Distal Tibial Osteotomy Research Articles

Sports activities after lower limb osteotomy

Active sports participation can be important in some patients with degenerative joint disease in the lower limb. We investigated whether this is possible after an osteotomy for osteoarthritis of the hip, knee and ankle joints. We performed a literature search using Medline, Cochrane, CINAHL and Google Scholar with no restriction to time period or language using the keywords: 'osteotomy and sports'. Eleven studies (all level IV evidence) satisfied our inclusion and exclusion criteria. Nine reported on high tibial osteotomies, one on periacetabular osteotomies and one on distal tibial osteotomies. The Coleman Methodology Score to assess the quality of studies showed much heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment. Participation in recreational sports is possible in most patients who were active in sports before lower limb osteotomy. In no study were patients able to participate in competitive sports. Intensive participation in sports after osteotomy may adversely affect outcome and lead to failures requiring re-operation. Patients may be able to remain active in selected sports activities after a lower limb osteotomy for osteoarthritis. More rapid progression of arthritis is however a possibility. Prospective comparative studies investigating activities and sports participation in age-matched patients undergoing osteotomy or joint replacement could lead to useful conclusions. Increased activity and active sports participation may lead to progression of arthritis and earlier failure requiring additional surgery.

Distal femoral and proximal tibial osteotomy for correction of genu valgum in Morquio syndrome: a case report

Distal femoral and proximal tibial osteotomy for correction of genu valgum in Morquio syndrome: a case report

Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis

In patients with asymmetric (varus or valgus) ankle osteoarthritis, realignment surgery is an alternative treatment to fusion or total ankle replacement in selected cases. To determine whether realignment surgery in asymmetric ankle osteoarthritis relieved pain and improved function, we clinically and radiographically followed 35 consecutive patients with posttraumatic ankle osteoarthritis treated with lower leg and hindfoot realignment surgery. We further questioned if outcome correlated with achieved alignment. The average patient age was 43 years (range, 26-68 years). We used a standardized clinical and radiographic protocol. Besides distal tibial osteotomies, additional bony and soft tissue procedures were performed in 32 patients (91%). At mean followup of 5 years (range, 3-10.5 years), pain decreased by an average of 4 points on a visual analog scale; range of ankle motion increased by an average of 5 degrees . Walking ability and the functional parts of the American Foot and Ankle Society score increased by an average of 10 and 21 points, respectively, and correlated with achieved reversal of tibiotalar tilt and the score of Takakura et al. Revision surgery was performed in 10 ankles (29%), of which three ankles (9%) were converted to total ankle replacement. We believe the data support realignment surgery for patients with asymmetric ankle osteoarthritis.

Strain in Distal Tibial Osteotomy Stabilized With Metaphyseal and Distal Tibial Locking Compression Plates

Strain in Distal Tibial Osteotomy Stabilized With Metaphyseal and Distal Tibial Locking Compression Plates

Supramalleolar Tibial Osteotomy Secured With the Puddu Plate

Clinical indications for distal tibial osteotomies are rare and information on fixation techniques is limited. This article reviews a retrospective study of 4 patients who underwent 5 distal tibial open-wedge osteotomies stabilized with a Puddu plate. All osteotomies healed within 3 months with no incidence of malunion, nonunion, or fixation failure and all deformities were adequately corrected. The Puddu plate (Arthrex Inc, Naples, Fla) provides secure fixation for open-wedge distal tibial osteotomies with accurate and reproducible results.

Surgical correction of bowlegs in achondroplasia

A retrospective review of 39 surgical procedures to correct bowlegs in achondroplasia was performed. Three operative procedures had been used sequentially over 27 years. Sixteen tibiae were treated by proximal closing wedge tibial osteotomy, proximal fibular epiphysiodesis and casts. Twelve tibiae were treated by opening wedge osteotomies using external fixation with no fibular shortening. Eleven tibiae were treated by the Ilizarov technique with 3-cm tibial lengthening, deformity correction, and distal translation of the proximal fibula. The Ilizarov technique is the most satisfactory method for correction of proximal bowlegs in early childhood. Distal tibial osteotomy and fibular shortening is recommended for correction of distal bow legs in older children.

Results of Tibial Rotational Osteotomy Without Concomitant Fibular Osteotomy in Children With Cerebral Palsy

A retrospective review was performed of 46 consecutive ambulatory children with cerebral palsy and tibial torsion who underwent 72 distal tibial derotational osteotomies without concomitant fibular osteotomy. The average amount of derotation measured at surgery was 21 +/- 5 degrees. The average change in thigh-foot angle at follow-up was 21 +/- 9 degrees. There were eight perioperative complications (11%): three delayed unions, three superficial wound dehiscences, one case of osteomyelitis, and one superficial pin tract infection. There were no incidences of malunion or nonunion. Preoperative and postoperative three-dimensional gait analysis data were used to determine the effect of distal tibial osteotomy on foot progression angle in seven subjects (11 limbs). Foot progression improved significantly. This study shows that distal tibial osteotomy alone (without concomitant fibular osteotomy) is an effective and safe procedure for correcting and maintaining correction of tibial torsion in patients with cerebral palsy.

Calculation of the Opening Wedge for a Low Tibial Osteotomy

Medial opening wedge distal tibial osteotomy, a relatively new technique for treatment of intermediate ankle joint arthritis, is a technically demanding procedure that requires preoperative planning to determine the size of the wedge that will restore anatomic alignment of the joint surface. The purpose of this study was to facilitate the preoperative planning process for distal tibial osteotomy by determining angular correction obtained with various wedge heights. Measurements of the distal tibia were taken from cadaver specimens to develop a database of average distal tibial widths. A distal tibial osteotomy was then done on the cadaver specimens with the placement of wooden block wedges of various heights at the osteotomy site. Preoperative and postoperative radiographic measurements of the joint surface angle were obtained on all specimens. The measured amount of angular change was compared to the mathematically predicted angular change using the formula tan theta = H/W. The mathematical model accurately predicted the amount of measured angular correction of the distal tibial articular surface. There was an approximate 2-degree angular change of the articular surface per millimeter of wedge height. As the tibial width increased, a smaller amount of angular correction per millimeter of wedge height was noted, and as wedge height increased with the same tibial width, less angular correction was obtained per millimeter of wedge height. With appropriate preoperative planning, an accurate prediction can be made as to the amount of ankle joint correction that should be obtained with surgery. The size of the wedge that will provide the desired amount of correction can be accurately determined preoperatively.

Alignment and technique in total ankle arthroplasty

Total ankle arthroplasty has emerged as a promising alternative to ankle arthrodesis, especially in cases where multiple hindfoot joints are arthritic. Proper alignment of the limb must be restored to be most successful over the long term. Misalignment above the ankle typically involves a malunion of a previous tibia fracture and can be treated by corrective osteotomy. Deformity in the joint itself can arise from congenital malformation or from bony erosion, usually as a late result of joint trauma. Mild amounts of bone loss can be corrected through bone cuts during ankle replacement, but more severe deformity may require distal tibial osteotomy. Misalignment below the ankle (in the foot) is probably the most common deformity. Secondary procedures in the foot and leg, including muscle balancing, osteotomies, or fusions are often a part of the surgical plan and are performed either before or simultaneously with ankle replacement. The goal is to restore an ankle with neutral static and dynamic balance during stance and gait. Achieving that goal will give the best chance for pain free ankle motion over the long term.

Split tibialis posterior tendon transfer with concomitant distal tibial derotational osteotomy in children with cerebral palsy.

Fifteen lower extremities with a spastic equinovarus foot deformity associated with internal tibial torsion were identified. Each lower extremity underwent a split tibialis posterior tendon transfer combined with a distal tibial derotational osteotomy. The medical record of each patient was reviewed retrospectively. We paid particular attention to clinic visits, gait analyses, and surgical procedures performed. These patients were followed up for an average of 4 years and 5 months after surgery. Twenty-seven percent had an excellent result, 13% developed a rigid equinovarus deformity, and 40% developed a severe planovalgus deformity. Eight of the 15 lower extremities required further corrective surgery because their resultant deformities limited their ambulation, was painful, or both. The combination of a split tibialis posterior tendon transfer with a distal tibial derotational osteotomy increases the difficulty of balancing the muscle forces across the spastic equinovarus foot, increasing the likelihood that overcorrection and a planovalgus deformity will develop.

Split Tibialis Posterior Tendon Transfer with Concomitant Distal Tibial Derotational Osteotomy in Children with Cerebral Palsy

Split Tibialis Posterior Tendon Transfer with Concomitant Distal Tibial Derotational Osteotomy in Children with Cerebral Palsy

Kinematic and Kinetic Analysis of Distal Derotational Osteotomy of the Leg in Children with Cerebral Palsy

Patients with cerebral palsy often develop rotational deformities of the lower extremities. These deformities may be caused by abnormal muscle tone, soft-tissue contractures, or bony malalignment. When rotational deformity persists after correction of the soft-tissue components, bony-realignment procedures are warranted to improve gait in ambulatory patients. We performed a retrospective review of 10 ambulatory children with cerebral palsy and tibial torsion who underwent 13 distal tibial and fibular derotation osteotomies. Preoperative and postoperative three-dimensional gait analysis were used to determine the effect of distal tibial and fibular derotation osteotomy on tibial rotation, foot-progression angle, gait velocity, and moments about the ankle. Mean tibial rotation and foot-progression angle were significantly improved by the procedure. Gait velocity improved but not significantly. Moment data demonstrated a trend toward normal. This study demonstrates that the derotational distal tibial and fibular osteotomy stabilized with percutaneous crossed Kirschner wires is a safe, reliable, and effective procedure for correcting rotational deformities of the leg in patients with cerebral palsy.

Distal Tibial/Fibular Derotation Osteotomy for Correction of Tibial Torsion: Review of Technique and Results in 63 Cases

Despite a tendency for rotational abnormalities of the lower leg in children to improve spontaneously over time, some fail to correct and require corrective derotation osteotomy. In this retrospective study, we report the technique and results of the distal transverse tibial and fibular derotation osteotomy with Kirschner-wire fixation performed in 63 limbs of children with cerebral palsy, clubfoot, idiopathic tibial torsion, and myelomeningocele, as well as other less common conditions. There were no significant infections, neurologic complications, delayed or nonunions, or compartment syndromes as a result of the osteotomy. There were three (4.8%) complications, including late fracture (one), cross-union (one), and distal physeal closure (one). We conclude that transverse, same-level, distal tibial and fibular osteotomy fixated with crossed Kirschner wires is a safe, efficient, and effective surgical approach to the treatment of children with tibial torsion in a variety of clinical conditions.

Distal tibial and fibular derotation osteotomy in patients with cerebral palsy

Cerebral palsy is the most common motor disorder originating in childhood and spasticity is the most frequent manifestation. The treatment strategies to reduce spasticity and thereby ameliorate the attendant gait abnormalities have included physiotherapy, orthoses, antispastic medications, orthopaedic surgery and neurosurgery. Of these, the neurosurgical procedure known as selective dorsal rhizotomy has gained widespread exposure, and indeed acceptance, over the past two decades, despite there being some controversy as to its efficacy. In this paper we review: cerebral palsy, including classification and treatment; selective dorsal rhizotomy, including historical background, patient selection, operative procedure, clinical outcome and complications; and gait analysis studies, including temporal-distance parameters, joint kinematics, normalisation for growth, and long-term follow-up. Both the short-term (1 year) and long-term (10 years) evidence has demonstrated that selective dorsal rhizotomy not only reduces spasticity but it also provides lasting functional benefits as measured by improved range of motion during gait. Rhizotomy is not a panacea for children with spastic diplegia but it is an important treatment option for the clinician to consider.