deformities Research Articles

Limited orthopaedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis

To summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method. From the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017, 629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed. Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years (mean, 47.1 years). Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in 39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator. Of the 629 cases, 481 cases were less than 50 years old (76.47%), accounting for 144 cases between 51 and 65 years old (22.89%). Among them, 495 cases (78.70%) were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformities, the results were excellent in 23 cases, good in 20 cases, fair in 12 cases, and poor in 2 cases, with an excellent and good rate of 75.44%. The 2 patients with poor effectiveness were reoperated to improve their function. Limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis can effectively correct deformities of lower limbs, improve function, delay the disability aggravated by decay, and avoid serious complications.

Different osteotomy solutions influence future total knee arthroplasty in patients with multiapical lower extremity deformities

Background: Although osteotomy achieves success on correction of lower extremity deformities, a future total knee arthroplasty (TKA) is sometimes inevitable. The zigzagged fumer and tibia after previous osteotomy can somehow influence TKA. This study aimed to figure out how different osteotomy solutions, specifically, single-level or multi-level osteotomies, influence TKA in patients with multiapical lower limb deformities. Methods: A 25-year-old female of varus deformity on both lower extremities was studied. Single-level osteotomy solutions were used to correct deformities. A templating (both two- and three-dimensional) of posterior-stabilized high-flex implant was performed for pre-TKA planning, under the circumstances of both real single-level and simulated multi-level osteotomy solutions. Parameters according to specific nomenclature were measured. Results: The average location of the center of rotation of angulation was 17 cm from the knee joint orientation line on the left side, and 12 cm on the right. On the assessment of deformity correction, the medial proximal tibial angle (MPTA) improved from 76° to 87° on the left side and from 72° to 96° on the right. The mechanical lateral distal tibial angle (mLDTA) changed from 109° to 101° on the left side and from 98° to 90° on the right. Pre-TKA templating showed that the depths of the proximal tibial bone cut were different on both sides under single or multiple level osteotomy. Thus, the selected sizes of tibial component were different accordingly. Attributed to angulation of tibial anatomical axis, an impingement of the tibial stem upon the proximal lateral tibial cortex would likely occur on the right side after single osteotomy. Conclusions: Prior correction procedures influence future TKA in patients with severe multiapical deformities in lower extremities. A sufficient and excellent preoperative plan of osteotomy is necessary not only for achieving present correction of alignment, but also for achieving a successful TKA yet to come.

Guided Growth Technique for Correction of Lower Extremity Deformities in Children

Guided growth technique with temporary epiphysiodesis is used for the correction of lower extremities axial deformities in children before skeletal maturity. From 2009 to 2013 one hundred fifty epiphysiodesis procedures were performed in 93 children aged 3–15 years. Technique was performed both in patients with idiopathic deformities and in patients with severe systemic pathology (skeletal dysplasias, neuromuscular disorders, metabolic nephropathies). Treatment results were assessed at terms from 12 to 48 months after surgical intervention. Good results were achieved in 67 (72%), satisfactory — in 18 (19.3) and poor — in 8 (8.6%) patients. Mean rate of correction made up 0.81±0.17° per 1 month of epiphyseodesis with its maximum in valgus knee and ankle deformities. Advantages of the procedure included low invasiveness and simplicity of performance, low complication rate, possibility of simultaneous intervention on several levels as well as combination with other interventions. Thorough selection of patients, proper intervention technique and regular postoperative followup enable to avoid complications and unsatisfactory results.

Lumbosacral agenesis: a new classification correlating spinal deformity and ambulatory potential.

Lumbosacral agenesis is a rare congenital anomaly. There is no consensus regarding the optimal orthopaedic management of the spinal anomaly and the concomitant lower-extremity deformities. We propose a method to predict ambulatory potential and to identify patients who will benefit from early operative treatment of the lower-extremity deformities to facilitate walking. We reviewed the records and radiographs of eighteen patients with total or partial absence of the lumbar spine and total absence of the sacrum. Thirteen patients (Group I) had lumbosacral agenesis alone, and five patients (Group II) had a concomitant myelomeningocele. Three types of spinal deformity were identified. In Type A, there was either a slight gap between the ilia or the ilia were fused in the midline. One or more lumbar vertebrae were absent. The caudad aspect of the spine articulated with the pelvis in the midline, maintaining its vertical alignment. In Type B, the ilia were fused together, some of the lumbar vertebrae were absent, and the most caudad lumbar vertebra articulated with one of the ilia, with the most caudad aspect of the spine shifted away from the midline. In Type C, there was a total agenesis of the lumbar spine, the ilia were fused together, and there was a visible gap between the most caudad intact thoracic vertebra and the pelvis. In Group I, all seven patients with Type-A deformity were community ambulators and one patient with Type-B was a household ambulator. No other patient in the series was able to walk. Nine patients had cervical spine anomalies, and seven patients had scoliosis. No patient was managed with a spinopelvic fusion. We believe that all Group-I, Type-A patients should have correction of lower-extremity deformities as they have a very good potential to walk. The other patients should have operations on the lower extremities only if the deformities preclude sitting or wearing shoes or braces. The cervical spine should be examined radiographically for atlantoaxial instability or congenital anomalies.

The Use of the Ilizarov Technique in the Correction of Lower Extremity Deformities in Children

The first time the Ilizarov technique was used at Children's Hospital of Los Angeles, 25 limb segments were treated in 15 patients. Thirteen segments (52%) required angular correction, 6 (24%) required lengthening, and 6 (24%) required both angular correction and lengthening. Average angular correction was 21 degrees (8 degrees to 41 degrees); average length gained was 44 mm (25 to 85 mm). All patients except two achieved preoperative goals. A total of 17 minor (.68/limb) and four major (.16/limb) complications occurred in the 25 limb segments in the study. The total complication rate was .84 complications per limb segment. The most common complication was pin tract infection (11 patients). This comprised 52% of complications and occurred in 44% of limb segments.

Computer‐assisted surgery planning for lower extremity deformity correction by the Ilizarov method

Computer‐assisted surgery planning for lower extremity deformity correction by the Ilizarov method

Leg Lengthening and Correction of Lower Extremity Deformities by the Ilizarov Method

Leg Lengthening and Correction of Lower Extremity Deformities by the Ilizarov Method

One-Session Surgery for Correction of Lower Extremity Deformities in Children with Cerebral Palsy

Traditional thinking regarding surgery for the spastic child has favored correction of joint deformities one at a time. This often necessitates several operations. In addition, deformities of unoperated joints may jeopardize operative results. Since 1975, we have surgically treated all the lower extremity deformities of each cerebral palsied child in one session. We have carried out single measure operations as well as multiple operative procedures in which bilateral corrective operations are performed on several joints. Of 114 children treated, 40 had multiple and 74 had single operative procedures. Treatment was successful, without need for further surgery, in 80% of the former group and in 61% of the latter. The advantages of one-session surgery are a reduction in the number of operations and, possibly, a reduced chance of reoperation and complications.

One-Session Surgery for Correction of Lower Extremity Deformities in Children with Cerebral Palsy

Summary: Traditional thinking regarding surgery for the spastic child has favored correction of joint deformities one at a time. This often necessitates several operations. In addition, deformities of unoperated joints may jeopardize operative results. Since 1975, we have surgically treated all the lower extemity deformities of each cerebral palsied child in one session. We have carried out single measure operations as well as multiple operative procedures in which bilateral corrective operations are performed on several joints. Of 114 children treated, 40 had multiple and 74 had single operative procedures. Treatment was successful, without need for further surgery, in 80% of the former group and in 61% of the latter. The advantages of one-session surgery are a reduction in the number of operations and, possibly, a reduced chance of reoperation and complications.