Recurrence Of Varus Deformity Research Articles

КОРРЕКЦИЯ ДЕФОРМАЦИИ ПЯТОГО ПАЛЬЦА СТОПЫ

Introduction. The analysis of literature data on the surgical treatment of fifth toe static deformity, as well as unsatisfactory results, was carried out. The disadvantages of the known methods were identified and a method for correcting the fifth finger varus deviation was proposed. Aim. The purpose of this article is to present own clinical observation of the fifth toe varus deviation operative correction by a proposed method with a detailed description of its methodology. Material and methods. A clinical case of successful surgical correction of isolated fifth toe varus deformity of the foot is presented. Results and discussion. A 22-year-old patient with a painful fifth toe varus deformity, which was diagnosed by a clinical and radiological examination and requiring surgical correction. Surgical treatment, by proposed method, included performing a diaphyseal osteotomy of the fifth metatarsal bone with formation of two bone «steps» on plantar fragment along precisely marked lines, medial displacement of the plantar fragment by a predetermined distance, interlocking fragments of the metatarsal bone and fixing them with one screw. The proposed method allows to shift the plantar fragment as much as possible, straighten the fifth finger, restore the congruence of the articular surfaces of the fifth metatarsophalangeal joint, eliminate pain, and tightly stabilize the plantar and dorsal fragments. The patient was observed for 1 year. The result of the treatment was the elimination of fifth toe varus deviation. Conclusion. Surgical treatment of fifth toe varus deformity by using new method with special markings and simple surgical techniques, ensures the achievement of a positive result, good fixation and consolidation of osteotomized fragments of the fifth metatarsal, relief of pain, restoration of the anatomical condition and statodynamic function of the foot, reducing the risk of fracture of the fifth metatarsal and recurrence of varus deformity the fifth toe.

Orthopedic Interventions for Foot Deformities in Non-Ambulant People with Duchenne Muscular Dystrophy: A Retrospective Study on Indications, Post-Operative and Long-Term Outcomes.

Progressive equinovarus deformities are common in people with Duchenne Muscular Dystrophy (DMD); they may provoke pain, pressure spots, cause problems with wearing footwear, and may lead to an unstable sitting position. Explore indications and compare complications and long-term outcomes after soft tissue and osseous interventions in people with DMD. Retrospective, monocenter, longitudinal study. Data on indications, equinus and varus deformity before and after surgery, wound healing problems, 'pain', edema, and long-term outcomes were collected from medical files. Soft tissue interventions were compared with osseous interventions. From a series of 18 patients, data on 32 surgical interventions and 169 follow-up visits were analyzed. 'Footrest placement' was the most frequent surgical indication, followed by pain. Osseous interventions were performed in older patients with rigid deformities. Directly after surgery remaining deformities were reported after soft tissue interventions (18 %), no remaining deformities were reported after osseous interventions. Pain and edema were frequently present, especially after osseous surgery. Longitudinal follow-up showed that surgical interventions could lead to a neutral foot for a for more than 3 years on average years. Relapses of foot deformity occurred, especially the recurrence of varus deformity after osseous interventions. Surgical interventions can successfully lead to a neutral foot position for for more than 3 years on average. Soft tissue interventions appear to be superior to osseous corrections, considering the varus recurrence period and complications, and may be considered when feet are still (partly) correctable. Pain management and edema prevention should be anticipated before surgery. Future research on patient reported outcomes as well as evaluating the outcome of the initial indication is needed to further identify benefits.

Clinical Safety and Efficacy of a Novel Ultrasound-Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries.

Suture anchors have been used for soft tissue repair in orthopedic surgery for decades. Recently, bioabsorbable suture anchors have increased in popularity and have spurred the introduction of ultrasound-assisted systems. The purpose of our study was to determine the clinical safety and efficacy of a new ultrasound-assisted suture anchor system for foot and ankle procedures. We retrospectively reviewed 50 cases using the ultrasound-assisted suture anchor with at least 24 months of follow-up. We reviewed demographic data including comorbidities, type of procedure, adverse events, and clinical outcomes using the Foot and Ankle Outcome Score (FAOS) and visual analog scale (VAS) score. We divided complications into minor and major, with major complications requiring revision surgery or leading to long-term morbidity. Our primary outcome was complication rates and our secondary outcome was improvement in clinical scores. The most frequent cases using the anchor included lateral ankle ligament reconstruction (n = 19), insertional Achilles repair (n = 15), lateral ligament reconstruction in conjunction with a total ankle arthroplasty (n = 6), and plantar plate repair (n = 3). There were 5 superficial wound infections that resolved with wound care and/or oral antibiotics. There were 3 major complications (6%): a deep wound infection that required an irrigation and debridement, a deep venous thrombosis, and a recurrence of varus deformity in a patient who underwent a total ankle arthroplasty with lateral ligament reconstruction. Only the varus deformity recurrence case could possibly be directly linked to the suture anchor (2% of all cases). VAS scores improved from 6.0 to 1.2 (P < .001) and FAOS improved from 54.7 to 94.2 (P < .001). This bioabsorbable anchor was a safe device with low failure rates, and it was used for soft tissue repair cases in the foot and ankle with successful clinical outcomes. Level IV, retrospective case series.

Step cut closing wedge osteotomy and lateral plating for cubitus varus in adults

Background: Various osteotomies have been in use for correction of varus deformity at elbow in adults. The objective of the study was to determine the clinical, radiological and cosmetic outcome of closing wedge step cut osteotomy and lateral plating in adults with cubitus varus.Methods: This retrospective study was conducted among 15 cases of cubitus varus at an average age of 23.94 years (range, 18-31 years) and underwent closing wedge step cut osteotomy. Osteotomy was fixed with precontoured lateral locking plate. The carrying angle and range of motion of the elbow in preoperative period and final postoperative follow up was evaluated. Results: The average carrying angle improved from 20.8° (range, 12°-30°) varus to 8.66° (range, 5°-14°) valgus. Osseous union was radiographically demonstrated in all patients at an average of 13.33 weeks (range, 10-18 weeks). Lateral condylar prominence index improved from a mean of 6 (ranging from 2.5 to -8) to -12(ranging from -8 to -14). The preoperative (127.85°) and postoperative (124°) range of motion was almost similar. The average preoperative internal rotation was 14.66◦ (range, 0-25), which was corrected to 4.66◦ (range, 0–10) postoperatively. According to Oppenheim criteria, results were excellent in 6, and good in 9. The average final Mayo Elbow Performance Score was 93.33 points (range, 85–100 points). No patient had residual or recurrence of varus deformity, ulnar nerve palsy, elbow instability, implant failure or wound problems.Conclusions: Closing wedge step cut wedge osteotomy with lateral plating is an effective, reliable and technically less demanding corrective surgery in adults with minimum complications.

Correction osteotomy for bilateral varus knee deformity caused by premature epiphyseal closure induced by hypervitaminosis A: a case report

BackgroundA vitamin A derivative, 13-cis-retinoic acid (isotretinoin), has been administered to treat several types of pediatric cancer and has improved survival rates in patients despite being known to induce premature epiphyseal closure. As the number of patients treated by 13-cis-retinoic acid increases, demands for salvage treatment after systemic retinoid therapy are emerging. However, few studies have described the surgical treatment of this disease.Case presentationWe report a case with bilateral varus knee deformity due to premature epiphyseal closure that occurred during treatment with isotretinoin for neuroblastoma. The patient was successfully treated with correction osteotomy using a Taylor spatial frame in the right knee joint and femoral closed wedge osteotomy using a locking plate in left knee joint. Histopathological examination of the growth plate showed polar irregularity of chondrocytes and decreased cartilage matrix without apoptosis. In contrast, arthroscopic findings showed an intact joint surface. No recurrence of varus deformity was evident on follow-up at 1 year.ConclusionsTo the best of our knowledge, this represents the first report of correction osteotomy for varus knee deformity due to premature epiphyseal closure that occurred during treatment with isotretinoin.

Medial Metaphyseal Slope as a Predictor of Recurrence in Blount Disease.

ObjectiveThis study was aimed to find the radiographic parameter predicting recurrence of stage 2 Blount's disease.MethodWe retrospectively reviewed radiographs of 82 legs from 49 patients diagnosed with stage 2 Blount's disease by Langenskiöld classification who had failed brace treatment and underwent valgus osteotomy between 1998 to 2016. Age ranged from 26 to 47 months. The metaphyseal–diaphyseal angle was measured preoperatively. The medial metaphyseal slope of the proximal tibia and femorotibial angle were measured preoperatively and 3, 6, 12, and 24 months postoperatively in both non‐recurrence (group 1) and recurrence (group 2) group. The receiver operating characteristic curve calculated using MedCalc software was used to determine the medial metaphyseal slope predicting risk for recurrence. Statistical analysis was performed using SPSS software.ResultsThe mean follow‐up time was 4.83 ± 0.38 years. The mean age was 34.57 ± 5.76 in group 1 and 33.2 ± 1.48 in group 2 (P = 0.258). The mean preoperative metaphyseal slope was 62.39° ± 9.75° in group 1 and 73.22° ± 6.59° in group 2 (P = 0.02). The mean preoperative femorotibial angle (FTA) was −14.31° ± 8.25° in group 1 and −18.89° ± 7.74° in group 2 (P = 0.1). The mean preoperative metaphyseal diaphyseal angle (MDA) was 14.75° ± 4.21° in group 1 and 20.11° ±5.16° in group 2 (P = 0.001). Demographic data including age, gender, weight, height, and body mass index showed no statistically significant difference between both groups. Out of 82 legs, 9 (10.97%) had recurrence. Preoperatively, the metaphyseal–diaphyseal angle showed statistical significance between both groups. The medial metaphyseal slope showed statistically significant difference between group 1 and group 2 at 3, 6, 12, and 24 months postoperatively. The receiver operating characteristic curve showed that a medial metaphyseal slope more than 70° at 12 months (sensitivity 88.89% and specificity 69.86%) and more than 62° at 24 months postoperatively (sensitivity 100%, specificity 52.3%) was a predictor for recurrence of stage 2 Blount's disease.ConclusionMedial metaphyseal slope more than 62° over the 24‐month follow‐up was associated with recurrence of varus deformity.

Infantile tibia vara: Treatment of Langenskiold stage IV

An eight year old girl presented with a progressively increasing deformity of the left proximal tibia since last 2 years. She had no history of trauma, fever and swelling of left knee. There were no obvious signs of rickets/muscular dystrophy. She had 25 degrees of tibia vara clinically with lateral thrust and a prominent fibular head. The radiograph of left knee revealed tibia vara with medial beaking and a significant depression of the medial tibial epiphysis and metaphysis. A computed tomography (CT) scan revealed significant depression of the medial tibial epiphysis but no bony bar in the physis or fusion of the medical tibial epiphysis. There was a posterior slope in addition to the medial one. She was treated with elevation of the medial tibial hemiplateau with subtuberosity valgus derotation dome osteotomy. She also underwent a lateral proximal tibial hemiphysiodesis (temporary stapling). A prophylactic subcutaneons anterolateral compartment fasciotomy was also performed. All osteotomies united in 2 months. All deformities were corrected and she regained a knee range of 0 to 130 degrees. At final followup (4 years), there was no recurrence of varus deformity, knee was stable, with 1cm of leg length discrepancy. In Langenskiold stage IV tibia vara, elevation of medial tibial plateau, a subtuberosity valgus derotation osteotomy and a concomitant lateral hemiephiphysiodesis has given good results.

高位けい骨骨切り術（Ｉｎｔｅｒｌｏｃｋｉｎｇ Ｗｅｄｇｅ Ｏｓｔｅｏｔｏｍｙ）における手術要点

Interlocking wedge osteotomy (Ogata) shows many advantages compared with the traditional high tibial osteotomy (Coventry). In high tibial osteotomy, early weight bearing after the surgery using traditional internal fixation devices leads to correction loss of angulation. This correction loss causes recurrence of knee pain and poor long term results. In this paper, the surgery techniques used were mainly investigated and some problems of those techniques were shown retrospectively. Cases using blade staple were compared with cases using a newly designed Surfix Lock Plate system on roentgenograms.In interlocking wedge osteotomy, medial cortex of the tibia shows a marked tendency to split compared with Coventry osteotomy. And this split is associated with the recurrence of varus deformity at early weight bearing after the surgery using blade staple. In contrast, Surfix Lock Plate system caused no loss of correction in early weight bearing after surgery.

Stability, bone healing and loss of correction after valgus realignment of the tibial head. A roentgen stereometry analysis

In high tibial closing-wedge osteotomies (HTO), closure of an osteotomy gap after resection of a bony wedge can be associated with a fissure of the medial cortex of the tibial head (MCT). The effect of a broken MCT on the recurrence of varus deformity is disputed. In this study, serial roentgen stereometric analysis (RSA) was used to determine the fixation stability of a rigid internal "L" plate after HTO. Full weight lower limb radiographs were used to determine the sagittal alignment in patients with varying degrees of varus malalignment and correction over time. Forty-two patients with varus gonarthrosis stage I-III (Ahlback) were treated with HTO and internal fixation with an L-shaped rigid plate. Patients were followed by serial RSA, conventional radiographs, and clinical evaluation (Hospital of Special Surgery score) over a 12-month period. In 19 of 42 successive patients, an average wedge size of 6.9 degrees was resected leaving the MCT intact (group 1). In 23 of 42 of patients, the MCT was unintentionally fissured during surgery when an average 10.3 degrees -wedge was resected (group 2). In group 2, RSA revealed a fivefold increase in lateral displacement of the distal tibial segment within 3 weeks after HTO. Twelve weeks after HTO, translations between tibial segments were below the accuracy of the RSA setup in the majority of patients. Group 1 patients demonstrated a higher initial fixation stability, less occurrence of varus deformity, and a higher HSS score compared to patients with larger wedge sizes and frequent fracture of the MCT (group 2). Before bone healing is achieved, the integrity of the MCT plays a crucial role for the clinical and radiological outcome after HTO.

Posterior tibial tendon transfer and tendo-Achilles lengthening for equinovarus foot deformity due to severe crush injury.

Surgical correction was performed on nine patients who had equinovarus deformity caused by severe crush injury of the leg sustained in an earthquake. The operative procedure used involved the transfer of the posterior tibial tendon to the dorsum of the foot by passing it through the interosseous membrane using a modified procedure as published in 1978. This procedure was combined with percutaneous Achilles tendon lengthening and tenotomy of toe flexors when needed. The average follow-up time after the operation was 21 months. The treatment improved the heel-toe steppage gait in all patients and all were able to walk in standard shoes. There were no complications in the postoperative period. Recurrence of varus deformity was not seen in any of the patients. They had active dorsiflexion of the foot, with a median active dorsiflexion of 5 degrees (0 to 10 degrees) and median active plantarflexion of 16.1 degrees (10 to 25 degrees) compared to the median active dorsiflexion and plantarflexion on the uninvolved side. The total range-of-motion was 21.1 degrees (10 to 35 degrees).

Recurrence of Varus Deformity After Proximal Tibial Osteotomy in Blount Disease: Long-Term Follow-Up

In a retrospective review of 74 tibial osteotomies performed for Blount disease, the patients were divided into three groups based on age and treatment. Group A (26 osteotomies), 4 years old or younger, and group B (34 osteotomies), older than 4 years, were treated the same with osteotomy and crossed pins. Group C (14 osteotomies), older than 4 years, was treated with osteotomy and external fixator. At 6 years of follow-up, the recurrence of varus deformity was 46%, 94%, and 72% in groups A, B, and C, respectively. There was no correlation between recurrence of varus deformity and preoperative deformity angle or degree of surgical correction. Fixation with crossed pins or external fixator was not a factor. Surgery at 4 years old or younger and correction of the postoperative deformity angle in valgus may obviate recurrence of varus deformity in Blount disease at long-term follow-up.

Recurrence of varus deformity after proximal tibial osteotomy in Blount disease: long-term follow-up.

In a retrospective review of 74 tibial osteotomies performed for Blount disease, the patients were divided into three groups based on age and treatment. Group A (26 osteotomies), 4 years old or younger, and group B (34 osteotomies), older than 4 years, were treated the same with osteotomy and crossed pins. Group C (14 osteotomies), older than 4 years, was treated with osteotomy and external fixator. At 6 years of follow-up, the recurrence of varus deformity was 46%, 94%, and 72% in groups A, B, and C, respectively. There was no correlation between recurrence of varus deformity and preoperative deformity angle or degree of surgical correction. Fixation with crossed pins or external fixator was not a factor. Surgery at 4 years old or younger and correction of the postoperative deformity angle in valgus may obviate recurrence of varus deformity in Blount disease at long-term follow-up.

Varus inclination of the distal femur and high tibial osteotomy

We have analysed retrospectively the relationship between the axial parameters of alignment of the lower limb and the recurrence of varus deformity after high tibial osteotomy. We studied 29 patients (37 knees) with a mean age at surgery of 66 years. The mean follow-up was for 7.4 years (5 to 10.5). Recurrence of varus deformity was defined as an increase in the femorotibial angle of 3° or more, compared with that obtained six months after the operation. There were four patients (four knees) with recurrence of varus deformity. They had a greater varus inclination of the distal femur than those without varus recurrence. An association between varus inclination of the distal femur and horizontal obliquity of the joint surface was observed. Excessive obliquity prevents the shift of weight-bearing to the lateral compartment, and may cause a recurrence of varus deformity after high tibial osteotomy.

Varus inclination of the distal femur and high tibial osteotomy.

We have analysed retrospectively the relationship between the axial parameters of alignment of the lower limb and the recurrence of varus deformity after high tibial osteotomy. We studied 29 patients (37 knees) with a mean age at surgery of 66 years. The mean follow-up was for 7.4 years (5 to 10.5). Recurrence of varus deformity was defined as an increase in the femorotibial angle of 3 degrees or more, compared with that obtained six months after the operation. There were four patients (four knees) with recurrence of varus deformity. They had a greater varus inclination of the distal femur than those without varus recurrence. An association between varus inclination of the distal femur and horizontal obliquity of the joint surface was observed. Excessive obliquity prevents the shift of weight-bearing to the lateral compartment, and may cause a recurrence of varus deformity after high tibial osteotomy.

High tibial osteotomy without internal fixation for medial unicompartmental osteoarthrosis.

Between 1982 and 1993, a total of 35 patients underwent high tibial osteotomy for medial unicompartmental osteoarthrosis. The osteotomy was performed high in the tibia without the use of jigs, and internal fixation devices were avoided. Patients were assessed using the British Association for Surgery of the Knee score, and satisfactory results with minimal complications were obtained. Our results indicate that in a select group of patients, high tibial osteotomy preserves bone stock and is performed near the deformity so that excellent correction is achieved and recurrence of varus deformity is avoided.

Tendon Transfer for Equinovarus Deformed Foot Caused by Cerebrovascular Disease

Surgical correction was performed on 125 patients who had equinovarus deformity caused by a cerebrovascular accident and who needed an ankle foot orthosis for walking. The operative procedures involved anterior transfer of the long toe flexors (flexor hallux longus and flexor digitorum longus; long toe flexor group) or lateral transfer of the anterior tibial tendon (anterior tibial tendon group), combined with lengthening of the Achilles tendon. On evaluation more than 2 years after surgery, 83 of 110 patients of the long toe flexor group and eight of 15 patients of the anterior tibial tendon group were able to walk without a brace. Five patients of the anterior tibial tendon group who had shown strong contraction of the anterior tibial muscle during the swing phase before surgery, needed a brace because of a drop foot after surgery. Thus, lateral transfer of the anterior tibial tendon was abandoned in 1984. Recurrence of varus deformity was seen in approximately 15% of the patients in both groups. Anterior transfer of the long toe flexors, using them as dorsiflexor tendons or for tenodesis, seemed to produce better results.

Split Posterior Tibial Tendon Transfer for Varus Deformity of Hindfoot

Sixteen patients (23 feet) who underwent split posterior tibial tendon transfers were evaluated. The patients were seen on a followup basis for a minimum of 1 year postoperatively. The causes were spastic cerebral palsy in 13 feet, spastic-athetoid cerebral palsy in 3 feet, hydrocephalus in 3 feet, and other diseases in 4 feet. The indication for surgery was varus deformity during the stance phase of gait and increased varus deformity during the swing phase of gait because of spasticity of the posterior tibial muscle. Heel cord lengthening was done on 17 feet. Preoperative and postoperative gaits were evaluated while the patients were walking. Axial radiographs of the calcaneus and the tibia were taken of all patients while they were weightbearing. There were 15 excellent, 6 good, and 2 poor results. The poor ratings were assigned to patients who had recurrence of varus deformity; there were no cases of overcorrection. Split posterior tibial tendon transfer was effective for treating spastic varus deformity of the hind part of the foot. This treatment also could be considered for a patient with spastic-athetoid cerebral palsy, if the deformity was determined to be caused by overactivity of the tibialis posterior muscle.

Recurrence of varus deformity after proximal tibial osteotomy

Recurrence of varus deformity after proximal tibial osteotomy

内反型変形性膝関節症に対する高位けい骨骨切り術症例の検討

We evaluated the results in sixty-eight patients (eighty-one knees) who had a high tibial osteotomy for medial compartment osteoarthritis. The operations were performed between 1977 and 1986.The mean length of follow-up was 3.4 years (range, one to nine years). The osteotomy methods included closing wedge osteotomy (forty knees), dome osteotomy (forty knees), and interlocking wedge osteotomy (one knee).Sixty-three knees (77.8%) had satisfactory results, twelve knees (14.8%) had no improvement and six knees (7.4%) had poor results.The causes of non-improvement and poor results were recurrence of varus deformity, under-correction, over-correction and advanced radiographic grading of tibiofemoral osteoarthritis before operation.The patient's age at the time of osteotomy and alignment obtained by osteotomy did not necessarily correlate the results.

けい骨高位骨切術 術後１年から８年６カ月の追跡

We evaluated the results in 48 knees in 43 patients who had had a high tibial osteotomy for medial osteoarthritis. The mean length of follow up was 4 years and 3 months (range, 1 to 8.5 years). Out of 48 knees, 32 knees in 29 patients were thoroghly examined by us both clinically and radiologically. The satisfactory results were obtained in the 24 knees that had been positioned in 165 to 175 degrees of FTA and in this group, neither diminution of clinical score nor recurrence of varus deformity were observed.