Osteotomy In Patients Research Articles

Step-Cut Subtrochanteric Osteotomy Combined with Total Hip Arthroplasty for Neglected Traumatic Hip Dislocations.

BackgroundTotal Hip Arthroplasty remains the standard treatment protocol for patients with neglected traumatic dislocations of the hip with arthritis. A total hip arthroplasty needs to be frequently combined with a subtrochanteric shortening femoral osteotomy to aid in the reduction of the hip joint in such cases. Still long-term stable implant fixation, rigid construct, and favorable functional outcome remain a challenge. In respect to subtrochanteric shortening osteotomy, various techniques have been described in the literature, including the step-cut, double chevron, transverse, and oblique osteotomies. Out of these types, a subtrochanteric step-cut osteotomy provides a better rotational stability and a larger surface of contact to aid in union. As there is a paucity in the literature regarding the step-cut osteotomy for traumatic dislocations of the hip, we designed this study to evaluate the outcomes of this procedure.MethodsWe prospectively evaluated 24 patients with neglected traumatic dislocations of the hip, who underwent total hip arthroplasty with a step-cut subtrochanteric shortening osteotomy using a long modular stem within a span of 4 years. The indications were severe pain and difficulty in walking and performing activities of daily living. Patients fulfilling the inclusion criteria were evaluated in terms of Harris Hip Score, leg length discrepancy, neurological status, union of the osteotomy, and implant stability.ResultsThe mean Harris Hip Score significantly improved from 33.4 preoperatively to 89.2 postoperatively at the latest follow-up. At the final follow-up, all patients showed union at the osteotomy site and there were no cases of implant loosening or instability. No neurological complications were reported.ConclusionsTotal hip arthroplasty combined with a step-cut subtrochanteric femoral shortening osteotomy in patients with neglected dislocations of the hip was associated with good functional outcome and higher success rates in terms of stable implant fixation and union at the site of osteotomy.

Comparing Outcomes and Stability after Single- and Two-piece LeFort I Osteotomies in Patients with Cleft Lip and Palate

Purpose: LeFort I osteotomy is used to correct and improve the maxillary hypoplasia in secondary cleft deformities. However, surgical complex and challenge would be the risk factor of postsurgical instability. This study compared surgical and postsurgical changes in maxillary and mandibular movements and stability in patients with cleft lip and palate (CLP) who underwent single- or two-piece LeFort I osteotomies.

Clinical and radiological results of three different techniques for fixation of the olecranon osteotomy in the surgical treatment of distal humerus fractures: A retrospective comparison of plate-screw, tension band and intramedullary nail.

The aim of this study was to compare clinical and radiological results of three different techniques (plate-screw, tension band, and intramedullary nail) in the fixation of olecranon osteotomy in patients with intercondylar fracture of the distal humerus surgically treated by the olecranon osteotomy approach. Between January 2010 and December 2018, the study was initiated with 52 patients who underwent an olecranon osteotomy approach for an AO Type C distal humerus fracture. Thirty-seven patients (19 male, 18 female) who had regular control data and a final control examination were included in the study. In osteotomy fixation, we used tension band (K wire cerclage + Screw cerclage) in 20 patients, plate-screw in eight patients, and intramedullary nail fixation in nine patients. The functional evaluation included a measurement of the range of joint motion (flexion, extension, supination, pronation); MAYO elbow performance score; disabilities of the arm, shoulder, and hand (DASH) score; and comparative grip strength measurement, and a subjective pain assessment was performed using the visual analogue scale. The mean duration of follow-up was 44 (12-84) months. The mean time to union was 14 (7-32) weeks in patients that achieved union. The mean DASH score was 22 (0-72.7), the meanMAYOelbow performance score was 84 (35-100), and the mean VAS score was 3 (1-7). The mean grip strength was 32 (8-64) kgw in the treated extremity and 37 (17-70) kgw in the intact extremity. No statistically significant difference was detected between olecranon osteotomy fixation methods (tension band, plate-screw osteosynthesis, and intramedullary nailing) in terms of union time, DASH score, MAYO scale score, VAS score, extension, supination, and pronation (P > 0.05). The average grip strength (kgw) was lower than that in the uninvolved extremity, and this ratio was statistically significant (P = 0.04). The results of this study have shown that successful and comparable radiological and functional outcomes can be obtained by all the three different olecranon osteotomy techniques in the surgical treatment of intercondylar fracture of the distal humerus. Level III, Therapeutic Study.

Failure patterns and related risk factors of sagittal reconstruction following pedicle subtraction osteotomy in patients with ankylosing spondylitis and thoracolumbar kyphosis

The aim of this study was to analyze the specific patterns and risk factors of sagittal reconstruction failure in ankylosing spondylitis (AS)-related thoracolumbar kyphosis after pedicle subtraction osteotomy (PSO). A retrospective study was performed in patients with AS and thoracolumbar kyphosis after lumbar PSO with a minimum follow-up of 2 years. Patients were classified as having successful realignment (group A), inadequate correction immediately postoperatively (group B), and sagittal decompensation during follow-up (group C) according to the immediately postoperative and latest follow-up sagittal vertical axis (SVA). Radiographic parameters and clinical outcomes were collected. Pelvic tilt (PT) was used to assess the magnitude of pelvic backward rotation. Hip structural damage and ossification of the anterior longitudinal ligament (ALL) at the proximal junction, PSO level, and distal junction were also evaluated on radiographs. Overall, 109 patients with a mean age of 35.3 years were included. Patients in both group B (n = 16) and group C (n = 13) were older than those in group A (n = 80) (mean ages 43.6 vs 32.9 years, p < 0.011; and 39.2 vs 32.9 years, p = 0.018; respectively). Age (OR 1.102, p = 0.011), and preoperative PT (OR 1.171, p = 0.041) and SVA (OR 1.041, p = 0.016) were identified as independent risk factors of inadequate correction. Additionally, a higher distribution of patients with adequate ALL ossification at the PSO level was found in group B than in group A (37.5% vs 22.5%, p = 0.003). Age (OR 1.101, p = 0.011) and preoperative SVA (OR 1.013, p = 0.020) were identified as independent risk factors of sagittal decompensation. Furthermore, compared with group A, group C showed a higher distribution of patients with severe hip structural damage (15.4% vs 0, p = 0.018) and higher incidences of rod fracture (RF) (38.5% vs 8.8%, p = 0.011) and pseudarthrosis (15.4% vs 0, p = 0.018). Additionally, the incidence of RF (19.6% vs 6.9%, p = 0.045) and changes in the proximal junctional angle (0.5° vs 2.2°, p = 0.027) and the distal junctional angle (0.3° vs 2.2°, p = 0.019) were lower during follow-up in patients with adequate ALL ossification than in those without adequate ossification. Sagittal reconstruction failure in patients with AS could be attributed to inadequate correction immediately after surgery (14.7%) and sagittal decompensation during follow-up (11.9%). Adequate ALL ossification was a risk factor of inadequate correction. However, adequate ALL ossification could decrease the development of RF and relieve the junctional kyphotic change during follow-up. Older age and greater baseline SVA were independent risk factors for both inadequate correction and sagittal decompensation.

Is the Low and Short Medial Horizontal Osteotomy a Predictive Factor for Bad Splits in Sagittal Split Osteotomies?

Statement of the problemThe purpose of this study is to determine whether a low and short medial horizontal osteotomy is a predictive factor for determining bad splits in non-syndromic patients undergoing sagittal split osteotomies for dentofacial disorders. Materials and methodsA retrospective cohort analysis was conducted on subjects who received orthognathic surgery from 2017 to 2019 at Parkland Memorial Hospital. Inclusion criteria were a traditional osteotomy defined by Hunsck and Epker or a low and short osteotomy defined by Posnick.1,2 Exclusion criteria were the diagnosis of a syndromic condition, repeat surgery, or concomitant temporomandibular joint surgery. The predictor variable was the type of osteotomy performed, defined as either a low and short or traditional osteotomy. The primary outcome variable was the occurrence of a bad split. Secondary predictor variables were age and sex, defined as male or female, and faculty side (right side) versus resident side (left side). Descriptive, bivariate, and multiple logistic regression analyses were performed with P < .05 used to determine statistical significance. Results and outcomesFifty-nine patients met the defined inclusion criteria. The average age at the time of surgery was 21 years old. The cohort consisted of 27 males and 32 females. Thirty-six patients were treated with bilateral low and short osteotomies, and 23 patients were treated with bilateral traditional osteotomies. Of the 118 total osteotomies performed, there were a total of 9 bad splits (7.6%). There were 3 right-side bad splits and 6 left-side bad splits. The occurrence of a right-side bad split was 3 for the low and short group and 0 for the traditional group. The occurrence of a left-side bad split was 4 for the low and short group and 2 for the traditional group. There were no significant differences between the type of osteotomy performed and the occurrence of a right-side bad split (P = .1607) or a left-side bad split (P = .7695). There was no significant difference between sex and occurrence of a right-side bad split (P = .6640) or a left-side bad split (P = .2862). There was no significant difference between age and occurrence of a right-side bad split (P = .5233) or a left-side bad split (P = .4492). There was no significant difference between faculty side and resident side with regards to bad splits (P = .4903). Discussion and conclusionThe sagittal split osteotomy (SSO) was first reported by Trauner and Obwegeser in 1955, with the horizontal medial osteotomy further modified by Hunsuck to terminate superior and posterior to lingula.1 Posnick developed an additional modification of the SSO to reduce the frequency of unfavorable splits toward the condyle by modifying the medial horizontal osteotomy to terminate below lingula at the level of the mandibular occlusal plane (low) and anterior to lingula (short).2 The occurrence of bad splits using the traditional osteotomy ranges from 1% to 23%, while the incidence of bad splits reported by Posnick in his retrospective analysis was 0%. The results of the present study suggest a low and short osteotomy is at least as reliable as the traditional osteotomy with regards to intraoperative bad splits. Future prospective studies, including split-mouth study designs by this group, will further elucidate the low and short osteotomy as a reliable alternative to the traditional osteotomy.1.The low medial horizontal osteotomy in patients with atypical ramus morphology undergoing sagittal split osteotomy2.Occurrence of a ‘bad’ split and success of initial mandibular healing: a review of 524 sagittal ramus osteotomies in 262 patients

Calcaneal Lateral Column Lengthening Osteotomy for Symptomatic Flexible Flatfoot

Background: Existing methods of foot type classification based on foot morphology could be put into one of the 4 categories, including visual non-quantitative inspection, anthropometric values, footprint parameters and radiographic evaluation. Objective: The aim of the present study was to evaluate the clinical and functional outcome after calcaneal lateral column lengthening osteotomy in patients with symptomatic flexible flatfoot. Patient and Methods: This is clinical trial (pre-post intervention) included 18 patient with symptomatic flexible flatfoot who were admitted to Zagazig Orthopedic Department, with mean follow up period of 13.6±2.7 months. Results: Age was 9.05±1.89 with minimum 6 and maximum 13 years, and as regard sex distribution male were majority with 66.7%. There was significant improvement regarding talocalcaneal angle at anterior view from pre to 3, 6 and 12 months as it decreased from 46.94±5.19 to 29.66±2.86 at 3 months to 26.55±3.45 at 6 months and to 24.55±3.97 at 12 months. There was significant improvement regarding talocalcaneal angle at lateral view from pre to 3 months and also to 6 and 12 months. Conclusion: The advantages of calcaneal lengthening osteotomy are as follows: it is technically easy to be applied, has a low risk of neurovascular injury and low loss of blood. In addition, it allows other procedures to be applied in the future contrary to arthrodesis. If arthrodesis is required later in these feet, it will be far easier to do because of the corrected alignment of the foot.

Return to sports activity after opening wedge high tibial osteotomy in patients aged 70\xa0years and older

BackgroundThe purpose of this study was to evaluate return to sports (RTS) after opening wedge high tibial osteotomy (OWHTO) in elderly patients and associated factors affecting RTS.MethodsSeventy-four patients (mean age 68 years) who underwent OWHTO were enrolled. Clinical outcomes were evaluated using the Knee Society Score (KSS). Patients were asked regarding types of sports activities and their levels of participation within preoperative 1 year and postoperative 1 year. Levels of participation in sports and recreational activities were examined using the Tegner activity scale. The outcomes were compared between two age groups (≥ 70 years vs. < 70 years).ResultsOf the 74 patients overall, 59 participated in at least one sport preoperatively, and 55 returned to sports postoperatively (RTS 93%). The KSS knee score and function score were significantly improved after surgery in both age groups (P < 0.05), but no significant differences were found between the age groups. The Tegner activity scales for ≥ 70 years and < 70 years were 2.9 ± 1.1 and 4.0 ± 1.9 preoperatively (P < 0.01) and 2.7 ± 1.2 and 3.3 ± 1.4 postoperatively (P = 0.16), respectively. RTS was reported by 24 of 25 (96.0%) in the age < 70 years group and 31 of 34 (91.2%) in the age ≥ 70 years group. Majority of age ≥ 70 years participated in low-impact sports preoperatively and returned to the same impact level postoperatively.ConclusionsThe rate of RTS after OWHTO was high in patients aged 70 years and older with low-impact level. OWHTO is a preferred surgical option for elderly patients who desire RTS.

Corrective Osteotomy of malunited Fractures of the Base of the first Metacarpal Bone

In this study, the results after corrective osteotomy of the base of the first metacarpal bone are presented. There were 24 malunion following a fracture of the base of the first metacarpal, these included 19 Bennett's fractures, 3 Rolando fractures, and 2 Winterstein fractures. The time between the corrective osteotomy and the initial trauma averaged 16 (range, 4 to 66) weeks. The Bennett and Rolando fractures had an average step-off of 2.3 (range, 0 to 4) mm, as well as gaps between 0.9 and 5.4 mm in the basal articular surface of the first metacarpal. There was a subluxation in 16 patients. Patients with Rolando or Winterstein fractures showed an axis deviation of the first metacarpal ranging from 31° to 57°. Two of the patients with Rolando fracture showed a step-off of the articular surface of 1 and 3 millimetres, respectively. Screw osteosynthesis was carried out 10 times, K-wire osteosynthesis 13 times, and once, both procedures were combined. One osteotomy was performed with use of a plate osteosynthesis. The corrective osteotomy in patients with Bennett's fracture improved the radial abduction on average from 37° to 49° and the palmar abduction on average from 37° to 47°. Thirteen patients presented a congruent articular surface postoperatively. A step-off in the articular surface between 0.5 and 2.2 millimetres remained in 6 cases. In one patient the subluxation could not be completely corrected. In two cases a trapezectomy was required due to the remaining displacement in the joint and a post-traumatic osteoarthritis. The mobility after Rolando and Winterstein fractures improved on average from 31° to 41° for radial abduction and from 32° to 43° for palmar abduction. Congruent joint surfaces as well as repositioning of the first metacarpal was seen in all patients, only one patient showed a persisting axis deviation of 35° postoperatively. All patients returned to work. The study shows that posttraumatic malunion of the base of the first metacarpal can be treated effectively by corrective osteotomy resulting in good outcomes, if degenerative changes have not occurred, while alternative treatment methods remain to be performed.

Stress distribution pattern in the distal radioulnar joint before and after ulnar shortening osteotomy in patients with ulnar impaction syndrome

Ulnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). This study was performed to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed a significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with ulnar impaction syndrome, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.

The difficulty of continuing sports activities after open-wedge high tibial osteotomy in patient with medial knee osteoarthritis: a retrospective case series at 2-year-minimum follow-up

PurposeThis study aimed to investigate the rate at which patients returned to sports after open wedge high tibial osteotomy and identify the continuity of sports activity post-operatively.MethodsThirty-five patients (40 knees) who underwent open-wedge high tibial osteotomy (OW-HTO) in medial knee osteoarthritis were included in this study. The mean age of the patients who underwent surgery was 55.1 ± 10.7 years, and the mean follow-up period was 41.0 ± 24.7 months. Clinical results and radiographic parameters calculated in standing whole-leg radiographs preoperatively, post-operatively, and at the final follow-up were evaluated.ResultsThirty-one patients (88.6%) were able to return to preoperative sports activity; however, only 14 patients (40.0%) completely returned to preoperative sports activity levels. Of the 31 patients who returned to sports activity, 10 patients (32.3%) maintained post-operative sporting activity levels at the final follow-up. In radiographic parameters, the weight-bearing line ratio was considered loss of correction in the post-operative period leading to the final follow-up. Patients who completely returned to sports and maintained sporting activity levels at the final follow-up had significantly higher the Knee Injury and Osteoarthritis Outcome Score pain subscale values and lower visual analogue scale of knee pain at pre-surgery and final follow-up than other patients, including those who partially returned to sports.ConclusionsThe proportion of patients who returned to sports after OW-HTO and were able to participate in competitions at the same activity level as before surgery was low and insufficient.Level of evidenceRetrospective case series, IV

How does former Salter innominate osteotomy in patients with Legg-Calvé-Perthes disease influence acetabular orientation? An MRI-based study.

ABSTRACTSalter innominate osteotomy (SIO) has been successfully used in the treatment of Legg–Calvé–Perthes disease (LCPD). Recent studies that have raised concerns about acetabular retroversion after SIO have been based on plain radiographs. In order to assess the true acetabular orientation, the present study uses a specific magnetic resonance imaging (MRI) technique. In addition, the association between acetabular morphology and clinical function as well as health-related quality of life was assessed. Twenty-three patients with 24 operated hips who underwent SIO for LCPD between January 2004 and November 2014 were included. Mean age was 8.5 ± 2.2 years at surgery and 18.5 ± 2.9 years at follow-up. MRIs were conducted at 1.5 T using radial sequences. The analysis included the acetabular version, acetabular sector angles (ASAs) and alpha angles. Plain radiographs were used in order to obtain the Stulberg classification. Patient-related outcome measures included the international Hip Outcome Tool and Euroqol-5 dimensions scores. In comparison to the non-operated side, the MRI of previously operated hips showed no difference of version at the center of the femoral head but significantly decreased version just below the roof level. As a marker for posterior acetabular coverage, the ASAs between 9 and 11 o’clock were significantly decreased when compared with non-operated hips. In hips with a mild acetabular retroversion (<15°), the function was significantly decreased when compared with non-retroverted hips. The SIO is an effective tool in order to restore acetabular containment in LCPD. When compared with the non-operated hips, our collective displays only moderate changes of acetabular orientation and coverage.

Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option?

Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning-even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. Level III, retrospective cohort study, case series.

Is It Possible to Treat Developmental Dysplasia of the Hip with Anterior Open Reduction and Pemberton Osteotomy Under 18 Months of Age?

The purpose of the present study is to determine the outcome success of anterior open reduction with Pemberton osteotomy in patients under 18months of age with developmental dysplasia of the hip. We retrospectively reviewed the clinical and radiological results of 27developmentalhipdysplasiapatients under 18months of age(26 girls, 1 boy)who underwentanterior open reduction with Pemberton osteotomy. Bilateral surgery was performed in 18 patients and unilateral in nine patients. At the final follow-up, the clinical results were evaluated according to the McKay's clinical evaluation criteria, the radiological results according to the Severin's radiological evaluation criteria, and the presence of avascular necrosis according to the Kalamchi-MacEwen's classification criteria. We treated 36 hips of 27 patients who were younger than 18months of age (range 10-18months) at the time of surgery and followed up a minimum of 5years (mean 6.5years). At the final follow-up, 34 (94.4%) were assessed clinically as excellent, one hip (2.7%) as good and one hip (2.7%) as fair according to the McKay's clinical classification. Radiological classification revealed that, 97.2% of the hips were Severin Type-1 and 2.8% Severin Type-3. Avascular necrosis was observed in 5 of 36 hips (13.8%). Two hips were assessed as Type-2, two hips Type-3 and one hip Type-4 according to the Kalamchi-MacEwen's classification. We conclude that Pemberton osteotomy with anterior open reduction is useful technique for developmental hip dysplasia treatment of patients under the age of 18months with good clinical and radiological results as well as with low complication rates.

Improvement in lunate perfusion after radial closing-wedge osteotomy in patients with Kienböck’s disease

Radial closing-wedge osteotomy is a widely accepted treatment for Kienböck’s disease. However, despite favorable long-term clinical outcomes, its impact on lunate perfusion has not been documented. The purpose of this study was to determine whether radial closing wedge osteotomy improved lunate perfusion on gadolinium (Gd)-enhanced magnetic resonance imaging (MRI). We conducted a retrospective review of 12 patients with Kienböck’s disease who received radial closing wedge osteotomy. Mean age at surgery was 25 years. Preoperative Gd-enhanced MRI was performed in 7 patients. After bone union, implants were removed and MRI was repeated. Two patients were classified as Lichtman stage IIIA, and 5 as stage IIIB. Percentage pre- to post-operative perfused lunate volume was compared on MRI. At last follow-up, mean QuickDASH score improved from 43.7 to 6.2. Pre- to post-operative lunate fragmentation, collapse and perfusion were compared qualitatively on MRI. On quantitative analysis, perfusion increased from 24% to 54% (p = 0.018) using our method of measuring percentage perfused lunate volume. The method showed satisfactory reproducibility. Investigation using Gd-enhanced MRI suggested that radial closing wedge osteotomy increases lunate perfusion.

Functional Outcome of High Tibial Osteotomy in Patients with Medial Compartment Osteoarthritis Using Dynamic Axial Fixator

Objectives:Medial Compartment Osteoarthritis of the knee is becoming a widespread problem. The surgical options include high tibial osteotomy, unicompartmental knee replacement, and total knee replacement. Replacement surgeries are not advised in the younger age group, so in these patients, high tibial osteotomy is the only option. In this study, we have assessed the functional and radiological outcomes of high tibial osteotomy done by hemicallostasis method.Methods:We report the outcome of 30 patients (30 knees) who underwent hemicallostasis with a dynamic external fixator for medial compartment osteoarthritis of the knee. The radiological assessment was done with the help of Hip Knee Ankle angle. The functional scoring was done via Oxford knee score, IKDC, KOOS, and WOMAC score.Results:At a mean follow up of 35 months, the preoperatively mean HKA angle was 172 ± 30. The mean HKA angle postoperatively was 184 ±10. Appropriate correction of the HKA angle was achieved in 24 of 30 patients (80%). Whereas, there was under correction in 3 patients (10 %) and overcorrection in 3 (10%) patients. All the functional scores showed significant improvement in the postoperative scores. There was a positive correlation between the HKA angle and oxford, IKDC, KOOS, and WOMAC Score. Complications like superficial pin tract infection were seen in 3(10 %) patients, deep infection in 1(3%), and early union of osteotomy in 1 (3%) patient leading to re-osteotomy.Conclusion:HTO is effective in improving pain, function, activity of daily living, and quality of life in patients suffering from medial compartment Osteoarthritis of the knee. Hip Knee Ankle Angle is an important parameter to restore for better functional outcomes. The Advantage of using a dynamic axial fixator is the precision in achieving calculated correction without any implant in the bone once the correction is achieved along with good healing rates.

Factors related to oxygen desaturation index during sleep 7days after bilateral sagittal splitting ramus osteotomy in patients without previous obstructive sleep apnea.

The incidence of obstructive sleep apnea (OSA) immediately after surgery in patients with dentofacial deformities without previous OSA remains unknown. We aimed to perioperatively evaluate factors associated with oxygen desaturation index (ODI) during sleep, 7days after bilateral splitting ramus osteotomy (BSSRO) in patients without previous OSA. Fifty-one patients (15 males, 36 females) with dentofacial deformities, scheduled to undergo BSSRO, were included. Polysomnography was performed before orthognathic surgery. Perioperative OSA was evaluated with peripheral arterial tonometry on the day of surgery and 1, 2, 3, 4, and 7days postoperatively. Rapid eye movement (REM) sleep periods and the ODI were measured. Factors associated with perioperative ODI after surgery were statistically analyzed. REM sleep periods were significantly decreased on the day of surgery and significantly increased at 4 and 7days postoperatively, compared to the preoperative period. ODI increased on the day of surgery, decreased after 1day, and increased again at 4 and 7days postoperatively. ODI on the day of surgery was significantly increased due to increased preoperative ODI, overjet, and SN-MP angle and decreased SNA and SNB angle. ODI at 7days postoperatively was significantly increased due to increased REM sleep periods and decreased SN-MP and gonial angle. ODI was increased in response to REM sleep periods 7days after BSSO. Airway management in patients with dentofacial deformity should be given more attention by preoperative assessment for OSA, even in the absence of previous OSA, until 7days postoperatively due to REM rebound.

Madelung Deformity: Surgical Correction with Radial Dome Osteotomy

Madelung deformity is a rare wrist malformation caused by a growth disturbance of the palmar and ulnar part of the distal radial physis. The aim of this study is to evaluate the outcome of radial dome osteotomy in patients affected by Madelung deformity. The endpoint of this operation is to improve the orientation of the articular surface of the radius, so as to support to the carpal bones. Between 2017 and 2019, in our clinic, 4patients were treated using this technique. Post-operative pain was evaluated using the NRS. Functional outcomes were assessed through evaluation of ROM, grip strength via Jamar dynamometer and using DASH questionnaire. The aesthetic defects were estimated using a section of the Michigan Hand Outcome Questionnaire. Correction of deformities was evaluated on post-operative RX using McCarrol Criteria. Were also analyzed the accuracy and tolerance of the plates used.

Comparitive Study of Functional and Radiological Outcome of Open-Wedge High Tibial Osteotomy Versus Proximal Fibular Osteotomy in Patients with Osteoarthritis Knee

Aim: Proximal fibular osteotomy (PFO) and valgus high tibial osteotomy (HTO) are the well-established treatment options for patients with K-L grade 2, 3 medial compartment knee osteoarthritis where replacement may not be the treatment of choice. The aim of the present study was to compare the radiological and clinical outcomes following HTO and PFO. Materials and Methods: During the duration of 2 years, two groups of 30 patients each undergoing PFO with a mean age of 53.9 years (range 40–65 years) and HTO with a mean age of 54.7 years (range 40–65 years) were compared and followed up for 1 year. They were compared on the basis of preoperative and postoperative range of walking distance, Numerical Pain Rating Score, American Knee Society Score, Knee Injury and Osteoarthritis Outcome Score, femorotibial angle, and medial joint space narrowing. Results: In PFO group, immediate postoperative functional scores improved and maintained for 3 months during follow-up. Following which there was the decline in the functional score up to 1-year follow-up, whereas in the HTO group, the improvement is seen with a gradual increase in postoperative functional scores that progressed positively for the entire follow-up period of 1 year. Conclusion: Both PFO and HTO lead to good and comparable radiological and functional results. However, HTO provided slow but long-term success in terms of functional and radiological scores after the follow-up period of 1 year.

Comparative study between internal and external osteotomy in rhinoplasty

Background: The aim of this study is to compare between internal osteotomy and external osteotomy in patients undergoing rhinoplasty. Methods: The study involved 50 patients, 25 of them had external percutaneous lateral osteotomy, the other 25 patients had internal endonasal lateral osteotomy. The internal osteotomy was done low to high using 4 mm. curved guarded osteotome. The external osteotomy was done low to low using 2 mm sharp osteotome. The grading system of Kara and Gokalan was followed for edema and ecchymosis. Results: The mucosal tear is found in 4 patients of group - A (those who had external osteotomy). (16%), while 20 patients of group-B (those who had internal osteotomy) (80%) had injury to nasal mucosa. In group-A patients only 5 patients (20%) develop periorbital oedema, all were of Grade 2. All the patients of group-B (100%) develop periorbital edema, 2 patients (8%) of grade 4 edema, 10 patients (40%) of grade 3 edema, 12 patients (48%) of grade 2 edema and one patient (4%) of grade 1 edema. The ecchymosis of grade 1 was found in 3 patients of group-A (12%) and in 20 patients of group-B (80%). Conclusion: External osteotomy is preferred over internal osteotomy with less complication rate. It causes much less mucosal injury and significant reduction in periorbital edema and ecchymosis without scar formation.

Changes of synovial fluid biomarker levels after opening wedge high tibial osteotomy in patients with knee osteoarthritis

The purpose of this study was to evaluate the effects of high tibial osteotomy (HTO) on the biological status of knee osteoarthritis (OA) using joint markers in synovial fluid (SF). Fifty patients with medial compartmental OA of the knee who underwent opening wedge HTO were enrolled. Paired SF samples from the affected knee and arthroscopic evaluation of articular cartilage were collected at the time of HTO surgery and the time of plate removal (postoperative 17±4 months). The concentrations of the following SF biomarkers were measured: interleukin (IL)-1β, IL-6, IL-8, IL-10, tumour necrosis factor-α, matrix metalloproteinase (MMP)-2, MMP-3, MMP-9, MMP-13, vascular endothelial growth factor (VEGF), and cartilage oligomeric matrix protein (COMP). The Knee Society Score (KSS) and hip-knee-ankle (HKA) angle were assessed before and 2 years after HTO. The KSS knee and function scores were significantly improved after HTO (mean changes of 36.4 and 23.7, respectively). The mean HKA angle was altered from mechanical varus (-8.6°) to valgus (5.2°). Concentrations of IL-6, IL-8, MMP-2, MMP-3, MMP-13, VEGF, and COMP in SF were significantly decreased after HTO (mean changes of-49.1%,-30.2%,-31.1%,-26.3%,-30.8%,-42.5%, and-13.7% from preoperative baseline, respectively). The cartilage status was improved in 19 cases (38%) after HTO. However, changes of all biomarkers were not significantly different between subjects with and without an improved cartilage status. SF levels of biochemical markers for cartilage degradation and synovial inflammation were altered after HTO, suggesting an improvement in the OA disease state.