Corrective Osteotomy Research Articles

Osteotomy Correction Angle Cut-off Points Can Guide the Operation to Prevent a Significant Decrease in Patella Height.

Patients who undergo a biplanar ascending medial open-wedge high tibial osteotomy with an excessive correction angle might experience patella infera and even knee pain after surgery. The purpose of this study was to identify the cut-off points for the degree of knee varus correction of open-wedge high tibial osteotomy, which is related to the symptomatic patellar position change. This retrospective study included 124 patients (mean age 61.69 ± 6.28 years; 78 women, 46 men) with varying degrees of varus knee osteoarthritis. All patients had undergone standard biplanar medial open-wedge high tibial osteotomy. They were divided into nine groups according to the change in hip-knee-ankle angle. Plain radiographs and three-dimensional CT images were obtained preoperatively and 18 months postoperatively. Patellar height was assessed using the Caton-Deschamps index, the Insall-Salvati index, and the Blackburne-Peel index. The patellofemoral index and patellar tilt were used to evaluate the degree of horizontal displacement of the patella. The varus correction, medial-proximal tibial angles, joint line convergence angles, and hip-knee-ankle angles were also measured. The subjective score was evaluated using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). There were significant changes in patella indexes in each group after surgery, among which there was no significant difference in patellar height changes for Groups A to F (p > 0.05), which were significantly lower than those in Group G, H, and I (p < 0.001). The patellar tilt and patellofemoral index also followed the same trend. The improvement in WOMAC scores for Groups G, H, and I was also significantly less for Groups A to F (p < 0.001). The patellar height, patellar tilt, and patellofemoral index all changed significantly in parallel with increasing degrees of osteotomy correction. The cut-off points for correction angle are 12.5° to 13.4°. When the correction angle is larger than this range, the patellar position can be significantly affected. Postoperative patellofemoral joint pain may be related to the changes in patella position.

Three-Dimensional Hinge Axis Orientation Contributes to Simultaneous Alignment Correction in All Three Anatomical Planes in Opening-Wedge High Tibial Osteotomy

To investigate the simultaneous effect of 3-dimensional (3D) hinge axis (HA) orientation on alignment parameters in all 3 anatomical planes in high tibial osteotomy. A computed tomography-based 3D model of a human tibia/fibula was used to establish a 3D tibial coordinate system based on the tibial mechanical axis. In here, an HA was positioned and an opening-wedge high tibial osteotomy with a rotation angle of 10° over the HA was simulated. HA rotation in the axial plane ranged from 0° to 90° and HA tilt relative to the axial plane ranged from -20° to+20°. The study quantified the simultaneous effect of HA orientation on change of alignment parameters in all anatomical reference planes. HA rotation within the tibial axial plane between orientations perpendicular to the coronal and sagittal planes primarily affected both coronal and sagittal plane alignment, with an inverse relationship between these planes (range: 0°-9.7°); the effect of HA rotation on the change in axial plane alignment was maximally 0.9°. In contrast, HA tilt relative to the tibial axial plane primarily affected axial alignment (maximum change: 6.9°); the effect on change in both coronal and sagittal plane alignment was maximally 0.6°. HA rotation in the tibial axial plane primarily affects sagittal and coronal plane alignment, and HA tilt relative to the tibial axial plane primarily affects axial plane alignment. Integrating 3D HA orientation in malalignment planning and correction offers the potential to minimize unintended corrections in nontargeted planes in uniplanar correction osteotomies and to facilitate intentional multiplanar correction with a single osteotomy.

Biomechanical Effect of Distal Tibial Oblique Osteotomy: A Preliminary Finite-Element Analysis.

The biomechanical effect of distal tibial oblique osteotomy (DTOO) on osteoarthritic ankles has not been investigated. Using finite element (FE) models, we aimed to elucidate the effect of DTOO on the ankle contact pressure (CP) distribution. This study included two patients with ankle osteoarthritis who underwent DTOO and one asymptomatic control. Patient-specific FE models were reconstructed by matching standing radiographs with supine computed tomography scans. The joint contact area (CA) and maximumCPon the articular surface of the talus were calculated before and after DTOO and compared with those of the control. In the control, the CA was 584 mm2 and the maximum CP was 2.6 MPa. In case 1, the CA increased by 125% from 166 mm2 preoperatively to 375 mm2 postoperatively, accompanied by a 36% decrease in the maximum CP from 9.8 MPa to 6.3 MPa. Similarly, in case 2, the CA increased by 46% from 301 mm2 to 439 mm2, accompanied by a 27% decrease in the maximum CP from 6.7 MPa to 4.9 MPa. This study suggests DTOO improves the biomechanics of the ankle, but not sufficiently compared to the control. This analytical approach may enhance understanding of ankle pathophysiology and assist in the design of the ideal corrective osteotomy.

Managing the Intra-articular Distal Radius Malunion.

Intra-articular malunion of the distal radius represents a difficult clinical problem. While not all patients require treatment, corrective osteotomy may significantly improve motion, grip strength, and patient-reported outcome measures. Meticulous planning and technical precision are required with the possible need for multiple surgical approaches and both volar and dorsal implants. Arthroscopic assistance may be used to visualize the joint and articular reduction. Custom 3-dimensional planning guides are helpful in addressing complex multiplanar deformities. Regardless, intervention may not change the natural history of these injuries and post-traumatic arthritis is to be expected.

Three-Dimensional-Printed Patient-Specific Total Cuboid Replacement for Treatment of Post-traumatic Arthritis: A Case Report.

Cuboid injuries, including fractures, are rare and infrequently occur in isolation. Often, cuboid injuries can be treated nonoperatively. However, when surgery is indicated, appropriate management is necessary for maintaining the associated biomechanics of the midfoot. Current procedures for surgical management of the cuboid include open reduction and internal fixation, application of external fixation, or primary arthrodesis of the calcaneocuboid joint. Secondary procedures for symptomatic or poor outcomes of nonoperative and operative cuboid injuries consist of corrective osteotomy, bone resection, and interpositional arthroplasty. We present a novel surgical technique using a patient-specific three-dimensional-printed total cuboid replacement. This is an alternative treatment for post-traumatic arthritis of the cuboid along with a shortened lateral column. A single case example is given as well as details and discussion of the surgical technique.

Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation.

To compare the clinical outcomes and biomechanical characteristics of 1-, 2-, and 3-level pedicle subtraction osteotomy (PSO), and establish selection criteria based on preoperative radiographic parameters. Patients undergone PSO to treat ankylosing spondylitis from February 2009 to May 2019 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. According to the quantity of osteotomy performed, the participants were divided into group A (1-level PSO, n = 24), group B (2-level PSO, n = 19), and group C (3-level PSO, n = 11). Clinical outcomes were assessed before surgery and at the final follow-up. Comparisons of the radiographic parameters and quality-of-life indicators were performed among and within these groups, and the selection criteria were established by regression. Finite element analysis was conducted to compare the biomechanical characteristics of the spine treated with different quantity of osteotomies under different working conditions. Three-level PSO improved the sagittal parameters more significantly, but resulted in longer operative time and greater blood loss (p < 0.05). Greater stress was found in the proximal screws and proximal junction area of the vertebra in the model simulating 1-level PSO. Larger stress of screws and vertebra was observed at the distal end in the model simulating 3-level PSO. Multilevel PSO works better for larger deformity correction than single-level PSO by allowing greater sagittal parameter correction and obtaining a better distribution of stress in the hardware construct, although with longer operation time and greater blood loss. Three-level osteotomy is recommended for the patients with preoperative of global kyphosis > 85.95°, T1 pelvic angle > 62.3°, sagittal vertical alignment > 299.55 mm, and pelvic tilt+ chin-brow vertical angle > 109.6°.

Radiographic Investigation of Coronal Plane and Patellar Height and Changes Following Tibial Deflection Osteotomy for Correction of Tibial Slope in Combination With ACL Reconstruction

Background: A tibial deflexion osteotomy (TDO) is performed to decrease the sagittal tibial slope to reduce the relative risk of anterior cruciate ligament (ACL) reconstruction (ACLR) graft failure. Given that coronal plane osteotomies can cause consequential changes in the sagittal plane to patellar height and tibial slope, potential changes to coronal plane alignment and patellar height can result after a sagittal plane osteotomy. Purpose: To compare preoperative and postoperative coronal plane alignment after TDO, as well as to analyze the effect of the osteotomy on patellar height. Study Design: Case series; Level of evidence, 4. Methods: This study was conducted on a consecutive series of patients with primary and revision ACLR with concomitant TDO between 2011 and 2022. Inclusion criteria were 1-stage autograft ACLR combined with supratubercular TDO with pre- and 3 months postoperative radiographs of sufficient quality. Indications for TDO were anterior instability requiring ACL revision surgery and a posterior tibial slope (PTS) >9° or a PTS >14° in the primary ACL surgery patients. Anteroposterior and lateral knee radiographs were reviewed, and the medial proximal tibial angle (MPTA), PTS, Caton-Deschamps index (CDI), and modified Insall-Salvati ratio were measured directly from the radiographs by 2 independent reviewers. Results: A total of 68 patients were included in this study. Pre- and postoperative radiographs were performed 1 month before and 3 months after surgery, respectively. There was a significant increase in the mean MPTA of 0.95° varus (SD, 2.1°; range, increase of 4.23° valgus to increase of 7.74° varus; P < .01), a decreased PTS of 8.86° (SD, 3.03°; P < .01), and an increased CDI of 0.08 (range, decrease of 0.27 to increase of 0.64) (P < .01; SD, 0.17) in patients undergoing TDO. Insall-Salvati ratio measurements showed no difference. There was good intra- and interobserver reliability, with intraclass correlation coefficients of 0.97 and 0.91 for MPTA, 0.97 and 0.87 for PTS, 0.87 and 0.93 for CDI, and 0.88 and 0.76 the Insall-Salvati ratio. Conclusion: This study, the largest series on TDO for ACLR, demonstrates that the TDO can be performed safely without large changes to coronal alignment or patellar height. The tibial slope was reduced by a mean of 8.86° (range, 2.3°-11.5°; P < .01). The TDO produces a small statistically significant change to coronal alignment, inducing a mean increased varus of <1° and an increased patellar height of 0.1 CDI. Therefore, TDO can be performed safely without dramatic changes to coronal alignment or patellar height, this study highlights technical aspects to minimize iatrogenic varus.

3D-assisted corrective osteotomies of the distal radius: a comparison of pre-contoured conventional implants versus patient-specific implants

PurposeThere is a debate whether corrective osteotomies of the distal radius should be performed using a 3D work-up with pre-contoured conventional implants (i.e., of-the-shelf) or patient-specific implants (i.e., custom-made). This study aims to assess the postoperative accuracy of 3D-assisted correction osteotomy of the distal radius using either implant.MethodsTwenty corrective osteotomies of the distal radius were planned using 3D technologies and performed on Thiel embalmed human cadavers. Our workflow consisted of virtual surgical planning and 3D printed guides for osteotomy and repositioning. Subsequently, left radii were fixated with patient-specific implants, and right radii were fixated with pre-contoured conventional implants. The accuracy of the corrections was assessed through measurement of rotation, dorsal and radial angulation and translations with postoperative CT scans in comparison to their preoperative virtual plan.ResultsTwenty corrective osteotomies were executed according to their plan. The median differences between the preoperative plan and postoperative results were 2.6° (IQR: 1.6–3.9°) for rotation, 1.4° (IQR: 0.6–2.9°) for dorsal angulation, 4.7° (IQR: 2.9–5.7°) for radial angulation, and 2.4 mm (IQR: 1.3–2.9 mm) for translation of the distal radius, thus sufficient for application in clinical practice. There was no significant difference in accuracy of correction when comparing pre-contoured conventional implants with patient-specific implants.Conclusion3D-assisted corrective osteotomy of the distal radius with either pre-contoured conventional implants or patient-specific implants results in accurate corrections. The choice of implant type should not solely depend on accuracy of the correction, but also be based on other considerations like the availability of resources and the preoperative assessment of implant fitting.

The Use of Dome Shaped Osteotomy and Plating in Correction of Genu Varum

The Use of Dome Shaped Osteotomy and Plating in Correction of Genu Varum

Skull-femoral traction followed by osteotomy correction is a safe and effective treatment for severe scoliosis with split cord malformation.

This study aimed to evaluate the safety and efficacy of skull-femoral traction followed by osteotomy correction in patients with severe spinal scoliosis and split cord malformation. We retrospectively analyzed ten cases of severe spinal scoliosis with Pang I type split cord malformation treated between August 2012 and August 2023. Patients underwent skull-femoral traction prior to osteotomy correction. We assessed changes in height, weight, coronal and sagittal Cobb's angles, and physiological indicators such as vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and blood gas levels before, during, and after treatment. Traction duration ranged from 9 to 19 days, with height and weight showing significant increases post-treatment. The coronal Cobb's angle improved from pre-treatment to post-corrective surgery and remained stable at the final follow-up. Similar improvements were observed in the sagittal plane. Physiological indicators such as VC, FVC, and FEV1, as well as blood gas levels, normalized after treatment. Nutritional status, indicated by triceps skinfold thickness, albumin, and transferrin concentrations, also improved. No neurological complications or device-related complications occurred during or after treatment. Skull-femoral traction followed by osteotomy correction is a safe and effective treatment for severe spinal scoliosis with split cord malformation, offering an alternative to high-risk procedures.

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.

The utilization of 3D printing in surgery as an innovative approach to preoperative planning.

3D printing, a concept over 40 years old, is finding broader application in clinical practice thanks to technological advancements. At University Hospital Ostrava, 3D printing is utilized to create anatomically accurate models of specific patients before surgical procedures based on imaging data. 3D printing is employed as a complement to conventional imaging methods to produce morphologically precise models of anatomical structures of individual patients. These models primarily serve for preoperative planning in elective abdominal, vascular, and thoracic surgery. They are also used in planning osteosynthesis of complex fractures and corrective osteotomies. Multicolor printing, although increasing the process's time demands, allows better clarity and differentiation of individual anatomical structures within a single model. Compared to 2D images, 3D models provide better spatial orientation and awareness of the operated structures, contributing to improved surgical outcomes. The benefits of 3D printing in preoperative planning and patient education are confirmed by studies across the fields ranging from cardiac surgery to traumatology. After overcoming initial challenges, 3D printing has become a reliable component of the surgical arsenal at University Hospital Ostrava for elective surgery. While 3D printing does not represent a universal answer to all medical challenges, its role is highly beneficial and promising in many indicated cases.

Management of post-traumatic ankle deformities in children.

The objective of this clinical appraisal was to assess the clinical-radiological results of ankle deformity correction secondary to physeal injury, utilizing the methods based on the age of the child, site & severity of the deformity, remaining growth potential, condition of the soft tissue envelop and integrity of neurovascular status. Fifteen subjects ≤ 16 years of age, with angular deformities of the ankle secondary to physeal injury, were included. Deformities secondary to infection and pathological fractures were excluded. Demographic data, type of injury, treatment method, and follow-up were recorded from the case files. Treatment categories included osteotomies for acute correction (> 10 years) and growth modulation (≤ 10 years). Male to female ratio was 7:8, with an average age of 11.8 ± 2.31 years (range 9-16 years). The right and left ratio was 7:8. Mean duration of follow-up was 1 year and 4 months. Gradual deformity correction was done in 2 cases utilizing the principle of growth modulation, while acute correction by osteotomy was done in 13 cases. The average pre-operative ankle deformity was 20.8 ± 3.11 degrees (Range -25 to 24 degrees). Radiological union was attained at a mean of 11 weeks (8-24). Nine patients achieved neutral ankle alignment. The mean residual varus was 2.3°, and the valgus was 4°. There was a statistically significant improvement of the AOFAS score by 17 points from a mean pre-operative score of 57 (44-84) to 74 (56-100) points at the final follow-up (p-value < 0.001). The average pre-operative shortening was 2.36 ± 0.21 cm, which was completely corrected in 9 individuals. Management of angular deformities around the ankle calls attention to correcting the resultant angular deformity and/or limb length disparity, utilizing acute or gradual correction. A successful outcome depends on early recognition and patient-specific treatment of paediatric ankle fracture patterns. Correlating the results of our study with the available literature, we feel that both acute or gradual correction for angular deformities around the ankle is a feasible solution as long as principles of deformity correction are adhered to. Techniques for salvaging and restoring the viability of injured physeal plate warrant additional research.

Experience in Managing Posttraumatic Lumbar Kyphosis Patients with Multi-level Ponte Osteotomies and Posterior Spinal Fusion

Posttraumatic kyphosis (PTK) is a spinal deformity resulting from severe trauma, posing significant challenges for surgical correction. PTK can lead to chronic pain and disability, necessitating careful evaluation and individualized treatment strategies. We present the case of a 50-year-old male with a decade-long history of PTK following a traumatic fall from a truck. Despite initial mobility, his condition worsened, affecting his posture and causing pain. Radiographic assessments revealed marked lumbar lordosis (LL) loss, positive sagittal vertebral axis, and pelvic parameters mismatch. Surgical planning involved multilevel Ponte osteotomy from L1 to L4 and posterior spinal fusion from Th10 to S1 to restore sagittal balance. Treating PTK is complex and technically demanding, with no universal approach due to the diversity of cases. Detailed diagnostics, including spinal alignment analysis and neurologic assessments, guide surgical decisions. Our patient’s successful treatment employed grade 1/2 Ponte osteotomies for lumbar correction, achieving improved sagittal balance and LL. However, an increase in pelvic incidence (PI) and persistent PI-LL mismatch was noted postsurgery, suggesting potential effects on the sacroiliac joint. Severe trauma can lead to PTK, necessitating meticulous evaluation and individualized surgical strategies. The primary goal is to alleviate neurological deficits and restore sagittal balance, with surgical choices tailored to each patient’s unique circumstances. Surgical correction may influence pelvic parameters, emphasizing the importance of comprehensive postoperative assessment and follow-up care.

Retrospective Analysis of Radiographic Outcomes After Closing Base Wedge Osteotomy for Correction of Bunion Deformity.

Closing base wedge osteotomy (CBWO) is a common procedure to correct severe bunion deformities with high intermetatarsal angles. There are few data demonstrating the radiographic success of CBWOs. We evaluated the radiographic outcomes of a CBWO. The primary aim was to assess the change in elevatus after a CBWO. Secondary aims included measuring the change in hallux abductus (HA) and intermetatarsal angles after the osteotomy. The medical records of 24 consecutive patients across 4 years were reviewed. All of the CBWOs were fixated with either one screw and one Kirschner wire or two screws. We hypothesized that the CBWO would reduce the amount of elevatus present. The mean patient age was 35 years. Average preoperative HA and intermetatarsal angles were 35.2° and 15.7°, respectively. Mean postoperative HA and intermetatarsal angles at last radiographic follow-up were 13.3° and 6.1°, respectively. The change in HA and intermetatarsal angles was 21.9° and 9.6°, respectively. All of the patients achieved clinical union. Mean radiographic follow-up was 6 months; median radiographic follow-up was 5 months. The mean preoperative elevatus measurement was 3.5 mm; the mean postoperative elevatus measurement was 2.0 mm (difference, -1.6 mm; P = .0282), indicating that the osteotomy plantarflexed the first metatarsal. Three patients had radiographic evidence of postoperative elevatus; they were asymptomatic at the last clinical follow-up. Although clinical concern persists for the development of postoperative elevatus with CBWO, this case series showed plantarflexion of the CBWO. The CBWO is a powerful yet stable procedure for severe bunion deformities and should be viewed as a viable alternative to the Lapidus procedure.

Preoperative Three-Dimensional Planning of Screw Length is not Reliable in Osteotomies of the Humerus and Forearm.

Pediatric upper extremity fractures are seen frequently and sometimes lead to malunion. Three-dimensional (3D) surgery planning is an innovative addition to surgical treatment for the correction of post-traumatic arm deformities. The detailed planning in three dimensions allows for optimization of correction and provides planning of the exact osteotomies which include the advised material for correction and fixation. However, no literature is available on the precision of this computerized sizing of implants and screws. This study aimed to investigate the differences between 3D planned and surgically implanted screws in patients with a corrective osteotomy of the arm. Planned and implanted screw lengths were evaluated in patients who underwent a 3D planned corrective osteotomy of the humerus or forearm using patient-specific 3D printed drill- and sawblade guides. Postoperative information on implanted hardware was compared to the original planned screw lengths mentioned in the 3D planned surgery reports. Of the 159 included screws in 17 patients, 45% differed >1 mm from the planned length (P<0.001). Aberrant screws in the radius and ulna were often longer, while those in the humerus were often shorter. Most aberrant screws were seen in the proximity of the elbow joint. This study showed that 3D-planned screws in corrective osteotomies of the humerus and forearm differ significantly from screw lengths used during surgery. This illustrates that surgeons should be cautious when performing osteotomies with 3D techniques and predefined screw sizes.

SURGICAL TREATMENT OF PATIENTS WITH OSTEOARTHRITIS OF THE KNEE JOINTS

Introduction. Osteoarthritis affects 7 % of the world’s population. The number of affected people worldwide increased by 48 % from 1990 to 2019. At the initial stages of knee osteoarthritis treatment, conservative treatment and corrective osteotomies are used. Corrective osteotomies in the area of the knee joint have shown excellent results for the treatment of limited arthrosis with a predominant lesion of the medial part of the joint in relatively young patients. However, despite the good results reported in the literature, patient satisfaction usually deteriorates over time, and some inevitably require further treatment with total knee arthroplasty in cases of progression of osteoarthritis.&#x0D; The aim of the study. On the basis of a retrospective analysis of surgical treatment of patients with osteoarthritis of the knee joints, justify the differentiated use of surgical interventions.&#x0D; Materials and methods. The article considers a differentiated approach to peri-articular osteotomies and primary endoprosthesis in gonarthrosis, in particular, in the focus of the endoprosthesis selection algorithm, based on related factors, such as the stage of the disease, the patient’s age, and the presence of concomitant complications, including the presence or absence of aseptic necrosis, contractures, instability ligamentous apparatus and defects of the condyles of the tibial bone. 391 knee joints were operated on in 383 patients.&#x0D; Results. In general, good results were obtained in 65 % (210 people) of endoprosthetics. The patients felt well, did not feel pain, did not limp, the range of motion was restored within normal limits, there was no deformation of the joint, the axis of the limb was correct, the joint was stable. Satisfactory results were obtained in 35 % (114 people), the patients felt well, did not feel pain, moderate lameness remained, range of motion was limited to no more than 800, there was no joint deformation, the axis of the limb was correct, the joint was stable. No unsatisfactory results were obtained.&#x0D; Conclusions. The developed differentiated approach to operative treatment of patients with osteoarthritis of the knee joints allowed to obtain 65 % good and 35 % satisfactory results.&#x0D; The prospect of further development in this direction continues due to the improvement of the design of endoprostheses and the technique of surgical intervention

Early rehabilitation after total arthroplasty with custom hip prosthesis – case report

Background: The main aim of this study was to compare conventional radiograph and computer tomograph (CT)-scan measurements of femoral offset. The second aim was the compare the pre- and postoperative values of femoral offsets as well as the variations cre-ated by total hip arthroplasty (THA) replacements using the same protocol of analysis for a patient operated on both hips by the same surgeon using a modified lateral approach. Methods: The CT protocol involves 1mm slices from top of the iliac crest to the isthmus of the femur, 2mm slices from top to the bottom of femoral condyles and top and bottom of the ankle joint. The CT protocol involves 1mm slices from top of the iliac crest to the isth-mus of the femur, 2mm slices from top to the bottom of femoral condyles and top and bot-tom of the ankle joint. The implant came with an operative plan to guide the neck osteot-omy site, and with its own bone compacting or bone removing rasp according to the in-tramedullary cortical or cancellous bony architecture indicated by the 3D-CTplan. Results: In addition to a clinical review and oxford hip scoring, the patient had postoperative radi-ographs and were reviewed regularly at 6 weeks and 6 months. Conclusions: We conclud-ed that this 3D-CT guided custom design femoral stem produces reliable proximal ‘fit and fill’ and primary stability with restoration of limb length discrepancy with complex prox-imal femoral deformity without the need of a corrective osteotomy.

Arthroscopic Posterior Glenoid Osteotomy

Management of posterior shoulder instability in patients with excessive glenoid retroversion can be challenging. However, a corrective posterior glenoid osteotomy is an option. Although various open techniques are available, minimally invasive and arthroscopy surgery are the most advantageous. This study describes the feasibility and safety of an arthroscopic posterior open wedge glenoid osteotomy using an autologous scapular spine graft along with additional posterior capsulolabral complex reattachment. This procedure is a viable option for patients with symptomatic posterior shoulder instability.

Disturbance of Growth in Pediatric Patients Due to Osteomyelitis Caused by Growth Plate Infection.

Osteomyelitis, a severe bone infection, poses a multifaceted challenge to healthcare professionals. While its pathophysiology and treatment have been extensively studied, the impact of osteomyelitis on skeletal growth, particularly in pediatric patients, is an area that warrants attention. This abstract highlights the significance of understanding and managing growth disturbances in osteomyelitis, providing key findings and recommendations for clinicians. Understanding growth disturbance in osteomyelitis is essential because it can lead to lifelong consequences for pediatric patients. The infection may affect the growth plate, leading to limb length discrepancies, angular deformities, and functional impairments. These complications not only diminish the quality of life but also pose a substantial economic burden on the healthcare system. Therefore, early recognition and intervention are crucial. Key findings indicate that the risk of growth disturbances in osteomyelitis is particularly high in pediatric patients due to the vulnerability of the growth plate. Timely diagnosis, appropriate management, and targeted interventions can mitigate the long-term sequelae of growth disturbances. These include utilizing advanced imaging techniques to assess the extent of growth plate involvement, optimizing antibiotic therapy, and employing surgical techniques like epiphysiodesis, guided growth, or corrective osteotomies. Additionally, fostering a multidisciplinary approach that involves orthopedic surgeons, infectious disease specialists, and pediatric endocrinologists is vital to achieving successful outcomes. Recommendations for managing growth disturbance in osteomyelitis encompass early detection, meticulous monitoring, and a tailored treatment plan. Healthcare providers should remain vigilant for signs of growth plate involvement in osteomyelitis patients, especially in the pediatric population. A thorough evaluation, including advanced imaging and clinical assessment, is essential for accurate diagnosis. Close collaboration between specialists to address the infection and its skeletal consequences is crucial. Furthermore, patient and family education plays a pivotal role in fostering compliance with the treatment regimen. In conclusion, understanding and managing growth disturbances in osteomyelitis is paramount, particularly in pediatric patients. The implications of growth plate involvement are significant, and timely intervention is essential to prevent lifelong consequences. By implementing a comprehensive approach that combines accurate diagnosis, multidisciplinary collaboration, and patient education, healthcare professionals can enhance the quality of life and well-being of those affected by this challenging condition.