Bone Osteotomy Research Articles

A bloodless technique for correction of equinovarus deformities by Taylor spatial frame: a prospective case series

Background: Rigid ankle and foot deformities as a sequela of relapsed talipes equinovarus or vascular or neurological disorders are a challenge for orthopedic surgeons. This study introduces a bloodless technique to correct the deformities of the ankle in patients with these disorders using the Taylor Spatial Frame (TSF). Methods: Eighteen feet in 18 patients with equinovarus deformities were prospectively enrolled in this study. All patients underwent preoperative clinical evaluation that included neurovascular assessment. Deformity components were measured using a goniometer. All patients had gradual correction of the rigid equinovarus ankle and foot by TSF without any soft-tissue or bony procedures. Preoperative and postoperative ankle and foot equinus and varus angles, in association with the American Orthopaedic Foot and Ankle Society (AOFAS) score, were used for assessment of the functional outcome. Results: There were 13 male patients (72.2%) and five female patients (27%). The mean age of the patients was 25.89 (range 14 to 43, SD 7.28) years. The right side was affected in 11 patients (61.1%), and left side was affected in seven patients (38.9%). At the final follow-up the average AOFAS ankle hindfoot scores improved from 25.17 (range 12 to 39, SD 9.91) preoperatively to 74.78 (range 48 to 88, SD 15.33) postoperatively, (t=22.13, P<0.001). Fifteen patients (83.3%) were categorized as “good”, and three patients (16.7%) were categorized as “fair”. Conclusions: TSF is a safe, effective, and simple method of correcting rigid equinovarus deformities of the ankle without soft-tissue releases or bone osteotomies and is a bloodless technique. Level of Evidence: Level IV.

Nonunion and dislocation in metatarsal bone osteotomy of lessor toes

Nonunion and dislocation in metatarsal bone osteotomy of lessor toes

Prevalence of vitamin D deficiency in pediatric limb lengthening and deformity patients

Background: Vitamin D deficiency is one of the most common vitamin deficiencies in the world, afflicting over 1-billion children. Currently, there is a shortage of studies evaluating Vitamin D levels in pediatric limb lengthening or deformity correction (LLDC) patients. The purpose of this study is to determine the prevalence of Vitamin D deficiency in pediatric patients undergoing lower extremity osteotomies for LLDC. Materials and Methods: We retrospectively analyzed pediatric patients undergoing a lower extremity long bone osteotomy for lengthening/deformity correction at a single center from 2014 to 2018. Of 214 subjects, 80% had perioperative 25-hydroxyvitamin D (25[OH]D) levels available. Variables included age, sex, race, diagnosis, long bone treated, and perioperative 25(OH) D levels. Most patients were female, Caucasian, had a congenital diagnosis, and averaged 12.7 years old. Results: A single long bone was treated in 138 subjects (80%), while 19 patients (11%) underwent ipsilateral femur and tibial surgery and 15 patients (9%) underwent a bilateral surgery. The mean 25(OH)D level was 28.7 ng/mL. Deficient levels were found in 32% of subjects, and insufficient levels were found in an additional 41%. All patients healed appropriately. Conclusions: LLDC requires optimal bone metabolism for the generation of new bone. This study revealed a high proportion of Vitamin D insufficiency in pediatric limb-lengthening patients. Identifying these patients preoperatively may allow for Vitamin D “prehabilitation” to optimize bone health before limb-lengthening procedures in order to obtain satisfactory outcomes.

Correction of bony deviation in rhinoplasty.

In rhinoplasty, osteotomy is becoming more and more frequent as a way to achieve aesthetically pleasing and functional results, as well as patient satisfaction. In procedures to correct a deviated nose, osteotomy to correct the bone plays an essential role in addition to correction of the septum and cartilage, and osteotomy can reduce the wide nose bridge and give a slightly higher appearance in Asian rhinoplasty. However, osteotomy is relatively invasive, and the nasal bones of Asians are often low and thick, so bleeding or swelling during surgery can be somewhat more severe, and a stuffy nose can occur after surgery if osteotomy is performed incorrectly. Since side effects are possible, it is necessary to have a precise understanding of the relevant anatomy and technique. Several articles have described nasal bone osteotomy in rhinoplasty, and this review article introduces the methods presented in various articles, describes indications and limitations, and reviews the relevant anatomical structures and techniques in an accurate manner. We introduce a method that can increase patients’ satisfaction and the completeness of surgery through accurate osteotomy, as well as reducing the risk of side effects.

Medial Displacement Calcaneal Osteotomy as a Novel Treatment for Recurrent Pain after Kidner Procedure for Accessory Navicular Syndrome

Category:Hindfoot; Midfoot/ForefootIntroduction/Purpose:The accessory navicular is often considered to be related to flatfoot deformity. While the Kidner procedure is commonly utilized in treating painful accessory navicular, its ability to correct flatfoot deformity is debated. Patients may also have recurrent pain due to increased tension of the posterior tibial tendon (PTT) in the setting of an uncorrected flatfoot. In the literature, both PTT lengthening and tendon transfer are techniques described to address this issue with varying success and outcomes. Because medial displacement calcaneal osteotomy (MDCO) is a powerful procedure capable of reducing tension of the medial column and correcting hindfoot valgus deformity, we investigated its use in addressing these symptoms. We report outcomes of a novel use of MDCO in treating patients with recurrent pain following Kidner procedure.Methods:We retrospectively identified 21 patients who underwent MDCO for recurrent pain after Kidner procedure at our institution. MDCO was indicated when patients failed to perform single heel raise due to pain at the PTT attachment site at minimum 6 months following index surgery. Pre- and postoperative radiographic parameters were measured: lateral talo-1st metatarsal angle (Meary’s), talonavicular coverage angle (TNC), calcaneal pitch (CP), and hindfoot moment arm (HMA). Using previously validated cut-offs in describing flatfoot deformity, a Meary’s angle less than -4 degrees was considered a flattened arch, and a HMA more than 3.2mm was considered a valgus heel deformity. Measurements were also performed in x-rays of the contralateral foot to determine whether foot deformity in the involved foot was attributed to Kidner procedure or a preexisting deformity. Pre- and postoperative visual analogue scale (VAS) and FAOS outcome scores were compared to assess for improvement in patient-reported outcomes.Results:The mean age was 25.7 years (range, 21-49) and the mean follow-up was 20.1 months (range, 14-26). The average time from the index surgery was 7.3 months (range, 6-10). Average size of the accessory navicular before excision was 11 mm (range, 4.6-18.3). Concomitant procedures included medial head gastrocnemius recession (n=11), plantarflexion osteotomy of first metatarsal bone (n=1), and talocalcaneal coalition excision (n=1). Radiographically, 12 patients (57%) had a flattened arch and all patients (100%) had heel valgus deformity. All radiographic parameters except Meary’s angle (p=0.885) improved postoperatively. Contralateral radiographs revealed that fifteen patients (71%) had a flattened arch, and 19 patients (90%) had heel valgus deformity. There were no differences between both sides. VAS and FAOS improved significantly (p <0.001).Conclusion:Our data suggest that recurrent pain after Kidner procedure may be related to unaddressed preexisting hindfoot valgus deformity. MDCO provided satisfactory outcomes in relieving this symptom without performing surgery to the PTT. Therefore, MDCO can be a viable option for treatment of recurrent pain following Kidner procedure while potentially avoiding loss of inversion power and donor-site comorbidities associated with PTT lengthening and tendon transfer.

Computer-Aided Surgical Simulation for Correcting Complex Limb Deformities in Children

This work aims to present an in-house low-cost computer-aided simulation (CASS) process that was recently implemented in the preoperative planning of complex osteotomies for limb deformities in children. Five patients admitted to the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019, for correcting congenital or post-traumatic limb deformities were included in the study. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our CASS method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. The surgery was precisely reproduced according to CASS and the deformities were successfully corrected in four cases, while in one case, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Our study describes the application of a safe, effective, user-friendly, and low-cost CASS process in paediatric orthopaedics (PO) surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood.

Quantifying Aerosolization of Facial Plastic Surgery Procedures in the COVID-19 Era: Safety and Particle Generation in Craniomaxillofacial Trauma and Rhinoplasty.

Background: COVID-19 poses a potentially significant infectious risk during procedures of the head and neck due to high viral loads in the nasal cavity and nasopharynx. Facial plastic surgery has significant exposure to these areas during craniomaxillofacial trauma procedures and rhinoplasty. Methods: Airborne particulate generation in the 1-10 μm range was quantified with an optical particle sizer in real time during cadaveric-simulated rhinoplasty and facial trauma conditions. Procedures tested included mandibular plate screw drilling, calvarial drilling, nasal bone osteotomy, nasal dorsal rasping, and piezoelectric saw use. Particulate generation was measured both adjacent to the surgical site and at surgeon mouth level (SML). Results: Mandibular plate screw drilling without irrigation generated significant particulate both adjacent to the surgical site and at SML (p < 0.01). Irrigation mitigated particulate generation at SML to nonsignificant levels. Calvarial drilling additionally produced substantial particulate above baseline adjacent to the surgical site (p < 0.01). Standard nasal osteotomies and dorsal rasping did not generate detectable airborne particulate, whereas piezoelectric saw use was associated with significant particulate generation both adjacent to the surgical site (p < 0.001) and at SML (p < 0.01). At SML, smaller particulate represented a significantly higher proportion of total particulate detected. Conclusions: The majority of craniomaxillofacial trauma procedures involve particle generation that may be limited in spread by the use of local irrigation. Most bony work involved in rhinoplasty can be safely performed without a high degree of particle formation. The use of piezoelectric instruments in rhinoplasty should be avoided when concerned for particulate generation.

Management of Recurrent Posterior Hip Dislocation in a Down Syndrome Patient with Dysplastic Hip Using Ganz Periacetabular Osteotomy: Follow Up After 4 Years

Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status and the dysplastic hip forces limited option as a treatment. This is the first case world wide reporting 4 year follow up of dysplastic hip with Down Syndrome treated successfully with PAO technique.Methods:An eighteen years old female with history of Down Syndrome had multiple posterior hip dislocation episodes since 3 years prior. Several attempts of close reduction and hip spica applications were performed upon dislocation despite no successful retaining of reduction. Acetabular index of right hip were 550 and epiphyseal plate hasclosed. PatientwasperformedopenreductionusingSouthern-Mooreposteriorapproachand osteotomy of ischium, continued with capsulorrhaphy followed with Smith-Peterson anterior approach and osteotomy of superior ramus pubis and iliac bone. Then, derotation maneuver was performed under image intensifier to obtain adequate coveragefollowedwithbonegraftandfixationusing2cannulatedscrewandhipspica castapplication.Results:Within four years after surgery, the hip has never been dislocated again, patient could sit without pain and walk with full weight bearing although Harris Hip Score could not be performed due to Down Syndrome. Leg length discrepancy was negligible,fracture has fully united and acetabularin dex was300.Conclusions:Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological ou tcome

The Variable Effects of NSAIDs on Osteotomy Healing and Opioid Consumption

Background:In an effort to fight the opioid epidemic, an NSAID pain protocol was created for osteotomy patients. The study asked if NSAIDs negatively affect bone healing or reduce the need for opioids.Methods:This was a retrospective review of 155 limbs that underwent osteotomy of a long bone with fixation. Patients received an NSAID-free protocol or an NSAID protocol. Time to union and bone healing index were recorded.Results:There was not a significant difference in the time to union (P = 0.89) or bone healing index (P = 0.07). In the deformity correction group, the total milligrams of morphine equivalents prescribed after discharge was significantly less in patients receiving NSAIDs (P < 0.001).Conclusions:The use of NSAIDs after osteotomy surgery did not negatively affect bone healing and resulted in a dramatic decrease in narcotic consumption for deformity correction patients.Level of Evidence:Level III retrospective cohort study

Surgical management of compound odontomas: piezoelectric surgery or rotary instruments? A clinical study.

Odontomas are odontogenic tumors with a clinicopathological heterogeneity and a variable biological behavior. They usually are asymptomatic and can be discovered by routine radiographic investigations. This study aims to examine and compare intra- and postoperative consequences associated with use of piezosurgery and conventional rotary instruments for the removal of these oral lesions. Clinical and histological data of 120 consecutive patients with a mean age of 22 years and 1 month (age range from 19 years and 1 month to 25 years and 3 months) with compound odontomas, diagnosed by biopsy, were assembled. Of a total of 120, 100 oral lesions were placed in the anterior region of the maxilla; of these, 50 were extracted through traditional rotary instruments (GROUP 1) and 50 with piezoelectric surgery (GROUP 2). The remaining 20 oral masses took place in the posterior area of the same bone; of these, 10 were extracted through traditional rotary instruments (GROUP 1a) and 10 with piezosurgery. (GROUP 2b). The piezoelectric cutting device was (Mectron Medical Technology) with MT1-10 insert, pump level 4, vibration level 7. Finally, pain, swelling, and surgical time evaluation were measured 24-48-72 hours after the intervention. As regards the mean time of surgery, in Group (1 and 1a) were 12 minutes, while in Group (2 and 2a) were 18 minutes. Regarding surgery, the osteotomy of the cortical bone was performed in all cases. As regards the measure of bone saved, calculated through a surgery gauge, it was greater of 3.2 mm in Group (2 and 2a) than in Group (1and 1a). The main of facial swelling in both Groups (1 and 1a) was 5.82 mm and 2.23 mm for the Groups (2 and 2a) immediately after surgery. Piezosurgery produced less postoperative discomfort about the swelling. It is an effective technique in daily surgical practice, especially as regards the safety of soft tissues, bone, and nerves.

Improving Oral Surgery: A Workflow Proposal to Create Custom 3D Templates for Surgical Procedures

Background: Computer-guided technologies are adopted in various fields of surgery to limit invasiveness and obtain patient benefits in terms of surgery duration and post-operative course. Surgical templates realized through CAD/CAM technologies are widely diffused in implant dentistry. The aim of this work is to propose, beyond implantology, the feasibility of application of 3D printed surgical templates in oral surgery procedures requiring osteotomies (like maxillary cyst enucleation and tooth disimpaction) in order to obtain accurate surgeries, avoid anatomical damage of surrounding structures and decrease patient’s morbidity, using a simple, low-cost protocol of fabrication. Objective: To provide a reliable CAD-CAM workflow for the realization of surgical templates in oral surgery. Methods: Three clinical scenarios are described: A maxillary canine disimpaction, a mandibular cyst removal, and an orthodontic miniscrew placement. Each one was managed using custom surgical templates realized using the proposed workflow. A Stereolithography (STL) file of maxillary structures was obtained by the use of a 3D medical image processing software (Materialise Mimics 20.0) a segmentation toolbox acquiring RX volumes by Cone-Beam Computed Tomography (CBCT). Digital models of the teeth, acquired as STL files directly, are imported in the same 3D medical image processing freeware (Materialise Mimics 20.0) to merge STL files of maxillary structures and teeth. Data are transported into Blue Sky Plan 4.0 (Blue Sky Bio, LLC), a software for 3D implant guides fabrication, together with the DICOM images package of maxillary volumes to carry out the pre-surgical treatment planning. Anatomical structures at risk are identified; a contour of ideal incision shape and bone osteotomy extent is drawn. Finally, the resulting three-dimensional guide is digitally generated and the surgical guide printed. The resulting 3D template shows the following major features: teeth support, flap management and bone osteotomy design. Results: The proposed work-flow aided the surgeon in both pre-operative and intra-operative work phases through accurate virtual planning and the fabrication of precise surgical guides to be used in oral surgery practice. In each clinical scenario, the use of custom 3D templates allowed better control of the osteotomy planes and flap management. No adverse events occurred during both surgical and healing phases. Conclusion: The proposed digital workflow represents a reliable and straightforward way to produce a surgical guide for oral surgery procedures. These templates represent a versatile tool in maxillary cyst enucleations, tooth disimpaction, and other surgical procedures, increasing accuracy, minimizing surgical complications, and decreasing patient’s morbidity.

Proximal Crescentic Osteotomy Versus Proximal Opening Wedge Osteotomy of the First Metatarsal Bone in the Treatment of Moderate to Severe Hallux Valgus

Objectives: To compare the therapeutic outcomes of proximal crescentic osteotomy (PCO) versus proximal opening wedge osteotomy (POWO). Methods: In this retrospective analytical study, 88 patients with moderate to severe unilateral hallux valgus (HV) were enrolled. HV severity and angle, intermetatarsal angle, MTPJ status, and AOFAS score were collected. Results: The AOFAS score, HV and intermetatarsal angles, and MTPJ status improved in all patients with no significant differences between the two groups. The POWO group showed significantly higher satisfaction score at the 3rd month post-operation. Conclusions: Both osteotomies demonstrated acceptable outcomes; however, short term patient satisfaction was greater in the POWO technique.

Medial Nasal Bone Scoring: A Novel Technique for Improving Osteotomies During Rhinoplasty

Nasal bone osteotomies are commonly performed in rhinoplasty to manipulate the upper third of the nose. In patients with a dorsal hump, reduction is often performed, followed by lateral osteotomies to medialize the nasal bone complex. However, fracture patterns are often unknown in vivo. We intend to map nasal bone osteotomies and describe a novel and minimally invasive method of performing medial scoring osteotomies to improve fracture patterns and surgical speed, and decrease complications. In total, 19 formalin-fixed cadavers were dissected to reveal nasal bone architecture. The nasal dorsum (bony and cartilaginous) was reduced to form an open roof deformity. Osteotomies were then performed on all 19 specimens, followed by digital infracture. Medial scoring osteotomies were performed unilaterally, along with a lateral osteotomy. On the contralateral side, only lateral osteotomies were performed. Fracture patterns were mapped and compared. Of 19 cadaver specimens, 38 sides were examined in total: 19 sides underwent medial scoring and 19 sides served as controls. Fracture patterns were linear with less comminution on sides with medial scoring osteotomies. Sides with medial scoring osteotomies also achieved uniform closure of the open roof deformity, compared with 73% in sides without. Rocker deformity was not seen in either group. Osteotomies are integral to nasal dorsum reduction and modification of the upper third of the nose in rhinoplasty. Scoring of the medial nasal bone prior to lateral osteotomy and digital infracture allows for an increased rate of open roof closure. Furthermore, medial scoring osteotomies create smooth, linear fracture patterns that prevent bony spicules, comminution, and irregularities that may be evident in patients with thin nasal skin. Performing the medial scoring osteotomy is a fast, safe method of achieving consistent nasal bone infracture during rhinoplasty.

Results of the Application of the Original Method of Surgical Treatment of Patients with Severe Hallux Valgus

Background. Traditional methods of surgical treatment of severe Hallux valgus (HV) lead to a large number of complications and poor results. In order to avoid complications and improve the quality of treatment, an original technique of double osteotomy of the first metatarsal bone has been proposed. The aim of the study was to conduct a comparative assessment of the results of applying the original technique in the treatment of patients with severe Hallux valgus. Materials and methods. A retrospective analysis of the treatment of 95 patients operated on at the Seversk Clinical Hospital for severe Hallux valgus in the period from 2008 to 2016 was performed. The study group included 60 patients who underwent surgery according to the original method. In a comparison group of 35 people, Logroshino's surgery was performed. Clinical, radiological, surgical and statistical research methods were used. Results. The final assessment of the results 1 year after the operation showed an unacceptably high number of Hallux valgus relapses, complications, and unsatisfactory results in the comparison group. The use of original approachesfor osteotomy of the first metatarsal bone in patients of the study group allowed to significantly improve treatment results and achieve good results in 85 % of cases. Conclusion. The proposed surgical technique is effective and shows statistically significantly better results 1 year after surgery. Application of the original technique will improve the results of surgical correction of the severe degree of Hallux valgus, which consists in reducing the number of complications and improving functional indicators.

A FEA-Based Methodology to Predict the Osteotome Wear Status during Nasal Bone Surgical Operations

A FEA-based methodology was developed in order to predict the wear status of an osteotome (surgical instrument) during its use in a lateral nasal bone osteotomy considering its fatigue strength. The latter parameter was determined by appropriate FEM-evaluation of the perpendicular impact test results. For the simulation of the surgical procedure, two scenarios were examined: (i) when utilizing a brand new osteotome and (ii) when utilizing an already used osteotome characterized by decreased fatigue strength. The actual nasal bone geometry used in the FEA model was obtained from a high-resolution, maxillofacial, computed tomography (CT) scan of a single patient. In both cases examined, depiction of fracture patterns for the osteotome and the nasal bone were obtained. The wear of a new osteotome and an already used osteotome was also calculated and compared. The developed von Mises stresses in both the osteotome and nasal bone were depicted. The proposed methodology allowed an accurate prediction of the critical number of impacts that the osteotome can receive during the lateral nasal osteotomy which is followed in all rhinoplasties. Based on the developed methodology, a preventive replacement of the osteotome before its extensive fracture can be determined, thereby minimizing the risk of postoperative complications.

Nasal dermoid cysts with intracranial extension: avoiding coronal incision through midline exposure and nasal bone osteotomy.

Up to 10% of midline nasal dermoid cysts have intracranial extension. Previous techniques of excision include frontal and frontonasal craniotomies via a coronal approach, combined with a direct cutaneous excision of the dermoid cyst. While the coronal incision allows for wide visualization, it carries significant risks of transfusion, blood loss, and scarring. The authors present an alternative technique in which access is gained through a midline extension of the dermoid cyst excision that provides direct access for a keyhole frontal craniotomy. The authors utilize a nasal bone osteotomy, pericranial flap, and keyhole-type craniotomy performed through a nasal midline incision for the treatment of nasal dermoid cysts with intracranial extension. They performed a retrospective chart review of all patients with nasal dermoid cysts treated at the Ann & Robert H. Lurie Children's Hospital of Chicago from 2009 to 2017. Patient demographic data, operative data, and in- and outpatient complication data were collected. In 10 patients with cyst extension near or into the intracranial cavity (7 with true intracranial extension), the nasal osteotomy technique was performed. The mean blood loss was 13 ml, with a 0% transfusion rate. The mean length of inpatient stay was 1 day. A durotomy was made and repaired as part of the dermoid cyst dissection in 3 patients. One patient underwent intraoperative placement of a lumbar drain. The mean operative time was 228 minutes. There were no intraoperative or postoperative complications, including the need for a reoperation. No patients had any long-term complications, and no patients have had dermoid cyst recurrence. The appearance of the scar was acceptable in all cases. The midline approach to nasal dermoid cysts with intracranial extension is safe and results in limited blood loss, short operative times, and short lengths of inpatient hospital stay. This is a viable technique for the treatment of this challenging pathology.

Lateral Osteotomy Fixation Technique in Rhinoplasty.

Rhinoplasty is the most challenging facial aesthetic surgical procedure according to many plastic surgeons. Nasal bone osteotomies, especially lateral osteotomies, have a complicated history. If lateral osteotomy is not stable after osteotomy during intraoperative period, stabilization is attempted with internal and external nasal splints but it is not possible to be confident about the stabilization since it is not fully fixed and cannot be observed directly. The authors presented the technique stabilization of the lateral osteotomy inferior tip with cerclage wire, if there is a stabilization problem or step-off deformity after lateral osteotomy.

Comparison of Intra-articular versus Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

Background: Total knee arthroplasty (TKA) is commonly performed for the advanced knee joint disease. Considerable postoperative blood loss, however, is an unavoidable occurrence because of extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. In addition, knee flexion and extension activities that begin the day after the operation adds to the problem. Aim of the Work: to compare between the intravenous the intraarticular tranexamic acid (TXA) administration in total knee arthroplasty surgery. Patients and Methods: It is a prospective double-blinded randomized controlled study. This prospective, two-arm, parallel-group study was conducted at El-Hussein University Hospital and El-Agouza Hospital on 20 patients who underwent total knee arthroplasty and fulfilled all assumed inclusion and exclusion criteria. Results: The average total blood loss amount in the drain after 48 hrs. in the 1st group was 365±74.722 while in the 2 nd group it was 575±88.976. This indicates a significant decrease in blood loss amount in the 1st group (intraarticular TXA group) than the 2 nd group (intravenous TXA group). Also, it was found that the decrease in hemoglobin (Hb) level is less in the 1st group than in the 2nd group which indicates less postoperative anemia. Conclusion: Concerning intraarticular administration of TXA seemed to be effective much more than intravenous injection in terms of blood loss amount and transfusion frequency.

Comparison of Intra-articular versus Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

Background: Total knee arthroplasty (TKA) is commonly performed for the advanced knee joint disease. Considerable postoperative blood loss, however, is an unavoidable occurrence because of extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. In addition, knee flexion and extension activities that begin the day after the operation adds to the problem. Aim of the Work: to compare between the intravenous the intraarticular tranexamic acid (TXA) administration in total knee arthroplasty surgery. Patients and Methods: It is a prospective double-blinded randomized controlled study. This prospective, two-arm, parallel-group study was conducted at El-Hussein University Hospital and El-Agouza Hospital on 20 patients who underwent total knee arthroplasty and fulfilled all assumed inclusion and exclusion criteria. Results: The average total blood loss amount in the drain after 48 hrs. in the 1st group was 365±74.722 while in the 2 nd group it was 575±88.976. This indicates a significant decrease in blood loss amount in the 1st group (intraarticular TXA group) than the 2 nd group (intravenous TXA group). Also, it was found that the decrease in hemoglobin (Hb) level is less in the 1st group than in the 2nd group which indicates less postoperative anemia. Conclusion: Concerning intraarticular administration of TXA seemed to be effective much more than intravenous injection in terms of blood loss amount and transfusion frequency.

Ilizarov External Fixation: Percutaneous Gigli Saw Versus Multiple Drill-hole Osteotomy Techniques for Distraction Osteogenesis

IntroductionMany different methods and variations have been employed to perform osteotomy for deformity correction, bone lengthening, and segmental bone transport. Currently, multiple drill-hole (MDH) and Gigli saw osteotomies are the two most preferred ones, being favoured over other techniques. Our objective is to compare the modified healing index (mHI) of these two commonly used procedures.MethodologyThis retrospective study was conducted at the department of Orthopedics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. The study population consisted of all skeletally mature patients who underwent tibial bone osteotomy for bone lengthening or bone transport using Ilizarov circular fixator from June 2016 to September 2018. We excluded patients with metabolic bone disease and patients who underwent osteotomy for deformity correction. Preoperative and operative patients’ demographics and clinical data were gathered through a review of medical record and mHI was calculated to compare the effectiveness of osteotomy techniques.ResultsA total of 50 patients, 74% males and 26% females 26% with a mean age of 33.14 ± 12 years were included in the study. Of the 50 patients, 23 (27 osteotomies) had undergone MDH osteotomy (group I), whereas 27 patients (37 osteotomies) had a Gigli saw osteotomy (group II). The overall mHI of both groups was 1.60 ± 0.34 month/cm (range 1.0-2.5 month/cm). When we compared the mHI of both techniques, the mean mHI was 1.72 ± 0.33 month/cm (range 1.2 - 2.5 months/cm) in MDH group and 1.54 ± 0.36 month/cm (range 1.0-2.5 month/cm) in the Gigli saw group. The healing index was significantly lower in the Gigli saw group. None of our patients showed nonunion at the osteotomy site. However, the problems of incomplete osteotomy in two cases and bone fractures in four cases were seen in MDH osteotomy.ConclusionAccording to our results, percutaneous Gigli saw osteotomy technique by two small incisions minimizes the local soft tissue trauma and periosteal disruption around the osteotomy more than the multiple drill holes osteotomy, resulting in better consolidation following distraction osteogenesis.