Osteotomy For Management Research Articles

Increased Risk for Non-Union in First Metatarsophalangeal Joint Arthrodesis following High-Velocity Reaming: A Retrospective Study

Objective: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a reliable procedure for treating various pathologies related to this joint. However, non-union is a common and debilitating complication of the procedure. The purpose of this study was to assess whether the use of a mechanical reamer to prepare the joint surface increases the risk of non-union compared to traditional manual osteotomy. Methods: A retrospective study of all patients who underwent their first MTPJ arthrodesis surgery in our medical center between 2010 and 2015. The articular surface preparation of the MTPJ was either manually performed (Group 1) or mechanically conducted with reamers (Group 2). Data regarding demographic characteristics, indications for surgery, osteosynthesis methods, and post-operative complications, including non-union, infection, and revision rates, were collected for all patients. Results: A total of 83 patients with 92 primary first MTPJ arthrodesis (44 cases in Group 1 and 48 cases in Group 2) were included with a mean follow-up time of 45.3 months (SD 16.8). The two groups were comparable in terms of age, gender, comorbidities, indication for surgery, and follow-up time. The non-union rate was 15.9% in Group 1 and 25% in Group 2 (p = 0.28). Group 2 showed a significantly higher rate of revision surgery compared to Group 1 (43.7% vs. 22.7%, p = 0.03). Conclusions: The mechanical reamer group had a higher non-union rate and a significantly higher rate of revision surgery compared to low-energy manual joint preparation. In light of these findings, the use of mechanical reamers for joint preparation in the first MTPJ arthrodesis was discontinued at our medical center.

Combined Arthroscopic Wafer Procedure and Triangular Fibrocartilage Complex Debridement versus Ulnar Shortening Diaphyseal Osteotomy in Management of Ulnar Impaction Syndrome: A Randomized Clinical Trial

Abstract Background The literature presents great challenge in comparing the arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) in the treatment of ulnar impaction syndrome (UIS). Purpose We aimed primarily to compare the clinical and functional outcomes of AWP with triangular fibrocartilage complex (TFCC) debridement versus USO in the management of UIS. Methods The study was conducted as a randomized clinical trial including 43 patients with UIS whose ulna variance was less than 4 mm. Patients were randomly allocated to either the AWP group (21 patients) who underwent AWP and TFCC debridement or the USO group (22 patients) who underwent diaphyseal USO. Patients were followed up for at least 12 months. The primary outcome measure was the Modified Mayo Wrist (MMW) score. The Disabilities of the Arm, Shoulder, and Hand (DASH) score, the mean operative time, postoperative complications, and patient satisfaction were our secondary outcomes. Results Radiological correction of variance was achieved in all patients. The mean operative time was significantly shorter in the AWP group. The postoperative MMW and DASH scores were better in the AWP group than in the USO group. Fewer complications occurred in the AWP group (1 of 21 patients) compared with the USO group (3 of 22 patients). Conclusions AWP with TFCC debridement is a reliable and safe method for the management of UIS with a positive variance of less than 4 mm with better clinical and functional results than diaphyseal USO. Type of study/level of evidence Therapeutic type II.

Combined Knee Arthroscopy with Medial Open Wedge High Tibial Osteotomy in Management of Medial Knee Joint Disorder of Adults Varus Knee

Combined Knee Arthroscopy with Medial Open Wedge High Tibial Osteotomy in Management of Medial Knee Joint Disorder of Adults Varus Knee

Triple Innominate Osteotomy in Management of Residual Acetabular Dysplasia in Young Adolescent Patients (Systematic Review and Meta-Analysis)

Background: Aim of the Work The aim of this work is to provide cumulative data about the effic cy and safety of triple innominate osteotomy in management of residual acetabular dysplasia in young adolescent patients. Methods This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Results We found that; the total number of patients in all the included studies was 631 patients; while their average follow up time was (7.2 ± 4.6 years); with longest follow up time of 14.5 years. The average age of all patients was (12.67 ± 3.7 years); with youngest mean age of 7.5 years. Regarding Pre-operative assessment, the average CE angle was (10.4 ± 7.2) degrees, and the average HHS score was (77.7 ± 17.69) degrees. Regarding Post-operative sequel, the overall complications rate was (184/631) (29.1%), and the overall AVN rate was (123/631) (19.5%). Regarding 1 ry efficacy outcome measures, Conclusion Acetabular dysplasia is among the anatomical abnormalities seen in developmental dyplasia of the hip (DDH). One of the goals of surgical treatment during childhood is to achieve optimal femoral head coverage by correcting this architectural flaw, thereby preventing osteoarthritis. Pelvic osteotomy is a treatment option in children and adolescents with residual acetabular dysplasia after developmental dyplasia of the hip.

Proximal femoral derotation osteotomy formanagement offemoral malversion: a systematic review.

Femoral malversion is an under-recognized contributor to hip pain in younger adults. Under treatment is often a contributor to poor outcomes in hip preservation surgery. We reviewed the literature to analyse the outcomes of proximal femoral derotation osteotomy as a treatment for femoral malversion as well as propose our own management algorithm for treating such patients. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines searching four databases (PubMed, CINALH, MEDLINE and EMBASE) for studies investigating the outcomes of derotation osteotomy in treating malversion. Nine studies were found encompassing 229 hips. At a mean follow-up of 39.9 months across the studies, there were only two conversions (1%) to total hip arthroplasty and four revision cases in total. Seven of the nine studies reported improved functional outcomes in their cohorts, with the mean Harris hip score improved from 63.7 to 87.3 where reported. There is a paucity of literature around the outcomes of proximal femoral derotation osteotomy. However, both the evidence available and the authors' experience suggest that consideration of femoral malversion is an essential component of hip preservation surgery, improving functional outcomes in cases of excessive femoral anteversion and femoral retroversion.

Valgus osteotomy in management of non-union of inter-trochanteric fracture: A case report

Valgus osteotomy in management of non-union of inter-trochanteric fracture: A case report

Wearing Effect of Implant Steel Drills and Tappers for the Preparation of the Bone Osteotomies: An Infrared Thermal Analysis and Energy Dispersive Spectroscopy-Scanning Electron Microscopy (EDS-SEM) Study

Background: The thermal effect correlated with implant osteotomy could produce significant effects on the healing process and fixture osseointegration. The aim of the present investigation was to assess the heat generation and surface wearing of dental implant drills and manual tappers during simulated osteotomies on animal ribs. Methods: Steel drills (20 units per type) and tappers (20 units per type) were evaluated for a total of 30 osteotomies. The infrared thermal analysis was performed at the first and thirtieth osteotomy. The surface alteration and wearing was assessed by energy dispersive spectroscopy–scanning electron microscopy (EDS-SEM) prior to and after use. Conclusions: The drill material produced a non-significant temperature change during bone osteotomy. Lower heating was reported for manual tappers in favor of a manual osteotomy instead rotary instruments.

High Fibular Osteotomy in Management of Medial Compartment Osteoarthritis of the Knee

High Fibular Osteotomy in Management of Medial Compartment Osteoarthritis of the Knee

Assessment of Medial Open Wedge High Tibial Osteotomy in Management of Medial Compartment Osteoarthritis of The Knee

Assessment of Medial Open Wedge High Tibial Osteotomy in Management of Medial Compartment Osteoarthritis of The Knee

Assessment of an Artificial Intelligence Mandibular Osteotomy Design System: A Retrospective Study.

In this study, an AI osteotomy software was developed to design the presurgical plan of mandibular angle osteotomy, which is followed by the comparison between the software-designed presurgical plan and the traditional manual presurgical plan, thus assessing the practicability of applying the AI osteotomy software in clinical practices. (1) Develop an AI osteotomy software: design an algorithm based on convolutional neural networks capable of learning feature point and processing clustering segmentation; then, select 2296 cases of successful 3D mandibular angle osteotomy presurgical plans, followed by using those 2296 cases to train the deep learning algorithm; (2) compare the osteotomy presurgical plan of AI osteotomy software and that of manual: first step: randomly selecting 80 cases of typical female head 3D CTs, and designing those 80 cases by means of AI osteotomy software designing (group A) and manually designing (group B), respectively; second step: comparing several indexes of group A and those of group B, including the efficiency index (time from input original CT data to osteotomy presurgical plan output), the safety index (the minimum distance from the osteotomy plane to the mandibular canal), the symmetry indexes (bilateral difference of mandibular angle, mandibular ramus height and mandibular valgus angle) and aesthetic indexes (width ratio between middle and lower faces (M/L), mandibular angle and mandibular valgus angle). The efficiency index: the design time of group A is 1.768±0.768 min and that of group B is 26.108±1.137 min, with P=0.000; the safety index: The minimum distances from the osteotomy plane to the mandibular canal are 3.908±0.361mm and 3.651±0.437mm, p=0.117 in groups A and B, respectively; The symmetry indexes: Bilateral differences of mandibular angle are 1.824±1.834° and 1.567±1.059° in groups A and B, respectively, with P=0.278; bilateral differences of mandibular ramus height are 2.083±1.263 and 2.965±1.433, respectively, with P=0.119 in groups A and B; Aesthetic indexes: M/L in groups A and B is 1.364±0.074 and 1.371±0.067, respectively, with P=0.793; mandibular angles in groups A and B are 127.724±5.800° and 127.242±5.545°, respectively, with P=0.681; Valgus angles in groups A and B are 11.474±5.380 and 9.743±4.620, respectively, with P=0.273. With high efficiency, as well as safety, symmetry and aesthetics equivalent to those of a manual design, the AI osteotomy software designing can be used as an alternative method for manual osteotomy designing. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Development of Autonomous Robot Osteotomy for Mandibular Ramal Bone Harvest and Evaluation of Its Accuracy: A Phantom Mandible-Based Trial

An autonomous robot osteotomy using direct coordinate determination for registering was developed, and the accuracy of the designed osteotomy along the preprogrammed plan was evaluated. Furthermore, the accuracy of the robotic and manual osteotomy was compared in regard to cut position, length, angle and depth. A light-weight robot was used in this study, with an electric gripper. Twenty stone models were used to evaluate accuracy of osteotomy and sixteen mandible phantoms were used to simulate the ramal bone harvest osteotomy for comparison between robotic and manual surgery. In the stone model experiment, the absolute mean values for osteotomy errors for position, length, angle, and depth were 0.93 ± 0.45 mm, 0.81 ± 0.34 mm, 1.26 ± 1.35°, and 1.19 ± 0.73 mm, respectively. In the mandible phantom model experiment, the robotic surgery showed lower errors for position, length and angle (0.70 ± 0.34 mm, 0.35 ± 0.19 mm and 1.32 ± 0.96°) and somewhat higher errors for depth (0.59 ± 0.46 mm) than manual surgery (1.83 ± 0.65 mm, 0.62 ± 0.37 mm, 5.96 ± 3.47° and 0.40 ± 0.31 mm). This study may provide a basis for developing clinical application of an autonomous robot osteotomy.

Error Analysis of Robot-Assisted Orthognathic Surgery.

Orthognathic surgery is an effective method to correct the dentomaxillofacial deformities. The aim of the study is to introduce the robot-assisted orthognathic surgery and demonstrate the accuracy and feasibility of robot-assisted osteotomy in transferring the preoperative virtual surgical planning (VSP) into the intraoperative phase. The CMF robot system, a craniomaxillofacial surgical robot system was developed, consisted of a robotic arm with 6 degrees of freedom, a self-developed end-effector, and an optical localizer. The individualized end-effector was installed with reciprocating saw so that it could perform osteotomy. The study included control and experimental groups. In control group, under the guidance of navigation system, surgeon performed the osteotomies on 3 skull models. In experimental group, according to the preoperative VSP, the robot completed the osteotomies on 3 skull models automatically with assistance of navigation. Statistical analysis was carried out to evaluate the accuracy and feasibility of robot-assisted orthognathic surgery and compare the errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy. All the osteotomies were successfully completed. The overall osteotomy error was 1.07 ± 0.19 mm in the control group, and 1.12 ± 0.20 mm in the experimental group. No significant difference in osteotomy errors was found in the robot-assisted osteotomy groups (P = 0.353). There was consistence of errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy. In robot-assisted orthognathic surgery, the robot can complete an osteotomy according to the preoperative VSP and transfer a preoperative VSP into the actual surgical operation with good accuracy and feasibility.

Clinical and radiological evaluation of the open reduction, Dega osteotomy and derotational femoral osteotomy for management of DDH after walking age

Clinical and radiological evaluation of the open reduction, Dega osteotomy and derotational femoral osteotomy for management of DDH after walking age

Short-term Outcome Analysis of Proximal Fibular Osteotomy in Management of Osteoarthritis Knee

ABSTRACT Aim Proximal fibular osteotomy (PFO) for osteoarthritis (OA) knee is an emerging concept with good early results. This short-term study aimed to analyze the usefulness of PFO in Indian patients with OA knee with regard to pain relief and correction of deformity. Materials and methods This study involves a surgical technique where 2 cm of proximal fibular bone is resected, and patient is permitted full-weight-bearing walking as early as possible. Subjective and objective outcome analyses done using Lysholm knee scoring sheet and radiographs, respectively. Minimum follow-up time was 6 months. Results We had a of total of 20 knees in 18 patients, with average age of 56.1 years. The average visual analog score reduced by 6.8 points, and the average Lysholm knee score improved by an average of 34 points at the end of follow-up. The mean alpha angle correction achieved was 3.738°. The calculation of Pearson's correlation coefficient between the amount of correction of alpha angle and reduction of visual analog scale during the immediate postoperative period was −0.186. Among the 20 knees, we had four cases of weakness of extensor hallucis longus. Conclusion Through our short-term prospective cohort study, we conclude that PFO helps in improvement of pain and function, in patients suffering from medial compartment OA knee. The effectiveness of proximal tibiofibular joint mechanism in immediate pain relief is evident in our study by subjective and objective means. A proper selection of case with regard to severity and duration of disease and patellofemoral involvement is vital in getting good results. Clinical significance Proximal fibular osteotomy is an emerging concept in the management of OA of knee and gives the patient, more years, with native knee to walk. How to cite this article Gopi T, Thirunarayanan V, Manimaran KP, et al. Short-term Outcome Analysis of Proximal Fibular Osteotomy in Management of Osteoarthritis Knee. J Orth Joint Surg 2019;1(1):5–10.

Comparison between dome and wedge osteotomy in management of hallux valgus deformity

Background: the condition of hallux valgus is considered as the most common deformities affecting females more than males, characteristically manifested as lateral deviation of the big toe and widening of first and second inter -metatarsal angle with a deformity of second toe in some severe cases.Objective: to make a radiological and clinical assessment of two surgical methods of osteotomy used in treatment of hallux valgu and to compare between them: first one is the distal dome osteotomy, and second one is a distal wedge metatarsal osteotomy. Patients and methods: a total of 36 feet of 28 patients suffer from hallux valgus, with mean age of 50.3 years were included in this study, followed for 6- 30 months ( mean follow-up of 8.8 months). Nineteen feet treated by dome osteotomy and seventeen feet treated by wedge osteotomy. All the cases were evaluated by the american orthopedics foot and ankle society (aofas) score, also, through the hallux valgus angle and intermetatarsal angle, both before and after surgery. Results: by dome osteotomy, the preoperative mean result of aofas score was about 45.7, with hallux valgus angle (hva) of 33.2o and intermetatarsal angle (IMA) of 11.7º. Postoperatively, the mean result of AOFAS score was 82.8, with HVA of 14.3º and IMA of 7º, with about 94.7% satisfactory results. In the other hand, the method of wedge osteotomy showed a preoperative mean result for AOFAS score of 45.2, with HVA of 34º and IMA of 12.8º , compared with postoperative mean result of AOFAS score of about 80.7, with HVA of 15.8º and IMA of 7.7º, with about 82.8 % satisfactory results.Conclusions: the two methods of osteotomy were used with very good outcome in radiological and clinical treatment of hallux valgus.

Early results of partial capitate shortening osteotomy in management of Kienböck disease

Background: Capitate shortening is the best decompression procedure in the management of Kienböck’s disease in patients with ulnar neutral or positive variance, although carpal collapse develops inevitably. The current study was to report our experience in partial capitate shortening osteotomy as an alternative procedure. Methods: This was a prospective study of 20 patients with Lichtman stage II and IIIa Kienböck’s disease managed by partial capitate shortening osteotomy. Results: At final follow-up (average 36.5 mo), visual analog pain scores improved significantly postoperatively to 3.3. Flexion and extension improved from 62% (±17%) and 52% (±21%) preoperatively to 63% (±13%) and 68% (±13) postoperatively, respectively. The power grip improved significantly from 49% (±16%) to 63% (±12%) postoperatively. The average quick Disability of the Arm Shoulder and Hand Score improved from 60.8(±13.8) to 38.3(±13.9) postoperatively. Conclusions: Partial capitate shortening is a simple and effective procedure for the management of ulnar neutral or ulnar positive Kienböck’s disease before the onset of radiocarpal arthrosis without violation of scaphocapitate joint thus avoiding carpal collapse that follows complete capitate shortening. Type of Study/Level of Evidence: Therapeutic IV.

Pedicle Subtraction Osteotomy in Management of Rigid Thoracolumbar Kyphosis in Adults

Introduction Thoracolumbar kyphosis represent a big challenge for spine surgeons specially if the case is of significant deformity which may affect patients life, Pedicle subtraction osteotomy (PSO) is one of the best methods that cane correct the deformity and give satisfactory result to the patients as it corrects the deformity and allow the patients to gain near normal daily activity. Material and Methods Four patients were treated by this method by PSO of lumbar 2 vertebra, 3 of them complaining of ankylosing spondylitis and one post traumatic, all patients are neurologically stable. All are assisted by X-ray and MRI preop. PSO is carried through a posterior midline approach with fixation of D12 to L4 Results All patients are satisfied with near full correction average 90%. Conclusion PSO is an excellent method for management of rigid thoracolumbar kyphosis in adults

Role of anterior segmental osteotomy for management of dento-osseous deformities

The procedures of anterior segmental osteotomy are stable, versatile and can be undertaken for multiple deformities affecting the anterior portion of jaws. To describe indications in which anterior segmental osteotomy alone can correct maxillomandibular deformities and if adjunct surgery is needed or not. Orthosurgical planning with cephalometric predictions of those deformities of anterior portions of jaws which can be corrected by anterior segmental osteotomy. Achieve occlusion and periodical follow-up of the operated patients to analyze changes produced by surgery and stability of results clinico-radiographically. The study consisted of 16 selected patients of which 9 were female and 7 were male. The ages ranged from 17 to 25 years. Patients with skeletal deformity along with malocclusion which was too severe to be corrected orthodontically were selected. History and examinations were carried out as per standardized protocol. The parameters were laid down only after reviewing the literature and discussion with an orthodontist as presurgical and postsurgical orthodontics are considered mandatory for these cases. Presurgical orthodontics is required for decompensating the intradental and interdental relationship. Cephalometric studies should be mandatory. Model surgery and construction of an occlusal wafer was of great help in achieving the desired position of osteotomized segments intraoperatively.

Posterior maxillary segmental osteotomy for management of supraerupted teeth

Posterior maxillary segmental osteotomy for management of supraerupted teeth

No thermal tool using methods in endoscopic dacryocystorhinostomy: no cautery, no drill, no illuminator, no more tears

The purpose of this study was to evaluate the surgical outcome of the endoscopic dacryocystorhinostomy (DCR) without thermal tools such as cautery, drill and illuminator. The study is a retrospective analysis of patients in a tertiary care unit for oculoplastic surgery. The participants enrolled into the study are a retrospective series of 127 consecutive endonasal DCRs performed between January 2008 and March 2011. The surgical procedure in this conventional endoscopic transnasal DCR involved a manual osteotomy of the frontal process of the maxilla and removal of the lacrimal bone by punch without illuminator, cauterization and drill. We evaluated the result of the manual Endo-DCR technique without cauterization or drilling-assisted technique. Data of 127 eyes were reviewed. Full success was achieved in 90.5 % (115/127) of manual Endo-DCR technique with an average follow-up period of 6 months. Our study appears to show favorable results compared to other previously published outcomes including Endo-DCR surgery with thermal equipments. No thermal tool methods in endonasal DCR can achieve a good surgical success rate. Therefore, the newest tools, cauterization, drilling or illumination, are generally not necessary for endoscopic dacrycystorhinostomy.