Correction Of Varus Deformity Research Articles

Three-dimensional printing combined with distal humeral osteotomy for cubital varus deformity in children

To explore clinical effect of three-dimensional(3D) printing combined with distal humerus osteotomy for children with cubital varus deformity. From January 2017 to January 2020, 17 cubital varus deformity children treated with distal humerus osteotomy were retrospective analysis, included 11 boys and 6 girls, aged from 5 to 11 years old with an average of (7.8±1.7) years old. A model of affected side elbow joint was made by 3D printing technique before operation, pre-operation was performed on the model. Three-dimensional model was successfully used for distal humeral osteotomy during operation. Carrying angle, flexion and extension angle of elbow joint were compared before and six months after operation, and Flynn scoring criteria was used to evaluate clinical effect. All children were followed up for 6 to 12 months with an avergae of (9.6±1.7) months. One child occurred wound infection and healed completely after dressing change. No complications such as nonunion, internal fixation and nerve injury occurred. Carrying angle of affected limb was improved from (-20.8±2.4)°before operation to (7.2±2.3)°at 6 months after operation (P<0.01). Angle of affected elbow joint extension improved from (-5.6±3.9)° before opeation to(-2.6±2.1)°at 6 months after operation (P<0.01). There was no significant difference in extension angle of elbow joint between preopertaion and postopertaion at 6 months (P>0.05). While there was no difference in elbow joint function on the healthy side and affected side at 6 months after opertaion (P>0.05). According to Flynn scoring criteria, 13 patients got excllent results and 4 moderate. Three-dimensional printing combined with distal humerus osteotomy in treating elbow varus deformity could receive satisfactory clinical effect, which could accurately assist correction of cubital varus deformity, restore physiological structure and function of elbow joint.

Is modified reverse step-cut osteotomy better than Yun's reverse V osteotomy in paediatric cubitus varus deformity correction? A prospective, double-blinded, randomized controlled trial.

Various corrective osteotomy techniques have been described in the literature for correcting paediatric cubitus varus. But we are still in search of the perfect technique that gives maximum possible deformity correction and cosmetic appearance that satisfies parents with minimal complications. We compared the outcomes of two technically sound osteotomy techniques having minimal postoperative lateral condyle prominence described in the literature. Is modified reverse step-cut osteotomy (MRSO) better in terms of clinical, radiological, and cosmetic outcomes than Yun's reverse V osteotomy (RVO) in pediatric cubitus varus deformity correction? In total, 20 children with unilateral cubitus varus resulting from malunited supracondylar humerus fractures were included. Randomization was done by computer-generated random slips. A total of ten cases each were operated by MRSO and RVO techniques, respectively. Clinical, radiological, and cosmetic appearance assessments were done at the final two year follow-up and compared between the two groups. The mean age of children in the MRSO and RVO groups is 9.9years (3-16) and 8.6years (3-16), respectively. The mean pre-operative carrying angle in the deformed elbow of MRSO and RVO group was - 20.5° and - 19.5°, respectively, and the mean pos-toperative carrying angle in the corrected elbow of MRSO and RVO group was + 6.8° and + 6.5°, respectively. Regarding the lateral prominence index (LPI), a positive correlation was noted between pre-operative and post-operative periods with a value of 0.855 and 0.844 (p value: 0.001 and 0.03, respectively) in both MRSO and RVO groups, respectively. However, the change was statistically not significant when compared between the two groups (p = 0.63). There was no statistically significant difference (p > 0.05) when the clinical, radiological, and cosmetic outcomes were compared between the groups at final follow-up. The surgeon can choose either one of these techniques based on their expertise since the results of both the techniques are comparable in terms of clinical, radiological, and cosmetic outcomes.

Enhanced Mid-Resection Workflow Technique for Severe Varus Deformity Correction Using Robotic-Arm Assisted Total Knee Arthroplasty

Introduction: Robotic technology in total knee arthroplasty has been proven to improve accuracy of component positioning, achieve alignment targets, and balance the knee objectively. However, the utility of robotics in correction of severe varus deformities of the knee has not been investigated in detail. The aim of this paper was to establish the utility and describe the technique of robotic-arm assisted total knee arthroplasty (RA-TKA) in achieving pre-balance in severe varus deformities of the knee. Materials and Methods: Among the existing Mako (Stryker, Kalamazoo, Michigan) RA-TKA workflows, pre-resection workflow is limited to knees which can be pre-balanced by component positioning according to functional alignment. Mid-resection workflow (distal femur/tibia first) is reserved for complex cases, whereby the extension gap is balanced first. In our experience, both workflows could not achieve pre-balance in severe varus deformities, necessitating the need to develop a novel technique. The ability of the robot to execute precise bone cuts allows for a provisional postero-medial femoral bone cut in flexion, giving access to remove large inaccessible posterior osteophytes and the tight posterior capsule, thus balancing the knee in extension. The flexion gap is subsequently matched to the extension gap by alterations in axial component positioning. Conclusion: This novel “enhanced mid-resection workflow” technique establishes the utility of the RA-TKA in balancing severe varus deformities of the knee. We also propose an algorithm which simplifies and helps surgeons choose between the three workflows to pre-balance knees irrespective of the severity of the varus deformity.

Évaluation expérimentale des déplacements des fragments osseux avec un fixateur hexapode au moyen de diodes infrarouge sur os synthétique

BackgroundThe purpose of this study was an experimental assessment of changes in bone fragment position in patients with nonunion of the tibia treated with a hexapod fixator. HypothesisWe hypothesized that the use of hexapod fixators leads to differences between the planned and actual position of bone fragments. MethodsThe study was conducted in physical models of the hexapod fixator–bone fragment system. Bone fragment displacement was measured using the Optotrak Certus Motion Capture System. We assessed differences between the planned and actual position of bone fragments. ResultsAssessment of bone fragment compression demonstrated a difference between the target and actual correction ranging from 1.5% to 13.2% (depending on the force applied to bone fragments) for configuration 1, from 17% to 21.3%for configuration 2,and from 13.2%to17.9% for configuration 3. The achieved varus deformity correction constituted 93.7–98.4%of the target correction for configuration 2 and 98.3–98.9%of the target correction for configuration 3.Torsional deformity correction showed considerable discrepancies between the target and achieved correction, ranging from 65.6% to 83%. DiscussionThe value of the applied compression force had no marked effect on the differences between the target and achieved correction or on the magnitude of unintended rotational and transverse displacement of bone fragments. The use of hexapod fixators helped achieve complete correction of the simulated varus deformity; however, complete correction of torsional deformities was not achieved. Deformity correction in physical models with the use of a hexapod fixator yielded instances of unintended rotational and transverse bone-fragment displacement. The use of hexapod fixators in physical models leads to differences between the planned and actual position of bone fragments. Level of EvidenceIV, case series.

Experimental assessment of changes in bone fragment position using infraread diodes on saw bone models with a hexapod fixator

BackgroundThe purpose of this study was an experimental assessment of changes in bone fragment position in patients with non-union of the tibia treated with a hexapod fixator. HypothesisWe hypothesized that the use of hexapod fixators leads to differences between the planned and actual position of bone fragments. MethodsThe study was conducted in physical models of the hexapod fixator–bone fragment system. Bone fragment displacement was measured using the Optotrak Certus Motion Capture System. We assessed differences between the planned and actual position of bone fragments. ResultsAssessment of bone fragment compression demonstrated a difference between the target and actual correction ranging from 1.5% to 13.2% (depending on the force applied to bone fragments) for configuration 1, from17% to 21.3% for configuration 2, and from 13.2% to 17.9% for configuration 3. The achieved varus deformity correction constituted 93.7–98.4% of the target correction for configuration 2 and 98.3–98.9% of the target correction for configuration 3. Torsional deformity correction showed considerable discrepancies between the target and achieved correction, ranging from 65.6% to 83%. DiscussionThe value of the applied compression force had no marked effect on the differences between the target and achieved correction or on the magnitude of unintended rotational and transverse displacement of bone fragments. The use of hexapod fixators helped achieve complete correction of the simulated varus deformity; however, complete correction of torsional deformities was not achieved. Deformity correction in physical models with the use of a hexapod fixator yielded instances of unintended rotational and transverse bone-fragment displacement. The use of hexapod fixators in physical models leads to differences between the planned and actual position of bone fragments. Level of evidenceIV, case series.

Outcome of distal femoral osteotomy for the correction of varus deformities originating in the distal femur: a prospective study

Background: The authors hypothesized that implication of distal femur osteotomy (DFO) in patients with varus deformities that originated in the distal femur will reduce the rate of joint-line obliquity, thereby improving the radiographic, clinical, and functional outcomes of the patients. Here, the authors aimed to evaluate the outcome of DFO in the correction of varus deformities that originated in the distal femur. Methods: In a prospective study, 27 patients (31 knees) with varus deformities located in the distal femur who underwent a lateral biplane closed wedge DFO were included. Radiographic evaluations included the joint-line obliquity, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint-line convergence angle (JLCA). Lysholm-Tegner score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for the evaluation of functional outcome. The union of the osteotomy site was assessed radiographically. Results: At the final evaluation session, the mean preoperative varus angle significantly improved from 12.7±3.4 degrees to 1.6±1.6 degrees (P&lt;0.001). The mean preoperative LDFA significantly improved from 96±2.1 degrees to 87.9±1.1 degrees (P&lt;0.001). The mean preoperative JLCA significantly improved from 3.1±0.4 degrees to 2±0.3 degrees (P&lt;0.001). The mean preoperative Lysholm-Tegner scores also improved considerably from 66.4±2 degrees to 88.9±2.6 degrees (P&lt;0.001). The mean KOOS of the patients improved from 63.9±4.1 degrees to 86.1±4.6 degrees. Only one patient (3.2%) was observed to have joint-line obliquity (greater than±4 degrees). Bone union was seen in all patients at an average period of 9±1.9 wk. Conclusions: DFO results in small rate of joint-line obliquity, as well as acceptable radiographic, clinical, and functional outcomes in patients with varus deformities located in the distal femur. Level of Evidence: Level III.

High Tibial Osteotomy Effects on Subtalar Joint in Patients with Genu Varum.

osteotomy around the knee is one of the most common corrective surgeries for lower limb deformities. The exact relationship between the effects of these surgeries on the ankle joint is unclear.This study aimed to investigate the effect of HTO on the subtalar joint in patients with genu varum. In the case series study33 patients including 27.2% men and 72.7% womenwith an average age of 41.9, with genu varum who underwent corrective surgery of open wedge high tibial osteotomy were studied. the heel alignment angle was determined before and after surgery in 10-months follow-up based on Saltzman view in conventional radiography. The data were then compared. Average genu varum correction angle was 11.9±1.3°. Heel alignment degree was 5.9±1.3° before HTO surgery, and after the surgery,in final follow-up,it was to 3.4±1.2° valgus, this value was statisticallysignificant(p=0.04). Moreover, there was a significant statistical relationship between average correction of Varus deformity and heel alignment anglechanges (P=0.02, r=0.3). Correcting Varus knee deformity can be effectiveon heel alignment angle in patients undergoing HTO surgery with genu varum. The angle of the subtalar valgus decreases as a result.

Unsuccessful mid-term results for distal humeral hemiepiphysiodesis to treat cubitus varus deformity in young children.

Cubitus varus is the most common complication following a pediatric humeral supracondylar fracture. No reports are available on the result of hemiepiphysiodesis to correct this deformity. We report the use of a transphyseal crossed cannulated screw (Metaizeau technique) in five very young children (mean 3 years and 7 months). No correction was observed after a mean of 3 years and 10 months of follow-up. The low growing capacity of the distal humeral physis makes corrective osteotomy the procedure of choice for cubitus varus deformity correction in children.

Medial malleolar osteotomy for the correction of tibiotalar varus deformity during total ankle arthroplasty: Results in 95 ankles

BackgroundThe importance of deformity correction before or during total ankle replacement (TAR) has been recognized for a long time. Our results of TAR, combined with medial malleolar lengthening osteotomy, for the reconstruction of osteoarthritic ankles with varus deformity are hereby reported. MethodsAll ankles in which a medial malleolar osteotomy was performed during implantation of an ankle prosthesis during the period 1998–2018 were filtered out of our database. Preoperative coronal talar alignment was evaluated by measuring the angle between the tibial shaft and talar dome on the weightbearing mortise ankle radiograph. Patient-reported outcomes were measured with the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). A Kaplan-Meier survival curve was constructed and the number of revisions per 100 observed component years was calculated for interprosthetic comparison. ResultsA total of 95 TARs were included, consisting of the Alpha Ankle Arthroplasty (n = 22); Buechel-Pappas (n = 14) and the Ceramic Coated Implant Evolution (n = 59) prostheses. The preoperative average talar angle in these ankles was 12.4 degrees varus. In 33% (31/95) corrective procedures, in addition to the medial malleolar osteotomy, were performed. A reoperation rate of 44% (42/95) was found, including 28 revisions (revision rate 29% (4% septic; 25% aseptic) at an average follow-up of 5.9 years, resulting in a survival of 0.69 for the total cohort at 10 years of follow-up.At an average follow-up of 6.6 years the average FAOS scores were: FAOSsymptoms 66, FAOSpain 73, FAOSfunction 78, FAOSsport 45 and FAOSquality of life 56 respectively. The FAAMadl score averaged 64. ConclusionThis is the largest cohort of TAR combined with medial malleolar osteotomy to date. A 29% revision rate at 5.9 years of average follow-up compares unfavorably with regular cohort studies and with most other results in varus-deformed ankles. Scores on the FAOS and FAAM are comparable to those obtained in regular cohorts with similar length of follow-up. TAR in varus-deformed ankles necessitating medial malleolar osteotomy has an even higher failure rate than regular TAR. Obtaining a stable prosthesis with a neutrally-aligned hindfoot at the end of the procedure is of paramount importance. Level of evidenceIV.

Early failure of all polyethylene tibial components in bilateral total knee arthroplasty: A case report

Introduction: Outcomes of Total Knee Arthroplasty (TKA) performed with modern all polyethylene (AP) tibial components have been reported to be comparable with or better than those TKAs performed using metal-backed modular (MBM) tibial components in several medium and long term studies. As AP components also provide substantial cost savings, there has been increase in their use in primary TKA. In spite of such good results, failure of AP tibial components has been reported.Case Presentation: A sixty three year old lady operated for bilateral cruciate retaining PFC Sigma TKA utilizing AP tibial components without patellar resurfacing in 2011 presented to us in December 2014 with two-year history of severe pain in both knees and inability to walk or stand. She had marked varus deformity of both knees. Radiological examination revealed fracture of the medial tibial plateau with failure of AP tibial component and marked varus deformity. She was treated with bilateral staged revision TKA which resulted in a satisfactory outcome. Conclusion: This case report describes previously unreported complication of AP tibial component following cruciate retaining bilateral AP tibia PFC Sigma TKA in a patient of varus osteoarthritis of knee joint. Early collapse of medial tibial plateau leading to failure of bilateral TKA, which could be attributed to under correction of varus deformity and instability, was managed with bilateral revision TKA using tibial metaphyseal sleeves which led to a very satisfactory outcome and excellent five year follow up.

Correction of Ankle Varus Deformity using Patient Specific Dome Shaped Osteotomy Guides Designed on Weight Bearing CT

Category:Ankle Arthritis; HindfootIntroduction/Purpose:Dome shaped supramalleolar osteotomies are a well-established treatment option for correcting ankle deformity. However, the procedure remains technically demanding and is limited by a two-dimensional (2-D) radiographic planning of a three-dimensional (3-D) deformity. Therefore, we implemented a weight-bearing CT-scan (WBCT) to plan a 3-D deformity correction using patient specific guides.Methods:A 3-D guided dome shaped supramalleolar osteotomy was performed to correct ankle varus deformity in a cohort of 5 patients with a mean age of 53,8 years (range: 47-58). WBCT images were obtained to generate 3-D models, which enabled a deformity correction using patient specific guides. These technical steps are outlined and associated with a retrospective analysis of the clinical outcome using the EFAS score, Foot and Ankle Outcome Score (FAOS) and Visual Analog Pain scale (VAS).Radiographic assessment was performed using the tibial anterior surface angle (TAS), tibiotalar angle (TTS), talar-tilt angle (TTA), hindfoot angle (HA), tibial lateral surface angle (TLS) and tibial rotation angle (TRA).Results:The mean follow-up was 40,8 months (range 8-65) and all patients showed improvements in the EFAS score, FAOS and VAS (p < 0.05). A 3-month postoperative WBCT confirmed healing of the osteotomy site and radiographic improvement of the TAS, TTS and HA (p<0.05), but the TTA and TRA did not change significantly (p>0.05).Conclusion:Dome shaped supramalleolar osteotomies using 3-D printed guides designed on WBCT, are a valuable option in correcting ankle varus deformity and mitigates the technical drawbacks of free-hand osteotomies.

Correction of the Hindfoot Alignment after Supramalleolar Osteomy in Ankle Varus Deformity - A Three-Dimensional Analysis Using Weightbearing CT

Category:Ankle; Ankle Arthritis; HindfootIntroduction/Purpose:While correction of varus alignment at the level of the ankle joint has been investigated extensively after supramalleolar osteotomy (SMOT), the effect on the hindfoot alignment remains unclear. This can be attributed to the limitations of former 2-dimensional radiographic measurements used to quantify the complex 3-dimensional subtalar joint alignment.Therefore, we aimed to determine both the ankle and subtalar joint alignment before and after SMOT using a weightbearing CT and autogenerated 3-dimensional measurements.Methods:Twenty-seven patients with a mean age of 53 years (SD=10.1; range=25-73) were retrospectively analyzed in a pre- post study design using weightbearing CT images. Inclusion criteria were correction of ankle varus deformity by either an opening wedge (N=19) or dome osteotomy (N=8). Exclusion criteria consisted of an additional inframalleolar bony correction, i.e. calcaneal osteotomy or subtalar arthrodesis. Corresponding three-dimensional bone models were reconstructed to compute the autogenerated measurements: tibial anterior surface (TAS) -, tibiotalar surface (TTS)-, talar tilt (TT) - and talocalcaneal (TC) angle.Results:The pre-operative (TAS=86.9°, SD=4.9; TTS=79.8°, SD=5.6; TT=8.8°, SD=4.3) radiographic parameters of the ankle joint alignment improved significantly compared to the post-operative parameters (TAS=92.4°, SD=4.9; TTS=87.1°, SD=6.3; TT=5.1°, SD=2.7; P<0.05). (Fig. 1A) Radiographic parameters to assess the subtalar joint alignment improved significantly from preoperatively (TCax =42.8°, SD=9.3; TCsag=42.3°,SD=10.9; TCcor =29.5°,SD=11.8) to post-operatively (TCax =37.8°, SD=8.8; TCsag=39.1°, SD=10.6; TCcor=24.6°,SD=9.1; P<0.05). (Fig. 1B)Conclusion:A supramalleolar osteotomy is able to correct both the ankle and subtalar joint alignment. However, correction at the level of the subtalar joint accounted for only 3 to 4 degrees, which was less than found for the ankle joint alignment. For cases where a higher correction at the subtalar joint is necessary, we thus suggest adding a calcaneal osteotomy or subtalar arthrodesis to the SMOT.

Pes varus correction in dachshunds with mini hybrid external skeletal fixators.

To evaluate the clinical and radiographic outcome of pes varus deformity correction in dachshunds managed with acute medial opening wedge osteotomy of the distal tibia and stabilised with a mini hybrid external skeletal fixator (HESF). Surgical correction involved a transverse osteotomy over the premeasured location at the distal tibia and application of a IMEX mini HESF. All corrections were evaluated using centre of rotation and angulation methodology. Medical records and radiographies of 20 dachshunds (28 pes varus corrections) were reviewed. All osteotomies healed and fixators were removed between 6 and 12 weeks. Lameness resolved in 18 dachshunds (90%) and significantly improved in two dachshunds (10%). Lateral patella luxation (LPL) was detected in 11/28 (39.2%) of the involved pelvic limbs, all of which resolved following pes varus correction. Mean frontal plane alignment (FPA) of the normal and abnormal tibiae were 12.3° valgus (range: 4°-18°) and 25° Varus (range: 16°-41°) respectively. Angular correction ranged between 30° and 50° (Mean: 39°) and the mean post-operative FPA was 13° valgus (range: 5°-21°). Pes varus deformity in dachshunds can be corrected by medial opening wedge osteotomy of the distal tibia stabilised by HESF. Single-session bilateral pes varus corrections can also be performed with minimal morbidity. LPL was commonly detected in dogs with pes varus deformity and all resolved spontaneously following pes varus correction alone.

Role of the Ilizarov fixator in high tibial osteotomy

Role of the Ilizarov fixator in high tibial osteotomy

Correction of ankle varus deformity using patient-specific dome-shaped osteotomy guides designed on weight-bearing CT: a pilot study.

Dome-shaped supramalleolar osteotomies are a well-established treatment option for correcting ankle deformity. However, the procedure remains technically demanding and is limited by a two-dimensional (2D) radiographic planning of a three-dimensional (3D) deformity. Therefore, we implemented a weight-bearing CT (WBCT) to plan a 3D deformity correction using patient-specific guides. A 3D-guided dome-shaped supramalleolar osteotomy was performed to correct ankle varus deformity in a case series of five patients with a mean age of 53.8years (range 47-58). WBCT images were obtained to generate 3D models, which enabled a deformity correction using patient-specific guides. These technical steps are outlined and associated with a retrospective analysis of the clinical outcome using the EFAS score, Foot and Ankle Outcome Score (FAOS) and visual analog pain scale (VAS). Radiographic assessment was performed using the tibial anterior surface angle (TAS), tibiotalar angle (TTS), talar tilt angle (TTA), hindfoot angle (HA), tibial lateral surface angle (TLS) and tibial rotation angle (TRA). The mean follow-up was 40.8months (range 8-65) and all patients showed improvements in the EFAS score, FAOS and VAS (p < 0.05). A 3-month postoperative WBCT confirmed healing of the osteotomy site and radiographic improvement of the TAS, TTS and HA (p < 0.05), but the TTA and TRA did not change significantly (p > 0.05). Dome-shaped supramalleolar osteotomies using 3D-printed guides designed on WBCT are a valuable option in correcting ankle varus deformity and have the potential to mitigate the technical drawbacks of free-hand osteotomies. Level 5 case series.

Application of picture archiving and communication systems in lateral wedge osteotomy for cubitus varus deformity in teenagers

To investigate effectiveness of picture archiving and communication systems (PACS) in lateral wedge osteotomy for cubitus varus deformity in teenagers. A clinical data of 16 teenagers with cubitus varus deformity between July 2014 and July 2016 was retrospectively analyzed. All patients were treated with lateral wedge osteotomy and fixed with plate. Before operation, the osteotomy design (the osteotomy angle and length) was done in the PACS, including the carrying angle of healthy limb and the varus angle of affected side. There were 10 males and 6 females, with an average age of 11.4 years (range, 10-17 years). The disease duration ranged from 2 to 10 years (mean, 5.6 years). The preoperative X-ray film showed that the supracondylar fractures of the humerus had all healed, and 9 cases had internal rotation deformity; the varus angle of the affected side was 19.5°-33.5°. After operation, the fracture healing and cubitus varus deformity correction were observed by X-ray films, the elbow function was evaluated by Mayo scoring, and the elbow range of motion was detected. There was no significant difference between the actual intraoperative osteotomy angle and length and the preoperative design ( P>0.05). The hospital stay was 2-8 days, with an average of 4.5 days. No complication such as incision infection or ulnar nerve injury occurred. All 16 cases were followed up 12-18 months, with an average of 14 months. X-ray films showed that the osteotomy healed at 2-7 months after operation, with an average of 2.5 months. The internal fixators were removed within 8-14 months after operation (mean, 12.0 months). X-ray films measurement showed that the carrying angle of the affected side recovered to (10.3±2.0)° at 1 day after operation, which was not significantly different from that of the healthy side [(10.6±1.5)°] before operation ( t=0.480, P=0.637). The carrying angle of the affected side was (9.8±2.6)° at 1 year after operation, which was not significantly different from that of the healthy side [(10.4±1.6)°] at the same time point ( t=0.789, P=0.438). At 1 year after operation, the ranges of flexion and extension of affected side were (131.6±8.4)° and (6.4±2.6)°, respectively; and the ranges of flexion and extension of healthy side were (134.2±6.3)° and (5.9±2.2)°, respectively. There was no significant difference between the healthy and affected sides ( t=1.143, P=0.262; t=0.587, P=0.561). The elbow joint function at 1 year after operation evaluated by Mayo scoring standard rated as excellent in 9 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 93.7%. Before lateral wedge osteotomy, the PACS is used to design the osteotomy angle and length, which can guide the operation and make the osteotomy more accurate and simple.

Corrective Osteotomy in cubitus varus deformity in children: A prospective study

Background and Aim: Cubitus varus deformity is the most common late complication aftersupracondylar fracture of the distal humerus in children, incidence varying from 4% to 58%. Thepresent study was done to evaluate the results of dome osteotomy. Material and Methods: Thisprospective study was conducted in a tertiary care hospital over 16 months. In all patients humerus-elbow wrist angle was measured on both sides and the correction needed was calculated. The lateralcondyle prominence index (LCPI) was calculated by anteroposterior view radiographs of thedeformed and the normal elbow in full extension by (AB-BC)/AC. Dome osteotomy with para tricepsapproach was used. Pre and post-operative carrying angle of elbow, range of motion and lateralprominence indices were compared. Results: The age of patients ranged from 3 to 15 years with amean age of 8.47±3.14 years. Preoperative carrying angle of normal side ranged from 80 to 140and that of effected side ranged from -23 to -13 and the difference was statistically significant(p&lt;0.05). LCPI ranged from -8.4 to 5.9%. The majority of cases had LCPI &gt;2.7%. As compared to,an improvement in carrying angle at defect side was observed to be 28.41±2.15 which wassignificant (p&lt;0.05). At baseline mean LCPI was 0.39±3.87% which changed to -0.86±3.47%, themean change of this was significant (p=0.01). baseline Conclusion: Dome osteotomy is a relativelytechnically demanding technique for correction of cubitus varus deformity but with a betterfunctional outcome without being associated with lateral condyle prominence.

Defining clinically significant outcomes following high tibial osteotomy with or without concomitant procedures

IntroductionThe threshold values needed to achieve MCID and PASS following HTO with or without concomitant procedures are not well known. ObjectivesTo determine values and variables predictive for achieving the minimally clinically important difference (MCID) and patient acceptable symptom state (PASS) of patient-reported outcome (PRO) scores following high tibial osteotomy (HTO) with or without associated restoration procedures for the correction of varus deformity. MethodsA prospectively collected HTO outcomes registry was retrospectively reviewed for patients who underwent HTO between 2001 and 2018. Collected PROs included International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scores. A distribution-based approach was used to calculate MCID, and an anchor-based approach was used for the calculation of PASS. ResultsFifty-five patients were identified (n = 43 males; n = 12 females) with a mean age of 37.9 ± 9.0 years at surgery and average follow-up of 3.3 ± 3.1 years. The MCID and PASS for IKDC were calculated as 12.5 and 40.23, respectively. MCID and PASS values for each of the KOOS subscales were as follows: symptoms: 9.9 and 71.43; pain: 11.3 and 72.22; daily living: 12.0 and 77.94; sports: 16.0 and 40; quality of life: 15.1 and 56.25, respectively. ConclusionsBased on calculated values for MCID and PASS following HTO using IKDC and KOOS subscales, higher preoperative PROs, prior medial meniscectomy, higher BMI, concomitant ACL reconstruction and worker's compensation status were associated with failure to achieve clinically significant outcomes. Prior ACL reconstruction was found to be predictive of MCID for KOOS-symptoms.

Changes in the quality of life of patients with Blount’s disease undergoing simultaneous bilateral varus deformity correction with the use of the Ilizarov method.

IntroductionBlount’s disease is a growth disorder of the proximal tibia, which leads to the varus deformity and internal rotation of this bone. The treatment is mainly surgical and involves proximal tibial osteotomy and deformity correction. The aim of this study was to assess the change in the quality of life of patients with tibia vara deformity who underwent correction via the Ilizarov method.Material and methodsA total of 23 Blount’s disease patients who had undergone bilateral varus deformity correction with the Ilizarov method were included in this study. The following parameters were assessed retrospectively: duration of treatment with Ilizarov frames, baseline and postoperative values of the medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD). The quality of life was assessed with a Short Form (SF)-36 survey.ResultsThe study population comprised 13 females and 10 males (mean age of 28.43), in whom the Ilizarov fixators were kept for an average duration of 106.65 days. MAD values diminished significantly after the surgery. We also observed significant increases in the MPTA values. The SF-36 scores increased across all of the questionnaire’s domains, which indicates a significant improvement in the postoperative quality of life.ConclusionsSimultaneous bilateral correction of the varus deformity with Ilizarov external fixators is a safe and effective treatment method. It helps reduce pain and improve gait, which translates to improving the quality of life in all its aspects. The duration of treatment depends to a large extent on the degree of patient cooperation, their attitude, and self-discipline.

Is open bone graft always necessary when treating aseptic subtrochanteric nonunion with a reamed intramedullary nail?

BackgroundThis study aimed to compare the radiological results between closed nailing without bone graft (BG) and open nailing with BG for aseptic subtrochanteric nonunion and to determine when an open procedure with BG should be considered.MethodsIn this retrospective study, we investigated patients who underwent surgical intervention for subtrochanteric nonunion between January 2008 and March 2018 in two institutions. Patients with infection, large bone defect, pathologic fracture, open fracture, previous surgery using plate, and follow-up of less than 1 year were excluded. We compared the demographic details and radiological results between patients who underwent the open procedure with BG (BG group) and the closed procedure without BG (non-BG group) as a historical control, and risk factors for the failure of revision surgery were evaluated.ResultsThirty-seven patients met the criteria and were divided into the following two groups: the BG group (n=19) who underwent open nailing with BG and the non-BG group (n=18) who underwent closed reamed nailing without BG. The mean degrees of correction of varus and flexion deformity were significantly different (p=0.001, respectively), 6.2° and 2.9° in the BG group and 4.1° and 0.6° in the non-BG group, respectively. Bony union was observed in 17 cases (89.5%) in an average of 7.4 months in the BG group and in 16 cases (88.9%) in 7.6 months in the non-BG group, with no significant differences. The factors that were significantly associated with failure of revision were atypical fracture, two or more previous surgeries, and varus and sagittal anterior angulation.ConclusionsThe radiological results of closed reamed nailing without BG for subtrochanteric nonunion were satisfactory. In the effort of percutaneous realignment, gap reduction, and intramedullary reaming, the radiological results of closed nailing without BG were not different from those of open nailing with BG; therefore, closed procedure without BG may be an acceptable option in appropriately selected patients.