Recurrence Of Deformity Research Articles

Residual deformity versus recurrence following Dupuytren's palmar fasciectomy-a long term follow-up of 142 cases

Introductionand background: Surgical options for Dupuytren's disease (DD) are multiple, and Dupuytren's palmar fasciectomy (PF) is a common surgical procedure performed for contractures that cause functional and cosmetic disability. The recurrence rate for PF has been reported to be very variable, ranging from 12 to 73%, according to various studies. One of the reasons for the varied range is the inconsistency in the method followed to define recurrence. Subsequently, a consensus-based definition was formulated in 2016, and we analysed the outcome in our series of patients treated with PF based on this standard definition. We also analysed the residual deformity associated in these cases. Methodology: Our study is a retrospective analysis of 142 consecutive cases of primary Dupuytren's palmar fasciectomy by a single surgeon in three different centres. We followed the international consensus definition for analysing recurrence in these cases, and we also analysed residual cases as a separate entity. ResultsThe mean age of the cases was 67.13 years and the mean follow-up period was 3.95 years. Alcoholism, smoking, diabetes and hypercholesterolemia were the commonest associated risk factors. The commonest affected finger and the finger with the maximum deformity were the little finger. The overall rate of recurrence of deformity was 3.5% and the rate of residual deformity was 30.3%. The overall complication rate was 11.9%. ConclusionRecurrence and residual deformity can be considered as separate entities. The term ‘residual deformity’ can be used to denote patients with persisting deformity or those who incur deformity within one year of the primary surgery.

Staged Hindfoot Fusion for Osteomyelitis of the Distal Tibia and Talus

Category:Ankle; Diabetes; Hindfoot; TraumaIntroduction/Purpose:Management of hindfoot osteomyelitis involves eradication of infection, deformity correction, and bony stabilization in the setting of bone loss and poor bone quality. In this case series of 12 patients, we present a two-stage technique; debridement, deformity correction, joint surface preparation, and intramedullary reaming with placement of antibiotic rod and ring external fixation followed by a second stage of external fixator removal and exchange of antibiotic rod for definitive hindfoot rod. The purpose of this poster is to highlight techniques that can improve the success of obtaining stable fixation, remission of infection, and ultimately fusion. Techniques highlighted are ring fixator placement, preparation of the antibiotic rod, intramedullary canal preparation, rod exchange, and use of blocking screws to enhance compression and axial loading of the fusion.Methods:Twelve patients were treated with this two-stage protocol. The most common indication was post-traumatic osteomyelitis followed by neuropathic (Charcot) joint. All were treated in a staged manner with an initial debridement of nonviable tissue including osteomyelitic bone. The tibiotalar and talocalcaneal joints were resected and prepared for fusion at the initial debridement. Provisional stabilization and compression were obtained through the use of a ring external fixator. An intramedullary antibiotic impregnated cement coated rod was introduced through the calcaneus, talus, and the intramedullary space of the tibia. The patients were kept in the fixator until the skin was healed and all incisions were dry. At this point, the fixator was removed, and the antibiotic rod was exchanged for the definitive hindfoot fusion rod.Results:Cultures were positive for Staphylococcal or Streptococcal species in 58% of cases, fungal in 8%, and Gram negative organisms in 33%. On average patients spent 93 days in the fixator while wounds were healing, and they were receiving systemic antibiotics. One patient died while in the frame. There have been no amputations in the series. Of the patients that have completed the protocol, all have gone on to either bony fusion or stable fibrous union. All are able to walk unaided. And thus far, all are free of active infection. Secondary procedures are described.Conclusion:This technique of staged fusion for hindfoot osteomyelitis offers the following advantages. the first stage involves thorough debridement and deformity correction. Oftentimes there is extensive scarring and the soft tissue envelope is not conducive to internal fixation. This technique allows the soft tissues to heal before placing the definitive internal fixation. It also allows for graduated compression at the fusion site with the ring fixator. The antibiotic rod not only delivers high concentration of local antibiotics, but it prevents deformity recurrence during the compression phase. The definitive rod provides support of pathologic bone and maintains deformity correction.

Complications of first tarsometatarsal joint arthrodesis

Objective: First tarsometatarsal joint (TMTJ) arthrodesis, also known as Lapidus, is a surgical procedure used to treat severe hallux valgus, associated hypermobility of the first ray, and/or osteoarthritis of the first TMTJ. Despite the high satisfaction rate and high corrective power, this technique is not without complications. This study aimed to report the complications of first TMTJ arthrodesis. Methods: This is a case series of 16 patients treated with first TMTJ arthrodesis. Patients were evaluated based on foot radiographs, clinical alignment of the hallux, and signs and symptoms. Results: Eight patients had either major or minor complications. Three patients had recurrent deformity (1 with associated nonunion), 2 had delayed union, 2 had hardware loosening (1 with associated nonunion), and 1 had wound dehiscence. Conclusion: First TMTJ arthrodesis requires greater care in choosing the surgical technique for the treatment of hallux valgus. In addition, some points should be considered to minimize complications as much as possible. We believe that data are still scarce to provide a concrete basis. Level of Evidence IV; Therapeutic Studies; Case Series.

Correlation of Loss of Correction With Postoperative Radiological Factors After Distal Chevron Osteotomy in Dependence of Concomitant Akin Osteotomy

Loss of correction is frequently observed following hallux valgus correction and is associated with recurrence of a hallux valgus deformity. The purpose of this study was to correlate loss of correction and radiological parameters following distal chevron (Group C) and combined chevron/akin (Group AC) osteotomy. A total of 859 feet were included for analysis and grouped according to treatment with a distal chevron osteotomy alone or a combined chevron/akin osteotomy. Radiographs were evaluated preoperatively, postoperatively, after 6 weeks, 3 months and, if available, at long term follow-up with a mean of 34.2 (range 7.5-155.3) months. With the exception of the proximal to distal phalangeal articular angle (PDPAA), preoperative deformity was comparable between both groups. Significant correction of all examined parameters (p < .001) was seen. Loss of correction at 6 weeks with minor deterioration until follow-up was also detected, with group AC somewhat better than Group C. A strong correlation with loss of correction was found for the postoperative hallux valgus angle (HVA) (p < .002), intermetatarsal angle (IMA) (p < .001), distal metatarsal articular angle (DMAA) (p < .002), positioning of the sesamoids (p < .002) and joint congruity (p < .035) in Group C and for the DMAA (p < .033) and HVA (p < .046) in Group AC. Multiple postoperative radiological parameters correlated with loss of correction following distal chevron osteotomy. In Group AC only postoperative HVA and DMAA determined loss of correction. Correction of the deformity in Group AC showed greater stability.

Minimally Invasive Modified Nuss Procedure for Repair of Pectus Excavatum in Pediatric Patients: Single-Centre Retrospective Observational Study.

Background: The treatment of pectus excavatum can be conservative or surgical. The aim of this study was to determine the factors influencing the outcomes of treatment after a minimally invasive Nuss corrective surgery procedure in pediatric patients. Methods: A total of 30 patient who underwent a minimally invasive Nuss corrective procedure for pectus excavatum from 1 January 2014 to 31 December 2020 were included in thisretrospective study. The collected data included thepatient’s demographic characteristics (age, sex, height, weight, body mass index—BMI, Haller index), treatment outcomes (duration of surgery, length of hospital stay, intraoperative complications, early and late complications, postoperative analgesia), and overall patient and legal guardian satisfaction two years after the procedure. Results: A total of 22 male and 8 female patients were included in the study. The median age was 15 years (interquartile range—IQR 14, 16), and the median BMI was 18.5 kg/m2 (IQR 17.7, 20.4) and 18.2 kg/m2 (IQR 16.9, 18.6) for males and females, respectively. The median CT Haller index was 3.67 (IQR 3.48, 4.09) for male and 3.69 (IQR 3.45, 3.9) for female patients. The median surgery duration was 120 min (IQR 100, 130), and the median hospital stay length was 8.5 days (IQR 8, 9.75). Indications for surgery were psychological (47%), followed by respiratory (30%) and combined respiratory-cardiac (20%) and respiratory-psychological disorders (3%). Early complications were observed in 18 patients (60%), and late complications were observed in 7 patients (23.3%). Intraoperative complications were not recorded. The most common early complications were pneumothorax and subcutaneous emphysema (30%), while late complications included bar displacement (10%) and deformity recurrence (6.6%). Overall, the procedure was successful in 93.1% of patients. Upon arrival home, 22 patients (81.5%) used analgesics for at least one day, up to a maximum of six months. A total of 23 (76.7%) operated patients determined that the surgical procedure had excellent results (grade 5), 4 (13.3%) patients report a good result (grade 4), 1(3.3%) patient reported a mediocre result, and one patient (3.3%) reported a bad result (grades 3 and 2, respectively). Conclusion: The Nuss procedure is a safe and effective method for treating funnel chest in children and adolescents. It also providesexcellent cosmetic and aesthetic results as well as subjective satisfaction with the outcome of surgical treatment.

Clinico-Radiological and Functional Outcome of Difficult Talipes Equinovarus Deformity Corrected With an Ilizarov Fixator

Relapsed, resistant, and untreated congenital talipes equinovarus poses significant challenges in view of functional outcome following conventional serial casting and soft tissue release procedures. The Ilizarov ring fixator here offers significant possibilities as an extended conservative treatment modality. The aim of the present study was to critically evaluate effectiveness of the Ilizarov ring fixator with regard to radiological, clinical, and functional outcomes, in the difficult clubfeet. The study was carried out on patients presenting with relapsed, resistant, or untreated congenital talipes equinovarus deformity, who underwent deformity correction using the Ilizarov ring fixator application. All patients were reviewed at 6 monthly intervals for over 3 years following fixator removal with an objective clinical, radiological, and functional assessment. Twenty-three patients with 30 clubfeet were enrolled in our study. The mean age was 8.3 ± 3.6 (range 4-17) years. The postoperative clinical, radiological, and functional scores showed statistically significant improvement among all patients when compared with the preoperative data. All 30 feet developed varying complications during treatment with pin track infections being the most common. However, they were managed while continuing the distraction correction process. The Ilizarov ring fixator is an effective and reliable solution for difficult and challenging clubfeet. However, one must be aware of a strict adherence to a bracing protocol to avoid recurrence of deformities. A regular periodical functional and clinical follow up must be ensured among these children for a favorable outcome.

Retrospective case series of inverted V-shape tenotomy of gastrocnemius and recession of soleus at the musculotendinous junction for the treatment of fixed equinus deformity in children with cerebral palsy

Background: The authors describe results of a surgical percutaneous procedure for gastrocnemius-soleus lengthening at musculotendinous junction using a one-cut inverted V-shape technique for equinus correction in patients with cerebral palsy (CP). Methods: This was a retrospective case-series study of 52 patients with spastic CP between November 2001 and November 2016. Gross Motor Function Classification System (GMFCS) levels (II-IV) were involved. Statistical analysis was carried out for ankle dorsiflexion angles with knee extended and flexed, popliteal angle, and Gillette Functional Assessment Questionnaire (FAQ). Failure was determined by recurrence of equinus deformity or developing crouch gait due to overlengthening. Results: A mean age of 7 yr was recorded, with a minimum follow-up of 1 yr. A total number of 88 feet were operated upon, including several children who had bilateral deformities. Twelve (23%) patients were operated previously by either percutaneous or open tendo-Achilles lengthening. Success was achieved in 44 patients (85%), and eight patients (15%) had failure. Noncompliance with physical therapy and night splinting were the determined causes of failure for patients who had recurrence. GMFCS level-IV was a particular risk of failure (75%). No patient developed postoperative crouch gait caused by an over-lengthened tendo-Achilles. The improvement in the outcome measures were clinically significant in the successful group. Conclusions: The authors’ percutaneous gastrocnemius-soleus lengthening one-cut technique is a safe, cosmetic, and economic day-case surgery. It has low recurrence rate, with minimal risk of developing a crouched gait from overlengthening. Level of Evidence: Level IV.

P072 Lobstein's disease: about 12 observations

Abstract Background Osteogenesis imperfecta (OI), or Lobstein's disease, is a rare inherited disorder characterized by bone fragility and low bone mass. The symptoms are diverse, with varying severity of skeletal signs and inconstant extra-skeletal signs. Type 1 is the most frequent form (about 60% of cases). Our objective is to describe the different clinical pictures hospitalized in our department during the last 15 years. Patients and methods This is a retrospective descriptive study including 12 patients followed for OI, hospitalized in the rheumatology department of Fattouma Bourguiba University Hospital Monastir TUNISIA between 2006 and 2019. The records were collected and analyzed. Results There were 9 boys and 3 girls with a mean age of 14.9 ± 8.6 years. Consanguinity was reported in 25% of cases. The chief reason for consultation was recurrent fractures (75%), blue sclera (16.7), and bone deformation (8.3%). The average number of anterior fractures was 5, with low-energy trauma as the mechanism in all cases. Similar cases in the family were noted in 41.6% of cases, in siblings in 25% of cases. The mean age of the first fracture was 4.41 ± 3.2 years. The most frequent fracture sites were respectively: femur (7/12), leg (6/12), tibia (3/12), humerus (4/12), ankle (2/12), and forearm (2/12). The deformity was noted in 58.3% of cases: lumbar kyphosis (2), exaggerated dorsal kyphosis (2), bracketed femurs (2), and anarchic deformity of 2 lower limbs (1). Dentinogenesis imperfecta was found in 8.3% of cases, while ENT examination revealed a conductive and sensorineural hearing loss in 2 patients each. The main radiological abnormalities were diffuse bone demineralization in 9 patients, thinning of the cortical bone in 5 patients, vertebral fractures in 3 patients, and fracture in 2 patients. Bone densitometry showed a mean Z-score of 3.49 ± 1.4 in the lumbar spine. The mean blood calcium level was 2.38 ± 1.15, alkaline phosphatase was elevated in all cases with a mean of 756 ± 624.9, and vitamin D levels were deficient in all cases with a mean of 22.75 ± 5.3. In addition to vitamin-calcium supplementation, all patients received intravenous pamidronate at a dose of 9 mg/kg/year with an average of 6 courses. The main side effects noted at the time of infusion were abdominal pain, polyarthralgia and asthenia (1 patient), chest pain (1 patient), and fever and chills (1 patient). Control bone densitometry showed a mean Z score of 1.81 ± 1.2 in the lumbar spine. Conclusions Osteogenesis imperfecta is a severe disease with a risk of serious complications t. In the absence of etiological treatment, symptomatic management must be both early and multidisciplinary.

Роль плантарного апоневроза в формировании кавусного компонента при рецидивах врожденной эквино-поло-варусной косолапости

Актуальность. Врожденная эквино-поло-варусная косолапость (ВЭПВК) является второй по частоте среди всех врожденных аномалий костно-мышечной системы у детей и одной из самых распространенных причин детской инвалидности в Украине. Частота ВЭПВК достигает 1–3 случая на 1000 новорожденных (35–40 % от всех деформаций стоп). По данным ряда авторов, выполнение плантарной фасциотомии позволяет улучшить форму и функцию опоры и ходьбы у пациентов. Цель: определить роль плантарного апоневроза в формировании кавусного компонента в случаях рецидива ВЭПВК у детей. Материалы и методы. Проведены математические исследования с использованием графоаналитического метода. Результаты. Для снижения высоты свода стопы при коррекции ее полой деформации необходимо увеличить длину апоневроза на значительную величину (до 25 % его начальной длины). Для выполнения такой задачи к апоневрозу необходимо приложить значительную растягивающую силу, величина которой зависит от величины снижения высоты свода стопы. Так, для снижения высоты свода на 10 мм нужно удлинить апоневроз на 12 мм, для чего к нему нужно применить постоянно действующую силу величиной 932 Н. Для снижения высоты свода стопы на 20 мм величину растягивающей силы, приложенной к апоневрозу, необходимо увеличить до 1438 Н, что осуществить практически невозможно. Поэтому наличие сокращенного апоневроза является значительным препятствием для эффективного устранения полой деформации стопы. Выводы. Коррекция полой деформации стопы требует значительного уменьшения высоты ее продольного свода, что приводит к значительному удлинению апоневроза — до 25 % от его первоначальной длины. Для обеспечения увеличения длины апоневроза необходимо наличие постоянно действующей растягивающей силы значительной величины, превышающей значение 1000 Н. Плантарный апоневроз играет непосредственную роль в поддержке продольного свода стопы и является одной из причин устойчивости кавусной деформации у пациентов с рецидивом ВЭПВК, что не поддается консервативному лечению. Для устранения кавусной деформации стопы при отсутствии эффекта от консервативного лечения необходимо удлинение апоневроза путем хирургического вмешательства (пересечения). Величину угла продольного свода стопы в 110° можно выбрать в качестве критерия принятия решения в пользу сохранения или отсечения апоневроза.

Association of First Metatarsal Pronation Correction With Patient-Reported Outcomes and Recurrence Rates in Hallux Valgus.

The purpose of this study was to determine if a postoperative decrease in first metatarsal pronation on 3-dimensional imaging was associated with changes in patient-reported outcomes as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function, pain interference, and pain intensity domains or recurrence rates in patients with hallux valgus (HV) who undergo a first tarsometatarsal fusion (modified Lapidus procedure). Thirty-nine consecutive HV patients who met the inclusion criteria and underwent a modified Lapidus procedure had preoperative and ≥2-year postoperative PROMIS scores and had first metatarsal pronation measured on preoperative and at least 5-month postoperative weightbearing CT scans were included. Multivariable regression analyses were used to investigate differences in the change in PROMIS domains preoperatively and 2 years postoperatively between patients with "no change/increased first metatarsal pronation" and "decreased first metatarsal pronation." A log-binomial regression analysis was performed to identify if a decrease in first metatarsal pronation was associated with recurrence of the HV deformity. The decreased first metatarsal pronation group had a significantly greater improvement in the PROMIS physical function scale by 7.2 points (P = .007) compared with the no change/increased first metatarsal pronation group. Recurrence rates were significantly lower in the decreased first metatarsal pronation group when compared to the no change/increased first metatarsal pronation group (risk ratio 0.25, P = .025). Detailed review of this limited cohort of patients who underwent a modified Lapidus procedure suggests that the rotational component of the HV deformity may play an important role in outcomes and recurrence rates following the modified Lapidus procedure. Level III, retrospective cohort study.

The Outcome of the Combined Procedure of Abdominoplasty and Repair of Umbilical Hernia

Abstract Background Umbilical hernias (UH) are common in patients seeking abdominal contouring surgery and the question of simultaneous abdominoplasty and UH repair is raised. This presents, however, a risk to the umbilicus vascularization with possible umbilical necrosis. As a result, the umbilicus maintains its only blood supply from the underlying fascial attachments via the umbilical stalk. Abdominoplasty in the setting of a hernia repair can improve patients satisfaction, particularly appearance, hygiene, self-confidence and decrease the incidence of recurrence. Objective To assess the outcome of the combined procedure of abdominoplasty and repair of umbilical hernia. Patients and Methods This study Included 26 patients (18 females and 8 males) who were selected from those who presented to the department of general surgery at EL Demerdash University Hospital and Nasr city insurance hospital during the period between april2019 and october 2019. All patients had a physical examination of the UH and diastasis. Divided into two groups, each group formed of 13 patients. First group (group A) with patients underwent herniorrphy alone and the other group (group B) with patients underwent hernioplasty with combined abdominoplasty. Results It may be concluded that (1) during an abdominoplasty, midline fascial plication and ventral hernia repair can be performed in defects &amp;lt;3 cm without mesh reinforcement with no increase in hernia recurrence rates, (2) in patients with defects &amp;gt; 3 cm, mesh reinforcement is indicated after suture hernia repair and midline plication,, yields lower recurrence of abdominal deformity and less refashioning procedures with minimal complications. Conclusion Finally, it may help to reduce the incidence of recurrence by enabling removal of a large pannus and the resultant weight on the anterior abdominal wall, though this has not been proven. Also it improves the quality of life and obtains patients satisfaction with this approach.

Ponseti treated idiopathic clubfoot - outcome predictive factors in the test of time: analysis of 500 feet followed for five to 20 years.

PurposeTo investigate a set of risk factors on the outcome of Ponseti treated idiopathic clubfeet (ICF).MethodsThis study was approved by the institutional review board. A retrospective analysis of prospectively gathered data over a 20-year period, at a single dedicated clubfoot clinic. Records of 333 consecutive infants with 500 ICF were analyzed. Initial Pirani score, number of casts, need for tenotomy, foot abduction brace compliance and functional score had been documented. The need for surgery after initial correction was the outcome measure. All children were followed by the same team throughout the study period. Descriptive statistics, chi-squared and multivariate analysis were performed.ResultsIn total, 82 children (24%) with 119 feet (23.8%) were operated on, with 95.1% of feet being operated up to the age of nine years. There was a significant correlation between the Pirani score at presentation and the number of surgical procedures (chi-squared = 79.32; p < 0.001). Achilles tenotomy was done in 94.8% of patients. Pirani score of > 4.5 before casting was strongly associated with increased surgical risk (odds ratio = 1.95). When six to eight cast changes were needed, surgical prospect was 2.9 more, increasing to 11.9 when nine or more casts were needed.ConclusionFoot severity and number of cast changes were the strongest predictors for future surgery. Estimation of the risk of deformity recurrence after initial correction may help in tailoring a cost-effective personal treatment and follow-up protocol. Personalized focused protocol will help patients and caregivers and will reduce expenses.Level of EvidenceLevel II - prognostic study.

Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis

Background and purpose — After initial clubfoot correction through Ponseti treatment, recurrence rates range from 26% to 48%. Even though various factors have been associated with increased recurrence risk, systematic assessments of the prognostic capacity of recurrence risk factors and their clinical relevance are lacking. Therefore we assessed clinically relevant prognostic factors for recurrent idiopathic clubfoot deformity after initial correction through Ponseti treatment. Methods — PubMed, Embase, Cinahl, and Web of Science were systematically searched for studies investigating the association between clinically relevant factors and recurrence rates. Prognostic factors were qualitatively assessed and included in the meta-analysis if ≥ 2 studies investigated the same factor and methods were comparable. Results — 34 articles were included in the qualitative synthesis, of which 22 were also included in the meta-analysis. Meta-analysis revealed that poor evertor muscle activity (OR = 255, 95% CI 30–2,190), brace non-compliance (OR = 10, CI 5–21), no additional stretching (OR = 31, CI 10–101), more casts (OR = 3.5, CI 1.6–7.8), lower education level of parents (OR = 1.8, CI 1.2–2.6), non-marital status of parents (OR = 1.8, CI 1.1–3.0), and higher Dimeglio scores (OR = 1.9, CI 1.2–3.3) were associated with higher recurrence rates. Interpretation — Brace non-compliance and poor evertor muscle activity have been identified as main recurrence risk factors and are therefore important to be closely monitored during clinical follow-up of clubfoot patients. Adding additional stretching during the bracing protocol might be promising in the quest to prevent relapse, but scientific evidence for clear clinical treatment recommendations is still limited.

Episodic transport of discrete magma batches beneath Aso volcano

Magma ascent, storage, and discharge in the trans-crustal magmatic system are keys to long-term volcanic output and short-term eruption dynamics. How a distinct magma batch transports from a deep reservoir(s) to a pre-eruptive storage pool with eruptible magma remains elusive. Here we show that repetitive very-long-period signals (VLPs) beneath the Aso volcano are preceded by a short-lived (~50–100 s), synchronous deformation event ~3 km apart from the VLP source. Source mechanism of a major volumetric component (~50–440 m3 per event) and a minor low-angle normal-fault component, together with petrological evidence, suggests episodic transport of discrete magma batches from an over-pressured chamber roof to a pre-eruptive storage pool near the brittle-ductile transition regime. Magma ascent velocity, decompression rate, and cumulative magma output deduced from recurrent deformation events before recent 2014 and 2016 eruptions reconcile retrospective observations of the eruption style, tephra fallouts, and plume heights, promising real-time evaluation of upcoming eruptions.

The Syndesmosis Procedure Correction of Hallux Valgus Feet Associated With the Metatarsus Adductus Deformity

Metatarsus adductus and hallux valgus are common foot deformities. Corrective surgery of hallux valgus feet with metatarsus adductus deformity can be challenging and experience a high deformity recurrence rate. The purpose of this study was to demonstrate if the syndesmosis procedure can correct such feet satisfactorily without osteotomies and arthrodesis. 75 hallux valgus feet in 45 patients with a Sgarlato's metatarsal adductus angle ≥15° were studied after having undergone the syndesmosis procedure for an average of 20.22 months. Their average preoperative intermetatarsal angle of 12.56° was improved to 6.00° (p < .001) and metatarsophalangeal angle from 35.61° to 23.46° (p < .001) significantly. Their average American Orthopedic Foot and Ankle Society's clinical scores improved significantly from 56.41 to 90.53 points (p < .001). Fifty-five feet (73.33%) had preoperative metatarsal calluses, and all but 3 had a noticeable reduction in severity. Forty-one patients (91.11%) were able to return to their desired activities and footwear. All relevant raw data formed this study, including x-ray and photographic images, were submitted as Supplementary Material for online viewing and reference. Despite the possible intrinsic rigidity of metatarsus adductus forefoot, this study demonstrated that hallux valgus feet with metatarsus adductus deformity could be corrected anatomically and functionally with the soft tissue syndesmosis procedure and without correcting the preexisting metatarsus adductus deformity. This study also supports the notion that the MA deformity accentuates hallux valgus alignment preoperatively and postoperatively, and possibly all feet in general.

Recurrence of Lower Extremity Rotational Deformities after Derotation Osteotomyin Ambulatory Children with Cerebral Palsy

Recurrence of Lower Extremity Rotational Deformities after Derotation Osteotomyin Ambulatory Children with Cerebral Palsy

Reconstructive surgery in recurrent deformity (clubfoot relapse)

Introduction Recurrent clubfoot deformity may be due to either an imperfect initial correction, or a natural history of a severe disease. In the later, idiopathic clubfoot is uncommon. In the review we describe reconstructive surgery in recurrent deformity of idiopathic clubfoot. Material and methods Surgery may be justified at different age and according to the type of deformity. Different surgical approaches and their indications are exposed in the article. Results After Ponseti’s method application additional surgeries may be considered in recurrent clubfoot deformity which may represent 10 to 20 % of cases: second Achilles tenotomy, postero-lateral relapse, complete antero-medial and postero-lateral relapse, transfer of the anterior tibial tendon, correction of sequelae: metatarsus varus, residual equinus, residual rotation of the calcaneopedal unit. Conclusion Idiopathic equine varus clubfoot is a frequent condition. Well-codified management should lead to extremely favorable functional results. Unfortunately, some cases lead to a recurrence of the deformity. Surgical procedures are sometimes required. The goal is to avoid as much as possible arthrodesis and secondary degenerative arthritis.

Correction of long standing severely flexed ankylosed knee deformity using Ilizarov’s technique: A case report

A 25 years old female with limp and a gradually progressive flexion deformity at the knee, being able to walk only on crutches, following septic arthritis of the knee joint during childhood had a fixed flexion deformity of 70 degrees at the knee with a limb shortening of 7cm with evidence of multiple healed previous sinuses and secondary deformities of spine, pelvis and ankle. The soft tissue over the posterior aspect of knee joint was scarred with a degenerated and ankylosed knee joint. A supracondylar anteriorly based closing wedge osteotomy of the femur at the CORA was done to correct the deformity gradually using a long spanning Ilizarov’s ring external fixator with corticotomy and sequential lengthening done later. At final follow up at 12 months after completion of treatment apart from pin tract infections the patient had no other complications like residual or recurrence of deformity, delayed consolidation, non-union, refracture, peroneal nerve injury or hardware failure. Also with satisfactory hip and ankle range of motion and a limb that was pain free and in functional position unaided ambulation was possible. Hence, wedge resection and gradual correction with Ilizarov’s technique can achieve desired results without causing any neurovascular complications or soft tissue procedure requirement in a chronic severely flexed ankylosed knee.

Customized Two-Dimensional Computed Tomography-Guided Preoperative Pectus Bar Shaping.

Successful minimally invasive repair of pectus excavatum relies on a pectus bar that closely conforms to the desired shape of the sternum and ribs to produce optimal elevation and remodeling. However, the present method of empirical intraoperative bar shaping is tedious and risks trauma to surrounding structures. To overcome this, we devised a technique using a life-sized computed tomography (CT) printout of the patient's chest wall to guide preoperative bar bending. A 5-cm-wide polymethylmethacrylate block placed on the sternum as the patient underwent chest CT was used as a marker to guide scaling of an axial screenshot of the patient's chest to life-size. This life-size image was printed and the planned correction of the patient's chest wall was traced onto it. The pectus bar was bent according to this template. Patient demographics, Haller index, surgical indications, operative technique, complications, aesthetic and functional improvements, and overall satisfaction were assessed. Thirty patients (4 women) underwent primary minimally invasive repair of pectus excavatum with a single pectus bar shaped preoperatively over an 8-year period. The average age and Haller index was 20.6 years and 5.4, respectively. The mean operative time was 66.4 minutes. Satisfactory sternal elevation was attained with a single attempt at bar insertion in all cases. Two patients had pneumothoraxes that resolved without intervention. The mean follow-up period was 50.1 months. There were no cases of bar migration or recurrence of deformity after bar removal. On a 5-point Likert scale, all patients indicated an improvement in aesthetic appearance (4.6), and patients with physical symptoms (10) reported an improvement in function (4.4). The overall satisfaction score was 4.7. This technique of CT-guided preoperative pectus bar shaping is straightforward, eliminates the need for intraoperative revisions to bar shape, and achieves effective correction of the pectus excavatum deformity. All patients were satisfied with the aesthetic, functional, and overall outcomes.

Evaluation of Distraction Osteogenesis by Ilizarov Ring Fixator for Hypertrophic Nonunion of Tibia with Shortening and Deformity

Background: Hypertrophic nonunion often develops due to improper fracture immobilization or failed internal fixation. Gross mobility at the fracture site interferes with the normal healing process with the formation of fibrocartilage, which fails to mature into solid callus. Aim of the study: The aim of this study was to evaluate distraction osteogenesis by ilizarov ring fixator for hypertrophic nonunion of tibia with deformity and shortening. Methods: This was a quasi-experimental study conducted at National Institute of Traumatology &amp; Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh in the period from June 2011 to December 2012. Study population were all the patients with hypertrophic nonunion of tibia with shortening and deformity, attending out-patient department in NITOR. A total of 10 patients were included for evaluation from which 8 patients were selected using purposive sampling method. Surgery was with detailed preoperative x-ray analysis and measurement of magnitude of deformity and LLD. Other necessary investigations were done if clinically indicated and to prepare the patient for anesthesia. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The mean age of patients was 32.62 years and the lowest and the highest ages were 14and 55 years respectively. Type of deformity out of 08 patients, 07 patients had only angulation deformity and 01 had angulation translation deformity. Distribution of patients with the Plane of deformity reflects that 2 patients had sagittal plane and 6 had oblique plane. Conclusion: As the outcome evaluation was done 5-11 months after operation, changes in outcome beyond 3-11 months like Knee, ankle arthritis and symptom status, recurrence of deformity, collapse of lengthen segment could not be ascertained.