Correction Of Torsion Research Articles

Non-surgical Management of Uterine Torsion in Goat: A Report of Five Cases

Background: Uterine torsion is a relatively infrequent occurrence in goats, with reported incidence rates ranging between 1.8% to 2.0%. Accurate diagnosis of this condition poses a notable challenge due to inherent limitations associated with traditional palpation techniques, namely trans-rectal and trans-vaginal examinations. Moreover, the resemblance of clinical signs to incomplete cervical dilation compounds the diagnostic conundrum, necessitating more precise diagnostic modalities. Trans abdominal sonography has been introduced for diagnosis but is not considered completely reliable for confirming the condition. Laparohysterotomy is considered the treatment of choice. Besides, Modified Schaffer’s Method has also been used for the correction of torsion and has proven competent. Methods: Trans-vaginal examination for the diagnosis of the condition followed by correction using Modified Schaffer’s Method was attempted in every case. As per the circumstance, a mutation in necessary cases followed by forced extraction was attempted for the removal of the fetus. Result: The non-surgical detorsion approach proved effective, allowing transvaginal palpation of the fetus in the birth canal in all cases, relieving maternal discomfort from dystocia. Additionally, this method eliminated the need for laparohysterotomy, thus mitigating the risk to the goat.

Double-Level Torsional Osteotomy in Severe Torsional Malalignment: A Surgical Technique

Background: Torsional malalignment of the femur and/or tibia is associated with patellar maltracking, and torsional osteotomies have shown to improve clinical symptoms. In patients with severe torsional malalignment, a double-level torsional osteotomy may be necessary. Indications: Symptomatic torsional malalignment leading to patellofemoral maltracking associated with anterior knee pain and/or patellofemoral instability. Technique Description: A double-level torsional osteotomy correcting both increased internal femoral torsion and increased external tibial torsion, is described. Meticulous preoperative deformity analysis and planning of the osteotomy is mandatory. An arthroscopy of the knee is performed first to evaluate the patellofemoral joint and patellar tracking. Tibial torsional correction is performed by a lateral approach. A biplanar osteotomy is performed, and the amount of torsional correction is controlled by 2 Schanz screws. Osteosynthesis can be done via a bended 5-hole DC-Plate or an angle-stable plate. The femoral osteotomy is performed by a medial approach. A uniplanar osteotomy is performed perpendicular to the mechanical axis of the femur. The amount of torsional correction is controlled by 2 Schanz screws. Osteosynthesis is achieved by an angle-stable plate. Results: Double-level torsional osteotomy has been shown to be an effective treatment for patients with patellar dislocation or subluxation associated with severe torsional malalignment. In a series of 18 patients, double-level osteotomy led to improved patellofemoral stability, decreased pain, and increases subjective outcome scores. Discussion/Conclusion: In patients with patellofemoral problems caused by a combined increased tibial external torsion and increased femoral internal torsion, a double-level torsional osteotomy is able to correct torsional angles to normal. Available clinical data on this procedure are promising. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Single-cut derotational osteotomy of the distal femur for correction of torsion and frontal axis

Arotational osteotomy requires acomplete cut of the bone in order to correct maltorsion. An additional correction of the frontal axis can be achieved via an oblique cut of the bone. The osteotomy with bone to bone contact is fixed with an angle stable plate. Symptoms such as anterior knee pain, inwardly pointing knee syndrome, lateral patellar subluxation or dislocation, lateral patellar hypercompression syndrome are a common indication for derivational osteotomy if clinically increased femoral internal rotation and radiologically increased femoral antetorsion is detected. Increased hip external rotation versus internal rotation, increased femoral torsion but no increased internal hip rotation, malcompliance, inability for partial weight bearing, risk of delayed union (nicotine abuse and obesity) as well as patellofemoral arthritis and systematic glucocorticoids, immunosuppressants are (relative) contra-indications. Alateral or optionally medial approach to the distal femur and exposure of the bone with Eva hooks for the osteotomy is done. The use of patient-specific cutting blocks accurately specify the planned extent of derotation and level of incision. Adefined oblique cutting plane of the single-cut osteotomy and derotation will additionally correct/change frontal axis. An additional biplanar osteotomy with an anterior wedge increases intraoperative stability and generates alarger bone contact area for consolidation. With the use of an extra medullary fixation devicepartial weight bearing with 15-20 kg with crutches up to 6weeks is required, but no restriction on knee movement is given. The literature shows significantly improved patient satisfaction regarding patellofemoral stability and knee function.With the use of patient-specific cutting guides, high accuracy of the osteotomy and 3‑dimensional correction can be achieved, while delayed union rate is up to 10%.

Selective plication and grading of plication for correction of torsion in superior oblique palsy

Abstract: Acquired palsy of the trochlear nerve has been associated with closed-head injuries. We report the case of a 33-year-old male patient, who presented with complaints of torsional diplopia in the straight gaze which increased in the down gaze following head trauma. After a detailed ophthalmic evaluation, the patient was diagnosed with bilateral superior oblique (SO) palsy causing torsional diplopia. To counteract excyclotorsion, we have plicated the anterior one-third of the fibers of the SO in both eyes. Postoperatively, the patient was diplopia free and orthophoric, which maintained up to 3-month follow-up. Correction of excyclotorsion by selective plication of anterior fibers of the SO has already been reported in literature. However, the amount of plication to be performed for various degrees of torsion has not been appropriately described in the previously reported articles. We aim to improve the efficacy of plication anterior fibers of the SO by objective gradation.

Free vibration analysis of hygrothermally stable stiffened composite plates with plate-stiffener interfacial debonding

Stiffeners are frequently utilized in many engineering projects because they boost strength while adding only a small amount of weight to the overall structure. The environments that the stiffened composite constructions are typically exposed to are harsh, which can result in damage like interlayer delamination and debond at the plate-stiffener interface, which can cause catastrophic failure. As a result, it is necessary to examine these structures’ dynamic behavior in addition to their stability performance. The current study attempts to investigate the free vibration response of stiffened composite plates with plate-stiffener interfacial debonding under hygrothermal circumstances using a robust finite element (FE) model. The skin and stiffener flange are simulated in the current work using a 9-noded heterosis element to prevent the shear-locking issue. Additionally, to considerably enhance computational performance, the stiffener web is formulated as a 3-noded isoparametric beam element with the torsion correction factor. Additionally, a dummy node is created to represent the debond, and a fictitious spring is added to stop the nodes from interpenetrating one another. Three schemes of hygrothermally stable laminates (θ/(90- θ))s, (22.5/−67.5)s and (77.5/−12.5)s are considered to identify the stiffened plate configuration with improved free vibration characteristics. Further, extensive parametric analyses are conducted on the obtained stiffened plate with improved performance in a hygrothermal environment by considering debond at the skin-stiffener interface. The vibrational behavior of the debonded plate is shown to be significantly more affected by moisture than by temperature. Additionally, the debond has a more obvious impact on the vibration characteristics in the plate with a centrally attached stiffener than in the plate with an eccentricity attached stiffener. As a result, the established FE formulation is anticipated to be trustworthy and computationally effective while effectively analyzing the debonded stiffened panel’s free vibration behavior in a hygrothermal environment.

Comparison of the deformity reduction device (DRD) mini and the Slocum jig in the precision of torsional correction during distal femoral osteotomies in small to medium breed dogs.

Previous studies have compared the use of the Slocum- jig to the deformity reduction device (DRD) jig for the correction of distal femoral deformities of varying degrees in the frontal plane. The objective of the current study is to further investigate the use of the mini DRD jig in comparison to the Slocum jig for correction of varying degrees of torsional deformities of the distal femur. Femoral models (n = 60) were developed based on a CT scan of an approximately 16.5 kg normal canine femur. Models were created with a standard varus deformity of 15 degrees, and external torsional deformities of 15, 20, or 30 degrees. Using center of rotation of angulation (CORA) methodology, corrective osteotomies were planned and performed on each of the 3D printed models based on the group assigned. Modeling clay was applied the proximal femur to mimic visualization of a routine lateral surgical approach, while retaining the ability to palpate surgical landmarks. Post-correction anatomic lateral distal femoral angle (aLDFA) and femoral torsion angle (FTA) were measured and recorded. The mean post-correction FTA of groups using the DRD jig for correction were consistently closer to the ideal value compared to those using the Slocum jig, although these differences were not always statistically significant. Correction of external torsion between the DRD jig and the Slocum jig was significantly different in groups 1 and 2 (P = 0.026 and P = 0.046), but not in group 3. For the correction of varus deformity, no significant difference was found between the two jig types in any group. Results of this study suggest jig selection during distal femoral osteotomy for correction of torsional deformity may result in varying precision of post-correction alignment. Clinical significance of this variance remains unclear, and intra-operative visual assessment of alignment should be implemented to guide corrections.

Degrees of Testicular Atrophy Following Orchidopexy for Testicular Torsion.

Introduction Testicular torsion is an urological emergency. It is a time-sensitive condition in which twisting of the spermatic cord and testicular blood supply occurs, causing acute onset severe scrotal pain. The incidence of testicular torsion is highest amongst prepubertal males; however, it can occur at any age. Every hour that passes from the onset of symptoms has been shown to decrease the salvageability rate of the torted testis. Another significant factor that impacts testicular salvage is the degree of torsion. Prompt surgical exploration of the scrotum and orchidopexy, if the testis is salvageable, is the mainstay of treatment. A major sequela following orchidopexy for torsion is the decrease in testicular volume. The aim of this study is to assess testicular volume loss post orchidopexy in patients who presented with testicular torsion, as well as to identify the significance of the degree of rotation and duration of torsion in post-fixation volume loss. Methods This is a retrospective study in which all patients who underwent scrotal exploration for a primary diagnosis of testicular torsion between June 1, 2016, to January 15, 2023, were reviewed. The information obtained included the patients' demographics such as age, duration of symptoms, and laterality. Ultrasound images were reviewed for pre- and postoperative findings which included confirmation of testicular torsion as well as testicular volume measurements. Patients were excluded if they underwent an orchidectomy, had a diagnosis other than testicular torsion once scrotal exploration was done, or did not perform a follow-up scrotal ultrasound. Additionally, patients who underwent an orchidopexy for undescended testis earlier in life were also excluded. For statistical analysis purposes, degrees of testicular torsion and time to surgery were classified into mild, moderate, and severe. Results A total of 109 patient records were reviewed within the specific time frame. Of these, 47 patients were excluded as per the exclusion criteria mentioned previously, which gave us a sample size of 62 patients. Our findings showed that increasing severity of the degree of torsion as well as the time for surgery have statistically significant (p-value <0.05) effects on postoperative testicular volume loss. However, it was noted that time to surgery has a more pronounced effect on the mean volume loss than the degree of torsion. Moreover, the analysis also showed that, on average, with every additional hour from the onset of symptoms to surgery, the approximate volume loss is 0.15 ml. However, once time exceeds the 4.5-hour mark, the mean volume loss is 0.4 ml for each additional hour. Conclusion The current study indicates that earlier surgical intervention and correction of torsion are associated with enhanced preservation of postoperative testicular volume. Both the degree of torsion and time to surgery influence mean volume loss; however, time to surgery has a greater impact on the mean volume loss. These results highlight the importance of early diagnosis and intervention in cases of testicular torsion to minimize the risk of long-term testicular volume loss.

Unlocking physiological transformations in riverine buffaloes following uterine torsion correction

This study aimed to examine the physiological alterations in riverine buffaloes with incompletely dilated cervix after the uterine torsion correction and the main objective was to understand the hormonal changes that lead to complete cervical dilatation following detorsion, facilitating per-vaginal birth. Torsion characteristics in buffaloes (n=24) were examined, and detorsion was performed using Sharma’s Modified Schaffer’s approach. Blood samples were collected pre-detorsion, post-detorsion, and at parturition. The average cervical dilation rate was 1.22±0.16 cm/h, and detorsion-to-parturition duration averaged 17.38±1.44 h. There were no significant differences between haematological and biochemical parameters at three-time intervals except serum calcium. Progesterone levelsdecreased progressively (1.43±0.01 ng/mL, 1.37±0.01 ng/mL, 1.34±0.01 ng/mL), while estradiol levels increased significantly (65.86±2.05 pg/mL, 77.08±2.05 pg/mL, 91.8±2.55 pg/mL) from pre-detorsion to post-detorsion and parturition. The levels of cortisol were significantly higher pre-detorsion (24.3±2.07 ng/mL) and post-detorsion (27.1±2.5 ng/mL) than at parturition (18.31±1.76 ng/mL). In conclusion, elevated estradiol levels, coupled with reduced progesterone, post-detorsion, trigger complete cervical dilatation, facilitating per-vaginal birth. This study sheds light on the hormonal dynamics driving the birthing process in buffaloes after uterine torsion correction.

Miserable malalignment syndrome associated knee pain: a case for infra-tubercle tibial de-rotation osteotomy using an external fixator

IntroductionMiserable malalignment syndrome is a complex torsional lower limb deformity with limited consensus on surgical treatment. We present the outcome of de-rotation of the tibia alone using an external fixator.MethodsFifteen patients (22 segments) were operated on between 2012 and 2020; 13 presented with anterior knee pain, and two presented with out-toeing. Gait analysis was done in nine patients, and CT scan rotational profile, including tibial tubercle–trochlear groove distance, femoral version, and tibial torsion, were calculated. Kujala knee pain score and visual analogue pain score (VAS) were recorded. All underwent infra-tubercular osteotomy of the tibia and midshaft osteotmy of the fibula and application of a hexapod circular frame to gradually internally rotate the tibia until the foot aligned with the patella.ResultsThere was no preoperative clinical or radiographic evidence for patellar instability, femoral anteversion 30° (21°–54°), and external tibial torsion 50° (37–70). The mean age at surgery was 21 years (12–37) with a mean follow-up of 20 months (9–83). All osteotomies healed, and the frames were removed at a mean of 111 days (80–168). The mean VAS score improved from 8(5–9) to 1(0–4) postoperatively (P < 0.001). The mean Kujala knee pain score increased from 53 (30–75) to 92 (54–100) postoperatively (P < 0.001). The mean preoperative foot progression angle (FPA) was 37° (20°–50°), with 13 postoperatively walking with neutral FPA. One patient walked with symmetrical + 10° and the other with − 5° FPA. All patients reported relief of knee pain and were satisfied with the alignment.ConclusionGradual correction of severe external tibia torsion with a hexapod external fixator and an infra-tubercle tibial osteotomy could provide an optimum method to eliminate knee pain and improve limb alignment in miserable malalignment syndrome.

Intraoperative control by Schanz-screws is inaccurate to achieve the exact amount of correction in de-rotational osteotomies.

The accuracy of intraoperative control of correction commonly is achieved by K-wires or Schanz-screws in combination with goniometer in de-rotational osteotomies. The purpose of this study is to investigate the accuracy of intraoperative torsional control in de-rotational femoral and tibial osteotomies. It is hypothesized, that intraoperative control by Schanz-screws and goniometer in de-rotational osteotomies around the knee is a safe and well predictable method to control the surgical torsional correction intraoperatively. 55 consecutive osteotomies around the knee joint were registered, 28 femoral and 27 tibial. The indication for osteotomy was femoral or tibial torsional deformity with the clinical occurrence of patellofemoral maltracking or PFI. Pre- and postoperative torsions were measured according to the method of Waidelich on computed tomography (CT) scan. The scheduled value of torsional correction was defined by the surgeon preoperatively. Intraoperative control of torsional correction was achieved by 5mm-Schanz-screws and goniometer. The measured values of torsional CT scan were compared to the preoperative defined and intended values and deviation was calculated separately for femoral and tibial osteotomies. The surgeon's intraoperative measured mean value of correction in all osteotomies was 15.2° (SD 4.6; range 10-27), whereas the postoperatively measured mean value on CT scan was 15.6 (6.8; 5.0-28.5). Intraoperatively the femoral mean value measured 17.9° (4.9; 10-27) and 12.4° (1.9; 10-15) for the tibia. Postoperatively the mean value for femoral correction was 19.8 (5.5; 9.0-28.5) and 11.3 (5.0; 5.0-26.0) for tibial correction. When considering a deviation of plus or minus 3° to be acceptable femorally 15 osteotomies (53.6%) and tibially 14 osteotomies (51.9%) fell within these limits. Nine femoral cases (32.1.%) were overcorrected, four cases undercorrected (14.3%). Four tibial cases of overcorrection (14.8%) and 9 tibial cases of undercorrection (33.3%) were observed. However, the observed difference between femur and tibia regarding the distribution of cases between the three groups did not reach significance. Moreover, there was no correlation between the extent of correction and the deviation from the intended result. The use of Schanz-screws and goniometer in de-rotational osteotomies as an intraoperative control of correction is an inaccurate method. Every surgeon performing derotational osteotomies must consider this and include postoperative torsional measurement in his postoperative algorithm until new tools or devices are available to guarantee a better intraoperative accuracy of torsional correction. Observational study. III.

Hodnocení frontálního postavení distální části dolní končetiny podle sklonu horizontální linie kloubní štěrbiny hlezna

PURPOSE OF THE STUDY Osteotomies around the knee are an established technique for treating knee osteoarthritis and other knee conditions by redistributing the body's weight and force within and around the knee joint. The aim of this study was to determine if the Tibia Plafond Horizontal Orientation Angle (TPHA) is a reliable measure for describing ankle alignment of the distal tibia in the coronal plane. MATERIALS AND METHODS This retrospective study included patients who underwent supracondylar rotational osteotomies for correction of femoral torsion. All patients had standing radiographs taken preoperatively and postoperatively with both knees pointed forward. Five variables, including Mechanical Lateral Distal Tibia Angle (mLDTA), Mechanical Malleolar Angle (mMA), Malleolar Horizontal Orientation Angle (MHA), Tibia Plafond Horizontal Orientation Angle (TPHA), and Tibio Talar Tilt Angle (TTTA), were collected. The preoperative and postoperative measurements were compared to each other using the Wilcoxon signed rank test. RESULTS A total of 146 patients were included in the study, with a mean age of 51.47 ± 11.87 years. There were 92 (63.0%) males and 54 (37.0%) females. MHA decreased from 14.0° ± 5.32° preoperatively to 10.59° ± 3.93° (p < 0.001) postoperatively, and TPHA decreased from 4.88° ± 4.07° preoperatively to 3.82 ± 3.10° (p = 0.013) postoperatively. The change in TPHA was significantly correlated with the change in MHA (r = 0.185, CI 0.023 - 0.337; p = 0.025). No differences were found between the measurements of mLDTA, mMA, and mMA pre- and postoperatively. DISCUSSION The orientation of the ankle should be taken into consideration during preoperative planning of osteotomies and should be measured in cases of postoperative ankle pain. CONCLUSIONS The TPHA is a reliable measure for describing ankle alignment of the distal tibia in the frontal plane. Key words: osteotomy, ankle, realignment, coronal alignment, preoperative planning.

Torsionally-Induced Stability in Spinors

We consider the role of the torsion axial-vector played in the dynamics of the Dirac spinor fields: we show that the torsional correction entails effects that render regular the otherwise singular spinorial matter field distribution. Comments about consequences for physics are eventually given.

Stability Performance of Perforated Stiffened Laminated Composite Plates Under the Influence of Environmental and Operational Loading Conditions Using FE Approach

Eccentrically stiffened plates are widely used as a structural component in many engineering applications. However, these structures are exposed to complex loading conditions, resulting in strength reduction leading to failure. This research aims to examine the stability performance of the perforated stiffened laminated composite plate subjected to non-uniform edge load under the influence of environmental conditions. Towards this, a robust and computationally efficient finite element (FE) formulation has been developed, where the plate is modeled using a 9-noded heterosis element to avoid the shear locking of the plate element and a 3-noded isoparametric beam element is adopted to model the stiffener by applying a displacement compatibility condition at the skin-stringer interface. A torsion correction factor is introduced in the beam formulation to account for the twisting of the stiffener. A unique dynamic technique is utilized to obtain the buckling load by employing two types of boundary conditions due to the non-uniform stress distribution in the perforated plate under environmental and operational loading conditions. An analysis is performed on the unstiffened plate to determine a suitable cutout shape, loading pattern and lamina scheme based on its improved stability performance. Unlike previous studies, several stiffener configurations are considered to comprehend the influence of temperature and moisture on the stability behavior of centrally placed cutout plates and obtain a stiffener configuration with improved performance. It is noticed that when the perforated stiffened plate is exposed to thermal or hygroscopic load close to a critical temperature or moisture, the buckling capacity drops suddenly in the plate attached to a stiffener of greater depth. Moreover, it is observed that when the stiffened plate is exposed to higher intensity of hygrothermal load, the plate’s buckling capacity drops significantly as the thickness of the plate reduces.

Correction of Penile Torsion by Dissection and Resection of the Dysplastic Dartos Fascia

Correction of Penile Torsion by Dissection and Resection of the Dysplastic Dartos Fascia

Correction of tibial tubercle trochlea groove distance is related to torsional correction in high tibial derotational osteotomy.

High tibial osteotomy with internal tibial derotation (high tibial derotation osteotomy = HTDRO) is a common surgical treatment in patients with patellofemoral malalignment alone or in combination with patellofemoral instability. Operative techniques and theoretical calculations may assume that correction of the tibial tubercle-trochlear groove (TTTG) distance is related to the amount of torsional correction. The purpose of this investigation was to predict the change in TTTG distance in HTDRO through a clinical study. Twenty-one consecutive cases of derotational HTO were evaluated by torsional CT scanning in terms of the pre- and postoperative tibial torsion and TTTG distance. Changes in the TTTG distance were related to the changes in the amount of torsional correction. The change in patellar height was measured pre- and postoperatively, and the Caton-Deschamps Index (CDI) was calculated. The mean change in tibial torsion was 13.9°, and the mean change in the TTTG distance was 6.3mm. A strong relationship (0.90) between the change in torsion and the change in TTTG distance from pre- to postoperative status was found (p < 0.001). No statistically significant change in CDI could be seen between the preoperative [mean value (MV) 1.0] and postoperative (MV 1.1) periods. In patients with patellofemoral instability or patellofemoral maltracking with both a high tibial external torsion and a high TTTG distance, a derotational HTO can correct both bony deformities. Patella height does not change significantly with this surgical technique. With 1° of torsional correction, the TTTG distance decreases 0.45mm with our surgical technique of derotational HTO.

AUGMENTING CERVIMETRY, FETAL SURVIVABILITY, CALVING EASE, AND UTERINE HEALTH DURING BUFFALO UTERINE TORSION TREATMENT

A total of 52 buffalo cows suffering from uterine torsion were divided into seven groups.Each animal in the groupwas subjected to diagnosis depending upon clinical signs, rectal, vaginal, and ultrasonographic examination then subjected to one of the formulatedtherapeutic regimes.Cervimetry, state of fetal livability, parturition easiness, placental dropping time, and uterine health witheach specific treatment were recorded. Results: groups injected with denaverine hydrochloride, denaverine hydrochloride potentiated with methylergometrine showed rapid cervical dilation rate (3.1±0.26cm and 3.2±0.19cm, respectively).Moreover, had an extending effect, where an efficient cervimetry rate (17±0.52 cm and16±0.46cm, respectively)was achieved after 24h from starting the treatment.Denaverine hydrochloride, denaverine hydrochloride potentiated with methylergometrine and cloprostenol sodium plus methylergometrineshowed the unique parturition process that took place with no maneuverers (2.1±0.26, 1.8±0.22 and 2.1±0.55) with preserved fetal viability (100, 88.8 and 85.7 %) and uterine health (85.7, 88.8 and 85.7%). While,methylergometrine alone was an inefficient therapeutic protocol that didntassisted the process of normal delivery (3.2±0.17) and increases the rate of fetal deaths (50%).Denaverine hydrochloride, denaverine hydrochloride potentiated with methylergometrine andcloprostenol plus methylergometrinetreated groups showed significantly the shortest placental dropping time (9.4±1.2, 10±1.1and10±0.67hrs, respectively), while methylergometrine and misoprostol recorded the longest placental dropping time (13±0.49 and 13±0.37hrs, respectively).In conclusion,this study was considered the first attempt that follows the degree of cervimetryafter uterine torsion correction. Denaverine hydrochloride plus methergin is an efficient treatment regime that improved the reproductive health of buffalocow after uterine torsion correction.The cervical dilation rate starting from 13.00 -14.00 cmwas an articulated size at which the process of eutocia can start in buffalocows. The maximum achieved mean of the internal cervical luminal diameter for buffalo-cow after detorsion was 17±0.52cm, this diameter assisted the delivery process with little maneuverers.

Three-dimensional volume rendering planning, surgical treatment, and clinical outcomes for femoral and tibial detorsional osteotomies in dogs.

To describe a computed tomographic (CT) methodology for planning the correction of femoral and tibial torsion and report the clinical outcomes after femoral (FDO) and tibial (TDO) detorsional osteotomy in dogs affected by torsion malalignment and patellar luxation (PL). Multicenter retrospective study. Eighteen client-owned dogs. Dogs underwent CT to measure femoral (FTA) and tibial torsion angle (TTA). Abnormal femoral external torsion was defined when FTA <20°, abnormal femoral internal torsion if FTA >35°; abnormal tibial external torsion was defined when TTA < -10°, and abnormal tibial internal torsion when TTA >2°. The cortical arch length (CAL) was measured with CT and used intraoperatively to determine the magnitude of correction. The medical records and radiographs were reviewed and used to report clinical and radiographic outcomes. Radiographs were reviewed to evaluate postoperative limb alignment, patellar position, and bone healing. Twenty-two detorsional osteotomies were performed. Mean preoperative FTA was 14° for medial-PL and 45.2° for lateral-PL. Mean preoperative TTA was 11° for medial-PL. Physiological patellar tracking was restored in 22/22 of cases. CAL measurement allowed for correction of abnormal torsion in 19/22 of cases. Seventeen out 18 dogs had full or acceptable functional outcome. The median radiographic follow-up was 3months. Major complications occurred in 2/22 cases, which suffered an iatrogenic abnormal femoral internal torsion and a persistent hindlimb lameness. CAL can be measured with CT and used intraoperatively to guide the correction of abnormal torsion in dogs. Abnormal femoral and tibial torsion are predisposing factors for PL. A higher complication rate is expected when FDO and TDO are performed in the same hindlimb.

Combined distal femoral osteotomy and tibial tuberosity distalization is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment.

Patellar malalignment has been considered one of the major pathomechanical causes of patellofemoral instability and pain. The results have been reported after femoral varization/torsional osteotomy and tibial tuberosity distalization osteotomy (TTD-O). However, the combination of a femoral deformity (genu valgum/increased femur antetorsion) and patella alta remains underreported. Therefore, the aim of this study was to investigate the clinical outcomes of patients simultaneously treated by distal femoral osteotomy and TTD-O. The hypothesis was that restoration of patellofemoral (PF) alignment via the abovementioned osteotomies would achieve good patient-reported outcome measures. Between 2016 and 2019, a series of 25 knees in 20 patients were treated by a distal femoral osteotomy combined with a TTD-O aiming to correct patellofemoral malalignment consisting of genu valgum and/or increased femur antetorsion and patella alta. Six patients were lost to follow-up, and one patient refused to participate. Thus, 17 knees in 13 patients (male/female 1/12; age 27.4 ± 5.4years) were included and comprised the study group for this investigation. Patients were evaluated after a mean of 3.1 ± 0.9years postoperatively. The Kujala anterior knee pain scale and the PF-subscale of the Knee Osteoarthritis and Outcome score (KOOS-PF) were used to assess patients' reported outcome measures from pre- to postoperatively. The mean amount of torsional correction, valgus correction, and tibial tuberosity distalization averaged 14° (10°-18°), 5.2° (3.8°-8°), and 9mm (6°-15mm), respectively. The Kujala score increased by an average of 24.18 points from a mean of 66.6 ± 18.3 points (34-93 points) preoperatively to 90.8 ± 14.2 points (44-100 points) postoperatively (95% CI -33.0 to -15.3; p < 0.0001). The KOOS-PF score increased by an average of 33.7 points from a mean of 49.5 ± 24.5 points (9.1-88.6 points) preoperatively to 83.2 ± 21.6 points (15.9 -100 points) postoperatively (95% CI -47.5 to -19.9; p < 0.0001). The findings of this study indicate that the combination of a distal femoral osteotomy and a tibial tuberosity distalization osteotomy is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment.

Pediatric lower limb peripheral nerve blocks: Indications, effectiveness, and the incidence of adverse events.

While the proportion of pediatric anesthetics with regional anesthesia in pediatric patients has steadily increased, there are only a few series that describe the use of lower limb peripheral nerve blocks in children. Our aim was to describe the indications, anesthetic approach, and complications associated with lower limb blocks in children undergoing orthopedic surgery in a center with a large caseload of complex patients. In a retrospective analysis of prospectively collected data, we reviewed children who had a peripheral nerve block for orthopedic surgery placed between January 2016 and January 2021 at the Royal Children's Hospital Melbourne. Block data were sourced from the electronic medical record and departmental regional anesthesia database. Data collected included demographics, the site of catheter placement and technique of nerve block, presence of sensory/motor blockade, the use of perioperative opioids, and any complications related to peripheral nerve block. A total of 1438 blocks were performed in 1058 patients. Four patients had clinical features of perioperative neurological injury giving an incidence of 3 per 1000 blocks (95% CI 1.1-8:1000). Only one patient had a sensory deficit persisting longer than 6months for an incidence of 0.8 per 1000 blocks (95% CI 0.1-5:1000). All four peripheral nerve injury followed tibial osteotomy for lengthening procedures or correction of tibial torsion. The etiology of the injury could not be determined despite imaging and surgical exploration and the contribution of popliteal sciatic nerve block to the subsequent PNI could not be confirmed. There were no cases of local anesthetic systemic toxicity. An increased risk of perioperative peripheral nerve injury is associated with pediatric tibial osteotomy for congenital deformity. While popliteal sciatic nerve block was not directly implicated in the nerve injury the presence of a prolonged sensory block can delay early recognition and treatment of peripheral nerve injury.

Subtrochanteric osteotomy in the management of femoral maltorsion results in anteroposterior malcorrection of the greater trochanter: computed simulations of 3D surface models of 100 cadavers.

The purpose of this study was to investigate the greater trochanter's (GT) behaviour in simulated subtrochanteric osteotomy. Measurement of functional and anatomical femoral torsion, and position of the GT and lesser trochanter was performed using 3-dimensional (3D) surface models of 100 cadaveric femora. Femoral torsion between 2° and 22° was defined as normal, femora with <2° and >22° of femoral torsion were assigned to the low- and high-torsion group. Subtrochanteric osteotomy was simulated to normalise torsional deformities to 12°. With subtrochanteric osteotomy, functional torsion was simultaneously corrected while adjusting anatomical torsion (R2 = 0.866, p < 0.001). Compared to the normal-torsion group, an anteroposterior (AP) overcorrection of ±0.5 centimetres (range 0.02-1.1 cm) of the GT resulted in the high- and low-torsion group, respectively (p < 0.001): Mean AP GT distance to a standardised coronal plane was 2.1 ± 0.3 cm (range 12-30 cm) in the normal-torsion group compared to 1.61 ± 0.1 cm (range 1.4-1.71 cm) and 2.6 ± 0.6 cm (range 1.8-3.6 cm) for the corrected high and low-torsion groups, respectively. The extent of the GT shift in AP direction correlated strongly with the extent to which anatomical femoral torsion was corrected (R2 = 0.946; p < 0.001). Subtrochanteric osteotomy for femoral maltorsion reliably adjusts anatomical and functional torsion, but also results in a ±1 cm AP shift of the GT per 10° of torsional correction. However, this effect of the procedure is most likely not clinically relevant in relation to hip abductor performance.