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Sample records for valgus osteotomy combined

  1. Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

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    Albuquerque Roberto Freire da Mota e

    2003-01-01

    Full Text Available Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

  2. Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies: a reliable technique.

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    Jeyaseelan, L; Chandrashekar, S; Mulligan, A; Bosman, H A; Watson, A J S

    2016-09-01

    The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus. We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51). The mean AOFAS score improved from 54.7 to 92.3 (p technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202-7. ©2016 The British Editorial Society of Bone & Joint Surgery.

  3. Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients

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    Kilmartin Timothy E

    2010-02-01

    Full Text Available Abstract Background The Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies. Methods Between 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed. Results Post-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet; 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet. 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process. Conclusions When combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia

  4. [Distal osteotomy for the treatment of hallux valgus (Chevron osteotomy)].

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    Stukenborg-Colsman, C; Claaßen, L; Ettinger, S; Yao, D; Lerch, M; Plaaß, C

    2017-05-01

    Distal osteotomies, like the Chevron osteotomy, is indicated for mild to moderate hallux valgus deformities. Splayfoot, painful pseudoexostosis, and transfer metatasalgia are observed in the clinical examination. Radiographic examination should be done with weight bearing in two planes. Preoperatively the intermetatarsal (IM), hallux valgus, and distal metatarsal articular (DMAA) angles should be measured. The operative technique is based on soft tissue and bony correction. Modifications of the osteotomy allow a shortening, lengthening, or neutral correction of the first metatarsal. With a modified Chevron osteotomy, an increased DMAA can be also corrected.

  5. Proximal supination osteotomy of the first metatarsal for hallux valgus.

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    Yasuda, Toshito; Okuda, Ryuzo; Jotoku, Tsuyoshi; Shima, Hiroaki; Hida, Takashi; Neo, Masashi

    2015-06-01

    Risk factors for hallux valgus recurrence include postoperative round-shaped lateral edge of the first metatarsal head and postoperative incomplete reduction of the sesamoids. To prevent the occurrence of such conditions, we developed a proximal supination osteotomy of the first metatarsal. Our aim was to describe this novel technique and report the outcomes in this report. Sixty-six patients (83 feet) underwent a distal soft tissue procedure combined with a proximal supination osteotomy. After the proximal crescentic osteotomy, the proximal fragment was pushed medially, and the distal fragment was abducted, and then the distal fragment of the first metatarsal was manually supinated. Outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and radiographic examinations. The average follow-up duration was 34 (range, 25 to 52) months. The mean AOFAS score improved significantly from 58.0 points preoperatively to 93.8 points postoperatively (P hallux valgus and intermetatarsal angle decreased significantly from 38.6 and 18.0 degrees preoperatively to 11.0 and 7.9 degrees postoperatively, respectively (both, P hallux valgus, defined as a hallux valgus angle ≥ 25 degrees. The rates of occurrence of a positive round sign and incomplete reduction of the sesamoids significantly decreased postoperatively, which may have contributed to the low hallux valgus recurrence rates. We conclude that a proximal supination osteotomy was an effective procedure for correction of hallux valgus and can achieve a low rate of hallux valgus recurrence. Level IV, retrospective case series. © The Author(s) 2015.

  6. Ischiofemoral impingement secondary to valgus intertrochanteric osteotomy: a case report

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    Alice Duarte de Carvalho

    Full Text Available Abstract We report an unusual case of ischiofemoral impingement secondary to valgus intertrochanteric osteotomy. The osteotomy was performed for treatment of epiphysiolysis of the left femoral head.

  7. Distal Metatarsal Osteotomy in Hallux Valgus Surgery: Chevron Osteotomy

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    Fatih Dogar

    2016-04-01

    Full Text Available Aim: Hallux valgus is a complex foot deformity resulting from medial deviation of first metatarsal and lateral deviation of toe. Radiographic and functional outcomes of chevron type distal metatarsal osteotomy applied to symptomatic hallux valgus patients with moderate deformity were assessed in the present study. Chevron osteotomy was applied to 27 feet (13 left, 14 right of 22 patients (12 women and 10 men; mean age: 45±16.7 years. Mean follow-up was 15.4± 4.71 months (range, 10%u201324. Material and Method: The average preoperative AOFAS score of 39.1 ± 8.55 (range, 32%u201357 improved (p < 0.0001 to 87.8 ± 4.7 (range, 82%u201397. The average preoperative hallux valgus angle (HVA of 37.4 ± 5.8 (range, 29%u201350 improved (p < 0.0001 to 14.8 ± 3.1 (range, 10%u201320 , and the average preoperative intermetatarsal 1-2 angle (IMA of 13.1 ± 1.5 (range, 11%u201317 improved (p < 0.0001 to 7.1 ± 1.4 (range, 5%u20139 . The average sesamoid position improved from 2.9 ± 0.2 (range, 2-3 preoperatively to 1.2 ± 0.4 (range, 1-2 (p < 0.0001. Toe hypoesthesia was developed in one patient as a complication. At the end of follow-up, patient satisfaction was found to be excellent in 16 feet (59.2% and good in 11 feet (40.8%. Results: The results of the study that chevron osteotomy yields good radiological result, high degree of postoperative patient satisfaction with minimal complications. Chevron ostoetomy is most effective method in the treatment of moderate hallux valgus.

  8. Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach.

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    Park, Yu-Bok; Lee, Keun-Bae; Kim, Sung-Kyu; Seon, Jong-Keun; Lee, Jun-Young

    2013-11-06

    There are two surgical approaches for distal soft-tissue procedures for the correction of hallux valgus-the dorsal first web-space approach, and the medial transarticular approach. The purpose of this study was to compare the outcomes achieved after use of either of these approaches combined with a distal chevron osteotomy in patients with moderate to severe hallux valgus. One hundred and twenty-two female patients (122 feet) who underwent a distal chevron osteotomy as part of a distal soft-tissue procedure for the treatment of symptomatic unilateral moderate to severe hallux valgus constituted the study cohort. The 122 feet were randomly divided into two groups: namely, a dorsal first web-space approach (group D; sixty feet) and a medial transarticular approach (group M; sixty-two feet). The clinical and radiographic results of the two groups were compared at a mean follow-up time of thirty-eight months. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale hallux metatarsophalangeal-interphalangeal scores improved from a mean and standard deviation of 55.5 ± 12.8 points preoperatively to 93.5 ± 6.3 points at the final follow-up in group D and from 54.9 ± 12.6 points preoperatively to 93.6 ± 6.2 points at the final follow-up in group M. The mean hallux valgus angle in groups D and M was reduced from 32.2° ± 6.3° and 33.1° ± 8.4° preoperatively to 10.5° ± 5.5° and 9.9° ± 5.5°, respectively, at the time of final follow-up. The mean first intermetatarsal angle in groups D and M was reduced from 15.0° ± 2.8° and 15.3° ± 2.7° preoperatively to 6.5° ± 2.2° and 6.3° ± 2.4°, respectively, at the final follow-up. The clinical and radiographic outcomes were not significantly different between the two groups. The final clinical and radiographic outcomes between the two approaches for distal soft-tissue procedures were comparable and equally successful. Accordingly, the results of this study suggest that the medial transarticular

  9. Revisional Surgery for Hallux Valgus with Serial Osteotomies at Two Levels

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    Jason B. T. Lim

    2011-01-01

    Full Text Available The aetiology and form of hallux valgus (HV is varied with many corrective procedures described. We report a 39-year-old woman, previously treated with a Chevron osteotomy, who presented with recurrent right HV, metatarsus primus varus, and associated bunion. Osteotomies were performed at two levels as a revisional procedure. This report highlights (1 limitations of the Chevron osteotomy and (2 the revisional procedure of the two level osteotomies: (i proximal opening-wedge basal osteotomy and (ii distal short Scarf with medial closing wedges. If a Chevron osteotomy is used inappropriately, for example, in an attempt to correct too large a deformity, it may angulate laterally causing a malunion with an increased distal metatarsal articular angle. Secondly, it is feasible to correct this combined deformity using a combination of proximal opening-wedge and distal short Scarf osteotomies.

  10. Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity

    DEFF Research Database (Denmark)

    Wester, Jens Ulrik; Hamborg-Petersen, Ellen; Herold, Niels

    2016-01-01

    BACKGROUND: Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after...... operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. METHODS: Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal...... and 12 months after the operation. RESULTS: In group 1 the hallux valgus angle decreased from 39.0̊ to 24.1̊ after 4 months and 27.9̊ after 12 months. In group 2 the angle decreased from 38.3̊ to 21.4̊ after 4 months and 27.0̊ after 12 months. The intermetatarsal angle in group 1 was 19.0̊ preoperatively...

  11. Triple osteotomy for the correction of severe hallux valgus deformity: Patient reported outcomes and radiological evaluation.

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    Booth, Sean; Bhosale, Abhijit; Mustafa, Abubakar; Shenoy, Ravi; Pillai, Anand

    2016-08-01

    Symptomatic Hallux valgus can be treated with metatarsal osteotomy combined with proximal phalangeal osteotomy, however this might not be sufficient to treat severe HV deformities. Fifteen feet in eleven female patients treated with double first metatarsal and proximal phalanx osteotomies without lateral release were prospectively studied and outcome measures including radiological angles and validated patient reported outcome scores collected. Mean radiological follow up was 15 months and PROMs data 17 months. Mean hallux valgus and intermetatarsal angles were corrected from 45 to 24.7° and 18.7 to 7.4° respectively. There was an eight degree recurrence of hallux valgus angle. There was no wound problems, non-unions or evidence of avascular necrosis. The EQ-5D descriptive index showed a non-statistically significant improvement. All three elements of the MOxFQ score showed a statistically significant improvement: Forefoot pain (59-26.8), Walking and Stability (49.9-29.6) and Social Interaction (56.4-33.1) CONCLUSION: Triple osteotomy, without a lateral soft tissue release, leads to good radiological and functional outcomes in those with severe hallux valgus deformity. Patients need to be warned of the recovery time and potential for future metalwork removal. The risk of early recurrence suggests that a lateral release should be included in order to maintain a long lasting correction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Double First Metatarsal and Akin Osteotomy for Severe Hallux Valgus.

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    Al-Nammari, Shafic Said; Christofi, Theodoros; Clark, Callum

    2015-10-01

    The technique of double first metatarsal osteotomies was first developed in response to the high frequency of recurrence noted in the treatment of severe adolescent congruent hallux valgus deformities. The concept behind the use of this technique is that it allows the individual correction of each component of the deformity. We have modified the technique for use in adult hallux valgus where the majority of deformities are incongruent deformities and the distal chevron osteotomy is used primarily for its additional translational properties rather than purely to correct the distal metatarsal articular angle (DMAA). We report on a series of double first metatarsal osteotomies (basal opening wedge and distal chevron osteotomy) with Akin osteotomy in the treatment of moderate to severe adult hallux valgus deformity. All patients presenting to our institution with a hallux valgus deformity and treated with this procedure between 2008 and 2013 with a minimum of 1 year of follow-up were identified. Data were obtained through review of case notes, electronic charts, and digital imaging. A total of 50 feet in 48 patients underwent double first metatarsal osteotomy with Akin osteotomy. Three patients were excluded due to loss to follow-up, leaving 47 feet in 45 patients with a mean follow-up of 45 months (range, 14-60 months). Of these 43 (96%) were female and the mean age was 56 years (range, 35-70 years). The mean preoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, sesamoid position, and lateral first metatarsotalar angle were 42 degrees (range, 32-52 degrees), 18 degrees (range, 6-26 degrees), 12 degrees (range, 4-26 degrees), stage 6 (range, 4-7), and 2 degrees of dorsiflexion (range, 20 degrees of dorsiflexion to 4 degrees of plantar flexion), respectively. The mean postoperative HVA, IMA, DMAA, sesamoid position, and lateral first metatarsotalar angle were 7 degrees (range, 2 to 24 degrees), 4 degrees (range, 4-14 degrees), 6 degrees (range, 10

  13. Evaluation of Hallux Valgus Correction With Versus Without Akin Proximal Phalanx Osteotomy.

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    Shibuya, Naohiro; Thorud, Jakob C; Martin, Lanster R; Plemmons, Britton S; Jupiter, Daniel C

    2016-01-01

    Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and ≥6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain. Published by Elsevier Inc.

  14. Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

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    Marcus Jaeger

    2009-05-01

    Full Text Available Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years. Surgical indications were: intermetatarsal angle (IMA of 12-23°; increased proximal articular angle (PAA>8°, and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness. The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor. The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor. The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5° which was statistically significant (p<0.01. The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01. Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

  15. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.

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    Lucas y Hernandez, J; Golanó, P; Roshan-Zamir, S; Darcel, V; Chauveaux, D; Laffenêtre, O

    2016-03-01

    The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. ©2016 The British Editorial Society of Bone & Joint Surgery.

  16. Scarf-Akin osteotomy for hallux valgus in juvenile and adolescent patients.

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    Agrawal, Yuvraj; Bajaj, Sunil K; Flowers, Mark J

    2015-11-01

    Hallux valgus (HV) has been reported to affect 22-36% of adolescents, with a recurrence rate of around 30-40%. Operative treatment may be indicated in symptomatic deformities where conservative management has failed to halt progression of the deformity. There remains genuine concern with respect to high complication rates including recurrence and stiffness of the metatarsophalangeal joint following operative treatment in adolescents. We report the clinical, functional and radiological outcomes of the Scarf-Akin procedure in the treatment of juvenile and adolescent HV. A review of single surgeon series was carried out of all children who underwent Scarf and Akin osteotomies as a combined procedure for HV between February 2001 and 2010. The preoperative and postoperative intermetatarsal angle (IMA1-2), hallux valgus angle, distal metatarsal articular angle and ratio of the length of first metatarsal to that of the second metatarsal were determined. The American Orthopaedic Foot and Ankle Score was used for functional assessment. Twenty-nine patients (47 feet) underwent Scarf-Akin osteotomies for moderate to severe HV. The average age of the patients at surgery was 11.7 years. The 6-week postoperative radiographs confirmed a significant improvement in the IMA, hallux valgus angle and distal metatarsal articular angle, in all the 47 feet, but 10 patients (14 feet, 29.8%) reported recurrence of hallux valgus at subsequent reviews. The radiological recurrence rate in our series was 29.8%, with 21.3% of patients symptomatic enough to require a revision operation. We report a high recurrence rate in hallux valgus operation in children and hence recommend postponement of correction until skeletal maturity.

  17. Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy.

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    Varghese, Viju D; Boopalan, Palapattu R; Titus, Vijay T K; Oommen, Anil T; Jepegnanam, Thilak S

    2014-07-01

    To evaluate preoperative neck resorption and postoperative valgus orientation as predictors of union and functional outcome after valgus intertrochanteric osteotomy for treatment of neglected femoral neck fractures and nonunions. Retrospective cohort study. Tertiary care center. Forty consecutive patients with neglected femoral neck fracture and nonunions were treated with valgus intertrochanteric osteotomy, and follow-up was available in 32 patients (average age, 43 years; range, 14-60 years; average nonunion duration, 6 ± 7 months; range, 1-36 months). Valgus intertrochanteric osteotomy. Clinical outcome was assessed with Harris hip score. Plain radiographs were evaluated for union, avascular necrosis, preoperative bone deficiency (neck resorption ratio), and postoperative femoral head fragment alignment (head-shaft angle). Follow-up at 5 ± 3 years (range, 2-12 years) after surgery showed union in 29 patients (91%), and Harris hip score was 82 ± 13 points (range, 63-100 points). The 3 patients with persistent nonunion at the neck of femur had neck resorption ratio 15 degrees compared with the contralateral side was associated with poor functional outcome. The presence of avascular necrosis did not affect the outcome. Valgus intertrochanteric osteotomy resulted in union and satisfactory functional outcome in most patients who had neglected femoral neck fractures and nonunions. Preoperative neck resorption ratio <0.5 was a risk factor for nonunion, and excessive valgus alignment was a risk factor for poor functional outcome after osteotomy. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  18. Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity - A prospective comparative study.

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    Wester, Jens Ulrik; Hamborg-Petersen, Ellen; Herold, Niels; Hansen, Palle Bo; Froekjaer, Johnny

    2016-03-01

    Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal open wedge osteotomy and fixation with plate (Hemax), group 1, or operation with proximal crescentic osteotomy and fixation with a 3mm cannulated screw, group 2. The mean age was 52 years (19-71). Forty-one females and four males were included. Clinical and radiological follow-ups were performed 4 and 12 months after the operation. In group 1 the hallux valgus angle decreased from 39.0̊ to 24.1̊ after 4 months and 27.9̊ after 12 months. In group 2 the angle decreased from 38.3̊ to 21.4̊ after 4 months and 27.0̊ after 12 months. The intermetatarsal angle in group 1 was 19.0̊ preoperatively, 11.6̊ after 4 months and 12.6̊ after 12 months. In group 2 the mean intermetatarsal angle was 18.9̊ preoperatively, 12.0̊ after 4 months and 12.6̊ after 12 months. The AOFAS score improved from 59.3 to 81.5 in group 1 and from 61.8 to 84.8 in group 2 respectively measured 12 months postoperatively. The relative length of the 1 metatarsal compared to 2 metatarsal bone was 0.88 and 0.87 preoperatively and 0.88 and 0.86 for group 1 and 2 respectively measured after 12 months. Crescentic osteotomy and open wedge osteotomy improve AOFAS score and VAS scores on patients operated with severe hallux valgus. No significant difference was found in the two groups looking at the postoperative improvement of HVA and IMA measured 4 and 12 months postoperatively. The postoperative VAS score and AOFAS score were

  19. Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

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    Karpe, Prasad; Killen, Marie C; Pollock, Raymond D; Limaye, Rajiv

    2016-12-01

    Translation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia. To evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities. Fifteen patients (20feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction. Mean follow-up was 25 months (range 22-30). The IM angle improved from a median of 18.60 (range 13.4-26.20) preoperatively to 9.70 (range 8.0-13.70) postoperatively (8.9; 95% CI=7.6-10.3; phallux valgus deformities with no transfer metatarsalgia. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial.

    NARCIS (Netherlands)

    Deenik, A.; Mameren, H van; Visser, E. de; Waal Malefijt, M.C. de; Draijer, F.; Bie, R. de

    2008-01-01

    BACKGROUND: Chevron osteotomy is a widely accepted osteotomy for correction of hallux valgus.(18) Algorithms were developed to overcome the limitations of distal osteotomies. Scarf osteotomy has become popular as a versatile procedure that should be able to correct most cases of acquired hallux

  1. Scarf osteotomy or Mau osteotomy for correction of moderate to severe hallux valgus deformity: a prospective, randomized study

    OpenAIRE

    Avcu, Bülent; Akalın, Yavuz; Çevik, Nazan; Öztürk, Alpaslan; Şahin, Namık; Öztaş, Savaş; Özkan, Yüksel

    2017-01-01

    Objective. The aim of this studywas to compare the clinical and radiological results of Mau osteotomy and Scarfosteotomy with a modified McBride procedure to patients with moderate to severehallux valgus deformity. Methods. The study included 40 feetwhich patients were separated into 2 groups followed up for 5 months. Scarfosteotomy was applied to 20 patients including 16 females and 4 males (Scarfgroup)) and a Mau osteotomy to 20 patients including 17 females and 3 males(Mau group). Radiolog...

  2. Correction of Hallux Valgus Interphalangeus With an Osteotomy of the Distal End of the Proximal Phalanx (Distal Akin Osteotomy).

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    Vander Griend, Robert

    2017-02-01

    Operative correction of a symptomatic hallux valgus interphalangeus (HVI) deformity is often achieved with an osteotomy at the proximal end of the proximal phalanx (Akin osteotomy). However, the apex of the typical HVI deformity (center of rotation angle) is at the interphalangeal joint of the hallux. This study was done to evaluate the results of performing a medial closing wedge osteotomy at the distal end of the proximal phalanx. Thirty-three patients (33 feet) underwent an osteotomy at the distal end of the proximal phalanx for correction of HVI. All of the patients had other forefoot deformities which were corrected at the same time. Eight of these were revision procedures of prior forefoot operations. The length of follow-up was determined by the associated procedures with a minimum follow-up of 4 months. The preoperative hallux valgus interphalangeus angle averaged 16 degrees of valgus (range 7-32 degrees) and was corrected to an average of 2 degrees of valgus (range 5 degrees valgus to 5 degrees varus). All of the patients were satisfied with the postoperative appearance and function of the first toe. Because of simultaneous correction of numerous other forefoot problems, it was not possible to specifically isolate or evaluate the effects and benefits of this osteotomy using outcomes measures. There was one intraoperative complication resulting in a fracture extending into the adjacent IP joint. Correction of an HVI deformity can be achieved with an osteotomy at the distal end of the proximal phalanx. This was a safe technique with few complications and with good results in terms of both correction and patient satisfaction. Level IV, retrospective case series.

  3. Staple fixation for akin proximal phalangeal osteotomy in the treatment of hallux valgus interphalangeus.

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    Neumann, Julie A; Reay, Kathleen D; Bradley, Kendall E; Parekh, Selene G

    2015-04-01

    The Akin proximal phalangeal osteotomy is commonly used in conjunction with metatarsal osteotomies to treat hallux valgus. Multiple fixation methods including suture, wire, screw, and staple fixation have been described. The aims of this study were to assess the intraoperative and postoperative complications and to evaluate short-term postoperative outcomes in patients who underwent Akin osteotomy with staple fixation. Forty-four patients (51 feet) with painful hallux valgus were retrospectively reviewed at an average of 40.4 ± 15.8 (range, 25.9 to 79.9) weeks following an Akin osteotomy with staple fixation. Patient reported preoperative and postoperative Visual Analog Score (VAS) (0 to 10, 0 = no pain) was recorded. Level of activity was reported postoperatively. Hallux valgus angles (HVAs), intermetatarsal angles (IMAs), and hallux valgus interphalangeus angles (IPAs) were evaluated on preoperative as well as final postoperative radiographs. Postoperative clinical and radiographic examinations were used to evaluate for complications. Mean VAS improved from 4.4 ± 2.6 to 1.0 ± 1.2 (P hallux valgus correction with improvement in pain and hallux valgus deformity with a low risk for complications. Level IV, case series. © The Author(s) 2014.

  4. Preoperative radiological factors correlated to long-term recurrence of hallux valgus following distal chevron osteotomy.

    Science.gov (United States)

    Pentikainen, Ilkka; Ojala, Risto; Ohtonen, Pasi; Piippo, Jouni; Leppilahti, Juhana

    2014-12-01

    The purpose of this article was to analyze the long-term radiologic results after distal chevron osteotomy for hallux valgus treatment and to determine the preoperative radiographic factors correlating with radiological recurrence of the deformity. The study included 100 consecutive patients who received distal chevron osteotomy for hallux valgus. The osteotomy included fixation with an absorbable pin in 50 cases, and no fixation in the other 50. For 6 weeks postoperatively, half of each group used a soft cast and half had a traditional elastic bandage. Weight-bearing radiographs were evaluated at 6 weeks, 6 months, 1 year, and a mean of 7.9 (range, 5.8-9.4) years postoperatively. At the final follow-up, radiological recurrence of hallux valgus deformity (HVA > 15 degrees) was observed in 56 feet (73%). Eleven feet (14%) had mild recurrence (HVA hallux valgus recurrence was significantly affected by preoperative congruence, DMAA, sesamoid position, HVA, and I/II IMA. Radiological recurrence of hallux valgus deformity of 15 degrees or more was very common at long-term follow-up after distal chevron osteotomy. Preoperative congruence, DMAA, sesamoid position (LaPorta), HVA, and I/II IMA significantly affected recurrence. Level III, comparative case series. © The Author(s) 2014.

  5. Midterm outcome after correction of hallux valgus deformity using scarf osteotomy in adult population

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    Laura Ibrahim Alolayan; Mohammed H Alshehri; Amjaad Hamad Almohawis; Thuriya Saud Alsumai; Alkenani, Nader S.

    2017-01-01

    Context: Determining the efficacy of any surgical treatment is the key to achieve better practice and best outcomes for patients. Aims: This study is designed to address midterm outcome in adult patients with moderate-to-severe hallux valgus (HV), who underwent scarf osteotomy from 2012 to 2014. Settings and Design: This is a retrospective cohort study in which charts of all adult patients with moderate-to-severe HV who underwent scarf osteotomy from 2011 to 2014 were reviewed. Subjects and M...

  6. High Rate of Recurrence Following Proximal Medial Opening Wedge Osteotomy for Correction of Moderate Hallux Valgus.

    Science.gov (United States)

    Iyer, Sravisht; Demetracopoulos, Constantine A; Sofka, Carolyn M; Ellis, Scott J

    2015-07-01

    The proximal medial opening wedge (PMOW) osteotomy has become more popular to treat moderate to severe hallux valgus with the recent development of specifically designed, low-profile modular plates. Despite the promising results previously reported in the literature, we have noted a high incidence of recurrence in patients treated with a PMOW. The purpose of this study was to report the clinical and radiographic outcomes of an initial cohort of patients treated with a PMOW osteotomy for moderate hallux valgus. We retrospectively analyzed prospectively gathered data on a cohort of 17 consecutive patients who were treated by the senior author using a PMOW osteotomy for moderate hallux valgus deformity. Average time to follow-up was 2.4 years (range, 1.0-3.5 years). The intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA) were assessed on standard weightbearing radiographs of the foot preoperatively and at all follow-up visits. The Foot and Ankle Outcome Score (FAOS) was collected on all patients preoperatively and at final follow-up. Despite demonstrating good correction of their deformity initially, 11 of the 17 patients (64.7%) had evidence of recurrence of their hallux valgus deformity at final follow-up. Patients who recurred had a greater preoperative HVA (P = .023) and DMAA (P = .049) than patients who maintained their correction. Improvement in the quality-of-life subscale of the FAOS was noted at final follow-up for all patients (P = .05). There was no significant improvement in any of the other FAOS subscales. There was a high rate of recurrence of the hallux valgus deformity in this cohort of patients. Recurrence was associated with greater preoperative deformity and an increased preoperative DMAA. The PMOW without a concomitant distal metatarsal osteotomy may be best reserved for patients with mild hallux valgus deformity without an increased DMAA. Level IV, retrospective case series. © The Author

  7. Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

    NARCIS (Netherlands)

    van Groningen, B. (Bart); M.C.M. (Marieke) van der Steen,; M. Reijman (Max); Bos, J. (Janneke); Hendriks, J.G.E. (Johannes G.E.)

    2016-01-01

    textabstractClinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more

  8. Minimally Invasive Distal Metatarsal Osteotomy for Mild-to-Moderate Hallux Valgus Deformity

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    Yu-Chuan Lin

    2009-08-01

    Full Text Available Minimally invasive surgery has recently been introduced for foot and ankle surgery, and hallux valgus surgery is no exception. The purpose of our study was to analyze the early results and to present our experience of minimally invasive distal metatarsal osteotomy in correcting mild-to-moderate hallux valgus deformities. Between September 2005 and December 2006, 31 consecutive patients (47 feet with mild-to-moderate hallux valgus deformities underwent minimally invasive distal metatarsal osteotomies. The clinical and radiographic outcomes were assessed. The satisfaction rate was 90.32%. The mean total American Orthopedic Foot and Ankle Society halluxmetatarsophalangeal-interphalangeal scale was 92.7 points. Complications included two (4.26% episodes of stiffness, six (12.77% episodes of pin tract infection, and one (2.13% deep infection. There were no cases with nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. On weight-bearing anteroposterior foot radiographs, the mean hallux valgus angle and first intermetatarsal angle corrections were 11.8° and 6.3°, respectively, which is a statistically significant difference (p < 0.001 between the preoperative and postoperative status. Here, minimally invasive distal metatarsal osteotomy was associated with good satisfaction, functional improvement and low complication rates. This technique offers an effective, safe and simple way to treat hallux valgus with a first intermetatarsal angle less than 15°.

  9. First Metatarsal Proximal Opening Wedge Osteotomy for Correction of Hallux Valgus Deformity: Comparison of Straight versus Oblique Osteotomy

    Science.gov (United States)

    Han, Seung Hwan; Park, Eui Hyun; Jo, Joon; Koh, Yong Gon; Lee, Jin Woo; Choi, Woo Jin

    2015-01-01

    Purpose The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. Materials and Methods We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. Results Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1±2.7° in group A and 6.0±2.1° in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2±8.2°; distance, 25.1±0.2 mm) compared to group A (HVA, 20.9±7.7°; distance, 28.1±0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005). Conclusion Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes. PMID:25837181

  10. Mitchell′s osteotomy in the management of hallux valgus: An Indian perspective

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    Baba Asif

    2009-01-01

    Full Text Available Background: Hallux valgus is a common condition that affects the forefoot. A large number of procedures are described for managing this condition. Mitchell′s osteotomy and its modifications are being widely used for treating hallux valgus. However, most of the studies describe the results from the developed world. We present results of the classic Mitchell′s osteotomy in hallux valgus in Indian subcontinent. Materials and Methods: Forty eight adult patients (including 12 bilateral ones in the age range of 18-60 years with hallux valgus were managed with the classic Mitchell′s osteotomy. Pain over the bunion was the reason for surgery in 53 of 60 feet and cosmesis in the remaining 7 feet. Patients with hallux valgus angle more than 20° degrees and not responding to a trial of conservative treatment were included. Patients having metatarsophalangeal (MTP joint osteoarthritis (Grade II and higher, hallux rigidus, rheumatoid arthritis, and with subluxation of MTP joint were excluded from the study. Further, patients with first metatarsal more than 3 mm shorter than second metatarsal were also excluded. Results: The average follow-up period is 3 yrs (range 18months - 6yrs. About 55 feet (83% were painless after surgery. Forty-two (70% patients were happy with the cosmetic results of the surgery. Metatarsalgia was the reason for dissatisfaction with the procedure in five patients. The average correction of hallux valgus and the intermetatarsal angles achieved was 19.7° and 6.9°, respectively. Using the Broughton and Winson scoring system, 37 (61.7% feet had excellent results, 18 (30% had good, and five (8.3% feet had a poor results. Conclusion: The classic Mitchell′s procedure is a simple procedure and gives good cosmetic and radiological results.

  11. The early functional outcome of Mau osteotomy for the correction of moderate-severe hallux valgus

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    Tanujan Thangarajah

    2013-11-01

    Full Text Available Hallux valgus is one of the commonest conditions of the foot and has been reported to affect nearly half of the adult population. It is most effectively treated by a corrective osteotomy of which there a numerous subtypes. The Mau osteotomy confers the greatest structural stability but is not thought to provide adequate correction of moderate-severe deformities. Accordingly, complications such as under correction and non-union are common. The aim of this study was to determine the functional outcome in patients with moderate-severe hallux valgus following a Mau osteotomy. A retrospective review of 23 patients with moderate-severe hallux valgus treated by Mau osteotomy was conducted. Patients were assessed clinically by the American Orthopedic Foot and Ankle Society (AOFAS scoring system and radiologically by measuring the first intermetatarsal (IM and hallux abductovalgus angles (HAV. The mean AOFAS score had improved from 47 preoperatively to 92 postoperatively (P<0.01. Additionally, preoperative HAV and IM angles improved from 39° and 15° respectively to 15° and 9° respectively (P<0.01. There were no cases of undercorrection or non-union. In this series, the Mau osteotomy was able to achieve good correction of the IM and HAV angles in patients with moderate-severe hallux valgus. This was reflected in a significantly higher postoperative AOFAS score. Contrary to other studies there were no cases of undercorrection and despite allowing patients to fully weight-bear postoperatively there were no cases of non-union.

  12. A modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus.

    Science.gov (United States)

    Vasso, Michele; Del Regno, Chiara; D'Amelio, Antonio; Schiavone Panni, Alfredo

    2016-03-01

    The purpose of this brief paper is to present the preliminary results of a modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus. In this procedure, the dorsal arm of the osteotomy is performed orthogonal to the horizontal plane of the first metatarsal, the main advantage being that this allows much easier and more accurate multiplanar correction of first metatarsal deformities. From 2010 to 2013, 184 consecutive patients with symptomatic hallux valgus and 48 patients with hallux rigidus without severe metatarsophalangeal joint degeneration underwent such modified chevron osteotomy. Mean patient age was 54.9 (range 21-70) years, and mean follow-up duration was 41.7 (range 24-56) months. Ninety-three percent of patients were satisfied with the surgery. Mean American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 56.6 preoperatively to 90.6 at last follow-up, and mean visual analog scale (VAS) pain score decreased from 5.7 preoperatively to 1.6 at final follow-up (p hallux valgus, mean hallux valgus angle decreased from 34.1° preoperatively to 6.2° at final follow-up, and mean intermetatarsal angle decreased from 18.5° preoperatively to 4.1° at final follow-up (p < 0.05). One patient developed postoperative transfer metatarsalgia, treated successfully with second-time percutaneous osteotomy of the minor metatarsals, whilst one patient had wound infection that resolved with systemic antibiotics. Level IV.

  13. The coronal hypomochlion: a tipping point of clinical relevance when planning valgus producing high tibial osteotomies.

    Science.gov (United States)

    Heijens, E; Kornherr, P; Meister, C

    2016-05-01

    In patients undergoing medial opening wedge high tibial osteotomy (MOWHTO), soft tissue opening on the medial side of the knee is difficult to predict. When the load bearing axis is corrected beyond a certain point, the knee joint tilts open on the medial side. We therefore hypothesised that there is a tipping point and defined this as the coronal hypomochlion. In this prospective study of 150 navigated MOWHTOs (144 consecutive patients), data were collected before surgery and at three months post-operatively. In order to calculate the hypomochlion, we compared the respective changes to the joint line convergence angle (JLCA) with the post-operative axis of the leg. The change to the medial proximal tibial angle accounts for only about 80% of the change to the femorotibial angle; 20% of the correction can therefore be attributed to non-osseous, soft-tissue changes. We were able to demonstrate a linear change of JLCA in a range of 0° to 5° of valgus which started when the post-operative long-leg axis was corrected beyond 2° of valgus. We found that the coronal hypomochlion occurs at 2° of valgus. It is recommended to plan realignment for medial open wedge high tibial osteotomy at a maximum of 2° valgus. Cite this article: Bone Joint J 2016;98-B:628-33. ©2016 The British Editorial Society of Bone & Joint Surgery.

  14. [Double Osteotomy of the First Metatarsal for Treatment of Juvenile Hallux Valgus Deformity - Our Experience].

    Science.gov (United States)

    Jochymek, J; Peterková, T

    2016-01-01

    The aim of the study was to evaluate the mid-term results in a group of selected patients undergoing corrective surgery for juvenile hallux valgus, using double osteotomy of the first metatarsal. The group included eight patients, seven girls and one boy, with a more severe form of this deformity treated by double osteotomy of the first metatarsal between 2010 and 2013. The indication for corrective surgery was serious pain when walking; all patients had previously undergone conservative treatment with no effect. All patients had pre-operative clinical examination, the affected foot was X-rayed with the patient standing and radiographic assessments of the intermetatarsal and hallux valgus angles were made. The evaluation of treatment outcomes was based on the scoring system of the American Orthopaedic Foot and Ankle Society (AOFAS) and X-ray images of the foot. The average follow-up was 37 months. Post-operatively, none of the patients reported pain while walking, only two of them experienced pain during sports activities. The average post-operative AOFAS score was 92 points. Both the intermetatarsal angle and the hallux valgus angle improved after surgery in all patients, with two reporting only mild hallux valgus deformity. One patient showed postoperative restriction of motion at the first metatarsophalangeal joint. This was the only complication recorded in association with the surgery. Almost all authors dealing with the treatment of hallux valgus deformity primarily prefer conservative therapy. However, this treatment is usually not very effective in severe forms of the disorder. Surgical management is indicated in symptomatic patients or in those with severe juvenile hallux valgus deformity. In paediatric patients it is necessary to respect the presence of an epiphyseal growth plate in the first proximal metatarsal and therefore it is often preferred to use distal first metatarsal osteotomy. At our department, Mitchell's osteotomy for hallux valgus deformity

  15. Outcomes in chevron osteotomy for Hallux Valgus in a large cohort.

    Science.gov (United States)

    van Groningen, Bart; van der Steen, M C Marieke; Reijman, Max; Bos, Janneke; Hendriks, Johannes G E

    2016-12-01

    Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations. All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS. For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72-84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58-100 versus 73-89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle. In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details. Copyright © 2016 Elsevier Ltd. All rights

  16. Secondary Subacromial Impingement after Valgus Closing-Wedge Osteotomy for Proximal Humerus Varus

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    Hirotaka Sano

    2015-01-01

    Full Text Available A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement.

  17. Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

    Science.gov (United States)

    Brogan, Kit; Lindisfarne, Edward; Akehurst, Harold; Farook, Usama; Shrier, Will; Palmer, Simon

    2016-11-01

    Minimally invasive surgical (MIS) techniques are increasingly being used in foot and ankle surgery but it is important that they are adopted only once they have been shown to be equivalent or superior to open techniques. We believe that the main advantages of MIS are found in the early postoperative period, but in order to adopt it as a technique longer-term studies are required. The aim of this study was to compare the 2-year outcomes of a third-generation MIS distal chevron osteotomy with a comparable traditional open distal chevron osteotomy for mild-moderate hallux valgus. Our null hypothesis was that the 2 techniques would yield equivalent clinical and radiographic results at 2 years. This was a retrospective cohort study. Eighty-one consecutive feet (49 MIS and 32 open distal chevron osteotomies) were followed up for a minimum 24 months (range 24-58). All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire. Radiographic measures included hallux valgus angle, the intermetatarsal angle, hallux interphalangeal angle, metatarsal phalangeal joint angle, distal metatarsal articular angle, tibial sesamoid position, shape of the first metatarsal head, and plantar offset. Statistical analysis was done using Student t test or Wilcoxon rank-sum test for continuous data and Pearson chi-square test for categorical data. Clinical and radiologic postoperative scores in all domains were substantially improved in both groups (P .05). There were no significant differences in complications between the 2 groups ( > .5). The midterm results of this third-generation technique show that it was a safe procedure with good clinical outcomes and comparable to traditional open techniques for symptomatic mild-moderate hallux valgus. Level III, retrospective comparative study. © The Author(s) 2016.

  18. Modified Wilson’s Osteotomy for Hallux Valgus Deformity. A New Approach

    Science.gov (United States)

    Xarchas, Konstantinos C; Mavrolias, Dimitrios; Kyriakopoulos, Georgios

    2014-01-01

    We introduce a new set of modifications and present the results from 48 patients (a total of 60 feet operated), who underwent this modified Wilson’s osteotomy for the correction of Hallux Valgus. Patients were of an average age of 52 years old (from 21 to 75 years of age) and were followed up for a mean of 12 months post-operatively. Patient evaluation was made with the symptom scoring system as presented by Kataraglis et al., with the final outcome being satisfactory in all of the cases. This set of modifications introduced to the original Wilson’s osteotomy, proved to offer a stable, predictable and satisfactory outcome in all cases and we strongly recommend it. PMID:25352929

  19. Proximal First Metatarsal Osteotomy and Mc Bride Procedure in Hallux Valgus: 5-years results of 25 cases

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    Ali Yeganeh

    2016-05-01

    Full Text Available More than 130 operations have been described for the treatment of hallux valgus, However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients who had undergone Proximal osteotomy of first metatarsal and Mc Bride procedure and had been followed up for 5 years. In This prospective study During a 6 years period, (2005-2010, 25 feet in 24 cases with hallux valgus underwent Proximal first metatarsal osteotomy and MCbride procedure, With a mean follow-up of 3/5±1/5 years. The cases were evaluated by American Orthopaedics Foot & Ankle Society HalluxMetatarsophalangeal-interphalangeal scale (AOFAS/HMI. Pre and post hallux valgus angle (HVA, intermetatarsal angle (1-2IMA, and the correlation between the angles and patient satisfaction were statistically evaluated. The mean angular corrections for hallux valgus (HVA, and intermetatarsal angle (IMA were 28 and 10/6 degrees respectively. 13 Patients reported good to excellent results, while in 11 cases dissatisfaction were reported. Proximal first metatarsal osteotomy and Mc Bride procedure for hallux valgus is an acceptable procedure in Patients with hallux valgus deformity correction.Pain and first MTP joint contractures are two main side effects.

  20. Operative treatment of hallux valgus – the effect of three osteotomy types on the first metatarsal, hallux valgus and metatarsal distal articulation angles

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    Andrej Prlja

    2007-11-01

    Full Text Available Background: Modern approach to hallux valgus deformations enables not only the stage treatment considering the magnitude of the deformity but also the objective evaluation of the results.We investigated the influence of the three most commonly used osteotomies on three most common demonstrative factors, especially proximal osteotomy on the distal metatasal articulation angle.Methods: Three groups were created regarding the magnitude of the deformation. X rays of 15 corrections in each group were reviewed (45 cases, 34 women, 2 men. Each group was treated with only one of the three osteotomies: distal chevron osteotomy (Ch, distal chevron osteotomy with medial edge (ChM and proximal osteotomy (POT. The effect on the three most comonly used demonstrative factors were noted: first intermetatarsal angle (IM, hallux valgus angle (HV, distal metatarsal articulation angle (DMAA. The age and the demonstrative factors were compared pre- and postoperative, in and between the groups.Results: The correct, graded selection of the patients for the treatment was confirmed and false negative results excluded. Preoperative values of HV and DMAA are significantely different between three groups (p < 0.001 while IM are not (p = 0.118. Postoperative values of the HV and IM are significantely lower in all three groups (p < 0.001. DMAA is statisticaly different (positive postoperatively in the ChM group (p < 0.001 but not in the Ch and POT groups (P = 0.398; p = 0.456.Conclusions: Modern approach on hallux valgus deformations enables stage treatment and objective evaluation of the results what is demonstrated by the effect of the osteotomies on the demonstrative factors. Further investigations of the factors not yet considered or even unknown are also possible as shown on the example of the difference between the expected and measured effect of POT on DMAA.

  1. Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction.

    Science.gov (United States)

    Choi, Jun Young; Suh, Yu Min; Yeom, Ji Woong; Suh, Jin Soo

    2017-01-01

    We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level III, retrospective comparative series.

  2. First Metatarsophalangeal Contact Properties Following Proximal Opening Wedge and Scarf Osteotomies for Hallux Valgus Correction: A Biomechanical Study.

    Science.gov (United States)

    Kia, Cameron; Yoshida, Ryu; Cote, Mark; DiVenere, Jessica; Geaney, Lauren E

    2017-04-01

    Proximal opening wedge osteotomy (POWO) is an established procedure for moderate to severe hallux valgus. A common concern of this procedure is that it results in lengthening of the first metatarsal, which could cause increased intra-articular pressure of the first metatarsophalangeal joint (MTP) and may ultimately lead to arthritis because of these altered mechanics. The purpose of this study was to use a cadaveric model to compare intra-articular pressures and articulating contact properties of the MTP joint following either scarf osteotomy or POWO. Fresh-frozen cadaveric below-knee specimens with pre-existing hallux valgus (n = 12) and specimens without hallux valgus (n = 6, control group) were used. The hallux valgus specimens were stratified into 2 groups (n = 6 each): POWO or scarf osteotomy. The groups were matched based on the degree of deformity. Peak intra-articular pressure, force, and area were measured in all normal, preoperative, and postoperative specimens with a simulated weightbearing model. These measurements were made with a pressure transducer placed within the first MTP joint. Postoperatively POWO group had slightly higher contact forces and pressures compared to the scarf group and lower contact forces and pressures than those of the normal group but were not statistically significant ( P > .05). Normal specimens had higher intra-articular force, pressure, and area than postoperative specimens but the difference was not found to be significant. First metatarsal lengthening was found in both the scarf and POWO specimens; however, neither increase was found to be significant ( P > .05). The results from this study show that after operative correction, contact properties of the fist MTP joint among normal, POWO, and scarf osteotomy groups revealed no significant differences. First MTP joints in those with hallux valgus had significantly lower contact force and pressure compared to those without hallux valgus. With little long-term outcomes of

  3. Midterm outcome after correction of hallux valgus deformity using scarf osteotomy in adult population

    Directory of Open Access Journals (Sweden)

    Laura Ibrahim Alolayan

    2017-01-01

    Full Text Available Context: Determining the efficacy of any surgical treatment is the key to achieve better practice and best outcomes for patients. Aims: This study is designed to address midterm outcome in adult patients with moderate-to-severe hallux valgus (HV, who underwent scarf osteotomy from 2012 to 2014. Settings and Design: This is a retrospective cohort study in which charts of all adult patients with moderate-to-severe HV who underwent scarf osteotomy from 2011 to 2014 were reviewed. Subjects and Methods: Between 2011 and 2014, 39 patients (41 feet who underwent scarf osteotomy for correction of HV deformity were retrospectively evaluated. Standard weight-bearing dorsoplantar radiographs were obtained pre- and postoperatively. HV angle (HVA, intermetatarsal angle (IMA and distal metatarsal articular angles (DMAA were measured pre- and postoperatively to evaluate the efficacy of the surgery. The complication rate was reported. The average follow-up was 13.5 months, and the patients' mean age was 37 years. Statistical Analysis Used: Data were compared using Chi-square test or Fisher's exact test whichever was appropriate. All tests were two-sided, and a P> 0.01 was considered statistically significant. Results: The average preoperative HVA and IMA were 32° and 14.3°, which improved to 11° and 7.9°, respectively. The changes were statistically significant (P 0.18. Conclusions: This study suggests that scarf osteotomy surgery is a very versatile osteotomy in correcting moderate-to-severe HV deformity. It offers a greater degree of correction and stability, lower rate of complications and good outcome. However, long-term follow-up studies are still needed.

  4. Percutaneous Triple and Double Osteotomies for the Treatment of Hallux Valgus.

    Science.gov (United States)

    Díaz Fernández, Rodrigo

    2017-02-01

    Percutaneous surgery to correct deformities of the forefoot presents the advantages of using a minimal incision, which involves less soft tissue damage and less risk of wound complications. For severe deformities, percutaneous techniques have not been proven as effective. We propose a technique for the treatment of severe hallux valgus. In a sample of 52 feet operated on 48 patients, we performed a double percutaneous osteotomy (closure proximal osteotomy and a distal Akin) or triple when a Reverdin-Isham osteotomy was added. We measured preoperatively the American Orthopaedic Foot & Ankle Society (AOFAS) score at the 1-year and 2-year follow-up, as well as the values of hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular ankle (DMAA), and shortening and elevation of the first metatarsal. The presence of metatarsalgia was recorded before and after the surgery. HVA, IMA, and DMAA improved from 39.3 ± 7.1, 17.0 ± 2.0, and 16 ± 8.7 to 11.2 ± 6.2, 8.4 ± 3.4, and 8.3 ± 6.2, respectively. In 5 cases (10%), there was an elevation of the distal metatarsal bone, but only in 2 cases did a transfer metatarsalgia develop. There were no significant correlations between the amount of shortening and the presence of postoperative metatarsalgia. Scores on the AOFAS scale improved from 47.6 ± 5.6 to 89.7 ± 10.1 points. The results are comparable to those reported with other more established techniques. Transfer metatarsalgia did not correlate with lifting or shortening of the metatarsal. We indicate the percutaneous technique for IMA above 15 degrees and increased DMAA or congruent joints. Level IV, retrospective case series.

  5. Comparison of the Modified McBride Procedure and the Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

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    Choi, Gi Won; Kim, Hak Jun; Kim, Taik Seon; Chun, Sung Kwang; Kim, Tae Wan; Lee, Yong In; Kim, Kyoung Ho

    2016-01-01

    Distal metatarsal osteotomy and the modified McBride procedure have each been used for the treatment of mild to moderate hallux valgus. However, few studies have compared the results of these 2 procedures for mild to moderate hallux valgus. The purpose of the present study was to compare the results of distal chevron osteotomy and the modified McBride procedure for treatment of mild to moderate hallux valgus according to the severity of the deformity. We analyzed the data from 45 patients (49.5%; 48 feet [49.0%]), who had undergone an isolated modified McBride procedure (McBride group), and 46 patients (50.5%; 50 feet [51.0%]), who had a distal chevron osteotomy (chevron group). We subdivided each group into those with mild and moderate deformity and compared the clinical and radiologic outcomes between the groups in relation to the severity of the deformity. The improvements in the American Orthopaedic Foot and Ankle Society scale score and the visual analog scale for pain were significantly better for the chevron group for both mild and moderate deformity. The chevron group experienced significantly greater correction in the hallux valgus angle and intermetatarsal angle for both mild and moderate deformity. The chevron group experienced a significantly greater decrease in the grade of sesamoid displacement for patients with moderate deformity. The McBride group had a greater risk of recurrence than did the chevron group for moderate deformity (odds ratio 14.00, 95% confidence interval 3.91 to 50.06, p hallux valgus recurrence than did the distal chevron group. Therefore, we recommend distal chevron osteotomy rather than a modified McBride procedure for the treatment of mild and moderate hallux valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Can Double Osteotomy Be a Solution for Adult Hallux Valgus Deformity With an Increased Distal Metatarsal Articular Angle?

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    Park, Chul Hyun; Cho, Jae Ho; Moon, Jeong Jae; Lee, Woo Chun

    2016-01-01

    No previous study has reported the results of double metatarsal osteotomy for adult hallux valgus deformity with an increased distal metatarsal articular angle (DMAA). The purpose of the present study was to evaluate the results after double metatarsal osteotomy in adult patients with incongruent hallux valgus deformity. We retrospectively reviewed 16 cases of consecutive first metatarsal double metatarsal osteotomy without lateral soft tissue release in 14 patients with symptomatic hallux valgus associated with an increased DMAA (≥15° after proximal chevron osteotomy on intraoperative radiographs). Clinical results were assessed using the American Orthopaedic Foot and Ankle Society scale and the visual analog scale. The radiographic results were assessed over time, and changes in the DMAA and the relative length of the first metatarsal were assessed by measuring each value preoperatively and at the last follow-up visit. The American Orthopaedic Foot and Ankle Society and visual analog scale scores were significantly improved after surgery. The hallux valgus angle and intermetatarsal angle were stabilized >3 months after surgery. The sesamoid position did not increase significantly beyond the immediate postoperative period. The mean DMAA was corrected from 21.6° (range 15° to 29°) preoperatively to 11.1° (range -2° to 17°) at the last follow-up visit. The mean amount of shortening of the first metatarsal after surgery was 5.5 (range 4 to 7) mm. In conclusion, double metatarsal osteotomy without lateral soft tissue release in adult hallux valgus deformity results in high postoperative recurrence and complication rates. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Preliminary radiographic outcomes of surgical correction in juvenile hallux valgus: single proximal, single distal versus double osteotomies.

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    Edmonds, Eric W; Ek, Dorsey; Bomar, James D; Joffe, Avrum; Mubarak, Scott J

    2015-01-01

    Surgical correction of juvenile hallux valgus has a high risk of recurrence and complications. This short-term follow-up study evaluates the radiographic differences between 3 osteotomy types: distal first metatarsal osteotomy, proximal first metatarsal osteotomy, and double first metatarsal osteotomy with regard to ability to achieve correction and the risk of hallux varus. A total of 106 feet were evaluated. Percent correction of hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) was recorded, as well as complication and reoperation rates. Radiographs were evaluated at the initial visit, intraoperatively, and at final follow-up. The single distal osteotomy achieved: IMA within normal limits 21% of the time with no cases of overcorrection; HVA within normal limits 42% of the time with 13% overcorrected; and DMAA within normal limits 46% of the time with 4% overcorrected.The single proximal osteotomy achieved: IMA within normal limits 36% of the time with no cases of overcorrection; HVA within normal limits 36% of the time with no cases of overcorrection; and DMAA within normal limits 36% of the time with 7% overcorrected.The double osteotomy achieved: IMA within normal limits 54% of the time with no cases of overcorrection; HVA within normal limits 40% of the time with 7% overcorrected; and DMAA within normal limits 56% of the time with 22% overcorrected.The rate of HVA overcorrection was not found to be correlated with osteotomy type (P=0.37). The double osteotomy was found to have a higher DMAA overcorrection rate than either single osteotomy (PDMAA. Level III-retrospective case control study.

  8. Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding.

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    Akpinar, Evren; Buyuk, Abdul Fettah; Cetinkaya, Engin; Gursu, Sarper; Ucpunar, Hanifi; Albayrak, Akif

    2016-01-01

    The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All

  9. Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series.

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    Gavaskar, Ashok S; Chowdary, Naveen T

    2013-03-15

    Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion. 11 patients with proximal femur nonunions {intracapsular fractures--7, extracapsular fractures--4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score. Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up. The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

  10. Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases

    Science.gov (United States)

    Ortiz, Cristian; Wagner, Emilio

    2017-01-01

    More than 200 different surgical techniques exist for hallux valgus (HV). Some of them are designed for mild, moderate, or severe deformities depending on their correction power. Nevertheless, they all correct only the coronal and/or sagittal plane deformity. Just a handful of them correct the known axial malrotation that exists in most HV cases. This malrotation is one possible factor that could be the source of recurrence of an operated HV as it has been described. We describe a new technique which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone wedge resection. Also, there is a broader bone surface contact than on a transverse proximal osteotomy. This technique is easy to remember and relatively simple to perform in primary and revision cases. The authors results show that it is as safe and effective as other procedures, with some advantages to be discussed. Levels of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence. PMID:28286430

  11. Modified Mitchell osteotomy alone does not have higher rate of residual metatarsalgia than combined first and lesser metatarsal osteotomy

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    Shu-Jung Chen

    2015-04-01

    Full Text Available Transfer metatarsalgia (TM is a common forefoot disorder secondary to hallux valgus (HV. Some authors suggest that a combined lesser metatarsal osteotomy while undergoing HV surgery improves metatarsalgia, whereas others concluded that isolated HV corrective osteotomy can improve symptomatic metatarsalgia. The main purpose of this retrospective study was to compare clinical outcomes in patients with and without combined lesser metatarsal osteotomy while receiving HV correction surgery. We retrospectively reviewed the patients who underwent osteotomy for HV correction between January 2000 and December 2010. All patients underwent HV correction with modified Mitchell osteotomy. Clinical evaluations including the American Orthopaedic Foot and Ankle Society score and residual metatarsalgia were assessed, and radiographic measurements were carried out. Sixty-five patients (83 feet meeting the selection criteria were enrolled. Thirty feet receiving a combined lesser metatarsal osteotomy were classified as the combined surgery (CS group, and the others were classified as the control (CN group (53 feet. The overall rate of persistent symptomatic metatarsalgia was 19.28% after operative treatment. There were six feet with residual metatarsalgia in the CS group, and 10 feet in the CN group. There was no significant difference in the rate of persistent symptoms between the two groups (p = 0.9. According to this result, modified Mitchell osteotomy alone did not have a higher rate of residual metatarsalgia than CS. We also found that the average recovery rate of TM was about 80.7% and those patients whose preoperative HV angle was > 30° had the higher risk of residual metatarsalgia after surgery.

  12. [Treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy of the first metatarsal bone].

    Science.gov (United States)

    Díaz Fernández, R

    2015-01-01

    To evaluate the clinical and radiological results in the surgical treatment of moderate and severe hallux valgus by performing percutaneous double osteotomy. A retrospective study was conducted on 45 feet of 42 patients diagnosed with moderate-severe hallux valgus, operated on in a single centre and by the same surgeon from May 2009 to March 2013. Two patients were lost to follow-up. Clinical and radiological results were recorded. An improvement from 48.14 ± 4.79 points to 91.28 ± 8.73 points was registered using the American Orthopedic Foot and Ankle Society (AOFAS) scale. A radiological decrease from 16.88 ± 2.01 to 8.18 ± 3.23 was observed in the intermetatarsal angle, and from 40.02 ± 6.50 to 10.51 ± 6.55 in hallux valgus angle. There was one case of hallux varus, one case of non-union, a regional pain syndrome type I, an infection that resolved with antibiotics, and a case of loosening of the osteosynthesis that required an open surgical refixation. Percutaneous distal osteotomy of the first metatarsal when performed as an isolated procedure, show limitations when dealing with cases of moderate and severe hallux valgus. The described technique adds the advantages of minimally invasive surgery by expanding applications to severe deformities. Percutaneous double osteotomy is a reproducible technique for correcting severe deformities, with good clinical and radiological results with a complication rate similar to other techniques with the advantages of shorter surgical times and less soft tissue damage. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  13. MRI evaluation of abnormalities of subchondral bone after tibial condyle valgus osteotomy

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    Otsuka, Kazutaka; Mimura, Hiroshi; Yuge, Daishiro [Yamaguchi Central Hospital, Hofu (Japan); Teramoto, Tsukasa [Nagasaki Friendship Hospital, Sanwa (Japan); Taguchi, Katsuki [Goto Central Hospital, Fukue, Nagasaki (Japan)

    2002-03-01

    We evaluated subchondral low signal intence abnormality on T1-weighted MRI in the osteoarthritis (OA) and osteonecrosis (ON), of the knee after tibial condyle valgus osteotomy (TCVO). Subjects consisted of 11 OA patients, aged 71 on average (range: 66-79) and 3 ON patients, aged 59 on average (range:46-72). The MRI follow-up period was 18 months (range: 12-25) in the OA group and 17 months (range: 12-24) in the ON group. Clinical improvement was observed in all patients. Except for one patient in the OA group, T1-weighteed MRI showed low signal intense area in the medial compartment of the knee. At follow-up, the MRI evaluation revealed a decrease in the low signal intense areas in 9 of the 10 OA patients and in 2 of the 3 ON patients. These results suggest that bone remodelling of the subchondral lesion can be expected after decompression and stabilizing surgery, TCVO. (author)

  14. Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation.

    Science.gov (United States)

    Park, Chul-Hyun; Ahn, Ji-Yong; Kim, Yu-Mi; Lee, Woo-Chun

    2013-06-01

    The purpose of this study was to compare the results of hallux valgus surgery between feet fixed with Kirschner wires and those fixed with a plate and screws. Between December 2008 and November 2009, 53 patients (62 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. Thirty-four patients (41 feet) were stabilised with Kirschner wires (K-wire group) and 19 patients (21 feet) were stabilised with a locking plate (plate group). Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic parameters were compared between these groups. Recurrence rate at the last follow-up was compared between the K-wire and plate groups. Mean AOFAS score was lower in the plate group, however, the difference between the groups was not statistically significant in AOFAS score at the last follow-up. Hallux valgus angle and intermetatarsal angle were significantly larger in the plate group at the last follow-up. Mean 1-2 metatarsal (MT) distance on immediately postoperative radiographs was significant larger in the plate group. Four (9.8 %) of the 41 feet in the K-wire group and 7 (33.3 %) of the 21 feet in the plate group showed hallux valgus recurrence at the last follow-up. The plate group had a significantly higher risk of recurrence than the K-wire group. Fixation of proximal chevron osteotomy using a plate and screws has a greater risk of hallux valgus recurrence than fixation using Kirschner wires.

  15. Early proximal tibial valgus osteotomy as a very important prognostic factor in Thai children with infantile tibia vara.

    Science.gov (United States)

    Kaewpornsawan, Kamolporn; Tangsataporn, Suksan; Jatunarapit, Ratiporn

    2005-10-01

    To find the effectiveness of the early surgery (2-3 years of age)as a very important prognostic factor affecting the outcomes in Thai children with infantile tibia vara and all the prognostic factors including the usefulness of arthrographic study in correcting the deformity. From 1994 to 2004, sixteen children aged average 3.61 years old (2.08-7.0) were treated in Siriraj Hospital and diagnosed as infantile tibia vara by Langenskiold radiographic staging were included in the present study and retrospectively reviewed with an average of 6.4 years follow up (range 6 month - 11.1 years). All cases were initially treated by surgery because of low compliance for brace or brace failure. They consisted of 3 boys and 13 girls. There were 24 legs including the bilateral involvement in 8 cases (2 boy and 6 girls). After arihrography, the midshaft fibular osteotomy was performed then the proximal tibial dome-shaped valgus osteotomy was done and fixed with 2 pins. The desired position was 12 degree knee valgus . The patients were divided in two groups, 1)group A,the successful group with the knee becoming normal without any deformity after single osteotomy, 2)group B,the recurrent group with recurrence of the varus deformity required further corrective osteotomies to make normal axis of the knee. All variables were analyzed and compared between group A and group B. The general characteristics and radiographic findings were recorded in 1)age, 2)sex, 3)side, 4)weight in kilogram and in percentage of normal or overweight(obesity) compared with the standard Thai weight chart, 5)tibiofemoral angle (TFA) pre and postoperative treatment, 6) metaphyseal diaphyseal angle (MDA), 7)the medial physeal slope angle (MPS, 8)The preoperative arthrographic articulo-diaphyseal angle (ADA), 9.arthrographic articulo-medial physeal angle (AMPA). There were 14 legs in group A and the remaining 10 legs were in group B (average 2.4 operations). All cases healed in good alignment of the legs without

  16. Lateral parapatellar approach with tibial tubercle osteotomy for the treatment of non-correctable valgus knee osteoarthritis: a retrospective clinical study.

    Science.gov (United States)

    Chalidis, Byron E; Ye, Ken; Sachinis, Nick P; Hawdon, Gabrielle; McMahon, Stephen

    2014-01-01

    The aim of this retrospective study was to evaluate the efficacy of a lateral parapatellar approach combined with a tibial tubercle osteotomy (TTO) in patients undergoing total knee arthroplasty (TKA) with non-correctable valgus knee osteoarthritis. We studied 53 consecutive patients (57 knees) who had a primary TKA via lateral parapatellar approach with a global step-cut "coffin" type TTO over a 10-year period. All patients had non-correctable grade II valgus deformity according to the Ranawat classification. The average age of patients was 71 years (45 to 77) and the mean follow-up was 39 months (20 to 98). Post-surgery, there was a significant improvement in knee extension (p=0.002), flexion (p=0.006), Knee Society Pain and Function Scores (pOsteoarthritis Index (pknee developed infection treated with two-stage reconstruction. A proximal tibial stress fracture also occurred in a patient on long-term bisphosphonate therapy. Lateral parapatellar approach along with TTO is an effective technique for addressing non-correctable valgus knee deformity during TKA. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Use of Minimally Invasive Distal Metatarsal Osteotomy for Correction of Hallux Valgus

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    Chun-Kit Tong

    2012-06-01

    Conclusion: Good clinical and radiographic results have been achieved with minimally invasive techniques for treatment of hallux valgus. This is an acceptable alternative operation for mild-to-moderate hallux valgus.

  18. Long-term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction.

    Science.gov (United States)

    Jeuken, Ralph M; Schotanus, Martijn G M; Kort, Nanne P; Deenik, Axel; Jong, Bob; Hendrickx, Roel P M

    2016-07-01

    Hallux valgus is one of the most common foot deformities. This long-term follow-up study compared the results of 2 widely used operative treatments for hallux valgus: the scarf and chevron osteotomy. Conventional weight bearing anteroposterior (AP) radiographs of the foot were made for evaluating the intermetatarsal angle and hallux valgus angle. For clinical evaluation, the American Orthopaedic Foot & Ankle Society (AOFAS) rating system for the hallux metatarsophalangeal-interphalangeal scale was used together with physical examination of the foot. These data were compared with the results from the original study. The Short Form 36 questionnaire, the Manchester-Oxford Foot Questionnaire (MOXFQ), and a general questionnaire including a visual analog scale (VAS) pain score were used for subjective evaluation. The primary outcome measures were the radiologic recurrence of hallux valgus and reoperation rate of the same toe. Secondary outcome measures were the results from the radiographs and subjective and clinical evaluation. The response rate was 76% at the follow-up of 14 years; in the chevron group, 37 feet were included compared with 36 feet in the scarf group. Twenty-eight feet in the chevron group and 27 in the scarf group developed recurrence of hallux valgus (P = .483). One patient in the scarf group had a reoperation of the same toe compared with none in the chevron group (P = .314). Current VAS pain scores and results from the SF-36, MOXFQ, and AOFAS did not significantly differ between groups. Both techniques showed similar results after 2 years of follow-up. At 14 years of follow-up, neither technique was superior in preventing recurrence. Level II, randomized controlled trial. © The Author(s) 2016.

  19. Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity

    Science.gov (United States)

    Fakoor, Mohammad; Sarafan, Naser; Mohammadhoseini, Payam; Khorami, Mohsen; Arti, Hamidreza; Mosavi, SeyedShahnam; Aghaeeaghdam, Amir

    2014-01-01

    Background: Hallux valgus deformity is a common chronic problem with a reported prevalence of 28.4% and its chief complaint is pain. Thus far, different surgical procedures with their proposed indications have been introduced. This study compared three current procedures, namely the chevron and scarf osteotomies and the McBride procedure. Methods: This retrospective cohort was conducted at the Ahvaz University of Medical Sciences on 44 patients with moderate hallux valgus deformity from 2010 and 2013. All of the patients underwent one of the three procedures (chevron, scarf or McBride). Preoperative and follow up radiographies were evaluated in terms of hallux valgus and intermetatarsal angle correction. The Foot and Ankle Disability Index was filled out to assess the functional outcome and the Visual Analogue Scale was used to evaluate pain. Also, satisfaction, aesthetics and the rate of recurrence was evaluated. Results: Hallux valgus angle and intermetatarsal angle correction were significantly higher in scarf, but not in chevron and McBride. However, from amongst the three procedures, there was no significant difference in terms of the Foot and Ankle Disability Index score, aesthetics, satisfaction level, pain score and recurrence rate. Conclusions: Considering that scarf osteotomy had better results in this study, we think that scarf osteotomy can be considered as a first choice for the treatment of moderate hallux valgus deformity. PMID:25207310

  20. A Modified Technique of Fixation for Proximal Femoral Valgus Osteotomy in Abnormal Bone: A Report of Two Cases

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    Logheswaren S

    2017-07-01

    Full Text Available The ideal size of intramedullary device to fix corrective osteotomy of proximal femur in abnormal bone in children and small patients may not be easily available. We report the successful use of Rush rod in combination with multiple Kirschner wires to fix the corrective osteotomy of coxa vara and shepherd crook deformity in two patients with osteogenesis imperfecta and fibrous dysplasia. The union was achieved on time, neck shaft angle and rotation were maintained.

  1. Surgical correction of bilateral metacarpophalangeal valgus with curved osteotomies and type II external skeletal fixation in a seven-month-old alpaca.

    Science.gov (United States)

    Schoonover, Mike J; Whitfield, Chase T; Rochat, Mark C; Streeter, Robert N; Sippel, Kate

    2016-09-20

    To report the successful surgical correction of severe bilateral metacarpophalangeal valgus angular limb deformities in a seven-month-old intact male alpaca cria using curved osteotomies stabilized with type II external skeletal fixation. Using a 21 mm crescentic shaped oscillating saw blade, bilateral osteotomies were performed in the distal metaphyses of the fused third and fourth metacarpal bones to correct valgus angular limb deformity of the metacarpophalangeal joints. Axial alignment of each limb was achieved by medially rotating the distal metacarpus in the frontal plane along the curved osteotomies. The osteotomies were stabilized using type II external skeletal fixators. The alpaca was immediately weight-bearing following the surgical procedure and no to minimal lameness was observed during healing of the osteotomies. Evaluation at five and 10 months following the surgery demonstrated acceptable axial alignment in the left forelimb while moderate to severe varus deformity (overcorrection) was observed in the right. Curved osteotomy of the distal metacarpus stabilized with type II external skeletal fixation can provide a favourable outcome in older alpaca crias affected with metacarpophalangeal angular limb deformities. Placement of the distal transfixation pins relative to the metacarpal physes should be carefully evaluated as overcorrection is possible, especially if growthpotential remains in only one physis of the fused third and fourth metacarpal bones.

  2. Comparison of Clinical Outcomes of Scarf and Chevron Osteotomies and the McBride Procedure in the Treatment of Hallux Valgus Deformity

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    Mohammad Fakoor

    2014-03-01

    Full Text Available Background:   Hallux valgus deformity is a common chronic problem in middle age and elderly. Different surgical procedures have been introduced so far with their proposed indications for each. This study aimed to compare three   current procedures namely Chevron osteotomy, Scarf osteotomy and McBride technique.     Methods:   In this study, 44 patients were included from 2010 to 2013. All patients had been undergone one of the three current procedures including Chevron, Scarf or McBride techniques. Preoperative and follow-up radiographies     were evaluated in terms of hallux valgus and intermetatarsal angles. Foot Ankle Disability Index was filled to assess the functional. A Visual Analogue Scale evaluated pain. Also, satisfaction, aesthetic and the rate of recurrence were evaluated. Results:   Functional score, aesthetic and satisfaction level were higher in Scarf technique rather than Chevron and McBride techniques. Also, pain score and recurrence rate were lower in Scarf Technique rather the other two techniques.     Conclusions:   With respect to better results with Scarf osteotomy in this study, we recommend Scarf osteotomy as   a first choice for treatment of moderate hallux valgus deformity.

  3. Percutaneous Chevron Osteotomy in Treating Hallux Valgus: Hong Kong Experience and Mid-Term Results

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    Ka-Lee Karry Lam

    2015-06-01

    Conclusion: The mid-term results are encouraging, indicating that this is an effective method in the treatment of mild to moderate hallux valgus with advantages of percutaneous technique. Further study with longer-term results and larger sample size is needed in order to compare with other percutaneous or open techniques.

  4. Treatment of hallux valgus deformity.

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    Fraissler, Lukas; Konrads, Christian; Hoberg, Maik; Rudert, Maximilian; Walcher, Matthias

    2016-08-01

    Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone.Taking the patient's history and a thorough physical examination are important steps. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus.Non-operative treatment of the hallux valgus cannot correct the deformity. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms.There are many operative techniques for hallux valgus correction. The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. The role of stability of the first tarsometatarsal joint is controversial.Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically.Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Post-operative radiographs are taken in regular intervals until osseous healing is achieved. Cite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev 2016;1:295-302. DOI: 10.1302/2058-5241.1.000005.

  5. The Scarf Osteotomy with Minimally Invasive Lateral Release for Treatment of Hallux Valgus Deformity: Intermediate and Long-Term Results.

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    Bock, Peter; Kluger, Rainer; Kristen, Karl-Heinz; Mittlböck, Martina; Schuh, Reinhard; Trnka, Hans-Joerg

    2015-08-05

    Little is known about the long-term results of surgical correction of hallux valgus deformity, in particular, the recurrence rate and factors leading to recurrence. Of one hundred and eight patients (115 feet) who underwent a Scarf osteotomy, ninety-three patients (ninety-three feet) were examined at an average duration of follow-up of 124 months. Clinical examination before surgery and at the time of final follow-up included an evaluation of range of motion, pain as measured with a visual analog scale, and American Orthopaedic Foot & Ankle Society (AOFAS) scores. The Foot and Ankle Outcome Score (FAOS) was also assessed postoperatively. Radiographic data were evaluated preoperatively, at six weeks postoperatively, and at the time of final follow-up. Additional radiographic data were available for seventy-nine patients of the same patient cohort at an average of twenty-seven months postoperatively. The median overall AOFAS score improved from 57 points preoperatively to 95 points at the time of final follow-up. All radiographic measurements (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and sesamoid bone position) showed significant (p < 0.05) improvement at the time of final follow-up compared with preoperatively. The rate of recurrence (an HVA of ≥20°) at the time of final follow-up was 30%. We were unable to determine if recurrence resulted in functional impairment or consequences for quality of life. The recurrence rate after ten years was 30%, and a higher final HVA resulted in higher pain levels. The limitations imposed by nonvalidated outcome measures precluded conclusions about the influence of HVA on function or quality of life. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  6. Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy.

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    Bode, Gerrit; von Heyden, Johanna; Pestka, Jan; Schmal, Hagen; Salzmann, Gian; Südkamp, Norbert; Niemeyer, Philipp

    2015-07-01

    Open-wedge high tibial osteotomy using internal plate fixation is a well-established and frequently performed treatment option for the management of medial compartment osteoarthritis (OA) in the young and active patients. The present study provides survival rate and functional outcome preoperatively and after 6, 12, 24, 36 and 60 months following open-wedge high tibial osteotomy. Hypothesis of the authors was high survival rates after 5 years with still remaining satisfying functional results. Sixty-two patients suffering from tibial conditioned knee joint varus deformity and medial compartment OA that underwent high tibial osteotomy using an internal plate fixator (TomoFix™, Synthes) were included. Functional outcome was evaluated prior to surgery and in the further clinical course using standard instruments (IKDC score, Lysholm score). Treatment failure was defined as the need for total knee arthroplasty (TKA). Fifty-one patients (mean age 46.8 ± 10.2 years) were available at a mean of 60.5 (SD ± 2.5) months (follow-up rate 82.3 %) postoperatively. Sixty-month IKDC (69.4 % SD ± 18.6) and Lysholm (76.6 SD ± 20.5) improved significantly when comparing with preoperative values (IKDC 44.6 SD ± 17.8; Lysholm 52.1 SD ± 20.8). Two of 51 subjects underwent TKA, resulting in a survival rate of 96 % among those patients followed (51 of 60; 85 %). Overall complication rate was 8.6 %. With a survival rate of over 96 % at 5 years, high tibial osteotomy seems to be a reliable treatment option with satisfying clinical outcome. Functional outcome was stable following 60 months. While a delay of the necessity for TKA seems likely with regard to the survival rate demonstrated in this article, possible avoidance needs to be demonstrated by longer follow-up studies. Therapeutic case series, Level IV.

  7. Review Outcome of Combined Open Reduction and Femoral Shortening Osteotomy for Developmental Dysplasia of the Hip in Children

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    Nguyen Ngoc Hung

    2017-02-01

    Full Text Available BACKGROUND: Reports of the efficacy of Open reduction combined femoral shortening osteotomy on children for developmental dislocation of the hip. Surgical outcomes were evaluated clinically and roentgenographically. METHODS: We performed a retrospective match-controlled study in which 58 patients, they were surgical femoral shortening osteotomy following Open reduction, Zigzag Osteotomy, Fibular Allograft (ZOFA and femoral shortening osteotomy. Deformity of femoral head or neck or acetabulum according to the Severin, Avascular Necrosis (AVN according to Kalamchi, Clinical evaluation according to Barrett modified McKay criteria. RESULTS: Between 2009 and 2014, Femoral shortening Osteotomy For 58 Hips (all patients operated unilateral side. There were 42 (72.4% were girls and 16 (27.6% were boys. None had preoperative skin or skeletal traction, nor derotational varus or valgus osteotomies. The Femoral Neck Anteversion angle: Average 27.726º (SD = 12.153, The Shaft - Neck angle: Average 149.649º (SD = 5.815, The Femoral Neck - Shaft angle: Average 162° (SD = 8.642. Average age at femoral shortening osteotomy was 29.9 months (range, 14-36 months. Average distance shortening osteotomy was 1.52 cm. Duration of the Follow-up was 28. 6 months (range, 24-62 months; Average age at latest Follow- up 66.3 months (range, 38-85 months.There were 1 (1.7% Trendelenberg gait. AVN in 9 (15.5%. Subluxation in 2 (3.4%. At lastest result: Excellent in 44 (75.9%, Good in 8 (13.8%, Fair 4 (6.9%, and Poor 2 (3.4%; Satisfy Results (Excellent and Good of Open reduction and Femoral Shortening in 52 (97.5%. The femoral head or neck or acetabulum were normal in 44 (75.9% hips. CONCLUSIONS: On the basis of this study, the femoral shortening Osteotomy reduce incidence AVN, Re-Dislocation, and improved Postoperative result.

  8. The effect of valgus and varus femoral osteotomies on measures of anteversion in the dog.

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    Adams, Rachel W; Gilleland, Brad; Monibi, Farrah; Franklin, Samuel P

    2017-05-22

    To determine whether femoral osteotomies that change frontal plane alignment without affecting torsion influence anteversion and inclination. Femurs without deformity were scanned to create three-dimensional reconstructions. The femoral head-neck axis was identified by placement of a virtual intramedullary pin. A proximal osteotomy was simulated to create three conditions while keeping torsion constant: Normal, Coxa Valga (neck-shaft angle increased by 12°), and Coxa Vara (neck-shaft angle decreased by 12°). Femoral anteversion was measured from an axial image in all three conditions. Femoral inclination was calculated for all conditions using the neck-shaft and anteversion angles. Changes in anteversion and inclination were calculated and compared using a one-way repeated measures analysis of variance. Distal femoral osteotomies were then simulated with the native femurs, inducing 18° of distal varus with no change to torsion. Changes in anteversion and inclination for the Normal and Distal Varus conditions were calculated and compared by a paired t-test. Version changed by a mean of 13.9° (± 1.5; p Coxa Valga to Coxa Vara conditions while inclination changed by a mean of 1.3° (± 0.39; p <0.01). Version changed by a mean of 6.6° (± 0.7; p <0.0001) between the Distal Varus and Normal conditions while inclination changed by a mean of -3.8° (± 0.75; p <0.001). Femoral version changes with changing frontal plane alignment even when torsion is constant. This should be considered when correcting femoral deformities.

  9. [Humerus varus: correction by proximal valgus osteotomy with precontourned plate fixation in children].

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    Tallón-López, J; Domínguez-Amador, J J; Andrés-García, J A

    2014-01-01

    Varus deformity of the proximal humerus in children is a little known pathology due to its low incidence of presentation. Progress has been made in recent years in understanding the possible etiology and pathophysiological causes. Radiological criteria for diagnosis and functional impairment that occurs have also been defined. However, there are few reports in the literature about the surgical treatment of this deformity in children. In this paper we present a case of surgical treatment of this deformity by corrective osteotomy fixed with precontoured external maleolar plate osteosynthesis. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  10. Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs.

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    Weh, Jennifer L; Kowaleski, Michael P; Boudrieau, Randy J

    2011-08-01

    To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling osteotomy (TPLO) and transverse corrective osteotomy. Cases series. Dogs (n=12; 19 stifle joints). Medical records of dogs that had combination TPLO and transverse corrective osteotomy, were reviewed. Pre- and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective osteotomy technique, method of fixation, and complications were recorded. In hospital re-evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long-term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview. Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre- and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88-96°) and 96.1° (range, 94-101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In-hospital re-evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long-term follow-up was obtained. Long-term clinical outcome of combination TPLO and

  11. A comparison of proximal and distal Chevron osteotomy, both with lateral soft-tissue release, for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction: a prospective randomised controlled trial.

    Science.gov (United States)

    Lee, K B; Cho, N Y; Park, H W; Seon, J K; Lee, S H

    2015-02-01

    Moderate to severe hallux valgus is conventionally treated by proximal metatarsal osteotomy. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was to compare the outcome of proximal and distal Chevron osteotomy in patients undergoing simultaneous bilateral correction of moderate to severe hallux valgus. The original study cohort consisted of 50 female patients (100 feet). Of these, four (8 feet) were excluded for lack of adequate follow-up, leaving 46 female patients (92 feet) in the study. The mean age of the patients was 53.8 years (30.1 to 62.1) and the mean duration of follow-up 40.2 months (24.1 to 80.5). After randomisation, patients underwent a proximal Chevron osteotomy on one foot and a distal Chevron osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score, patient satisfaction, post-operative complications, hallux valgus angle, first-second intermetatarsal angle, and tibial sesamoid position were similar in each group. Both procedures gave similar good clinical and radiological outcomes. This study suggests that distal Chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting moderate to severe hallux valgus as proximal Chevron osteotomy with a distal soft-tissue procedure. ©2015 The British Editorial Society of Bone & Joint Surgery.

  12. Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up.

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    Biz, Carlo; Fosser, Michele; Dalmau-Pastor, Miki; Corradin, Marco; Rodà, Maria Grazia; Aldegheri, Roberto; Ruggieri, Pietro

    2016-12-05

    Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release. Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures. ClinicalTrials.gov PRS Protocol Registration and Results System: NCT02886221.

  13. Technique tip: Simultaneous first metatarsal lengthening and metatarsophalangeal joint fusion for failed hallux valgus surgery with transfer metatarsalgia.

    Science.gov (United States)

    Chowdhary, Ashwin; Drittenbass, Lisca; Stern, Richard; Assal, Mathieu

    2017-03-01

    Failed hallux valgus surgery may result in residual or recurrent hallux valgus, and as well transfer metatarsalgia. The present technical tip concerns the combination of fusion of the first metatarsophalangeal (MTP) joint and lengthening of the first metatarsal (MT) through a scarf osteotomy. Six patients underwent the presented technique, all for the indication of failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint. Follow-up at six months revealed all patients had complete healing of the osteotomy and arthrodesis sites. They were all asymptomatic and fully active, completely satisfied with the outcome. Combined fusion of the first MTP joint and lengthening of the first MT through a scarf osteotomy results in an excellent outcome in patients with failed hallux valgus surgery with shortening of the first MT and degenerative changes in the 1st MTP joint. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  14. Recurrence of Hallux Valgus Can Be Predicted from Immediate Postoperative Non-Weight-Bearing Radiographs.

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    Park, Chul Hyun; Lee, Woo-Chun

    2017-07-19

    The aims of this study were to identify risk factors for the recurrence of hallux valgus deformity and to clarify whether recurrence after surgery to treat hallux valgus can be predicted using radiographic parameters assessed on immediate postoperative non-weight-bearing radiographs. A proximal chevron osteotomy combined with a distal soft-tissue procedure was performed by a single surgeon to treat moderate to severe hallux valgus deformity in 93 patients (117 feet). The feet were grouped according to nonrecurrence or recurrence. Changes in the hallux valgus angle, the intermetatarsal angle, and sesamoid position over time were analyzed by comparing values measured during each postoperative period. The relative risks of recurrence as indicated by preoperative and postoperative radiographic parameters were determined. Twenty (17.1%) of the 117 feet showed hallux valgus recurrence at the time of the last follow-up. The hallux valgus angle and the intermetatarsal angle stabilized at 6 months after surgery in the nonrecurrence group. An immediate postoperative hallux valgus angle of ≥8°, an immediate postoperative sesamoid position of grade 4 or greater, a preoperative metatarsus adductus angle of ≥23°, and a preoperative hallux valgus angle of ≥40° were significantly associated with recurrence. Recurrence of hallux valgus after a proximal chevron osteotomy can be reliably predicted from immediate postoperative non-weight-bearing radiographs. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  15. Injury tolerance and moment response of the knee joint to combined valgus bending and shear loading.

    Science.gov (United States)

    Bose, Dipan; Bhalla, Kavi S; Untaroiu, Costin D; Ivarsson, B Johan; Crandall, Jeff R; Hurwitz, Shepard

    2008-06-01

    Valgus bending and shearing of the knee have been identified as primary mechanisms of injuries in a lateral loading environment applicable to pedestrian-car collisions. Previous studies have reported on the structural response of the knee joint to pure valgus bending and lateral shearing, as well as the estimated injury thresholds for the knee bending angle and shear displacement based on experimental tests. However, epidemiological studies indicate that most knee injuries are due to the combined effects of bending and shear loading. Therefore, characterization of knee stiffness for combined loading and the associated injury tolerances is necessary for developing vehicle countermeasures to mitigate pedestrian injuries. Isolated knee joint specimens (n=40) from postmortem human subjects were tested in valgus bending at a loading rate representative of a pedestrian-car impact. The effect of lateral shear force combined with the bending moment on the stiffness response and the injury tolerances of the knee was concurrently evaluated. In addition to the knee moment-angle response, the bending angle and shear displacement corresponding to the first instance of primary ligament failure were determined in each test. The failure displacements were subsequently used to estimate an injury threshold function based on a simplified analytical model of the knee. The validity of the determined injury threshold function was subsequently verified using a finite element model. Post-test necropsy of the knees indicated medial collateral ligament injury consistent with the clinical injuries observed in pedestrian victims. The moment-angle response in valgus bending was determined at quasistatic and dynamic loading rates and compared to previously published test data. The peak bending moment values scaled to an average adult male showed no significant change with variation in the superimposed shear load. An injury threshold function for the knee in terms of bending angle and shear

  16. ERRORS AND COMPLICATIONS IN SURGICAL TREATMENT OF NON-STABLE EQUINO-PLANO-VALGUS FOOT DEFORMITY IN PATIENTS WITH CEREBRAL PALSY, WITH USE OF THE CALCANEUS CORRECTING OSTEOTOMY TECHNIQUE

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    Valery V. Umnov

    2017-03-01

    Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

  17. Hálux valgo: estudo comparativo entre duas técnicas cirúrgicas de osteotomia proximal de adição Hallux valgus: comparative study between two surgical techniques of proximal addition osteotomy

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    Luiz Carlos Ribeiro Lara

    2012-12-01

    Full Text Available OBJETIVO: Comparar clínica e radiograficamente os resultados da correção do hálux valgo, através de duas técnicas de osteotomia de adição: uma utilizando-se da exostose ressecada e outra, mediante a fixação com placa para cunha de adição. MÉTODOS: Avaliamos 24 pés em 19 pacientes, com média de idade de 51,3 anos, portadores de hálux valgo, com seguimento médio de 50,1 meses. Submeteram-se à técnica de osteotomia de adição com exostose óssea (OAEO 13 pés e à osteotomia de adição com placa para cunha de adição (OPCA 11 pés. Foram avaliados no pré e pós operatório o escore AOFAS, os ângulos intermetatársicos 1 e 2, e ângulo de valgismo do hálux. RESULTADOS: Na técnica OAEO a média no pré-operatório do AOFAS foi 46,6 pontos, AIM 14º e AVH 32º, enquanto no pós-operatório AOFAS 81,3 pontos, AIM 9º e AVH 25ºcom 92,3% de resultados satisfatórios. Na técnica OPCA a média no pré-operatório do AOFAS foi 42,1 pontos, AIM 15º e AVH 29º, enquanto no pós-operatório AOFAS 77,4 pontos, AIM 11º e AMF 23º com 81,8% de resultados satisfatórios. CONCLUSÕES: Ambas as técnicas cirúrgicas mostraram-se eficazes no tratamento do hálux valgo, clínica e radiograficamente, sem diferença estatística entre elas. Nível de evidência III, Estudo retrospectivo comparativo.OBJECTIVE: To clinically and radiographically compare the results of treatment of hallux valgus, by two addition osteotomy techniques: one using resected exostosis, and the other using a plate fixation for addition wedge. METHODS: We evaluated 24 feet of 19 patients, mean age 51.3 years, affected by hallux valgus, with a mean follow-up of 50.1 months. 13 feet underwent addition osteotomy with resected exostosis (AORE and 11 patients (11 feet underwent addition osteotomy with plate (AOP. The AOFAS score, intermetatarsal 1 and 2 angles, and hallux valgus angle were evaluated before and after surgery. RESULTS: In the AORE technique, the mean

  18. Surgical correction of hallux valgus complicated with adult-type pes plano-valgus.

    Science.gov (United States)

    Choi, Jun Young; Yoon, Hyeong Hwa; Suh, Yu Min; Suh, Jin Soo

    2017-01-01

    To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.

  19. [Clinical effects of simple hallux valgus surgery for transfer metatarsalgia].

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    Wang, X J; Bao, B X; Wei, F Y; Zhang, J Z

    2017-09-19

    Objective: To analyze the clinical effects of simple hallux valgus surgery for transfer metatarsalgia. Methods: From September 2011 to November, a total of 21 patients(30 feets)with transfer metatarsalgia of hallux valgus and underwent the simple hallux valgus surgery without lateral metatarsal shortening osteotomy In Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, were enrolled in the study.The hallux valgus angle (HVA), intermetatarsal angle (IMA) , AOFAS scale and analogue score (VAS) were measured pre-operation and a half year, one year, two years after operation.The data were measured repeatedly and analyzed with analysis of variance. Results: The mean preoperative HVA changed [(39.6±9.7), (14.2±7.9), (14.8±7.9), (13.2±6.5)°] at 6 months, 1 year and 2 years follow-up; the mean IMA decreased [(13.8±4.0), (4.5±4.3), (5.8±3.9), (5.4±4.9)°] at 6 months, 1 year and 2 years follow-up(all Phallux , AOFAS for lesser toes and VAS were improved from 58.96 to 95.42, from 84.38 to 92.04 and from 7.5 to 1.3, respectively. All the results are statistically significant(P<0.001). Conclusion: These results suggest that a simple osteotomy of the first metatarsal provides excellent outcomes with a low rate of complications when compared with the combining lateral metatarsal shortening osteotomy.

  20. Early outcomes of one-stage combined osteotomy in Legg-Calve´-Perthes disease

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    Basant Kumar Bhuyan

    2016-01-01

    Conclusions: The surgical treatment of LCPD with the best expected outcome is still a challenge. Advanced containment methods by one-stage combined osteotomy can be considered as an alternative treatment where femoral head subluxation or deformity which makes containment difficult or impossible by more conventional methods.

  1. Combined osteotomy in patients with severe Legg-Calve-Perthes disease.

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    Eamsobhana, Perajit; Kaewpornsawan, Kamolporn

    2012-10-01

    The purpose of the present study was to describe the clinical and radiographic results obtained with the combined osteotomy in patients with severe Legg-Calve-Perthes disease. During 2000 to 2010 patients with Legg-Calve-Perthes disease who intervened with combined osteotomy at Siriraj Hospital were evaluated. Clinical evaluation was categorized by Ratliff classification and radiographic evaluation was performed by Moss index, Lloyd Roberts classification and Stulberg classification. Twenty patients intervened with combined osteotomy. There were nineteen males and one female with a mean age of 7.7 years. The average follow-up was 49 months. Nine had a Catterall III and eleven had a Catterall IV. According to Herring classification, fourteen patients were Herring B and six were Herring C. In accordance with the Ratliff classification, the postoperative clinical results: fifteen good, three fair and two poor. According to Mose scale, eight patients had good results, nine had fair results and three had poor results. According to the Lloyd-Roberts classification eight patients had good results, nine had fair results and three had poor results. Based on the Stulberg classification, there were ten patients in class II, nine in class III and one in class V. The surgical treatment for severe Perthes disease with the best expected outcome is still a challenge. According to the results reported here, the combined osteotomy is safe and effective procedure for patients with severe Perthes disease in whom the femoral head cannot be contained by conventional forms of treatment.

  2. Early outcomes of one-stage combined osteotomy in Legg-Calve´-Perthes disease.

    Science.gov (United States)

    Bhuyan, Basant Kumar

    2016-01-01

    Legg-Calve´-Perthes disease (LCPD) is an idiopathic avascular necrosis of the femoral head. There are multiple approaches to the treatment of LCPD ranging from conservative management to a wide variety of surgical methods. Conservative management necessitates extreme degrees of abduction in an orthosis for a longer period of time which further jeopardize capital femoral head vascularity. Surgical containment methods are used in cases where it is desirable. Initial surgical containment methods are varus or varus-derotational osteotomy of the proximal femur or an innominate osteotomy as described by Salter and other pelvic osteotomies. The purpose of this study was to describe the early results of containment methods by one-stage combined osteotomy (femoral varus osteotomy and Salter innominate osteotomy) in patients with severe LCPD. 23 children were operated in the age group of 4-9 years for LCPD by one-stage combined osteotomy procedure between January 2005 and June 2012. There were 19 boys and 4 girls, left hip involved in 10 cases and right in 13 cases. Preoperatively, they were classified according to Catterall, Joseph's stage and lateral pillar (LP) classification. Postoperatively, clinical results were evaluated in accordance with Ratliff classification and radiological assessment was made by Mose's index, modified Stulberg classification and Epiphyseal extrusion index. Seventeen hips were Catterall group III, 6 in group IV and all had two or more "head-at-risk" signs. There were 2 patients with stage IIA, 15 were in stage IIB and 6 were in stage IIIA as classified by Joseph's stage of disease. According to LP classification, 11 patients were group B, 3 were group B/C and 9 were in group C. At an average followup of 5.4 years (range 2-9.5 years), the clinical results were good in 12, fair in 9 and poor in 2. According to Mose scale, 8 patients had good results, 13 fair results and 2 had poor results. Based on modified Stulberg classification, there were 10

  3. Surgical treatment of hallux valgus associated with flexible flatfoot during growing age.

    Science.gov (United States)

    Faldini, Cesare; Nanni, Matteo; Traina, Francesco; Fabbri, Daniele; Borghi, Raffaele; Giannini, Sandro

    2016-04-01

    During growth, hallux valgus could present associated with flatfoot. Considering the current disagreement about correction of hallux valgus during growth and the lack of reports about simultaneous correction of hallux valgus associated with flexible flatfoot, we present simultaneous treatment of both deformities during growth combining subtalar arthroeresis and SERI first metatarsal osteotomy, reporting results at an average five-year follow-up. Thirty-two children (64 feet, age range 8-12 years) affected by hallux valgus associated with flexible flatfoot underwent surgical treatment combining SERI first metatarsal osteotomy and subtalar arthroereisis with bioabsorbable endorthotic implant. Clinical evaluation was summarized with AOFAS score, and standard standing radiographs were performed. AOFAS score ranged from 86 ± 2 to 98 ± 2 (hindfoot) and from 80 ± 4 to 98 ± 2 (forefoot). HVA ranged from 21° ± 2 to 5° ± 2, IMA from 14° ± 2 to 7° ± 2, DMAA from 18° ± 2 to 2° ± 2, and Meary's angle from 162° ± 11 to 175° ± 4. Complications included one case of delayed wound healing, inflammatory skin reaction around the outlet of the percutaneous Kirschner wire in two cases, displacement of the endorthotic implant in one case, and a second surgery to replace the implant. SERI osteotomy and subtalar arthroereisis resulted in an effective, technically simple and easily combined approach, with a high rate of good results and low rate of complications at mid-term follow-up. These techniques performed simultaneously represent a viable option in case of hallux valgus associated with flexible flatfoot during growth. Nevertheless, considering the limitations of this study, we believe that a larger case series and a longer follow-up should be desirable.

  4. Combining valgus knee brace and lateral foot wedges reduces external forces and moments in osteoarthritis patients.

    Science.gov (United States)

    Jafarnezhadgero, Amir Ali; Oliveira, Anderson S; Mousavi, Seyed Hamed; Madadi-Shad, Morteza

    2018-01-01

    Osteoarthritis progression can be related to the external knee adduction and flexion moments during walking. Lateral foot wedges and knee braces have been used as treatment for osteoarthritis, but little is known about their influence on knee joint moments generated in the sagittal and frontal planes. Therefore, the aim of the present study was determine the effects of the isolated and combined use of valgus knee brace and lateral wedge foot orthotic on peak forces and moments during gait in knee osteoarthritis patients. Twenty four males (age: 62.1±2.0years) with varus alignment, symptomatic medial compartment knee osteoarthritis participated in this study. Subjects walked over ground at preferred speed in four conditions: (1) no assistive device (control); (2) using lateral wedges, (3) using knee braces, and (4) using both lateral wedges and knee braces. Ground reaction forces (GRF) and moments, as well as lower limb kinematics were recorded. Peak GRF, vertical loading rate, free moment, external knee adduction and flexion moments were compared across conditions. The concurrent use of lateral wedge and knee brace reduced the first peak GRF in the vertical (6%, p=0.002), anterior-posterior (30%, p=0.028) and medial-lateral directions (44%, p=0.029). Moreover, the use of these devices reduced the peak external knee adduction moment (25%, p=0.019), but not the external flexion moment and free moment (p>0.05). The combined use of lateral wedges and knee braces can reduce medial-lateral knee joint loading, but despite reduced peak forces in the sagittal plane, these device do not reduce joint moments. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Principles of first metatarsal osteotomies.

    Science.gov (United States)

    Nyska, M

    2001-09-01

    Summarizing all the data while choosing the suitable procedure for hallux valgus deformity leads to classification of 3 main categories, which are based on the intermetatarsal angle (Table 1). Mild deformity has less than 15 degrees intermetatarsal angle, intermediate deformity has 15 degrees to 20 degrees intermetatarsal angle, and severe deformity has more than 20 degrees [table: see text] intermetatarsal angle. Every category may be divided further into low degree of DMAA (8 degrees) or high degree of DMAA (> 15 degrees). When choosing the correct procedure, the length of the first metatarsal has to be considered. In short first metatarsals, base angular osteotomies lead to further shortening of the metatarsal. Displacement osteotomies are preferred. In mild deformity, a distal osteotomy can be performed. If a mild deformity has a high DMAA, it can be corrected by a distal rotated chevron osteotomy. Intermediate deformity with a normal DMAA can be corrected by displacement osteotomies, and high DMAA can be corrected by rotated scarf of double osteotomy, which includes a base osteotomy to correct the intermetatarsal angle and a distal osteotomy, such as Riverdin, to correct the DMAA. Severe deformity can be corrected only by angular osteotomies. Inherently, these osteotomies increase the DMAA; they can be performed only in normal DMAA. Only a base angular osteotomy and distal rotation osteotomy can correct high levels of DMAA in severe intermetatarsal angles.

  6. Treatment of Pseudoarthrosis After Minimally Invasive Hallux Valgus ...

    African Journals Online (AJOL)

    7.4% poor results (4 feet). All osteotomies healed well,. ABSTRACT. Objective: Treatment of mild and moderate hallux valgus deformities. Discussion: Minimally invasive technique enables surgeons to treat mild and moderate hallux valgus deformities with excellent and good results in the majority of patients. Nonunion of ...

  7. Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review.

    Science.gov (United States)

    Maffulli, Nicola; Longo, Umile Giuseppe; Marinozzi, Andrea; Denaro, Vincenzo

    2011-01-01

    Minimally invasive techniques for hallux valgus correction include arthroscopy, percutaneous and minimum incision surgery. In the last few decades, several techniques have been increasingly used. We performed a comprehensive search of CINAHL, Embase, Medline, HealthSTAR and the Cochrane Central Registry of Controlled Trials, from inception of the database to 4 January 2010, using various combinations of the keywords terms 'Bosch', 'PDO', 'percutaneous distal osteotomy', 'SERI', 'percutaneous', 'minimal incision', 'minimum incision', 'minimally invasive', 'less invasive', 'mini-invasive', 'hallux valgus', 'bunion', 'surgery', 'arthroscopy', 'metatarsal' 'forefoot'. Only articles published in peer reviewed journals were included in this systematic review. Several new techniques are available for minimally invasive correction of the hallux valgus. Minimally invasive correction of the hallux valgus may provide better outcome for patients who would not recover well from traditional open approaches, because of decreasing recovery and rehabilitation times, as surgical exposure and deep tissue dissection are smaller and gentler to the soft tissues. Data are lacking to allow definitive conclusions on the use of these techniques for routine management of patients with hallux valgus. Given the limitations of the current case series, especially the extensive clinical heterogeneity, it is not possible to determine clear recommendations regarding the systematic use of minimally invasive surgery for hallux valgus correction, even though preliminary results are encouraging. Studies of higher levels of evidence, concentrating on large adequately powered randomized trials, should be conducted to help answer these questions.

  8. Osteotomia valgizante de tíbia com placa "calço" de Puddu: apresentação de técnica Valgus tibial osteotomy with "wedge" plate of Puddu: technique presentation

    Directory of Open Access Journals (Sweden)

    João Luiz Ellera Gomes

    2000-09-01

    Full Text Available O objetivo do presente trabalho é apresentar os resultados iniciais, obtidos com a osteotomia valgizante de adição de tíbia, fixada com placa calço descrita por Puddu. Foram operados 29 joelhos em 27 pacientes para correção de geno-varo, sendo que, em apenas um paciente o procedimento bilateral teve objetivo profilático. O seguimento foi de 3 a 28 meses com média de 14 meses. A osteotomia proximal de tíbia foi feita de forma oblíqua iniciando na inserção distal do ligamento colateral medial em direção ao tubérculo de Gerdy. A osteotomia foi aberta e fixada com uma placa calço de Puddu. O espaço aberto da osteotomia foi preenchido por enxerto autólogo de ilíaco. A carga total era dada com 45 dias de pós-operatório. Os resultados obtidos mostraram que entre 4 a 6 meses os pacientes tiveram uma significativa melhora na sintomatologia indutora do procedimento cirúrgico. A avaliação final mostrou 27 resultados satisfatórios e apenas 2 regulares. Como conclusão essa técnica tornou a osteotomia de tíbia um procedimento reprodutível com resultados previsíveis com excelente manutenção no pós-operatorio da correção obtida no trans-operatório.The objective of this paper is to present the initial results obtained with the valgus tibial osteotomy, fixed with the wedge plate described by Puddu. This surgery was performed in 29 knees, in 27 patients, for correction of genu-varum, and as a profilatic measure in only one patient. The follow up time was from 3 to 28 months with average of 14 months. The proximal tibial osteotomy was done in an oblique way with start in the distal insertion of the colateral medial ligament and directed to the Gerby tubercle. The osteotomy was opened and fixed with a wedge plate of Puddu. The space opened by the osteotomy was filled with autologous iliac graft. Total weightbearing was allowed 45 days after surgery. The results show that in 4 to 6 months patients had a significant improvement of

  9. Single-Tooth Osteotomy Combined Wide Linear Corticotomy Under Local Anesthesia for Correcting Anterior Protrusion With Ectopically Erupted Canine.

    Science.gov (United States)

    Iskenderoglu, Nur Serife; Choi, Byung-Joon; Seo, Kyung Won; Lee, Yeon-Ji; Lee, Baek-Soo; Kim, Seong-Hun

    2017-01-01

    This article presents the alternative surgical treatments of both anterior protrusion by carrying out retraction on mandibular anterior fragment, meanwhile applying retraction force on maxilla anterior teeth and ectopically erupted canine with using platelet-rich fibrin (PRF). Anterior segmental osteotomy was combined with linear corticotomy under local anesthesia. The correction of right ectopic canine was achieved through 2 stages. First, dento-osseous osteotomy on palatal side was performed. Then second osteotomy with immediate manual repositioning of the canine with concomitant first premolar extraction was enhanced with PRF, which was prepared by centrifuging patient's blood, applied into buccal side of high canine during osteotomy. Mandibular retraction was accomplished by anterior segmental osteotomy. Single-tooth osteotomy is a more effective surgical method for ankylosed or ectopically erupted tooth in orthodontic treatment. It can reduce the total orthodontic treatment time and root resorption, 1 common complication. Significant improved bone formation was seen with the addition of PRF on noncritical size defects in the animal model. It is reasonable to think that PRF can promote bone regeneration. So early bone formation also can reduce the complication such as postoperative infection. As an alternative to anterior protrusion and ectopically erupted canine treatment, segmental osteotomy and corticotomy combined platelet-rich plasma can enhance orthodontic treatment outcome.

  10. Valgus Slipped Capital Femoral Epiphysis: Pathophysiology of Motion and Results of Intracapsular Realignment.

    Science.gov (United States)

    Kalhor, Morteza; Gharanizadeh, Kaveh; Rego, Paulo; Leunig, Michael; Ganz, Reinhold

    2018-02-01

    The purpose of this study was to report (1) a different but specific pattern of impingement in hips involved with valgus slipped capital femoral epiphysis (valgus SCFE) and (2) the results of surgical treatment using intracapsular realignment techniques. Case series. Multiple academic centers. Six patients with 8 involved hips referred for valgus alignment of proximal femoral epiphysis (valgus SCFE). Intracapsular realignment osteotomy combined with periacetabular osteotomy if needed. The clinical and radiographical results and pathophysiology of motion. Eight hips in 6 patients were treated with subcapital (5 hips) or femoral neck (3 hips) osteotomy for realignment. The medially prominent metaphysis created an inclusive impingement at the anterior acetabular wall, whereas the high coxa valga favored impacting impingement at the posterior head-neck junction. The mean preoperative epiphyseal-shaft angle of 110.5 (range 90-125 degrees) was reduced to 62 degrees (range 55-70 degrees) postoperatively. At the last follow-up, all but 1 hip were pain-free and impingement-free, with normal range of motion. One hip was replaced after repeated attempts of correction. The overall hip functional result using modified Merle d'Aubigne scoring system was excellent in 5 hips (18-16 points), good in 2 hips (16-15 points), and poor in 1 hip (6 points). Impingement in valgus SCFE deformity is specific and complex. Anatomical realignment can lead to favorable results by the restoration of normal morphology and impingement-free range of motion. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  11. Estudo retrospectivo da osteotomia de base do primeiro metatarso com tratamento do hálux valgo Retrospective study of first metatarsal base osteotomy as a treatment os hallux valgus

    Directory of Open Access Journals (Sweden)

    Helencar Ignácio

    2006-01-01

    Full Text Available Os autores avaliaram 33 pacientes (48 pés com hálux valgo moderado a grave tratados cirurgicamente com a técnica de osteotomia de base do I metatarso em cunha de adição associada a reparação de tecidos moles. Comparações correlacionando sexo, idade e parâmetros radiográficos, foram feitas pelo teste t para amostras independentes; o desvio do sesamóide foi comparado pelo teste não paramétrico de Kruskal-Wallis. Todos os pacientes responderam a um questionário no qual expressaram o grau de satisfação com o resultado final da cirurgia. 76% dos pacientes eram do sexo feminino, com idade entre 14 e 60 anos (média de 38,15 anos, com tempo médio de seguimento de 41 meses. Em relação ao sexo não houve diferença na variação radiográfica. Também não foram constatadas diferenças no pré e pós-operatório quando comparado os valores médios dos pés direito e esquerdo. A avaliação radiológica apresentou 73% de resultados excelentes e o grau de satisfação total foi de 60,7% . Não há evidência da idade média influenciar no grau de satisfação, porém acima de 60 anos todos os pacientes relataram satisfação parcial. Concluímos que o procedimento cirúrgico apresentado seja um método seguro e eficaz para o tratamento do halux valgo moderado e grave.The authors evaluated 33 patients (48 feet with moderate to severe hallux valgus, surgically treated by using a 1st metatarsal wedged base osteotomy technique associated to soft tissues repair. Comparisons correlating gender, age, and x-ray parameters were performed by using the t-test for independent samples; sesamoid deviation was compared by Kruskal-Wallis non-parametric test. All patients answered to a questionnaire in which they expressed their degree of satisfaction regarding the final results of the surgery. Seventy six per cent of patients were women between 14 and 60 years old (average 38.15 years old with an average follow-up time of 41 months. There was no

  12. The effect of gastrocnemius tightness on the pathogenesis of juvenile hallux valgus: a preliminary study.

    Science.gov (United States)

    Barouk, Louis Samuel

    2014-12-01

    Hallux valgus is the most common foot disorder associated with gastrocnemius tightness, and there is a particularly strong association with juvenile hallux valgus. This article describes an oblique windlass mechanism that can be a causative or a contributory factor in the pathogenesis of juvenile hallux valgus. This article presents a study of 108 patients who underwent a proximal gastrocnemius release and hallux valgus correction using a scarf osteotomy. We believe that assessment of gastrocnemius tightness in juvenile hallux valgus is important and that gastrocnemius lengthening should be routinely considered as part of the operative strategy. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Dentoalveolar Segmental Osteotomy Combined with Orthodontic Treatment for an Impacted and Ankylosed Upper Canine

    DEFF Research Database (Denmark)

    Aludden, Hanna Cecilia; Jensen, Thomas

    2016-01-01

    for the management of ankylosed teeth involving extraction, surgical luxation, and osteotomy followed by dentoalveolar distraction or conventional orthodontic treatment. This case report describes a 55-year-old female who was referred by her orthodontist due to an impacted and ankylosed maxillary upper left canine....... A dentoalveolar segmental osteotomy with immediate repositioning of an upper canine was performed. One year after final orthodontic treatment a satisfying occlusal and esthetic treatment outcome was obtained....

  14. Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle.

    Science.gov (United States)

    Talaat, Miriam B; Kowaleski, Michael P; Boudrieau, Randy J

    2006-12-01

    To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO). Retrospective clinical study. Fifteen client-owned dogs (18 stifle joints). Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.

  15. A comparative study on the results of the modified Ludloff osteotomy for hallux valgus deformities with minimal erosion of the metatarsophalangeal joints in rheumatoid patients versus non-rheumatoid patients.

    Science.gov (United States)

    Sung, Il-Hoon; Sung, Yoon-Kyoung; Huh, Dong-Ryul; Kim, Sung-Jae

    2015-09-01

    We aimed to compare the outcomes of joint-preserving surgery for hallux valgus deformities with minimal erosion of the metatarsophalangeal joint in rheumatoid patients with non-rheumatoid controls, and to determine the prognostic factors of recurrence in rheumatoid patients. A total of 18 rheumatoid patients (20 feet, Group I) and 35 non-rheumatoid patients (39 feet, Group II) were included. The mean follow-up was 29.6 months. Radiographic and clinical outcomes were compared. To identify the prognostic factors for recurrences in rheumatoid patients, subgroup analyses were done in Group I. Most of the outcomes showed favorable results in both groups. However, Group II had better results in hallux valgus angle (HVA) (15.9° vs. 7.9°, p hallux valgus deformities in rheumatoid forefoot deformity showed favorable results in mid-term follow-up; however, it should be warned of possible recurrent deformities.

  16. Modified biplanar chevron osteotomy.

    Science.gov (United States)

    Corte-Real, Nuno M; Moreira, Rodrigo M

    2009-12-01

    The surgical treatment of hallux valgus with an increased distal metatarsal articular angle (DMAA) should include the correction of this angle to maintain a congruent joint. The purpose of this study was to report our results with this procedure. From January 2000 until December 2006, 23 feet (13 patients) with an increased DMAA were operated upon by the same surgeon using a biplanar chevron osteotomy. The technique was modified making the plantar cut more horizontal and only removing a wedge from the dorsal cut. Clinical and radiographic evaluation was made after a mean followup of 56 months. The AOFAS score for the hallux was used and angular deformities were measured. The patients had a mean age of 51 years and were all female. A good functional result was achieved with a mean AOFAS score of 87. An improvement of the angular deformities was noted in all patients. The mean hallux valgus angle improved from 28 degrees pre-op to 14 degrees post-op, the intermetatarsal angle from 12 degrees to 7 degrees and the DMAA from 20 degrees to 7 degrees. All patients except one were satisfied with the outcome of the procedure. Minimally symptomatic AVN of the metatarsal head was observed in one foot. We conclude that this procedure is a good choice for the treatment of symptomatic hallux valgus with an increased DMAA, producing a good clinical and radiographic result.

  17. Biplanar chevron osteotomy.

    Science.gov (United States)

    Nery, Caio; Barroco, Rui; Réssio, Cibele

    2002-09-01

    Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25 degrees to 14 degrees, the first intermetatarsal angle from 12 degrees to 8 degrees and the DMAA from 15 degrees to 5 degrees. At the end of treatment, 94% of patients were classified as having grade 0 or 1 sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.

  18. Effect of Bipartite Hallucal Sesamoid on Hallux Valgus Surgery.

    Science.gov (United States)

    Park, Young Hwan; Jeong, Chan Dong; Choi, Gi Won; Kim, Hak Jun

    2017-06-01

    Bipartite hallucal sesamoids are often found in patients with hallux valgus. However, it is unknown whether bipartite hallucal sesamoids affect the results of hallux valgus surgery or not. The purpose of the present study was to evaluate the outcomes of chevron osteotomy for hallux valgus with and without bipartite hallucal sesamoid. A total of 152 patients (168 feet) treated with distal or proximal chevron osteotomy for hallux valgus constituted the study cohort. The 168 feet were divided into 2 groups: bipartite hallucal sesamoid (31 feet) and without bipartite hallucal sesamoid (137 feet). Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), tibial sesamoid position, and first metatarsal length were measured for radiographic outcomes and the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score was measured for clinical outcomes. All radiographic measurements and the AOFAS score showed significant ( P .05) were found between the 2 groups in terms of HVA, IMA, DMAA, tibial sesamoid position, metatarsal shortening, and AOFAS score on final follow-up. This study suggests that bipartite hallucal sesamoids do not affect the results of hallux valgus surgery. Level III, retrospective comparative study.

  19. Tibial rotational osteotomy for idiopathic torsion. A comparison of the proximal and distal osteotomy levels.

    Science.gov (United States)

    Krengel, W F; Staheli, L T

    1992-10-01

    A retrospective analysis was done of 52 rotational tibial osteotomies (RTOs) performed on 35 patients with severe idiopathic tibial torsion. Thirty-nine osteotomies were performed at the proximal or midtibial level. Thirteen were performed at the distal tibial level with a technique previously described by one of the authors. Serious complications occurred in five (13%) of the proximal and in none of the distal RTOs. For severe and persisting idiopathic tibial torsion, the authors recommend correction by RTO at the distal level. Proximal level osteotomy is indicated only when a varus or valgus deformity required concurrent correction.

  20. Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis.

    Science.gov (United States)

    Moyer, Rebecca; Birmingham, Trevor; Dombroski, Colin; Walsh, Robert; Giffin, J Robert

    2017-05-01

    The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17-0.52, pknee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes. Copyright © 2017. Published by Elsevier B.V.

  1. Characteristics of male adolescent-onset hallux valgus.

    Science.gov (United States)

    Young, Ki Won; Kim, Jin Su; Cho, Ju Won; Lee, Keun Woo; Park, Young Uk; Lee, Kyung Tai

    2013-08-01

    Several studies show that hallux valgus has a female preponderance and that approximately 50% of patients have an adolescent onset of deformity. However, little is known about male adolescent-onset hallux valgus. We evaluated the radiologic characteristics and the result of deformity correction in male adolescent-onset hallux valgus (MAHV). We evaluated 31 feet with MAHV that received corrective osteotomies (16 scarf, 11 distal chevron, 4 proximal chevron, and 21 Akin). The patients' mean age was 22 years. Using standard weight-bearing radiographs, we measured hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), proximal phalangeal angle (PPA), metatarsus adductus angle (MAA), and congruency, preoperatively and at an average of 21 months after surgery. We assessed the clinical outcome at follow-up with regard to patient satisfaction using the American Orthopedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal score. The mean HVA, IMA, DMAA, and PPA decreased from 28.8, 12.0, 11.9, and 6.5 degrees to 10.9, 4.2, 9.7, and 6.3 degrees, respectively (P DMAA. They also had high PPA and relatively lower IMA. Metatarsal osteotomy with lateral translation and phalangeal corrective osteotomy for MAHV was a reliable technique with successful outcomes and low complication rates. Level IV, retrospective case series.

  2. Combined effects of a valgus knee brace and lateral wedge foot orthotic on the external knee adduction moment in patients with varus gonarthrosis.

    Science.gov (United States)

    Moyer, Rebecca F; Birmingham, Trevor B; Dombroski, Colin E; Walsh, Robert F; Leitch, Kristyn M; Jenkyn, Thomas R; Giffin, J Robert

    2013-01-01

    To test the hypothesis that a custom-fit valgus knee brace and custom-made lateral wedge foot orthotic will have greatest effects on decreasing the external knee adduction moment during gait when used concurrently. Proof-of-concept, single test session, crossover trial. Biomechanics laboratory within a tertiary care center. Patients (n=16) with varus alignment and knee osteoarthritis (OA) primarily affecting the medial compartment of the tibiofemoral joint (varus gonarthrosis). Custom-fit valgus knee brace and custom-made full-length lateral wedge foot orthotic. Amounts of valgus angulation and wedge height were tailored to each patient to ensure comfort. The external knee adduction moment (% body weight [BW]*height [Ht]), frontal plane lever arm (cm), and ground reaction force (N/kg), determined from 3-dimensional gait analysis completed under 4 randomized conditions: (1) control (no knee brace, no foot orthotic), (2) knee brace, (3) foot orthotic, and (4) knee brace and foot orthotic. The reduction in knee adduction moment was greatest when concurrently using the knee brace and foot orthotic (effect sizes ranged from 0.3 to 0.4). The mean decrease in first peak knee adduction moment compared with control was .36% BW*Ht (95% confidence interval [CI], -.66 to -.07). This was accompanied by a mean decrease in frontal plane lever arm of .59cm (95% CI, -.94 to -.25). These findings suggest that using a custom-fit knee brace and custom-made foot orthotic concurrently can produce a greater overall reduction in the knee adduction moment, through combined effects in decreasing the frontal plane lever arm. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Management of Metatarsus Adductus, Bean-Shaped Foot, Residual Clubfoot Adduction and Z-shaped Foot in Children, with Conservative Treatment and Double Column Osteotomy of the First Cuneiform and the Cuboid

    Directory of Open Access Journals (Sweden)

    Hassan Najdi

    2015-10-01

    Full Text Available Metatarsus adductus is a deformity located at Lisfranc’s joint in a pure transverse plane. It is spontaneously corrected for the majority of newborns. In rare toddler cases, it demonstrates a clinical stiffness and results in Z-shaped foot, where valgus of the heel creates equilibration of resistant metatarsus adductus. Although, recurrent metatarsus adductus varus is observed in treated idiopathic clubfeet, usually in children over three years, but presence of heel's valgus is related to the surgical overcorrection of the heel’s varus. Conservative treatment is advocated in flexible metatarsus adductus. Surgery is performed after conservative treatment fail, and in walking patient. Soft tissue releases, osteotomies of metatarsals and lateral epiphysiodesis of the metatarsal base gave good results on short term, but deformity recurrence and foot growth disturbance couldn't be avoided. Although, osteotomies carried out proximal to the Lisfranc's joint: opening wedge osteotomy of medial cuneiform, calcaneocuboid fusion and the anterior resection of calcaneus, gave permanent correction, but they act only on one of the sides of deformity. Therfore, the theory of elongated lateral column associated with a shortened medial column is crucial in dealing with this deformity: combining opening wedge osteotomy of cuneiform with closing wedge osteotomy of cuboid described by Jawish et al. in children after 4 years allows in all causes of metatarsus adductus stiffness a lateral shifting of forefoot. Concerning the associated heel’s valgus, it is corrected in Z-shaped foot after the double osteotomy cuneiform/ cuboid. However, in complicated treated clubfoot a particular treatment for the posterior tarsal is necessary.

  4. Hallux valgus surgery affects kinematic parameters during gait.

    Science.gov (United States)

    Klugarova, Jitka; Janura, Miroslav; Svoboda, Zdenek; Sos, Zdenek; Stergiou, Nicholas; Klugar, Miloslav

    2016-12-01

    The aim of our study was to compare spatiotemporal parameters and lower limb and pelvis kinematics during the walking in patients with hallux valgus before and after surgery and in relation to a control group. Seventeen females with hallux valgus, who underwent first metatarsal osteotomy, constituted our experimental group. The control group consisted of thirteen females. Kinematic data during walking were obtained using the Vicon MX system. Our results showed that hallux valgus before surgery affects spatiotemporal parameters and lower limb and pelvis kinematics during walking. Hallux valgus surgery further increased the differences that were present before surgery. Specifically after hallux valgus surgery, the walking speed decreased even more (p=0.09, η(2)=0.19) while step time increased (p=0.002, η(2)=0.44) on both legs. The maximum ankle plantar flexion of the operated leg during toe-off decreased to a greater extend (p=0.03, η(2)=0.26). The asymmetry in the hip and the pelvis movements in the frontal plane (present preoperatively) persisted after surgery. Hallux valgus is not an isolated problem of the first ray, which could be just surgically addressed by correcting the foot's alignment. It is a long-term progressive malfunction of the foot affecting the entire kinematic chain of the lower extremity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Supramalleolar Osteotomies.

    Science.gov (United States)

    Chopra, Varun; Stone, Paul; Ng, Alan

    2017-10-01

    Distal tibial malalignment can result from posttraumatic malunion, physeal disturbances, congenital or metabolic diseases, and degenerative arthritis. Malalignment leads to an altered load distribution across the joint leading to early ankle joint arthritis. If a substantial part of the joint is salvageable, ankle fusion or joint replacement is not always the best option. Realignment of the distal tibia with a joint-sparing supramalleolar osteotomy is a valuable procedure in correcting deformity at the distal tibia. The goal of a supramalleolar osteotomy is to restore axial alignment. Several studies have demonstrated the successes of the osteotomy in improving function and relieving pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Mandibular atrophy and metabolic bone loss. Mandibular ridge augmentation by combined sandwich-visor osteotomy and resorption related to metabolic bone state

    NARCIS (Netherlands)

    Bras, J.; van Ooij, C. P.; van den Akker, H. P.

    1985-01-01

    22 edentulous women, 11 with and 11 without signs of metabolic bone loss were treated by a combined sandwich-visor osteotomy. Longitudinal studies showed a higher rate of resorption in women with radiographic signs of metabolic bone loss. The analysis was based upon lateral cephalometry

  7. Mandibular atrophy and metabolic bone loss. Mandibular ridge augmentation by combined sandwich-visor osteotomy and resorption related to metabolic bone state. A 5-year follow-up

    NARCIS (Netherlands)

    Habets, L. L.; Bras, J.; van den Akker, H. P.; Borgmeyer-Hoelen, A. M.; van Ooij, C. P.

    1987-01-01

    92 patients, 31 with and 61 without signs of metabolic bone loss, were treated with a combined sandwich-visor osteotomy. A 5-year follow-up showed a significantly higher rate of resorption in patients with radiographic signs of metabolic bone loss. The analysis was based upon lateral cephalometry

  8. Dentoalveolar Segmental Osteotomy Combined with Orthodontic Treatment for an Impacted and Ankylosed Upper Canine

    DEFF Research Database (Denmark)

    Aludden, Hanna Cecilia; Jensen, Thomas

    2016-01-01

    Ankylosis is the abnormal adhesion of alveolar bone to dentin or cementum and commonly seen after traumatic dental injuries. Treatment of impacted and ankylosed teeth solely by orthodontics alignment may be challenging. Consequently, several treatment alternatives have been proposed for the manag......Ankylosis is the abnormal adhesion of alveolar bone to dentin or cementum and commonly seen after traumatic dental injuries. Treatment of impacted and ankylosed teeth solely by orthodontics alignment may be challenging. Consequently, several treatment alternatives have been proposed...... for the management of ankylosed teeth involving extraction, surgical luxation, and osteotomy followed by dentoalveolar distraction or conventional orthodontic treatment. This case report describes a 55-year-old female who was referred by her orthodontist due to an impacted and ankylosed maxillary upper left canine...

  9. Sex-related differences in outcomes after hallux valgus surgery.

    Science.gov (United States)

    Choi, Gi Won; Kim, Hak Jun; Kim, Tae Wan; Lee, Ji Wun; Park, Sung Bum; Kim, Jin Kak

    2015-03-01

    With differences between the sexes in foot bone anatomy and ligamentous laxity, there is the possibility that the results of hallux valgus surgery may also differ between the sexes. We aimed to compare the results of hallux valgus surgery between the sexes. The authors retrospectively reviewed 60 males (66 feet) and 70 females (82 feet) who underwent distal or proximal chevron osteotomy for the treatment of hallux valgus deformity between June 2005 and December 2011. We compared the clinical and radiologic outcomes between the sexes. There were no statistically significant differences in demographics between the sexes. The mean American Orthopedic Foot and Ankle Society score, visual analogue scale for pain, and patient satisfaction at the last follow-up did not differ significantly between the sexes. The mean preoperative hallux valgus angle (HVA) and inter-metatarsal angle (IMA) were not significantly different between the sexes. At the last follow-up, the mean HVA was significantly greater in females (p=0.003) than in males; mean IMA was not significantly different between the sexes. The mean correction of HVA in males was significantly greater than that in females (p=0.014). There were no significant differences between the sexes regarding clinical outcomes after distal and proximal chevron osteotomy. However, male patients achieved greater correction of HVA than female patients. There is a possibility that sexual dimorphism of the foot may affect postoperative HVA.

  10. Coronal patellar osteotomy of the external facet combined with the release of the lateral retinaculum improves the clinical outcomes of isolated lateral release in lateral knee compartment syndrome.

    Science.gov (United States)

    Rosales-Varo, A P; Roda-Murillo, O; Prados-Olleta, N; García-Espona, M A

    2016-01-01

    To describe a novel coronal osteotomy of the external facet of the patella, and to evaluate if the outcomes of the treatment of lateral knee compartment syndrome (LKCS) with this osteotomy, combined with the release of the external lateral retinaculum, are better than the isolated lateral retinacular release. A prospective study with a 2 year follow up that included 70 patients diagnosed with LKCS, distributed into 2 groups. The first group included 50 patients on whom the lateral retinacular release combined with osteotomy was performed, and a second group on whom an isolated retinacular release was performed. Measurements were made using the Werner functional scale before the surgery and at 3, 12, and 24 months follow-up. There were significant differences in the overall functional state between the two groups after the surgery (better in the osteotomy group at all the intervals, P<.05). The improvement, which was progressive up to 12 months, was slightly less at 24 months, although the values were still better than the pre-surgical ones in both groups. Pain was the variable that showed most improvement. The patients with LKCS with degenerative signs showed a benefit in all cases. The results demonstrate that the described patellar osteotomy technique, combined with lateral retinacular release, significantly improves the pain and the functional scale score of patients with LKCS after 2 years of follow-up, to a greater extent than isolated lateral retinacular release, including those in which there was evidence of degenerative signs. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Multi-centered Comparison of Patient Reported Outcomes After Hip Arthroscopy versus Combined Hip Arthroscopy Alone and Peri-acetabular Osteotomy in Patients with Acetabular Dysplasia

    OpenAIRE

    Domb, Benjamin G.; Kenney, Raymond James; Cook, Christopher; Lareau, Justin M.; Childs, Sean; Chaharbakhshi, Edwin; Giordano, Brian D.

    2017-01-01

    Objectives: The purpose of this study was to compare prospectively collected patient reported outcomes (PRO) data in patients undergoing Hip Arthroscopy alone versus combined Hip Arthroscopy and Peri-acetubular Osteotomy (HA/PAO). Methods: Prospectively collected PRO data was reviewed in patients enrolled in IRB approved studies at two high volume hip preservation centers who underwent either Hip Arthroscopy alone or combined HA/PAO. Patients were included who had a lateral center edge angle

  12. Osteotomia da base do I metatarsal no tratamento do hálux valgo moderado e grave: resultados após seguimento médio de oito anos Osteotomy of the 1st metatarsal base on the treatment of moderate to severe hallux valgus after mean follow-up time of 8 years

    Directory of Open Access Journals (Sweden)

    Marco Túlio Costa

    2009-06-01

    to severe hallux valgus with osteotomy of the first metatarsal base associated to distal release of soft parts and medial capsuloplasty. METHODS: 13 patients were assessed (15 feet submitted to surgical treatment of hallux valgus moderate to severe. The mean follow-up time was 102 months; there were 12 female and 1 male patients, with mean age at the time of surgery of 49 years. The patients enrolled were interviewed according to the questionnaire developed by our service, clinically examined according to the AOFAS scale and submitted to X-ray tests for comparing the results with baseline images. RESULTS: The mean score of the AOFAS scale obtained at the final assessment was 82 points. Nine of the 15 feet (60% showed some late complications, with four (27% varus deformities, three (20% recurrences; two patients (13% presenting with pain complaints with no associated deformity. In the hallux metatarsophalangeal joint, movement loss was 41º (57%; dorsiflexion movement was mostly affected, with a mean loss of 37º (60%. The range of motion on the contralateral intact side served as control group. Arthrosis progression was seen on the final X-ray evaluation. In all cases, shortening and lifting of the first metatarsal were noticed; however, we couldn't correlate the shortening and lifting with metatarsalgia, plant callosity or lower scoring on the AOFAS scale at the final evaluation. CONCLUSIONS: The osteotomy technique by the basis and with distal realignment of soft parts employed in the treatment of moderate to severe hallux valgus showed a high rate of late complications. Due to the high number of complications, we believe that adopting this technique for correcting hallux valgus deformities should be carefully considered.

  13. Combined use of alveolar distraction osteogenesis and segmental osteotomy in anterior vertical ridge augmentation.

    Science.gov (United States)

    Öncü, Elif; Isik, Kubilay; Alaaddinoğlu, E Emine; Uçkan, Sina

    2015-01-01

    Vertical defects of the anterioral veolar ridge are challenging cases in implant dentistry. Various techniques, such as onlay bone grafting, segmental osteotomy (SO) oral veolar distraction osteogenesis (ADO), have been suggested to manage those situations. ADO has an advantage of being capable of enhancing both hard and soft tissue simultaneously. One of the possible complications of ADO is rotation ortilting the transport segment (TS). In this report, we present a 30-year old woman who had a severe anterior vertical deficiency. ADO was started to manage the case, but advancement of the TS lagged on the left side and the segment rotated. A SO was planned and the lagged side was corrected. Two years after the surgery, hard and soft tissue gains were found to be preserved. Vertical alveolar bone deficiencies are challenging cases for dental implantology. Alveolar DO promotes soft tissue along with hard tissue, and the bone regeneration process and shows lower infection rates and greater stability over the long term. However, the technique has some disadvantages and can lead to complications, such as breaking of the distraction device, nerve injury or paresthesia, fracture of transport bone, hematoma, wound dehiscence, severe bleeding, and even jaw fractures. Deviation of the TS from the distraction path is another undesired situation. The rigidity of the device, the width of the mucosa, the volume of the transport and anchor segments, and the amount of augmentation can affect vector deviation. We suggest that SO can be used in similar cases in which TS could not be distracted on a straight vector line. Copyright © 2015. Published by Elsevier Ltd.

  14. Stability Following Combined Maxillary and Mandibular Osteotomies Treated with Rigid Internal Fixation.

    Science.gov (United States)

    1987-06-01

    combined two-jaw surgical procedures through Improved oral hygiene, nutritional maintenance, early mandibular mobilization and masticatory function ...better oral hygiene, and resuming masticatory function sooner and more efficiently.11-13 In summary, stability following combined double-jaw procedures was...healing, early to immediate restoration of function by shortening or eliminating intermaxllilary fixation, and simultineously curtailing postoperative

  15. Short- and long-term changes of condylar position after bilateral sagittal split ramus osteotomy for mandibular advancement in combination with Le Fort I osteotomy evaluated by cone-beam computed tomography.

    Science.gov (United States)

    Chen, Shuo; Lei, Jie; Wang, Xing; Fu, Kai-Yuan; Farzad, Payam; Yi, Biao

    2013-11-01

    Bilateral sagittal split ramus osteotomy (BSSO) may change condylar position, which can be one of the factors contributing to skeletal relapse. This study evaluated short- and long-term changes in condylar position using cone-beam computed tomography (CBCT) and investigated changes in temporomandibular joint (TMJ) signs after BSSO for mandibular advancement in combination with Le Fort I osteotomy. Thirty-one patients were included, and CBCT data of 62 TMJs were collected before surgery (T0), immediately after surgery (T1), 3 months after surgery (T2), and at the last follow-up at 12.1 ± 3.0 months after surgery (T3). The relation of the condyle to the fossa was evaluated by the method of Pullinger and Hollender (Oral Surg Oral Med Oral Pathol 62:719, 1986). Clinical examination, with a special focus on signs of temporomandibular disorder (TMD), was documented at T0, T2, and T3. Repeated-measures analysis of variance (P = .05) and χ2 test (P = .05) were performed. Data of 27 patients were used for statistical analysis. Values from the formula of Pullinger and Hollender changed significantly with time, but there was no significant difference between the right and left condyles. Condyles moved inferoposteriorly immediately after surgery (T0 to T1) followed by anterosuperior movement 3 months after surgery (T1 to T2). The superimposed effect showed posterosuperior movement compared with the initial position before surgery (T0 to T2) and this position remained stable at 1-year follow-up (T2 to T3). A decrease of TMD signs over time, from 22.6% (T0) to 12.9% (T2) and 9.7% (T3), was observed, which showed no statistical significance. There were obvious changes in condylar position after BSSO in combination with Le Fort I osteotomy. Condyles tended to be located in a concentric position in relation to the glenoid fossa 3 months after surgery and remained stable during the 1-year follow-up. These changes did not cause an increase of TMD signs. Copyright © 2013 American

  16. [Distal soft-tissue procedure in hallux valgus deformity].

    Science.gov (United States)

    Arbab, D; Wingenfeld, C; Frank, D; Bouillon, B; König, D P

    2016-04-01

    Distal, lateral soft tissue release to restore mediolateral balance of the first metatarsophalangeal (MTP) joint in hallux valgus deformity. Incision of the adductor hallucis tendon from the fibular sesamoid, the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Hallux valgus deformities or recurrent hallux valgus deformities with an incongruent MTP joint. General medical contraindications to surgical interventions. Painful stiffness of the MTP joint, osteonecrosis, congruent joint. Relative contraindications: connective tissue diseases (Marfan syndrome, Ehler-Danlos syndrome). Longitudinal, dorsal incision in the first intermetatarsal web space between the first and second MTP joint. Blunt dissection and identification of the adductor hallucis tendon. Release of the adductor tendon from the fibular sesamoid. Incision of the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. Postoperative management depends on bony correction. In joint-preserving procedures, dressing for 3 weeks in corrected position. Subsequently hallux valgus orthosis at night and a toe spreader for a further 3 months. Passive mobilization of the first MTP joint. Postoperative weight-bearing according to the osteotomy. A total of 31 patients with isolated hallux valgus deformity underwent surgery with a Chevron and Akin osteotomy and a distal medial and lateral soft tissue balancing. The mean preoperative intermetatarsal (IMA) angle was 12.3° (range 11-15°); the hallux valgus (HV) angle was 28.2° (25-36°). The mean follow-up was 16.4 months (range 12-22 months). The mean postoperative IMA correction ranged between 2 and 7° (mean 5.2°); the mean HV correction was 15.5° (range 9-21°). In all, 29 patients (93%) were satisfied or very satisfied with the postoperative outcome, while 2 patients (7%) were not satisfied due to one delayed wound healing and one recurrent hallux valgus deformity. There were no

  17. Nasal osteotomies: a cadaveric study of fracture lines.

    Science.gov (United States)

    Gabra, Nathalie; Rahal, Akram; Ahmarani, Christian

    2014-01-01

    The different nasal osteotomy patterns used to perform rhinoplasty are poorly described in the literature, and there is a continuous debate between surgeons on the ideal sequence and technique to obtain desired results. (1) To evaluate the necessity of a paramedian osteotomy when performing a high-low-high (HLH) osteotomy, (2) to study the fracture pattern of a high-low-low (HLL) osteotomy when combined with a paramedian osteotomy in the presence and in the absence of a transverse osteotomy, and (3) to evaluate the mobility of the central segment (located between the paramedian osteotomies) after digital pressure and the ideal osteotomy to mobilize it if needed. This was a prospective cadaveric study performed in the dissection laboratory in our tertiary referral center. Twenty cadavers were divided in 2 groups of 10. Group A had a paramedian osteotomy combined with an HLH osteotomy on 1 side and an HLH osteotomy alone on the other side. Group B had a paramedian combined with a transverse osteotomy followed by HLL osteotomy on 1 side. On the other side, we performed a paramedian combined with an HLL osteotomy. Finally, we evaluated the mobility of the central segment in group B, first with digital manipulation and then with a transverse osteotomy. The 3 authors evaluated individually the different fracture patterns. A result was considered successful when (1) the fracture followed the desired pattern, (2) a continuous line was obtained, and (3) a complete mobilization of the nasal segment was visualized. In group A, the side without a paramedian osteotomy had more unstable and greenstick fractures than the other side (P Digital manipulation alone was not enough to mobilize the central segment in 8 of the 10 cadavers studied. Following this study we make the following suggestions: (1) to perform a paramedian osteotomy when an HLH osteotomy is needed, (2) to perform a transverse osteotomy before an HLL osteotomy when combined with paramedian osteotomy, and (3) to

  18. Smith–Petersen osteotomy combined with anterior debridement and allografting for active thoracic and lumbar spinal tuberculosis with kyphotic deformity in young children

    Science.gov (United States)

    Abulizi, Yakefu; Liang, Wei-Dong; Maimaiti, Maierdan; Sheng, Wei-Bin

    2017-01-01

    Abstract The purpose of this study is to determine the efficacy and safety of Smith–Petersen osteotomy combined with anterior debridement and allogenic strut bone grafting for the treatment of active thoracic and lumbar spinal tuberculosis with kyphotic deformity in young children. Spinal tuberculosis is more destructive in young children and often causes severe kyphosis and paraplegia. Despite much progress has been made, surgical treatment is still controversial and technically challenging. From October 2010 to August 2014, 25 children (11 males, 14 females; aged under 6 years) with active thoracic and lumbar spinal tuberculosis treated by Smith–Petersen osteotomy combined with anterior debridement and allogenic strut bone grafting were enrolled in this study. The pre- and postoperative data, follow-up medical records, imaging studies, and laboratory data were collected prospectively. Clinical outcomes were evaluated on the basis of kyphotic angle and the Frankel motor score system. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms, and complications were investigated. Graft fusion was evaluated using the Bridwell grading criteria. The mean age was 3.5 ± 1.76 years (range, 1–6 years). All patients were followed up for 25 to 45 months (average, 34.3 ± 5.86 months). The average kyphotic angle was changed significantly from a preoperative value of 44.1 ± 10.8° to a postoperative value of 11.4 ± 3.9°, with an average correction rate of 74% (P spinal tuberculosis, Smith–Petersen osteotomy combined with anterior debridement and allogenic strut bone grafting is a safe and simple procedure to achieve sufficient kyphosis correction, good neurological recovery, and reliable anterior column reconstruction. PMID:28796043

  19. Results of Lindgren-Turan Operation in Hallux Valgus

    Directory of Open Access Journals (Sweden)

    İstemi YÜCEL,

    2010-05-01

    Full Text Available Purpose: We evaluated the results of the Lindgren-Turan operation in the treatment of halluxvalgus.Methods: 24 feet of 18 patients were operated by the Lindgren-Turan osteotomy. Radiological,functional and pain assessments were applied to all patients.Results: Treatment produced a statistically highly significant difference in the hallux valgusangle and 1.-2.intermetatarsal angle (p0.001. Themean subjective evaluations of the patients were 8.43±0.72.Conclusion: We conclude that Lindgren-Turan osteotomy which revealed successful results onpain, deformity correction and bone healing and also provided high personal satisfaction, is areliable technique in the surgical correction of hallux valgus

  20. Hallux valgus angle as main predictor for correction of hallux valgus

    Science.gov (United States)

    Deenik, Axel R; de Visser, Enrico; Louwerens, Jan-Willem K; Malefijt, Maarten de Waal; Draijer, Frits F; de Bie, Rob A

    2008-01-01

    Background It is recognized that different types of hallux valgus exist. Classification occurs with radiographic and clinical parameters. Severity of different parameters is used in algorithms to choose between different surgical procedures. Because there is no consensus about each parameter nor their cut-off point we conducted this study to analyze the influence of these variables on the postoperative hallux valgus angle. Methods After informed consent 115 patients (136 feet) were included. Bunionectomy, osteotomy, lateralization of the distal fragment, lateral release and medial capsulorraphy were performed in all patients. Data were collected on preoperative and postoperative HVA, IMA and DMAA measurements. Forty cases were included since our findings in a previous article [1], therefore, current data concern an expanded study group with longer follow-up and were not published before. At least two-year follow-up data were evaluated with logistic regression and independent t-tests. Results Preoperative HVA was significant for prediction of postoperative HVA in logistic regression. IMA and DMAA were not significant for prediction of postoperative HVA in logistic regression, although they were significantly increased in larger deformities. In patients with preoperative HVA of 37 degrees or more, satisfactory correction could be obtained in 65 percent. The other nine of these 26 patients developed subluxation. Conclusion The preoperative HVA was the main radiological predictor for correction of hallux valgus, correction rate declined from preoperative HVA of 37. IMA and DMAA did have a minor role in patients with preoperative HVA lower than 37 degrees, however, likely contributed to preoperative HVA of 37 degrees or more. PMID:18482455

  1. Hallux valgus angle as main predictor for correction of hallux valgus

    Directory of Open Access Journals (Sweden)

    Malefijt Maarten

    2008-05-01

    Full Text Available Abstract Background It is recognized that different types of hallux valgus exist. Classification occurs with radiographic and clinical parameters. Severity of different parameters is used in algorithms to choose between different surgical procedures. Because there is no consensus about each parameter nor their cut-off point we conducted this study to analyze the influence of these variables on the postoperative hallux valgus angle. Methods After informed consent 115 patients (136 feet were included. Bunionectomy, osteotomy, lateralization of the distal fragment, lateral release and medial capsulorraphy were performed in all patients. Data were collected on preoperative and postoperative HVA, IMA and DMAA measurements. Forty cases were included since our findings in a previous article 1, therefore, current data concern an expanded study group with longer follow-up and were not published before. At least two-year follow-up data were evaluated with logistic regression and independent t-tests. Results Preoperative HVA was significant for prediction of postoperative HVA in logistic regression. IMA and DMAA were not significant for prediction of postoperative HVA in logistic regression, although they were significantly increased in larger deformities. In patients with preoperative HVA of 37 degrees or more, satisfactory correction could be obtained in 65 percent. The other nine of these 26 patients developed subluxation. Conclusion The preoperative HVA was the main radiological predictor for correction of hallux valgus, correction rate declined from preoperative HVA of 37. IMA and DMAA did have a minor role in patients with preoperative HVA lower than 37 degrees, however, likely contributed to preoperative HVA of 37 degrees or more.

  2. Increased Incidence and Severity of Postoperative Radiographic Hallux Valgus Interphalangeus With Surgical Correction of Hallux Valgus.

    Science.gov (United States)

    Dixon, Alexis E; Lee, Lydia C; Charlton, Timothy P; Thordarson, David B

    2015-08-01

    A previous study has shown an increased radiographic prevalence and severity of hallux valgus interphalangeus (HVIP) after surgical correction of hallux valgus (HV) due to correction of pronation deformity. The purpose of this study was to evaluate the change in pre- and postoperative HVIP deformity with correction of HV with multiple radiographic parameters. A retrospective chart review identified all bunion surgeries performed at a single center from July 1, 2009, to September 30, 2012. Exclusion criteria included prior bony surgery to the first ray, inadequate films, nonadult bunion, Akin osteotomy, or surgical treatment other than bunion correction. Pre- and postoperative films were reviewed for 2 HV angular measurements and 5 HVIP measurements, which were compared. The angles measured were hallux valgus angle (HVA), first intermetatarsal angle (IMA), hallux interphalangeus angle (HIA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), proximal to distal phalangeal articular angle (PDPAA), and total distal deformity (TDD). Prevalence of HVIP was analyzed in pre- and postoperative radiographs. A 1-sided Student t test was used to compare continuous data, and a chi-square test was used to compare categorical data. Ninety-two feet in 82 patients were eligible. The average preoperative HV improved with surgery. Preoperative HVA improved from 27 to 11 degrees (P DMAA worsened from 7.3 to 9.2 degrees (P = .001). PPAA worsened from 3.2 to 6.2 degrees. PDPAA worsened from 6.7 to 8.2 degrees (P < .001). The TDD increased from 14.6 to 17.9 degrees (P < .001). The prevalence of HVIP pre- and postoperatively as defined by HIA increased from 26% to 79% (P < .001) and by PPAA from 12% to 46% (P < .001). Initial assessment of preoperative radiographs underestimated HVIP. Postoperative correction of the deformity revealed HVIP that was not obvious preoperatively. Level III, retrospective comparative series. © The Author(s) 2015.

  3. Pediatric hallux valgus.

    Science.gov (United States)

    Chell, Julian; Dhar, Sunil

    2014-06-01

    Hallux valgus in children is a relatively uncommon deformity, also known by several other names such as juvenile or adolescent bunion, metatarsus primus varus, and metatarsus primus adductus. The presence of an open growth plate is considered by most to be part of the definition of this condition. However, others include patients up to age 20 years, owing to the plastic nature of the various components of the condition. The presenting complaint is invariably of the bunion and its cosmetic appearance. Treatment should be conservative and surgery avoided till skeletal maturity is achieved due to the high incidence of recurrence in children. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. [The profile surgery. Mandibular osteotomies].

    Science.gov (United States)

    Sancho, M A; Grande, C; Parri, F J; Rivera, A; Sarget, R; Morales, L

    1996-04-01

    During the years 1987-1994, 31 mandibular osteotomies have been performed in 25 patients, 15 had mandibular alteration alone, 10 of them with prognatism, 2 with microretrognatia and 3 with chin hipoplasia. The other 10 had a combined maxillary-mandibular alteration with hipoplasia and maxillary retrussion. The preoperative work-up included cephalometric and dental study, and a cast model was done to asses the theoretical benefic of the osteotomy. All these patients underwent orthodontic treatment before and after surgery. The results have been good or very good in 96% of the cases. The ortognatic surgery offers significant aesthetic and functional improvement to these patients.

  5. Reanalysis of Agelietti Procedure (A Method of Corrective Supracondylar Femoral Osteotomy

    Directory of Open Access Journals (Sweden)

    Sharat Agarwal

    2012-04-01

    Full Text Available Objective: Supracondylar femoral osteotomy is the time tested method, used for correcting the angular (varus & valgus deformities at the knee. Traditionally, Coventry type of osteotomy where a medial or lateral based wedge of bone is removed or an open wedge osteotomy is made & the space filled with bone graft, is done to achieve the desired correction. This osteotomy is subsequently stabilized with Kirschner wires or plates & screws. Later the limb is externally supported in brace or plaster cast. Here we present a case series of 10 cases, where we have analyzed the efficacy of Aglietti procedure, as a method of femoral supracondylar osteotomy for correcting the valgus deformity at the knee. Methods: Ten valgus adolescent knees were operated in 7 patients by following the Aglietti procedure for correcting the angular deformity at the knee. The results were analyzed taking into consideration the operating time, blood loss during surgery estimated by the number of surgical mops used, stability of the osteotomy in the post-operative period & ultimate range of motion (ROM obtained at the end of 6 months after the surgery. Results: The average age of patients dealt with was 12.6 years (n=7 with females predominating (n=5 against 2 males. The average time was 47.5 minutes. The average size of the surgical mops used was 15x20 cms. Surgical mops used per patient were 1.6. The average range of flexion achieved at the end of 6 months after surgery was 131.45 degrees ( Rounded average to a measurable value being 131 degrees. Conclusion: In our case series we found Aglietti procedure as an effective method to correct the valgus deformity in adolescent knees. Supracondylar femoral osteotomies are not only for varus an valgus corrections; this osteotomy is used as well for rotation correction and flexion and extension correction, mainly in CP patients. But we used the Agelietti procedure for the correction of angular deformities(varus/valgus in patients of

  6. Outcomes of Combined Shelf Acetabuloplasty with Femoral Varus Osteotomy in Severe Legg-Calve-Perthes (LCP) Disease: Advanced Containment Method for Severe LCP Disease.

    Science.gov (United States)

    Lim, Kyung Sup; Shim, Jong Sup

    2015-12-01

    Standard treatments may provide adequate containment in mild to moderate Legg-Calve-Perthes disease (LCPD), but they can be problematic in more severe cases. The purpose of this study was to report the results of combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD. We reviewed 12 patients who had undergone combined shelf acetabuloplasty with femoral varus osteotomy. The indications for this type of operation were: (1) above 8 years of age at clinical onset; (2) massive femoral epiphysis involvement (Catterall group 4, lateral pillar C); (3) femoral head lateral subluxation on the anteroposterior radiograph; and (4) impending hinged abduction on preoperative magnetic resonance imaging or arthrography. The mean age was 9.3 years (range, 8 to 10.8 years). The patients were clinically evaluated with Iowa hip score and leg length discrepancy at the final follow-up. Radiographic outcome was assessed using the Stulberg classification to evaluate femoral head sphericity. The presence of osteoarthritis was evaluated by the Tonnis classification. Correlation analysis was conducted to analyze the preoperative factors that were strongly associated with patients' outcomes. The mean follow-up period was 10.1 years (range, 7.1 to 13.2 years). Functional grade was excellent in all patients at last follow-up (mean, 92; range, 82 to 99). The mean leg length discrepancy after skeletal maturity was 0.9 cm (range, 0 to 1.7 cm). There were no significant complications or need for additional surgery. Radiographically, 92% of patients reached satisfactory outcomes: Stulberg grade I, 0 cases; Stulberg grade II, 4 cases (34%); Stulberg III, 7 cases (58%), Stulberg IV, 1 case (8%); and Stulberg V, 0 cases. There was no osteoarthritis by Tonnis classification. The surgical outcomes for combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD patients over 8 years old are comparable with other advanced surgical methods. In the cases of severe disease

  7. Combined tibial plateau levelling osteotomy and tibial tuberosity transposition for treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation.

    Science.gov (United States)

    Leonard, Katherine C; Kowaleski, Michael P; Saunders, William B; McCarthy, Robert J; Boudrieau, Randy J

    2016-11-23

    To describe the surgical technique and report short-term outcome for combined tibial plateau levelling osteotomy and tibial tuberosity transposition (TPLO-TTT) as an option in the treatment of cranial cruciate ligament insufficiency with concomitant medial patellar luxation. Medical records were reviewed (2011-2013) of dogs that underwent a standard tibial plateau levelling osteotomy followed by a tibial tuberosity transposition in the frontal plane and stabilized with pin and tension-band wire fixation as a component of surgical treatment for combined cranial cruciate ligament insufficiency and medial patellar luxation. Signalment, fixation method together with any ancillary procedures, function at the in-hospital follow-up examinations, and any complications were recorded. Healing was assessed retrospectively based on the grading criteria of the International Society Of Limb Salvage. Fifteen stifle joints in 11 dogs were identified; 13 stifles were available for in-hospital follow-up. All 13 achieved union (3 with grade III/IV and 10 with grade IV/IV radiographic healing scores); mean time to healing was 10.6 (± 2.9) weeks. Patellar ligament thickening was also identified radiographically in seven of the 13 of stifle joints. All dogs were reported to have mild or no lameness at their last follow-up examination. No catastrophic or major postoperative complications occurred that required additional surgery. Patellar re-luxation did not occur in any of the 13 stifles available for in-hospital follow-up. The TPLO-TTT was found to be a reliable and effective technique when used as a part of the treatment of combined cranial cruciate ligament insufficiency with concomitant medial patellar luxation in this series of dogs.

  8. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs.

    Science.gov (United States)

    Kim, Stanley E; Pozzi, Antonio; Kowaleski, Michael P; Lewis, Daniel D

    2008-02-01

    To review the biomechanical considerations, experimental investigations, and clinical data pertaining to tibial osteotomy procedures for treatment of cranial cruciate ligament (CrCL) insufficiency in dogs. Literature review. Literature search through Pub Med, Veterinary Information Network, Commonwealth Agricultural Bureau Abstracts, and conference proceedings abstracts (November 1977 to March 2007). Reported tibial osteotomy procedures attempt to eliminate sagittal instability (cranial tibial thrust) in CrCL-deficient stifles by altering the conformation of the proximal tibia. Functional stability can be achieved by decreasing the tibial plateau slope (cranial tibial closing wedge osteotomy [CTWO], tibial plateau leveling osteotomy [TPLO], combined TPLO and CTWO, proximal intraarticular osteotomy, chevron wedge osteotomy), altering the alignment of the patellar tendon (tibial tuberosity advancement), or both (triple tibial osteotomy). Clinical reports assessing the efficacy of these procedures frequently use subjective outcome measures, and the periods of follow-up evaluation are highly variable. Satisfactory results have been reported in most (>75%) dogs irrespective of the type of tibial osteotomy procedure. Currently available data does not allow accurate comparisons between different tibial osteotomy procedures, or with traditional methods of stabilizing the CrCL-deficient stifle. Carefully designed long-term clinical studies and further biomechanical analyses are required to determine the optimal osteotomy technique, and whether these procedures are superior to other stabilization methods. Limb function in dogs with CrCL insufficiency can be improved using the currently described tibial osteotomy techniques.

  9. Saare Jazz toob valguse augustipimedusse

    Index Scriptorium Estoniae

    2009-01-01

    22. augustil Saaremaal Pidula Forelli puhkekülas toimuvast esimesest Saare Jazzist alapealkirjaga "Valgus pimeduses", peaesinejaks laulja Sofia Rubina koos ansambliga Club Eclectic, soojendusesinejaks laulja Teele Viira ja erikülaliseks Soome trompetist Kalevi Louhivuori, esinejatest

  10. Efficacy of Bilateral Simultaneous Hallux Valgus Correction Compared to Unilateral.

    Science.gov (United States)

    Boychenko, Anton Viktorovich; Solomin, Leonid Nikolaevich; Parfeyev, Sergey Gennadievich; Obukhov, Ilya Esatovich; Belokrylova, Maria Sergeevna; Davidov, Denis Vladimirovich

    2015-11-01

    Hallux valgus affects up to 29% of adults and can be bilateral in 84% of cases. Contemporary surgical techniques provide the possibility of simultaneous bilateral correction, but still there is no consensus on whether staged or simultaneous correction should be performed if both feet are involved. The aim of the present study was to report our experience of treatment of patients with hallux valgus and to perform comparative analysis of results obtained from unilateral and simultaneous bilateral surgical correction. Data on 60 feet (40 patients) with hallux valgus that underwent surgery between 2010 and 2013 using scarf osteotomy and lateral soft tissue release were analyzed. Unilateral correction was performed in 30 feet (25 patients) and bilateral correction in 30 feet (15 patients). The patients from both groups were admitted to hospital for 7 days. Functional assessment (American Orthopaedic Foot & Ankle Society [AOFAS] score) and radiographic examination (intermetatarsal and hallux valgus angles) were performed preoperatively and at 6, 12, and 24 months after the procedure. Comparative analysis between groups with bilateral and unilateral correction was carried out. At 24 months after surgery in the bilateral and unilateral groups, the mean AOFAS score was 86 ± 6.2 and 86 ± 6.9 (P > .05), the mean intermetatarsal angle was 8.4 ± 0.5 and 8.8 ± 0.8 degrees (P > .05), and the mean metatarsophalangeal angle was 13.0 ± 1.2 and 13.0 ± 0.9 degrees (P > .05), respectively. According to the data obtained, simultaneous bilateral correction had the same functional and radiographic results as unilateral surgery. Level III, case series. © The Author(s) 2015.

  11. A radiographic analysis of the contribution of hallux valgus interphalangeus to the total valgus deformity of the hallux.

    Science.gov (United States)

    Strydom, Andrew; Saragas, Nikiforos Pandelis; Ferrao, Paulo Norberto Faria

    2017-03-01

    The hallux valgus interphalangeus (HVI) deformity is described as rare, but improved outcomes in hallux valgus (HV) surgery is associated with its surgical correction via an Akin osteotomy. The hypothesis of this study is that HVI is common and makes a significant contribution to the total valgus deformity of the hallux (TVDH). 285 pre-operative foot radiographs (193 with HV, 92 non-HV), utilising standardised radiographic and measurement techniques, were analysed retrospectively. The hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA) and distal metatarsal articular angle (DMAA) were measured. The TVDH was calculated as the sum of the HVA and IPA. 163 (57.2%) of the study population were Caucasian, 119 (41.8%) African and 3 Indian (1.0%). 236 (82.8%) of the population was female. There was a statistically significant difference in the proportion of abnormal IPA in the Caucasian population 112 (68.7%) compared to the proportion of abnormal IPA in the African population 64 (53.8%), p=0.01. The average contribution of the IPA to the TVDH across the whole study population was a mean (SD) of 37.9% (21.2). The average contribution of IPA to TVDH was greater in feet without HV (58.0%) when compared to feet with HV (28.3%). HVI is common, particularly in Caucasians (p=0.01) and makes a significant contribution to the TVDH (p<0.01). The contribution to the TVDH is more significant in mild HV. There is an inverse relationship between the IPA and other angular measurements in the foot. HVI is a common entity. The significant contribution of the IPA to the TVDH dictates that HVI must be incorporated in management algorithms. The TVDH should replace the isolated concepts of HV and HVI. Level III, retrospective cohort. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  12. Treatment of Hallux Valgus with Hyaluronic Acid: A Pilot Study

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    Ižlhan Sezer

    2017-05-01

    Full Text Available Aim: Hallux valgus is the deformity of the first metatarsophalangeal (MTP joint with abduction and valgus rotation of the great toe, combined with a medially prominent first metatarsal head. Hyaluronic acid injection has been used in the treatment of degenerative disorders of several joints successfully. In this research, we aimed to investigate the effectiveness of hyaluronic acid injection in patients with hallux valgus. Material and Method: Eleven female and two male patients with hallux valgus were included in this pilot study. Only patients with mild and moderate hallux valgus were included in the study. 1 cc hyaluronic acid was injected into the affected MTF joint three times, at one-week intervals. Visual analogue scale(VAS score, walking time without pain, walking distance, and daily analgesic needs of the patients were recorded. All clinical outcomes were assessed before, and then one and three months after the first injection. Results:The mean VAS score was 83.08±4.58. One month after the first injection, VAS scores of patients had decreased significantly (30±4.38, P: 0.001. Also, increased walking time and distance and decreased daily analgesic need were observed at the first month of postinjection follow-up (P: 0.001. After 3 months, the positive outcomes remained significant compared to preinjection evaluations. Discussion: According to our preliminary results, we suggest thathyaluronic acid injectionsmay be effective in reducing pain and increasing walking time and distance in patients with hallux valgus.Future studies are needed to clarify the beneficial effects of hyaluronic acid injection in patients with hallux valgus.

  13. A retrospective study of 63 hallux valgus corrections using the osteodesis procedure.

    Science.gov (United States)

    Wu, Daniel Yiang

    2015-01-01

    Osteotomy procedures have been the most popular approach to hallux valgus deformity correction. Soft tissue approaches have, in general, been regarded as ineffective for moderate and severe hallux valgus deformities. Osteodesis is a soft tissue technique that has been shown to be effective in the past but is still seldom practiced. In the present report, we describe a retrospective study of 63 hallux valgus feet in 36 patients who had undergone the osteodesis procedure. Their mean age was 46 ± 12 years, and the mean follow-up period was 25.4 ± 9.6 months. The surgical technique consisted of metatarsus primus varus deformity correction by intermetatarsal cerclage sutures and hallux valgus deformity correction by rebalancing the ligaments. The first metatarsophalangeal angle improved from a mean of 32.5° ± 7.6° preoperatively to 18.4° ± 7° postoperatively, the first intermetatarsal angle improved from 14.6° ± 2.6° to 6.8° ± 1.8°, and the American Orthopaedic Foot and Ankle Society score improved from 59 ± 14 to 93 ± 8 points. The rate of patient satisfaction after surgery was 92% (33 of 36 patients, 59 of 63 feet). The complications included a second metatarsal stress fracture in 3 feet (5%), metatarsophalangeal joint medial subluxation in 3 feet (5%), and metatarsophalangeal joint stiffness in 5 feet (8%). This soft tissue, nonosteotomy procedure was a safe technique that effectively corrected hallux valgus and metatarsus primus varus deformities of various severities without osteotomy or fusion. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  14. The Kalish osteotomy. A review and retrospective analysis of 265 cases.

    Science.gov (United States)

    Kalish, S R; Spector, J E

    1994-05-01

    One hundred seventy-two patients (265 feet) were reviewed following correction of hallux abducto valgus surgery, using the Kalish modification of the Austin bunionectomy. Fifty-three cases were followed up on an average of 2.5 years from 1986 through 1992. The statistical results support the use of this osteotomy with rigid internal fixation for the reduction of the intermetatarsal angle, hallux abductus angle, and tibial sesamoid position. Patients are weightbearing immediately and are usually back in soft shoes or sneakers 2 weeks after surgery. Surgical techniques and complications of this procedure are discussed to help surgeons use this procedure in correcting hallux abducto valgus deformities.

  15. Triple Pelvic Osteotomy and Double Pelvic Osteotomy.

    Science.gov (United States)

    Guevara, Francisco; Franklin, Samuel P

    2017-07-01

    Triple and double pelvic osteotomy (TPO, DPO) are performed with the goal of increasing acetabular ventro-version, increasing femoral head coverage, and decreasing femoral head subluxation. Since the first descriptions of TPO, there have been modifications in technique, most notably omission of the ischial osteotomy for DPO, and improvements in the implants, including availability of locking TPO/DPO bone plates. Associated complication rates seem to have declined accordingly. The most salient questions regarding these procedures remain what selection criteria should be used to identify candidates and whether halting or preventing osteoarthritis is necessary to consider these surgeries clinically beneficial. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Prevalence of Metatarsus Adductus in Symptomatic Hallux Valgus and Its Influence on Functional Outcome.

    Science.gov (United States)

    Loh, Bryan; Chen, Jerry Yongqiang; Yew, Andy Khye Soon; Chong, Hwei Chi; Yeo, Malcolm Guan Hin; Tao, Peng; Yeo, Nicholas Eng Meng; Koo, Kevin; Rikhraj Singh, Inderjeet

    2015-11-01

    Metatarsus adductus (MA) increases the risk of developing symptomatic hallux valgus (HV). This study aimed to determine the prevalence of MA in patients with symptomatic HV and to evaluate how it affected the functional outcome after scarf osteotomy. Between January 2007 and June 2012, a total of 206 patients who underwent scarf osteotomy for symptomatic HV at a tertiary hospital were included. The metatarsus adductus angle (MAA) was determined using the Modified Sgarlato method, and these patients were categorized into 2 groups: MA (MAA > 20 degrees); and Control (MAA ≤ 20 degrees). The patients were prospectively followed for 2 years. The prevalence of MA was 33% (68/206) with a mean MAA of 24 ± 4 degrees (range = 20-39). There was a 21 ± 12 degrees and 18 ± 9 degrees improvement in hallux valgus angle for the MA and Control groups, respectively (P = .061), whereas there was a 6 ± 4 degrees and 6 ± 3 degrees improvement in intermetartarsal angle for the MA and Control groups, respectively (P = .475). The visual analog scale, AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale, and Physical and Mental Component Scores were comparable between the 2 groups both preoperatively and at 2 years' follow-up (all P > .05). Two patients in the control group required revision surgery for recurrence symptomatic HV. The authors conclude that MA did not predispose the patient to poorer functional outcome after scarf osteotomy with the advent of good operative techniques. Level II, prospective comparative study. © The Author(s) 2015.

  17. Plantar pressure characteristics in hallux valgus feet.

    Science.gov (United States)

    Koller, Ulrich; Willegger, Madeleine; Windhager, Reinhard; Wanivenhaus, Axel; Trnka, Hans-Joerg; Schuh, Reinhard

    2014-12-01

    Due to the pathoanatomical changes in hallux valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the hallux is decreased during push-off. We assessed loading parameters in hallux valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, hallux valgus-, distal metatarsal articulation-angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed® system during level walking. We found negative correlations between hallux valgus angle and peak pressure in the great toe (r=-0.301, phallux (r=-0.481, phallux (r=-0.232, phallux valgus angle, and sesamoid subluxation, load shows significant lateral transmission in hallux valgus feet. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  18. Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time

    NARCIS (Netherlands)

    van Egmond, N.; Hannink, G.; Janssen, D.; Vrancken, A.C.; Verdonschot, N.; van Kampen, A.

    2017-01-01

    Purpose: The objective of this study was to investigate the effect of a medial open-wedge osteotomy (OWO) and the release of the superficial medial collateral ligament (MCL) on the tibiofemoral cartilage pressure, the MCL tension and the valgus laxity of the knee. Methods: Seven fresh-frozen, human

  19. Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time

    NARCIS (Netherlands)

    Egmond, N. van; Hannink, G.J.; Janssen, D.W.; Vrancken, A.C.; Verdonschot, N.J.; Kampen, A. van

    2017-01-01

    PURPOSE: The objective of this study was to investigate the effect of a medial open-wedge osteotomy (OWO) and the release of the superficial medial collateral ligament (MCL) on the tibiofemoral cartilage pressure, the MCL tension and the valgus laxity of the knee. METHODS: Seven fresh-frozen, human

  20. Patella height changes post high tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Siew Ghim Gooi

    2017-01-01

    Full Text Available Background: Medial opening wedge high tibial osteotomy (HTO is a well-described treatment in early medial compartmental osteoarthritis of the knee. However, two undesirable sequelae may follow –patella baja and changes in the posterior tibial slope (TS. Materials and Methods: We conducted a retrospective study in patients who underwent HTO in our center between September 2009 and February 2017. Preoperative and 6-week postoperative long-leg weight bearing films and lateral knee radiographs were assessed. Pre- and postoperative radiological measurements include the Caton-Deschamps Index (CDI, the mechanical axis deviation (MAD, and the posterior TS. Independant t-test and Pearson correlation test were performed. Results: A total of 106 knees were recruited. The mean age was 48.8 ± 10.8 years. 66 (62.3% and 40 (37.7% knees were from males and females, respectively. The mean pre- and postoperative measurements was (−9.70° ± 3.67° to 0.08° ± 2.80° (−varus; +valgus for the MAD, (7.14° ± 1.78° to 8.72° ± 3.11° for posterior TS, and (0.93° ± 0.084° to 0.82° ± 0.13° for CDI (P ≤ 0.001 for all. The association between patella height change and the level of osteotomy (supra-tubercle vs. infra-tubercle was statistically significant (P < 0.001. A supra-tubercle osteotomy cut significantly lowering patella height (P = 0.011. There was otherwise no statistically significant correlations between patella height changes and the correction angle (P = 0.187 or posterior TS change (P = 0.744. Conclusions: A medial opening wedge HTO above the tibial tubercle was significantly associated with lowering patella height or reducing CDI postoperatively. Based on our results, we would recommend the use of an infra-tubercle osteotomy during the corrective surgery to prevent the complication of patella baja.

  1. Osteotomy for treating knee osteoarthritis

    NARCIS (Netherlands)

    R.W. Brouwer (Reinoud); T.M. van Raaij (Tom); S.M. Bierma-Zeinstra (Sita); A.P. Verhagen (Arianne); T.S. Jakma (Tijs); J.A.N. Verhaar (Jan)

    2007-01-01

    textabstractBackground: Patients with unicompartmental osteoarthritis of the knee can be treated with a correction osteotomy. The goal of the correction osteotomy is to transfer the load bearing from the pathologic to the normal compartment of the knee. A successful outcome of the osteotomy relies

  2. Combining a joint health supplement with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture. An exploratory controlled trial

    Directory of Open Access Journals (Sweden)

    Filippo M. Martini

    2017-12-01

    Full Text Available Canine cranial cruciate ligament rupture (CrCLR is a very common pathology. Surgical stabilization is the first choice treatment, although it does not fully eliminate the increased risk of osteoarthritis. This preliminary study was carried out to explore whether a newly formulated joint health supplement would benefit metabolic, clinical and radiographic changes in dogs with CrCLR surgically treated with tibial plateau leveling osteotomy (TPLO. Besides chondroitin sulfate and glucosamine hydrochloride, the studied supplement contained anti-inflammatory and antioxidant ingredients, the main ones being N-palmitoyl-D-glucosamine (Glupamid® and quercetin. It was thus intended to target not only chondrodegenerative components of osteoarthritis, but also post-injury inflammatory response and oxidative stress of joint tissues. Thirteen dogs underwent TPLO and were randomly allocated to treatment (n = 6 and control groups (n = 7, the former receiving the joint supplement for 90 days. Lameness and radiographic osteoarthritis changes were scored before (i.e., baseline and at 30 and 90 days post-surgery. Synovial fluid samples were collected from injured stifles at the same time points. Levels of representative metabolites were measured by proton nuclear magnetic resonance spectroscopy in a blinded fashion. In the metabolomic analysis, special attention was paid to lactate, due to its emerging recognition as a key marker of inflammation. In the last time period (from the 30th to the 90th day, lameness improved by a factor of 2.3 compared to control dogs. No significant difference was observed in the radiographic osteoarthritis score between groups. In the first postoperative month, lactate and creatine levels significantly dropped in treated compared to control dogs. Compared to surgery alone, combining the joint supplement with TPLO resulted in a trend to a better clinical outcome in the later time interval but did not influence

  3. Radiographic Evaluation of Intermetatarsal Angle Correction Following First MTP Joint Arthrodesis for Severe Hallux Valgus.

    Science.gov (United States)

    McKean, R Matthew; Bergin, Patrick F; Watson, Geoffrey; Mehta, Siddhant K; Tarquinio, Thom A

    2016-11-01

    Arthrodesis is a standard operative treatment for symptomatic arthritis of the first metatarsophalangeal (MTP) joint. Patients with degenerative joint disease (DJD), severe hallux valgus, and metatarsus primus varus may also require fusion of the first MTP joint. An important question in the latter group of patients is whether a proximal first metatarsal osteotomy is required, in addition to the first MTP joint fusion. Our hypothesis was that patients with severe hallux valgus and metatarsus primus varus, treated with first MTP joint arthrodesis alone, would have correction of the first-to-second intermetatarsal angle (1-2 IMA) and hallux valgus angle (HVA) to near population norms, without the addition of a proximal first metatarsal osteotomy. Preoperative and postoperative radiographs of 19 feet, in 17 patients, with preoperative IMA greater than 15 were analyzed. Weight-bearing radiographs were divided into pre- and postoperative cohorts. Three independent reviewers measured these radiographs and mean 1-2 IMA and HVA were calculated. Mean follow-up was 10 months. The mean preoperative 1-2 IMA was 19.2 degrees (15.6-24.3). The mean preoperative HVA was 48.5 (36-56.6). The mean postoperative values for 1-2 IMA and HVA were 10.8 and 12.3 degrees, respectively. The mean change in IMA was 8.3 degrees and in the hallux valgus angle was 36.4 degrees. The differences between pre- and postoperative measurement for both angles were statistically significant (P < .001). Seven of 19 (37%) feet were corrected to an IMA of less than 9 degrees (normal), whereas in 15/19 feet the postoperative IMA was 12.3 degrees or less. The postoperative HVA was less than 15 degrees in 15/19 (79%) feet. This pre- and postoperative radiographic analysis of patients with severe bunion deformity demonstrated that HVA and 1-2 IMA were acceptably corrected without the addition of a proximal first metatarsal osteotomy. Level III, retrospective comparative series. © The Author(s) 2016.

  4. Tibial osteotomy - slideshow

    Science.gov (United States)

    ... GO GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Tibial osteotomy - series—Normal anatomy URL of this page: //medlineplus.gov/ency/presentations/ ...

  5. Radiographic Outcomes of Postoperative Taping Following Hallux Valgus Correction.

    Science.gov (United States)

    Ponzio, Danielle Y; Pedowitz, David I; Verma, Kushagra; Maltenfort, Mitchell G; Winters, Brian S; Raikin, Steven M

    2015-07-01

    Traditionally, hallux valgus operative correction has been accompanied by serial spica taping of the great toe during the postoperative period. We retrospectively reviewed 187 adult patients who underwent proximal first metatarsal osteotomy with a modified McBride procedure in 2008-2009 (n = 83) and 2011-2012 (n = 104). Postoperatively, to maintain the corrected position of the hallux, patients from 2008 through 2009 underwent weekly spica taping, while patients from 2011 through 2012 utilized a toe separator. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured using anteroposterior weight-bearing preoperative, 2-week postoperative non-weight-bearing, and 3-month weight-bearing final follow-up radiographs. A mixed-effects linear regression model identified differences between the treatment groups over time, and a t test compared actual radiographic differences at final follow-up. The mixed-effects model revealed no significant difference in the HVA over time when comparing patients taped to those not taped at the preoperative (33 ± 6 vs 33 ± 6), 2-week postoperative (10 ± 7 vs 9 ± 6), and 3-month follow-up (14 ± 6 vs 11 ± 7) visits (P = .08). At final follow-up, the HVA was lower for the group that was not taped, but the difference (2.5 degrees) was below the minimal clinically important difference (MCID) (P = .015, 95% CI 0.5-4.5). For IMA, there was improved maintenance of correction over time in the patients that were not taped compared to those taped at the preoperative (15 ± 3 vs 15 ± 3), 2-week postoperative (2 ± 2 vs 3 ± 3), and 3-month follow-up (5 ± 4 vs 7 ± 4) visits (P = .002). At final follow-up, the IMA was lower for the group that was not taped, but the difference (1.7 degrees) was below the MCID (P = .004, 95% CI 0.7-2.9). We report no radiographic benefit of postoperative taping after hallux valgus correction. The present study challenges the previous dogma of postoperative spica taping as the protocol is cost and

  6. Acute ischemia after revision hallux valgus surgery leading to amputation.

    Science.gov (United States)

    Goforth, W David; Kruse, Dustin; Brantigan, Charles O; Stone, Paul A

    2013-01-01

    Acute arterial insufficiency after revision hallux valgus surgery is a rare complication. The identification of surgical candidates who are at risk of vascular complications is of utmost importance. The patient-reported symptoms and physical findings combined with noninvasive vascular studies are generally reliable to assess the vascular status but can fail to identify patients with atypical disease patterns. We present the case of a patient with normal pulses who underwent revision hallux valgus surgery, leading to gangrene of the hallux that required transmetatarsal amputation. We reviewed the vascular evaluation methods and causes of acute ischemia after surgery, including vasculitis. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application

    Science.gov (United States)

    Seo, Jeong-Ho; Boedijono, Dimas

    2016-01-01

    Purpose The aim of this study was to investigate new point-connecting measurements for the hallux valgus angle (HVA) and the first intermetatarsal angle (IMA), which can reflect the degree of subluxation of the first metatarsophalangeal joint (MTPJ). Also, this study attempted to compare the validity of midline measurements and the new point-connecting measurements for the determination of HVA and IMA values. Materials and Methods Sixty feet of hallux valgus patients who underwent surgery between 2007 and 2011 were classified in terms of the severity of HVA, congruency of the first MTPJ, and type of chevron metatarsal osteotomy. On weight-bearing dorsal-plantar radiographs, HVA and IMA values were measured and compared preoperatively and postoperatively using both the conventional and new methods. Results Compared with midline measurements, point-connecting measurements showed higher inter- and intra-observer reliability for preoperative HVA/IMA and similar or higher inter- and intra-observer reliability for postoperative HVA/IMA. Patients who underwent distal chevron metatarsal osteotomy (DCMO) had higher intraclass correlation coefficient for inter- and intra-observer reliability for pre- and post-operative HVA and IMA measured by the point-connecting method compared with the midline method. All differences in the preoperative HVAs and IMAs determined by both the midline method and point-connecting methods were significant between the deviated group and subluxated groups (p=0.001). Conclusion The point-connecting method for measuring HVA and IMA in the subluxated first MTPJ may better reflect the severity of a HV deformity with higher reliability than the midline method, and is more useful in patients with DCMO than in patients with proximal chevron metatarsal osteotomy. PMID:26996576

  8. Biomechanical comparison of two alternative tibial plateau leveling osteotomy plates with the original standard in an axially loaded gap model: an in vitro study.

    Science.gov (United States)

    Kloc, Paul A; Kowaleski, Michael P; Litsky, Alan S; Brown, Nancy O; Johnson, Kenneth A

    2009-01-01

    To compare the axial compression stiffness of osteotomized canine tibiae stabilized with Slocum, Securos, or Synthes plates after a tibial plateau leveling osteotomy (TPLO) procedure. In vitro, paired comparison of cadaveric tibial constructs subjected to mechanical testing under an axial load. Canine tibiae (n=16 pairs) from skeletally mature male and female dogs of various breeds (18-55 kg). Tibial pairs (n=16) were randomly assigned to 1 of 2 study cohorts (n=8 pairs/cohort): cohort 1, tibial osteotomy stabilization with a Slocum or a Securos plate, or cohort 2, tibial osteotomy stabilization with a Slocum or a Synthes plate. One tibia from each pair was stabilized with 1 of each plate design assigned to the cohort after TPLO. A 3.2 mm osteotomy gap was maintained during plate application in all constructs. Load and axial displacement were recorded while constructs were loaded to 2000 N in axial compression. Failure loads were not reported because no distinct yield point or failure point was evident within the load range for many specimens. Failure modes were recorded for each construct, and photographs of typical failures were obtained. Stiffness (N/mm) was calculated from load-displacement curves. Paired comparisons of mean stiffness were performed within study groups using a paired t-test. Significance was set at P<.05. The mean construct stiffnesses for the Slocum (383+/-183 N/mm) and Securos (258+/-64.1 N/mm) constructs were not significantly different (P=.164; power=0.566). The mean construct stiffness for the Synthes constructs (486+/-91.0 N/mm) was significantly greater than that of the Slocum constructs (400+/-117 N/mm); P=.0468. Modes of failure for the Slocum (16/16) and Securos (8/8) constructs included plastic deformation of the implant with valgus deformity combined with fibular luxation (2/16 Slocum; 1/8 Securos) or fibular fracture (2/16 Slocum; 4/8 Securos). Most Synthes constructs underwent elastic deformation (7/8). One Synthes construct

  9. Korrekturosteotomie bei lateraler Tibiakopfimpression und Valgusfehlstellung == Correction of lateral tibial plateau depression and valgus malunion of the proximal tibia

    NARCIS (Netherlands)

    Marti, René K.; Kerkhoffs, Gino M. M. J.; Rademakers, Maarten V.

    2007-01-01

    OBJECTIVE: Improvement of joint congruency in malunited lateral tibial plateau fractures, reduction of pain, prevention of osteoarthritis. INDICATIONS: Valgus malalignment of the proximal tibia combined with intraarticular depression of the tibial plateau. CONTRAINDICATIONS: Patients in poor general

  10. Valgus ümber kodu / Madis Tross

    Index Scriptorium Estoniae

    Tross, Madis

    2003-01-01

    Thorn Lighting Eesti filiaali juhataja Aivar Simmermann ja firma Moodne Valgustus projektijuht Ahto Kallas aia kujundamisest valguse abil. Soovitusi välisvalgustite valikuks ja ökonoomseks kasutamiseks

  11. Combined Femoral and Acetabular Osteotomy in Children of Walking Age for Treatment of DDH; A Five Years Follow-Up Report

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    Mahdi Mazloumi

    2015-01-01

    Full Text Available Background: The prevalence of neglected developmental dysplasia of the hip (DDH has been decreasing. Nowadays, the disease is rarely seen in walking age children. The purpose of this study is to assess the results of simultaneous osteotomy of femur and pelvic bones in such children. Method: We performed a retrospective study on 30 children aged 3.8±0.9 (range: 1.5-7 years old, with DDH who underwent surgical operation in our hospital from August 2001 to September 2006. Tönnis and Severin grading systems were used to classify the radiographic status of the hip in pre- and postoperative era, respectively. Improvement in function and limp was also evaluated by the modified McKay’s classification. Results: From the 30 cases, six patients excluded in the course of the study and among the remaining patients, 12 had bilateral involvement. The mean follow-up period was 7.6±0.8 (range: 5.1-11.3 years. During the last visit, radiographic status of the operated joints, according to Severin classification was as follows: Class I: 12 patients; Class II: 20 patients; Class III: 3 patients; Class IV: 1 patient; and Class VI: 1 patient. Conclusion: Although through the follow-up, two hips subluxated, necrosis happened in three and one joint was re-dislocated, simultaneous femoral and innominate osteotomy in the walking age children with DDH has relatively good clinical outcomes.

  12. Effectiveness of Headless Bioabsorbable Screws for Fixation of the Scarf Osteotomy.

    Science.gov (United States)

    Kim, Jin Su; Cho, Hun Ki; Young, Ki Won; Lee, Sang Young; Kim, Ji Soo; Lee, Kyoungtae

    2016-11-01

    Scarf osteotomy has been used in hallux valgus surgery due to its large fixation surface for screws and low postoperative complications. However, screws may cause skin irritation from their head, which may require an additional surgical procedure to remove. This study included 115 patients (106 females and 9 males, 115 feet) who underwent hallux valgus correction with a scarf osteotomy using bioabsorbable screws between September 2010 and September 2012. Preoperative and postoperative 1-month and 1-year radiographic measurements, including intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), and lateral translational distance (LTD), were obtained. American Orthopaedic Foot & Ankle Society (AOFAS) hallux/forefoot scores were used for patient satisfaction. Preoperative mean values of HVA, IMA, and PPA of 32.8 degrees, 14.6 degrees, and 7.52 degrees, respectively, improved to 10.7 degrees, 6.0 degrees, and 4.6 degrees, respectively at 1-year follow up (P < .05). The difference in LTD between the 1-month and 1-year follow-up was not statistically significant. AOFAS hallux/forefoot score improved from 69.1 to 96.1 at the 1-year follow up (P < .001). Complete screw absorption was not seen radiographically. Sixteen feet had complications reported. One patient complained of skin irritation over a small protrusion of the screw, and another patient had a foreign body reaction. There were 3 patients with neurologic injury from a popliteal block and 3 patients with dorsal cutaneous nerve symptoms. Four feet had metatarsal fracture during surgery. We found the scarf osteotomy using bioabsorbable screws to have satisfactory clinical and radiographic results with a low complication rate. Level IV, case series. © The Author(s) 2016.

  13. SURGICAL TREATMENT OF HALLUX VALGUS AND ITS POSSIBLE COMPLICATIONS (REVIEW

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    E. P. Sorokin

    2011-01-01

    Full Text Available Hallux valgus surgery remains the most important direction of modern orthopedics. In this article authors analyzed the history of Hallux valgus surgical treatment development observing the details of different types of methods directing on various pathogenic parts of pathology as well as complications occurring with different types of methods. Main tendencies of development and improvements of hallux valgus surgery are described.

  14. Adolescent hallux valgus: a systematic review of outcomes following surgery.

    Science.gov (United States)

    Harb, Ziad; Kokkinakis, Michail; Ismail, Hiba; Spence, Gavin

    2015-04-01

    The management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV. A comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar and PubMed. The study was performed in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographic data, radiographic parameters and results of validated clinical scoring systems were analysed. The published literature on AHV is largely heterogeneous and retrospective. Nine contemporary studies reporting on 140 patients (201 osteotomies) were included. The female to male ratio was 10:1. The mean age at operation was 14.5 years (range 10.5-22). The mean follow-up was 41.6 months (range 12-134). The mean post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score was 85.8 (standard deviation, SD ±7.38). The mean AOFAS patient satisfaction showed that 86 % (SD ±11.27) of patients were satisfied or very satisfied with their outcome. On the duPont Bunion Rating Score (BRS), 90 % rated their outcome as good or excellent. There was a statistically significant improvement in the inter-metatarsal angle (IMA, p = 0.0003), hallux valgus angle (HVA, p DMAA, p = 0.019). Based on the most current published evidence, contemporary surgical interventions for AHV show excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is a need for high-level, multi-centre collaborative studies with prospective data to

  15. Correction of midface hypoplasia using a novel trapezoidal osteotomy.

    Science.gov (United States)

    Li, Wenyang; Khadka, Ashish; Hu, Jing; Wang, Dazhang; Wang, Qiushi; Li, Jihua

    2012-05-01

    Currently, investigating an optimal method to deal with midface hypoplasia has become a significant issue in the field of facial aesthetic surgery. Traditional ways to address this problem primarily include segmental osteotomies and using autogenous bone or cartilage grafts or synthetic implants. For the patients with paranasal hypoplasia but without malocclusion, autogenous bone grafts or implants are recommended. However, some of these patients have a flattened nose and protrusive malar, especially in the Eastern Asian; the nose will seem more flattened after augmentation the paranasal area. Hence, osteotomy is necessary in these patients to bring the flattened nose forward to get a more satisfying contour of the midface. We propose a novel osteotomy through the application of model surgery to solve the problem of midface hypoplasia combined with flattened nose but without malocclusion. When compared with other techniques, this novel method not only allows the augmentation to be performed on a broader scale composed of different segments of the midface skeleton, but also results in a lower surgical risk and maintenance of the stability of occlusion. This novel osteotomy can bring the premaxilla in combination with the nasal bone forward to solve the problem of midface hypoplasia combined with flattened nose in patients with normal occlusion. Through simultaneous augmentation of the different segments of the midface through this novel osteotomy, a more pleasing contour of the midface in all 3 dimensions can be achieved.

  16. Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities

    Science.gov (United States)

    Smith, Kathryn E.; Dupont, Kenneth M.; Safranski, David L.; Blair, Jeremy; Buratti, Dawn; Zeetser, Vladimir; Callahan, Ryan; Lin, Jason; Gall, Ken

    2016-01-01

    Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within. PMID:28337049

  17. High tibial closing wedge osteotomy for medial compartment osteoarthrosis of knee

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    Tuli S

    2008-01-01

    Full Text Available Background: Most patients of symptomatic osteoarthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment of osteoarthrosis of the knee. Materials and Methods: Between 1996 and 2004 we performed closing wedge osteotomy in 78 knees in 65 patients. The patients selected for osteotomy were symptomatic essentially due to medial compartment osteoarthrosis associated with moderate genu varum. Of the 19 patients who had bilateral symptomatic disease 11 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Preoperative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA rating scale. Results: At a minimum follow-up of 2 years (range 2-9 years 6-10° of valgus correction at the site of osteotomy was maintained, there was significant relief of pain while walking, negotiating stairs, squatting and sitting cross-legged. Walking distance in all patients improved by two to four times their preoperative distance of 200-400 m. No patient lost any preoperative knee function. The mean JOA scoring improved from preoperative 54 (40-65 to 77 (55-85 at final follow-up. Conclusion: Closing wedge high tibial osteotomy performed by our technique can be undertaken in any setup with moderate facilities. Operation related complications are minimal and avoidable. Kirschner wire fixation is least likely to interfere with replacement surgery if it becomes necessary.

  18. Extreme femoral valgus and patella dislocation following lateral plate fixation of a pediatric femur fracture.

    Science.gov (United States)

    Ezzat, Ahmed; Iobst, Christopher

    2016-07-01

    A 15-year-old boy presented with a 35° femoral valgus deformity, leg-length discrepancy, painful retained hardware, and a lateral dislocation of the patella 4 years after undergoing lateral plate fixation of a distal femur fracture. Femoral valgus is a possible complication of lateral plate fixation in up to 30% of pediatric distal femur fractures. With this patient's unusual combination of deformities as an example, we suggest early hardware removal after fracture union to prevent the development of deformity. If plate removal is not chosen, then continued close monitoring of the patient is necessary until skeletal maturity.

  19. Association of Metatarsalgia After Hallux Valgus Correction With Relative First Metatarsal Length.

    Science.gov (United States)

    Nakagawa, Satoru; Fukushi, Jun-Ichi; Nakagawa, Takeshi; Mizu-Uchi, Hideki; Iwamoto, Yukihide

    2016-06-01

    Metatarsalgia is frequently associated with hallux valgus. The aim of this study was to evaluate how the relative length and position of the first metatarsal head influenced metatarsalgia and plantar callosities beneath the lesser metatarsal heads. A retrospective analysis of the clinical data and radiographs of 102 cases was performed at a mean follow-up of 16 months after biplane interlocking osteotomies. Clinical evaluation was made using the Japanese Society for Surgery of the Foot (JSSF) hallux scale. Radiologic evaluation was made with standard weight-bearing anteroposterior radiographs, and the hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA), distal metatarsal articular angulation (DMAA), and the sesamoid position were evaluated. Relative first metatarsal length (RML) was determined according to Nilsonne/Morton's technique. The mean preoperative HVA decreased from 37 to 3 degrees, and the mean IMA from 17 to 4 degrees. The mean JSSF-hallux score improved from 56 to 96 points. The mean preoperative area of plantar callosities decreased from 3.1 to 1.5 mm(2). Sixty percent of metatarsalgia cases improved, and 85% of painless callosities disappeared postoperatively. Among radiologic parameters, postoperative RML was most significantly associated with JSSF score (P < .0001) and the presence of postoperative metatarsalgia (P < .0001). Receiver operating characteristic analysis revealed that the RML cut-off point was -3 mm for avoiding metatarsalgia, with an area under the curve of 0.88, a specificity of 88%, and a sensitivity of 85%. Preservation of relative first metatarsal length during first metatarsal osteotomy was important to prevent postoperative metatarsalgia. Level IV, retrospective case series. © The Author(s) 2016.

  20. Bosch percutaneous osteotomy. Does the patient accept the nail? Clinical and functional analysis and short-term result

    Directory of Open Access Journals (Sweden)

    Ignacio Ricardo Arzac Ulla

    2015-11-01

    Full Text Available Introduction Hallux valgus is a common deformity of the metatarsophalangeal joint. Its percutaneous surgical treatment is a demanding procedure that involves a long learning curve and constitutes a challenge for the surgeon. Methods Retrospective cohort study. Seventy patients with hallux valgus operated on with percutaneous Bösch technique. Intraoperative characteristics and hospitalization, functional results according to AOFAS score and discomfort with the use of a Steinmnann pin for osteotomy fixation, and radiological results were evaluated. The average follow-up was 12.8 month. Results The Steinmann pin was used for an average of 31.44 days. Eighteen patients showed discomfort with the Steinmann pin in the postoperative period, but they said they would turn to operate with a similar surgical technique. However, three patients who were dissatisfied said they would not be operated with this technique. Conclusion Bösch surgery and the stabilization of the osteotomy with a Steinmann pin is an effective solution for the treatment of hallux valgus.

  1. Valguse ja varjupooled Endla Teatrigaleriis / Rica Semjonova

    Index Scriptorium Estoniae

    Semjonova, Rica

    2004-01-01

    3. mail avati Pärnu Endla Teatrigaleriis Nerva näitus "Valguse varjus", peale näituse avamist oli kõigil võimalus Küüni saalis vaadata Priit Valkna dokumentaalfilmi "Hunt", mis valminud ETV sarjale "Eesti lood"

  2. First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus.

    Science.gov (United States)

    Lenz, Robin C; Nagesh, Darshan; Park, Hannah K; Grady, John

    2016-09-02

    Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Medial eminence width was 1.12 mm larger in patients with hallux valgus (P hallux valgus (P hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference.

  3. Bilateral varus osteotomies in hip deformities: are early interventions superior?

    Science.gov (United States)

    Marti, R. K.

    2006-01-01

    Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26 patients with a symmetrical hip deformity for which we performed a therapeutic osteotomy on the symptomatic hip. The contralateral hip had the same anatomical predisposition to develop an OA, but there were only minor to no complaints. We advised and performed an early osteotomy on these hips. On radiological evaluation, an average Sharp angle of 42.2 degrees and an average CCD of 142 degrees was present. During an average follow-up period of 19.9 years (range 15.0–25.9), 14 hips were converted to THR after the primary osteotomy, whereas there were only 6 after the early osteotomy (chi-square coxa valga with excessive femoral anteversion and acetabular dysplasia can be superior to the results achieved when surgery is postponed until the complaints and arthrosis have become more severe. PMID:16783551

  4. PELVIC OSTEOTOMY IN THE COMPLEX TREATMENT OF CHILDREN WITH LEGG-CALVE-PERTHES DISEASE

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    Дмитрий Борисович Барсуков

    2014-06-01

    Full Text Available At the Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner we analyzed survey data of 120 patients aged from 6 to 14 years old with Legg-Calve-Perthes disease with severe epiphysis deformation, in order to improve the outcomes. All patients underwent reconstructive (remodeling surgery - a corrective hip osteotomy, a pelvic osteotomy by Salter, a combination of these techniques and a triple pelvic osteotomy. Postoperative follow-up period averaged 10 years. It is shown that pelvic osteotomy is an operation of choice for Legg-Calve- Perthes disease along with corrective hip osteotomy, and remodeling of the femoral head is only possible when the degree of bone coverage is equal to one or more. We highlighted radioanatomical structure of the affected hip joint, allowing to precise indications for surgical remodeling type of femoral head.

  5. Biomechanical effects of valgus knee bracing: a systematic review and meta-analysis.

    Science.gov (United States)

    Moyer, R F; Birmingham, T B; Bryant, D M; Giffin, J R; Marriott, K A; Leitch, K M

    2015-02-01

    To review and synthesize the biomechanical effects of valgus knee bracing for patients with medial knee osteoarthritis (OA). Electronic databases were searched from their inception to May 2014. Two reviewers independently determined study eligibility, rated study quality and extracted data. Where possible, data were combined into meta-analyses and pooled estimates with 95% confidence intervals (CI) for standardized mean differences (SMD) were calculated. Thirty studies were included with 478 subjects tested while using a valgus knee brace. Various biomechanical methods suggested valgus braces can decrease direct measures of medial knee compressive force, indirect measures representing the mediolateral distribution of load across the knee, quadriceps/hamstring and quadriceps/gastrocnemius co-contraction ratios, and increase medial joint space during gait. Meta-analysis from 17 studies suggested a statistically significant decrease in the external knee adduction moment (KAM) during walking, with a moderate-to-high effect size (SMD = 0.61; 95% CI: 0.39, 0.83; P brace use only (β, -0.01; 95% CI: -0.03, 0.0001; P = 0.06); with longer durations of brace use associated with smaller treatment effects. Minor complications were commonly reported during brace use and included slipping, discomfort and poor fit, blisters and skin irritation. Systematic review and meta-analysis suggests valgus knee braces can alter knee joint loads through a combination of mechanisms, with moderate-to-high effect sizes in biomechanical outcomes. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  6. Pain Resolution After Hallux Valgus Surgery.

    Science.gov (United States)

    Chen, Jerry Yongqiang; Ang, Benjamin Fu Hong; Jiang, Lei; Yeo, Nicholas Eng Meng; Koo, Kevin; Singh Rikhraj, Inderjeet

    2016-10-01

    Although more than 1500 publications on hallux valgus can be found in the current literature, none of them have reported on the course of pain resolution after hallux valgus surgery. Thus, this study aimed to investigate pain resolution after hallux valgus surgery and to identify predictive factors associated with residual pain at 6 months after surgery. We prospectively followed up 308 patients who underwent hallux valgus surgery at a tertiary hospital at 6 months and 2 years after surgery. Multivariate logistic regression analysis was performed to evaluate the risk factors associated with residual pain after surgery. Ninety-four patients (31%) had some degree of residual pain at 6 months after surgery. After excluding 4 patients who developed osteoarthritis of the first metatarsophalangeal joint over the next 18 months, 73 of the remaining 90 (81%) experienced improvement in visual analog scale (VAS) by the 2-years follow-up. Their median VAS improved from 4 (interquartile range [IQR] 3, 5) at 6 months to 0 (IQR 0, 3) at 2 years (P < .001). A higher preoperative VAS increased the risk of having persistent pain at 6 months after sugery (odds ratio [OR] 1.388, 95% confidence interval [CI] 1.092, 1.764, P = .007), whereas a higher preoperative Mental Component Score of SF-36 (MCS) reduced this risk (OR 0.952, 95% CI 0.919, 0.987, P = .007). As much as 31% of patients will have residual pain at 6 months after surgery. Preoperative VAS and MCS are predictors for residual pain. However, these patients will continue to improve over the next 18 months, with 71% of them being pain free at 2 years after surgery. Level II, prospective comparative study. © The Author(s) 2016.

  7. Use of a geometric formula to improve the radiographic correction achieved by the scarf osteotomy.

    Science.gov (United States)

    O'Briain, David E; Flavin, Robert; Kearns, Stephen R

    2012-08-01

    Many procedures for hallux valgus treatment have high recurrence rates, often related to operative considerations such as accuracy of deformity correction, soft tissue balancing and sesamoid alignment. Inadequate distal metatarsal-articular angle (DMAA) correction is common with uni- and bi-planar osteotomies which principally address the inter-metatarsal angle (IMA). The scarf osteotomy is a tri-planar osteotomy which corrects the DMAA and IMA, thereby achieving a more anatomical correction and potentially reducing the recurrence rate. Our hypothesis was that by controlling the length and relative proximal and distal translations of the scarf with a geometric formula, more accurate correction of the IMA and DMAA is possible. A formula was generated to determine the specific adjustments required to correct the deformity. A prospective trial was performed to assess the accuracy of this formula. Thirty-four adult patients were enrolled in the study. Seventeen patients underwent a standard scarf procedure; 17 were operated on using the corrections prescribed by the formula. Hallux valgus angle (HVA), IMA and DMAA corrections improved with the formula (p = 0.036, p = 0.049, and p = 0.006, respectively). Patient and procedure selection has changed in our unit as a result of this study, which identified some preoperative deformities as beyond the capabilities of the scarf procedure. The formula allows precise, reproducible, anatomical correction of IMA and DMAA deformities. The degree of correction attainable with the scarf is dependent on the first metatarsal width and the preoperative deformities. The formula highlighted the limitations of the scarf, thereby aiding in appropriate patient and procedure selection.

  8. Valgus Stress Radiographs Predict Lateral-Compartment Cartilage Thickness but Not Cartilage Degeneration in Varus Osteoarthritis.

    Science.gov (United States)

    Waldstein, Wenzel; Schmidt-Braekling, Tom; Perino, Giorgio; Kasparek, Maximilian F; Windhager, Reinhard; Boettner, Friedrich

    2017-03-01

    Intact cartilage in the lateral compartment is an important requirement for medial unicompartmental knee arthroplasty. This study sought to determine how measurements of joint space width in the lateral compartment on valgus stress radiographs compare to cartilage thickness as measured with a precise needle test, and whether cartilage thickness is a predictor of cartilage degeneration. A consecutive series of 100 knees undergoing total knee arthroplasty for end-stage varus osteoarthritis was studied. Twenty-eight knees were retrospectively excluded because not all data were available, leaving 72 knees (61 patients; mean age, 67 years [49-87]). On calibrated valgus stress radiographs, lateral-compartment joint space width was measured. During surgery, osteochondral samples of the distal lateral femur and the lateral tibia plateau were harvested. Cartilage thickness and histology were assessed. Cartilage thickness of tibia and femur was defined as lateral-compartment cartilage thickness. Lateral-compartment joint space width on valgus stress radiographs and lateral-compartment cartilage thickness correlated well (rs = 0.671, P cartilage histology according to the osteoarthritis cartilage histopathology assessment system, and cartilage thickness on the lateral tibia plateau (rs = -0.060, P = .614) and cartilage thickness on the distal lateral femur (rs = -0.128, P = .282) was observed. Valgus stress radiographs can assess combined cartilage thickness in the lateral compartment of the knee. Cartilage thickness, however, is a poor predictor of cartilage degeneration. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Osteotomies in the Cervical Spine

    Science.gov (United States)

    Nemani, Venu M.; Derman, Peter B.

    2016-01-01

    Rigid cervical deformities are difficult problems to treat. The goals of surgical treatment include deformity correction, achieving a rigid fusion, and performing a thorough neural decompression. In stiff and ankylosed cervical spines, osteotomies are required to restore sagittal and coronal balance. In this chapter, we describe the clinical and radiographic workup for patients with cervical deformities, and delineate the various factors that must be considered when planning surgical treatment. We also describe in detail the various types of cervical osteotomies, along with their surgical technique, advantages, and potential complications. PMID:26949476

  10. Distal femoral osteotomy in genovalgum: internal fixation with blade plate versus casting.

    Science.gov (United States)

    Makhmalbaf, Hadi; Moradi, Ali; Ganji, Saeid

    2014-10-01

    To compare the results of two different ways of distal femoral osteotomy stabilization in patients suffering from genuvalgum: internal fixation with plate, and casting. In a non-randomized prospective study, after distal femoral osteotomy with the zigzag method, patients were divided into two groups: long leg casting, and internal fixation with blade plate. For all patients, questionnaires were filled to obtain data. Information such as range of motion, tibiofemoral anatomical angle and complications were recorded. 38 knees with valgus deformity underwent distal femoral supracondylar osteotomy. (8 with plaster cast and 30 with internal fixation using a blade plate). Preoperative range of motion was 129±6° and six months later it was 120±14°. The preoperative tibiofemoral angle was 32±6°; postoperative tibiofemoral angles were 3±3°, 6±2°, and 7±3° just after operation, six months, and two years later, respectively. Although this angle was greater among the group stabilized with a cast, this difference was not statistically significant. In postoperative complications, over-correction was found in five, recorvatom deformity in one, knee stiffness in three and superficial wound infection was recorded in three knees. There is no prominent difference in final range of motion and alignment whether fixation is done with casting or internal fixation. However, the complication rate seems higher in the casting method.

  11. Radiographic correlates of hallux valgus severity in older people

    Science.gov (United States)

    2010-01-01

    Background The severity of hallux valgus is easily appreciated by its clinical appearance, however x-ray measurements are also frequently used to evaluate the condition, particularly if surgery is being considered. There have been few large studies that have assessed the validity of these x-ray observations across a wide spectrum of the deformity. In addition, no studies have specifically focused on older people where the progression of the disorder has largely ceased. Therefore, this study aimed to explore relationships between relevant x-ray observations with respect to hallux valgus severity in older people. Methods This study utilised 402 x-rays of 201 participants (74 men and 127 women) aged 65 to 94 years. All participants were graded using the Manchester Scale - a simple, validated system to grade the severity of hallux valgus - prior to radiographic assessment. A total of 19 hallux valgus-related x-ray observations were performed on each set of x-rays. These measurements were then correlated with the Manchester Scale scores. Results Strong, positive correlations were identified between the severity of hallux valgus and the hallux abductus angle, the proximal articular set angle, the sesamoid position and congruency of the first metatarsophalangeal joint. As hallux valgus severity increased, so did the frequency of radiographic osteoarthritis of the first metatarsophalangeal joint and a round first metatarsal head. A strong linear relationship between increased relative length of the first metatarsal and increased severity of hallux valgus was also observed. Conclusions Strong associations are evident between the clinical appearance of hallux valgus and a number of hallux valgus-related x-ray observations indicative of structural deformity and joint degeneration. As it is unlikely that metatarsal length increases as a result of hallux valgus deformity, increased length of the first metatarsal relative to the second metatarsal may be a contributing factor to

  12. Radiographic correlates of hallux valgus severity in older people

    Directory of Open Access Journals (Sweden)

    D'Arcangelo Paul R

    2010-09-01

    Full Text Available Abstract Background The severity of hallux valgus is easily appreciated by its clinical appearance, however x-ray measurements are also frequently used to evaluate the condition, particularly if surgery is being considered. There have been few large studies that have assessed the validity of these x-ray observations across a wide spectrum of the deformity. In addition, no studies have specifically focused on older people where the progression of the disorder has largely ceased. Therefore, this study aimed to explore relationships between relevant x-ray observations with respect to hallux valgus severity in older people. Methods This study utilised 402 x-rays of 201 participants (74 men and 127 women aged 65 to 94 years. All participants were graded using the Manchester Scale - a simple, validated system to grade the severity of hallux valgus - prior to radiographic assessment. A total of 19 hallux valgus-related x-ray observations were performed on each set of x-rays. These measurements were then correlated with the Manchester Scale scores. Results Strong, positive correlations were identified between the severity of hallux valgus and the hallux abductus angle, the proximal articular set angle, the sesamoid position and congruency of the first metatarsophalangeal joint. As hallux valgus severity increased, so did the frequency of radiographic osteoarthritis of the first metatarsophalangeal joint and a round first metatarsal head. A strong linear relationship between increased relative length of the first metatarsal and increased severity of hallux valgus was also observed. Conclusions Strong associations are evident between the clinical appearance of hallux valgus and a number of hallux valgus-related x-ray observations indicative of structural deformity and joint degeneration. As it is unlikely that metatarsal length increases as a result of hallux valgus deformity, increased length of the first metatarsal relative to the second metatarsal may

  13. Long-term results of intertrochanteric varus osteotomy for the dysplastic hip.

    Science.gov (United States)

    Nishiyama, Takayuki; Saegusa, Yasuhiro; Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Kurosaka, Masahiro

    2012-01-01

    Total hip arthroplasty (THA) is a well established treatment for arthrosis of the hip, however many problems remain which have not yet been resolved, including component loosening and infection. Therefore, surgeons hesitate to perform THA in younger patients showing early signs of the disease. Intertrochanteric varus osteotomy was developed for osteoarthrosis with coxa valga. This procedure has been commonly used in patients with dysplastic hips. However, femoral head coverage is not sufficiently improved by this procedure. In order to overcome the disadvantages of this procedure, since 1972 we performed intertrochanteric varus osteotomy simultaneously combined with acetabuloplasty for the treatment of osteoarthrosis secondary to dysplasia. Between 1969 and 1994, we performed 104 intertrochanteric varus osteotomies for prearthrosis and early stage arthrosis of the hip due to acetabular dysplasia in 84 patients. In this study, we reviewed these patients clinically and radiographically, over 15 years. The intertrochanteric varus osteotomy alone was employed in 38 hips (varus group). Combined intertrochanteric varus osteotomy and acetabuloplasty was employed in 63 hips (combined group). The average Harris hip score at the latest follow-up in the combined group significantly higher than that in the 'varus' group. Postoperative centre-edge angle and age at operation were correlated with the Harris hip score at the most recent follow-up. The results of the present study indicate that this combined intertrochanteric varus osteotomy and acetabuloplasty for dysplastic hip should be considered in young patients when the disease is at an early stage.

  14. Mechanical evaluation of pin and tension-band wire factors in an olecranon osteotomy model.

    Science.gov (United States)

    Neat, Benjamin C; Kowaleski, Michael P; Litsky, Alan S; Boudrieau, Randy J

    2006-06-01

    To evaluate the effect of altering pin and wire diameter, wire position and configuration, and osteotomy angle on applied load and absorbed strain energy in a pin and tension-band wire (PTBW) fixation model. In vitro mechanical study. Delrin models (n=96). PTBW was applied to Delrin olecranon osteotomy models. A control configuration was defined and then altered, 1 variable (wire diameter, pin diameter, wire-hole position, wire configuration, osteotomy angle) at a time, to create 11 test configurations. Tensile force was applied and displacement at the caudal aspect of the osteotomy was measured. Fixation strength, in terms of tensile load and strain energy, was compared between control and each test configuration at 4 osteotomy displacements. Models with larger wire, pins, or combined figure-of-eight/lateral wires were stronger than control, whereas those with smaller wire, pins, or a solitary lateral wire were weaker. The superior strength of the larger wire was apparent for all assessed osteotomy displacement. PTBW fixation strength increases as implant diameter is increased, with wire diameter having greatest effect. Lateral wire configuration is weaker than figure-of-eight, but can be added to figure-of-eight configuration to increase strength. Wire-hole position and osteotomy angle have little effect on PTBW strength. Wire diameter is the key determinant of PTBW strength, whereas pin diameter is somewhat less critical. Wire passage through an additional hole proximally provides equivalent strength and may avoid soft-tissue entrapment and subsequent loosening.

  15. Hallux valgus angle as main predictor for correction of hallux valgus

    NARCIS (Netherlands)

    Deenik, A.R.; Visser, E. de; Louwerens, J.W.; Waal Malefijt, M.C. de; Draijer, F.F.; Bie, R.A. de

    2008-01-01

    BACKGROUND: It is recognized that different types of hallux valgus exist. Classification occurs with radiographic and clinical parameters. Severity of different parameters is used in algorithms to choose between different surgical procedures. Because there is no consensus about each parameter nor

  16. Percutaneous hallux valgus treatment: Unilaterally or bilaterally.

    Science.gov (United States)

    Carvalho, Paulo; Viana, G; Flora, M; Emanuel, P; Diniz, P

    2016-12-01

    Currently there is no consensus regarding the use of bilateral simultaneous percutaneous surgery for Hallux valgus treatment. Although the technique described in M. Prado's book, recommends operating only one foot at a time there are no published studies confirming it. The aim of this study was to evaluate whether there is a difference between the results of patients that have been percutaneously operated on one foot and those operated on both feet at the same surgical time for mild to moderate Hallux valgus correction. We did a retrospective single centre evaluation of 93 feet (61 patients) with Hallux valgus operated percutaneously. 29 patients were operated unilaterally (group I) and 32 bilaterally simultaneously (group II) between 2005 and 2009. The Metatarsophalangeal angle (MPA), Intermetatarsal angle (IMA) and Distal metatarsal articular angle (DMAA) were evaluated pre- and postoperatively. The AOFAS score, the degree of patients' satisfaction and the complications were evaluated postoperatively. The mean follow-up was 24.0 months in group I, and 28.0 in group II. The average postoperative AOFAS score was 86.8, 82.9 in group I and 88.6 in group II (p>0.05). 90.6% were satisfied or very satisfied in group I, and 89.7% in group II (p>0.05). There was no statistically significant difference (p>0.05) in the average correction of MPA, DMAA, and IMA. The complications rate was similar in both groups. The similar results obtained in both groups suggest that the simultaneous bilateral percutaneous surgery gives equivalent results to the unilateral, which has an important socioeconomic impact since there is only one recovery time for both feet. Further research is needed. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  17. Impacted valgus fractures of the proximal humerus

    Directory of Open Access Journals (Sweden)

    Fabiano Rebouças Ribeiro

    2016-04-01

    Full Text Available Impacted valgus fractures of the proximal humerus are considered to be a special type fracture, since impaction of the humeral head on the metaphysis with maintenance of the posteromedial periosteum improves the prognosis regarding occurrences of avascular necrosis. This characteristic can also facilitate the reduction maneuver and increase the consolidation rate of these fractures, even in more complex cases. The studies included were obtained by searching the Bireme, Medline, PubMed, Cochrane Library and Google Scholar databases for those published between 1991 and 2013. The objective of this study was to identify the most common definitions, classifications and treatment methods used for these fractures in the orthopedic medical literature.

  18. Reliability and relationship of radiographic measurements in hallux valgus.

    Science.gov (United States)

    Lee, Kyoung Min; Ahn, Soyeon; Chung, Chin Youb; Sung, Ki Hyuk; Park, Moon Seok

    2012-09-01

    Although various radiographic measurements have been developed and used for evaluating hallux valgus, not all are universally believed to be necessary and their relationships have not been clearly established. Determining which are related could provide some insight into which might be useful and which would not. We investigated the reliability of eight radiographic measurements used to evaluate hallux valgus, and determined which were correlated and which predicted the hallux valgus angle. We determined eight radiographic indices for 732 patients (mean age, 51 years; SD, 17 years; 107 males and 625 females) with hallux valgus: hallux valgus angle, intermetatarsal angle, hallux interphalangeal angle, distal metatarsal articular angle, proximal phalangeal articular angle, simplified metatarsus adductus angle, first metatarsal protrusion distance, and sesamoid rotation angle. Intraobserver and interobserver reliabilities of each radiographic measurement were analyzed on 36 feet from 36 randomly selected patients. Correlations among the radiographic measurements were analyzed. Radiographic measurements predicting hallux valgus angle were evaluated using multiple regression analysis. Hallux valgus angle had the highest reliability, whereas the distal metatarsal articular angle and simplified metatarsus adductus angle had the lowest. Distal metatarsal articular angle, intermetatarsal angle, and sesamoid rotation angle had the highest correlations with hallux valgus angle. Distal metatarsal articular angle correlated with sesamoid rotation angle. The intermetatarsal angle, interphalangeal angle, distal metatarsal articular angle, first metatarsal protrusion distance, sesamoid rotation angle, and metatarsus adductus angle predicted the hallux valgus angle. We suggest using hallux valgus angle, intermetatarsal angle, interphalangeal angle, sesamoid rotation angle, and first metatarsal protrusion distance considering their reliability and prediction of the deformity.

  19. THE CORRECTION OF HALLUX VARUS DEFORMITY IN CONSEQUENCE OF SURGICAL TREATMENT FOR HALLUX VALGUS

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    V. M. Mashkov

    2010-01-01

    Full Text Available The analysis of treatment of 21 patients (24 feet with postoperative hallux varus deformity which have arisen after operations apropos hallux valgus is carried out. For correction of vicious position of the first finger we successfully carried out the Brandes procedure, sometimes in a combination to operations on sinews of muscles of the first finger - an adductor hallucis tendotomy and/or lengthening of the extensor hallucis longus tendon.

  20. Consequences of Avulsion Fracture of the Proximal Phalanx Caused by a Technical Failure of Hallux Valgus Surgery.

    Science.gov (United States)

    Park, Young Uk; Lee, Kyung Tai; Jegal, Hyuk; Kim, Ki Chun; Choo, Ho Sik; Kweon, Heon Ju

    2016-01-01

    Several cases of avulsion fracture of the proximal phalanx of the big toe during the lateral capsular release procedure were observed. However, these fractures have not been reported as a complication of hallux valgus surgery. The purpose of the present study was to report the proximal phalanx base fracture as an unrecognized complication and to evaluate the clinical and radiographic consequences of this complication. We retrospectively reviewed 225 feet that had undergone hallux valgus surgery involving proximal chevron osteotomy and distal soft tissue release from May 2009 to December 2012. Of these 225 feet (198 patients), 12 (5.3%) developed proximal phalanx base fracture postoperatively. These patients were assigned to the fracture group. The remaining patients were assigned to the nonfracture group. Patients were followed to observe whether the fractures united and whether degenerative changes developed at the first metatarsophalangeal joint because of this fracture. The mean follow-up period was 36 (range 12 to 72) months. All the subjects in the fracture and nonfracture groups underwent weightbearing anteroposterior and lateral radiographs of the foot at the initial presentation and final follow-up point. The 2 groups were compared with respect to the hallux valgus angle, intermetatarsal angle, range of motion, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes. No significant differences were found in age, follow-up period, hallux valgus angle, intermetatarsal angle, range of motion of the first metatarsophalangeal joint, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes between the 2 groups. Ten (83.3%) of the 12 fractures healed, 2 (16.7% of the fractures, 0.89% of the operated feet) progressed to asymptomatic nonunion, and 3 (1.33%) developed first metatarsophalangeal joint degeneration. Avulsion fracture of the proximal phalanx of the big toe is an uncommon complication of

  1. Impact of podiatry resident experience level in hallux valgus surgery on postoperative outcomes.

    Science.gov (United States)

    Fleischer, Adam E; Yorath, Martin C; Joseph, Robert M; Baron, Adam; Nordquist, Thomas; Moore, Braden J; Robinson, Richmond C O; Reilly, Charles H

    2014-06-15

    Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences midterm outcomes in hallux valgus surgery (HVS). Consecutive adults who underwent isolated HVS via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using linear and logistic regression analyses. A total of 102 adult patients (n = 102 feet) agreed to participate with a mean age of 46.8 years (standard deviation 13.1, range 18-71) and average length of follow-up 6.2 y (standard deviation 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% confidence interval, 0.98-1.01], P = 0.827) or multivariate analyses (odds ratio 1.00 [95% confidence interval, 0.97-1.02], P = 0.907). We conclude that podiatry resident level of experience in HVS does not contribute appreciably to postoperative clinical outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Is McMurray′s osteotomy obsolete?

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    Phaltankar P

    1995-10-01

    Full Text Available A review of the method of performing, advantages, disadvantages of McMurray′s displacement osteotomy with regard to treatment of nonunion of transcervical fracture neck femur with viable femoral head was carried out in this study of ten cases, in view of the abandonment of the procedure in favour of angulation osteotomy. Good results obtained in the series attest to the usefulness of McMurray′s osteotomy in the difficult problem of nonunion of transcervical fracture neck femur in well selected cases with certain advantages over the angulation osteotomy due to the ′Armchair effect′.

  3. Computer assisted SCFE osteotomy planning

    Energy Technology Data Exchange (ETDEWEB)

    Drapikowski, Pawel [Poznan University of Technology, Institute of Control and Information Engineering, Poznan (Poland); Tyrakowski, Marcin; Czubak, Jaroslaw; Czwojdzinski, Adam [Postgraduate Medical Education Center, Department of Orthopaedics, Warsaw (Poland)

    2008-11-15

    Slipped capital femoral epiphysis (SCFE) is a common pediatric orthopedic disorder that requires surgical correction. Preoperative planning of a proximal femoral osteotomy is essential in cases of SCFE. This planning is usually done using 2D radiographs, but 3D data can be acquired with CT and analyzed with 3D visualization software. SCFEanalyzer is a computer program developed for preoperative planning of proximal femoral osteotomy to correct SCFE. Computed tomography scans were performed on human bone specimens: one pelvis and two femoral bones (right and left) and volume data of a patient. The CT data were used to test the abilities of the SCFEanalyzer software, which utilizes 3D virtual models of anatomic structures constructed from CT image data. Separation of anatomical bone structures is done by means of ''cutting'' 3D surface model of the pelvis. The software enables qualitative and quantitative spatial analysis of chosen parameters analogous to those done on the basis of plain radiographs. SCFEanalyzer makes it possible to evaluate the function of the hip joint by calculating the range of motion depending on the shape of bone structures based on oriented bounding box object representation. Pelvic and hip CT scans from a patient with SCFE were subjected to femoral geometry analysis and hip joint function assessment. These were done to plan and simulate osteotomy of the proximal femur. Analogous qualitative and quantitative evaluation after performing the virtual surgery were evaluated to determine the potential treatment effects. The use of computer assistance in preoperative planning enable us to increase objectivity and repeatability, and to compare the results of different types of osteotomy on the proximal femur, and thus to choose the optimal operation in each individual case. (orig.)

  4. Effects of combined orthodontic-orthognathic treatment for class II and III correction on posterior airway space : Comparison of mono- and bignathic osteotomies.

    Science.gov (United States)

    Hourfar, Jan; Kinzinger, Gero Stefan Michael; Feifel, Hartmut; Vehr, Verena Maria; Lisson, Jörg Alexander

    2017-06-28

    Comparison of treatment effects on the posterior airway space (PAS) in patients treated with combined orthodontic-orthognathic surgical treatment. Pre- and postsurgical lateral cephalograms of 53 (34 females, 19 males) Caucasian patients were analyzed using a customized set of measurements. According to malocclusion (Class II or III) and surgical approach (either monognathic or bignathic), patients were allocated into four groups. PAS was assessed from cranial to caudal at six levels (P1-P6). Paired t tests were used for intragroup and t tests for independent samples for intergroup comparisons. Results were considered statistically significant at p Class II malocclusion, PAS retropalatally (P1 level) almost remained unchanged, whereas measurements at levels P2-P6 showed a mean increase ranging from approximately 2-5.5 mm. Significant changes were most pronounced in monognathic Class II patients (group 1) at levels P2-P4 with mean values ranging from approximately 3.7-5.5 mm. In patients treated for Class III malocclusion (groups 3 and 4), measurements at the P1 level almost remained unchanged in patients who underwent mandibular setback surgery (group 3), whereas the same measurements exhibited significant increase (>6 mm) in patients treated with bignathic surgery (group 4). Bignathic surgery led to smaller changes of pharyngeal depth in Class II and III patients than monognathic surgery. Alterations of the PAS due to orthognathic surgery should be considered during orthodontic and presurgical treatment planning.

  5. Surgical reduction and ligament reconstruction for chronic dorsal dislocation of the lesser metatarsophalangeal joint associated with hallux valgus.

    Science.gov (United States)

    Shima, Hiroaki; Okuda, Ryuzo; Yasuda, Toshito; Jotoku, Tsuyoshi; Hida, Takashi; Mori, Katsunori; Neo, Masashi

    2015-11-01

    Hallux valgus (HV) is occasionally associated with chronic dislocation of the lesser metatarsophalangeal (MTP) joints. We have developed a novel surgical procedure to treat dislocation of the lesser MTP joints. This study aimed to describe our procedure and investigate the outcomes of surgical intervention in the treatment of HV with dislocation of the lesser MTP joints. Twenty-three patients (27 feet, average age: 63.6 years, average follow-up: 49.5 months; a minimum follow-up of 24 months) underwent surgical intervention for HV and dislocation of the lesser MTP joints. Twenty-three feet had dislocation (10 feet) or subluxation (13 feet) of the second MTP joint, whereas 4 feet had dislocation of the second and third MTP joints. The surgical procedure included a distal soft-tissue procedure combined with proximal osteotomy for correction of the HV, and reconstruction of the collateral ligaments (CL) following open reduction with complete release of the capsule and the CL at the metatarsal head for dislocation of the lesser MTP joints. Outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) scale and radiological examinations. The JSSF score improved significantly from an average of 49.7 points preoperatively to 93.1 points postoperatively. The average HV angle and intermetatarsal angle decreased significantly from 44.6° and 18.1° preoperatively to 7.9° and 6.0° postoperatively, respectively. The average extension and flexion of the second MTP joint was 53.1° and 13.8° at the most recent follow-up, respectively. Postoperatively, no feet had dislocation of the second or third MTP joint, three had subluxation of the second MTP joint, and one had subluxation of the third MTP joint. Osteoarthritis of the lesser MTP joint had developed in two feet (7.4 %) at the time of the most recent follow-up. Our surgical procedure achieved significant correction of HV, a low rate of postoperative re-dislocation of the lesser MTP joints, and significant

  6. Tendon shift in hallux valgus: observations at MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Eustace, S. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Williamson, D. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Wilson, M. [Department of Orthopedics, Brigham and Womens Hospital, Boston, Massachusetts (United States); O`Byrne, J. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Bussolari, L. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Thomas, M. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States); Stephens, M. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Stack, J. [Department of Radiology, Boston University Medical Center Hospital, 88 East Newton Street, Atrium - 2, Boston, MA 02118 (United States); Weissman, B. [Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts (United States)

    1996-08-01

    Objective. This study was undertaken to demonstrate a shift in tendon alignment at the first metatarsophalangeal joint in patients with hallux valgus by means of magnetic resonance imaging. Design. Ten normal feet and 20 feet with the hallux valgus deformity conforming to conventional clinical and radiographic criteria were prospectively studied using magnetic resonance imaging. Correlation was made between tendon position at the first metatarsophalangeal joint and the severity of the hallux valgus deformity. Results. There is a significant shift in tendon position at the first metatarsophalangeal joint of patients with hallux valgus. The insertion of the abductor hallucis tendon is markedly plantarward and the flexor and extensor tendons bowstring at the first metatarsophalangeal joint compared with patients without the deformity. The severity of the tendon shift correlates with the hallux valgus angle and clinical severity of the hallux valgus deformity in each case. Conclusion. Patients with hallux valgus have a significant tendon shift at the first metatarsophalangeal joint which appears to contribute to development of the deformity. (orig.). With 4 figs., 1 tab.

  7. El Hallux Abductus Valgus en la bailaora de flamenco. Hallux Abductus Valgus in female flamenco dancer.

    Directory of Open Access Journals (Sweden)

    Joaquín Pérez Rendón

    2011-04-01

    Full Text Available El Hallux Abductus Valgus (HAV, comúnmente llamado juanete, se define como la desviación lateral del primer dedo del pie y su rotación en valgo. Su origen es multifactorial, existiendo etiología patomecánica de base: hiperpronación subastragalina, excesiva longitud del primer metatarsiano y/o del primer dedo, o la insuficiencia del músculo peroneo largo. Estadísticamente, afecta más al sexo femenino que al masculino, y, en relación al baile flamenco, hay dos factores que se han asociado con una alta incidencia: uso del calzado de tacón y puntera estrecha, y ciertas modalidades del gesto deportivo.Mediante estudio observacional transversal realizado en diferentes academias de flamenco de Andalucía, Área Clínica de Podología de la Universidad de Sevilla y centros privados de Investigación y Podología, sobre 32 bailaoras de flamenco, se determina que existe una muy alta prevalencia de hallux abductus valgus en la bailaora profesional de flamenco.The hallux abductus valgus (HAV, commonly known as bunion, is defined as first toe lateral curvature and its rotation in valgus. Its origin can be derived from multiple factors, such as the existence of pathomechanics etiology: subastragalina joint hiperpronation, excessive length of first metatarsal and/or first toe, or peroneus longus muscle failure. Statiscally, it affects more to females than males, and as regards flamenco dance there are two factors which are closely related to such high levels of deformity: high-heeled shoes and narrow toe cap use, and some sports gesture methods.

  8. Total hip arthroplasty (S-ROM stem and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip

    Directory of Open Access Journals (Sweden)

    Liangtao Li

    2016-01-01

    Conclusions: In the primary THA for the treatment of irreducible DDH, subtrochanteric oblique osteotomy combined with the freely-rotatable S-ROM stem provided favorable short term outcomes by affording both morphological and functional advantages.

  9. Subtrochanteric osteotomy for femoral mal-torsion through a surgical dislocation approach

    Science.gov (United States)

    Kamath, Atul F.; Ganz, Reinhold; Zhang, Hong; Grappiolo, Guido; Leunig, Michael

    2015-01-01

    Missed torsional femur deformities may contribute to reasons for failure after open and more likely arthroscopic hip preservation surgery. A number of surgical approaches have been described for addressing torsion abnormalities. This report describes a subtrochanteric osteotomy technique in a consecutive series of patients with complex hip pathologies, for which intertrochanteric osteotomy is not suitable and precise derotation is required. Subtrochanteric derotation was performed, always in combination with a surgical hip dislocation, in accordance with the authors’ preferred technique. Before osteotomy, a localized decortication was executed. Application of a 4.5-mm broad or narrow plate was undertaken with dynamic compression of the osteotomy. Twenty-eight consecutive subtrochanteric derotational osteotomies were performed in 26 patients. Twenty-one females and five males were treated at an average age of 21.4 years (range, 12–43). Underlying diagnoses included dysplasia, arthrogryposis, cerebral palsy, Down’s syndrome, instability and impingement. The decision to perform derotation was for antetorsion over 20° or less than 0° (retrotorsion). Patients were followed clinically and radiographically till final follow-up. All patients went on to successful osteotomy union. There were two initial failures: one delayed union prompting revision fixation in a chronic smoker and one plate failure due to self-accelerated weight-bearing in a patient status post successful contralateral derotational osteotomy. Rotational deformity of the femur must be considered in the patient undergoing hip preservation surgery. This technique of subtrochanteric derotational osteotomy, with adjunctive surgical hip dislocation, is applicable and reproducible in the setting of complex hip pathologies. Level of evidence: IV, case series. PMID:27011816

  10. Spinal osteotomies: indications, limits and pitfalls

    Science.gov (United States)

    Kose, Kamil Cagri; Bozduman, Omer; Yenigul, Ali Erkan; Igrek, Servet

    2017-01-01

    The aims of spinal deformity surgery are to achieve balance, relieve pain and prevent recurrence or worsening of the deformity. The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR), in order of increasing complexity. SPO is a posterior column osteotomy in which the posterior ligaments and the facet joints are removed and correction is performed through the disc space. A mobile anterior disc is essential. SPO is best in patients with +6-8 cm C7 plumbline. The amount of correction is 9.3° to 10.7°/level (1°/mm bone). PSO is a technique where the posterior elements and pedicles are removed. Then a triangular wedge through the pedicles is removed and the posterior spine is shortened using the anterior cortex as a hinge. The ideal candidates are patients with a severe sagittal imbalance. A single level osteotomy can produce 30° 40° of correction. A single level osteotomy may restore global sagittal balance by an average of 9 cm with an upper limit of 19 cm. BDBO is an osteotomy done above and below a disc level. A BDBO provides correction rates in the range of 35° to 60°. The main indications are deformities with the disc space as the apex and severe sagittal plane deformities. VCR is indicated for rigid multi-planar deformities, sharp angulated deformities, hemivertebra resections, resectable spinal tumours, post-traumatic deformities and spondyloptosis. The main indication for a VCR is fixed coronal plane deformity. The type of osteotomy must be chosen mainly according to the aetiology, type and apex of the deformity. One may start with SPOs and may gradually advance to complex osteotomies. Cite this article: EFORT Open Rev 2017;2:73-82. DOI: 10.1302/2058-5241.2.160069 PMID:28507779

  11. Hallux valgus, hallux varus and metatarsus adductus terms are misnomers

    OpenAIRE

    Kumar, Kush

    2015-01-01

    The terms hallux valgus, hallux varus and metatarsus adductus are misnomers. The time line when these misnomers startedcan not be easily determined. It is certain that these terms are fairly old. Over time, they have become so well engraved intothe minds of the medical professionals, that it may not be easy to revert to referring to hallux valgus as hallux varus and viceversa or metatarsus adductus as metatarsus abductus. Let the reader be informed of the correct terminology, and act on thisi...

  12. The percutaneous pie-crusting medial release during arthroscopic procedures of the medial meniscus does neither affect valgus laxity nor clinical outcome.

    Science.gov (United States)

    Jeon, Sang-Woo; Jung, Min; Chun, Yong-Min; Lee, Su-Keon; Jung, Woo Seok; Choi, Chong Hyuk; Kim, Sung-Jae; Kim, Sung-Hwan

    2017-12-28

    To analyze the effect of percutaneous pie-crusting medial release on valgus laxity before and after surgery and on clinical outcomes. Eight-hundred fourteen consecutive patients who underwent an arthroscopic procedure for the medial compartment of the knee were evaluated retrospectively. Sex, age, type of operation (meniscectomy, meniscal repair, and posterior root repair), type of accompanying surgery (none, cartilage procedure, ligament procedure and osteotomy) were documented. Sixty-four patients who underwent percutaneous pie-crusting medial release (release group) and 64 who did not undergo medial release (non-release group) were matched using the propensity score method. Each patient was evaluated for the following variables: degree of valgus laxity on stress radiographs, Lysholm knee score, visual analog scale score, and International Knee Documentation Committee knee score and grade. At the 24-month follow-up, no significant increase in side-to-side differences in the valgus gap was observed in comparison to the preoperative value in the release group [preoperative, - 0.1 ± 1.3 mm; follow-up, - 0.1 ± 1.4 mm; (n.s.)]. The follow-up Lysholm score, visual analog scale score and International Knee Documentation Committee knee score and grade were similar between the two groups. Percutaneous pie-crusting medial release is an additional procedure that can be performed during arthroscopic surgery for patients with a narrow medial joint space of the knee. Percutaneous pie-crusting medial release reduces iatrogenic injury to the cartilage and does not produce any residual valgus laxity of the knee. IV.

  13. Posterior maxillary anatomy: implications for Le Fort I osteotomy.

    Science.gov (United States)

    Cheung, L K; Fung, S C; Li, T; Samman, N

    1998-10-01

    The most common site of haemorrhage in maxillary osteotomies is the posterior maxilla. Better understanding of the anatomy in this region may minimize possible vascular complications. The aim of the study was to study the osteology of the posterior maxillary region and establish clinical safety guidelines for the Le Fort I osteotomy Thirty human dry skulls were selected and assessed by a combination of direct inspection, computerized imaging and computed tomography (CT) scan analysis. Results showed that the presence of maxillary third molars influenced the transverse angulation of the posterior vertical cut. Synostosis of the pterygomaxillary junction was noted in 12% of samples. The mean length of the medial sinus wall from the piriform rim to the descending palatine canal at the Le Fort I level was 34 mm. The three-dimensional CT-reconstructed descending palatine canal ran at 60 degrees anteroinferiorly to the palatine plane and slightly medially to the exit through the greater palatine foramen.

  14. COMPARATIVE RADIOGRAPHIC ANALYSIS OF THE RESULTS OF TREATMENT OF HALLUX VALGUS DEFORMITY ACCORDING TO MITCHELL AND KELLER OPERATIVE METHODS

    Directory of Open Access Journals (Sweden)

    Georgieva Daniela

    2016-03-01

    Full Text Available Introduction: Hallux valgus represents a complex progressive deformity of the front part of the foot, with the most distinguished malformation as lateral deviation of the toe. Radiography is extremely important in the decision of the surgical procedure for the best correction of this deformity. Aim:The aim of this work is to show the significance of radiographic examinations in operated patients with Hallux Valgus deformityaccording to Mitchell and Keller techniques. Material and methods: The study included 70 patients having hallux valgus deformity of the foot, and they were divided to two groups. The patients were grouped according their sex, age, the degree of deformity (moderate or severe degree of deformity and according to radiographic findings. The first group (Group 1 was composed of 35 patients who were treated by osteotomy of the 1st metatarsal bone according to Mitchell, while the second group (Group 2 was also composed of 35 patients who were treated by resectional arthroplasty according to Keller. Radiographic examinations (Method of Hardy and Clapham, Piggott classification, presence and absence of the secondary arthritic and reactive changes of the first metatarsophalangeal joint were analyzed comparatively during the evaluation. The analyses of the radiographic results were performed pre-operatively and post-operatively for the two groups. Results: According to their sex, the patients were 5 men and 65 women. The average age of the patients in group 1 was 42 years, while for group 2 it was 56 years. There is no significant difference (p>0.05 in the patients of the two groups concerning the pre-operative mean dimension values of the I metatarsophalangeal angle and 1st intermetatarsal angle. However, the radiographic analysis of the same angles in both groups, one year post-operatively, showed a high statistically significant difference (p<0.001. The patients operated by Mitchell’s technique, according to Piggott classification

  15. Prevalence of metatarsus adductus in patients undergoing hallux valgus surgery.

    Science.gov (United States)

    Aiyer, Amiethab A; Shariff, Raheel; Ying, Li; Shub, Jeffrey; Myerson, Mark S

    2014-12-01

    Metatarsus adductus (MA) is a congenital condition in which there is adduction of the metatarsals in conjunction with supination of the hindfoot through the subtalar joint. It is generally believed that MA precedes the development of hallux valgus. Historically, studies have demonstrated that patients with a history of MA were ~3.5 times more likely to develop hallux valgus. The purpose of this study was to identify the relative prevalence of MA in patients undergoing surgery for symptomatic hallux valgus. Between 2002 and 2012, 587 patients who underwent hallux valgus surgery were retrospectively identified following IRB approval and parameters including the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the metatarsus adductus angle (MAA) were recorded. The MAA was considered abnormal if the value was greater than 20 degrees. Interobserver and intraobserver reliability studies for the measurement of the MAA were completed as well. Using the modified Sgarlato technique for measurement of the MAA, there was a high interobserver and intraobserver reliability. The interclass and intraclass coefficients were greater than .90. The prevalence of MA in this patient population was found to be 29.5%. Of those patients with MA, 23 males and 150 females were identified. This gave a male to female ratio of 1:6.5 (P hallux valgus has been reported to be 35%. The data in this study indicate a comparable prevalence at 29.4%. The presence of concomitant MA may portend different outcomes for operative treatment of hallux valgus. Further research needs to delineate rates of persistence of deformity in this patient population to guide operative management. Level IV, case series. © The Author(s) 2014.

  16. Bilateral Hallux Valgus: A Utility Outcome Score Assessment.

    Science.gov (United States)

    Makhdom, Asim M; Sinno, Hani; Aldebeyan, Sultan; Cota, Adam; Hamdy, Reggie Charles; Alzahrani, Mohammad; Janelle, Chantal

    2016-01-01

    Hallux valgus is the most common forefoot problem in adults. Although it can cause considerable disability and affect the quality of life of those affected, many patients seek medical attention because of cosmetic concerns. Our aim was to objectively measure the perceived health burden of living with bilateral hallux valgus. Previously validated utility outcome measures, including the visual analog scale, time trade-off, and standard gamble tests, were used to quantify the health burden for single-eye blindness, double-eye blindness, and bilateral hallux valgus in 103 healthy subjects using an online survey. The Student t test and linear regression analysis were used for statistical analysis. The mean visual analog scale, time trade-off, and standard gamble scores for bilateral hallux valgus were 0.86 ± 1.6, 0.95 ± 0.5, and 0.95 ± 0.14, respectively. These were significantly greater than the utility scores for single-eye and double-eye blindness (p hallux valgus. In conclusion, we have objectively demonstrated the effect of living with bilateral hallux valgus deformities. Our sample population reported being willing to undergo a procedure with a 5% mortality rate and sacrifice 1.8 years of life to attain perfect health and avoid the bilateral hallux valgus health state. Our findings will guide us in counseling our patients and understanding how they perceive their foot deformity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Algorithm for Severe Hallux Valgus Associated With Metatarsus Adductus.

    Science.gov (United States)

    Sharma, Jyoti; Aydogan, Umur

    2015-12-01

    Radiographic angles, such as the intermetatarsal angle, hallux valgus angle, and distal metatarsal articular angle, are commonly used to help guide operative planning for soft tissue and osseous treatment options for hallux valgus. Hallux valgus treatment in the setting of associated metatarsus adductus is less common and not well described. The presence of metatarsus adductus reduces the gap between the first and second metatarsals. Consequently, it complicates the measurement of the first-second intermetatarsal angle and can limit the area available for transposition of the first metatarsal head. A compensatory pronation is also created, which must be compensated for. We present 4 cases of patients that had hallux valgus with severe metatarsus adductus treated operatively, as well as a treatment algorithm. For concomitant correction of both the metatarsus adductus and the hallux valgus, a thorough surgical treatment algorithm was implemented to address the hallux, lesser toe deformities, and pes planus deformity. Postoperatively, the patients were kept non-weight bearing for 6 weeks, followed by gradual weight bearing in a protective boot. Physical therapy was instituted at the start of weight bearing to encourage a return to activities of daily living. At follow-up, patients reported significant relief of their pain symptoms with a narrower and improved appearance of the foot. No recurrence was noted. One patient used a medial arch support but was otherwise symptom free. Radiographic measurements improved on postoperative radiographs. For the treatment of hallux valgus with metatarsus adductus, the second and third metatarsals may need to be addressed for the first metatarsal to be laterally transposed adequately. Overall, this comprehensive approach addresses the hindfoot, midfoot, and forefoot for patients with hallux valgus associated with metatarsus adductus, with successful results. © The Author(s) 2015.

  18. Bilateral varus osteotomies in hip deformities: are early interventions superior?: A long-term follow-up

    OpenAIRE

    Haverkamp, D.; Marti, R. K.

    2006-01-01

    Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26 patients with a symmetrical hip deformity for which we performed a therapeutic osteotomy on the symptomatic hip. The contralateral hip had the same anatomical predisposition to develop an OA, but th...

  19. Valgus slipped capital femoral epiphysis with contralateral pre-slip.

    Science.gov (United States)

    Amiraian, Dana E; Sarwar, Zahir; Bireley, William R; Moran, Elizabeth

    2017-09-01

    Slipped capital femoral epiphysis (SCFE) is a common hip disorder in older children and adolescents, classically with medial and posterior slippage of the proximal femoral epiphysis. However, valgus SCFE is a very rare entity, where the proximal femoral epiphysis slips laterally and posteriorly. To our knowledge, valgus SCFE with magnetic resonance imaging (MRI) features of contralateral pre-slip has not yet been reported. We present a case of a 9 year old girl with symptomatic valgus SCFE on the left and asymptomatic contralateral pre-slip on the right with concurrent radiographic, sonographic, and MRI findings. Such findings include bilateral coxa valga, radiographic irregularity of the left proximal femoral physis, bilateral hip effusions, abnormal MRI signal and enhancement about both proximal femoral physes, and minimal posterolateral slippage of the left proximal femoral epiphysis. We highlight these pertinent imaging findings and review the importance of accurately diagnosing this rare entity for appropriate surgical management.

  20. Multisegmental Foot and Ankle Motion Analysis After Hallux Valgus Surgery

    Science.gov (United States)

    Canseco, Karl; Long, Jason; Smedberg, Thomas; Tarima, Sergey; Marks, Richard M.; Harris, Gerald F.

    2015-01-01

    Background Gait changes in patients with hallux valgus, including altered kinematic and temporal-spatial parameters, have been documented in the literature. Although operative treatment can yield favorable clinical and radiographic results, restoration of normal gait in this population remains unclear. Segmental kinematic changes within the foot and ankle during ambulation after operative correction of hallux valgus have not been reported. The aim of this study was to analyze changes in multisegmental foot and ankle kinematics in patients who underwent operative correction of hallux valgus. Methods A 15-camera Vicon Motion Analysis System was used to evaluate 24 feet in 19 patients with hallux valgus preoperatively and postoperatively. The Milwaukee Foot Model was used to characterize segmental kinematics and temporal-spatial parameters (TSPs). Preoperative and postoperative kinematics and TSPs were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Outcomes were evaluated using the SF-36 assessment tool. Results Preoperatively, patients with hallux valgus showed significantly altered temporal-spatial and kinematic parameters. Postoperatively, kinematic analysis demonstrated restoration of hallux position to normal. Hallux valgus angles and intermetatarsal angles were significantly improved, and outcomes showed a significant increase in performance of physical activities. Temporal-spatial parameters and kinematics in the more proximal segments were not significantly changed postoperatively. Conclusion Postoperative results demonstrated significant improvement in foot geometry and hallux kinematics in the coronal and transverse planes. However, the analysis did not identify restoration of proximal kinematics. Clinical Relevance Further investigation is necessary to explore possible causes/clinical relevance and appropriate treatment interventions for the persistently altered kinematics

  1. Role of high tibial osteotomy in cartilage regeneration – Is correction of malalignment mandatory for success?

    Directory of Open Access Journals (Sweden)

    Matthew Dhanaraj Thambiah

    2017-01-01

    Full Text Available Malalignment of the knee can cause debilitating symptoms such as pain, resulting in a decline in function and mobility. Surgical options that exist to address this problem include realignment osteotomies and joint replacements. Realignment osteotomies are the more appropriate options in certain patient populations, especially with regard to age and level of activity. Since a high tibial osteotomy (HTO was first used to manage malalignment of the knee and osteoarthritis, different techniques involving the use of specialized implants have been developed and further refined to good effect. There has also since been much research into the field of cartilage restoration techniques, both as a standalone treatment option and as an adjunct to a realignment osteotomy. This review attempts to detail the origin and the evolution of HTO, particularly in regard to combining this tried and tested procedure with adjunct cartilage restoration techniques, and the overall patient outcomes. A literature search on PubMed was performed, and articles pertaining to the outcomes of the use of an HTO and cartilage restoration techniques were reviewed. The literature in this field indicates good outcomes in terms of objective measurements of cartilage regeneration (such as arthroscopic visualization and magnetic resonance imaging evaluation and subjective patient outcome scoring systems (such as the International Knee Documentation Committee and Lysholm scores with a realignment osteotomy alone, and studies have shown that patient outcomes can be further improved with the use of a cartilage restoration procedure as an adjunct.

  2. Management of varus or valgus ankle deformity with ankle replacement.

    Science.gov (United States)

    Coetzee, J Chris

    2008-09-01

    Ankle replacements are probably here to stay. Improved designs and surgical technique led to much better mid-term and longer term outcomes than the first-generation replacements in the 1970s. Multiple recent papers also have discussed the many potential complications with total ankle replacement surgery. As we proceed in the future, one should be cognizant of all the pitfalls and know how to deal with the difficult ankles, especially varus and valgus deformities. There should be a clear understanding that the greater the varus or valgus, the harder the procedure and the less predictable the outcome of ankle replacement.

  3. Simultaneous femoral and tibial osteotomies during total knee arthroplasty for severe extra-articular deformity.

    Science.gov (United States)

    Moyad, Thomas F; Estok, Daniel

    2009-01-01

    Total knee arthroplasty (TKA) performed in knees with mild or moderate intraarticular deformity often can be resolved with careful ligament balancing and bone resection. However, extra-articular deformity may require an osteotomy to safely create rectangular flexion and extension gap balance. In these challenging situations, restoring the mechanical axis through intra-articular bone resection and soft tissue releases alone can lead to excessive bone loss and ligament instability. We report a case of TKA with combined femoral and tibial osteotomies in a post-polio patient with extra-articular deformities. Although a few small case studies have been previously published in the literature, specific details regarding this procedure are lacking. Our objective is to provide a detailed surgical technique and to review the indications for extra-articular osteotomies performed during TKA.

  4. Osteotomy of the Spine to Correct the Spinal Deformity

    OpenAIRE

    Kim, Ki-Tack; Park, Kyoung-Jun; Lee, Jung-Hee

    2009-01-01

    There are a number of reports on Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). However, there are few systematic reviews of all three kinds of osteotomies. Literature review and author's experience of SPO, PSO and VCR osteotomy will be described. Various surgical techniques can be applied according to the disease entity and magnitude of the deformity. The most appropriate methods for deformity correction should be chosen and the pote...

  5. Sacral and pelvic osteotomies for correction of spinal deformities.

    Science.gov (United States)

    Bodin, Arnaud; Roussouly, Pierre

    2015-01-01

    Restoring a physiological sagittal spine balance is one of the main goals in spine surgery. Several technics have been described previously, as pedicle subtraction osteotomy. In more complicated cases involving spino-pelvic disorders, three authors proposed sacral osteotomy to restore sagittal balance of the spine. The authors describe the use of pelvic osteotomies for the correction of lumbo-sacral kyphosis, for decreasing pelvic incidence and for achieving sagittal balance correction in cases of lumbo-sacral sagittal deformity as an alternative of pedicle subtraction osteotomies (PSO). We simulate four types of pelvic osteotomies previously described for hip pathology (Salter, modified Salter, Chiari and posterior sacral osteotomy) on drawing software, and calculate during these osteotomies the variation of pelvic incidence (PI). Then, we compare the behaviour in this simulation to a cadaveric model where we perform the same four pelvic osteotomies. Via X-rays made the study, we calculate also the PI. Then, we analyse 11 patients who underwent pelvic osteotomies for sagittal unbalance, analysing operative and clinical data. We find a mathematical law governing the PI during anterior opening and posterior closing osteotomies (respectively Salter and sacral osteotomy):[Formula: see text]These laws are confirmed in the cadaveric model which retrieves the same behaviour. In the clinical series, Salter osteotomy is easy and efficient on sagittal rebalancing; sacral osteotomy is more powerful. The Salter osteotomy is efficient for restoring sagittal balance of the spine. The posterior sacral osteotomy is more powerful but technically demanding. The indications of such special osteotomies are fixed lumbo-sacral kyphosis, especially high-grade spondylolisthesis, previously operated or not. A study of a more substantial series would be considered.

  6. The Level of Fibula Osteotomy and Incidence of Peroneal Nerve ...

    African Journals Online (AJOL)

    2010-06-29

    Jun 29, 2010 ... Osteotomy of the fibula is an inseparable component of tibial osteotomy and may be performed at different levels. Studies have shown that the site of osteotomy of the fibula contributes to the incidence of peroneal nerve palsy (PNP).[1-4] Significant complications were observed in adults who had fibular.

  7. Intertrochanteric osteotomy for posttraumatic arthritis after acetabular fractures

    NARCIS (Netherlands)

    Marti, R. K.; Chaldecott, L. R.; Kloen, P.

    2001-01-01

    To evaluate the long-term results of intertrochanteric osteotomies for posttraumatic arthritis after acetabular fractures. Retrospective study of eight patients who underwent a total of ten intertrochanteric osteotomies. Two patients underwent two osteotomies of the same hip. Academic Level I trauma

  8. Proximal femoral osteotomy in cerebral palsy.

    Science.gov (United States)

    Tylkowski, C M; Rosenthal, R K; Simon, S R

    1980-09-01

    The purpose of this study was to examine the results of the proximal femoral osteotomy for the management of hip deformity in 32 children, aged 4 to 15 years. Twenty-two bilateral and ten unilateral procedures were performed. The indications for surgery were subluxation in 16, dislocation in two, and intoeing and femoral anteversion in 14. The average follow-up was two years and 11 months. CE angle of Wiberg, acetabular index and neck shaft angle were evaluated. The average time to regain preoperative ambulatory status was six months with intensive physical therapy. In osteotomies performed for subluxation, dislocation did not occur; roentgenographic indices showed variability in the degree of subluxation. Osteotomy performed in children older than 8 years of age produced no evidence of acetabular remodeling. THere was no recurrence with osteotomies for dislocation. In those patients with internal rotation gait, improvement resulted. Complications were few and minor. Hip dislocation in children with progressive subluxation, in spite of previous soft-tissue releases, is preventable by proximal femoral osteotomy. The inability of the roentgenographic indices to quantitate the increased stability indicates the procedure's major effect is to realign muscle forces about the hip. Treatment of the intoeing gait produced improvement of rotational deformity.

  9. Secondary fractures of Le Fort I osteotomy.

    Science.gov (United States)

    Wilson, M W; Maheshwari, P; Stokes, K; Wheatley, M J; McLoughlin, S; Talbot, M; Shults, W T; Dailey, R A; Wobig, J L

    2000-07-01

    To report the ophthalmic complications of Le Fort I osteotomy for the correction of dentofacial deformities and to determine the maximal compressive loads applied during pterygomaxillary separation in a cadaver model. Two cases of ophthalmic complications arising after Le Fort I osteotomy are reported. Le Fort I osteotomy was performed on five cadavers. The maximal compressive load applied during pterygomaxillary separation was recorded with a 10 kN (3,000 lbf) load cell of a MTS Mini-Bionix servo-hydraulic machine (MTS, Eden Prairie, MN, U.S.A.). A paired t test was used to compare forces applied to the right and left sides. Computed tomography scans of each specimen were obtained after Le Fort I osteotomy to document secondary fractures. The skulls were subsequently stained with 1% fuschin red to highlight secondary fractures. Maximum compressive loads during pterygomaxillary separation ranged from 22 N (5.0 lbf) to 162 N (36.5 lbf), with an average of 106 N (23.8 lbf) (SD 47.6 N [10.7 lbf]). Forces applied on the first operative side were significantly greater than forces applied on the second operative side (p = 0.0034). Secondary fractures were found in three specimens by computed tomography and in two specimens by 1% fuschin red. All secondary fractures occurred on the second operative side. Secondary fractures in the Le Fort I osteotomy procedures occurred on the side opposite the greater maximal compressive load and on the second operative side.

  10. Perisciatic infusion of ropivacaine and analgesia after hallux valgus repair

    DEFF Research Database (Denmark)

    Zaric, D; Jørgensen, B G; Laigaard, F

    2010-01-01

    Moderate to severe pain after hallux valgus repair can be successfully treated with a continuous popliteal sciatic nerve block in ambulatory patients. Different anesthesiologists use various infusion rates for this purpose. The aim of this study was to compare the analgesic efficacy of two infusion...

  11. Valgus Slipped Capital Femoral Epiphysis in Patient with Hypopituitarism

    Directory of Open Access Journals (Sweden)

    Yoshihiro Kotoura

    2017-01-01

    Full Text Available Slipped capital femoral epiphysis (SCFE is a common disease of adolescent and the epiphysis is positioned more posteromedially in relation to the femoral neck shaft with varus SCFE; however, posterolateral displacement of the capital epiphysis, valgus SCFE, occurs less frequently. We report a case of valgus SCFE in a 17-year-old boy with hypopituitarism. After falling down, he experienced difficulty in walking. The radiographs were inconclusive; however three-dimensional computed tomography images showed lateral displacement of the epiphysis on the right femoral head. Valgus SCFE was diagnosed. The patient underwent in situ pinning of both sides. In situ pinning on the left side was performed as a prophylactic pinning because of endocrine abnormalities. At the 1-year follow-up, he could walk without any difficulty and there were no signs of pain. The epiphysis is commonly positioned more posteromedially in relation to the femoral neck shaft with most SCFE, but, in this case, the epiphysis slipped laterally. Differential diagnosis included femoral neck fracture (Delbet-Colonna type 1; however, this was less likely due to the absence of other clinical signs. Therefore, we diagnosed the patient as SCFE. When children complain of leg pain and limp, valgus SCFE that may not be visualized on anteroposterior radiographs needs to be considered.

  12. Valgus instability of the knee joint: a simple surgical repair ...

    African Journals Online (AJOL)

    The technique described for the lare treatment of valgus instability of the knee joint appears to be far simpler rhan the grear variety of alternative methods. In these late cases, the deep part of the medial ligament is almost always unsuitable for direct repair by suture or stapling. Generally it shows extensive fibrosis and ...

  13. Oldest Mummified Case of Hallux Valgus from Ancient Egypt.

    Science.gov (United States)

    Isidro, Albert; Malgosa, Assumpció

    2017-05-01

    Hallux valgus is the most common orthopedic problem of the adult foot. The etiology can be congenital, associated with the occurrence of metatarsus primus varus, or acquired, which is closely related to wearing ill-fitting shoes. Hallux valgus occurs almost exclusively in shod societies and, therefore, is a very uncommon finding in archaeological remains. We present a partial first ray of the left foot belonging to a dismembered Egyptian mummy recovered in the necropolis of Sharuna (Middle Egypt) and dated to the end of the Old Kingdom (circa 2100 BC). The mummification process led to a metatarsophalangeal joint in connection by means of soft tissues. The alignment of this joint could be diagnosed as a hallux valgus. Further examination showed a metatarsophalangeal angle of 28°. After a comprehensive literature search and noting that all of the previous cases were described by indirect factors, such as mounting the joint in dry bones, we can state with certainty that the piece we present herein is the oldest case of mummified hallux valgus.

  14. Valgus slipped capital femoral epiphysis: subcapital growth plate orientation analysis.

    Science.gov (United States)

    Koczewski, Paweł

    2013-11-01

    The aim of the study was to determine the risk factors of unusual, lateral direction of epiphyseal displacement in primarily unilateral slipped capital femoral epiphysis (SCFE) patients with a special focus on radiological parameters of an unaffected hip. A total of 115 patients (75 boys, 40 girls), mean age 13.2 years (8.4-18.6), were analyzed. The mean follow-up time was 11 years (2-29). The proportion of valgus slip among SCFE patients was 11 of 115 cases (9.6%). The patients with valgus slip compared with the classic ones were predominantly females (55 vs. 33%), were younger (11.1 vs. 13.4 years), had a greater epiphyseal-shaft angle (67.4 vs. 59.1°), smaller displacement in the frontal plane (absolute value 6.7 vs. 15°), and a lower risk of contralateral slip (27 vs. 65%). There was no difference in the neck-shaft angle and epiphyseal-neck angle value. A more horizontal orientation of the subcapital growth plate, assessed by epiphyseal-shaft angle, can be considered a conducive factor in the valgus direction of epiphyseal slip in SCFE. In valgus SCFE cases, there is a smaller degree of epiphyseal displacement in both the sagittal and the coronal plane and a lower risk of consecutive contralateral slip.

  15. Osteotomia tibial alta em pacientes com artrose do joelho High tibial osteotomy in patients with knee arthrosis

    Directory of Open Access Journals (Sweden)

    Roger Avakian

    2008-01-01

    Full Text Available OBJETIVO: Avaliar o tratamento da gonartrose medial com osteotomia tibial tipo cunha de fechamento lateral associado à liberação da articulação tibiofibular proximal. MÉTODOS: Realizamos esta técnica associado com liberação da articulação tibiofibular proximal no tratamento da gonartrose medial em 36 pacientes (41 joelhos de janeiro de 1995 a abril de 2003, com idade de 53,4 anos (média, seguidos por 51,6 meses (média. RESULTADOS: Na avaliação notamos que as osteotomias tibiais com cunha de fechamento lateral permitem correção satisfatória da deformidade fêmorotibial, com angulação femorotibial final em torno de 7º de valgo; o eixo mecânico foi desviado da região tibial medial (posição 1,2% para o centro do joelho (posição 50,5%; a inclinação tibial na incidência perfil pré-operatória de 9,8º foi corrigida para 6,5º (média; a mobilidade articular apresentou perda de 2,3º na extensão (média. CONCLUSÃO: A técnica permite correção satisfatória da deformidade em varo fêmorotibial, porém não é isenta de complicações (14,6%. O grau de satisfação (Lysholm dos pacientes teve incremento de 27,3 para 89. Assim, constitui uma parte essencial no arsenal de tratamento da gonartrose.PURPOSE: To assess medial gonarthrosis treatment with wedge-like side-closed tibial osteotomy combined with proximal tibial-fibular joint release. METHODS: we employed this technique combined with proximal tibial-fibular joint release in the treatment of medial gonarthrosis in 36 patients (41 knees, from January 1995 to April 2003, with mean age of 53.4 years, followed-up for 51.6 months (in average. RESULTS: In the assessment, we noticed that wedge-like side-closed tibial osteotomies allow for a satisfactory repair of the femorotibial deformity, with end femorotibial angle of about 7° valgus; the mechanical axis was dislocated from the medial region of the tibia (position: 1.2% to knee center (position: 50.5%; the 9.8° tibial

  16. [Is calcaneal osteotomy justified in Haglund's disease?].

    Science.gov (United States)

    Maynou, C; Mestdagh, H; Dubois, H H; Petroff, E; Elise, S

    1998-11-01

    The authors report their experience of Zadek's wedge osteotomy in the treatment of posterior talalgia in adults and evaluate the various radiographical measurements for calcaneus deformity measurement.... This procedure was performed in 27 patients with a total of 36 calcanea treated between 1985 and 1996. The sex ratio was 20 women for 7 men with an average age of 27 years. Prior to this osteotomy nine feet were operated by resection of the postero-superior tuberosity with recurrence of pain and disability, and two patients presented an inflammatory arthritis. For the surgical procedure, the patient was placed in lateral position. Skin incision was five to six centimeters long, curvilinear along the lateral side of the tendo achillis. Two dorsal pins were inserted, creating a triangle so that the apex pointed plantarly and the base dorsally. The sagittal saw was then used to create a wedge osteotomy with a dorsal base of seven to ten millimeters. A screw was then driven across the osteotomy site for ultimate fixation. Eighty per cent (29 osteotomies) of patients had been examined clinically and radiologically with a mean follow-up of 29 months. Considering pain, daily activity and discomfort with footwear, results were excellent in 12 cases, good in 10, fair in 5 and poor in two cases. No radiological criteria used for the diagnosis of Haglund's disease were absolutely reliable. The "total angle" of Ruch, the "c.l angle" of Chauveaux and the "parallel pitch lines" of Heneghan reflect the amount of deformation most accurately, but especially, the calcaneal inclination angle was always increased (16 cases between 18 degrees and 30 degrees, 6 cases > 30 degrees). All patients had a weight-bearing calcaneal talus, either alone or in the context of posterior pes cavus. This study confirms the responsibility of rearfoot morphostatic disorders in posterior talalgia and the goods results obtained by Zadek osteotomy.

  17. Drilling- and withdrawing-related thermal changes during implant site osteotomies.

    Science.gov (United States)

    Strbac, Georg D; Giannis, Katharina; Unger, Ewald; Mittlböck, Martina; Vasak, Christoph; Watzek, Georg; Zechner, Werner

    2015-02-01

    Intrabony temperature increase is not only dependent on shearing energy and mechanical friction between bone and surgical drill but is also related to heat capacity and thermal conductivity of the surrounding bone and the applied surgical instrument. Thus time of occurrence of the highest temperature rise can be expected after the shearing process of the osteotomy, potentially affecting the process of osseointegration. The aim of this study was to evaluate temperature changes during the shearing and withdrawing processes during osteotomies. An overall 160 automated intermittent osteotomies (10/16 mm drilling depth) with 2 mm diameter twist drills and 3.5 mm diameter conical drills and different irrigation methods (without/external/internal/combined) were performed on standardized bone specimens. The drilling cycles were operated by a computer-controlled surgical system, while a linear motion potentiometer and multichannel temperature sensors in various intrabony levels ensured the real-time documentation of temperature changes during the shearing and withdrawing processes. The highest temperature changes were invariably recorded during the process of withdrawal. Significantly lower temperature changes (p irrigation method. During coolant supply, 2 mm diameter twist drills showed higher temperatures (10 mm, p irrigation (16 mm, p irrigation by the use of conical implant drills. Considering that heat generation during osteotomies is a multifactorial scenario, this study could demonstrate that the highest temperature rise during implant osteotomies occurs during the withdrawing process and that the time of occurrence is influenced by predominant factors such as osteotomy depth and mode of irrigation. © 2013 Wiley Periodicals, Inc.

  18. Why do lesser toes deviate laterally in hallux valgus? A radiographic study.

    Science.gov (United States)

    Roan, Li-Yi; Tanaka, Yasuhito; Taniguchi, Akira; Tomiwa, Kiyonori; Kumai, Tsukasa; Cheng, Yuh-Min

    2015-06-01

    Hallux valgus foot with laterally deviated lesser toes is a complex condition to treat. Ignoring the laterally deviated lesser toes in hallux valgus might result in unsatisfactory foot shape. Without lateral support of the lesser toes, it might increase the risk of recurrence of hallux valgus. We sought to identify associated radiographic findings in patients where lesser toes follow the great toe in hallux valgus and deviate laterally. The weight-bearing, anteroposterior foot radiographs of 24 female hallux valgus feet with laterally deviated lesser toes (group L), 34 female hallux valgus feet with normal lesser toes (group H), and 43 normal female feet (group N) were selected for the study. A 2-dimensional coordinated system was used to analyze the shapes and angles of these feet by converting each dot made on the radiographs onto X and Y coordinates. Diagrams of the feet in each group were drawn for comparison. The hallux valgus angle, lateral deviation angle of the second toe, intermetatarsal angles, toe length, metatarsal length, and metatarsus adductus were calculated according to the coordinates of the corresponding points. The mapping showed the bases of the second, third, and fourth toe in group L shifted laterally away from their corresponding metatarsal head (P hallux valgus angles (P hallux valgus angle, more adducted first metatarsal, and divergent lateral splaying of the lesser metatarsals were associated with lateral deviation of the lesser toes in hallux valgus. Level III, comparative study. © The Author(s) 2015.

  19. Treatment of severe early onset Blount's disease by an intra-articular and a metaphyseal osteotomy using the Taylor Spatial Frame.

    Science.gov (United States)

    Bar-On, Elhanan; Weigl, Daniel Martin; Becker, Tali; Katz, Kalman

    2008-12-01

    Severe Blount's disease results in a multiplanar deformity of the lower limb. The mechanical axis is disrupted, there is a rotational deformity, and also shortening of the limb. A depression of the medial tibial plateau causes joint incongruity and instability. The purpose of this study is to review the results of treatment addressing all the aspects of the deformity. Four patients were treated for severe Blount's disease. The index procedure consisted of a medial tibial plateau elevating osteotomy, a lateral tibial and proximal fibular epiphysiodesis, a proximal tibial metaphyseal osteotomy, and the application of the Taylor Spatial Frame programmed for correction of varus, rotation and shortening, and preemptive lengthening to compensate for growth arrest. Mechanical axis was corrected from a mean 23 degrees (13 degrees -30 degrees ) to 0 degrees in three patients and 6 degrees valgus in 1. Tibias were lengthened by 1-4 cm. At follow-up, the mechanical axis was 0 degrees in two patients and 7 degrees varus in two. The overlengthening was diminishing as planned. The double osteotomy and Taylor Frame correction was found to be accurate, safe, and effective for multiplanar deformity correction in severe Blount's disease.

  20. Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus.

    Science.gov (United States)

    Kim, Moon-Hwan; Yi, Chung-Hwi; Weon, Jong-Hyuck; Cynn, Heon-Seock; Jung, Do-Young; Kwon, Oh-Yun

    2015-04-01

    [Purpose] This study investigated whether the toe-spread-out exercise affects the hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction. [Subjects and Methods] Twenty-four subjects with hallux valgus were randomly assigned to orthosis and orthosis plus toe-spread-out exercise groups. The orthosis group wore the orthosis for 8 weeks, while the orthosis plus toe-spread-out group also performed the toe-spread-out exercise. The hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction were measured initially and after 8 weeks by radiography and ultrasonography. [Results] While there were no significant changes in the three parameters in the orthosis group, there were significant differences in the orthosis plus toe-spread-out exercise group after 8 weeks. In addition there were significant differences in the three measures between the two groups. [Conclusion] The toe-spread-out exercise reduces the hallux valgus angle and hallux valgus angle during active abduction, and increases the cross-sectional area of the abductor hallucis muscle. The toe-spread-out exercise is recommended for patients with mild to moderate hallux valgus.

  1. Minimally invasive opening wedge tibia outpatient osteotomy, using screw-to-plate locking technique and a calcium phosphate cement.

    Science.gov (United States)

    Schwartz, Claude

    2018-01-10

    Medial knee osteoarthritis on angular varus deformity of a lower limb is very common. Open-wedge high tibial osteotomy is a treatment of choice if cartilage is not excessively worn (Allback 1 or 2). The technique based on a plate fixation and the bone defect filled with calcium phosphate cement is thoroughly described. Data at 1, 3, 6 months and 1 year of a 19 cases continuous and prospective series are collected and analysed. Mean age at the time of operation was 55 years. The average preoperative varus deformity was 5° and corrected to an average postoperative valgus of 4° (range 3°-6°). Each control includes the collection of eventual complications, the measurement of health status (quality of life and functional scores) and antero-posterior and lateral X-rays. All osteotomies were considered healed at 6 weeks without any correction loss except one, probably result of a technical error. There was no difference in clinical and functional results between the group and the literature, but the final result occurred earlier in the treatment when the bone defect was filled with either calcium phosphate cement. Faster recovery involved no specific complication and enabled outpatient treatment in a majority of patients.

  2. Can the Syndesmosis Procedure Prevent Metatarsus Primus Varus and Hallux Valgus Deformity Recurrence? A 5-Year Prospective Study.

    Science.gov (United States)

    Wu, Daniel Yiang; Lam, Eddy Kwok Fai

    2018-01-12

    One of the main objectives of hallux valgus surgery is correction of the metatarsus primus varus deformity by osteotomy, arthrodesis, or soft tissue correction. The syndesmosis procedure uses intermetatarsal cerclage sutures to realign the first metatarsal and also induces a syndesmotic bonding between the first and second metatarsals to prevent metatarsus primus varus deformity recurrence. The purpose of the present study was to demonstrate radiologic evidence of the effectiveness of the syndesmosis concept and to identify the incidence and nature of deformity recurrence. A total of 55 feet from 60 consecutive procedures were followed regularly at 6 fixed points for 5 years. The radiologic inclusion criterion was a first intermetatarsal angle >9° or metatarsophalangeal angle >20°. The initial postoperative radiographs showed significant correction of the intermetatarsal angle from a preoperative average of 14.5° to 4.3° (p surgical technique. Also included are 6 relevant radiographs and photographs of the included and excluded feet in the online Supplementary Material for reference. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Is correctional osteotomy crucial in primary varus knees undergoing anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Kim, Sung-Jae; Moon, Hong-Kyo; Chun, Yong-Min; Chang, Woo-Hyuk; Kim, Sul-Gee

    2011-05-01

    Valgus high tibial osteotomy (HTO) has been recommended for ligament stability and enhanced function after anterior cruciate ligament (ACL) reconstruction in varus-angulated knees. However, it is not clear whether HTO should be performed in patients undergoing ACL reconstruction who have primary varus knees without medial compartment arthrosis. We therefore asked whether stability and function differed in patients having ACL reconstruction with differing degrees of preoperative alignment. We retrospectively reviewed 201 patients who had primary, single-bundle ACL reconstructions with primary varus knees based on the preoperative mechanical axis deviation (MAD) on preoperative standing hip-knee-ankle radiographs. Patients were categorized into four groups according to the MAD: Group 1: 0 mm to 4 mm, Group 2: 5 mm to 9 mm, Group 3: 10 mm to 14 mm, and Group 4: greater than 15 mm. A total of 201 patients, 67 in Group 1, 53 in Group 2, 38 in Group 3, and 43 in Group 4, were assessed. Ligament stability was determined with the Lachman test, pivot shift test, and KT 2000™ arthrometer. Functional scores were assessed using the Lysholm score and the International Knee Documentation Committee (IKDC) score. The minimum followup was 24 months (mean, 45 months; range, 24-96 months). We observed no differences in the side-to-side KT 2000™ measurements, Lysholm score, or IKDC functional scores based on the preoperative MAD. The stability and functional scores after ACL reconstruction were not adversely altered by primary varus alignment. Thus, if there is no medial compartment arthritis or varus thrust, we do not believe a correctional tibial osteotomy is crucial in primary varus knees undergoing ACL reconstruction.

  4. Clinical and radiological outcome after periacetabular osteotomy

    DEFF Research Database (Denmark)

    Dahl, Line B; Dengsø, Kristine; Bang-Christiansen, Karl

    2014-01-01

    PURPOSE: Few papers have described results after periacetabular osteotomy (PAO) and risk factors for conversion to total hip arthroplasty (THA). The aim of the present paper was to analyse clinical and radiographic outcome, survival of the hip joint and risk factors of early conversion to THA in ...

  5. Periacetabulaer osteotomi og hoftedysplasi hos yngre voksne

    DEFF Research Database (Denmark)

    Troelsen, Anders; Søballe, Kjeld

    2009-01-01

    The periacetabular osteotomy is recognized as the surgical treatment of choice in young adults with symptomatic hip dysplasia. The procedure is performed to delay or prevent the development of osteoarthritis. The procedure has the ability to improve function and preserve hip joints in > 80...

  6. Valgus-varus motion of the knee in normal level walking and stair climbing.

    Science.gov (United States)

    Yu, B; Stuart, M J; Kienbacher, T; Growney, E S; An, K-N

    1997-07-01

    OBJECTIVE: The knee valgus-varus moment and the knee angles were compared between normal level walking and stair climbing. DESIGN: Ten healthy subjects were tested for ascent, descent, and level walking. BACKGROUND: An understanding of the normal valgus-varus motion of the knee during stair climbing is needed to apply biomechanical analysis of stair climbing as a evaluation tool for knee osteoarthritis patients. METHODS: A motion analysis system, three force plates, and a flight of stairs were used to collect kinematic and kinetic data. The knee angles and moments were calculated from the collected kinematic and kinetic data. RESULTS: The knee varus angle for the maximum knee valgus moments in stair climbing was significantly greater than that in level walking. The knee valgus moment was significantly correlated to ground reaction forces and knee valgus-varus angle during stair climbing and level walking. CONCLUSIONS: There is a coupling between the knee valgus-varus motion and flexion-extension motion. Ground reaction forces are the major contributors to the within-subject variation in the knee valgus-varus moment during stair climbing and level walking. The knee valgus-varus angle is a major contributor to the between-subject variation in the knee valgus moment during stair climbing and level walking.

  7. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial.

    Science.gov (United States)

    van der Woude, J A D; Wiegant, K; van Heerwaarden, R J; Spruijt, S; van Roermund, P M; Custers, R J H; Mastbergen, S C; Lafeber, F P J G

    2017-03-01

    Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. Sixty-nine patients with medial knee joint OA with a varus axis deviation of knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. Randomized controlled trial, Level I.

  8. VARIATION OF VALGUS ANGLE IN PATIENTS PRESENTING FOR TOTAL KNEE ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Abhinav Bhatnagar

    2017-04-01

    Full Text Available BACKGROUND Total Knee Arthroplasty (TKA nowadays is a commonly used treatment for patients suffering from severe osteoarthritis. The success of TKA is influenced by a complex interaction between the bony anatomy, the geometry of the components and the soft tissue balancing. Valgus angle subtended between the mechanical and anatomical axis of femur is one of the major factors influencing the alignment of implants. The objective of this study is to determine the variation of this valgus angle using a scannogram in patients with severe osteoarthritis presenting for TKA. MATERIALS AND METHODS 150 consecutive patients of osteoarthritis of the knee joint presenting for total knee arthroplasty participated in our study. All patients underwent a preoperative scannogram, the mechanical and anatomical axis were drawn and the valgus angle was measured on the PACS (picture archiving and communication system software. RESULTS The mean age of patients undergoing TKA was 63.62±8.38 years. Although, the mean valgus angle for the patients was 6.009±0.89 degrees, only 45 (30% of 150 had valgus angle between 6-7 degrees. 72 (48% had valgus angle in the range of 5-6 degrees and 9 (6% had valgus angle in the range of 4-5 degrees. In 21 (14% knees, valgus angle was more than 7 degrees, while in 3 (2% knees, it was less than 4 degrees. CONCLUSION Fixed valgus angle resection is not reliable in restoring mechanical axis in total knee arthroplasty. A proper preoperative planning to determine the accurate valgus angle is a must to maintain alignment while performing total knee arthroplasty and thereby improve the long-term results. Scannogram is an easy, reliable and cost-effective method to determine the valgus angle.

  9. Varus-valgus motion and functional ability in patients with knee osteoarthritis.

    Science.gov (United States)

    van der Esch, M; Steultjens, M; Harlaar, J; Wolterbeek, N; Knol, D; Dekker, J

    2008-04-01

    To assess the relationship between knee varus-valgus motion and functional ability, and the impact of knee varus-valgus motion on the relationship between muscle strength and functional ability in patients with osteoarthritis (OA) of the knee. Sixty-three patients with knee OA were tested. Varus-valgus motion was assessed by optoelectronic recording and three-dimensional motion analysis. Functional ability was assessed by observation, using a 100 m walking test, a Get Up and Go test, and WOMAC questionnaire. Muscle strength was measured by a computer-driven isokinetic dynamometer. Regression analyses were performed to assess the relationships between varus-valgus motion and functional ability, and to assess the impact of varus-valgus motion on the relationship between muscle strength and functional ability. In patients with high varus-valgus range of motion, muscle weakness was associated with a stronger reduction in functional ability (ie, longer walking time and Get Up and Go time) than in patients with low varus-valgus range of motion. A pronounced varus position and a difference between the left and right knees in varus-valgus position were related with reduced functional ability. In patients with knee OA with high varus-valgus range of motion, muscle weakness has a stronger impact on functional ability than in patients with low varus-valgus range of motion. Patients with knee OA with more pronounced varus knees during walking show a stronger reduction in functional ability than patients with less pronounced varus knees or with valgus knees.

  10. Ulnar shortening osteotomy with a new sliding-hole plate.

    Science.gov (United States)

    Kitzinger, Hugo B; Löw, Steffen; Krimmer, Hermann

    2003-09-01

    Ulnar shortening osteotomy represents a common procedure for surgical treatment of the ulnar impaction syndrome but is still associated with complications like malrotation, angulation, or malunion because of incomplete closure of the osteotomy gap. Therefore, the authors developed a special 7-hole compression plate that allows fixation of the ulna before the osteotomy is carried out to prevent rotation. With this plate, a shortening of up to 10 mm is possible and the compression holes allow closure of the osteotomy gap. The plate has been used in 23 ulnar shortening cases at their center with good results. The authors describe the technique and report their results of ulnar shortening with this device.

  11. The comparison of designed slipper splints with the splints available on the market in the treatment of hallux valgus

    Directory of Open Access Journals (Sweden)

    babak Mirzashahi

    2011-08-01

    Conclusion: This study showed that despite the contraversies in nonoperative treatment of Hallux valgus, if the Hallux valgus angle of patients are mild to moderate, this splints can be used to treat it.

  12. Periacetabular osteotomy. Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years.

    Science.gov (United States)

    Pogliacomi, Francesco; Stark, André; Wallensten, Richard

    2005-02-01

    When surgical treatment of dysplastic hip osteoarthrosis is necessary, osteotomy is preferable to fusion or THR. We evaluated periacetabular osteotomy as a method of choice. We treated 36 symptomatic dysplastic hip joints (32 patients) with the Bernese periacetabular osteotomy (PAO) between 1994 and 2001. We used the ilio-inguinal (I-I) approach in 32 hips and a modified Smith-Petersen (S-P) approach in 4. The patients were followed for mean 4 (1.5-8) years. In 1 patient with coxa valga, a varus femoral osteotomy was performed 1 year after PAO. 2 hips, in which we used the modified S-P approach, necessitated a capsulotomy. The median Merle d'Aubignè score increased from 13 points preoperatively to 16 points postoperatively. This improvement in terms of pain, motion and ambulation was accompanied by spatial reorientation and correction. The lateral center edge angle of Wiberg (CE) improved from an average of 7 degrees to 28 degrees. The anterior center edge angle of Lequesne (FP) improved from an average of 18 degrees to 28 degrees. The acetabular index angle (AC) improved from an average of 22 degrees to 10 degrees. Major complications included 1 partial lesion of the sciatic nerve, 1 malunion and 1 combined nonunion of the pubic and ischiatic osteotomy. 2 patients underwent subsequent total hip replacement (THR) for progressive osteoarthrosis with pain. We found good radiographic correction of deformities, improvement of hip function and pain relief with an acceptable complication rate. With appropriate patient selection, this procedure is the most physiological treatment of symptomatic hip dysplasia in young adults. In addition to relieving symptoms, it may prevent and postpone the development of secondary osteoarthrosis.

  13. Bilateral varus osteotomies in hip deformities: are early interventions superior? A long-term follow-up.

    Science.gov (United States)

    Haverkamp, D; Marti, R K

    2007-04-01

    Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26 patients with a symmetrical hip deformity for which we performed a therapeutic osteotomy on the symptomatic hip. The contralateral hip had the same anatomical predisposition to develop an OA, but there were only minor to no complaints. We advised and performed an early osteotomy on these hips. On radiological evaluation, an average Sharp angle of 42.2 degrees and an average CCD of 142 degrees was present. During an average follow-up period of 19.9 years (range 15.0-25.9), 14 hips were converted to THR after the primary osteotomy, whereas there were only 6 after the early osteotomy (chi-square Pcoxa valga with excessive femoral anteversion and acetabular dysplasia can be superior to the results achieved when surgery is postponed until the complaints and arthrosis have become more severe.

  14. COMBINATION TREATMENT FOR ANTERIOR FOOT DEFORMITIES VIA RECONSTRUCTIVE AND JOINT-SPARING SURGERY IN PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Ya B Khrennikov

    2011-01-01

    Conclusion. The Weil-osteotomy group showed the preservation and partial salvage of osteotomized heads, which promoted the recovery of swinging function of the foot. The new procedures made it possible to prevent recurrent valgus and hammer toe deformities and callus formation in the late postoperative period, to improve quality of life, and to reduce the time of rehabilitation and the length of hospital stay.

  15. [Anatomy in relation to posterior maxillary osteotomy].

    Science.gov (United States)

    Hua, Z; Chen, Z; Hu, X

    2000-09-01

    The most common site of haemorrhage in maxillary osteotomies is the posterior maxilla. Better understanding of the anatomy of this region would minimize possible vascular complications. The aim of this study is to investigate the anatomy of posterior maxilla and establish safety guidelines for Le Fort I osteotomy. Thirty dry human skulls were selected for direct measurement and computerized image analysis. Synosteosis of the pterygomaxillary junction was noted in 10% of the samples. The height of the pterygomaxillary junction was 13.15 mm. The height from the inferior point of the pterygomaxillary junction to the inferior point of the maxillary tuberosity was 5.25 mm. The height from the superior point of the pterygomaxillary junction to the inferior point of the maxillary tuberrosity was 18.05 mm. The average distance from the piriform rim to the descending palatine canal was 35.25 mm. The width of the pterygoid process was 12.34 mm. The average length from the zygo-alveolar ridge to the pterygomaxillary junction was 25.47 mm. The average length from anterior nasal spine to the posterior nasal spine was 46.27 mm, and the angle between the descending palatine canal and the palate plane was 58 degrees 47'. The study is to provide further understanding of the posterior maxillary anatomy in relation to the bone-cut design of Le fort I osteotomy and to create clinical safety guidelines in order to avoid damaging the descending palatine vessels.

  16. Mild hallux valgus angle affects single-limb postural stability in asymptomatic subjects.

    Science.gov (United States)

    Çınar-Medeni, Özge; Atalay Guzel, Nevin; Basar, Selda

    2016-01-01

    Single-limb postural stability is a key component of lower extremity functional status. Factors affecting postural stability should be well defined to prevent injuries. The aim of this study was to investigate the effect of the hallux valgus angle on postural stability in asymptomatic subjects. A total of 19 subjects were included in the study. The hallux valgus angle and postural stability were assessed. Participants were assigned to two groups according to whether the hallux valgus angle was pathological or not. A hallux valgus angle greater than 15 degrees was accepted as pathological. The relationship between the hallux valgus angle and postural stability, and the differences in postural stability scores between the two groups were analyzed. Postural stability was assessed with a stabilometer. The test was performed with the eyes open. We found a significant correlation between the hallux valgus angle and mediolateral and overall stability index (r= 0.484, p= 0.036; r = 0.463, p= 0.046 respectively). Subjects with a pathological mild hallux valgus angle had greater stability index scores than normal subjects (phallux valgus angle has negative effects on postural stability as a forefoot deformity. This deformity should be taken into account for injury prevention strategies in pain-free younger adults.

  17. Characterization of gait in female patients with moderate to severe hallux valgus deformity.

    Science.gov (United States)

    Chopra, S; Moerenhout, K; Crevoisier, X

    2015-07-01

    Hallux valgus is one of the most common forefoot problems in females. Studies have looked at gait alterations due to hallux valgus deformity, assessing temporal, kinematic or plantar pressure parameters individually. The present study, however, aims to assess all listed parameters at once and to isolate the most clinically relevant gait parameters for moderate to severe hallux valgus deformity with the intent of improving post-operative patient prognosis and rehabilitation. The study included 26 feet with moderate to severe hallux valgus deformity and 30 feet with no sign of hallux valgus in female participants. Initially, weight bearing radiographs and foot and ankle clinical scores were assessed. Gait assessment was then performed utilizing pressure insoles (PEDAR) and inertial sensors (Physilog) and the two groups were compared using a non-parametric statistical hypothesis test (Wilcoxon rank sum, Phallux valgus group compared to controls and 9 gait parameters (effect size between 1.03 and 1.76) were successfully isolated to best describe the altered gait in hallux valgus deformity (r(2)=0.71) as well as showed good correlation with clinical scores. Our results, and nine listed parameters, could serve as benchmark for characterization of hallux valgus and objective evaluation of treatment efficacy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Unilateral hallux valgus: is it true unilaterality, or does it progress to bilateral deformity?

    Science.gov (United States)

    Young, Ki Won; Park, Young Uk; Kim, Jin Su; Jegal, Hyuk; Lee, Kyung Tai

    2013-04-01

    This study was undertaken to determine whether unilateral hallux valgus progresses unilaterally and to evaluate the demographics, etiologies, and radiographic findings associated with symptomatic unilateral hallux valgus deformities. Patients treated for hallux valgus between January 2004 and December 2008 were identified, and of these, 33 patients with unilateral deformities were enrolled. Progression of deformities in normal feet were evaluated at last follow-up visit, and the clinical information and radiographic measurements of those with a deformed normal foot or an unchanged normal foot were compared. Thirty-three patients (3.4%) had a unilateral hallux valgus deformity on preoperative radiographs. The mean length of follow up was 4.7 years (range, 2.4-11). Twenty-four cases had no deformity of the normal foot at last follow-up (the unchanged group), but 15 cases had developed hallux valgus deformity (the deformed group). No significant intergroup differences were found in terms of metatarsus adductus angle (P = .412), Meary angle (P = .771), talocalcaneal angle (P = 1.000), or calcaneal pitch angle (P = .267). However, members of the deformed group were significantly younger at disease onset (P = .045), exhibited a curved first metatarsal head (P = .046), and had a larger initial hallux valgus angle (P hallux valgus was found to be over 97.3%, and significant differences were found between the deformed and unchanged groups in terms of age of onset, metatarsal head shape, and hallux valgus angle.

  19. Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time.

    Science.gov (United States)

    van Egmond, N; Hannink, G; Janssen, D; Vrancken, A C; Verdonschot, N; van Kampen, A

    2017-03-01

    The objective of this study was to investigate the effect of a medial open-wedge osteotomy (OWO) and the release of the superficial medial collateral ligament (MCL) on the tibiofemoral cartilage pressure, the MCL tension and the valgus laxity of the knee. Seven fresh-frozen, human cadaveric knees were used. Medial and lateral mean contact pressure (CP), peak contact pressure (peakCP), and contact area (CA) were measured using a pressure-sensitive film (I-Scan; Tekscan, Boston, MA). The MCL tension was measured using a custom-made device. These measurements were continuously recorded for 5 min after an OWO of 10°. After the osteotomy, the valgus laxity was measured with a handheld Newtonmeter. For one knee, the measurements were continued for 24 h. At the end, a complete release of the superficial MCL was performed and the measurements were repeated at 10°. There was relaxation of the MCL after the osteotomy; the tension dropped in 5 min with 10.7% (mean difference 20.5 N (95% CI 16.1-24.9)), and in 24 h, the tension decreased by 24.2% (absolute difference 38.8 N) (one knee). After the osteotomy, the mean CP, peakCP and CA increased in the medial compartment (absolute difference 0.17 MPa (95% CI 0.14-0.20), 0.27 MPa (95% CI 0.24-0.30), 132.9mm2 (95% CI 67.7-198.2), respectively), and decreased in the lateral compartment (absolute difference 0.02 MPa (95% CI 0.03 -0.01), 0.08 MPa (95% CI 0.11 - 0.04), 47.0 mm2 (95% CI -105.8 to 11.8), respectively). Only after a release of the superficial MCL, the mean CP, peak CP and CA significantly decreased in the medial compartment (absolute difference 0.17, 0.27 MPa, 119.8 mm2, respectively), and increased in the lateral compartment (absolute difference 0.02, 0.11 MPa, 52.4 mm2, respectively). After the release of the superficial MCL, a mean increase of 7.9° [mean difference - 0.1° (95% CI -1.9 to 1.6)] of the valgus laxity was found. A release of the superficial MCL helps achieve the goal of reducing

  20. Hallux valgus in dancers: a closer look at dance technique and its impact on dancers' feet.

    Science.gov (United States)

    Davenport, Kathleen L; Simmel, Liane; Kadel, Nancy

    2014-01-01

    Hallux valgus is a common deformity of the forefoot. There is no doubt that some dancers develop hallux valgus, but the question remains as to whether dancers are at greater risk than the general population for developing this deformity. Review of the literature reveals on-going debate regarding risk factors for hallux valgus, which may include increasing age, female gender, genetic predisposition, constrictive shoe wear, first ray hypermobility, foot architecture, tight Achilles tendon, and first metatarsal length. There is insufficient evidence to demonstrate conclusively that dancing, specifically pointe work, increases the prevalence or severity of hallux valgus; more research is needed. Treatment of hallux valgus in dancers should be conservative, with delay of surgical correction until retirement if possible.

  1. Radiological results of modified Dega osteotomy in Tönnis grade 3 and 4 developmental dysplasia of the hip.

    Science.gov (United States)

    Akgül, Turgut; Bora Göksan, Süleyman; Bilgili, Fuat; Valiyev, Natiq; Hürmeydan, Onder Murat

    2014-07-01

    Dega acetabuloplasty at the time of open reduction is effective in improving the acetabular coverage of the femoral head, hence improving the stability of reduction and preventing possible surgery in the future for residual acetabular dysplasia in older children with Tönnis grade 3 and 4 developmental dysplasia of the hip (DDH). The aim of this study was to assess the radiological results of open reduction combined with Dega osteotomy in DDH. Twenty-two children's 26 hips were operated on at a mean age of 38±20.4 SD months and followed up for an average of 42 (range 24-108) months. Thirteen hips (50%) were operated on with concomitant open reduction and capsulorrhaphy, and 13 hips (50%) were treated with concomitant open reduction, capsulorrhaphy and femoral shortening osteotomy. Radiological examination included acetabular index (AI) and centre edge angle measurements. The mean preoperative AI was 39.4±6.9° SD, which improved to 18.3±4.5° SD postoperatively, and AI was measured as 15±3.5° SD at the latest follow-up. There was a significant difference in the mean AI values between the last follow-up and the preoperative measurements (Pcoxa valga anteverta. One of them was operated with a femoral varus osteotomy. The Dega osteotomy combined with anterior open reduction and femoral osteotomies is a safe and effective acetabular osteotomy for surgical treatment of severe DDH such as Tönnis grade 3 and 4 dislocations.

  2. Simultaneous anterior cruciate ligament reconstruction and dome-shaped high tibial osteotomy for severe medial compartment osteoarthritis of the knee

    Directory of Open Access Journals (Sweden)

    Nobuyuki Kumahashi

    2016-10-01

    Conclusion: An ACL reconstruction combined with a dome-shaped high tibial osteotomy using a locking plate is one option for treating an aged athlete with ACL deficiency and severe medial compartment osteoarthritis, and can allow the athlete to return to sports activity.

  3. Bilateral varus osteotomies in hip deformities: are early interventions superior? A long-term follow-up

    NARCIS (Netherlands)

    Haverkamp, D.; Marti, R. K.

    2007-01-01

    Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26

  4. Triple pelvic osteotomy in the treatment of hip dysplasia

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2009-01-01

    Full Text Available Introduction. Insufficient femoral head coverage is found in a variety of diseases, with acetabular dysplasia as the most frequent disorder and triple pelvic osteotomy as the most recently introduced surgical treatment. Objective. This study analyses pre- and postoperative pathoanatomic characteristics of triple in comparison to Salter and Chiari osteotomies, with a logistic regression analysis of outcome predictor and effect explanator factors in relation to the chosen type of operation. Methods. The study involved 136 adolescents treated with Salter and Chiari osteotomies or a triple pelvic osteotomy at the Institute of Orthopaedic Surgery 'Banjica' in Belgrade. The patients were between 10-20 years old at the time of operation. We collected and analyzed data from all the patients: illness history, operative parameters, preoperative and postoperative pathoanatomic data. The data was statistically processed using the statistical software SPSS, defining standard descriptive values, and by using the appropriate tests of analytic statistics: t-test for dependent and independent variables, χ2-test, Fisher's exact test, Wilcoxon's test, parameter correlation, one-way ANOVA, multi-factorial ANOVA and logistic regression, according to the type of the analyzed data and the conditions under which the statistical methods were applied. Results. The average CE angle after triple pelvic osteotomy was 43.5°, more improved than after the Salter osteotomy (33.0° and Chiari osteotomy (31.4° (F=16.822; p<0.01. Postoperative spherical congruence was also more frequent after the triple osteotomy than after the other two types of operations, and with a high significance. Preoperative painful discomfort was found to be a valid predictor of indications for the triple osteotomy over both Chiari and Salter osteotomies. The valid explanators of effect for the triple osteotomy are: postoperative joint congruence (compared to the Chiari osteotomy and increase in joint

  5. Percutaneous Hallux Valgus Surgery Without Distal Metatarsal Articular Angle Correction.

    Science.gov (United States)

    Crespo Romero, Eusebio; Arcas Ordoño, Alvaro; Peñuela Candel, Raquel; Gómez Gómez, Silvia; Arias Arias, Angel; Gálvez González, Jaime; Crespo Romero, Ricardo

    2017-01-01

    Many factors are considered predictors of recurrence after hallux valgus (HV) surgery, including preoperative distal metatarsal articular angle (DMAA). The restoration of the bone and joint alignment would be more important than realigning the cartilaginous surface of the metatarsal head. Therefore, is DMAA correction essential for a good clinical and radiological results after HV surgery? This study aims to illustrate the results of percutaneous forefoot surgery (PFS) for correction of HV deformity without DMAA correction. A prospective single-center study of 74 patients (89 feet), with mild-to-moderate hallux valgus deformity, who underwent PFS. The mean latest follow-up was 57.3 months. Preoperative median visual analog scale was 7 points and AOFAS scores were 52 points. At the mean latest follow up both scores improved to 0 points and 90 points, respectively. Median HV angle and intermetatarsal angle changed from 30° and 12° preoperatively, to 21° and 11° at mean latest follow-up. Overall, 80% of the patients were satisfied or very satisfied. Recurrence of medial first metatarsal head pain occurred in 12 cases (13.5%). PFS, without DMAA correction, is a valid procedure for surgical correction in patients with HV, despite the slightly worse radiographic results in our study. Level II: Prospective study.

  6. EFFICACY OF BILATERAL SIMULTANEOUS HALLUX VALGUS CORRECTION COMPARED TO UNILATERAL

    Directory of Open Access Journals (Sweden)

    A. V. Boychenko

    2014-01-01

    Full Text Available The aim - to compare the results of simultaneous bilateral and unilateral surgical correction of hallux valgus and to create recommendations for treatment of the patients with this pathology. Material and methods. The authorse analyzed the data of 40 patients (60 feet who carried out an operative treatment of hallux valgus in SPb multiprofile city hospital N 2 since 2011 to 2013. Functional (AOFAS score and X-ray results were compared between groups with bilateral and unilateral correction. Mean AOFAS score in these 2 groups after 12 months after surgery was 85,6±6,2 and 85,5±6,9 (p>0,05, mean intermetatarsal angle - 8,4±0,5° and 8,8±0,8° (p>0,05 respectively. No statistically significant difference between these two groups was found. Conclusion. A bigger surgical trauma in case of simultaneous bilateral correction neither worsens functional and x-ray results nor increases a complication rate.

  7. Rod strain after pedicle subtraction osteotomy

    DEFF Research Database (Denmark)

    Gehrchen, Poul Martin; Hallager, Dennis Winge; Dahl, Benny

    2016-01-01

    Pedicle subtraction osteotomy (PSO) can provide major sagittal correction for adult spinal deformity, sometimes achieving correction greater than 308. Surgeons have reported failure rates up to 30% within 2 years, increasing to 46% after 4 to 5 years (SDC Figure 1, http://links.lww.com/BRS/B87......). Revision following failure is difficult on the patient. PSO has achieved positive outcomes, but when used to correct posture in older patients with spinal deformity and fixed sagittal imbalance, rod breakage often leads to multiple surgical revisions. These complications must be avoided....

  8. Knee valgus angle during landing tasks in female volleyball and basketball players.

    Science.gov (United States)

    Herrington, Lee

    2011-01-01

    Increased knee valgus angles have been associated with an increased risk of a variety of knee injuries. It has yet to be established if knee valgus angles during jump landing tasks differ between jumping sports with relatively higher and lower knee injury rates-namely, basketball and volleyball. Any difference in knee angles on landing may be related to sport-specific differences, which may in turn relate to the different injury risk rates. Fifteen elite female basketball and volleyball players had their knee valgus angles assessed during 2 landing tasks: 1 bilateral (drop jump landing) and 1 unilateral (step landing task). During the drop jump task knee valgus angle was significantly greater in the basketball group (p = 0.017) in the right knee, but there was no significant difference in performance between sports in the left knee (p = 0.67). During the step landing task volleyball players had significantly greater knee valgus angles than basketball players for both the left (p = 0.018) and right (p = 0.025) knees. The basketball group showed superior control of knee valgus during the unilateral task, which may be related to sport-specific skills. The basketball players showed significant asymmetry in knee valgus angle during bilateral drop jump landings; this finding reflects those of previous studies and may be related to the relative increased knee injury risk reported for this population group.

  9. Relationship between pedographic analysis and the Manchester scale in hallux valgus.

    Science.gov (United States)

    Iliou, Kalliopi; Paraskevas, George; Kanavaros, Panagiotis; Gekas, Christos; Barbouti, Alexandra; Kitsoulis, Panagiotis

    2015-01-01

    The aim of this study was to evaluate the correlation between the Manchester scale and foot pressure distribution in patients with hallux valgus deformity. The study included 152 feet of 87 patients with hallux valgus and a control group of 391 feet of 241 individuals without hallux valgus deformity. The severity of hallux valgus was determined using the Manchester scale grading system. Plantar loading patterns in 10 foot areas were determined for all participants. According to the Manchester scale, 72% of the participants had no, 12.9% mild, 10.7% moderate and 4.4% severe deformity. The Manchester scale grade was highly correlated with both hallux valgus angle and first intermetatarsal angle (p=0.00). Significant differences between the four grades were present for mean pressure under the hallux and the first and second metatarsal heads only (p=0.00). The load distribution under these areas was higher as the hallux valgus progressed from mild to more severe. In all groups, the highest pressure was observed under the second metatarsal head. The Manchester scale was strongly associated with both the hallux valgus angle and the first intermetatarsal angle. The progression from mild to moderate and severe deformation is associated with peak pressure raise at the hallux, first and second metatarsal heads. The Manchester scale appears to be a useful tool to provide information for the degree of deformity and the pressure under painful foot areas.

  10. Safety and efficacy of osteotomies in adult spinal deformity: what happens in the first year?

    Science.gov (United States)

    Ayhan, Selim; Aykac, Bilal; Yuksel, Selcen; Guler, Umit Ozgur; Pellise, Ferran; Alanay, Ahmet; Perez-Grueso, Francisco Javier Sanchez; Acaroglu, Emre

    2016-08-01

    Spinal surgery for adult spinal deformity (ASD) may require the use of osteotomies, which may have high complication rates (up to 80 %). These may be expected to affect health-related quality of life (HRQOL) in the early postoperative phase but little is known about the clinical course of these patients in the first year following surgery. The aim of the study is to evaluate the radiological results and HRQOL in patients undergoing a spinal osteotomy for ASD within the first year following surgery with special reference to the effect of complications. From a prospective multicenter ASD database, patients who had undergone a Smith-Petersen osteotomy (SPO), pedicle substraction osteotomy (PSO), vertebral column resection (VCR) or any combination of these were reviewed for radiological sagittal alignment parameters [sagittal vertical axis (SVA), global tilt, lumbar lordosis, T2-sagittal tilt (ST)] as well as HRQOL [Oswestry Disability Index (ODI), short form-36 items (SF-36) Physical Component Score (PCS), SF-36 mental CS (MCS), Scoliosis Research Society (SRS)-22 questionnaire (SRS-22) subtotal] preoperatively and at the 6th- and 12th-month follow-ups with special reference to complications classified as major (life threatening or requiring additional surgery) and minor and their effects on HRQOL. 121 patients (85 F, 36 M) with a total of 71 SPOs, 45 PSOs and 13 VCRs were evaluated. Osteotomy resulted in correction of the major coronal Cobb angle from 43.0 ± 3.7° to 24.8 ± 2.8° (p death were observed. Osteotomies were moderately effective in radiological improvement but resulted in a significant increase in HRQOL. They were associated with a high rate of complications but these had no/minimal effect on the clinical outcome. Contrary to the general perception, the greatest improvements in HRQOL were seen to take place during the first 6 months after surgery, even in the presence of complications.

  11. [Shortening osteotomy for alloarthoplastic joint replacement for hip dislocation in adults].

    Science.gov (United States)

    Tohtz, S W; Perka, C

    2012-04-01

    Total hip arthroplasty to create an articulating hip joint. Acetabular cup implantation in the original rotational center of the pelvis. Simultaneous femoral shortening osteotomy to prevent neurovascular damage and equalize leg length in patients with unilateral occurrence. Developmental dysplasia of the hip (DDH) in adults; type 3 and 4 dislocation according to Crowe. Cerebrospinal dysfunction with permanent restriction of coordination ability, muscular dystrophies, and multiple malformations of the musculoskeletal system. Apparent disturbance of the bone metabolism. The Watson-Jones interval approach to the hip joint is used to avoid functional disorders of the hip abductors. After preparation of the proximal femur and femoral neck resection, adjustment of the non-regularly developed acetabular cavity with reduced anterior coverage takes place. The cup component is implanted and the interval between the vastus intermedius and the vastus lateralis below the lesser trochanter examined. Loss of periosteum of the femoral cortex due to blunt spreading is to be avoided. Following the femoral shortening osteotomy initially the preparation of the distal bone segment takes place to adjust the endofemoral canal for shaft implantation in the following preparation of the metaphyseal segment. Afterwards osteotomy-bridging implantation of a cementless, distal anchoring stem design is performed. Partial weight bearing of the leg with 20 kp is necessary for 6 weeks combined with therapy of existing contractures and active pelvic rotation training. Within 10 postoperative weeks full weight bearing is usually reached. After this period mobilization without crutches is possible. Inpatient rehabilitation is possible after bony recovery of the femoral osteotomy. From 1993 to 1999, the first 15 total hip arthroplasties were performed in adult patients with DDH; they were treated with simultaneous femoral shortening osteotomy and without additive osteosynthesis. During the midterm

  12. McBride's operation for hallux valgus can be used in patients older than 30 years

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Soelberg, M; Larsen, T

    1992-01-01

    Over a 10-year period, 46 feet with hallux valgus in 36 patients were treated with the McBride procedure. The median age was 35 years. At follow-up of 2 to 11 years after operation, a reduction in the hallux valgus angles, the intermetatarsal angles and the width of the forefeet was found...... the age. In 37 of 46 feet the overall result was found satisfactory by the patients. The authors find that McBride's operation can be used for hallux valgus, also in patients above 30 years, in spite of the generally accepted restriction to younger individuals....

  13. Navigation-Assisted Nasal Bone Osteotomy for Malunited Fracture.

    Science.gov (United States)

    Ogino, Akihiro; Onishi, Kiyoshi; Nakamichi, Miho; Okaneya, Tetsuya

    2018-01-01

    Nasal bone osteotomy subjectively judges the position for osteotomy by visual inspection and by manual feel using the fingertip. Therefore, the outcome depends on the surgeon's experience and mastery of the procedure is technically challenging. The authors applied a navigation system for the intraoperative evaluation of the osteotomy line and reduction position in 5 patients with malunited nasal bone fracture. The authors performed the operation with a temporal bone post developed for otologic surgery using Stealth Station S7 System (Medtronic, Minneapolis, MN). The suretrack is attached to the bone chisel. The authors performed the osteotomies while visualizing the tip of the chisel on the monitor.In addition, evaluation of the reduction position was performed by insertion of a 23G needle syringe with the suretrack to the nasal bone surface. The tip of the bone chisel was visible on the monitor, and the authors could perform osteotomies while confirming the position and direction of osteotomy. In addition, the reduction position could be visualized clearly on the monitor. Navigation systems can confirm the 3-dimensional spatial relationship around the fracture site in real time, requiring only comparatively simple preoperative preparation and intraoperative operation without radiation exposure. Therefore, the advantage is that even an inexperienced surgeon can perform an accurate evaluation. This would be useful as a guide for young doctors and medical students as it would be possible to perform safe and accurate osteotomy for old nasal bone fractures.

  14. Ulnar shortening osteotomy with a premounted sliding-hole plate.

    Science.gov (United States)

    Kitzinger, Hugo B; Karle, Birgit; Löw, Steffen; Krimmer, Hermann

    2007-06-01

    Ulnar shortening osteotomy represents a common procedure for various ulnar-sided wrist disorders but is still associated with complications like malrotation, angulation, or nonunion because of incomplete closure of the osteotomy gap. We describe the use of a newly developed palmarly placed sliding-hole dynamic compression plate that allows fixation of the ulna before the oblique osteotomy is carried out. We performed ulnar shortening osteotomy on 27 consecutive patients. The indication was ulnar impaction syndrome in 25 patients and symptomatic ulnar plus variance secondary to malunited distal radial fracture in 2 patients. The mean preoperative ulnar variance was +2.1 mm (range, +1 mm to +8 mm). All patients were evaluated before and after surgery and graded with the Disability of Arm-Shoulder-Hand (DASH) scoring system. All 27 osteotomies healed uneventfully over an average of 9.2 +/- 2.1 weeks. The mean postoperative ulnar variance was -2.1 mm (range, -3.1 mm to 0 mm). There were significant improvements in DASH score, pain, and grip strength at an average follow-up of 8.1 months. Six patients complained of plate irritation. Favorable results suggest that ulnar shortening osteotomy using an oblique osteotomy and a premounted sliding-hole compression plate avoids malrotation and angulation and is associated with satisfactory outcomes. This device does not require an assisting device, which minimizes the surgical exposure of the ulna. Palmar placement of the plate seems to reduce hardware irritation.

  15. Planning for corrective osteotomy of the femoral bone using 3D-modeling. Part I

    Directory of Open Access Journals (Sweden)

    Alexey G Baindurashvili

    2016-09-01

    Full Text Available Introduction. In standard planning for corrective hip osteotomy, a surgical intervention scheme is created on a uniplanar paper medium on the basis of X-ray images. However, uniplanar skiagrams are unable to render real spatial configuration of the femoral bone. When combining three-dimensional and uniplanar models of bone, human errors inevitably occur, causing the distortion of preset parameters, which may lead to glaring errors and, as a result, to repeated operations. Aims. To develop a new three-dimensional method for planning and performing corrective osteotomy of the femoral bone, using visualizing computer technologies. Materials and methods. A new method of planning for corrective hip osteotomy in children with various hip joint pathologies was developed. We examined the method using 27 patients [aged 5–18 years (32 hip joints] with congenital and acquired femoral bone deformation. The efficiency of the proposed method was assessed in comparison with uniplanar planning using roentgenograms. Conclusions. Computerized operation planning using three-dimensional modeling improves treatment results by minimizing the likelihood of human errors and increasing planning and surgical intervention  accuracy.

  16. Stabilisation of periarticular fractures and osteotomies with a notched head locking T-plate.

    Science.gov (United States)

    Tan, C J; Johnson, K A

    2016-10-01

    To report the clinical outcomes and complications of small animals that had articular or periarticular fractures or osteotomies stabilised with a notched head locking T-plate. Medical records were searched retrospectively to identify animals that had a notched head locking T-plate used to stabilise a small articular or periarticular bone fragment. Nine dogs and two cats had an articular or periarticular bone fragment stabilised with a 2.0- or 2.4-mm notched head locking T-plate (12 procedures). The median body weight was 4.7 kg. The plate was modified by removing holes in 10/12 procedures and a combination of locking and non-locking screws were used in 7/12 procedures. All fractures or osteotomies progressed to clinical union. There were two intraoperative complications (intra-articular screw placement and overlong screw) and two postoperative complications (skin necrosis and stress protection) This study reports the successful use of a 2.0- or 2.4-mm notched head locking T-plate for articular or periarticular fractures or osteotomies in a variety of small-breed dogs and cats. Care must be taken to prevent inadvertent penetration of the articular surface, particularly in regions such as the proximal tibia. The ability to modify the plate dimensions intraoperatively proved beneficial in most cases. © 2016 Australian Veterinary Association.

  17. Joint Manipulation Under Anesthesia for Arthrofibrosis After Hallux Valgus Surgery.

    Science.gov (United States)

    Feuerstein, Catherine; Weil, Lowell; Weil, Lowell Scott; Klein, Erin E; Argerakis, Nicholas; Fleischer, Adam E

    2016-01-01

    Arthrofibrosis is a known complication of hallux valgus surgery. Joint manipulation under anesthesia has been studied for adhesive capsulitis of the shoulder; however, a paucity of published data exists on the use of this modality in the foot and ankle. The purpose of the present study was to investigate the outcomes of first metatarsophalangeal joint manipulation for arthrofibrosis that occurred as a complication of bunion surgery. The study population consisted of patients attending a single foot and ankle specialty clinic who were evaluated for arthrofibrosis after bunion surgery. Patients who underwent joint manipulation under anesthesia were asked to complete a research visit in which a clinical examination was performed and the presence and severity of joint pain were assessed. A total of 38 patients (34 females, 4 males, 53 feet), with a mean age of 55.7 ± 11.8 (range 30 to 83) years, agreed to participate. The mean follow-up period was 6.5 ± 3.4 (range 1 to 17) years. The visual analog scale scores improved significantly from baseline to the final follow-up visit (baseline 6.5 ± 1.5, range 2 to 10; final follow-up visit 2.3 ± 1.5, range 0 to 6; p < .001). Furthermore, joint motion had increased significantly (p < .001) for both dorsiflexion and plantarflexion at the final follow-up examination. The final range of motion (dorsiflexion, r = -0.431, p = .002; plantarflexion, r = -0.494, p < .001) correlated highly with patient self-reported pain in the first metatarsophalangeal joint. Our findings suggest that joint manipulation could be a useful modality for increasing first metatarsophalangeal joint mobility and alleviating pain in patients who experience arthrofibrosis after surgical correction of hallux valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Hallux valgus and plantar pressure loading: the Framingham foot study

    Science.gov (United States)

    2013-01-01

    Background Hallux valgus (HV), a common structural foot deformity, can cause foot pain and lead to limited mobility. The purpose of this study was to evaluate differences in plantar pressure and force during gait by HV status in a large population-based cohort of men and women. Methods A trained examiner performed a validated physical examination on participants’ feet and recorded the presence of hallux valgus and other specific foot disorders. Each foot was classified into one of four mutually exclusive groups based on the foot examination. Foot groups were: (i) HV only, (ii) HV and at least one additional foot disorder (FD), (iii) no HV but at least one other FD, and (iv) neither HV nor FD (referent). Biomechanical data for both feet were collected using Tekscan Matscan. Foot posture during quiet standing, using modified arch index (MAI), and foot function during gait, using center of pressure excursion index (CPEI), were calculated per foot. Further, walking scans were masked into eight sub-regions using Novel Automask, and peak pressure and maximum force exerted in each region were calculated. Results There were 3205 participants, contributing 6393 feet with complete foot exam data and valid biomechanical measurements. Participants with HV had lower hallucal loading and higher forces at lesser toes as well as higher MAI and lower CPEI values compared to the referent. Participants with HV and other FDs were also noted to have aberrant rearfoot forces and pressures. Conclusions These results suggest that HV alters foot loading patterns and pressure profiles. Future work should investigate how these changes affect the risk of other foot and lower extremity ailments. PMID:24138804

  19. Posttraumatic immobilization in flexion of a congenital valgus elbow and cubital tunnel syndrome-case report.

    Science.gov (United States)

    Di Rocco, Federico; Doglietto, Francesco; Tufo, Tommaso; Ciampini, Alessandro; Lauretti, Liverana; Fernandez, Eduardo

    2009-06-01

    Elbow trauma, cubitus valgus deformity, and prolonged flexion of the elbow are recognized risk factors for ulnar nerve entrapment. The 3 conditions coincided in the present case. In fact, a 36-year-old woman had a bilateral severe congenital cubitus valgus. A trauma of the right elbow caused luxation and supracondylar humeral fracture for which the joint was fixed in flexion at 90 degrees for 1 month. The patient developed a severe ulnar nerve entrapment syndrome that did not respond to several months of physiotherapy and active mobilization of the elbow. The symptoms recovered after surgical decompression and anterior subcutaneous transposition of the nerve. The present case illustrates how the development of a cubital tunnel syndrome should be considered as the expected outcome of a long immobilization in flexion of an elbow with a severe cubitus valgus. A simple subcutaneous anterior transposition of the ulnar nerve might be recommended before a long immobilization of a cubitus valgus elbow is performed.

  20. Growth modulation with a medial malleolar screw for ankle valgus deformity

    OpenAIRE

    Rupprecht, Martin; Spiro, Alexander S.; Breyer, Sandra; Vettorazzi, Eik; Ridderbusch, Karsten; Stücker, Ralf

    2015-01-01

    Background and purpose Growth modulation with a medial malleolar screw is used to correct ankle valgus deformity in children with a wide spectrum of underlying etiologies. It is unclear whether the etiology of the deformity affects the angular correction rate with this procedure. Patients and methods 79 children (20 girls) with ankle valgus deformity had growth modulation by a medial malleolar screw (125 ankles). To be included, patients had to have undergone screw removal at the time of skel...

  1. Effects of balance taping using kinesiology tape in a patient with moderate hallux valgus

    OpenAIRE

    Lee, Sun-Min; Lee, Jung-Hoon

    2016-01-01

    Abstract Background: Hallux valgus, an increased angle of lateral deviation in the big toe, can cause pain and difficulties in balancing and walking. This study aimed to investigate the effects of balance taping using elastic therapeutic tape on moderate hallux valgus. Methods: When she walked with shoes, she complained of pain over the medial eminence of the hallux metatarsophalangeal (MTP) joint. Balance taping using kinesiology tape was applied for 3 months (average, 16hours/d) to both big...

  2. The influence of valgus heel position on foot loading in a child's gait

    Directory of Open Access Journals (Sweden)

    Eliška Martinásková

    2012-12-01

    Full Text Available BACKGROUND: Flat foot is a typical clinical sign in childhood, expressed as valgus positioning of the heel during vertical foot loading. This may lead to medial deviation of the foot axis and cause overloading of some foot areas. OBJECTIVE: To determine the influence of valgus position of the heel (both bilateral and unilateral on foot loading during gait. METHODS: An experimental group consisting of children with bilateral heel valgus deformity (16 children, age 5.3 ± 1.3 years and children with unilateral heel valgus deformity (14 children, age 5.6 ± 1.6 years. The control group comprised of 14 children (age 4.5 ± 1.2 years. For measuring foot loading during gait, the Footscan (RSScan International, Olen, Belgium pressure plate was used. Each subject went through 8 trials of gait measurement. From each trial, 8 foot areas were evaluated. Data processing with mean values for each subject was performed by non-parametric tests (Mann-Whitney and Wilcoxon tests, Spearman correlation in the STATISTICA programme (StatSoft, Inc., Tulsa, USA. RESULTS: Pressure peak and pressure impulse in the first metatarsal was greater for the bilateral valgus group (p CONCLUSION: The results show that valgus positioning of the heel influences foot loading in children during gait. The findings of this study suggest the necessity of a complex solution to the problem of preventing further progression of pathological changes.

  3. The results of Grice Green subtalar arthrodesis of valgus foot in spina bifida

    Directory of Open Access Journals (Sweden)

    Fatih Küçükdurmaz

    2012-01-01

    Full Text Available Background: Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft. Materials and Methods: Between May 2000 and December 2003, 21 patients with bilateral (42 feet valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50-108 months. Results: The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5΀ and 31.9΀, respectively, which decreased to 38.5΀ and 29.1΀, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05. Conclusion: Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients.

  4. Evaluating the Quality, Accuracy, and Readability of Online Resources Pertaining to Hallux Valgus.

    Science.gov (United States)

    Tartaglione, Jason P; Rosenbaum, Andrew J; Abousayed, Mostafa; Hushmendy, Shazaan F; DiPreta, John A

    2016-02-01

    The Internet is one of the most widely utilized resources for health-related information. Evaluation of the medical literature suggests that the quality and accuracy of these resources are poor and written at inappropriately high reading levels. The purpose of our study was to evaluate the quality, accuracy, and readability of online resources pertaining to hallux valgus. Two search terms ("hallux valgus" and "bunion") were entered into Google, Yahoo, and Bing. With the use of scoring criteria specific to hallux valgus, the quality and accuracy of online information related to hallux valgus was evaluated by 3 reviewers. The Flesch-Kincaid score was used to determine readability. Statistical analysis was performed with t tests and significance was determined by P values hallux valgus" (P = .045). Quality and accuracy were significantly higher in resources authored by physicians as compared to nonphysicians (quality, P = .04; accuracy, P hallux valgus is poor and written at inappropriate reading levels. Furthermore, the search term used, authorship, and presence of commercial bias influence the value of these materials. It is important for orthopaedic surgeons to become familiar with patient education materials, so that appropriate recommendations can be made regarding valuable resources. Level IV. © 2015 The Author(s).

  5. Comparison of Ponte Osteotomies and 3-Column Osteotomies in the Treatment of Congenital Spinal Deformity.

    Science.gov (United States)

    Chan, Priscella; Andras, Lindsay M; Nielsen, Ena; Sousa, Ted; Joiner, Elizabeth; Choi, Paul D; Tolo, Vernon T; Skaggs, David L

    2017-08-02

    Congenital spinal deformity (CSD) has traditionally been treated with 3-column osteotomies [hemivertebrectomy (HV) or vertebral column resection (VCR)] to address rigid deformities. Alternatively, multiple Ponte osteotomies (PO) may provide correction while minimizing risk. The purpose of this study was to compare safety and outcomes of patients undergoing surgical treatment for CSD with these 3 procedures. Retrospective review of CSD patients treated with posterior spinal fusion between 1996 to 2013. Patients treated with multiple Ponte osteotomies (PO group) were compared with those managed with 3-column osteotomies (HV/VCR group). Patients with previous instrumentation, isolated cervical deformity, growing spine instrumentation, or Deformity angular ratio (DAR) was calculated as curve magnitude divided by number of levels of the deformity. There were 49 patients [17 PO, 32 HV/VCR (26 HV, 6 VCR)]. For the PO group, mean age was 14 years, and they had an average of 4 ponte osteotomies and 11 levels fused. Mean total DAR was 25 and mean number of congenital anomalies was 1.8 in the PO group. The HV/VCR group had a mean age of 7 years and 5 levels fused. Mean total DAR was 28 and mean number of congenital anomalies was 2.1 in the HV/VCR group. Patients had a mean of 54.1% correction of coronal deformity in the PO group and 54.4% in the HV/VCR group (P=0.78). Signal changes were observed less frequently with PO (1/17) and HV (1/26) than with VCR (4/6), P=0.001. Revision rates were 17.6% (3/17) in the PO group and 37.5% (12/32) in the HV/VCR group (P=0.35). Patients with CSD and a mean total DAR of 25 treated with multiple PO and long fusions had correction comparable with the HV/VCR group. Patients treated with VCR had the highest incidence of signal changes and postoperative neurologic deficits. Level III.

  6. The True Ponte Osteotomy: By the One Who Developed It.

    Science.gov (United States)

    Ponte, Alberto; Orlando, Giuseppe; Siccardi, Gian Luigi

    2018-01-01

    Technique and applications. To define the anatomy, biomechanics, indications, and surgical technique of the true Ponte osteotomy. The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. It has become a widely applied technique in various types of spine deformities and a frequent topic of presentations at meetings and in scientific articles. Several of them offer unquestionable evidence of an incorrect execution, with consequently distorted outcomes and erroneous conclusions. A clearing up became essential. Our original experience is based on a series of 240 patients with thoracic hyperkyphosis operated in the years 1969-2015, at first with a standard posterior Harrington technique and then by using the Ponte osteotomy with different instrumentations. A series of 78 of them, operated in the years 1987-1997, who had Ponte osteotomies at every level, is presented. The average preoperative kyphosis has been corrected from 80° (range 61°-102°) to 31° (range 15°-50°) by a substantial posterior shortening. A number of publications use the term Ponte osteotomy loosely for by far incomplete resections and mixing it up with Smith-Petersen's osteotomy. The true Ponte osteotomy is capable of producing marked flexibility in extension, flexion and rotation, justifying its wide use in thoracic deformities, mainly in scoliosis. An exact performance of the osteotomy with adequate bony resections, including the laminae, is an absolute condition to take full advantage of its properties. Level IV, therapeutic study. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  7. Endolog technique for correction of hallux valgus: a prospective study of 30 patients with 4-year follow-up

    OpenAIRE

    Biz, Carlo; Corradin, Marco; Petretta, Ilaria; Aldegheri, Roberto

    2015-01-01

    Background Hallux valgus (HV) is a complex deformity of the forefoot altering the kinematics of walking. Many different treatment alternatives exist for the correction of hallux valgus, but to date, none has been shown to be more effective than any other. The rate of complications following hallux valgus surgery is variable and has been reported as ranging from 1 to 55?% in the scientific literature. The purpose of this preliminary prospective study was to evaluate the result of the Endolog d...

  8. Mobility of the First Ray in Patients With or Without Hallux Valgus Deformity: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Shibuya, Naohiro; Roukis, Thomas S; Jupiter, Daniel C

    The hypermobility theory of the first ray is the reason for the popularization of procedures such as the modified Lapidus procedure involving arthrodesis of the first tarsal-metatarsal joint for correction of hallux valgus deformity. Although many studies have involved motion of the first ray in hallux valgus patients, the presence and clinical significance of hypermobility in the first ray remains controversial. We performed a systematic review and meta-analysis to evaluate the difference in the first ray range of motion between patients with or without hallux valgus deformity. The databases used for the present review included Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that had evaluated the motion of the first ray in patients with or without hallux valgus. After screening for inclusion and exclusion criteria, we identified 3 studies that were relevant to our study question. All 3 studies showed more first ray motion in the hallux valgus group. Our quantitative synthesis showed a mean difference in the range of motion of the first ray of 3.62 mm (95% confidence interval 2.26 to 4.98) between those with and without hallux valgus deformity. Thus, we found statistically significantly increased first ray motion in patients with hallux valgus deformity compared with those without hallux valgus deformity. However, the clinical significance of this small amount of increased sagittal plane motion as a response to or a cause of hallux valgus remains unanswered. Published by Elsevier Inc.

  9. A pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report.

    Science.gov (United States)

    van Loon, Piet J M; van Stralen, Gijs; van Loon, Corne J M; van Susante, Job L C

    2006-01-01

    A pedicle subtraction osteotomy can be considered as part of the surgical treatment of a symptomatic sagittal imbalance. The literature on the use of this technique is limited and thus far not applied to a rigid thoracolumbar hyperkyphosis. To evaluate our preliminary results of a pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of thoracolumbar kyphotic deformities. Case series Eleven patients with a symptomatic kyphotic deformity were treated with a thoracolumbar pedicle subtraction osteotomy in combination with a multilevel correction. The mean follow-up was 42.8 months (range 26-105). The clinical outcome, radiographic correction, and perioperative complications were analyzed. The results in six more traditional indications (ankylosing spondylitis, kyphoscoliosis, congenital and posttraumatic deformity), were compared with the results in a subgroup of five cases with a rigid thoracolumbar hyperkyphosis. All patients had a kyphotic thoracolumbar junction. An average of 5.8 levels was involved in the corrective fusion. A pedicle subtraction was always performed between the level Th10 and L2 to correct the sagittal balance. A lordotic correction of 38.8 (range 25-49) degrees was established with this fusion. The osteotomy contributed 66% (26.9 degrees) of the correction, whereas the remaining correction came from multilevel facetectomies. The visual analogue scale for both pain and impairment improved significantly (p<.005) for the entire group. Statistical analysis on the results for both subgroups separately was inappropriate because of the small number of patients available; however, overall both subgroups appeared to do equally well. All patients were very satisfied with the result and would choose surgical treatment again. No major complications were encountered. A pedicle subtraction osteotomy is a technically demanding but well tolerated operative procedure for the correction of a kyphotic deformity. This technique can also be

  10. [Clinical and gait analytical investigation of valgus knee bracing in therapy for medial degenerative joint disease of the knee].

    Science.gov (United States)

    Müller-Rath, R; Cho, H Y; Siebert, C H; Miltner, O

    2011-04-01

    The non-operative treatment of medial degenerative joint disease of the knee has proven to be difficult due to the underlying deformity and the pathological mechanical loading. Valgus knee bracing offers the possibility to directly address the mechanical deficit. The aim of this study was to analyse whether or not part-time valgus knee bracing in patients with medial osteoarthrits can effectively reduce knee pain and lead to reproducible changes in the gait analysis in comparison to an elastic knee bandage and an untreated control group. In a prospective trial, 33 patients with symptomatic medial osteoarthritis of the knee joint with a minimum of grade 2 according to the radiographic classification of Kellegren & Lawrence were randomised into a treatment group with a valgus brace (n = 13; M4 OA®, Medi) and an elastic knee bandage (n = 10; Genumedi®, Medi). Both supportive devices were to be applied for 2-4 hours per day, especially during activity. The control group (n = 10) consisted of untreated individuals. The deviation of the leg axis and the degree of degenerative joint disease were evaluated radiographically at the onset of the study by a standing whole leg X-ray. The evaluation at the beginning of the study and after 16 weeks consisted of a clinical examination including various knee scores (Insall score, Lequesne score, HSS score, Tegner score, WOMAC, and VAS for pain). Additionally, at both times a 3-dimensional, instrumented gait analysis was carried out to document the joint angles of the affected knee in all planes. The obtained knee joint angles from all groups at both time points were compared to a control group of healthy persons without a history of knee pain by qualitative measurement. Radiographically, the medial deviation of the load axis from the knee joint centre (MAD) was 29 mm. In 27 patients we found a combination of femoral, intra-articular and tibial changes contributing to the varus alignment. The joint line conversion angle (JLCA) was

  11. Kinetic and kinematic changes with the use of valgus knee brace and lateral wedge insoles in patients with medial knee osteoarthritis.

    Science.gov (United States)

    Fantini Pagani, Cynthia H; Hinrichs, Maren; Brüggemann, Gert-Peter

    2012-07-01

    The effect of a valgus knee brace and a lateral wedged insole on knee and ankle kinematics and kinetics was evaluated in ten patients with medial knee osteoarthritis (OA). The knee orthosis was tested in two valgus adjustments (4° and 8°), and the laterally wedged insole was fabricated with an inclination of 4°. A motion capture system and force platforms were used for data collection and joint moments were calculated using inverse dynamics. The valgus moment applied by the orthosis was also measured using a strain gauge implemented in the orthosis' rotational axis. For the second peak knee adduction moment, decreases of 18%, 21%, and 7% were observed between baseline and test conditions for the orthosis in 4° valgus, in 8° valgus, and insole, respectively. Similar decreases were observed for knee lever arm in the frontal plane. Knee adduction angular impulse decreased 14%, 18%, and 7% from baseline to conditions for the orthosis in 4° valgus, in 8° valgus, and insole, respectively. Knee angle in the frontal plane reached a more valgus position during gait using the valgus knee brace. The valgus moment applied by the orthosis with 8° valgus adjustment was 30% higher than with 4° valgus adjustment. The valgus knee orthosis was more effective than the laterally wedged insole in reducing knee adduction moment in patients with medial knee OA. Copyright © 2011 Orthopaedic Research Society.

  12. Reliability of Two Smartphone Applications for Radiographic Measurements of Hallux Valgus Angles.

    Science.gov (United States)

    Mattos E Dinato, Mauro Cesar; Freitas, Marcio de Faria; Milano, Cristiano; Valloto, Elcio; Ninomiya, André Felipe; Pagnano, Rodrigo Gonçalves

    The objective of the present study was to assess the reliability of 2 smartphone applications compared with the traditional goniometer technique for measurement of radiographic angles in hallux valgus and the time required for analysis with the different methods. The radiographs of 31 patients (52 feet) with a diagnosis of hallux valgus were analyzed. Four observers, 2 with >10 years' experience in foot and ankle surgery and 2 in-training surgeons, measured the hallux valgus angle and intermetatarsal angle using a manual goniometer technique and 2 smartphone applications (Hallux Angles and iPinPoint). The interobserver and intermethod reliability were estimated using intraclass correlation coefficients (ICCs), and the time required for measurement of the angles among the 3 methods was compared using the Friedman test. A very good or good interobserver reliability was found among the 4 observers measuring the hallux valgus angle and intermetatarsal angle using the goniometer (ICC 0.913 and 0.821, respectively) and iPinPoint (ICC 0.866 and 0.638, respectively). Using the Hallux Angles application, a very good interobserver reliability was found for measurements of the hallux valgus angle (ICC 0.962) and intermetatarsal angle (ICC 0.935) only among the more experienced observers. The time required for the measurements was significantly shorter for the measurements using both smartphone applications compared with the goniometer method. One smartphone application (iPinPoint) was reliable for measurements of the hallux valgus angles by either experienced or nonexperienced observers. The use of these tools might save time in the evaluation of radiographic angles in the hallux valgus. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Residual increased valgus stress angulation and posterolateral rotatory translation after simple elbow dislocation.

    Science.gov (United States)

    Kerschbaum, Maximilian; Thiele, Kathi; Scheibel, Markus; Gerhardt, Christian

    2017-07-01

    Purpose of this study was to evaluate increased valgus stress angulation and increased posterolateral rotatory translation after simple elbow dislocation and the associated clinical instability. Ten patients [three women, seven men; mean age 38 ± 11 years; mean follow-up 54 months (median 47 months; range 23-111 months)] with conservatively treated simple elbow dislocations were included into this study. The elbow function was graded by using the subjective elbow value (SEV), the Oxford Elbow Score (OES), the Mayo Elbow Performance Score (MEPS), as well as the DASH Score. Range of motion (ROM) and clinical signs of valgus and posterolateral rotatory instability (PLRI) were evaluated. Additionally, in all patients sonographic and fluoroscopic evaluation of valgus stress angulation and posterolateral rotatory translation was performed. Functional scores showed excellent to good results in all patients (SEV: 92 %; OES: mean 44 ± 5 points; MES: mean 91 ± 9 points; DASH Score: mean, 4 ± 4 points). The ROM did not reveal any significant differences compared to the non-affected side. Overall, three patients presented signs of clinical instability (valgus instability: n = 1; PLRI: n = 2). Sonographically, a slightly but not significantly increased valgus stress angulation in comparison with the non-affected side was measured (n.s.). The posterolateral rotatory translation was significantly increased compared to the non-affected side (p < 0.05). In this context, sonographically, four of ten patients revealed a valgus stress angulation and seven of ten patients a posterolateral rotatory translation more than 50 % compared to the non-affected. In four patients an increased valgus stress angulation and in four patients an increased posterolateral rotatory translation could be seen fluoroscopically. Patients after conservatively treated simple elbow dislocations show good clinical and functional results. However, a sufficient anatomical ligamentary

  14. Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus.

    Science.gov (United States)

    Slullitel, Gaston; López, Valeria; Calvi, Juan Pablo; Seletti, Maximiliano; Bartolucci, Carla; Pinton, Gustavo

    2016-03-01

    Two concepts have been proposed to explain the etiology of metatarsalgia in hallux valgus patients: First, as the magnitude of hallux valgus increases, there is a mechanical overload of the lesser metatarsals. Second, increased relative lesser metatarsal length is a factor in the development of metatarsalgia. However, there is no current evidence that these structural factors lead to primary metatarsalgia. The purpose of the study was to evaluate the factors associated with metatarsalgia in hallux valgus patients. A cross-sectional study of 121 consecutive adult patients with non-arthritic hallux valgus was carried out. Binary logistic regression was performed to identify the effect of the clinical and demographic factors on the occurrence of metatarsalgia. One hundred twenty-one patients (184 feet) with hallux valgus were analyzed. The median weight was 65 kg (interquartile range 58-72). Metatarsalgia was present in 84 (45.6%) feet. The binary logistic regression showed that lesser toe deformity (OR 2.6, 95% CI 0.2-0.5), gastrocnemius shortening (OR 5.8, 95% CI 2.8-12.3), metatarsal index (OR 0.3, 95% CI 0.2-0.5), and weight (OR 2.5, 95% CI 1.2-5.3) were significantly associated. Metatarsalgia occurs in almost half of hallux valgus patients. It has a multifactorial etiology. Our findings contradict the common theory that both the magnitude of hallux valgus deformity and an increased length of the lesser metatarsals, by themselves, lead to primary metatarsalgia. Metatarsalgia was associated with Achilles shortening, excessive weight, and associated lesser toe deformity. These factors should be addressed in order to treat this disorder adequately. Level III, comparative series. © The Author(s) 2015.

  15. Radiological Characteristics and Anatomical Risk Factors in the Evaluation of Hallux Valgus in Chinese Adults

    Science.gov (United States)

    Xu, Hailin; Jin, Kaiji; Fu, Zhongguo; Ma, Mingtai; Liu, Zhongdi; An, Shuai; Jiang, Baoguo

    2015-01-01

    Background: There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults. Methods: We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years). These patients attended Peking University People's Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA), 1–2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ). Results: We found positive correlations between the HVA and IMA (r = 0.279, P 0.05). Feet were divided into three groups based on HVA severity. IMA (P 0.05). Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°). The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development. PMID:25563313

  16. Radiological Characteristics and Anatomical Risk Factors in the Evaluation of Hallux Valgus in Chinese Adults

    Directory of Open Access Journals (Sweden)

    Hailin Xu

    2015-01-01

    Full Text Available Background: There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults. Methods: We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years. These patients attended Peking University People′s Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA, 1-2 intermetatarsal angle (IMA, proximal articular set angle (PASA, distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ. Results: We found positive correlations between the HVA and IMA (r = 0.279, P 0.05. Feet were divided into three groups based on HVA severity. IMA (P 0.05. Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92° than in a flat shape (17.66°. The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P < 0.01. The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different. Conclusions: PASA enlargement is an adaptive change during early hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development.

  17. Surgery for the correction of hallux valgus: minimum five-year results with a validated patient-reported outcome tool and regression analysis.

    Science.gov (United States)

    Chong, A; Nazarian, N; Chandrananth, J; Tacey, M; Shepherd, D; Tran, P

    2015-02-01

    This study sought to determine the medium-term patient-reported and radiographic outcomes in patients undergoing surgery for hallux valgus. A total of 118 patients (162 feet) underwent surgery for hallux valgus between January 2008 and June 2009. The Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for the assessment of outcome after surgery for hallux valgus, was used and patient satisfaction was sought. The medical records and radiographs were reviewed retrospectively. At a mean of 5.2 years (4.7 to 6.0) post-operatively, the median combined MOXFQ score was 7.8 (IQR:0 to 32.8). The median domain scores for pain, walking/standing, and social interaction were 10 (IQR: 0 to 45), 0 (IQR: 0 to 32.1) and 6.3 (IQR: 0 to 25) respectively. A total of 119 procedures (73.9%, in 90 patients) were reported as satisfactory but only 53 feet (32.7%, in 43 patients) were completely asymptomatic. The mean (SD) correction of hallux valgus, intermetatarsal, and distal metatarsal articular angles was 18.5° (8.8°), 5.7° (3.3°), and 16.6° (8.8°), respectively. Multivariable regression analysis identified that an American Association of Anesthesiologists grade of >1 (Incident Rate Ratio (IRR) = 1.67, p-value = 0.011) and recurrent deformity (IRR = 1.77, p-value = 0.003) were associated with significantly worse MOXFQ scores. No correlation was found between the severity of deformity, the type, or degree of surgical correction and the outcome. When using a validated outcome score for the assessment of outcome after surgery for hallux valgus, the long-term results are worse than expected when compared with the short- and mid-term outcomes, with 25.9% of patients dissatisfied at a mean follow-up of 5.2 years. ©2015 The British Editorial Society of Bone & Joint Surgery.

  18. Tibial Plateau Leveling Osteotomy Plate Contouring and Proximal Load Screw Angulation Affect Osteotomy Compression.

    Science.gov (United States)

    Mathis, Karl R; Roe, Simon C; Johnson, Kenneth A

    2015-11-01

    To evaluate the effect of contouring a tibial plateau leveling osteotomy (TPLO) plate, the associated angulation of the dynamic compression plate (DCP) hole relative to the long axis of the tibia, and angulation of the screw relative to the DCP hole on the osteotomy compression generated by load screws in a TPLO model. In vitro biomechanical study. Polyoxymethylene (POM) rod and synthetic cortical bone substitute model (n = 9). The distal portion of a Slocum TPLO plate was attached to a horizontally positioned POM rod that was connected to a load cell. A segment of synthetic cortical bone substitute was attached to the end mount of the testing frame and adjusted to conform to the angle of the proximal portion of the TPLO plate. A 3.5 mm cortical bone screw was inserted in the proximal DCP hole and tightened to 1.5 Nm. The peak longitudinal load (N) was recorded. Screw insertion and data collection were repeated for proximal plate angles of 0-40° at 5° increments. A significant increase in the compression generated was observed as the plate angle was increased from 0° to 10°. The compression ceased to significantly increase until the plate was bent more than 20°, after which a significant decrease in compression was noted. A marked reduction in the compression generated occurred at plate angles greater than 30°. Angulation of the DCP hole and screw insertion angle can have deleterious effects on the magnitude of osteotomy compression. © Copyright 2015 by The American College of Veterinary Surgeons.

  19. Hallux Valgus Surgery May Produce Early Improvements in Balance Control

    Science.gov (United States)

    Sadra, Saba; Fleischer, Adam; Klein, Erin; Grewal, Gurtej S.; Knight, Jessica; Weil, Lowell Scott; Weil, Lowell; Najafi, Bijan

    2016-01-01

    Background Hallux valgus (HV) is associated with poorer performance during gait and balance tasks and is an independent risk factor for falls in older adults. We sought to assess whether corrective HV surgery improves gait and balance. Methods Using a cross-sectional study design, gait and static balance data were obtained from 40 adults: 19 patients with HV only (preoperative group), 10 patients who recently underwent successful HV surgery (postoperative group), and 11 control participants. Assessments were made in the clinic using body-worn sensors. Results Patients in the preoperative group generally demonstrated poorer static balance control compared with the other two groups. Despite similar age and body mass index, postoperative patients exhibited 29% and 63% less center of mass sway than preoperative patients during double- and single-support balance assessments, respectively (analysis of variance P =.17 and P =.14, respectively [both eyes open condition]). Overall, gait performance was similar among the groups, except for speed during gait initiation, where lower speeds were encountered in the postoperative group compared with the preoperative group (Scheffe P = .049). Conclusions This study provides supportive evidence regarding the benefits of corrective lower-extremity surgery on certain aspects of balance control. Patients seem to demonstrate early improvements in static balance after corrective HV surgery, whereas gait improvements may require a longer recovery time. Further research using a longitudinal study design and a larger sample size capable of assessing the long-term effects of HV surgical correction on balance and gait is probably warranted. PMID:24297985

  20. Approach for measuring the angle of hallux valgus

    Directory of Open Access Journals (Sweden)

    Jin Zhou

    2013-01-01

    Materials and Methods: Fifteen age, body weight, and height matched male students were included and those with foot disorders, deformities, or injuries were excluded from the study. The dorsal protrusions of the first metatarsal and the hallux were marked by palpating from three experienced observers; then their barefoot model in standing was collected by a three dimensional laser scanning system. The AoH was defined in the X-Y plane by the angle between the line joining the marks of centre of head and centre of base of metatarsal shaft and the one connecting the marks of the centre of metatarsal head and the hallux. The same procedure was repeated a week later. Besides, other measures based on the footprint, outline, and the radiography were also available for comparisons. Paired t-test, linear regression, and reliability analysis were applied for statistical analysis with significant level of 0.05 and 95% confidence interval. Results: There were no significant differences recorded between the new method and the radiographic method ( P = 0.069. The AoH was superior to the methods of footprint and outline and it displayed a relative higher correlation with the radiographic method (r = 0.94, r2 = 0.89. Moreover both the inter and intraobserver reliabilities of this method were proved to be good. Conclusion: This new method can be used for hallux valgus inspection and evaluation.

  1. Inicial nasal mucosa detachment using piezoelectric device in the Le Fort I osteotomy: A technical note

    Directory of Open Access Journals (Sweden)

    Elio Hitoshi Shinohara

    2013-01-01

    Full Text Available In maxillary Le Fort I type osteotomy the detachment of the nasal mucosa should be done carefully. Piezoelectric surgery contributed much to increase the safety of osteotomies, despite the initial advantage of minimizing the risk of injury in nervous tissue, mainly in bilateral sagittal split osteotomy; we use the piezoelectric device for the initial detachment of the nasal mucosa in the maxillary osteotomy.

  2. Hallux valgus-a case for a physiotherapist or only for a surgeon? Literature review.

    Science.gov (United States)

    Mortka, Kamila; Lisiński, Przemysław

    2015-10-01

    [Purpose] Hallux valgus is one of the most common deformations of the human foot, and it causes great difficulties for the patients. The aim of this paper was to review available medical literature in search of evidence which would justify implementation of physiotherapy, based on its effectiveness for patients with hallux valgus. [Subjects and Methods] The following databases were searched for applicable papers: PubMed, Google Scholar, Clinical Key and UpToDate. Full-text articles from the last 15 years were subjected to a review, which ultimately selected seven papers about hallux valgus therapy published over the past 12 years. These studies were grouped according to their design and level of evidence and classified depending on whether they concerned physiotherapy as postoperative therapy or as the only treatment. [Results] The studies included in the present analysis used the following interventions for patients with hallux valgus: exercise, manual therapy, gait training, taping and orthosis. All the studies showed beneficial effects and the most frequently observed results were reductions in pain and improvements in function. [Conclusion] The evidence found in the reviewed materials clearly indicates that patients with hallux valgus should not only be subject to surgical procedures but also undergo physiotherapeutic treatment.

  3. Effects of balance taping using kinesiology tape in a patient with moderate hallux valgus

    Science.gov (United States)

    Lee, Sun-Min; Lee, Jung-Hoon

    2016-01-01

    Abstract Background: Hallux valgus, an increased angle of lateral deviation in the big toe, can cause pain and difficulties in balancing and walking. This study aimed to investigate the effects of balance taping using elastic therapeutic tape on moderate hallux valgus. Methods: When she walked with shoes, she complained of pain over the medial eminence of the hallux metatarsophalangeal (MTP) joint. Balance taping using kinesiology tape was applied for 3 months (average, 16hours/d) to both big toes of a 26-year-old woman with moderate hallux valgus. Results: On the right side, the hallux valgus angle (HVA) decreased from 21° to 14° and the intermetatarsal angle (IMA) decreased from 15° to 14.5°. On the left side, the HVA decreased from 22° to 11° and the IMA decreased from 15° to 12°. Furthermore, the patient was able to walk long distances in shoes without pain in the medial eminence of the hallux metatarsophalangeal joint. Conclusion: This study suggested that repeated balance taping with kinesiology tape could be used as a complementary treatment method for moderate hallux valgus. PMID:27861365

  4. Valgus hip with high antetorsion causes pain through posterior extraarticular FAI.

    Science.gov (United States)

    Siebenrock, Klaus A; Steppacher, Simon Damian; Haefeli, Pascal Cyrill; Schwab, Joseph Michael; Tannast, Moritz

    2013-12-01

    Valgus hips with increased antetorsion present with lack of external rotation and posterior hip pain that is aggravated with hip extension and external rotation. This may be the result of posterior femoroacetabular impingement (FAI). We asked whether (1) the range of motion (ROM); (2) the location of anterior and posterior bony collision zones; and (3) the prevalence of extraarticular impingement differ between valgus hips with increased antetorsion compared with normal hips and hips with idiopathic FAI. Surface models based on CT scan reconstructions of 13 valgus hips with increased antetorsion, 22 hips with FAI, and 27 normal hips were included. Validated three-dimensional collision detection software was used to quantify the simulated hip ROM and the location of impingement on the acetabular and the femoral sides. Hips with coxa valga and antetorsion showed decreased extension, external rotation, and adduction, whereas internal rotation in 90° of flexion was increased. Impingement zones were more anteroinferior on the femur and posteroinferior on the acetabular (pelvic) side; and the zones were more frequently extraarticular, posterior, or to a lesser degree anterior against the inferior iliac spine. We found a higher prevalence of extraarticular impingement for valgus hips with increased antetorsion. Valgus hips with increased antetorsion predispose to posterior extraarticular FAI and to a lesser degree anteroinferior spine impingement.

  5. The progression of hallux valgus in the oriental Chinese population in Hong Kong.

    Science.gov (United States)

    Koo, Kenneth Kin-Hoo; Tse, Lung Fung; Cheng, Hi Shan; Ho, Kevin Ki Wai

    2017-03-31

    Hallux valgus is the lateral deviation of the great toe at the MTPJ that has many attributing aetiologies. This study will aim to identify whether hallux valgus progresses over time in the oriental Chinese population in Hong Kong. Patients with acquired symptomatic hallux valgus who presented to clinic between 2008 and 2013 were included. The deformities were analysed radiologically at presentation and pre-operative and angles were measured. These angles were analysed in relation to the waiting time from presentation to surgery. A sample of 43 cases from 38 patients (Mean age 63 years, range 48-80 years) were included. Forty-one cases had a hallux valgus angle (HVA) >24° at presentation (Mean 40.4°) and all had an intermetatarsal angle (IMA) >9°. A significant difference is seen with HVA (p=0.040, t=-2.128) at presentation and pre-op but not IMA (p=0.281, t=-1.095). The average wait for surgery was 705.7days which had shown significant correlation with progression in HVA (p=0.031). No significant difference was seen between IMA and waiting time to surgery (p=0.195). The findings suggests severe hallux valgus deformity does progress over time in Hong Kong. Shorter waiting times for surgery could be beneficial to this population. Level III, retrospective comparative series. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  6. The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies.

    NARCIS (Netherlands)

    Muradin, M.S.; Rosenberg, A.; Bilt, A. van der; Stoelinga, P.J.W.; Koole, R.

    2009-01-01

    Adverse effects on the soft tissues after Le Fort I osteotomies include: broadening of the alar base, loss of vermilion show of the upper lip and down sloping of the commissures. In theory, an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) should improve not only the

  7. Tolko poetom hotel bõt : Rastrogannost; Dozhdlivõi den; Jaanov ogon; Setumaa I-II; Tolko poetom. Haralskije zhizneopissanija : Aire Valgus; Aare Valgus; Peeter Petrov; Vaike Metsleht; Valdur Laiapea; Hillar Aruda, ekonomist; Pärja Lumendi; Valjo Z

    Index Scriptorium Estoniae

    Traat, Mats, 1936-

    1996-01-01

    Orig.: Heldimus; Sajupäev; Jaanituli; Setumaa I-II; Ainult poeet. Harala elulood: Aire Valgus; Aare Valgus; Peeter Petrov; Vaike Metsleht; Valdur Laiapea; Hillar Aruda, ökonomist; Pärja Lumendi; Valjo Zeiger; Pavlo Moskalenko; Johannes Iva; Viljar Laanemägi; Olga Kaljusaar; Aimi Vaimets; Einard Kalm (1923-1984); Sonetid vaikimisest I; Kui

  8. Biomechanical superiority of plate fixation for proximal tibial osteotomy.

    Science.gov (United States)

    Hartford, James M; Hester, Peter; Watt, Phil M; Hamilton, Doris; Rohmiller, Michael; Pienkowski, David

    2003-07-01

    Proximal tibial osteotomies require secure and durable fixation to allow early range of motion; however, biomechanical data comparing commonly used fixation methods are lacking. The current study was done to quantify the dynamic biomechanical performance of blade staple fixation and plate fixation of simulated proximal tibial osteotomies. A 15 degrees proximal tibial osteotomy was done on each of 18 synthetic adult composite tibias. Blade staples were used as the means of fixation in nine tibias; plate fixation was used in the remaining nine tibias. The specimens were stressed cyclically in sinusoidal loading whose peak compression and tension loads imitate those measured during normal gait. Device performance was quantified by measuring displacement at the osteotomy site and the number of cycles to failure. Plate fixation had a greater fatigue life than staples (eight plates surviving past 200,000 cycles versus one blade staple) and showed a trend toward less displacement (0.69 mm versus 0.97 mm). Plate fixation of proximal tibial osteotomies offers better fixation and dynamic mechanical performance than blade staples.

  9. Concomitant Hip Arthroscopy and Periacetabular Osteotomy.

    Science.gov (United States)

    Domb, Benjamin G; LaReau, Justin M; Hammarstedt, Jon E; Gupta, Asheesh; Stake, Christine E; Redmond, John M

    2015-11-01

    To detail our early experience using concomitant hip arthroscopy and periacetabular osteotomy (PAO) for the treatment of acetabular dysplasia. We prospectively collected and retrospectively reviewed the surgical and outcome data of 17 patients who underwent concomitant hip arthroscopy and PAO between October 2010 and July 2013. Preoperative and postoperative range of motion, outcome and pain scores, and radiographic data were collected. Intraoperative arthroscopic findings and postoperative complications were recorded. The group consisted of 3 male and 14 female patients with a mean follow-up period of 2.4 years. Three patients had undergone previous surgery on the affected hip. Chondrolabral pathology was identified in all 17 patients. Twelve patients underwent labral repair, and five patients underwent partial labral debridement. No patient was converted to total hip arthroplasty or required revision surgery at short-term follow-up. All 4 patient-reported outcome scores showed statistically significant changes from baseline to latest follow-up (P hip arthroscopy and PAO has been favorable. We noted that all our patients have evidence of chondrolabral damage at the time of PAO when the joint is distracted and evaluated. All patients in this series had intra-articular pathology treated arthroscopically and showed satisfactory mean clinical improvement. Hip arthroscopy with PAO did not appear to introduce complications beyond the PAO alone. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. [Biomechanics of the Chiari pelvic osteotomy].

    Science.gov (United States)

    Shiba, N

    1991-05-01

    We have reviewed our findings on 476 hip joints that underwent a Chiari pelvic osteotomy (Chiari) between June 1983 and March 1990, employing computer simulation using non-linear analysis based on the rigid-body spring model (RBSM) proposed by Kawai. We further made estimates of the changes in the hip abduction force resulting from the Chiari. The abduction force was measured by a Cybex II machine, before and after Chiari, and they were compared with those from simulation modeling (using the abduction muscle model: ABMM) for the power change expected by Chiari. According to the results in the RBSM, the resultant force, the abduction force, deviation of the pelvis, and the joint stress improved outcome after Chiari. Chiari had a positive effect on the peak torque of the hip abduction, though the abduction force was not fully restored clinically. The simulation by ABMM, showed similar results with the abduction force decreasing with increasing degree of hip abduction. From these results, we have developed and established a new technique for the reattachment of the greater trochanter in Chiari.

  11. Three-dimensional reconstruction method for measuring the knee valgus angle of the femur in northern Chinese adults.

    Science.gov (United States)

    Liu, Tong; Wang, Chen-yu; Xiao, Jian-lin; Zhu, Lan-yu; Li, Xue-zhou; Qin, Yan-guo; Gao, Zhong-li

    2014-08-01

    The purpose of this study was to establish a method for measuring the knee valgus angle from the anatomical and mechanical axes on three-dimensional reconstruction imaging models, and to use this method for estimating an average knee valgus angle value for northern Chinese adults. Computed tomographic angiography data in DICOM format for 128 normal femurs from 64 adult subjects were chosen for analysis. After the femur images were subjected to three-dimensional reconstruction, the deepest point in the intercondylar notch (point A), the midpoint of the medullary cavity 20 cm above the knee-joint line (point B), and the landmark of the femoral head rotation center (point C) were identified on each three-dimensional model. The knee valgus angle was defined as the angle enclosed by the distal femoral anatomical axis (line AB) and the femoral mechanical axis (line AC). The average (mean±SD) of knee valgus angle for the 128 femurs was 6.20°±1.20° (range, 3.05° to 10.64°). Significant positive correlations were found between the knee valgus angles of the right and left sides and between the knee valgus angle and age. During total knee arthroplasty, choosing a valgus cut angle of approximately 6° may achieve a good result in reestablishing the natural mechanical alignment of the lower extremity for patients of northern Chinese ethnicity. Larger valgus cut angles should be chosen for older patients.

  12. Three-dimensional reconstruction method for measuring the knee valgus angle of the femur in northern Chinese adults*

    Science.gov (United States)

    Liu, Tong; Wang, Chen-yu; Xiao, Jian-lin; Zhu, Lan-yu; Li, Xue-zhou; Qin, Yan-guo; Gao, Zhong-li

    2014-01-01

    The purpose of this study was to establish a method for measuring the knee valgus angle from the anatomical and mechanical axes on three-dimensional reconstruction imaging models, and to use this method for estimating an average knee valgus angle value for northern Chinese adults. Computed tomographic angiography data in DICOM format for 128 normal femurs from 64 adult subjects were chosen for analysis. After the femur images were subjected to three-dimensional reconstruction, the deepest point in the intercondylar notch (point A), the midpoint of the medullary cavity 20 cm above the knee-joint line (point B), and the landmark of the femoral head rotation center (point C) were identified on each three-dimensional model. The knee valgus angle was defined as the angle enclosed by the distal femoral anatomical axis (line AB) and the femoral mechanical axis (line AC). The average (mean±SD) of knee valgus angle for the 128 femurs was 6.20°±1.20° (range, 3.05° to 10.64°). Significant positive correlations were found between the knee valgus angles of the right and left sides and between the knee valgus angle and age. During total knee arthroplasty, choosing a valgus cut angle of approximately 6° may achieve a good result in reestablishing the natural mechanical alignment of the lower extremity for patients of northern Chinese ethnicity. Larger valgus cut angles should be chosen for older patients. PMID:25091990

  13. Comparison of Designed Slippers Splints with the Splints Available on the Market in the Treatment of Hallux Valgus

    Directory of Open Access Journals (Sweden)

    Yadollah Pournia

    2012-02-01

    Full Text Available Hallux valgus or the lateral deviation of the great toe is a complex disease. If it is not treated, it will cause the deviation of other toes. Hallux valgus is three times more common in females and may cause uncomfortable deformity of the foot, problems in putting on unsuitable and narrow toe box shoes, and pain on the medial side of the first metatarsophalangeal joint; therefore, patients seek medical services. Untreated hallux valgus may cause the hammer toe deformity of the second toe. In this cohort study, 30 patients referring to the Orthopedic Clinic of Shohada Ashayer Hospital of Khorramabad, Iran, with a complaint of hallux valgus were randomly divided into two groups. The splints designed by the researches (slippers splints were given to the case group, and the splints on the market including night splints and interdigital pads were given to the control group. The patients were followed every three months for a year and every time the weight bearing anteroposterior radiography of both feet were taken and hallux valgus and inter-metatarsal angles were measured. The data was analyzed by the SPSS software using repeated measure tests. In the case group that used the designed splints regularly, hallux valgus angles decreased more dramatically than in the control group (P<0.001. This study showed that, despite controversies over the nonoperative treatment of hallux valgus, if hallux valgus angle in patient is mild to moderate, the splint can be used as a nonoperative treatment.

  14. A comparison of hallux valgus angles assessed with computerised plantar pressure measurements, clinical examination and radiography in patients with diabetes

    NARCIS (Netherlands)

    Janssen, D.M.; Sanders, A.P.; Guldemond, N.A.; Hermus, J.; Walenkamp, G.H.; Van Rhijn, L.W.

    2014-01-01

    Background Hallux valgus deformity is a common musculoskeletal foot disorder with a prevalence of 3.5% in adolescents to 35.7% in adults aged over 65 years. Radiographic measurements of hallux valgus angles (HVA) are considered to be the most reproducible and accurate assessment of HVA. However, in

  15. Effect of Fatigue on Knee Kinematics During Countermovement Jumps in Female Students of Physical Education With Valgus Knee Deformity

    Directory of Open Access Journals (Sweden)

    Najmeh Sharifi

    2016-06-01

    Discussion: According to the results, the effects of fatigue on the kinematic variables in patients with valgus knee deformity are greater than on the healthy people. This could have been caused by the changes in the lower extremities and muscle length in patients with valgus knee deformity.

  16. First metatarsophalangeal arthroscopy in patients with post-traumatic hallux valgus.

    Science.gov (United States)

    Lui, T H

    2015-12-01

    Post-traumatic hallux valgus is relatively rare and has been reported after rupture of the medial collateral ligament of the first metatarsophalangeal (MTP-1) joint; Lisfranc joint injury; turf toe injury; medial plantar nerve entrapment secondary to tibial fracture or first metatarsal fracture. Post-traumatic hallux valgus after medial collateral ligament injury has a high incidence of MTP-1 pathology. Detailed history and clinical examination can facilitate differentiation of the source(s) of the patient's symptoms and assist accurate formulation of the surgical plan. First, MTP arthroscopy is a feasible diagnostic and therapeutic tool to manage the MTP-1 joint pain in hallux valgus following injury to the MTP-1 joint. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. McBride's operation for hallux valgus can be used in patients older than 30 years

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Soelberg, M; Larsen, T

    1992-01-01

    Over a 10-year period, 46 feet with hallux valgus in 36 patients were treated with the McBride procedure. The median age was 35 years. At follow-up of 2 to 11 years after operation, a reduction in the hallux valgus angles, the intermetatarsal angles and the width of the forefeet was found....... In patients older than 30 years there were significant reductions. In patients younger than 30 years, the reduction was not significant. The rate of problems with daily footwear was reduced from 36 of 46 feet to 13 of 38 feet. The authors noted few problems and a high rate of satisfied patients, despite...... the age. In 37 of 46 feet the overall result was found satisfactory by the patients. The authors find that McBride's operation can be used for hallux valgus, also in patients above 30 years, in spite of the generally accepted restriction to younger individuals....

  18. The history, evolution and basic science of osteotomy techniques

    Directory of Open Access Journals (Sweden)

    John Dabis

    2017-10-01

    Full Text Available Abstract Osteotomy techniques date back to Hippocrates circa 415 BC (Jones Hippocrates collected works I, Harvard University Press, Cambridge, 2006; Brorson in Clin Orthop Relat Res 467(7:1907–1914, 2009. There is debate about the best way to divide the bone surgically and which technique yields the best bone regenerate in lengthening; ensuring predictable new bone formation and healing of the osteotomy are the primary goals. We review the history and techniques of the osteotomy and consider the evidence for optimum bone formation. Methods discussed include variants of the ‘drill and osteotome’ technique, use of the Gigli saw and use of a power saw. Differences in bone formation through the different techniques are covered.

  19. Carpal valgus in llamas and alpacas: Retrospective evaluation of patient characteristics, radiographic features and outcomes following surgical treatment

    Science.gov (United States)

    Hunter, Barbara; Duesterdieck-Zellmer, Katja F.; Huber, Michael J.; Parker, Jill E.; Semevolos, Stacy A.

    2014-01-01

    This study evaluated outcomes of surgical treatment for carpal valgus in New World camelids and correlated successful outcome (absence of carpal valgus determined by a veterinarian) with patient characteristics and radiographic features. Univariable and multivariable analyses of retrospective case data in 19 camelids (33 limbs) treated for carpal valgus between 1987 and 2010 revealed that procedures incorporating a distal radial transphyseal bridge were more likely (P = 0.03) to result in success after a single surgical procedure. A greater degree of angulation (> 19°, P = 0.02) and younger age at surgery (< 4 months, P = 0.03) were associated with unsuccessful outcome. Overall, 74% of limbs straightened, 15% overcorrected, and 11% had persistent valgus following surgical intervention. To straighten, 22% of limbs required multiple procedures, not including implant removal. According to owners, valgus returned following implant removal in 4 limbs that had straightened after surgery. PMID:25477542

  20. A geometric analysis of hallux valgus: correlation with clinical assessment of severity

    Directory of Open Access Journals (Sweden)

    Vila Joan

    2009-05-01

    Full Text Available Abstract Background Application of plane geometry to the study of bunion deformity may represent an interesting and novel approach in the research field of hallux valgus. For the purpose of contributing to development of a different perspective in the assessment of hallux valgus, this study was conducted with three objectives: a to determine the position on the intersection point of the perpendicular bisectors of the longitudinal axes of the first metatarsal and proximal phalanx (IP, b to correlate the location of this point with hallux valgus deformity according to angular measurements and according to visual assessment of the severity carried out by three independent observers, and c to assess whether this IP correlated with the radius of the first metatarsophalangeal arc circumference. Methods Measurements evaluated were intermetatarsal angle (IMA, hallux valgus angle (HVA, and proximal phalangeal articular angle (PPAA. The Autocad® program computed the location of the IP inside or outside of the foot. Three independent observers rated the severity of hallux valgus in photographs using a 100-mm visual analogue scale (VAS. Results Measurements of all angles except PPAA showed significantly lower values when the IP was located out of the foot more distantly and vice versa, significantly higher values for severe deformities in which the IP was found inside the foot (p p Conclusion The IP is a useful indicator of hallux valgus deformity because correlated significantly with IMA and HVA measurements, VAS scores obtained by visual inspection of the degree of deformity, and location of the center of the first metatarsophalangeal arc circumference.

  1. Preliminary Results and Learning Curve of the Minimally Invasive Chevron Akin Operation for Hallux Valgus.

    Science.gov (United States)

    Jowett, Charlie R J; Bedi, Harvinder S

    Minimally invasive surgery is increasing in popularity. It is relevant in hallux valgus surgery owing to the potential for reduced disruption of the soft tissues and improved wound healing. We present our results and assess the learning curve of the minimally invasive Chevron Akin operation for hallux valgus. A total of 120 consecutive feet underwent minimally invasive Chevron Akin for symptomatic hallux valgus, of which 14 were excluded. They were followed up for a mean of 25 (range 18 to 38) months. The patients were clinically assessed using the American Orthopaedic Foot and Ankle Society score. Complications and patient satisfaction were recorded. The radiographs were analyzed and measurements recorded for hallux valgus and intermetatarsal angle correction. The mean age of the patients undergoing surgery was 55 (range 25 to 81) years. Of the 78 patients, 76 (97.4%) were female and 2 (2.6%) were male; 28 (35.9%) cases were bilateral. The mean American Orthopaedic Foot and Ankle Society score improved from 56 (range 23 to 76) preoperatively to 87 (range 50 to 100) postoperatively (p hallux valgus and intermetatarsal angles preoperatively were 29.7° (range 12° to 46°) and 14.0° (range 8° to 20°). The corresponding postoperative angles were 10.3° (range 0° to 25°) and 7.6° (range 3° to 15°; p hallux valgus surgery. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Deformidade acentuada em valgo do joelho: descrição de nova técnica cirúrgica para correção Severe valgus deformity of the knee: description of new surgical technique for its correction

    Directory of Open Access Journals (Sweden)

    Robson Rocha da Silva

    2012-04-01

    Full Text Available A osteotomia supracondilar varizante do fêmur é o procedimento estabelecido para tratamento do joelho doloroso com artrose lateral e deformidade em valgo. Na descrição das técnicas cirúrgicas convencionais, há divergência com respeito ao local, via de acesso, grau de correção, tipo de fixação e região para colocação da síntese, sendo mais evidente nos casos graves de valgo com angulações acima de 30˚e deformação do fêmur distal associada à hipoplasia do côndilo lateral. Os autores descrevem uma nova técnica cirúrgica de osteotomia femoral distal, baseada em critérios anatômicos e geométricos, desenvolvida no próprio serviço para o tratamento de casos graves de valgo, apresentando um dos casos tratados. A nova técnica consiste em que a cunha a ser ressecada no ato operatório tem direção oblíqua e formato de um triângulo isósceles. A nova proposta para estes casos pretende, então, resolver os problemas apresentados, trazendo a correção do valgo sem causar uma nova deformidade do fêmur distal. É promovido um bom contato ósseo cortical, além de facilitar a aplicação de um sistema estável de síntese. Entretanto, ainda não se tem ideia dos limites de idade do paciente e do grau de artrose do joelho que possam contraindicar esta cirurgia, necessitando, portanto, de maior casuística e tempo de acompanhamento dos casos operados.Varus supracondylar osteotomy of the femur is the established procedure for treating painful knees that present lateral arthrosis and valgus deformity. In descriptions of the conventional surgical techniques, there are divergences regarding the location, access route, correction level, fixation type and area for synthesis insertion. This is most evident in cases of severe valgus with angles greater than 30º and distal femoral deformation, in association with hypoplasia of the lateral condyle. The authors describe a new surgical technique for distal femoral osteotomy, based on

  3. Factors Associated with Hallux Valgus in a Population-Based Study of Older Women and Men: the MOBILIZE Boston Study

    Science.gov (United States)

    Nguyen, Uyen-Sa D.T.; Hillstrom, Howard J.; Li, Wenjun; Dufour, Alyssa B.; Kiel, Douglas P.; Procter-Gray, Elizabeth; Gagnon, Margaret M.; Hannan, Marian T.

    2009-01-01

    Objective To examine potential risk factors for hallux valgus in community-dwelling elders. Method Data from 600 MOBILIZE Boston Study participants (386 women and 214 men) were analyzed. Hallux valgus was defined as > 15 degrees angular deviation of the hallux with respect to the first metatarsal bone toward the lesser toes. Associations of hallux valgus with age, body mass index (BMI), race, education, pes planus, foot pain, and in women, history of high heel shoe use, were assessed using sex-specific Poisson regression with robust variance estimation for risk ratios (RR) and 95% confidence intervals (CI). Results Hallux valgus was present in 58% of women and 25% of men. Higher BMI was inversely associated with presence of hallux valgus in women (p trend = 0.001), with the strongest inverse association observed in those with BMI of 30.0 or more compared to those with normal BMI (RR=0.7, 95% CI: 0.5, 0.9). Women, who usually wore high-heeled shoes during ages 20 to 64 years compared to those who did not, had increased likelihood of hallux valgus (RR=1.2, 95% CI: 1.0, 1.5). Among men, those with BMI between 25.0 and 29.9 had increased likelihood of hallux valgus compared to those with normal BMI (RR=1.9, 95% CI: 1.0, 3.5). Men with pes planus were more likely to have hallux valgus (RR=2.1, 95% CI: 1.3, 3.3) compared to men without pes planus. Conclusion In women, hallux valgus was associated with lower BMI and high heel use during ages 20 to 64, while in men, associations were observed with higher BMI and pes planus. Our results suggest that the etiologic mechanisms for hallux valgus may differ between men and women. PMID:19747997

  4. Correlation between Manchester Grading Scale and American Orthopaedic Foot and Ankle Society Score in Patients with Hallux Valgus.

    Science.gov (United States)

    Iliou, Kalliopi; Paraskevas, George; Kanavaros, Panagiotis; Barbouti, Alexandra; Vrettakos, Aristidis; Gekas, Christos; Kitsoulis, Panagiotis

    2016-01-01

    To evaluate the correlation between the Manchester Grading Scale and the American Orthopaedic Foot and Ankle Society (AOFAS) score in patients with a hallux valgus deformity. The study sample included 181 feet of 122 patients with hallux valgus and 424 feet of 212 individuals without hallux valgus deformity as the control group. The severity of hallux valgus, utilizing a relative nonmetric scale, the Manchester Grading Scale, and the metric AOFAS score, was determined for all individuals in the hallux valgus and control groups. SPSS version 18 (Chicago, Ill., USA) was used for data analysis. According to the Manchester Grading Scale, the 424 feet of the normal group were classified as 'no deformity'. In the hallux valgus group, 85 feet were classified as 'mild deformity', 67 as 'moderate deformity' and 29 as 'severe deformity'. The AOFAS total score in the control group was 99.14. In the hallux valgus group, patients with mild or moderate deformity had total scores of 86.20 and 68.19, respectively. For those with severe hallux valgus, the total score was 44.69 and the differences were statistically significant (p = 0.000). Using the Pearson correlation, strong negative correlations were found between the AOFAS score and the hallux valgus angle (HVA; r = -0.899, p = 0.000). Strong negative correlations were demonstrated between the AOFAS score and the first intermetatarsal angle (IMA) as well (r = -0.748, p = 0.000). The AOFAS score was negatively associated with the Manchester Grading Scale, HVA and first IMA. As the severity of hallux valgus increased, the AOFAS score seemed to decrease. © 2015 S. Karger AG, Basel.

  5. [Metal/alumine metallosis on tibial osteotomy. A case report].

    Science.gov (United States)

    Mathieu, G; Roue, J; Poignard, A; Hernigou, P

    2008-05-01

    Metallosis is mainly described in the hip joint at the time of wear or inappropriate use. Cases have also been reported in patients with a knee prosthesis, but never after tibial osteotomy. We report a rare case of metallosis resulting from metal-alumina contact after open wedge tibial osteotomy. The patient complained of pain, which was relieved after removal of the plate nine months after the first operation. Intraoperative inspection revealed metallosis at the synthesis site and local plate wear at zone of contact with the ceramic filler. Removal of the plate and cleaning of the metallosis zone led to full relief of the pain at one and a half months.

  6. Hallux valgus in males--part 1: demographics, etiology, and comparative radiology.

    Science.gov (United States)

    Nery, Caio; Coughlin, Michael J; Baumfeld, Daniel; Ballerini, Flávio José; Kobata, Silvia

    2013-05-01

    The high frequency of hallux valgus deformities in females is well known and has been widely reported in the literature. This finding tends to obscure the importance and the characteristic details of hallux valgus deformities in males. The severity of the deformity, its onset at an earlier age, and its inheritability seem to be more frequent in males, but there are no reports in the literature to substantiate these concepts. The purpose of this study was to analyze these questions in regard to males with hallux valgus. The records and plain radiographs of 31 males (53 feet) with a diagnosis of hallux valgus that were treated over a 20-year period (1985-2005) were analyzed. During that same period, the senior author (CN) performed 812 procedures for the correction of hallux valgus deformities in women. In order to compare gender-related differences associated with this deformity, 31 women's charts-paired by age and affected side-were randomly selected and both clinical and radiological data were statistically compared. The onset of the complaints of first ray pain in males was equally distributed by decades, indicating that the deformity begins earlier in this group. Among males, we found 68% of the subjects had a familial history of bunion deformities-58% were maternal and 10% were fraternal. In the control group of females, only 35% of the women reported inheritance of the deformity. No correlation with footwear was found among males. The radiographic measurements were significantly higher in the male group, which included the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the tarsal metatarsal angle (TMA). The main gender difference was found to be the DMAA with first metatarsophalangeal (MTP) joint congruence being much more common in males (males = 57%, females = 30%). No correlations were found for metatarsus primus varus or pes planus. Based on our observations, we conclude that hallux valgus in males is commonly hereditary in

  7. Valgus slipped capital femoral epiphysis: report of two cases and a comprehensive review of literature.

    Science.gov (United States)

    Venkatadass, K; Shetty, Ajoy P; Rajasekaran, S

    2011-09-01

    Valgus slip of the capital femoral epiphysis is a known but extremely rare form of a slipped capital femoral epiphysis. After the first report in 1926 up to the present, approximately 44 cases have been reported. We report two cases of valgus slip of the capital femoral epiphysis with a comprehensive review of the existing literature and the precautions that are needed while planning surgical management of these patients. Awareness of this condition is essential to make a prompt diagnosis and plan the appropriate management.

  8. Helpotusta hallux valgukseen! : 8 viikon harjoitusohjelman ja kinesioteippauksen vaikutus hallux valgus virheasentoon, koettuun kipuun ja toimintakykyyn

    OpenAIRE

    Uusihaka, Noora; Hiirikoski, Joonas

    2013-01-01

    Hallux valgus eli vaivaisenluu on yleinen jalkaterän toimintahäiriö, jota esiintyy jopa 25 prosentilla ihmisistä. Usein hallux valgus on kivulias ja vaikuttaa toimintakykyyn ja elämänlaatuun negatiivisesti. Jalkaterän toimintahäiriöt, jotka aiheuttavat hallux valgusta, ovat usein seurausta jalkaterän lihasten alentuneesta lihasvoimasta ja –kontrollista. Opinnäytetyön tarkoituksena on tuottaa tietoa hallux valguksen yleisyydestä, sen etiologisista tekijöistä ja konservatiivisen hoidon mahd...

  9. Total hip arthroplasty (S-ROM stem) and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip.

    Science.gov (United States)

    Li, Liangtao; Yu, Mingyang; Yang, Chen; Gu, Guishan

    2016-01-01

    Developmental dysplasia of the hip (DDH) in adults with severe pain and disability is best treated by total hip arthroplasty (THA). The purpose of this study was to retrospectively evaluate the outcomes of subtrochanteric shortening osteotomy combined with THA using S-ROM stem for those severe patients with a special focus on the effect of two shapes in the subtrochanteric osteotomy ends: Oblique and transverse. Twenty one cases with mean age of 43.6 years who met inclusion criteria and were operated between February 2007 and February 2012 were included in the study. Those cases had been divided into two groups (oblique vs. transverse) and all records between the two groups were analyzed. The Harris hip score significantly improved from 30.6 (range 18-59) preoperatively to 91.2 (range 87-98) postoperatively by the latest followup. Complications including one deep venous thrombosis, one intraoperative fracture of femur and two dislocations occurred while they were addressed properly afterward. The oblique group showed significant advantages in operative time, union time and additional fixation in comparison with the transverse group. In the primary THA for the treatment of irreducible DDH, subtrochanteric oblique osteotomy combined with the freely-rotatable S-ROM stem provided favorable short term outcomes by affording both morphological and functional advantages.

  10. Radical resection of a craniopharyngioma via the extradural anterior temporal approach with zygomatic arch osteotomy

    Science.gov (United States)

    Ota, Nakao; Tanikawa, Rokuya; Miyama, Masataka; Miyazaki, Takanori; Kinoshita, Yu; Matsukawa, Hidetoshi; Yanagisawa, Takeshi; Sakakibara, Fumihiro; Saito, Norihiro; Miyata, Shiro; Noda, Kosumo; Tsuboi, Toshiyuki; Takeda, Rihei; Kamiyana, Hiroyasu; Tokuda, Sadahisa

    2016-01-01

    Background: Though the extradural anterior temporal approach (EDATA) with zygomatic osteotomy is useful, there are only few reports of this approach being used for craniopharyngioma resection. Herein, we report our surgical case series and the technical importance of EDATA for the radical removal of a craniopharyngioma. Methods: We report 7 cases of craniopharyngiomas treated surgically between April 1999 and October 2015. The surgical approaches, clinical presentation, pre and postoperative radiographic examination results, surgical outcomes, and morbidity were analyzed. Results: The mean follow-up period was 89.1 months. The surgical approach was EDATA with zygomatic osteotomy in 4, combined interhemispheric translamina terminalis approach (IHTLA) and trans-sylvian anterior temporal approach (ATA) in 2, and IHTLA in 1 patient. Complete tumor resection was achieved in all cases, without any recurrence during the follow-up period. Transient morbidities were oculomotor nerve palsy in 2, and meningitis and hydrocephalus in 1 patient. There was 1 case of permanent morbidity due to hydrocephalus that needed a ventriculoperitoneal shunt, and 1 case of blindness on the operative side. Visual acuity and visual field improved in 4 cases, showed no change in 2 cases, and deteriorated in 1 case. Though the pituitary stalk was preserved in 2 cases, all 7 cases needed total hormone replacement therapy. Conclusion: EDATA with zygomatic osteotomy ensures sufficient mobility of the internal carotid artery, and provides a good lateral and look up operative view. Hence, it can be used effectively for radical resection of craniopharyngiomas through the opticocarotid space and retrocarotid space. PMID:28194297

  11. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy

    Science.gov (United States)

    Yoon, Seong-Dae; Zhang, GuoFeng; Kim, Hee-June; Lee, Byoung-Joo; Kyung, Hee-Soo

    2016-01-01

    Purpose The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO). Materials and Methods This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border. Results The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group. Conclusions In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method. PMID:27894175

  12. Medial opening wedge distal femoral osteotomy for post-traumatic secondary knee osteoarthritis.

    Science.gov (United States)

    Matsui, Gen; Akiyama, Takenori; Ikemura, Satoshi; Mawatari, Taro

    2014-04-30

    Osteoarthritis of the knee secondary to femoral fracture is difficult to treat. There are some surgical options, such as total knee arthroplasty or correction osteotomy. Opening wedge high tibial osteotomy is an established treatment of gonarthrosis. However, few reports are available on the effectiveness of a medial opening wedge distal femoral osteotomy. We present a case of a medial opening wedge distal femoral osteotomy on gonarthrosis secondary to a malunited femoral fracture with varus deformity and leg length discrepancy. This osteotomy was performed at the deformed femur, with locking plate fixation and autologous bone graft. Six months after the surgery, the osteotomy site was filled with bridging callus. Two years later, the Knee Society Score improved from 45 to 90 points. Medial opening wedge distal femoral osteotomy can be a useful method to treat knee osteoarthritis associated with distal femoral deformity.

  13. Correlation between generalized joint hypermobility and hallux valgus

    Directory of Open Access Journals (Sweden)

    A. A. Kardanov

    2015-01-01

    Full Text Available Purpose: to evaluate correlation between generalized joint hypermobility, forefoot deformities and elasticity of the first ray of the foot. Material and methods. We examined 138 patients with complaints related with deformities at the forefoot level. During this study the medical history was obtained, the elasticity type of the feet was defined and the degree of motion of the medial metatarsal-cuneiform joint was evaluated. Forefoot elasticity was identified by bringing together the heads I and V metatarsal bones with fingers. If convergence occurred with little resistance, those feet were called hyperelastic. The convergence of the heads I and V metatarsal bones of the foot with an average type of elasticity occurred with resistance. It was impossible to converge the heads of I and V metatarsal bones. Due to the results of weight-bearing and non-weight bearing X-ray, analysis of the main radiographic angles of the foot was performed: between I and V metatarsal bones, between the first and second metatarsal bones and between the first metatarsal bone and proximal phalanx of the great toe. Calculation formula of the forefoot flatness index, showing the average ratios of basic radiographic angles of the foot on the x-ray images (weight-bearing and non-weight bearing was created. An assessment of total joint hypermobility using Beighton scale and evaluation of first ray deformity using DuPont scale were performed. Statistical analysis of obtained data was performed, as a result of which significantly strong correlation between total joint hypermobility, forefoot elasticity and valgus deviation of the great toe were revealed. Results. 11% of the feet were hyperelastic. Calculation of the index of forefoot flatness showed that forefoot flatness wasn’t significant for a rigid foot - 5.6 %, for the feet with an average degree of mobility it was 6.0% and it was expressed for hypemobile feet - 12.3 %. Strong correlation relation between the forefeet

  14. Trochanteric reduction osteotomy as a treatment for refractory trochanteric bursitis

    NARCIS (Netherlands)

    Govaert, L. H. M.; van der Vis, H. M.; Marti, R. K.; Albers, G. H. R.

    2003-01-01

    We describe a new operative procedure for patients with chronic trochanteric bursitis. Between March 1994 and May 2000, a trochanteric reduction osteotomy was performed on ten patients (12 hips). All had received conservative treatment for at least one year. Previous surgical treatment with a

  15. Bilateral sagittal split osteotomy versus distraction osteogenesis for mandibular advancements

    NARCIS (Netherlands)

    Baas, E.M.

    2015-01-01

    The aim of this thesis was to compare the treatment modality of distraction osteogenesis (DO) with the gold standard for mandibular advancement surgery. In fact we compare distraction osteogenesis with the standard of care, which is a conventional bilateral sagittal split osteotomy as described by

  16. Horizontal osteotomy for reconstruction of the narrow edentulous mandible

    NARCIS (Netherlands)

    Raghoebar, GM; Batenburg, RHK; Meijer, HJA; Vissink, A

    The aim of this retrospective study was to evaluate the applicability of a horizontal osteotomy procedure for reconstruction of a narrow edentulous mandible in order to enable insertion of implants. In 7 edentulous patients a narrow inferior alveolar ridge was reconstructed with autogenous bone

  17. Triangle tilt and steel osteotomy: similar approaches to common problems.

    Science.gov (United States)

    Nath, Rahul K; Somasundaram, Chandra; Mahmooduddin, Faiz

    2011-03-24

    Each year, thousands of children worldwide suffer obstetric brachial plexus nerve injuries resulting not only in primary nerve injury, but also in development of secondary muscle and bone deformities of the shoulder. The triangle tilt surgery has been developed and shown to effectively address these deformities. The triangle tilt procedure was initially designed by the lead author (RKN) to follow the concepts of joint normalization featured in the Steel pelvic osteotomy used to correct developmental dysplasia of the hip joint, and indeed ultimately bears a striking resemblance to the Steel osteotomy. Prior to performing these bony surgical procedures, soft tissue procedures are performed to release the muscle contractures of the shoulder and hip. The purpose of this article is to compare and analyze the similarities between the indications, surgical techniques, involved anatomy, and outcomes of these operative procedures. A literature review was conducted using PubMed to identify articles pertaining to triangle tilt surgery and the Steel pelvic osteotomy. Functional parameters and surgical strategies were compared. Pre- and post-operative CTs were analyzed to compare anatomical results of the procedures. Similarities were found between both procedures in terms of indications, involved anatomy, surgical techniques, and outcomes. The triangle tilt surgery is indicated to correct the developmental dysplasia of the glenohumeral joint in obstetric brachial plexus injury patients. Steel pelvic osteotomy is performed to correct the subluxation and dislocation of the hip innominate bone in patients with congenital dysplasia, cerebral palsy myelodysplasia, and poliomyelitis. The involved anatomy of both procedures is similar in that both involve limb girdles and ball-and-socket joints, namely the shoulder and hip. Both procedures are also triple osteotomies, the triangle tilt involving the acromion, clavicle and scapula while the Steel osteotomy involves the iliac spine

  18. Valgus extension overload syndrome of the elbow in a test cricket ...

    African Journals Online (AJOL)

    Elbow injury in sports is dependent on the nature of the game. Well- defined injury patterns like the valgus hyperextension syndrome have been reported in throwers, in racquet sports and in baseball. The demands of throwing in cricket theoretically do not involve sig- nificant stress on the elbow. We report for the first time a ...

  19. Valgus extension overload syndrome of the elbow in a test cricket ...

    African Journals Online (AJOL)

    of valgus hyperextension syndrome in an international cricket fast bowler. The mechanism of trauma seems to ... programme designed to strengthen his forearm flexor-pronator and triceps group of muscles. He resumed ... elbow extension produce tensile stresses on medial compartment restraints (ulnar collateral ligament, ...

  20. Relationship of Radiographic and Clinical Parameters With Hallux Valgus and Second Ray Pathology.

    Science.gov (United States)

    Gribbin, Caitlin K; Ellis, Scott J; Nguyen, Joseph; Williamson, Emilie; Cody, Elizabeth A

    2017-01-01

    Hallux valgus is frequently associated with additional forefoot pathologies, including hammertoes and midfoot osteoarthritis (OA). However, the pathogenesis of these concurrent pathologies remains to be elucidated. We sought to determine whether there is a relationship between demographic and radiographic parameters and the incidence of secondary pathologies in the setting of a bunion, with an emphasis on second tarsometatarsal (TMT) OA and hammertoes. A total of 153 patients (172 feet) who underwent reconstruction for hallux valgus were divided into 3 groups: (1) bunion only (61 patients), (2) bunion with hammertoe without second TMT joint OA (78 patients), and (3) bunion with second TMT joint OA (14 patients). Preoperative age, sex, and body mass index (BMI) as well as hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), ratio of second to first metatarsal length, and Meary's angle were recorded. One-way analysis of variance (normality demonstrated) and Kruskal-Wallis (normality not demonstrated) tests were used to assess differences in continuous variables. Post hoc tests were conducted with the Bonferroni technique. Associations between discrete variables and the study groups were analyzed using χ(2) tests. Following the univariate analysis, multinomial logistic regression models were built to determine potential risk factors for hammertoe or TMT OA group placement. Patients in the hammertoe and TMT OA groups were significantly older than patients in the bunion only group ( P hallux valgus who are at greater risk for developing secondary pathologies. Level III, retrospective comparative series.

  1. The Mechanical Axis of the First Ray: A Radiographic Assessment in Hallux Abducto Valgus Evaluation.

    Science.gov (United States)

    LaPorta, Guido A; Nasser, Ellianne M; Mulhern, Jennifer L; Malay, D Scot

    2016-01-01

    The present report describes a new method of hallux abducto valgus deformity correction planning using the mechanical axis of the medial column (mechanical axis planning). This method of radiographic evaluation identifies an ideal position for the first metatarsal after correction and is useful regardless of the surgical procedure chosen. We retrospectively reviewed 200 radiographs to identify a "normal" value for the mechanical axis angle. We reviewed 100 radiographs of patients with hallux abducto valgus deformity (deformity group) and 100 radiographs of patients without hallux abducto valgus deformity (control group). The deformity group revealed an M1-M2 anatomic axis angle of 13.5° ± 2.83° and an M1-M2 mechanical axis angle of 11.58° ± 1°. The control group revealed an M1-M2 anatomic axis angle of 7.5° ± 1.76° and an M1-M2 mechanical axis angle of 11.19° ± 0.9°. The differences in the M1-M2 anatomic axis angle and M1-M2 mechanical axis angle were statistically significant between the control and deformity groups. We sought to provide a reliable method for planning hallux abducto valgus deformity correction by aligning the mechanical axis of the medial column and the mechanical axis of the first ray to the "normal" value of 11° to reduce the deformity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Tibial Sesamoid Position Influence on Functional Outcome and Satisfaction After Hallux Valgus Surgery.

    Science.gov (United States)

    Chen, Jerry Yongqiang; Rikhraj, Kiran; Gatot, Cheryl; Lee, Justine Yun Yu; Singh Rikhraj, Inderjeet

    2016-11-01

    During hallux valgus surgery, the abnormal position of the first metatarsal bone relative to the sesamoids is addressed. Our study aimed to investigate the influence of postoperative tibial sesamoid position (TSP) on functional outcome and patient satisfaction after hallux valgus surgery. Between February 2007 and November 2011, 250 patients who underwent hallux valgus surgery at our tertiary hospital were followed for 2 years after surgery. They were categorized into 2 groups based on Hardy and Clapham's TSP classification, recorded on postoperative weight-bearing anteroposterior (AP) radiographs: (1) normal (grades I-IV) and (2) outliers (grades V-VII). The mode TSP improved from grade VII preoperatively to grade IV postoperatively (P Hallux Metatarsophalangeal-Interphalangeal Scale was 6 (95% CI 2, 11) points higher in the normal group (P = .009). Patients in the outlier group were also more likely to be dissatisfied with the surgery performed when compared to the normal group (OR 3.881, 95% CI 1.689, 8.920, P = .001). We recommend correcting the TSP to grade of IV or less to improve functional outcome and satisfaction after hallux valgus surgery. Level III, retrospective comparative series. © The Author(s) 2016.

  3. Quality of Life in Patients With Untreated and Symptomatic Hallux Valgus.

    Science.gov (United States)

    Yamamoto, Yohei; Yamaguchi, Satoshi; Muramatsu, Yuta; Terakado, Atsushi; Sasho, Takahisa; Akagi, Ryuichiro; Endo, Jun; Sato, Yasunori; Takahashi, Kazuhisa

    2016-11-01

    The purposes of this study were to compare the quality of life (QOL) of subjects who had untreated symptomatic hallux valgus with the QOL of the general population and to investigate factors associated with the QOL of the subjects. One hundred sixteen subjects with previously untreated and symptomatic hallux valgus were surveyed. QOL was assessed using the 36-item Short Form Health Survey (SF-36). Additionally, clinical evaluations (the visual analog scale for pain, Japanese Society for Surgery of the Foot Scale, lesser toe pain, and pain in other parts of the body) and radiographic evaluations (hallux valgus angle, intermetatarsal angle between the first and second metatarsals, and dislocation of the second metatarsophalangeal joint) were performed. Differences in the SF-36 between the subjects and the general population were tested using independent t tests. Correlations between the QOL measurements, clinical evaluations, and radiographic evaluations were assessed using Spearman rank correlation coefficient. All SF-36 subscales and physical component summary scores for the subjects were significantly lower than those of the general population. Notably, the standardized physical function subscale (38.2 ± 15.8, P hallux valgus subjects was lower than that of the general population. All QOL and clinical evaluation parameters were not significantly or negligibly correlated with the severity of toe deformities. Surgical decision making should not be based on the severity of the deformity alone, but rather patient QOL should also be carefully assessed. Level III, comparative series. © The Author(s) 2016.

  4. Subjective versus objective assessment in early clinical outcome of modified Lapidus procedure for hallux valgus deformity.

    Science.gov (United States)

    Chopra, S; Moerenhout, K; Crevoisier, X

    2016-02-01

    Studies have assessed the outcome of hallux valgus surgeries based on subjective questionnaires, usually the American Orthopaedic Foot and Ankle Society Score, and radiographic results reporting good to excellent outcome at 6-12 months postoperatively. However, contrasting results were reported by gait studies at 12-24 months postoperatively. In a previous study, we found nine gait parameters which can describe the altered gait in hallux valgus deformity. This study aimed, to assess the outcome of modified Lapidus at 6 months postoperatively, using gait assessment method, to determine if the nine specified gait parameters effectively relates with the clinical scores and the radiological results or add information missed by these commonly used clinical assessments. We assessed 21 participants including 11 controls and 10 patients with moderate to severe hallux valgus deformity. The patient group was followed 6 months postoperatively. The ambulatory gait assessment was performed utilizing pressure insoles and inertial sensors. Clinical assessment includes foot and ankle questionnaires along with radiographic results. Comparison was made using non parametric tests, Phallux valgus surgeries. The existing clinical assessment overestimates the functional outcome at the early postoperative phase. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Hallux Valgus and the First Tarsometatarsal Joint: Clinical and Biomechanical Aspects

    NARCIS (Netherlands)

    F.W.M. Faber (Frank)

    2003-01-01

    textabstractThis thesis describes a series of cadaver, experimental, radiographic and clinical studies on the relation between a hallux valgus deformity and mobility of the first tarsometatarsal joint. Hypermobility of stiffnes of the joint was determined by Doppler imaging of vibrations and by

  6. Ultrasonic evaluation of the abductor hallucis muscle in hallux valgus: a cross-sectional observational study

    Directory of Open Access Journals (Sweden)

    Stewart Sarah

    2013-01-01

    Full Text Available Abstract Background The aim of the study was to investigate the abductor hallucis muscle characteristics, defined as dorso-plantar (DP thickness, medio-lateral (ML width, and cross-sectional area (CSA in relation to the severity of hallux valgus using musculoskeletal ultrasound. One hundred and two feet, mean (SD age of 60.3 (20.54 years old, displaying varying severities of hallux valgus were stratified into four groups representing the four grades of the Manchester Scale (grade 0: no deformity, grade 1: mild deformity, grade 2: moderate deformity and grade 3: severe deformity. Methods The abductor hallucis muscle was imaged in each foot using a portable ultrasound system. The mean (SD DP thickness, ML width, and CSA measurements were compared across the four Manchester Scale grades using a one-way ANOVA. Results Significant differences in DP thickness were found between feet with no hallux valgus (grade 0 and feet with hallux valgus grade 2 (p = 0.001 and 3 (p  0.0125. Conclusions We speculate that morphological changes to the abductor hallucis muscle occur early in the development of the deformity.

  7. A structural numerical model for the optimization of double pelvic osteotomy in the early treatment of canine hip dysplasia.

    Science.gov (United States)

    Zanetti, Elisabetta M; Terzini, Mara; Mossa, Luca; Bignardi, Cristina; Costa, Piero; Audenino, Alberto L; Vezzoni, Aldo

    2017-07-20

    Double pelvic osteotomy (DPO) planning is usually performed by hip palpation, and on radiographic images which give a poor representation of the complex three-dimensional manoeuvre required during surgery. Furthermore, bone strains which play a crucial role cannot be foreseen. To support surgeons and designers with biomechanical guidelines through a virtual model that would provide bone stress and strain, required moments, and three-dimensional measurements. A multibody numerical model for kinematic analyses has been coupled to a finite element model for stress/strain analysis on deformable bodies. The model was parametrized by the fixation plate angle, the iliac osteotomy angle, and the plate offset in ventro-dorsal direction. Model outputs were: acetabular ventro-version (VV) and lateralization (L), Norberg (NA) and dorsal acetabular rim (DAR) angles, the percentage of acetabular coverage (PC), the peak bone stress, and moments required to deform the pelvis. Over 150 combinations of cited parameters and their respective outcome were analysed. Curves reporting NA and PC versus VV were traced for the given patient. The optimal VV range in relation to NA and PC limits was established. The 25° DPO plate results were the most similar to 20° TPO. The output L grew for positive iliac osteotomy inclinations. The 15° DPO plate was critical in relation to DAR, while very large VV could lead to bone failure. Structural models can be a support to the study and optimization of DPO as they allow for foreseeing geometrical and structural outcomes of surgical choices.

  8. The effect of valgus braces on medial compartment load of the knee joint - in vivo load measurements in three subjects.

    Science.gov (United States)

    Kutzner, Ines; Küther, Steffen; Heinlein, Bernd; Dymke, Jörn; Bender, Alwina; Halder, Andreas M; Bergmann, Georg

    2011-04-29

    Knee osteoarthritis occurs predominately at the medial compartment. To unload the affected compartment, valgus braces are used which induce an additional valgus moment in order to shift the load more laterally. Until now the biomechanical effect of braces was mainly evaluated by measuring changes in external knee adduction moments. The aim of this study was to investigate if and to which extent the medial compartment load is reduced in vivo when wearing valgus braces. Six components of joint contact load were measured in vivo in three subjects, using instrumented, telemeterized knee implants. From the forces and moments the medio-lateral force distribution was calculated. Two braces, MOS Genu (Bauerfeind AG) and Genu Arthro (Otto Bock) were investigated in neutral, 4° and 8° valgus adjustment during walking, stair ascending and descending. During walking with the MOS brace in 4°/8° valgus adjustment, medial forces were reduced by 24%/30% on average at terminal stance. During walking with the GA in the 8° valgus position, medial forces were reduced by only 7%. During stair ascending/descending significant reductions of 26%/24% were only observed with the MOS (8°). The load reducing ability of the two investigated valgus braces was confirmed in three subjects. However, the load reduction depends on the brace stiffness and its valgus adjustment and varies strongly inter-individually. Valgus adjustments of 8° might, especially with the MOS brace, not be tolerated by patients for a long time. Medial load reductions of more than 25% can therefore probably not be expected in clinical practise. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Use of a Trochanteric Flip Osteotomy Improves Outcomes in Pipkin IV Fractures

    Science.gov (United States)

    Moon, Charles N.; Franco, Dennis P.

    2008-01-01

    The optimal surgical approach for combined femoral head and acetabular fractures (Pipkin IV) is controversial because of their rarity and lack of definitive reports. Surgical dislocation with trochanteric flip osteotomy (TFO) allows simultaneous exposure of the acetabulum and femoral head. We protected the obturator internus and inferior capsule during repair with a heavy suture at the inferior extent of the traumatic capsulotomy. We retrospectively reviewed 12 patients with Pipkin IV fractures treated using this approach during a 6-year period. The minimum followup was 24 months (mean, 47 months; range, 24–71 months). Clinical outcomes were measured using the Merle d’Aubigné-Postel and Thompson-Epstein scoring scales. Radiographically, all patients achieved healing of their acetabular fractures; 11 achieved healing of the femoral head fracture and osteonecrosis developed in one patient. The average Merle d’Aubigné-Postel score was 15.6 of 18; using the Thompson-Epstein score, 10 of the 12 patients had good or excellent outcomes, one had a fair outcome, and one had a poor outcome. Trochanteric flip osteotomy allowed for simultaneous exposure and repair of both lesions in Pipkin IV fractures. Using a uniform surgical protocol with TFO rendered clinical results comparable to previously reported outcomes in series of isolated femoral head fractures. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18800211

  10. Radiographic Shape of Foot With Second Metatarsophalangeal Joint Dislocation Associated With Hallux Valgus.

    Science.gov (United States)

    Kokubo, Tetsuro; Hashimoto, Takeshi; Suda, Yasunori; Waseda, Akeo; Ikezawa, Hiroko

    2017-09-01

    Second metatarsophalangeal (MTP) joint dislocation is associated with hallux valgus, and the treatment of complete dislocation can be difficult. The purpose of this study was to radiographically clarify the characteristic foot shape in the presence of second MTP joint dislocation. Weight-bearing foot radiographs of the 268 patients (358 feet) with hallux valgus were examined. They were divided into 2 groups: those with second MTP joint dislocation (study group = 179 feet) and those without dislocation (control group = 179 feet). Parameters measured included the hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), second MTP joint angle, hallux interphalangeal angle (IPA), second metatarsal protrusion distance (MPD), metatarsus adductus angle (MAA), and the second metatarsal declination angle (2MDA). Furthermore, the dislocation group was divided into 3 subgroups according to second toe deviation direction: group M (medial type), group N (neutral type), and group L (lateral type). The IPA and the 2MDA were significantly greater in the study group than in the control group. By multiple comparison analysis, the IMA was greatest in group M and smallest in group L. The IPA was smaller and 2MDA greater in group N than in group L. The HVA and MAA in group L were greatest, and MPD in group L was smallest. The patients with second MTP joint dislocation associated with hallux valgus had greater hallux interphalangeal joint varus and a second metatarsal more inclined than with hallux valgus alone. The second toe deviated in a different direction according to the foot shape. Level III, retrospective comparative study.

  11. Severe Degeneration of the Medial Collateral Ligament in Hallux Valgus: A Histopathologic Study in 12 Consecutive Patients

    Science.gov (United States)

    Prasitdumrong, Ittipol; Rungprai, Chamnanni; Reeboonlarb, Nitit; Poonpracha, Tara; Phisitkul, Phinit

    2013-01-01

    Objective To determine the degree and location of degenerative changes of the medial collateral ligament of the first metatarsophalangeal joint, using the lateral collateral ligament as a control, in patients undergoing hallux valgus correction. Materials and Methods A strip of medial and lateral collateral ligaments were biopsied from 12 consecutive patients (age 45 ± 4.8 years) with symptomatic hallux valgus. A blinded analysis of histopathology was performed by an experienced pathologist. Results The medial collateral ligament was significantly more degenerated compared to the lateral collateral ligament (x2 = 23.41, DF = 2, p hallux valgus correction. The Authors received no financial support for this study. PMID:24027461

  12. Novel TPLO Alignment Jig/Saw Guide Reproduces Freehand and Ideal Osteotomy Positions.

    Science.gov (United States)

    Mariano, Abigail D; Kowaleski, Michael P; Boudrieau, Randy J

    2016-01-01

    To evaluate the ability of an alignment jig/saw guide to reproduce appropriate osteotomy positions in the tibial plateau leveling osteotomy (TPLO) in the dog. Lateral radiographs of 65 clinical TPLO procedures using an alignment jig and freehand osteotomy performed by experienced TPLO surgeons using a 24 mm radial saw blade between Dec 2005-Dec 2007 and Nov 2013-Nov 2015 were reviewed. The freehand osteotomy position was compared to potential osteotomy positions using the alignment jig/saw guide. The proximal and distal jig pin holes on postoperative radiographs were used to align the jig to the bone; saw guide position was selected to most closely match the osteotomy performed. The guide-to-osteotomy fit was categorized by the distance between the actual osteotomy and proposed saw guide osteotomy at its greatest offset (≤1 mm = excellent; ≤2 mm = good; ≤3 mm = satisfactory; >3 mm = poor). Sixty-four of 65 TPLO osteotomies could be matched satisfactorily by the saw guide. Proximal jig pin placement 3-4 mm from the joint surface and pin location in a craniocaudal plane on the proximal tibia were significantly associated with the guide-to-osteotomy fit (P = 0.021 and P = 0.047, respectively). The alignment jig/saw guide can be used to reproduce appropriate freehand osteotomy position for TPLO. Furthermore, an ideal osteotomy position centered on the tibial intercondylar tubercles also is possible. Accurate placement of the proximal jig pin is a crucial step for correct positioning of the saw guide in either instance.

  13. Preferential loading of the ACL compared with the MCL during landing: a novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries.

    Science.gov (United States)

    Quatman, Carmen E; Kiapour, Ata M; Demetropoulos, Constantine K; Kiapour, Ali; Wordeman, Samuel C; Levine, Jason W; Goel, Vijay K; Hewett, Timothy E

    2014-01-01

    Strong biomechanical and epidemiological evidence associates knee valgus collapse with isolated, noncontact anterior cruciate ligament (ACL) injuries. However, a concomitant injury to the medial collateral ligament (MCL) would be expected under valgus collapse, based on the MCL's anatomic orientation and biomechanical role in knee stability. Purpose/ The purpose of this study was to investigate the relative ACL to MCL strain patterns during physiological simulations of a wide range of high-risk dynamic landing scenarios. We hypothesized that both knee abduction and internal tibial rotation moments would generate a disproportionate increase in the ACL strain relative to the MCL strain. However, the physiological range of knee abduction and internal tibial rotation moments that produce ACL injuries are not of sufficient magnitude to compromise the MCL's integrity consistently. Controlled laboratory study. A novel in sim approach was used to test our hypothesis. Seventeen cadaveric lower extremities (mean age, 45 ± 7 years; 9 female and 8 male) were tested to simulate a broad range of landings after a jump under anterior tibial shear force, knee abduction, and internal tibial rotation at 25° of knee flexion. The ACL and MCL strains were quantified using differential variable reluctance transducers. An extensively validated, detailed finite element model of the lower extremity was used to help better interpret experimental findings. Anterior cruciate ligament failure occurred in 15 of 17 specimens (88%). Increased anterior tibial shear force and knee abduction and internal tibial rotation moments resulted in significantly higher ACL:MCL strain ratios (P < .05). Under all modes of single-planar and multiplanar loading, the ACL:MCL strain ratio remained greater than 1.7, while the relative ACL strain was significantly higher than the relative MCL strain (P < .01). Relative change in the ACL strain was demonstrated to be significantly greater under combined multiplanar

  14. Serial Changes in the Joint Space Width and Joint Line Convergence Angle After Closed-Wedge High Tibial Osteotomy.

    Science.gov (United States)

    Park, Cheol Hee; Bae, Dae Kyung; Kim, Kang Il; Lee, Jong Whan; Song, Sang Jun

    2017-12-01

    There have been little data concerning serial changes in the joint space width (JSW) and joint line convergence angle over the course of follow-up periods after closed-wedge high tibial osteotomy (CWHTO). To evaluate serial changes in the JSW and joint line convergence angle after CWHTO. Case series; Level of evidence, 4. A total of 100 computer-assisted CWHTOs with a minimum follow-up period of 3 years (mean, 4.4 years) were analyzed. Clinically, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was evaluated. Radiographically, the mechanical axis was measured preoperatively and postoperatively. The minimal JSW was measured as the shortest distance between the femur and the tibia. The convergence angle was measured as the angle between the tangent to the subchondral plates of the femoral condyle and the tibial plateau. Serial changes in these measurements were analyzed preoperatively; at 3 months, 6 months, 1 year, and 2 years postoperatively; and at the final follow-up. The intraclass correlation coefficients for all measurements were greater than 0.8. The mean WOMAC score improved from 41.4 preoperatively to 14.9 at the final follow-up. The preoperative and postoperative mean mechanical axis was 8.1° varus and 1.6° valgus, respectively. The mean minimal JSW was 2.5, 2.9, 2.9, 3.1, 3.2, and 3.1 mm preoperatively and at 3 months, 6 months, 1 year, 2 years, and the final follow-up, respectively ( P angle was 4.4°, 3.9°, 4.0°, 4.1°, 4.2°, and 4.3°, respectively, during the same time periods ( P = .068). Cartilage healing, as indicated by the JSW, and clinical improvement were maintained over the minimum 3-year follow-up after CWHTO. Cartilage pressure, as indicated by the convergence angle, remained unchanged after CWHTO.

  15. Velopharyngeal Configuration Changes Following Le Fort I Osteotomy With Maxillary Advancement in Patients With Cleft Lip and Palate: A Cephalometric Study.

    Science.gov (United States)

    Wu, Yu; Wang, Xing; Ma, Lian; Li, Zili

    2015-11-01

    To describe the morphological changes of velopharyngeal components in patients with cleft lip and palate after Le Fort I osteotomy with maxillary advancement and to clarify whether the velopharyngeal morphological changes are related to the distance of maxillary advancement. Retrospective case series. Hospital and Stomatology Unit of Peking University, Beijing, China. A total of 47 patients with maxillary hypoplasia secondary to cleft lip and palate. Le Fort I osteotomy combined with bilateral sagittal split ramus osteotomy and/or genioplasty for treatment of maxillofacial deformity. The lateral cephalometric radiographs with velum at rest (n = 47) and during phonation of /i/ (n = 17) were undertaken preoperatively (T1), 1 week postoperatively (T2), and at least 6 months postoperatively (T3). Some measure indices of velopharyngeal configuration were collected and analyzed. The average maxillary advancement distance was 4.08 ± 1.58 mm. The velar length, velar angle, and nasopharyngeal depth increased, but velar thickness decreased. The motion of the soft palate had no significant change, but the motion of the posterior pharyngeal wall and the Passavant's ridge increased significantly. No significant linear correlation was found between maxillary advancement distance and velopharyngeal configuration changes. Correction of maxillary hypoplasia by Le Fort I osteotomy with maxillary advancement increases the velopharyngeal cavity depth, which may impair velopharyngeal competence. The compensatory effects of the velopharyngeal soft tissue and posterior pharyngeal wall may alleviate this impairment to a certain extent.

  16. Osteotomy for lower third molar germectomy: randomized prospective crossover clinical study comparing piezosurgery and conventional rotatory osteotomy.

    Science.gov (United States)

    Sivolella, Stefano; Berengo, Mario; Bressan, Eriberto; Di Fiore, Adolfo; Stellini, Edoardo

    2011-06-01

    The aim of the present study was to compare piezoelectric surgery and conventional rotatory osteotomy for mandibular third molar germ extraction to determine the 2 methods' suitability and the postoperative outcomes. Mandibular third molar germectomy was performed bilaterally, randomly choosing 1 side for rotatory osteotomy (rotatory group) and the other for piezoelectric surgery (piezo group). The predictor variable was the duration of the surgical procedure. The outcome variables were the suitability of the method used, bleeding, and the postoperative parameters (ie, mouth opening range, clinical appearance of soft tissues, exudate, abscess, wound dehiscence, locoregional lymphadenopathy, pain on palpation at the extraction site, persistent edema) at 7 and 30 days postoperatively. The patients recorded their subjective postoperative pain daily for 7 days using a visual analog scale. The Wilcoxon rank-sum test and stepwise logistic regression model with binary variables were used for statistical analysis. A total of 26 patients (mean age 15.4 ± 1.29 years) were enrolled in the present study. The time needed to complete the osteotomy and extraction was significantly greater for the piezo group (15.77 ± 6.56 minutes) than for the rotatory group (11.77 ± 6.24 minutes; P = .028). No statistically significant differences emerged between the 2 methods for the other outcome variables considered. Piezoelectric osteotomy proved comparable to the rotatory method in terms of the surgeon's perception of the suitability of the 2 methods and the related postoperative sequelae. However, piezoelectric osteotomy took longer to complete than the rotatory method. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Case Report: ‘Z’ osteotomy - a novel technique of treatment in Blount’s disease [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Raju Karuppal

    2015-11-01

    Full Text Available Blount’s disease is a progressive form of genu varum due to asymmetrical inhibition of the postero medial portion of the proximal tibial epiphysis. The surgical treatments involved in correction of Blount’s disease are often technically demanding, complicated procedures.  These procedures can lead to prolonged recovery times and poor patient compliance. In such a context we are suggesting “fibulectomy with Z osteotomy” of the proximal tibia, a relatively simple and highly effective technique. This technique is based on correcting the mechanical axis of the lower limb thereby restoring growth from the medial physis of proximal tibia. We have used a new surgical technique, which includes fibulectomy followed by a Z-shaped osteotomy. We have used this simple technique in a 5 year-old boy with unilateral Blount’s disease. The femoro-tibial angle was corrected from 18.2° of varus to 4.2° of valgus. The angular correction obtained after operation was 22°. There were no postoperative complications. This technique has the advantages of correcting both angular and rotational deformities simultaneously.  The purpose of this case study is to introduce a new surgical technique in the treatment of Blount’s disease.

  18. Total knee replacement for tricompartmental arthritis in a patient with a below-knee amputation after a previous closing wedge high tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Mark A. Fleming, MBBCH, FC orth(SA, MMED

    2016-06-01

    Full Text Available This is a report of a 64-year-old man who had undergone a high tibial osteotomy (HTO 17 years ago of his right knee for medial compartment osteoarthritis; 5 days later, he received a below-knee amputation owing to a missed popliteal artery injury at the time of the HTO. We elected to perform a total knee replacement (TKR for progressive arthritis of the ipsilateral knee 17 years after the transtibial amputation. Although there is a plethora of literature regarding TKR in the contralateral knee of amputees, there is a paucity of data of TKR in the ipsilateral knee. Using medical search engines including Google Scholar and PubMed, we were only able to identify 4 case reports of TKR in the ipsilateral knee of below-knee amputees. This is the first description in the English literature that has the following rare pathology list: tricompartmental arthritis with a previous closing wedge HTO with a resultant truncated valgus tibia and short transtibial amputation.

  19. Proximal femoral derotation osteotomy for idiopathic excessive femoral anteversion and intoeing gait

    OpenAIRE

    Naqvi, Gohar; Stohr, Kuldeep; Rehm, Andreas

    2017-01-01

    Aim: The purpose of this study is to assess the symptoms caused by excessive femoral anteversion and the outcomes of femoral derotation osteotomy. Methods: We reviewed data on patients who underwent proximal femoral derotation osteotomy for symptomatic intoeing gait caused by femoral anteversion. Only symptomatic patients were considered for corrective derotation osteotomy. Degree of femoral anteversion was confirmed on computed tomography (CT) scan. Results: T...

  20. Combined proximal and distal realignment procedures to treat the habitual dislocation of the patella in adults.

    Science.gov (United States)

    Shen, Hsain-Chung; Chao, Kuo-Hua; Huang, Guo-Shu; Pan, Ru-Yu; Lee, Chian-Her

    2007-12-01

    Habitual dislocation of the patella (HDP) is a rare condition. Many surgical procedures using proximal realignment have been reported to treat HDP in children, with around 80% satisfactory results. However, few articles have addressed the treatment of HDP associated with high-grade patellofemoral chondromalacia in adults. A combination of proximal and distal realignment procedures of the patella will reduce pain and increase function in adult patients with HDP. Case series; Level of evidence, 4. Twelve patients with 13 symptomatic cases of HDP of the knee underwent surgical treatment that included lateral release, medial retinaculum advancement, and the anteromedial tibial tubercle transfer procedure. The average period between dislocation and surgery was 10.8 years. One patient had an additional procedure, an open-wedge varus corrective osteotomy of the distal femur, because of a 20 degrees valgus deformity of the knee. The patellofemoral morphology study included routine and Merchant views of the knee and a computed tomography scan at full extension and at 30 degrees flexion of the knee, before the operation and at follow-up. Any associated intra-articular pathologic findings during the surgical procedure were addressed. Patellofemoral function was evaluated with the Kujala functional score before surgery and at the time of the final follow-up. Chondromalacia of the patella over the medial facet and central ridge was grade III in 8 knees and grade IV in 5 knees. Corresponding chondral erosion of the lateral femoral condyle was noted in every knee. All patients were followed for an average period of 67.3 months (range, 25-103 months). The average preoperative Kujala functional score was 43.9 and the average postoperative score was 88.9 (Ppatella effectively treat HDP in adults with associated high-grade patellofemoral chondromalacia.

  1. Alphabet Soup: Sagittal Balance Correction Osteotomies of the Spine-What Radiologists Should Know.

    Science.gov (United States)

    Takahashi, T; Kainth, D; Marette, S; Polly, D

    2017-11-30

    Global sagittal malalignment has been demonstrated to have correlation with clinical symptoms and is a key component to be restored in adult spinal deformity. In this article, various types of sagittal balance-correction osteotomies are reviewed primarily on the basis of the 3 most commonly used procedures: Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. Familiarity with the expected imaging appearance and commonly encountered complications seen on postoperative imaging studies following correction osteotomies is crucial for accurate image interpretation. © 2018 by American Journal of Neuroradiology.

  2. Triphalangeal Thumb Reduction Osteotomy Through a Versatile Spiral Approach.

    Science.gov (United States)

    Alrabai, Hamza M; Farr, Sebastian; Girsch, Werner

    2016-06-01

    Triphalangeal thumb (TPT) is a congenital condition characterized by the presence of an additional phalanx. Variable degrees of thumb deformity, malalignment, and excessive length are common features. Impairment of hand function has been reported with TPT probably secondary to anomalistic long thumb incompatible with fine hand skills. Abnormal thumb appearance moreover represents a major psychological concern from patient's perspective. Both removal of the extra phalanx and phalangeal reduction osteotomy with resection of the unhealthy extra interphalangeal joint are established methods for correction of the associated excessive thumb length. In our experience, however, previous surgical approaches have not been able to sufficiently reduce the skin and soft tissue surplus, which exists after reduction osteotomy through classic circular incisions. We thus feel that conduction of TPT reconstruction through a spiral incision provides a safe and generous anatomic exposure required for simultaneous reduction of skeletal and soft tissue components.

  3. Roentgen stereogrammetry in high tibial osteotomy for gonarthrosis

    Energy Technology Data Exchange (ETDEWEB)

    Tjoernstrand, B.; Selvik, G.; Egund, N.; Lingstrand, A.

    1981-01-01

    In three cases operated with high tibial osteotomy for medial gonarthrosis the exact method of roentgen stereophotogrammetry with tantalum balls as bone markers was used to study angular and translational movements in three dimensions at the operation and during the healing period. Tibial osteotomy caused angular and translational movements even in planes where correction was not intended, and the stereo technique revealed that stability was not present when knee mobilisation started. Correlation between the stereo values and conventional radiographic measurements were best in the frontal plane (root mean square value of discrepancies 1.3/sup 0/). Roentgen stereophotogrammetry gives superior information compared with the conventional radiographic technique, but it is concluded that the latter has sufficient accuracy for the clinical assessment of corrections in the frontal plane.

  4. Association Between Anatomical Characteristics, Knee Laxity, Muscle Strength, and Peak Knee Valgus During Vertical Drop-Jump Landings.

    Science.gov (United States)

    Nilstad, Agnethe; Krosshaug, Tron; Mok, Kam-Ming; Bahr, Roald; Andersen, Thor Einar

    2015-12-01

    Controlled laboratory study; cross-sectional. To investigate the relationship among anatomical variables, knee laxity, muscle strength, and peak knee valgus angles during a vertical drop-jump landing task. Excessive knee valgus has been associated with anterior cruciate ligament injury in females; however, the influence of anatomical characteristics, knee laxity, and muscle strength on frontal plane knee motion is not completely understood. Norwegian elite female soccer players (n = 279; mean ± SD age, 21 ± 4 years; height, 167 ± 6 cm; body mass, 63 ± 7 kg) were evaluated from 2009 through 2012. The evaluation included 3-D motion analysis of a vertical drop jump, anatomical measures (height, static knee valgus, leg length, and static foot posture), knee laxity, and muscle strength (quadriceps, hamstrings, and hip abductors). Multiple linear regression analyses were used to investigate the relationships among anatomical characteristics, knee laxity, muscle strength, and peak knee valgus angles. Anatomical characteristics explained 11% of the variance in peak knee valgus angles (Pangles during a vertical drop-jump landing task. However, these variables only explained 11% of the variance in peak knee valgus.

  5. Influence of third molars in Le Fort 1 osteotomy.

    Science.gov (United States)

    Balaji, S M

    2011-07-01

    The influence of maxillary third molar (M3) on the outcomes of Le Fort 1 osteotomy is not deeply investigated. To investigate the influence of M3 on Le Fort 1 osteotomies. Tertiary Referral Center, operated by a single surgeon, prospective study. January 2005 to December 2010. Consecutive Le Fort 1 osteotomy patients with both M3. Gender, position, M3 root morphology, and degree of impaction. Time taken after all osteotomy cuts to point of time when maxilla is placed in predetermined plane. A total of 658 M3 in line of cut were studied. Of all M3, 312 were impacted, 28.9% were partially impacted and 23.7% were erupted. Of all the M3, 2.9% had their cuspal tips above the horizontal cut, 13.8% along the line of cut, and in 20.7% below the line but not erupted. Buccoverted tooth took shortest time (7.74 minutes), while palatoversion required more time (8.44 minutes) (P = 0.000). When the cuspal tip of M3 was located above the horizontal line of cut, the mean time required to achieve the planned position was 7 minutes, while the completely erupted teeth took a mean of 8.24 minutes (P = 0.000). When the M3 is placed higher, it takes lesser time to prepare basal bone to receive the maxilla at its predetermined level. Angulation of M3 influences the outcome. Deeply placed M3 reduces the manipulation of the greater pterygoid palatine vessels in the area thereby minimizing the bleeding in the surgical field.

  6. Sarcoidosis Nodules on the Lateral Nasal Osteotomy Lines.

    Science.gov (United States)

    Basat, Salih Onur; Ceran, Fatih; Aksan, Tolga; Ozturk, Muhammed Besir

    2016-09-01

    Sarcoidosis is a multisystem inflammatory disease that manifests as noncaseating granulomas, commonly in the lungs and intrathoracic lymph nodes. Subcutaneous manifestations of sarcoidosis that are caused by granulomas are referred to as specific for sarcoidosis, whereas other lesions are considered nonspecific. The authors present "sarcoidosis nodule formation on the lateral nasal osteotomy lines" in a sarcoidosis patient undergoing rhinoplasty surgery as a rare patient. V.

  7. The effects of Mandibular Osteotomy on articulation and resonance

    Directory of Open Access Journals (Sweden)

    Delsa Geffen

    1978-08-01

    Full Text Available Pre- and post-operative speech samples were studied in nine adult cases who received Mandibular Osteotomy. Lateral cephalograms were taken during sustained production of selected sounds and trained listeners judged recordings. In most cases there was an improvement in the general quality of the speech. Considering that the functional  relationships between the speech organs had altered, it would appear that some form of adaptation by the speaker had in fact taken place.

  8. Lateral window and transalveolar osteotomy sinus lifting technique

    OpenAIRE

    Ruslin, Muhammad

    2011-01-01

    The insertion of dental implants in atrophy maxilla is a complicated issue because no bone support due to expansion of maxillary sinus and atrophy of maxillary ridge alveolar. Surgery by sinus lifting with autogenous bone transplantation has been proven to be an acceptable treatment to get bone support. The lateral window technique and transalveolar osteotomy sinus lifting are the methods to correct the height of inadequate bone in the posterior area of maxilla for preparation of implan denta...

  9. Osteotomies in ankylosing spondylitis: where, how many, and how much?

    Science.gov (United States)

    Koller, H; Mayer, M; Hempfing, A; Koller, J

    2017-12-30

    This article presents the current concepts of correction of spinal deformity in ankylosing spondylitis (AS) patients. Untreated AS can be a debilitating disease. In a few patients, disease progression results in severe spinal deformity affecting not only the thoracolumbar, but also the cervical spine. Surgery for correction in AS patients has a long history. With the advent of modern instrumentation, standardization of surgical and anesthesiologic techniques, surgical safety and corrective results could be improved and experiences from lumbar osteotomies could be transferred to the cervical spine. This article presents the current concepts of correction of spinal deformity in AS patients. In particular, questions regarding the localization and number of osteotomies, the optimal surgical target angle as well as planning and prediction of postoperative alignment are discussed. Insight into recent technical developments, current challenges with correction and geometric analysis of center of rotation (COR) in cervical 3-column osteotomies (3CO) will be presented. The article should encourage readers to improve surgical correction efficacy and provide a better understanding of correction geometry in 3CO for thoracolumbar and cervical spinal deformities.

  10. Use of locking plate and screws for triple pelvic osteotomy.

    Science.gov (United States)

    Rose, Scott A; Bruecker, Ken A; Petersen, Steve W; Uddin, Nizam

    2012-01-01

    To evaluate the efficacy and complication rate associated with use of a purpose-specific locking triple pelvic osteotomy (LTPO) plate. Prospective study. Dogs (n = 9; 15 hips). Physical examination, plain film radiography, computed tomography (CT) of the pelvis, and coxofemoral arthroscopy were performed before unilateral triple pelvic osteotomy (TPO) or staged bilateral TPO. Radiographs were taken after each procedure and 3-5, 6-8, and ≥12 weeks postoperatively. Pelvic width was measured at 3 locations to evaluate pelvic canal narrowing. No screw loosening occurred. Complications occurred in only 1 hip (7%) where pullout of the locking plate-screw construct from the caudal iliac segment occurred because of a fracture of the cis-cortex; the dog made a full recovery after a salvage procedure. There was no significant reduction in the cranial pelvic width but a small reduction at the level of the acetabuli and ischiatic tuberosities was noted 3-5 weeks after the 2nd TPO. The LTPO plate was associated with a lower complication rate than previously reported for TPOs using Slocum canine pelvic osteotomy plates (CPOP) and warrants further investigation. Pullout of the caudal plate-screw construct is a complication specific to LTPO implants. Bicortical screw purchase is recommended to prevent fracture of the cis-cortex and implant pullout. © Copyright 2011 by The American College of Veterinary Surgeons.

  11. Hardware Location and Clinical Outcome in Ulna Shortening Osteotomy.

    Science.gov (United States)

    Megerle, Kai; Hellmich, Susanne; Germann, Günter; Sauerbier, Michael

    2015-10-01

    The purpose of this study was to investigate the influence of plate location during ulna shortening osteotomy on the incidence of hardware irritation and clinical outcome. Forty patients (17 women, 23 men; mean age, 47 years) who underwent a shortening osteotomy of the ulna due to idiopathic ulna impaction syndrome were examined after a mean of 36 months. All complications and secondary procedures were extracted from the patients' records. The rate of hardware removal was higher in patients who had a dorsal placement of the plate in comparison with ulnar or palmar placements, although this difference was not statistically significant. Apart from hardware irritation, there were 4 nonunions, 1 secondary osteoarthritis of the distal radioulnar joint, and 1 case of chronic irritation of the dorsal branch of the ulnar nerve, which required secondary surgery. The incidence of secondary surgery other than hardware removal was not significantly related to the original location of the plate. Secondary surgery after ulnar shortening osteotomy is common. However, we found no difference in clinical outcomes based on plate location.

  12. Bipartite hallucal sesamoid bones: relationship with hallux valgus and metatarsal index

    Energy Technology Data Exchange (ETDEWEB)

    Munuera, Pedro V.; Dominguez, Gabriel [University of Seville, Department of Podiatrics, Seville (Spain); Centro Docente de Fisioterapia y Podologia, Departamento de Podologia, Seville (Spain); Reina, Maria; Trujillo, Piedad [Centro Docente de Fisioterapia y Podologia, Departamento de Podologia, Seville (Spain)

    2007-11-15

    The objective was to relate the incidence of the partition of the hallucal sesamoid bones to the size of the first metatarsal and the hallux valgus deformity. In a sample of 474 radiographs, the frequency of appearance of bipartite sesamoids was studied. The length and relative protrusion of the first metatarsal, and the hallux abductus angle, were measured and compared between the feet with and without sesamoid partition. The results showed that 14.6% of the feet studied had at least one partite sesamoid, that the sesamoid most frequently divided was the medial, and that unilateral partition was the most common. No difference was found in the incidence of partite sesamoids between men and women, or between left and right feet. Protrusion and length of the first metatarsal are greater in feet with partite sesamoids than in feet without this condition. A significantly higher incidence of bipartite medial sesamoid was obtained in feet with hallux valgus compared with normal feet. (orig.)

  13. Immediate effect of valgus bracing on knee joint moments in meniscectomised patients

    DEFF Research Database (Denmark)

    Thorning, Maria; Thorlund, Jonas Bloch; Roos, Ewa M

    2016-01-01

    knee brace on knee joint moments in patients following medial arthroscopic partial meniscectomy. DESIGN: Within-participant design. METHODS: Twenty-two patients (age 35-55 years) who had undergone medial arthroscopic partial meniscectomy within the previous 8-15 months completed three......OBJECTIVES: Patients undergoing medial arthroscopic partial meniscectomy are at increased risk of developing and/or progressing knee osteoarthritis, with increased medial compartment load being a potential contributor. The aim of this study was to evaluate the immediate effect of a valgus unloader......-dimensional analysis of gait, forward lunge and one-leg rise during two conditions: with and without a valgus unloader knee brace. Outcome measures included the peak and impulse of the knee adduction moment and the peak knee flexion moment. RESULTS: The peak knee flexion moment increased during brace condition...

  14. Inter- and intra-observer reliability of a smartphone application for measuring hallux valgus angles.

    Science.gov (United States)

    Walter, Richard; Kosy, Jonathan D; Cove, Richard

    2013-03-01

    Measurement of radiological angles can be useful in the planning of the management of patients with hallux valgus. A smartphone application offers an alternative way of measuring these angles in a clinic setting. We compared the reliability (inter- and intra-observer) of this method to the use of PACS. Radiographs of 30 feet from new patients referred with hallux valgus were examined and angles (HVA, IMA, and DMAA) recorded using the smartphone application and PACS. The smartphone application provided good inter-observer reliability for HVA and IMA (r=0.93 and r=0.79 respectively). Intra-observer reliability for HVA and IMA was also found to be good (r=0.93-0.97 r=0.82-0.93 respectively). The inter- and intra-observer reliability for using this method to measure DMAA fell below useful levels (rDMAA. Copyright © 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  15. Correction of sagittal relationship using mandibular anterior segmental osteotomy for middle-aged adults

    Directory of Open Access Journals (Sweden)

    You-Sun Lee

    2017-01-01

    Full Text Available Surgically assisted orthodontics can be an effective treatment option to overcome advanced periodontal diseases, especially if retraction of the anterior teeth is required. A 46-year-old woman was treated with mandibular anterior segmental osteotomy (ASO and prosthodontic restorations. Periodontally, hopeless teeth and an impacted canine were extracted in consideration of her age and treatment strategy. Mandibular ASO was performed for correction of anterior crossbite and lip protrusion. Treatment results were achieved in 22 months with combination of periodontal treatment and ASO-assisted orthodontic treatment. This report presents an effective surgically assisted orthodontic treatment option for correction of protrusion through mandibular ASO and premolar extraction in periodontally involved middle-aged adults.

  16. Sinus lifting before Le Fort I maxillary osteotomy: a suitable method for oral rehabilitation of edentulous patients with skelettal class-III conditions: review of the literature and report of a case

    Directory of Open Access Journals (Sweden)

    Meyer Ulrich

    2007-01-01

    Full Text Available Abstract Background Functional rehabilitation of patients afflicted with severe mandibular and maxillary alveolar atrophy might be challenging especially in malformed patients. Methods Treatment planning using sinus lifting and implant placement before Le Fort I maxillary osteotomy in a patient with severe mandibular and posterior maxillary alveolar atrophy and skelettal class-III conditions due to cleft palate are described. Results A full functional and esthetic rehabilitation of the patient was achieved by a stepwise surgical approach performed through sinus lifting as the primary approach followed by implant placement and subsequent Le Fort I maxillary osteotomy to correct the maxillo-mandibular relation. Conclusion Stabilisation of the maxillary complex by a sinus lifting procedure in combination with computer aided implant placement as preorthodontic planning procedure before Le Fort I maxillary osteotomy seems to be suitable in order to allow ideal oral rehabilitation especially in malformed patients.

  17. Minimal Invasive Percutaneous Osteosynthesis for Elderly Valgus Impacted Proximal Humeral Fractures with the PHILOS

    Directory of Open Access Journals (Sweden)

    Hang Chen

    2015-01-01

    Full Text Available There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO with the proximal humeral internal locking system (PHILOS for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61–74 with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11–34 months. The fractures united in an average of 7.2 (6–14 weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was 89.4±4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed.

  18. Growth modulation with a medial malleolar screw for ankle valgus deformity

    Science.gov (United States)

    Rupprecht, Martin; Spiro, Alexander S; Breyer, Sandra; Vettorazzi, Eik; Ridderbusch, Karsten; Stücker, Ralf

    2015-01-01

    Background and purpose Growth modulation with a medial malleolar screw is used to correct ankle valgus deformity in children with a wide spectrum of underlying etiologies. It is unclear whether the etiology of the deformity affects the angular correction rate with this procedure. Patients and methods 79 children (20 girls) with ankle valgus deformity had growth modulation by a medial malleolar screw (125 ankles). To be included, patients had to have undergone screw removal at the time of skeletal maturity or deformity correction, or a minimum follow-up of 18 months, and consistent radiographs preoperatively and at the time of screw removal and/or follow-up. The patients were assigned to 1 of 7 groups according to their underlying diagnoses. The lateral distal tibial angle (LDTA) was analyzed preoperatively, at screw removal, and at follow-up. Results Mean age at operation was 11.7 (7.4–16.5) years. The average lateral distal tibial angle normalized from 80° (67–85) preoperatively to 89° (73–97) at screw removal. The screws were removed after an average time of 18 (6–46) months, according to an average rate of correction of 0.65° (0.1–2.2) per month. No significant differences in the correction rate per month were found between the groups (p = 0.3). Interpretation Growth modulation with a medial malleolar screw is effective for the treatment of ankle valgus deformity in patients with a wide spectrum of underlying diagnoses. The individual etiology of the ankle valgus does not appear to affect the correction rate after growth modulation. Thus, the optimal timing of growth modulation mainly depends on the remaining individual growth and on the extent of the deformity. PMID:25909385

  19. Use of the iPhone for radiographic evaluation of hallux valgus.

    Science.gov (United States)

    Ege, Tolga; Kose, Ozkan; Koca, Kenan; Demiralp, Bahtiyar; Basbozkurt, Mustafa

    2013-02-01

    The purpose of this study was to compare the measurements made using a smartphone accelerometer and computerized measurements as a reference in a series of 32 hallux valgus patients. Two observers used an iPhone to measure the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (of anteroposterior foot radiographs in 32 patients with symptomatic hallux valgus on a computer screen. Digital angular measurements on the computer were set as the reference standard for analysis and comparison. The difference between computerized measurements and all iPhone measurements, and the difference between the first and second iPhone measurements for each observer were calculated. Inter- and intraobserver reliability of the smartphone measurement method was also tested. The variability of all measurements was similar for the iPhone and the computer-assisted techniques. The concordance between iPhone and computer-assisted angular measurements was excellent for the HVA, IMA, and DMAA. The maximum mean difference between the two techniques was 1.25 ± 1.02° for HVA, 0.92 ± 0.92° for IMA, and 1.10 ± 0.82° for DMAA. The interobserver reliability was excellent for HVA, IMA, and DMAA. The maximum mean difference between observers was 1.31 ± 0.89° for HVA, 0.90 ± 0.92° for IMA, and 0.78 ± 0.87° for DMAA. The intraobserver reliability was excellent for HVA, IMA, and DMAA. We conclude that the Hallux Angles software for the iPhone can be used for measurement of hallux valgus angles in clinical practice and even for research purposes. It is an accurate and reproducible method.

  20. Short-Term Clinical Outcomes of Radial Shortening Osteotomy and Capitates Shortening Osteotomy in Kienböck Disease

    Directory of Open Access Journals (Sweden)

    Ahmadreza Afshar

    2015-07-01

    Full Text Available Background:  There is no consensus on the best surgical treatment in Kienböck disease. We compared the shortterm outcomes of radial shortening osteotomy and capitate shortening osteotomy in patients affected with this disease.  Methods:  In a retrospective study of 21 patients with Lichtman stage IIIA of Kienböck disease, 12 patients with an average follow up of 3.2 ± 0.6 years had radial shortening osteotomy (group I and 9 patients with an average follow up of 3.1 ± 0.7 years had capitate shortening osteotomy (group II. The two groups were comparable in age, sex, operated side, initial Lichtman stage, and follow-up duration. At the last follow-up the patients were evaluated for pain, wrist range of motion, grip strength, wrist functional status and change in their Lichtman stage. The overall results were evaluated by the Cooney wrist function score and DASH score.  Results:  All the patients in the two groups had improvement of their wrist pains. According to the Cooney wrist function score group I had 1 excellent, 9 good, and 2 fair scores and group II had 1 excellent, 6 good, and 2 fair scores. Comparisons between the means of pain VAS scores, wrist range of movement, grip strength, DASH score, and Cooney wrist function score in the two groups were not significant. Also, the changes of the Lichtman stage in the two groups were not significant. Conclusions:  Both groups had reasonable short-term outcomes. We were unable to recognize a substantial clinical difference between the two surgical treatments in short-term outcomes.

  1. Sinus lifting dengan teknik lateral window dan transalveolar osteotomy Lateral window and transalveolar osteotomy sinus lifting technique

    OpenAIRE

    Muhammad Ruslin

    2011-01-01

    The insertion of dental implants in atrophy maxilla is a complicated issue because no bone support due to expansion of maxillary sinus and atrophy of maxillary ridge alveolar. Surgery by sinus lifting with autogenous bone transplantation has been proven to be an acceptable treatment to get bone support. The lateral window technique and transalveolar osteotomy sinus lifting are the methods to correct the height of inadequate bone in the posterior area of maxilla for preparation of ...

  2. Three-dimensional kinetic simulation before and after rotational acetabular osteotomy.

    Science.gov (United States)

    Iwai, Shintaro; Kabata, Tamon; Maeda, Toru; Kajino, Yoshitomo; Watanabe, Shin; Kuroda, Kazunari; Fujita, Kenji; Hasegawa, Kazuhiro; Tsuchiya, Hiroyuki

    2014-05-01

    Some reports indicate that one of major causes of clinical failure after periacetabular osteotomy is development of secondary femoroacetabular impingement (FAI). To assess the impact of range of motion (ROM) on the increase in FAI following rotational acetabular osteotomy (RAO), we performed FAI simulations before and after RAO. We evaluated 12 hips that had undergone RAO (study group), and 12 normal hips (control group). The study group was evaluated before and after surgery. Morphological parameters were evaluated to assess acetabular coverage. The acetabular anteversion angle, anterior CE angle, alpha angle, and combined anteversion angle were also measured. Impingement simulations were performed using 3D-CT. The ROM which causes bone-to-bone impingement was evaluated in flexion (flex), abduction, external rotation at 0° flexion, and internal rotation at 90° flexion. The lesions caused by impingement were evaluated. Radiographic measurements indicated improved postoperative acetabular coverage in the study group. The crossover sign was recognized pre- and postoperatively in every case in the study group and in no cases in the control group. In the simulation study, flexion, abduction, and internal rotation at 90° flexion decreased postoperatively. Impingement occurred within 45° internal rotation at 90° flexion in two preoperative and nine postoperative cases. The impingement lesions were anterosuperior of the acetabulum in all cases. There were correlations between anterior CE angle, CE angle, acetabular anteversion angle, and hip flexion angle. There were also correlations between the anterior CE angle, combined anteversion angle, and angle of internal rotation at 90° flexion. In the postoperative simulation, there was a tendency to reduce the ROM in flexion, abduction, and internal rotation at 90° flexion due to impingement. Since there were more cases which caused impingement within 45° internal rotation at 90° flexion after RAO, we consider there

  3. Analysis of biomechanical effectiveness of valgus-inducing knee brace for osteoarthritis of knee.

    Science.gov (United States)

    Schmalz, Thomas; Knopf, Elmar; Drewitz, Heiko; Blumentritt, Siegmar

    2010-01-01

    The biomechanical effectiveness of a valgus-inducing knee brace was investigated for 16 patients with knee osteoarthritis (mean +/- standard deviation age 56 +/- 10 yr, height 172 +/- 9 cm, mass 83 +/- 7 kg, body mass index 27.6 +/- 4.5 kg/m(2)). At the time of investigation, all subjects had been wearing the brace for at least 4 weeks. In addition to conducting standard gait analysis, we calculated the valgus moment generated by the brace by using a novel system that measured the actual deformation of the brace during stance phase and determined the reaction force created by the brace on the leg. The mean maximum value of the orthotic valgus moment was 0.053 Nm/kg, which represents approximately 10% of the external genu varus moment without the brace. This finding may explain the pain relief reported by patients using such braces in clinical studies. Use of the tested brace also decreased the magnitude of gait asymmetry between the braced and contralateral legs during walking (horizontal ground reaction force, external knee flexion moment), presumably because the subjects' need to walk abnormally to shield the knee from pain was reduced.

  4. Effect of shoes containing nanosilica particles on knee valgus in active females during landing

    Directory of Open Access Journals (Sweden)

    Zahra Bassiri

    2015-01-01

    Full Text Available Objective(s: The effect of silica nanoparticles (SNPs in sport shoes outsoles on the  parameters related to anterior cruciate ligament (ACL Injury has not been investigated. The aim of this study was to investigate the effect of shoes outsole containing a composite of thermoplastic elastomer based on styrene-butadiene and silica nanoparticles (TPEN shoe on Knee Valgus Angle (KVA as a risk factor of ACL injuries during landing Materials and Methods: Fourteen active healthy women without knee injuries and disorders performed bilateral drop jump (DJ and single leg drop landing (SLL tasks in barefoot, wearing shoes fabricated with polyvinyl chloride outsole (PVC shoe and TPEN shoes conditions , randomly. The knee valgus angle values of right and left legs were calculated in the landing conditions. Two factors repeated measures ANOVA were used to investigate the effect of landing and footwear conditions on KVA of right and left legs.  Results: For both left and right limbs, the KVA was at maximum and minimum values during landing with barefoot and TPEN shoes, respectively. PVC shoe significantly reduced the knee valgus by 3.84% in left and 4.18% in right knee (P

  5. Hallux valgus interphalangeus deformity: A case series in the pediatric population.

    Science.gov (United States)

    Grawe, Brian; Parikh, Shital; Crawford, Alvin; Tamai, Junichi

    2012-03-01

    The objective of this report is to describe three cases (four feet) of hallux valgus interphalangeus deformity in the pediatric population. A retrospective review was completed to identify three patients (four feet) with a deformity consistent with hallux valgus interphalangeus. Patients were followed at regular intervals for a minimum of 6 months. Treatment modalities and clinical results were reviewed for all patients for this relatively rare entity in the skeletally immature population. All patients in this report had a deformity that was not consistent with a traumatic etiology. Case number 1 had a significantly symptomatic deformity that failed conservative treatment, and eventually necessitated full surgical correction of the deformity. Symptom free unrestricted activity was obtained post-operatively, however final follow-up radiographs have demonstrated early changes consistent with arthritis. Case numbers 2 & 3 were relatively asymptomatic throughout their course of treatment, and responded well to non-operative intervention. Based on these findings excision of the exostosis and soft-tissue realignment appears to be a reliable option for symptom relief for patients who present with a painful symptomatic hallux valgus interphalangeus deformity. However, the risk of degenerative changes following spur removal must be entertained prior to the procedure. On the contrary a pain free deformity that does not impact functionality of toe, or impair shoe ware may be treated successfully with conservative measures. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  6. Radiographic Relevance of the Distal Medial Cuneiform Angle in Hallux Valgus Assessment.

    Science.gov (United States)

    Hatch, Daniel J; Smith, Abigail; Fowler, Troy

    2016-01-01

    The angle formed by the distal articular facet of the medial cuneiform has been evaluated and discussed by various investigators. However, no consistent method has been available to radiograph and measure this entity. The wide variability of the angle is not conducive to comparative analysis. Additionally, investigators have noted that the angles observed (obliquity) vary greatly because of changes in radiographic angle, foot position, rotation of the first ray, and declination of the first metatarsal. Recognizing that these variables exist, we propose a reproducible assessment using digital radiography and application of deformity of correction principles. Our results have indicated a mean distal medial cuneiform angle of 20.69° in normal feet, 23.51° with moderate hallux valgus, and 20.41° with severe hallux valgus deformity. The radiograph beam was kept at 15° from the coronal plane. An inverse relationship was found between the distal medial cuneiform angle and bunion severity. This was in contrast to our expected hypothesis. The overall angle of the first metatarsal-medial cuneiform did, however, correlate with the severity of the bunion deformity (p hallux valgus. A better indicator appears to be the first metatarsal-medial cuneiform angle. This pathologic entity is a 3-dimensional one that incorporates the joint morphology of the first ray, triplane osseous positioning, and soft tissue imbalances. Perhaps, 3-dimensional computed tomography imaging will provide better insight into this entity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Tensile Properties of the Deep Transverse Metatarsal Ligament in Hallux Valgus

    Science.gov (United States)

    Abdalbary, Sahar Ahmed; Elshaarawy, Ehab A.A.; Khalid, Bahaa E.A.

    2016-01-01

    Abstract The deep transverse metatarsal ligament (DTML) connects the neighboring 2 metatarsal heads and is one of the stabilizers connecting the lateral sesamoid and second metatarsal head. In this study, we aimed to determine the tensile properties of the DTML in normal specimens and to compare these results with hallux valgus specimens. We hypothesized that the tensile properties of the DTML would be different between the 2 groups of specimens. The DTML in the first interspace was dissected from 12 fresh frozen human cadaveric specimens. Six cadavers had bilateral hallux valgus and the other 6 cadavers had normal feet. The initial length (L0) and cross-sectional area (A0) of the DTML were measured using a digital caliper, and tensile tests with load failure were performed using a material testing machine. There were significant between-groups differences in the initial length (L0) P = 0.009 and cross-sectional area (A0) of the DTML P = 0.007. There were also significant between-groups differences for maximum force (N) P = 0.004, maximum distance (mm) P = 0.005, maximum stress (N/mm2) P = 0.003, and maximum strain (%) P = 0.006. The DTML is an anatomical structure for which the tensile properties differ in hallux valgus. PMID:26937914

  8. Periacetabular osteotomy for painful non-paralytic dysplastic hip joints in adults affected by poliomyelitis.

    Science.gov (United States)

    Lin, Tzu-Ping; Ko, Jih-Yang; Chen, Sung-Hsiung; Wu, Re-Wen; Wong, To; Chou, Wen-Yi

    2007-01-01

    Few researchers have discussed hip joint dysplasia in adults affected by poliomyelitis. We retrospectively studied the outcomes of hip joint function in poliomyelitic adults who underwent periacetabular osteotomy for the contralateral painful non-paralytic dysplastic hip joints. Eight female patients with the mean age of 35.9 years underwent periacetabular osteotomy from January 1991 through July 2002. The procedure was performed on eight non-paralytic hip joints via a modified Ollier transtrochanteric approach. Harris hip joint scores and radiographs were used to evaluate the hip joint functions. At a mean of 9.0 +/- 3.8 years postoperatively, the modified Harris hip joint scores had improved from 45.6 +/- 12.9 points preoperatively to 75.8 +/- 20.9 points. Radiographically, the degree of osteoarthrosis remained unchanged in seven hip joints and got worse in one. The anterior center-edge (CE) angle increased from 14.0 +/- 17.5 to 30.9 +/- 10.4 degrees. The lateral CE angle increased from -16.0 +/- 11.7 to 18.0 +/- 23.3 degrees. The acetabular index angle improved from 26.0 +/- 6.9 to 11.3 +/- 4.4 degrees. The acetabular head index increased from 36.1 +/- 11.7 to 63.1 +/- 20.7%. With an outcome system combining modified Harris hip joint scores and radiographic severity of osteoarthrosis, six patients had satisfactory results. Coxa valga usually occurred bilaterally with the neck-shaft angle of 159.1 +/- 15.7 degrees for the operated non-paralytic hip joints versus 161.4 +/- 6.7 degrees for the non-operated paralytic hip joints. Complications included osteonecrosis of the rotated acetabular fragment, acetabulofemoral impingement, a defect on the rotated ilium, and non-union of the superior pubic ramus (one hip joint each). Acetabular dysplasia can be severe in the non-paralytic leg because of coxa valga, leg length discrepancy, and pelvic tilt. Periacetabular osteotomy through a modified Ollier transtrochanteric approach provides extensive correction and relief of

  9. Evaluation of a CT-based technique to measure the transfer accuracy of a virtually planned osteotomy

    NARCIS (Netherlands)

    Dobbe, J. G. G.; Kievit, A. J.; Schafroth, M. U.; Blankevoort, L.; Streekstra, G. J.

    2014-01-01

    Accurate transfer of a preoperatively planned osteotomy plane to the bone is of significance for corrective surgery, tumor resection, implant positioning and evaluation of new osteotomy techniques. Methods for comparing a preoperatively planned osteotomy plane with a surgical cut exist but the

  10. Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus.

    Science.gov (United States)

    Karabicak, Gul Oznur; Bek, Nilgun; Tiftikci, Ugur

    2015-10-01

    The main aim of this study was to measure short-term effects of kinesiotaping on pain and joint alignment in the conservative treatment of hallux valgus. Twenty-one female patients diagnosed with a total of 34 feet with hallux valgus (13 bilateral, 6 right, and 2 left) participated in this study. Kinesiotaping was implemented after the first assessment and renewed in days 3, 7, and 10. The main outcome measures were pain, as assessed using visual analog scale, and hallux adduction angle, as measured by goniometry. Secondary outcome measure was patients' functional status, as measured by Foot Function Index and the hallux valgus scale of the American Orthopaedic Foot and Ankle Society (AOFAS). The radiographic results were also measured before and after 1 month of treatment. The Wilcoxon test was used to compare the differences between initial and final scores of AOFAS, as well as FFI scales and hallux valgus angle assessment scores. There was a significant reduction in goniometric measurement of hallux valgus angle (P = .001). There was a significant reduction in pain intensity (P = .001) and AOFAS and Foot Function Index scores at the end of the treatment (P = .001 and P = .001, respectively). There was a significant difference between radiographic results in 1-month control (P = .009). For this group of female patients, pain and joint alignment were improved after a 10-day kinesiotape implementation in patients with hallux valgus. The findings showed short-term decreased pain and disability in hallux valgus deformity. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  11. Relation between glenohumeral internal rotation deficit and valgus laxity of the elbow in high school baseball pitchers.

    Science.gov (United States)

    Tajika, Tsuyoshi; Kobayashi, Tsutomu; Yamamoto, Atsushi; Shitara, Hitoshi; Ichinose, Tsuyoshi; Shimoyama, Daisuke; Oya, Noboru; Sasaki, Tsuyoshi; Takagishi, Kenji

    2017-03-01

    There are few literatures describing the association between glenohumeral internal rotation deficits (GIRD) and valgus laxity of the elbow on the throwing side of high school pitchers with and without a history of elbow symptom. The passive range of motion of glenohumeral internal and external rotation on bilateral side shoulders was measured in 75 high-school baseball pitchers during the preseason. Using ultrasonography, the width of the ulnohumeral joint of the elbow was measured at 30° of flexion, both at rest and with valgus stress in the pitching side. Comparisons of glenohumeral internal rotation deficits and the difference between the width of ulnohumeral joint space with and without valgus stress on the throwing side were made between 75 high-school pitchers with and without a history of elbow symptom. Participants with a history of elbow symptom exhibited a greater difference between the width of ulnohumeral joint with and without valgus stress in the throwing side than participants with no history of elbow symptom (P<0.05). No difference in glenohumeral internal rotation deficits was found in participants with and without a history of elbow symptom. In all participants, significant association was found between glenohumeral internal rotation deficits on the pitching side and the difference from the width of the ulnohumeral joint with and without valgus stress (P=0.04, r=0.23). Elbow valgus instability was associated with elbow joint pain in high-school pitchers. Although GIRD was not significantly different between the two groups, GIRD and elbow valgus instability might be related to the throwing side in high-school pitchers.

  12. In-vivo imaging of the sentinel vein using the near-infrared vascular imaging system in hallux valgus patients.

    Science.gov (United States)

    Nakasa, Tomoyuki; Ishikawa, Masakazu; Ikuta, Yasunari; Yoshikawa, Masahiro; Sawa, Mikiya; Tsuyuguchi, Yusuke; Adachi, Nobuo

    2017-08-08

    A high incidence of dorsomedial cutaneous nerve (DMCN) damage in hallux valgus surgery has been reported. Identification of the vein around 1st metatarsal head is reported to be helpful to reduce the DMCN damage during surgery. The near-infrared (NIR) vascular imaging system, the VeinViewer(®) Flex, projects the vein onto the skin. The purpose of this study was to investigate the difference of the vein course between normal and hallux valgus foot using the VeinViewer(®) Flex, and to validate that the DMCN was accompanied with its vein. Twenty-seven feet with the hallux valgus and 27 feet in healthy subjects were included. The vein was projected onto the skin at the metatarsal head by the VeinViewer(®) Flex. The distance between the vein and the mid-line of the metatarsal head was measured. The correlation of the distance and hallux valgus angle or 1-2 intermetatarsal angle (IMA) was analyzed. The vein depicted by the VeinViewer(®) Flex and operative findings was compared in 4 patients during surgery. The vein in the hallux valgus patients shifted toward the dorsolateral side on the metatarsal bone head compared to that in healthy subjects. The distance from the midline of the 1st metatarsal bone to the vein in the hallux valgus (12.1 mm) was significantly higher than that in healthy subjects (2.7 mm) (p hallux valgus patients shifted toward the dorsolateral on the metatarsal bone and it could be a landmark to identify DMCN. The NIR vascular imaging system would be useful to reduce the risk of nerve damage in great toe surgery. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  13. "Angle to Be Corrected" in Preoperative Evaluation for Hallux Valgus Surgery: Analysis of a New Angular Measurement.

    Science.gov (United States)

    Ortiz, Cristian; Wagner, Pablo; Vela, Omar; Fischman, Daniel; Cavada, Gabriel; Wagner, Emilio

    2016-02-01

    The most common methods for assessing severity of hallux valgus deformity and the effects of an operative procedure are the angular measurements in weightbearing radiographs, specifically the hallux valgus angle and intermetatarsal angle (IMA). Our objective was to analyze the interobserver variability in hallux valgus patients of a new angle called the "angle to be corrected" (ATC), and to compare its capacity to differentiate between different deformities against IMA. We included 28 symptomatic hallux valgus patients with 48 weightbearing foot x-rays. Three trained observers measured the 1 to 2 IMA and the ATC. We then identified retrospectively 45 hallux valgus patients, which were divided into 3 operative technique groups having used the ATC as reference, and analyzed the capacity of the IMA to differentiate between them. The IMA average value was 13.6 degrees, and there was a significant difference between observer 3 and observer 1 (P = .001). The average value for the ATC was 8.9 degrees, and there was no difference between observers. Both angles showed a high intraclass correlation. Regarding the capacity to differentiate between operative technique groups, the ATC was different between the 3 operative technique groups analyzed, but the IMA showed differences only between 2. The ATC was at least as reliable as the intermetatarsal angle for hallux valgus angular measurements, showing a high intraclass correlation with no interobserver difference. It can be suggested that the ATC was better than the IMA to stratify hallux valgus patients when deciding between different operative treatments. Level III, comparative study. © The Author(s) 2015.

  14. Walking pattern in 9 women with hip dysplasia 18 months after periacetabular osteotomy

    DEFF Research Database (Denmark)

    Pedersen, Eva N G; Alkjaer, Tine; Søballe, Kjeld

    2006-01-01

    BaCKGROUND: Periacetabular osteotomy improves radiographic predictors of osteoarthrosis and diminishes pain and functional impairment. No changes in function quantified by gait analysis have yet been documented. We evaluated the functional outcome of periacetabular osteotomy in relation to gait. ...... upright walking pattern but continued to relieve the hip joint by maintaining a reduced flexor moment....

  15. Multi directional intertrochanteric osteotomy for primary and secondary osteoarthritis--results after 15 to 29 years

    NARCIS (Netherlands)

    Haverkamp, D.; Eijer, H.; Patt, T. W.; Marti, R. K.

    2006-01-01

    Between 1974 and 1987, 276 intertrochanteric osteotomies were performed in 217 patients. In 48 hips the osteotomy was done for idiopathic osteoarthritis. In 166 hips the osteoarthritis was secondary to acetabular dysplasia, in 23 to trauma, in 14 to slipped capital femoral epiphysis, in five to

  16. Intraoperative blood loss in bimaxillary orthognathic surgery with multisegmental Le Fort I osteotomies and additional procedures.

    Science.gov (United States)

    Kretschmer, W B; Baciut, G; Bacuit, Mihaela; Zoder, W; Wangerin, K

    2010-06-01

    Autologous blood donation is not currently recommended by most authors for routine bimaxillary osteotomies. There are few data about bimaxillary procedures with multisegmental maxillary osteotomies. Our aim was to investigate the effect of additional osteotomies and iliac crest grafts on operative blood loss. A total of 225 consecutive patients having bimaxillary multisegmental osteotomies during a three-year period (January 2006-January 2009) were examined to see if their haemoglobin concentration and packed cell volume were reduced. The influence of iliac crest grafts, additional osteotomies (genioplasty, malar osteotomy, iliac crest graft, anterior mandibular segmental osteotomy), operating time, age, and sex were assessed. Neither age nor sex influenced blood loss, whereas operating time correlated significantly with reductions in haemoglobin concentration and packed cell volume. Blood loss was significantly higher in the group who had additional procedures (p 0.001 for haemoglobin concentration and packed cell volume) than in the group who had no additional procedures, whereas there were no significant differences among the three subgroups who had additional procedures (additional osteotomies, iliac crest grafts, or both procedures). Four patients who had additional procedures required transfusion, whereas no blood was given in the group who had no additional procedures. Because the transfusion rate was so low, we could make no general recommendation for preoperative blood donation in such cases. Copyright 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Osteoarthritis of the second metatarsophalangeal joint associated with hallux valgus deformity.

    Science.gov (United States)

    Lee, Kyung Tai; Park, Young Uk; Jegal, Hyuk; Young, Ki Won; Kim, Jin Su; Lim, Seong Yeon

    2014-12-01

    Hallux valgus is speculated to increase the load on the second metatarsophalangeal (MTP) joint, possibly inducing degenerative osteoarthritis. In addition, the severity of arthritis may be correlated with the severity of hallux valgus. This study evaluated the association of arthritis of the second MTP joint in hallux valgus patients and the relationship between arthritis of the second MTP joint and hallux valgus deformity. A total of 382 patients (509 feet) underwent surgery for symptomatic hallux valgus deformities by the 2 senior authors (KTL, YUP) from November 2011 to December 2012. A total of 54 patients (61 feet), all female, were included in the osteoarthritis (OA) group. The rest were assigned to the nonosteoarthritis (NOA) group. There were 328 patients (448 feet) consisting of 16 men and 432 women. Osteoarthritis patients were then evaluated and classified according to joint space narrowing (JSN) and osteophyte (OP) formation. A statistical analysis was conducted to compare the 2 groups in terms of their hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), hypermobility of the first metatarsal ray, the length of the second metatarsal bone, and the length ratio of the first and second metatarsal bones. Correlation coefficients were calculated to compare the severity of hallux valgus and the degree of osteoarthritis of the second MTP joint. The IMA of the OA group was 16.2 ± 2.9 degrees, and that of the NOA group was 15.4 ± 3.3 degrees (P = .034, Mann-Whitney U test). The DMAA of the OA group was 18.2 ± 8.3 degrees, and that of the NOA group was 16.1 ± 8.0 degrees (P = .029, Mann-Whitney U test). There were no significant differences between the 2 groups in terms of the HVA, hypermobility, the length of the second metatarsal bone, and the length ratio of the second and first metatarsal bones. In the OA group, there was a positive correlation between the HVA and the degree of osteoarthritis (osteophyte

  18. Premaxillary osteotomy fixation in bilateral cleft lip/palate: Introducing a new technique.

    Science.gov (United States)

    Rahpeyma, Amin; Khajehahmadi, Saeedeh; Ghasemi, Ali

    2016-04-01

    In bilateral cleft lip/palate patients, sometimes the premaxilla is severely protruded and twisted. In such situations premaxillary osteotomy is beneficial. In this article a new technique for fixation of premaxilla after osteotomy is presented. The lip-split approach and premaxillary osteotomy and ostectomy from bony nasal septum were carried out. Fixation of osteotomized premaxilla was achieved with low profile miniplate or microplate. Bone grafting of that side was performed during the same session. This procedure was performed in three patients, with good labial repair after the lip split. The bone graft was successful in all the three cases and there were no complication for premaxillary osteotomy in this series. In protruding premaxilla, osteotomy and fixation of premaxilla with miniplate to the vomer bone during alveolar bone grafting through a lip-split approach yielded satisfactory results in patients requiring secondary functional cheilorhinoplasty. Copyright © 2015. Published by Elsevier Taiwan.

  19. A novel osteotomy in shoulder joint replacement based on analysis of the cartilage/metaphyseal interface.

    Science.gov (United States)

    Harrold, Fraser; Malhas, Amar; Wigderowitz, Carlos

    2014-11-01

    The accuracy of reconstruction is thought to impact on functional outcome following glenohumeral joint arthroplasty. The objective of this study was to define an area of minimal anatomic variation at the cartilage/metaphyseal interface of the proximal humerus to optimize the osteotomy of the humeral head, enabling accurate reconstruction with a prosthetic component. Hand held digitization and 3D surface laser scanning techniques were used to digitize 24 cadaveric arms and determine the normal geometry. Each humeral head was then examined to identify the most consistent anatomical landmarks for the ideal osteotomy plane to optimize humeral component positioning. The novel, posterior referencing, osteotomy resulted in a mean increase in retroversion of only 0.4° when compared to the original geometry. A traditional anterior referencing osteotomy, by comparison, produced a mean increase in retroversion of 11°. In addition, the novel osteotomy only increased axial diameter by 0.71mm and head height by 0.02mm compared to an anterior referencing osteotomy (3.0mm and 2.7mm respectively). The traditional osteotomy, referencing the anterior border of the cartilage/metaphyseal interface potentially resulted in an increase in prosthetic head size and retroversion. The novel osteotomy, referencing from the posterior cartilage/metaphyseal interface enabled a more accurate recovery of head geometry. Importantly, the increase in retroversion created by the traditional osteotomy was not replicated with the novel technique. Referencing from the posterior cartilage/metaphyseal interface produced a more reliable osteotomy, more closely matching the original humeral geometry. Basic Science, Anatomic study, Computer model. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Assessment and comparison of proximal segment changes following mandibular set-back through bilateral sagittal split ramus osteotomy and intraoral verticosagittal ramus osteotomy

    Directory of Open Access Journals (Sweden)

    Mahmood Hashemi H.

    2008-04-01

    Full Text Available Background and Aim: Proximal segment movements following different methods of ramus osteotomy is one of the undesired consequences of orthognathic surgery. Theoretically, it seems that intraoral verticosagittal ramus osteotomy can minimize the movement of proximal segment. In this study, changes in intergonial distance and ramus flaring angles were evaluated and compared in transverse plane after mandibular set back by two osteotomy techniques.Materials and Methods: In this randomized clinical trial 20 patients with mandibular prognathism without any asymmetry were selected and divided into two groups of 10 each.One group was treated by bilateral sagittal split ramus osteotomy and the other by intraoral verticosagittal ramus osteotomy technique. Intergonial width and inner ramal angle in transverse plane were measured on radiographs before and 1 and 12 weeks post surgery . Data were analyzed using covariance test with P<0.05 as the level of significance.Results: Changes of intergonial distance and interramal angle in each group were significant after 1 and 12 weeks after surgery. No statistically significant difference was observed between the two studied groups.Conclusion: According to the results of this study, there is no difference between bilateral sagittal split and intraoral verticosagittal ramus osteotomy techniques regarding mandibular width and ramus flaring changes.

  1. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus

    Directory of Open Access Journals (Sweden)

    Ford KR

    2015-08-01

    Full Text Available Kevin R Ford,1 Anh-Dung Nguyen,2 Steven L Dischiavi,1 Eric J Hegedus,1 Emma F Zuk,2 Jeffrey B Taylor11Department of Physical Therapy, High Point University, High Point, NC, USA; 2Department of Athletic Training, School of Health Sciences, High Point University, High Point, NC, USAAbstract: Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.Keywords: dynamic lower extremity valgus, hip neuromuscular control, ACL injury rehabilitation, patellofemoral pain, hip muscular activation

  2. Is valgus unloader bracing effective in normally aligned individuals: implications for post-surgical protocols following cartilage restoration procedures.

    Science.gov (United States)

    Orishimo, Karl F; Kremenic, Ian J; Lee, Steven J; McHugh, Malachy P; Nicholas, Stephen J

    2013-12-01

    Utilizing valgus unloader braces to reduce medial compartment loading in patients undergoing cartilage restoration procedures may be an alternative to non-weightbearing post-operative protocols in these patients. It was hypothesized that valgus unloader braces will reduce knee adduction moment during the stance phase in healthy subjects with normal knee alignment. Gait analysis was performed on twelve adult subjects with normal knee alignment and no history of knee pathology. Subjects were fitted with an off-the-shelf adjustable valgus unloader brace and tested under five conditions: one with no brace and four with increasing valgus force applied by the brace. Frontal and sagittal plane knee angles and external moments were calculated during stance via inverse dynamics. Analyses of variance were used to assess the effect of the brace conditions on frontal and sagittal plane joint angles and moments. With increasing tension in the brace, peak frontal plane knee angle during stance shifted from 1.6° ± 4.2° varus without the brace to 4.1° ± 3.6° valgus with maximum brace tension (P = 0.02 compared with the no brace condition). Peak knee adduction moment and knee adduction impulse decreased with increasing brace tension (main effect of brace, P knee biomechanics were minimally affected. The use of these braces following a cartilage restoration procedure may provide adequate protection of the repair site without limiting the patient's mobility.

  3. Effects of balance taping using kinesiology tape in a patient with moderate hallux valgus: A case report.

    Science.gov (United States)

    Lee, Sun-Min; Lee, Jung-Hoon

    2016-11-01

    Hallux valgus, an increased angle of lateral deviation in the big toe, can cause pain and difficulties in balancing and walking. This study aimed to investigate the effects of balance taping using elastic therapeutic tape on moderate hallux valgus. When she walked with shoes, she complained of pain over the medial eminence of the hallux metatarsophalangeal (MTP) joint. Balance taping using kinesiology tape was applied for 3 months (average, 16hours/d) to both big toes of a 26-year-old woman with moderate hallux valgus. On the right side, the hallux valgus angle (HVA) decreased from 21° to 14° and the intermetatarsal angle (IMA) decreased from 15° to 14.5°. On the left side, the HVA decreased from 22° to 11° and the IMA decreased from 15° to 12°. Furthermore, the patient was able to walk long distances in shoes without pain in the medial eminence of the hallux metatarsophalangeal joint. This study suggested that repeated balance taping with kinesiology tape could be used as a complementary treatment method for moderate hallux valgus.

  4. Transverse Expansion and Stability after Segmental Le Fort I Osteotomy versus Surgically Assisted Rapid Maxillary Expansion: a Systematic Review

    Directory of Open Access Journals (Sweden)

    Thomas Starch-Jensen

    2017-01-01

    Full Text Available Objectives: The objective of the present systematic review was to test the hypothesis of no difference in transverse skeletal and dental arch expansion and relapse after segmental Le Fort I osteotomy versus surgically assisted rapid maxillary expansion. Material and Methods: A MEDLINE (PubMed, Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted by including human studies published in English from January 1, 2000 to June 1, 2016. Results: The search provided 130 titles and four studies fulfilled the inclusion criteria. All the included studies were characterized by high risk of bias and meta-analysis was not possible due to considerable variation. Both treatment modalities significantly increase the transverse maxillary skeletal and dental arch width. The transverse dental arch expansion and relapse seems to be substantial higher with tooth-borne surgically assisted rapid maxillary expansion compared to segmental Le Fort I osteotomy. The ratio of dental to skeletal relapse was significantly higher in the posterior maxilla with tooth-borne surgically assisted rapid maxillary expansion. Moreover, a parallel opening without segment tilting was observed after segmental Le Fort I osteotomy. Conclusions: Maxillary transverse deficiency in adults can be treated successfully with both treatment modalities, although surgically assisted rapid maxillary expansion seems more effective when large transverse maxillary skeletal and dental arch expansion is required. However, considering the methodological limitations of the included studies, long-term randomized studies assessing transverse skeletal and dental expansion and relapse with the two treatment modalities are needed before definite conclusions can be provided.

  5. Skeletal Stability after Large Mandibular Advancement (> 10 mm with Bilateral Sagittal Split Osteotomy and Skeletal Elastic Intermaxillary Fixation

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    Kristoffer Schwartz

    2016-06-01

    Full Text Available Objectives: The aim of the present study was to assess the skeletal stability after large mandibular advancement (> 10 mm with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation and to correlate the skeletal stability with the vertical facial type. Material and Methods: A total of 33 consecutive patients underwent bimaxillary surgery to correct skeletal Class II malocclusion with a mandibular advancement (> 10 mm measured at B-point and postoperative skeletal elastic intermaxillary fixation for 16 weeks. Skeletal stability was evaluated using lateral cephalometric radiographs obtained preoperative (T1, 8 weeks postoperatively (T2, and 18 month postoperatively (T3. B-point and pogonion (Pog was used to measure the skeletal relapse and the mandibular plane angle (MP-angle was used to determine the vertical facial type. Results: The mean advancement from T1 to T2 were 11.6 mm and 13.5 mm at B-point and Pog, respectively. The mean skeletal relapse from T2 to T3 was -1.3 mm at B-point and -1.6 mm at Pog. The nineteen patients characterized as long facial types, showed the highest amount of skeletal relapse (-1.5 mm at B-point and -1.9 mm at Pog. Conclusions: The present study showed a limited amount of skeletal relapse in large mandibular advancement (> 10 mm with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation. Bilateral sagittal split osteotomy in combination with skeletal intermaxillary fixation can therefore be an alternative to distraction osteogenesis in large mandibular advancements.

  6. Osteotomia em Chevron modificada: análise preliminar do comportamento baropodométrico Modified Chevron osteotomy: preliminary analysis of baropodometric behavior

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    Juliana Motta Costa

    2010-01-01

    Full Text Available OBJETIVO: Avaliar as características clínicas e baropodométricas da marcha de indivíduos com Hálux Valgo após a osteotomia em Chevron modificada, isolada ou em associação com a osteotomia de Weil. MÉTODOS: FORAM avaliados, antes e três meses após a cirurgia, 27 pés com deformidade leve e moderada. A avaliação clínica incluiu a pontuação da AOFAS e medidas radiográficas. A avaliação baropodométrica foi realizada através da Plataforma Emed-at. As variáveis Pico de Pressão, Integral Pressão-Tempo e Carga Relativa foram calculadas em 10 regiões: calcanhar, mediopé, 1-5º metatársicos, hálux, 2º, 3-5º dedos. RESULTADOS: Após a cirurgia houve aumento na pontuação da AOFAS e redução dos parâmetros radiográficos. A avaliação baropodométrica, após osteotomia em Chevron isolada, demonstrou redução da pressão e da força sob o 1º metatársico e hálux, assim como, aumento dessas variáveis nos metatársicos centrais e laterais. Após a osteotomia em Chevron/Weil ocorreram alterações significativas apenas na região do hálux e dos dedos. CONCLUSÃO: Em curto prazo, a técnica em Chevron modificada promoveu melhora das condições clínicas e dos parâmetros radiográficos. Em relação a avaliação baropodométrica constatou-se uma transferência de cargas da região medial para lateral do antepé, possivelmente pelo curto período de pós-operatório.OBJECTIVE: To evaluate the clinical and baropodometric characteristics of the gaits of individuals with a hallux valgus deformity after modified Chevron osteotomy, in isolation or in association with the Weil osteotomy. METHODS: Foot evaluation happened before and three months after surgery analyzing 27 mildly and moderately deformed feet. The clinical evaluation included the AOFAS score and radiographic measurements. The baropodometric evaluation was done with the Emed-at platform. Peak of Pressure, Pressure-Time Integral and Relative Load were calculated in

  7. Association between hip abductor function, rear-foot dynamic alignment, and dynamic knee valgus during single-leg squats and drop landings

    Directory of Open Access Journals (Sweden)

    Yoshinori Kagaya

    2015-06-01

    Conclusion: Dynamic hip mal-alignment might be associated with both greater KID and HOD, whereas rear-foot eversion is associated only with greater KID. Hip abductor and rear-foot dysfunction are important factors for dynamic knee valgus and thus evaluating DTT and HFT will help to prevent dynamic knee valgus.

  8. Results and complications of percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in 54 consecutively operated GMFCS level IV and V cerebral palsy patients.

    Science.gov (United States)

    Canavese, Federico; Marengo, Lorenza; de Coulon, Geraldo

    2017-05-01

    This retrospective study evaluated mid-to-long-term outcome of a minimally invasive percutaneous pelvic osteotomy (PPO) approach combined with varus derotational shortening osteotomy (VDRSO) and soft tissue release in children with severe CP. A retrospective review was performed of all patients presenting with a diagnosis of CP with hip subluxation or dislocation treated surgically by simultaneous soft tissue release, VDRSO, and PPO between 2002 and 2015. Eligible patients included those with a diagnosis of spastic quadriplegia or CP GMFCS level IV or V with unilateral or bilateral hip subluxation or dislocation and surgical treatment of the deformity by simultaneous soft tissue release, VDRSO and PPO. All anterior-posterior (AP) radiographs of the pelvis were reviewed and Reimers migration percentage (MP) and acetabular angle (AA) were measured. In total, 54 children and adolescents (34 boys, 20 girls) with CP GMFCS level IV and V were treated during study period: 38 (70.4%) classified GMFCS level IV and 16 (29.6%) classified GMFCS level V. A total of 64 consecutive hips underwent simultaneous PPO associated with VDRSO. Overall, at the time of chart and radiograph review, mean age was 9.1 ± 3.3 years (range 4-16.5) and mean follow-up was 43.9 ± 19.5 months (range 3-72). Mean migration percentage improved from 66.8 ± 19.8% (range 33-100) preoperatively to 8.1 ± 16.5% (range 0-70) at last follow-up. Mean acetabular angle improved from 32.7° ± 7.1° (range 20-50) preoperatively to 14° ± 6.7° (range 0-27) at last follow-up. Only one case of bone graft dislodgment was observed. We did not observe any cases of avascular necrosis of the femoral head. All operated hips were pain free at the time of last follow-up. PPO through a less invasive surgical approach offers a valuable alternative to standard techniques as it gives similar outcome but with less muscle stripping and less time in surgery. III.

  9. Severe Hallux Valgus With Coalition of the Hallux Sesamoids Treated With Modified Lapidus Procedure: A Case Report.

    Science.gov (United States)

    Kurashige, Toshinori; Suzuki, Seiichi

    2017-04-01

    Coalition of the hallux sesamoids is an extremely rare condition. To our knowledge, only 1 case report has been published. We report a case of severe hallux valgus deformities with coalitions of the hallux sesamoids. The coalitions themselves were asymptomatic; however, this severe hallux valgus deformity needed to be surgically treated. The hallux sesamoids in both feet appeared to be fused and heart shaped on anteroposterior radiographs and dumbbell shaped on axial radiographs. It is known that postoperative incomplete reduction of the medial sesamoids can be a risk factor for the recurrence of hallux valgus. The computed tomography scan demonstrated a groove in the bottom of the center of the heart-shaped sesamoid. The flexor hallucis longus tendon was located in the groove. Therefore, a modified Lapidus procedure was performed considering the medial half of the heart-shaped sesamoid as the medial sesamoid. Although delayed union occurred, successful correction of the deformity was achieved. IV.

  10. Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative.

    Science.gov (United States)

    Felson, David T; Niu, Jingbo; Gross, K Douglas; Englund, Martin; Sharma, Leena; Cooke, T Derek V; Guermazi, Ali; Roemer, Frank W; Segal, Neil; Goggins, Joyce M; Lewis, C Elizabeth; Eaton, Charles; Nevitt, Michael C

    2013-02-01

    To study the effect of valgus malalignment on knee osteoarthritis (OA) incidence and progression. We measured the mechanical axis from long limb radiographs from the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI) to define limbs with valgus malalignment (mechanical axis of ≥1.1° valgus) and examined the effect of valgus alignment versus neutral alignment (neither varus nor valgus) on OA structural outcomes. Posteroanterior radiographs and knee magnetic resonance (MR) images were obtained at the time of the long limb radiograph and at followup examinations. Lateral progression was defined as an increase in joint space narrowing (on a semiquantitative scale) in knees with OA, and incidence was defined as new lateral narrowing in knees without radiographic OA. We defined lateral cartilage damage and progressive meniscal damage as increases in cartilage or meniscus scores at followup on the Whole-Organ Magnetic Resonance Imaging Score scale (for the MOST) or the Boston Leeds Osteoarthritis Knee Score scale (for the OAI). We used logistic regression with adjustment for age, sex, body mass index, and Kellgren/Lawrence grade, as well as generalized estimating equations, to evaluate the effect of valgus alignment versus neutral alignment on disease outcomes. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs). We studied 5,053 knees (881 valgus) of subjects in the MOST cohort and 5,953 knees (1,358 valgus) of subjects in the OAI cohort. In both studies, all strata of valgus malalignment, including 1.1° to 3° valgus, were associated with an increased risk of lateral disease progression. In knees without radiographic OA, valgus alignment >3° was associated with incidence (e.g., in the MOST, adjusted OR 2.5 [95% CI 1.0-5.9]). Valgus alignment >3° was also associated with cartilage damage on MR imaging in knees without OA (e.g., in the OAI, adjusted OR 5.9 [95% CI 1.1-30.3]).We found a strong relationship of valgus

  11. Effects of Osteotomy Lengths on the Temperature Rise of the Crestal Bone During Implant Site Preparation.

    Science.gov (United States)

    Katic, Zvonimir; Jukic, Tomislav; Stubljar, David

    2018-02-13

    To compare temperatures of the crestal bone during implant site preparation for different osteotomy lengths and implant systems. Bovine ribs were used to simulate the cortical bone of the human mandible. Three different implant systems were tested: Astra Tech, Ankylos, and XiVE. Six drills per system were performed, meaning each drilling set was used for 2 drills per 3 osteotomy lengths (8, 12, and 16 mm). Drilling force, drilling speed, drilling length, and temperature were recorded. Differences in the maximum temperature of the crestal bone during the first drilling for various osteotomy lengths (P = 0.021) and all implant systems (P = 0.013) were observed. A similar result was showed during the second drilling; osteotomy lengths (P = 0.014) and drilling systems (P = 0.003). Second drillings showed lower temperatures of the crestal bone with statistical differences on all measurements (P Ankylos implant systems showed similar performance; XiVE had lower temperature and higher temperature differences between osteotomy lengths. Different drilling lengths contributed to the variation in temperature regardless of the implant system. Longer drills and osteotomies induced higher temperatures on the crestal bone. The maximum temperature difference between the shortest and the longest osteotomy was under 1°C. Temperature above 47°C that could cause bone necrosis was not recorded at any time. The XiVE system showed the best performance.

  12. Miniplate 1.5 fixation for the repair of mandibular osteotomies in cats.

    Science.gov (United States)

    Silva, Adelina Maria da; Souza, Wilson Machado de; Barnabé, Patrícia de Athayde; Koivisto, Marion Burkhardt de; Souza, Nair Trevizan Machado de

    2011-02-01

    To evaluate the application of the maxillofacial miniplate 1.5 in the repair of unilateral mandibular osteotomies in cats. Twelve adult cats were divided into two groups. In group 1 (n=6), the osteotomy was performed in the body of the mandible, behind the 1(st) molar. In group 2 (n=6), the osteotomy was performed between the 4(th) premolar and 1(st) molar. The osteotomy was fixed with a titanium miniplate 1.5. Oral alimentation was reinitiated 24 hours after surgery. Cats were euthanized at 12 weeks postoperative. Radiographs taken 1 week after surgery showed a radiolucent line. The osteotomy line was not more visible on the radiographs taken at 12 weeks postoperative. Macroscopic examination confirmed alignment and bone union of operated hemimandibles. Histological examination showed formation of woven bone within the osteotomy line. The percentage of bone tissue at these areas was measured by the histometry. There was no statistically significant difference between the values of group 1(75.07 ± 5.99) and group 2 (74.76 ± 8.54) (Mann-Whitney's test p= 0.469). We concluded that the use of miniplate 1.5 for the fixation of mandibular osteotomy in cats provided the main goals in the treatment of mandibular fractures: bone union, normal dental occlusion and immediate return to oral alimentation.

  13. [Treatment of Hallux Valgus: Current Diagnostic Testing and Surgical Treatment Performed by German Foot and Ankle Surgeons].

    Science.gov (United States)

    Arbab, Dariusch; Schneider, Lisa-Maria; Schnurr, Christoph; Bouillon, Bertil; Eysel, Peer; König, Dietmar Pierre

    2017-11-10

    Background Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany. Material and Methods A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired. Results 427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%. Conclusion Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future. Georg Thieme Verlag KG Stuttgart · New York.

  14. "Viimne reliikvia" ja "Valgus koordis" : žanrifilmist žanrifilmini / Lauri Kärk

    Index Scriptorium Estoniae

    Kärk, Lauri, 1954-

    2010-01-01

    Žanrifilmi mõistmisest, 1960-ndate žanriuuendustest. Kahest eesti žanrifilmist: "Viimne reliikvia" (1969) ja "Valgus Koordis" (1951). Artikli järjes kõrvutatakse "Viimset reliikviat" Paul-Eerik Rummo "Tuhkatriinumänguga" (Vanemuises 1969., lavastaja E. Hermaküla). Sarnaseid jooni ka "Viimse reliikvia" ja teiste žanrifilmidega, pikemalt filmidest: Kaljo Kiisa "Hullumeelsus" (1968), Christian-Jaque'i "Tulp-Fanfanil" (Prantsusmaa, 1951), Tony Richardsoni "Tom Jones" (Inglismaa, 1963), Edmond Keosajani "Tabamatud tasujad" (Venemaa, 1966), Vytaytas Žalakeviciuse "Keegi ei tahtnud surra" (Leedu, 1965), Arthur Penni "Bonnie ja Clyde"

  15. The role of the first metarsocuneiform joint in juvenile hallux valgus.

    Science.gov (United States)

    Vyas, Shail; Conduah, Augustine; Vyas, Neil; Otsuka, Norman Y

    2010-09-01

    Juvenile hallux valgus (JHV) is a relatively common condition in the female adolescent. The etiology of the condition has been attributed to various deformities in the forefoot, ranging from the first metatarsophalangeal joint, the morphology of the distal metatarsal, and the intermetatarsal angle (IMA). There have been very few studies evaluating the first metarsocuneiform (MTC) joint, and the results available vary. The purpose of this study is to more critically evaluate the MTC joint with novel angular measurements as a contributor to JHV. A cohort of 46 feet from 29 patients (average age 14.2 years) with hallux valgus as defined as IMA of greater than 10 degrees were evaluated. The hallux valgus angle, IMA, base of first metatarsal to articular surface of medial cuneiform angle, first metatarsal to cuneiform (1MCA), second metatarsal to cuneiform (2MCA), intrinsic medial cuneiform obliquity angle (COA), distal metatarsal articular angle, and ratio of first cuneiform to second cuneiform length were measured. The same was done for an age-matched control group of 36 normal feet from 25 patients (average age 13.2 years). The two groups were statistically compared. There were several statistically significant differences between the study and control groups. Naturally, the hallux valgus angle and IMA were statistically greater by definition. In addition, the distal metatarsal articular angle and 1MCA were significantly larger in the study group. The magnitude of the 2MCA was found to positively correlate with the magnitude of the IMA. The COA angle was not found to be statistically different. In conclusion, the role of the MTC joint in JHV has been evaluated earlier with varying results. The objective of this study is to critically evaluate the MTC joint with novel angular measurements to delineate its contribution to JHV. One such novel measurement is the 1MCA. The statistically significant increase in 1MCA suggests that a property intrinsic to the articulation

  16. [Effects of Le-Fort-I-Osteotomy on nasalance scores].

    Science.gov (United States)

    Zemann, Wolfgang; Feichtinger, Matthias; Santler, Gert; Kärcher, Hans

    2006-07-01

    Nasalance represents a measure of the relative amount of oral and nasal acoustic energy produced by a speaker. Literature shows changes in nasalance after surgery of the oropharynx. The aim of this prospective study was to evaluate the outcome of speech and nasalance scores after Le-Fort-I-Osteotomy. A total of 20 individuals with normal speech development were examined preoperatively and 6 weeks postoperatively with the Nasometer 6200 (Kay-Elemetrics, USA) after bimaxillary surgery. The tone materials used comprised the standardized text passage: "Ein Kindergeburtstag", the vowels: /a/, /e/, /i/, /o/, /u/ and a syllable repetition subtest. All patients showed changes in nasalance scores 6 weeks postoperatively. There were no significant changes reading the standard text. The syllable repetition test showed significant changes for repetition of "ma ma ma" and "na na na" (p=0,003, respectively p=0,033). Intonation of the vowel /a/1 also revealed significant changes regarding the pre- and postoperative values (p=0,006). However, the obtained values had no significant impact on the nasality characteristics of speech. This study confirms that maxillary osteotomies can result in significant changes of nasalance scores. However these changes do not have any impact on normal speech and voice.

  17. Complete Cranial Iliac Osteotomy to Approach the Lumbosacral Foramen

    Directory of Open Access Journals (Sweden)

    Barbara Dyall

    2017-05-01

    Full Text Available An approach using a complete cranial iliac osteotomy (CCIO to access the lumbosacral (LS foramen in dogs from lateral was developed using cadavers and applied in a clinical patient with degenerative lumbosacral stenosis (DLSS. The foraminal enlargement in the cadavers and the patient was documented on postoperative CT scans. The preoperative CT scan of the patient showed moderate cranial telescoping of the sacral roof and a moderate central disk protrusion, leading to moderate to severe compression of the cauda equina. In addition, there was lateral spondylosis with consequential stenosis of the right LS foramen. The right L7 nerve had lost its fat attenuation and appeared thickened. After a routine L7S1 dorsal laminectomy with a partial discectomy, a CCIO was performed, providing good access to the LS foramen and the adhesions around the proximal L7 nerve caudoventral to the foramen. The osteotomy was stabilized with a locking plate and a cerclage wire. The dog recovered well from the procedures and after 36 h, the dog walked normally and was discharged from the hospital. Eight and 16 weeks later, the signs of the DLSS had markedly improved. From these data, it can be concluded that the CCIO is a useful approach to the LS foramen and intervertebral disk in selected patients with DLSS, giving good access to the structures around the LS foramen.

  18. Partial ear canal ablation and lateral bulla osteotomy in rabbits.

    Science.gov (United States)

    Eatwell, K; Mancinelli, E; Hedley, J; Keeble, E; Kovalik, M; Yool, D A

    2013-06-01

    Six lop rabbits were presented with clinical signs of otitis media or externa. The presence of disease was confirmed by computerized tomography examination, with two rabbits suffering from bilateral disease. The rabbits were anaesthetized and underwent surgery of the affected bulla. Rabbits with bilateral disease had a minimum of 2 weeks between procedures. A single vertical incision was made over the base of the vertical canal, which was bluntly dissected free from surrounding tissue. The ventral portion of the vertical canal was removed and a lateral bulla osteotomy was performed. The mucosa at the base of the dorsal vertical canal was apposed and the aural cartilage sutured to form a blind-ending pouch open at the pretragic incisure. Histopathological samples taken from the dorsal margin of the vertical canal yielded subtle and non-specific changes in the six samples submitted. All rabbits were discharged within 48 hours of surgery. The cosmetic outcome was excellent with animals retaining visually normal aural anatomy. The partial ear canal ablation/lateral bulla osteotomy procedure is quick and has a good cosmetic result when performed in rabbits. © 2013 British Small Animal Veterinary Association.

  19. Predicting translational deformity following opening-wedge osteotomy for lower limb realignment.

    Science.gov (United States)

    Barksfield, Richard C; Monsell, Fergal P

    2015-11-01

    An opening-wedge osteotomy is well recognised for the management of limb deformity and requires an understanding of the principles of geometry. Translation at the osteotomy is needed when the osteotomy is performed away from the centre of rotation of angulation (CORA), but the amount of translation varies with the distance from the CORA. This translation enables proximal and distal axes on either side of the proposed osteotomy to realign. We have developed two experimental models to establish whether the amount of translation required (based on the translation deformity created) can be predicted based upon simple trigonometry. A predictive algorithm was derived where translational deformity was predicted as 2(tan α × d), where α represents 50 % of the desired angular correction, and d is the distance of the desired osteotomy site from the CORA. A simulated model was developed using TraumaCad online digital software suite (Brainlab AG, Germany). Osteotomies were simulated in the distal femur, proximal tibia and distal tibia for nine sets of lower limb scanograms at incremental distances from the CORA and the resulting translational deformity recorded. There was strong correlation between the distance of the osteotomy from the CORA and simulated translation deformity for distal femoral deformities (correlation coefficient 0.99, p < 0.0001), proximal tibial deformities (correlation coefficient 0.93-0.99, p < 0.0001) and distal tibial deformities (correlation coefficient 0.99, p < 0.0001). There was excellent agreement between the predictive algorithm and simulated translational deformity for all nine simulations (correlation coefficient 0.93-0.99, p < 0.0001). Translational deformity following corrective osteotomy for lower limb deformity can be anticipated and predicted based upon the angular correction and the distance between the planned osteotomy site and the CORA.

  20. A Modified Triple Pelvic Osteotomy for the Treatment of Hip Hypoplasia

    Directory of Open Access Journals (Sweden)

    Hassan Rahimi

    2013-09-01

    Full Text Available Background: The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results.   Methods: Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started. Results: The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement. Conclusion: This modified technique is suggested for corrective surgery on adult dysplastic hips.

  1. Proximal femoral geometry before and after varus rotational osteotomy in children with cerebral palsy and neuromuscular hip dysplasia.

    Science.gov (United States)

    Davids, Jon R; Gibson, Thomas W; Pugh, Linda I; Hardin, James W

    2013-03-01

    Surgical management of hip dysplasia in children with cerebral palsy (CP) usually includes varus rotational osteotomy (VRO) of the proximal femur. Several techniques of VRO (end-to-end, EE; end-to-side, ES) have been designed to maximize correction and minimize associated deformities. The goals of the current study were to establish the prevalence and contribution of caput valgum to coxa valga deformity in children with CP, compare the geometry of the proximal femur after EE and ES techniques of VRO, and document the response of the proximal femur to subsequent growth after VRO. The records of 75 children with CP (Gross Motor Function Classification System, levels IV and V) with 137 surgically treated hips were retrospectively reviewed. Outcomes were limited to the technical domain (eg, radiographic measurements and surgical complications). Measurements made for each hip (preoperative, operative, and follow-up) included the neck-shaft angle (NSA), head-shaft angle (HSA), and the medialization index. The mean age at the time of surgery was 7 years. The mean follow-up was 5 years and 6 months. Caput valgum was present in all hips, increasing the actual geometric valgus by a mean of 10%. The ES technique was more effective at medializing the femoral shaft; however, this benefit was lost with growth (P = 0.891). The ES technique was more effective at achieving and maintaining correction of the NSA (P = 0.026). Maintenance of correction of the HSA was comparable for both ES and EE surgical techniques (P = 0.099). Subsequent growth of the proximal femur resulted in loss of correction of the NSA (mean 29%) and HSA (mean 21%). Caput valgum is usually present in children with CP who are undergoing surgical hip reconstruction. The ES technique is a reasonable alternative for the correction of neuromuscular hip dysplasia associated with extreme coxa valga and long femoral necks. Recurrence of coronal plane deformity with growth after VRO is common, and further study is

  2. Lateral subvastus approach with tibial tubercle osteotomy for primary total knee arthroplasty: clinical outcome and complications compared to medial parapatellar approach.

    Science.gov (United States)

    Langen, Susanne; Gaber, Sonja; Zdravkovic, Vilijam; Giesinger, Karlmeinrad; Jost, Bernhard; Behrend, Henrik

    2016-02-01

    The lateral subvastus approach (LSVA) with tibial tubercle osteotomy (TTO) is an alternative approach for total knee arthroplasty (TKA) in selected patients. The aim of this study was to compare clinical outcomes between LSV and medial parapatellar approaches for primary TKA and to investigate incidence of complications related to TTO. A total of 580 patients with primary TKA, meeting the inclusion criteria, were treated at our hospital from February 2006 until February 2013. All patients' data were included in the local arthroplasty register and were followed up 12 months postoperatively. The data set contains: demographic data, the WOMAC score, the KSS as well as knee flexion and complications related to tibial tubercle osteotomy. The clinical outcome after TKA using the LSVA combined with TTO was comparable with those using the medial standard approach 1 year postoperatively. Four patients (3.8 %) needed a revision due to complications related to tubercle osteotomy. The LSVA is thus a viable alternative in cases of primary TKA if technical difficulties with the medial approach are anticipated. Applying precise surgical technique, the LSVA seems to be a safe and reproducible procedure.

  3. A mid-term follow-up of Koutsogiannis' osteotomy in adult-acquired flatfoot stage II and "early stage III".

    Science.gov (United States)

    Arvinius, Camilla; Manrique, Elena; Urda, Antonio; Cardoso, Zulema; Galeote, Jose Enrique; Marco, Fernando

    2017-01-01

    Koutsogiannis' osteotomy has been widely described to treat adult-acquired flatfoot. However, few articles describe its midterm follow-up. Our aim was to study clinical and radiological outcomes at least one year after surgery and to analyze whether a combined procedure on the medial soft tissue affected these outcomes. We performed a retrospective study of 30 feet of patients who underwent a Koutsogiannis' osteotomy due to adult-acquired flatfoot stage II and "early stage III": a stage III acquired flatfoot without any important structural deformities. The parameters studied were additional medial soft tissue procedures, clinical outcome through the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and midfoot score as well as complications and radiological measurements. Sixteen cases were "early stage III" and 14 stage II. Thirteen patients underwent an associated posterior tibial tendon (PTT) revision: in three cases an end-to-end suture was possible, seven cases needed a FDL transposition, and three underwent synovectomy. Statistically significant improvement was found in the AOFAS score although no significant changes were seen radiologically. No additional benefit was found with the revision of the posterior tibial tendon. As to clinical and radiological results, no differences were found between stage II and "early stage III". Five cases presented a mild dysesthesia but only one patient needed neurolysis. We consider the Koutsogiannis' osteotomy to be a safe and effective procedure to reduce pain in patients with stage II and "early stage III" adult-acquired flatfoot. © The Authors, published by EDP Sciences, 2017.

  4. Decortication and osteotomy for the correction of multiplanar deformity in the treatment of malunion in adult diaphyseal femoral deformity: a case series and technique description.

    Science.gov (United States)

    Middleton, S; Walker, R W; Norton, M

    2017-06-28

    To review patients that have undergone correction of a symptomatic femoral malunion using osteotomy combined with decortication. A retrospective review of all patients who have undergone decortication and multiplanar osteotomy, looking at the pre-operative deformity, correction achieved, time to union and complications. Seven patients underwent correction under the senior author from 2003 to 2012. Average age was 46 years (range 32-60 years). All had femoral shortening deformity (average 2.7 cm, range 2-4 cm). Each also had at least one other plane of deformity with rotation being the next most commonly encountered in 5 out of the 7 (average 33°, range 0°-45°). Two had tri-planar deformity with the five having bi-planar deformity. Average time to union was 16.3 months (range 7-39 months) with an average of 1.5 operations (range 1-3 operations) to union. One patient has a non-union after five corrective operations. Correction of multiplanar deformity of the femur is challenging. Osteotomy with decortication provides a technique to achieve significant femoral multiplanar deformity correction in a single operation. This publication provides technical description of the operative technique, guidance and results.

  5. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy?

    Science.gov (United States)

    Ziebarth, K; Balakumar, J; Domayer, S; Kim, Y J; Millis, M B

    2011-02-01

    The Bernese periacetabular osteotomy (PAO) is a popular option for treating symptomatic acetabular dysplasia. We noted symptomatic impingement after PAO in several male patients. We therefore determined (1) the incidence of clinical signs of FAI after PAO in the male population; and (2) whether any factors were associated with the positive impingement signs after PAO in males. We retrospectively reviewed 38 males who underwent 46 periacetabular osteotomies (PAO) between 2000 and 2007. Clinical and radiographic data were analyzed with the focus on pre- and postoperative incidence of femoroacetabular impingement. Minimum followup was 12 months (average, 43 months; range, 12-90 months). We found a positive impingement sign in 19 of the 46 hips during the preoperative examination compared to 22 (47.8%) hips postoperatively. The ROM (flexion and internal rotation) decreased postoperatively compared to preoperatively. Radiographic parameters of coverage LCE-, ACE- and Tönnis angle improved into the normal range. Twenty hips had postoperative heterotopic ossification to varying degrees, mostly minor. WOMAC scores improved in the function and pain domains postoperatively. Despite normalization of coverage we found a high postoperative rate of clinical signs of FAI after PAO in males. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  6. Chin Wing Osteotomy for Bilateral Goldenhar Syndrome Treated by "Chin Wing Mentoplasty": Aesthetic, Functional, and Histological Considerations.

    Science.gov (United States)

    Cortese, Antonio; Pantaleo, Giuseppe; Amato, Massimo; Claudio, Pier Paolo

    2015-07-01

    Various treatment strategies have been proposed to perform the aesthetic surgical correction of asymmetric deformities of the mandible. These techniques range from relatively simple to complex procedures including bimaxillary surgery associated with complex mandibular osteotomies. The authors describe a patient with grade III Goldenhar syndrome, treated by a "chin wing" mentoplasty as described by Triaca. These situations are classically treated with a bilateral sagittal splint osteotomy (BSSO) in combination with mentoplasty. However, because of a good occlusion with Angle's class I relation, slight imbalance of the occlusal plane with good function of the mouth opening, the patient refused to be treated with a BSSO, hence, a chin wing mentoplasty was performed. Size and stability of bone regeneration were evaluated by histological examination and dynamic-volume computed tomography (CT). Mature bone in the grafted areas was detected by histology and CT scan with stable results and a significant increase of facial aesthetics 1 year after surgery. The authors also demonstrated that the chin wing technique provided a little but significant breathing improvement as detected on CT scans and lateral X-ray cephalograms by measuring the breathing area. Chin wing mentoplasty is a moderately invasive technique that is able to improve the aesthetics of the face and patient breathing.

  7. Impaired varus-valgus proprioception and neuromuscular stabilization in medial knee osteoarthritis.

    Science.gov (United States)

    Chang, Alison H; Lee, Song Joo; Zhao, Heng; Ren, Yupeng; Zhang, Li-Qun

    2014-01-22

    Impaired proprioception and poor muscular stabilization in the frontal plane may lead to knee instability during functional activities, a common complaint in persons with knee osteoarthritis (KOA). Understanding these frontal plane neuromechanical properties in KOA will help elucidate the factors contributing to knee instability and aid in the development of targeted intervention strategies. The objectives of the study were to compare knee varus-valgus proprioception, isometric muscle strength, and active muscular contribution to stability between persons with medial KOA and healthy controls. We evaluated knee frontal plane neuromechanical parameters in 14 participants with medial KOA and 14 age- and gender-matched controls, using a joint driving device (JDD) with a customized motor and a 6-axis force sensor. Analysis of covariance with BMI as a covariate was used to test the differences in varus-valgus neuromechanical parameters between these two groups. The KOA group had impaired varus proprioception acuity (1.08±0.59° vs. 0.69±0.49°, pproprioceptive acuity) and muscular effectors (muscle strength and capacity to stabilize the joint). © 2013 Published by Elsevier Ltd.

  8. Effects of Corrective Taping on Balance and Gait in Patients With Hallux Valgus.

    Science.gov (United States)

    Gur, Gozde; Ozkal, Ozden; Dilek, Burcu; Aksoy, Songul; Bek, Nilgun; Yakut, Yavuz

    2017-05-01

    Taping is an effective temporary therapy for improving hallux valgus (HV) in adults. Although HV has been demonstrated to impair postural balance, there is a lack of information about how corrective taping affects balance and gait patterns in adults with HV deformity. Eighteen middle-aged female patients (average age, 53.5 years) with HV were included. Corrective tape was applied to correct HV angulation. A series of balance and gait stability tests were performed before applying tape and 1 hour after the tape was applied with a Balance Master computerized posturography device. The study involved the following tests: modified clinical test of sensory interaction and balance (mCTSIB), unilateral stance (US), limit of stability (LoS), step up/over (SUO), and walk across (WA) tests. No significant difference was found between the no-tape and taped condition in the static balance mCTSIB and US tests ( P > .05). The taping intervention resulted in significant improvement in the dynamic balance measures for the LoS test's backward reaction time and left maximum excursion ( P Taping for correcting HV angulation had negative acute effects on dynamic balance in the SUO and WA tests and positive effects in the LoS test. Corrective taping, although a form of conservative treatment for hallux valgus, has been insufficiently studied in terms of effects on balance. Our results show that taping, as an acute effect, may impair balance in middle-aged adults when walking or ascending and descending stairs.

  9. Prophylactic ankle braces and knee varus-valgus and internal-external rotation torque.

    Science.gov (United States)

    Venesky, Kandy; Docherty, Carrie L; Dapena, Jesus; Schrader, John

    2006-01-01

    Although prophylactic ankle bracing has been shown to be effective in reducing the incidence of ankle sprains,how these ankle braces might affect the other joints of the lower extremity is not clearly understood. To determine the effects of a prophylactic ankle brace on knee joint varus-valgus and internal-external rotation torque during a drop landing onto a slanted surface. A repeated-measures design. Biomechanics research laboratory. Twenty-four physically active college students. Participants were tested in a brace and no brace condition. We measured 3 dependent variables:(1) peak ankle inversion-eversion torque, (2) peak knee varus-valgus torque, and (3) peak knee internal-external rotation torque. A force plate was used to collect ground reaction force data, and 6 motion analysis cameras collected kinematic data during the unilateral drop landing. An adjustable bar was hung from the ceiling, and a slant board was positioned over the center of the force plate, so that the ankle of the participant's dominant leg would invert upon landing. Peak torque was measure din both the brace and no-brace conditions. The average of the peak values in 3 trials for both conditions was used for the statistical analysis. Ankle eversion torque was significantly greater in the brace condition (F1,23 19.75, P external rotation torque was significantly greater in the brace condition(F1,23 4.33, P external rotation torque increased when the ankle was braced.

  10. Outcome of peri-acetabular osteotomy for hip dysplasia in teenagers.

    Science.gov (United States)

    Sakamoto, Tetsuya; Naito, Masatoshi; Nakamura, Yoshinari

    2015-11-01

    Peri-acetabular osteotomy, especially curved peri-acetabular osteotomy, is an effective surgical procedure for re-orientating the acetabulum. However, there have been few reports on this procedure in teenagers. The purpose of this study was to investigate the treatment outcomes of curved peri-acetabular osteotomy in teenagers. We retrospectively reviewed 33 hips in 27 teenage patients with acetabular dysplasia who underwent curved peri-acetabular osteotomy between 1995 and 2012. The mean age was 17.0 years (range, 14-19 years). The mean follow-up duration at the most recent physical examination was 33.3 months (range, 24-96 months). All hips were evaluated in terms of the Harris hip score, radiographic measurements, and complications. The mean Harris hip score improved from 80.1 points pre-operatively to 95.4 points post-operatively (p teenagers.

  11. The role of trochanteric flip osteotomy in fixation of certain acetabular fractures

    Directory of Open Access Journals (Sweden)

    Sandeep Gupta

    2017-06-01

    Conclusion: Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.

  12. Premaxillary osteotomy fixation in bilateral cleft lip/palate: Introducing a new technique

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2016-04-01

    Conclusion: In protruding premaxilla, osteotomy and fixation of premaxilla with miniplate to the vomer bone during alveolar bone grafting through a lip-split approach yielded satisfactory results in patients requiring secondary functional cheilorhinoplasty.

  13. Bone grafting with granular biomaterial in segmental maxillary osteotomy: A case report

    Directory of Open Access Journals (Sweden)

    Orion Luiz Haas Junior

    2016-01-01

    Conclusion: This is the first report of bone grafting with a granular biomaterial in segmental maxillary osteotomy. Successful formation of new bone with density greater than that of the surrounding tissue was achieved, preventing pseudarthrosis and postoperative instability.

  14. Clinical Efficacy of an Arthroscopic Surgery in Open Wedge High Tibial Osteotomy.

    Science.gov (United States)

    Kim, Chang-Wan; Lee, Chang-Rack; Seo, Seung-Suk; Gwak, Heui-Chul; Kim, Jung-Han; Jeong, Jun-Woo

    2017-05-01

    Few studies have identified the effects of arthroscopic surgery on the clinical outcomes when open wedge high tibial osteotomy (OWHTO) and arthroscopic surgery were performed together. The purpose of this study was to evaluate the clinical efficacy of arthroscopic surgery in patients who had varus osteoarthritic knee and were treated with OWHTO combined with arthroscopic surgery. Among the 98 knees (88 patients) who underwent OWHTO between January 2008 and March 2013, 79 knees (71 patients) with more than 2 years of follow-up were reviewed retrospectively. The patients were divided into two groups: Group 1 (24 knees) underwent only OWHTO and Group 2 (55 knees) underwent OWHTO combined with arthroscopic surgery. For clinical evaluation, the range of motion (ROM), pain visual analog scale, Knee Society knee score, Knee Society function score, and complication were used. For radiologic evaluation, Kellgren-Lawrence grade, mechanical femorotibial angle, and posterior tibial slope were used. The average follow-up period was 29.1 months. Group 2 showed a significant increase in the ROM at the last follow-up (133.2  ± 6.0 degrees) compared with the preoperative time point (128.3 ± 7.7 degrees) (p arthroscopic surgery was performed, arthroscopic surgery helped increase the ROM of patients with mechanical symptoms. However, the amount of the ROM increase of 4.9 degrees was of unknown clinical significance. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Valgus bracing in patients with medial compartment osteoarthritis of the knee. A gait analysis study of a new brace.

    NARCIS (Netherlands)

    Gaasbeek, R.D.A.; Groen, B.E.; Hampsink, B.; Heerwaarden, R.J. van; Duysens, J.E.J.

    2007-01-01

    A new valgus brace was evaluated in 15 patients with medial osteoarthritis of the knee and a varus leg axis. Significant improvement of pain and function were found after 6 weeks of brace treatment. Gait analysis showed that the brace had a tendency of lowering the peak varus moment about the knee.

  16. Comparison of dorsal and dorsomedial displacement in evaluation of first ray hypermobility in feet with and without hallux valgus.

    Science.gov (United States)

    Singh, Dishan; Biz, Carlo; Corradin, Marco; Favero, Laura

    2016-06-01

    Hypermobility of the first ray, a probable primary cause of hallux valgus, has traditionally been evaluated in the dorsal direction only although the first tarso-metatarsal joint allows movement in a dorso-medial direction. 600 feet, divided according to the presence or absence of hallux valgus, were evaluated for both dorsal and dorso-medial displacement using a Klaue device. In the control group, the mean first ray displacement was 7.2mm (4.2-11.3) in the dorsal direction (sagittal plane) and 8.3mm (4.0-12.6) in the 45° dorso-medial direction. In the hallux valgus group, the mean first ray mobility was 9.8mm (5.2-14.1) in the dorsal direction compared to a mean of 11.0mm (5.9-16.2) in the 45° dorso-medial direction. It is a paradox that hypermobility of the first ray is measured in only a dorsal (vertical) direction whereas a hallux valgus angle and an intermetatarsal angle are only measured in a transverse plane. Furthermore, the weightbearing foot pronates during gait and the first metatarsal is displaced in a dorsomedial direction rather than a pure dorsal direction. It is suggested that measurement hypermobility of the first ray at a 45° dorso-medial direction is more appropriate. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  17. A technique of anterior screw removal through a posterior costotransversectomy approach for posterior-based osteotomies.

    Science.gov (United States)

    Lewis, Stephen J; David, Kenny; Singer, Syndie; Bacon, Sarah A; Kopka, Michaela; Gray, Randolph; Magana, Sofia

    2010-05-15

    Case report. To describe a novel technique to remove anterior instrumentation from a posterior approach while performing posterior-based osteotomies for spinal deformities. Posterior-based osteotomies such as pedicle subtraction osteotomies (PSOs) and vertebral column resections are performed to restore sagittal alignment. The removal of previously placed anterior implants at the desired osteotomy level can often be challenging. We propose a technique for the removal of anterior instrumentation through a posterior approach to facilitate osteotomy closure and deformity correction, while avoiding the need for an anterior incision. A 34-year-old woman presented with a residual deformity after several anterior and posterior procedures. The residual coronal Cobb angle measured 60 degrees between T7 and L2, with a 46 degrees thoracolumbar kyphosis between T10 and L2. The screw head at the desired osteotomy level was in close proximity to the liver after the previous right-sided thoracoabdominal approach. Therefore, the T11 anterior screw was accessed through a posterior costotransversectomy approach and disconnected from the rod proximally and distally with a high-speed side-cutting burr. A portion of the right lateral vertebral body of T11 was removed to expose the neck of the screw, which was separated from the shaft with the same burr. A PSO was performed at T11 and the remaining screw shank was removed with the posterior-based osteotomy. No major complications were encountered during the procedure. The anterior screw at T11 was removed from posteriorly, and the PSO was completed successfully. Postoperative recovery was without incident, and the patient was very satisfied with her results. This technique describes a novel, safe, and effective method to deal with anterior instrumentation from the posterior approach while performing posterior-based osteotomies for rigid spinal deformities.

  18. Unicompartmental Knee Osteoarthritis (UKOA: Unicompartmental Knee Arthroplasty (UKA or High Tibial Osteotomy (HTO?

    Directory of Open Access Journals (Sweden)

    E. Carlos RODRIGUEZ-MERCHAN

    2016-10-01

    Full Text Available Background: The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis.   Methods: The search engine used was PubMed. The keywords were: "high tibial osteotomy versus unicompartmental knee arthroplasty". Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they strictly focused on the topic. Results: In a meta-analysis the ratio for an excellent outcome was higher in unicompartmental knee arthroplasty than high tibial osteotomy and the risks of revision and complications were lower in the former. A prospective comparative study showed that unicompartmental knee arthroplasty offers better long-term success (77% for unicompartmental knee arthroplasty and 60% for high tibial osteotomy at 7-10 years. However, a review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that unicompartmental knee osteoarthritis without constitutional deformity should be treated with unicompartmental knee arthroplasty while in cases with constitutional deformity high tibial osteotomy should be indicated. A case control study stated that unicompartmental knee arthroplasty offers a viable alternative to high tibial osteotomy if proper patient selection is done. Conclusion: The literature is still controversial regarding the best surgical treatment for unicompartmental knee osteoarthritis (high tibial osteotomy or unicompartmental knee arthroplasty. However, unicompartmental knee arthroplasty utilization is increasing, while high tibial osteotomy utilization is decreasing, and a meta-analysis has shown better outcomes and less risk of revision and complications in the former. A systematic review has found that with correct patient selection, both procedures show effective and reliable results. However, prospective randomized studies

  19. The tilt-up osteotomy for correction of intractable plantar keratoses.

    Science.gov (United States)

    Berkun, R N; DeVincentis, A; Goller, W L

    1984-01-01

    The purpose of this paper is to describe and follow-up a new surgical technique used for the correction of intractable plantar keratoses. Twenty-five osteotomies were studied from 8 to 20 months postoperatively. The results showed a 60% success rate, but a patient satisfaction rate of 92%. The tilt-up osteotomy is a promising new procedure for the correction of intractable plantar keratoses.

  20. [Orthognathic mandibular osteotomy and condyle positioning: update and innovation].

    Science.gov (United States)

    Laurentjoye, Mathieu; Charton, Jérôme; Boileau, Marie-José

    2015-03-01

    The temporomandibular joints function in synergy with the dental occlusion within the manducatory system. Orthodontists and surgeons must take into account the condylar position since any problem related to positioning of the condyle could result in occlusal disorders including relapse and the risk of occurrence, decompensation or worsening of temporomandibular dysfunction. We wanted to answer three questions: What is the position of the condyle following orthognathic surgery? What benefit is there in repositioning the condyle? What means are available to check condylar position? Finally, in the light of the answers, we describe an innovative occlusal and condylar positioning device for mandibular osteotomies based on computer-assisted surgical planning techniques. It consists of a three-dimensional, printed guide enabling surgeons to position the condyles as desired. It is accurate, simple, reproducible, independent of operator experience as well as rapid and economical. © EDP Sciences, SFODF, 2015.

  1. Determination of muscle effort at the proximal femur rotation osteotomy

    Science.gov (United States)

    Sachenkov, O.; Hasanov, R.; Andreev, P.; Konoplev, Yu

    2016-11-01

    The paper formulates the problem of biomechanics of a new method for treatment of Legg-Calve-Perthes disease. Numerical calculations of the rotational flexion osteotomy have been carried out for a constructed mathematical model of the hip joint, taking into account the main set of muscles. The work presents the results of the calculations and their analysis. The results have been compared with the clinical data. The calculations of the reactive forces arising in the acetabulum and the proximal part of the femur allowed us to reveal that this reactive force changes both in value and direction. These data may be useful for assessing the stiffness of an external fixation device used in orthopedic intervention and for evaluating the compression in the joint.

  2. Mandibular nerve schwannoma resection using sagittal split ramus osteotomy.

    Science.gov (United States)

    Mahmood, Laith; Demian, Nagi; Weinstock, Yitzchak E; Weissferdt, Annikka

    2013-11-01

    A case is presented of a unique presentation and treatment of a mandibular nerve schwannoma. Its uniqueness stems from the fact that it consisted of 2 distinct tumors along the same nerve: one within the body of the mandible and the other within the ipsilateral pterygomandibular space. Rather than the standard approach of lip split and hemimandibulectomy, a unique approach of a sagittal split ramus osteotomy was used that allowed access to the 2 lesions and avoided the added morbidity of the former approach. The 2 portions of the lesion were successfully removed and the patient was satisfied with the result. Recurrence has not been detected after 6 months. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Hemivertebra resection and osteotomies in congenital spine deformity.

    Science.gov (United States)

    Ruf, Michael; Jensen, Rubens; Letko, Lynn; Harms, Jürgen

    2009-08-01

    Retrospective study of posterior hemivertebra resection and osteotomies with transpedicular instrumentation in very young children. Assessment of early intervention in congenital scoliosis with almost complete correction of the main deformity. There is a trend to early correction of congenital deformities, however, there is a lack of long-term follow-up. Forty-one children aged 1 to 6 years with congenital scoliosis were operated on by hemivertebra resection by a posterior only approach with transpedicular instrumentation. Mean age at time of surgery was 3 years 5 months. They were retrospectively studied with a mean follow-up of 6 years 2 months. In group 1 (patients without bar formation), the average Cobb angle of the main curve was 36 degrees before surgery and 7 degrees after surgery. Compensatory cranial curve improved spontaneously from 15 degrees to 3 degrees, compensatory caudal curve from 17 degrees to 4 degrees. The angle of kyphosis was 22 degrees before surgery and 8 degrees after surgery. In group 2 (patients with bar formation) the main curve improved from 69 degrees to 23 degrees, cranial curve from 27 degrees to 11 degrees, caudal curve from 34 degrees to 14 degrees, and kyphosis from 24 degrees to 9 degrees. Posterior hemivertebra resection, in case of bar formation with osteotomy of the bar, allows for excellent correction in both the frontal and sagittal planes, with a short segment of fusion. Early surgery in young children prevents the development of severe local deformities and secondary structural curves, thus allowing for normal growth in the unaffected parts of the spine.

  4. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis.

    Science.gov (United States)

    Debarge, Romain; Demey, Guillaume; Roussouly, Pierre

    2011-09-01

    This is a radiographic study of ankylosing spondylitis patients with severe fixed kyphotic deformity who underwent pedicle subtraction osteotomy. Our goal was to measure and validate new angle to assess global kyphosis and to evaluate the sagittal balance after surgery. This is the first report which describes new angle to assess global kyphosis (T1-S1). Pre and postoperative controls were compared according to the Pelvic Incidence. The sagittal parameters ankylosing spondylitis patients were compared with 154 asymptomatic patients. In addition to the pelvic parameters and the C7 tilt, we used the spino-sacral angle. Pelvic incidence in ankylosing spondylitis patients was higher than asymptomatic population (61° vs. 51°). For a same tilt of C7 for both groups, the low pelvic incidence group had a lower sacral slope and pelvic tilt and a higher global kyphosis (spino-sacral angle = 90°) than the high pelvic incidence group (spino-sacral angle = 98°). In the adult volunteers, the C7 tilt and spino-sacral angle measured, respectively, 95° and 135°. The preoperative C7 tilt measured 73° and increased to 83° (p = 0.0025). The preoperative spino-sacral angle measured 96° and increased to 113.3° (p = 0.003). A low pelvic incidence pelvis has a lower sacral slope than in high pelvic incidence and can support a bigger kyphosis. All the parameters were improved by the pedicle subtraction osteotomy, but the average spinosacral angle remained lower than the control group. When C7 tilt was useful to assess the improvement of the sagittal balance, SSA allowed a better evaluation of the correction of kyphosis itself.

  5. Midface distraction advancement in the canine without osteotomies.

    Science.gov (United States)

    Staffenberg, D A; Wood, R J; McCarthy, J G; Grayson, B H; Glasberg, S B

    1995-05-01

    Midface hypoplasia, often associated with exorbitism and malocclusion, has been traditionally corrected by using Le Fort advancement osteotomies through wide surgical exposure. These procedures suffer the disadvantages of hemorrhage, unpredictable bone graft resorption, the need for retained hardware, and bone graft donor-site morbidity. We present an investigation of midface distraction in the canine without osteotomies. Five canines were the subjects of this study and were divided into two groups. At the time of placement of the lengthening devices, Group 1 animals were 10 weeks of age and Group 2 animals were 5 years of age. Under general anesthesia, four modified Hoffman bone distractors were mounted on 2-mm half pins placed individually across the nasofrontal and the zygomaticotemporal sutures on each side of the craniofacial skeleton. Distraction of all devices was begun on postoperative day 1 at the rate of 0.5 mm/day for 4 days and then 1.0 mm/day for 28 days, after which interval the devices were removed. The dogs were serially monitored and examined for 3 months. One dog in the first group served as a sham control. The results were assessed by standardized cephalograms, and craniofacial computed tomographic scans with three-dimensional reconstruction performed before device placement as well as after removal of the device. In one Group 1 animal, computed tomographic scanning was performed every 2 to 4 weeks for 3 months. Gross examination of the Group 1 animals demonstrated the development of enophthalmos, dolichocephaly, and a class II malocclusion-overbite.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Subcapital Correction Osteotomy for Malunited Slipped Capital Femoral Epiphysis

    Science.gov (United States)

    Anderson, Lucas A.; Gililland, Jeremy; Pelt, Christoper; Peters, Christopher L.

    2013-01-01

    Background Slipped capital femoral epiphysis (SCFE), causing posterior and inferior displacement and retroversion of the femoral head, is a well-recognized etiology for femoroacetabular impingement (FAI) and can lead to premature arthritis in the young adult. The treatment of malunited SCFE remains controversial. Surgical dislocation and subcapital correction osteotomy (SCO) has been described as a powerful method to correct the proximal femoral deformity. Methods Between January 2003 and January 2010, 11 patients (12 hips) with closed femoral physes and symptomatic FAI from malunited SCFE were treated with surgical dislocation and SCO. We performed a retrospective review of patient histories, physical exams, operative findings, and pre and postoperative anteroposterior (AP) and groin lateral (GLat) radiographs. Mean follow-up was 61 months. Results There were 4 female and 7 male patients with an average age of 15 years at the time of SCO. On the AP radiograph the mean inferior femoral head displacement (AP epiphyseal-neck angle) was significantly improved (-26° to -6°, pfemoral head displacement (Lateral epiphyseal-neck angle) was significantly improved (-45° to -3°, pfemoral osteochondral defect, 8 Outerbridge grade 3-4 acetabular cartilage lesions, and 10 labral lesions. Significant improvement of the mean Harris hip score (HHS) was seen at latest follow-up (54 to 77, p=0.016). Complications occurred in 4 of the 12 cases with AVN in two patients, a worse postoperative HHS in one patient, and failure of fixation treated successfully with revision open reduction internal fixation in one patient. Conclusions Subcapital correction osteotomy as an adjunct to surgical dislocation and osteochondroplasty can be used to correct the deformity of the proximal femur associated with malunited SCFE. Normalization of proximal femoral anatomy may postpone progression to severe osteoarthritis and thus delay the need for arthroplasty in this young patient population. However

  7. Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows

    Directory of Open Access Journals (Sweden)

    Rex Chadrabose

    2011-12-01

    Full Text Available Abstract Background Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results. Materials Our case series includes 9 patients (seven males and two females with the mean age of 34 years (13-56 years. Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation. Results The average duration of follow up is 65 months (45 months-80 months. The mean Mayo's elbow performance score (MEPS preoperatively was 48 (35-70. The MEPS at final follow up was 80 (60-95. With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°. The mean post operative range of motion at final follow up was 27°of extension (20-500, 116°of flexion (1100-1300, and the arc of motion was 88°(800-1000. One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities. Conclusion We conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

  8. Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows.

    Science.gov (United States)

    Rex, Chadrabose; Periyasamy, Rameshkumar; Balaji, Subbachandra; Premanand, C; Alva, Shreyas; Reddy, Shiva

    2011-12-05

    Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results. Our case series includes 9 patients (seven males and two females) with the mean age of 34 years (13-56 years). Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation. The average duration of follow up is 65 months (45 months-80 months). The mean Mayo's elbow performance score (MEPS) preoperatively was 48 (35-70). The MEPS at final follow up was 80 (60-95). With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°). The mean post operative range of motion at final follow up was 27°of extension (20-500), 116°of flexion (1100-1300), and the arc of motion was 88°(800-1000). One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities. We conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

  9. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus.

    Science.gov (United States)

    Ring, David; Gulotta, Lawrence; Chin, Kingsley; Jupiter, Jesse B

    2004-08-01

    Although olecranon osteotomy provides excellent exposure of the distal humerus, enthusiasm for this approach has been limited by reports suggesting numerous complications. It has been suggested that specific techniques for creating and repairing an olecranon osteotomy may help limit complications. This paper describes a technique for olecranon osteotomy using an apex, distal, chevron-shaped osteotomy, Kirschner wires directed out the anterior ulnar cortex distal to the coronoid process and bent 180degrees and impacted into the olecranon proximally, and two 22- gauge, figure-of-eight, stainless steel tension wires. A single surgeon used this technique for exposure of a fracture (16 patients) or nonunion (29 patients) of the distal humerus in 45 consecutive patients. One patient returned to activity too soon, had loosening of the wire fixation, and required a second operation for plate fixation of the ulna. The remaining 44 osteotomies (98%) healed with good alignment within 6 months. There were no broken or migrated wires prior to healing. Twelve patients (27%) had removal of the wires used to repair the olecranon: in 6 patients, this was for symptoms related to the wires (13%); 1 for septic olecranon bursitis, and 5 at the time of another procedure (elbow capsular release in 4 patients and submuscular ulnar nerve transposition in 1). Olecranon osteotomy can be used for exposure of the distal humerus with a low rate of complications when specific techniques are used.

  10. A comparison of the biomechanical effects of valgus knee braces and lateral wedged insoles in patients with knee osteoarthritis.

    Science.gov (United States)

    Jones, Richard K; Nester, Christopher J; Richards, Jim D; Kim, Winston Y; Johnson, David S; Jari, Sanjiv; Laxton, Philip; Tyson, Sarah F

    2013-03-01

    Increases in the external knee adduction moment (EKAM) have been associated with increased mechanical load at the knee and progression of knee osteoarthritis. Valgus knee braces and lateral wedged insoles are common approaches to reducing this loading; however no study has directly compared the biomechanical and clinical effects of these two treatments in patients with medial tibiofemoral osteoarthritis. A cross-over randomised design was used where each intervention was worn by 28 patients for a two week period. Pre- and post-intervention gait kinematic/kinetic data and clinical outcomes were collected to evaluate the biomechanical and clinical effects on the knee joint. The valgus knee brace and the lateral wedged insole significantly increased walking speed, reduced the early stance EKAM by 7% and 12%, and the knee adduction angular impulse by 8.6 and 16.1% respectively. The lateral wedged insole significantly reduced the early stance EKAM compared to the valgus knee brace (p=0.001). The valgus knee brace significantly reduced the knee varus angle compared to the baseline and lateral wedged insole. Improvements in pain and function subscales were comparable for the valgus knee brace and lateral wedged insole. There were no significant differences between the two treatments in any of the clinical outcomes; however the lateral wedged insoles demonstrated greater levels of acceptance by patients. This is the first study to biomechanically compare these two treatments, and demonstrates that given the potential role of knee loading in osteoarthritis progression, that both treatments reduce this but lateral wedge insoles appear to have a greater effect. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Effects of foot orthoses and valgus bracing on the knee adduction moment and medial joint load during gait.

    Science.gov (United States)

    Shelburne, Kevin B; Torry, Michael R; Steadman, J Richard; Pandy, Marcus G

    2008-07-01

    Lateral shoe wedges and valgus knee braces are designed to decrease the force acting in the medial knee compartment by reducing the external adduction moment applied at the knee. The biomechanical changes introduced by these orthoses can be relatively small. Computer modeling and simulation offers an alternative approach for assessing the biomechanical performance of these devices. A three-dimensional model of the lower-limb was used to calculate muscle, ligament, and joint loading at the knee during gait. A lateral shoe wedge was simulated by moving the center of pressure of the ground reaction force up to 5mm laterally. A valgus knee brace was simulated by applying abduction moments of up to 12 Nm at the knee. Knee adduction moment and medial compartment load decreased linearly with lateral displacement of the center of pressure of the ground reaction force. A 1 mm displacement of the center of pressure decreased the peak knee adduction moment by 2%, while the peak medial compartment load was reduced by 1%. Knee adduction moment and medial compartment force also decreased linearly with valgus moments applied about the knee. A 1 Nm increase in brace moment decreased the peak knee adduction moment by 3%, while the peak medial compartment load was reduced by 1%. Changes in knee joint loading due to lateral shoe wedges and valgus bracing are small and may be difficult to measure by conventional gait analysis methods. The relationships between lateral shift in the center of pressure of the ground force, valgus brace moment, knee adduction moment, and medial joint load can be quantified and explained using computer modeling and simulation. These relationships may serve as a useful guide for evaluating the biomechanical efficacy of a generic wedge insole or knee brace.

  12. Three-dimensional analysis of tarsal bone response to axial loading in patients with hallux valgus and normal feet.

    Science.gov (United States)

    Watanabe, Kota; Ikeda, Yasutoshi; Suzuki, Daisuke; Teramoto, Atsushi; Kobayashi, Takuma; Suzuki, Tomoyuki; Yamashita, Toshihiko

    2017-02-01

    Patients with hallux valgus present a variety of symptoms that may be related to the type of deformity. Weightbearing affects the deformities, and the evaluation of the load response of tarsal bones has been mainly performed using two-dimensional plane radiography. The purpose of this study was to investigate and compare structural changes in the medial foot arch between patients with hallux valgus and normal controls using a computer image analysis technique and weightbearing computed tomography data. Eleven patients with hallux valgus and eleven normal controls were included. Computed tomograms were obtained with and without simulated weightbearing using a compression device. Computed tomography data were transferred into a personal computer, and a three-dimensional bone model was created using image analysis software. The load responses of each tarsal bone in the medial foot arch were measured three-dimensionally and statistically compared between the two groups. Displacement of each tarsal bone under two weightbearing conditions was visually observed by creating three-dimensional bone models. At the first metatarsophalangeal joint, the proximal phalanges of the hallux valgus group showed significantly different displacements in multiple directions. Moreover, opposite responses to axial loading were also observed in both translation and rotation between the two groups. Weightbearing caused deterioration of the hallux valgus deformity three-dimensionally at the first metatarsophalangeal joint. Information from the computer image analysis was useful for understanding details of the pathology of foot disorders related to the deformities or instability and may contribute to the development of effective conservative and surgical treatments. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Lateral Sesamoid Position Relative to the Second Metatarsal in Feet With and Without Hallux Valgus: A Prospective Study.

    Science.gov (United States)

    Geng, Xiang; Zhang, Chao; Ma, Xin; Wang, Xu; Huang, Jiazhang; Xu, Jian; Wang, Chen

    2016-01-01

    We sought to determine whether hallux valgus displaces the sesamoid bones laterally away from a stationary first metatarsal or whether the first metatarsal head is displaced medially from the stationary sesamoids, which remain in position relative to the rest of the forefoot. We reviewed weightbearing radiographs in the dorsal plantar view of 128 consecutive patients (149 feet) seen over 2 months in 2014. Of these, 82 feet (55%) had a hallux valgus angle of >15° (hallux valgus group) and 67 feet (45%) had an angle of no more than 15° (control group). We measured the absolute distances from the center of the lateral sesamoid and the first metatarsal head to the long axis of the second metatarsal. Next, the relative distances, defined as the ratio of these 2 absolute distances to the length of the second metatarsal, were calculated to adjust for foot size. Both the absolute and the relative distances from the center of the first metatarsal head to the second metatarsal differed significantly between the 2 groups and correlated positively with the hallux valgus angle and first intermetatarsal angle. However, neither the absolute nor the relative distance to the lateral sesamoid bone differed significantly between the groups, nor did they correlate with either of the 2 angles. Thus, despite medial shifting of the first metatarsal in hallux valgus, the lateral sesamoid retains its relationship to the second metatarsal in transverse plane. Its apparent lateral movement is a radiographic misinterpretation. Awareness of this misinterpretation should improve the success of corrective surgery. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Epidemiology of Shoe Wearing Patterns Over Time in Older Women: Associations With Foot Pain and Hallux Valgus.

    Science.gov (United States)

    Menz, Hylton B; Roddy, Edward; Marshall, Michelle; Thomas, Martin J; Rathod, Trishna; Peat, George M; Croft, Peter R

    2016-12-01

    Foot problems are prevalent in older women and are thought to be associated with footwear. This study examined women's shoe wearing patterns over time and evaluated associations between footwear characteristics and foot pain and hallux valgus. Women aged 50-89 years (n = 2,627) completed a survey that included drawings of four toe-box shapes and four heel heights. For each life decade, participants indicated which footwear style they wore most of the time. Foot pain in the past 12 months and hallux valgus were documented by self-report. Logistic regression examined associations between heel height, toe-box shape, foot pain and hallux valgus. Wearing shoes with a high heel and very narrow toe box between the ages of 20 and 29 was common, but decreased to less than 10% by the age of 40. Compared with women who had worn shoes with a very wide toe box, the likelihood of hallux valgus increased in those who had worn shoes with a wide (odds ratio [OR] 1.96, 95% CI 1.03-3.71), narrow (2.39, 1.29-4.42) and very narrow (2.70, 1.46-5.00) toe box between the ages of 20 and 29 and those who wore shoes with a very narrow toe box (1.93, 1.10-3.39) between the ages of 30 and 39. Women wear shoes with a lower heel and broader toe box as they age. Wearing constrictive footwear between the ages of 20 and 39 may be critical for developing hallux valgus in later life. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America.

  15. Hallux Valgus and Lesser Toe Deformities are Highly Heritable in Adult Men and Women: the Framingham Foot Study

    Science.gov (United States)

    Hannan, Marian T.; Menz, Hylton B.; Jordan, Joanne M.; Cupples, L. Adrienne; Cheng, Chia-Ho; Hsu, Yi-Hsiang

    2013-01-01

    Objective To estimate heritability of three common disorders affecting the forefoot: hallux valgus, lesser toe deformities and plantar forefoot soft tissue atrophy in adult Caucasian men and women. Methods Between 2002-2008, a trained examiner used a validated foot exam to document presence of hallux valgus, lesser toe deformities and plantar soft tissue atrophy in 2,446 adults from the Framingham Foot Study. Among these, 1,370 participants with available pedigree structure were included. Heritability (h2) was estimated using pedigree structures by Sequential Oligogenic Linkage Analysis Routines (SOLAR) package. Results were adjusted for age, sex and BMI. Results Mean age of participants was 66 years (range 39 to 99 years) and 57% were female. Prevalence of hallux valgus, lesser toe deformities and plantar soft tissue atrophy was 31%, 29.6% and 28.4%, respectively. Significant h2 was found for hallux valgus (0.29 ~ 0.89, depending on age and sex) and lesser toe deformity (0.49 ~ 0.90 depending on age and sex). The h2 for lesser toe deformity in men and women aged 70+ years was 0.65 (p= 9×10−7). Significant h2 was found for plantar soft tissue atrophy in men and women aged 70+ years (h2 = 0.37; p=3.8×10−3). Conclusion To our knowledge, these are the first findings of heritability of foot disorders in humans, and they confirm the widely-held view that hallux valgus and lesser toe deformities are highly heritable in European-descent Caucasian men and women, underscoring the importance of future work to identify genetic determinants of the underlying genetic susceptibility to these common foot disorders. PMID:23696165

  16. Vertigine parossistica posizionale benigna conseguente alla procedure di mini-rialzo del pavimento del seno mascellare: osteotomi a percussione vs. osteotomi a vite. RCT a triplo cieco.

    OpenAIRE

    Mariniello, Mauro

    2013-01-01

    Obiettivo: Comparare l’insorgenza della vertigine parossistica posizionale benigna (VPPB) nelle metodiche di mini-rialzo del seno mascellare a seconda che impieghino osteotomi a vite o osteotomi a percussione. Materiali e Metodi: Questo RCT a triplo cieco ha coinvolto 196 pazienti (107 uomini e 89 donne; età media 62.05 anni ± 7.10, range 49-79 anni) con un’edentulia mascellare di un singolo elemento, che richiedesse una metodica di mini-rialzo del seno mascellare. I pazienti mediante una...

  17. Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.

    Science.gov (United States)

    Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh

    2017-05-01

    The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value

  18. Multilevel Posterior Column Osteotomies Are Not Inferior For the Correction of Rigid Adult Spinal Deformity Compared with Pedicle Subtraction Osteotomy.

    Science.gov (United States)

    Han, Sanghyun; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib; Lee, Byoung Hun; Choi, Ho Yong

    2017-11-01

    Posterior column osteotomy (PCO) has been used for the correction of various spinal deformities. However, little evidence is available regarding the effects of multilevel PCO in adult spinal deformity (ASD) surgery. This study aimed to show the usefulness of PCO in rigid ASD surgery by assessing radiographic and clinical outcomes. We also aimed to assess the corrective potential of multilevel PCOs compared with a single-level pedicle subtraction osteotomy (PSO). Between 2012 and 2016, the medical records of 70 consecutive patients who underwent a multilevel PCO (35 patients) or a single-level PSO (35 patients) for ASD in a single institute were reviewed. Baseline data, radiographic measurements, and clinical outcomes using the Scoliosis Research Society-22 (SRS-22) questionnaire were compared between groups. The following variables were no different between the groups: age at surgery, sex, level fused, preoperative and postoperative radiologic parameters, and bone mineral density T score. However, operation time (380.0 vs. 483.6 minutes), estimated blood loss (1175.7 vs. 1362.6 mL), and the number of complications (8 vs. 20) were significantly reduced in the PCO group compared with the PSO group. A significant improvement in the SRS-22 score was seen in both groups after surgery, although no difference was observed between the groups postoperatively. Multilevel PCOs for the correction of rigid ASD were slightly superior to PSO, regarding clinical outcomes. Radiographic outcomes were similar between groups. Thus, multilevel PCOs may be a viable option for the treatment of rigid ASD with a mobile segment. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. An investigation on the incidence of neurosensory disturbances of inferior alveolar nerve and condylardisplacement with Choung (IVSRO osteotomy

    Directory of Open Access Journals (Sweden)

    Shirani Gh

    2004-02-01

    Full Text Available The choung osteotomy (Intraoral Vertico- Sagittal Ramus Osteotomy has developed"nsince 1992 in the treatment of mandibular prognathism. In IVSRO, osteotomy plane is theoretically parallel to"nthe original sagittal plane and thereby attempting to decrease the incidence of condylar dispacement. This"nosteotomy designed additionally to decrease neurosensory disturbances."nPurpose: The aim of this study was to evaluate the incidence of neurosensory deficit and condylar"ndisplacement with IVSRO and Sagittal Split Ramus Osteotomy (SSRO."nMaterials and Methods: In this study, mandibular set back surgery was accomplished upon 7 patients by"nchoung osteotomy. In addition to choung osteotomy, in 2 patients Lefort 1 osteomy was performed for"nmaxillary protrusion and for 2 other patients, chain surgery was performed. Variables such as the"nneurosensory disturbances of inferior alveolar nerve and condylar displacement following choung osteotomy"nwere investigated. All the patients were followed up one year after osteotomy. OPG, Lateral Cephalogram and"nSubmentovertex radiographies were take pre and postoperatively for all patients."nResults: No statistically significant differences were found in condylar displacement (P>0.5. However, Mc"nNemar analysis showed significant difference of neurosensory deficit between IVSRO and SSRO (P=0.001."nConclusion: It is suggested that choung osteotomy is a safe procedure for mandibular surgery.

  20. Cementless Total Hip Arthroplasty Involving Trochanteric Osteotomy without Subtrochanteric Shortening for High Hip Dislocation.

    Science.gov (United States)

    Lee, Soong Joon; Yoo, Jeong Joon; Kim, Hee Joong

    2017-03-01

    Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation. From 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications. The mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening over 3.5 cm. With proper

  1. Relationship Between Displacement and Degenerative Changes of the Sesamoids in Hallux Valgus.

    Science.gov (United States)

    Katsui, Ryuhei; Samoto, Norihiro; Taniguchi, Akira; Akahane, Manabu; Isomoto, Shinji; Sugimoto, Kazuya; Tanaka, Yasuhito

    2016-12-01

    Although the tangential sesamoid view is used to visualize the sesamoid position relative to the first metatarsal head, correctly evaluating patients with severe varus of the first metatarsal is difficult. Computed tomography (CT) can be helpful due to its cross-sectional images in any plane. The purposes of this study were to evaluate the alignment of the tibial sesamoid and investigate the relationship between malalignment and degenerative change in the sesamoid metatarsal joint (SMJ) using simulated weight-bearing CT imaging in patients with hallux valgus. In total, 269 feet from 142 patients with hallux valgus were included. The mean age was 63.7 years (range, 33-87 years). An anteroposterior weight-bearing radiograph was assessed for sesamoid position into 3 grades: grade 1, the tibial sesamoid was medial to the axis of the first metatarsal; grade 2, the tibial sesamoid was located below the first metatarsal axis; and grade 3, the tibial sesamoid was lateral to the first metatarsal axis. The hallux valgus and intermetatarsal angles (HVA and IMA, respectively) were measured. The lateral shift of the tibial sesamoid relative to the first metatarsal was classified into 3 grades on simulated weight-bearing CT classification: grade 1, tibial sesamoid was entirely medial to the intersesamoid ridge; grade 2, tibial sesamoid was subluxated laterally but located below the intersesamoid ridge; and grade 3, tibial sesamoid was located entirely lateral to the intersesamoid ridge. The differences of HVA and IMA in each grade were confirmed by using 1-way analysis of variance with Bonferroni post hoc corrections. Furthermore, multiple linear regression analysis was used to predict the degenerative change in the SMJ for age, sex, sesamoid position determined by CT or plain radiography, HVA, and IMA. The χ(2) test was used for descriptive statistics to analyze the agreement between radiography or CT classifications of sesamoid position against degenerative change in the SMJ

  2. Cifose de Scheuermann: comparação entre a abordagem por via posterior associada à osteotomia de Smith-Petersen e a fusão combinada anterior e posterior Scheuermann's kyphosis: comparison between the posterior approach associated with Smith-Petersen osteotomy and combined anterior-posterior fusion

    Directory of Open Access Journals (Sweden)

    Eduardo Frois Temponi

    2011-01-01

    with cross-sectional analysis. Twenty-eight patients, split into two groups conducted at different times, were evaluated. RESULTS: The first group comprised patients treated using the double approach, with an average age of 19 years, preoperative kyphosis of 77.6°, postoperative kyphosis of 35.8° and average correction of 53.2%. The second group comprised patients treated using the posterior route associated with Smith-Petersen osteotomy, with a mean age of 27.3 years, preoperative kyphosis of 72.9°, postoperative kyphosis of 44.3° and average correction of 39.3%. Analysis between the two groups showed statistically significant differences in the following variables: age (p = 0.02, postoperative kyphosis (p = 0.04 and degree and percentage of kyphosis correction (p = 0.001. There was no difference concerning preoperative kyphosis (p = 0.33. In the assessment of postoperative pain (VAS, the first group presented an average of 0.6, versus 0.5 in the second group. There were only minor complications: seven in the first group and two in the second. CONCLUSION: The two surgical techniques studied proved to be adequate for treating SK. In the present study, the deformity correction was greater in the first group, while the pain VAS results were better in the second group, with lower incidence of complications.

  3. TALONAVICULAR JOINT ARTHRODESIS AND MEDIAL DISPLACEMENT CALCANEAL OSTEOTOMY FOR TREATMENT OF PATIENTS WITH PLANOVALGUS DEFORMITY

    Directory of Open Access Journals (Sweden)

    G. O. Dubovik

    2012-01-01

    Full Text Available The aim of this study was to assess the results of talonavicular joint arthrodesis and medial displacement calcaneal osteotomy for surgical correction of pes planovalgus. Fourteenth patients with a pes planovalgus deformity were underwent surgery from February 2008 to December 2011. The mean age was 45,5. In 90% of cases, operations were performed on one foot, and 10% of cases at two feet. All patients were assessed before the operation with the scale of the American Orthopaedic Foot and Ankle Society (AOFAS. According to the AOFAS scale, the average improvement was 41 before the operation had reached values of 84.2 after the operation. Radiography showed an average decrease in the angle of the longitudinal arch from 12 and an average decrease in the angle of deviation between the vehicle collision and the calcaneus to 38°, increasing the height of a set of 5 mm. This combination of procedures allows greater correction and stability than either procedure performed alone, and provides a viable alternative to triple arthrodesis.

  4. Intra- and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus.

    Science.gov (United States)

    Chi, Thomas D; Davitt, James; Younger, Alastair; Holt, Sarah; Sangeorzan, Bruce J

    2002-08-01

    There is some uncertainty as to whether the distal metatarsal articular angle (DMAA) is a real entity or just radiographic artifact and whether it can be reliably measured. If it is intrinsic to the bone, it should not change with bone position. If it is clinically useful, it should be reproducible. Pre-operative and post-operative radiographs of 32 patients undergoing a proximal bony procedure of the first ray were evaluated independently by three foot and ankle specialists in order to determine the intra and inter-observer reliability of the distal metatarsal articular angle (DMAA). In addition, the hallux valgus angle (HVA), intermetatarsal angle (IMA) and joint congruency/subluxation were determined. We used ANOVA (Scheffe's F-test) to determine reliability of the angular measurements; a p value of less than 0.05 indicates poor reliability and a p value of greater than 0.05 indicates reliability. Intra-observer reliability was good for all angular measurements (HVA, IMA, DMAA pre-op, and DMAA post-op) with p values ranging from 0.33 to 0.95. Inter-observer reliability of the HVA and IMA was good (p=0.63 and p=0.32). Inter-observer reliability of the pre-op DMAA approached statistically poor reliability (p=0.09) and the post-op DMAA reliability was poor (p=0.002). The DMAA reduced after the proximal procedure as measured by all observers, and averaged a reduction of 3.9 degrees. Weighted kappa analysis also revealed that there was poor agreement in the determination of congruency and subluxation (Kappa statistic ranged from 0.07 to 0.19). This study suggests that there may be limited value in the DMAA as a clinical measure as it varies with examiner and with the hallux valgus angle.

  5. Chronic Bilateral Tibial Stress Fractures with Valgus Treated with Bilateral Intramedullary Nailing: A Case Report

    Directory of Open Access Journals (Sweden)

    Steven K Dailey

    2014-01-01

    Full Text Available Introduction: Stress fractures are overuse injuries most commonly seen in athletes, military recruits, and individuals with endocrine abnormalities. It has been demonstrated that chronic cases of anterior tibial stress fractures refractory to conservative management respond well to intramedullary nailing. To our knowledge, only one report has been published concerning patients with bilateral tibial stress fractures treated with bilateral intramedullary nailing. All patients in the series were high-level athletes. We present the case of a non-athletic patient with chronic bilateral tibial stress fractures and associated deformity successfully treated with bilateral intramedullary nails. Case Report: A 23-year-old Caucasian female full-time student presented with chronic bilateral shin pain for approximately five years. She had failed an extensive regimen of conservative management. She was diagnosed with chronic bilateral tibial stress fractures based on history, physical examination, and radiologic findings. She subsequently underwent sequential intramedullary nailing of her tibiae. Both tibiae were in valgus alignment; however, this did not preclude nail placement. The nails deformed upon insertion into the sclerotic canals to conform to the deformation. Post operatively the tibiae united and patient was relieved of her symptoms. Conclusion: Bilateral intramedullary nailing of chronic bilateral tibial stress fractures should be considered as a treatment option for all patients, not just high-level athletes, who fail a trial of conservative management. Additionally, mild to moderate tibial malalignment does not necessarily preclude tibial nailing as the smaller nails placed in sclerotic canals will likely deform on insertion and conform to the canal. Keywords: Bilateral intramedullary nailing, bilateral tibial stress fractures, valgus

  6. Varus/valgus and internal/external torsional knee joint stiffness differs between sexes.

    Science.gov (United States)

    Schmitz, Randy J; Ficklin, Travis K; Shimokochi, Yohei; Nguyen, Anh-Dung; Beynnon, Bruce D; Perrin, David H; Shultz, Sandra J

    2008-07-01

    Torsional joint stiffness is thought to play a role in the observed sex bias in noncontact anterior cruciate ligament injury rates. Women will exhibit lower torsional stiffness values of the knee in response to varus/valgus and internal/external rotations than will men. Controlled laboratory study. Knee kinematics of 20 university students (10 men, 27.3 +/- 3.4 years, 177.3 +/- 6.8 cm, 81.1 +/- 7.0 kg; 10 women, 22.9 +/- 1.5 years, 169.0 +/- 7.1 cm, 66.1 +/- 11.4 kg) were measured while 0 to 10 N . m of varus and valgus torques were applied with the subject nonweightbearing and while 0 to 5 N . m of internal and external torques were applied with the subject nonweightbearing and weightbearing with the use of a custom joint testing device. Joint stiffness values were calculated at 1-N . m increments. When low magnitudes of torque were applied to the knee, women had significantly lower stiffness values than did men. With the exception of applied external torque with the joint weightbearing and varus torque with the joint nonweightbearing, women demonstrated an increase in joint stiffness as the magnitude of torque increased from lower to higher magnitudes. In contrast, for the men, joint stiffness values remained unchanged as the magnitude of applied torque increased. Women exhibited lower knee stiffness in response to low magnitudes of applied torque compared to men and demonstrated an increase of joint stiffness as the magnitude of applied torque increased. The decreased stiffness behavior of the knee in response to low torques that was observed for women may have a role in detrimentally affecting knee biomechanics and resulting neuromuscular function, particularly when an individual transitions from nonweightbearing to weightbearing.

  7. Evaluation of the Pain and Foot Functions in Women with Hallux valgus deformities

    Directory of Open Access Journals (Sweden)

    Burcu Talu

    2016-06-01

    Full Text Available Objectives: The aim of this study was to investigate whether deformity affects pain and associated functional status in women with hallux valgus (HV. Methods: The study included 27 women (mean age: 40.5±10.3 years diagnosed with HV and with a deformity level of two or more as determined using the Manchester scale. Demographic data of the participants were recorded. In addi­tion, Visual Analog Scale (VAS was used to determine the intensity of pain during walking. To determine the function affected by pain and deformity, Foot Function Index (FFI, and the American Orthopaedic Foot and Ankle Society MTP-IP (AOFAS MTP-IP Scale along with AOFAS Midfoot (MF Scale were used. Results: Based on the study results, we determined a statistically significant relationship between foot function and pain among our patients (p<0.05. These significant relationships were observed between the pain and total scores of the Foot Function Index (p<0.05, the pain parameter of AOFAS MTP-IP and the pain and total scores of AOFAS midfoot-pain scale (p<0.05. Conclusion: It was concluded that when assessing and planning treatment for hallux valgus, all health profession­als dealing with foot health, pathologies, deformities and treatment should consider the patient as a whole, bearing in mind that pathologies can affect not only the perceived symptoms of individuals, but also their normal functions through various physical and social limitations. J Clin Exp Invest 2016; 7 (2: 144-149

  8. [Proximal femoral varus osteotomy in adults after developmental dysplasia of the hip: long-term results].

    Science.gov (United States)

    Rozkydal, Z; Janíček, P; Otiepka, P

    2010-01-01

    The aim of this retrospective study was to assess the results of varus osteotomy of the proximal femur in adults with coxa valga after developmental dysplasia of the hip (DDH) and to evaluate the efficacy of this method. Thirty hips in 28 patients treated by proximal femoral varus osteotomy in the period from 1983 to 1990 were evaluated. The indication for surgery involved coxa valga (145°-168°) with grade I- III of osteoarthritis and mild acetabular dysplasia. The patient group comprised twenty six women and two men with an average age of 28 years (18 to 42) at the time of surgery. The mean follow-up was 22 years (19 to 26). The preoperative radiographic examination included an AP view of the pelvis, AP views of the hip in neutral and in frog-leg position and AP views of the hip in 30° of abduction and neutral rotation. Varus osteotomy was indicated when the best position of the hip joint was achieved in abduction. The procedure was performed according to M. Müller. Hip assessment was based on the grade of osteoarthritis, CCD angle, Wiberg angle and AHI index. The results were statistically evaluated using the life table analysis of clinical survivorship of osteotomy and the Kaplan- Meier curve. Clinical failure was defined as conversion of osteotomy to total hip replacement (THR). At the latest follow-up of 22 years on the average, 18 patients (19 hips) still had osteotomy and 10 patients (11 hips) had undergone conversion to THR. The life table analysis showed the cumulative proportion of osteotomy with a clinical survivorship of 0.97 at 5 years, 0.75 at 10 and 15 years, and 0.68 at 20 and 25 years after surgery. The cumulative rate of clinical survivorship of osteotomy, as shown by the Kaplan-Meier curve, was 0.89 at 10 years, 0.75 at 20 years and 0.67 at 25 years after surgery. Nineteen patients were satisfied with the osteotomy outcome. The median of Harris hip scores in the patients with osteotomy was 48 points before surgery and 78 points at the latest

  9. Üksildased, patused ja vägivaldsed. Peategelasest Martin Scorsese loomingus, filmi "Aviaator - valguses ja varjus" põhjal / Allan Valge

    Index Scriptorium Estoniae

    Valge, Allan

    2006-01-01

    Howard Hughes - ameerika ärimees, kes teostas ennast jõuliselt lennunduses, produtsendina filmikunstis... Ta on prototüübiks Martin Scorsese mängufilmi "Aviaator - valguses ja varjus" ("The Aviator") peategelasele

  10. The effects of medial and lateral displacement calcaneal osteotomies on ankle and subtalar joint pressure distribution.

    Science.gov (United States)

    Davitt, J S; Beals, T C; Bachus, K N

    2001-11-01

    We compared the pressure distribution in the ankle and posterior facet of the subtalar joint following 1 cm medial and lateral displacement calcaneal osteotomies to the pressure distribution in the intact foot. Six cadaver specimens were loaded in neutral alignment while pressure measurements were recorded. A 1-cm medial displacement osteotomy shifted the average center of force in the ankle 1.0 mm medially (p = 0.36) while a lateral displacement osteotomy shifted the center of force 1.1 mm laterally (p = 0.42). There was also a slight shift in the percentage of pressure toward the side of the talus to which the calcaneus was shifted. For the lateral displacement osteotomy, the pressure increased 4.0% in the lateral-most quadrant (p = 0.05), while the medial osteotomy increased the pressure 1.3% in the medial quadrant (p = 0.30). In the subtalar joint, a medial displacement osteotomy shifted the pressure distribution slightly medially (5.9%, p = 0.06) and more anteriorly (9.6%, p = 0.02) while the distribution was shifted laterally (5.9%, p = 0.17) and anteriorly (5.6%, p = 0.03) with a lateral displacement osteotomy. These shifts of percentage of pressure between quadrants of the joints were slight-less than 5% in the ankle and less than 10% in the subtalar joint. Significant translation of the calcaneal tuberosity appears to have only a small effect on pressure distribution in the ankle and posterior facet of the subtalar joint in a weighted cadaver model.

  11. Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures.

    Science.gov (United States)

    Aydogan, Umur; Roush, Evan P; Moore, Blake E; Andrews, Seth H; Lewis, Gregory S

    2017-04-01

    Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800-804, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  12. Evaluation of First-Ray Mobility in Patients with Hallux Valgus Using Weight-Bearing CT and a 3-D Analysis System: A Comparison with Normal Feet.

    Science.gov (United States)

    Kimura, Tadashi; Kubota, Makoto; Taguchi, Tetsuya; Suzuki, Naoki; Hattori, Asaki; Marumo, Keishi

    2017-02-01

    Some physicians report that patients with hallux valgus have hypermobility at the tarsometatarsal (TMT) joint of the first ray and 3-dimensional (3-D) deformity. With use of non-weight-bearing and weight-bearing computed tomography (CT), we evaluated the 3-D mobility of each joint of the first ray in feet with hallux valgus compared with normal feet. Ten feet of 10 patients with hallux valgus and 10 feet of 10 healthy volunteers with no foot disorders were examined. All participants were women. Weight-bearing (a load equivalent to body weight) and non-weight-bearing CT scans were made with use of a device that we developed. Orthogonal coordinate axes were set and a 3-D model was reconstructed. Each joint of the first ray was aligned with the respective proximal bone, and 3-D displacement of the distal bone relative to the proximal bone under loading was quantified. At the talonavicular joint, significantly greater dorsiflexion of the navicular relative to the talus was observed in the hallux valgus group compared with the control group. At the medial cuneonavicular joint, the hallux valgus group showed significantly greater eversion and abduction of the medial cuneiform relative to the navicular. At the first TMT joint, the hallux valgus group showed significantly greater dorsiflexion, inversion, and adduction of the first metatarsal relative to the medial cuneiform. At the first metatarsophalangeal joint, the hallux valgus group showed significantly greater eversion and abduction of the first proximal phalanx relative to the first metatarsal (all p hallux valgus.

  13. Effectiveness of the custom-mold room temperature vulcanizing silicone toe separator on hallux valgus: A prospective, randomized single-blinded controlled trial.

    Science.gov (United States)

    Chadchavalpanichaya, Navaporn; Prakotmongkol, Voraluck; Polhan, Nattapong; Rayothee, Pitchaya; Seng-Iad, Sirirat

    2017-03-01

    Silicone toe separator is considered as a conservative treatment for hallux valgus. The prefabricated toe separator does not fit all. However, effectiveness in prescription of the custom-mold toe separator is still unknown. To investigate the effect of using a custom-mold room temperature vulcanizing silicone toe separator to decrease hallux valgus angle and hallux pain. The compliances, complications, and satisfactions of toe separator were also explored. A prospective, randomized single-blinded controlled trial. A total of 90 patients with a moderate degree of hallux valgus were enrolled in a study at the Foot Clinic, Siriraj Hospital, Thailand. Patients were randomized into two groups; the study group was prescribed a custom-mold room temperature vulcanizing silicone toe separator for 6 h per night for 12 months. Patients in both groups received proper foot care and shoes and were permitted to continue drug treatment. In total, 40 patients in the study group and 39 patients in the control group completed the study. The hallux valgus angle was obtained through radiographic measurement. At month 12, both groups had significant differences in mean hallux valgus angle with a decrease of 3.3° ± 2.4° for the study group and increase of 1.9° ± 1.9° for the control group. There were statistically significant differences of hallux valgus angle between the two groups ( p Hallux pain was decreased in the study group. A custom-mold room temperature vulcanizing silicone toe separator can decrease hallux valgus angle and pain with no serious complications. Clinical relevance The custom-mold room temperature vulcanizing silicone toe separator for treatment of hallux valgus reduces deformity and hallux pain.

  14. Trans trochanteric approach with coronal osteotomy of the great trochanter

    Directory of Open Access Journals (Sweden)

    Steffann Francois

    2015-01-01

    Full Text Available Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy, using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC, greater trochanter (GT reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci

  15. Hallux valgus and hallux rigidus: a comparison of impact on health-related quality of life in patients presenting to foot surgeons in Australia

    Directory of Open Access Journals (Sweden)

    Landorf Karl B

    2008-12-01

    Full Text Available Abstract Background Hallux valgus and hallux rigidus are common foot conditions that lead to a deterioration in health status. Patients with significant pain or deformity from these conditions frequently resort to surgery. In this project, the foot health status of patients with hallux valgus and hallux rigidus presenting to foot surgeons in Australia was compared. Methods Foot health status was measured in 120 participants using the Foot Health Status Questionnaire (FHSQ, a validated 0 – 100 point health status instrument. All participants had presented for surgical advice regarding hallux valgus/rigidus. The mean age of participants was 48.0 years (SD ± 14.3, range 19 – 79. Results In the sample, 68% of participants were diagnosed with hallux valgus and 32% with hallux rigidus. Participants with hallux rigidus had greater levels of pain and functional limitation compared with hallux valgus. The mean difference for pain was 13.8 points (95% CI 4.6 to 22.9 and the mean difference for function was 15.0 points (95% CI 5.3 to 24.7. Both conditions result in similarly negative levels of impact on shoe fit and overall foot health. Conclusion This study found measurable differences in foot health status between hallux valgus and hallux rigidus in participants presenting for surgical consultation. While both appear to have a negative impact on health status, hallux rigidus has a more significant impact.

  16. Hallux valgus and hallux rigidus: a comparison of impact on health-related quality of life in patients presenting to foot surgeons in Australia

    Science.gov (United States)

    Gilheany, Mark F; Landorf, Karl B; Robinson, Priscilla

    2008-01-01

    Background Hallux valgus and hallux rigidus are common foot conditions that lead to a deterioration in health status. Patients with significant pain or deformity from these conditions frequently resort to surgery. In this project, the foot health status of patients with hallux valgus and hallux rigidus presenting to foot surgeons in Australia was compared. Methods Foot health status was measured in 120 participants using the Foot Health Status Questionnaire (FHSQ), a validated 0 – 100 point health status instrument. All participants had presented for surgical advice regarding hallux valgus/rigidus. The mean age of participants was 48.0 years (SD ± 14.3, range 19 – 79). Results In the sample, 68% of participants were diagnosed with hallux valgus and 32% with hallux rigidus. Participants with hallux rigidus had greater levels of pain and functional limitation compared with hallux valgus. The mean difference for pain was 13.8 points (95% CI 4.6 to 22.9) and the mean difference for function was 15.0 points (95% CI 5.3 to 24.7). Both conditions result in similarly negative levels of impact on shoe fit and overall foot health. Conclusion This study found measurable differences in foot health status between hallux valgus and hallux rigidus in participants presenting for surgical consultation. While both appear to have a negative impact on health status, hallux rigidus has a more significant impact. PMID:19077213

  17. [Spasm of the adductor muscles, pre-dislocations and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part II. The importance of the iliopsoas tendon, its tenotomy, of the coxa valga antetorta, and correction through osteotomy turning the hip into varus (author's transl)].

    Science.gov (United States)

    Fettweis, E

    1979-02-01

    The following factors besides spasm and contraction of the adductor muscles contribute to the occurrence of dislocations of the hip in spastic paralysis: Spasm and contraction of the iliopsoas muscle and enhanced valgus position and antetorsion. The author holds the opinion that in case of malformation of the proximal end of the femur, it is not only the indirect action of the spastic musculature via the proximal femur-epiphyseal cartilage which is responsible for this phenomen in accordance with the law on functional adaption through longitudinal growth (Pauwels), but also the direct traction of the iliopsoas tendon. A clue in this direction is the often very pronounced elongation or enlargement of the trochanter minor. The author demonstrates the pathogenetic importance of iliopsoas contracture and malpositioning of the neck of the femur by means of analyses of the course in two patients. The following principles of treatment are postulated for spastic dislocation of the hip: Elimination of the pathogenetic factors through myotenotomy of the adductor muscles and complete resection of the obturator nerve, with observation of strict aftertreatment criteria, tenotomy of the iliopsoas, repositioning and osteotomy with turning into varus. Osteotomy without previous elimination of the pathogenetically acting muscular forces does not appear useful. Likewise, permanent re-positioning by means of muscle-relaxing operation cannot be sufficiently safe-guarded without additional osteotomy once the dislocation has taken place. In twelve patients with spastic dislocation of the hip, treated in accordance with these guidelines (two without osteotomy) aged 6 6/12 and 19 5/12 years, a roentgenologically good result was obtained in half of the cases, whereas the functional result was satisfactory not only with these patients but also with part of the other patients. If surgical treatment is instituted early enough, and if the experiences described here are taken into consideration

  18. Piezoelectric osteotomies in craniofacial procedures: a series of 15 pediatric patients. Technical note.

    Science.gov (United States)

    Kramer, Franz-Josef; Ludwig, Hans Christoph; Materna, Thomas; Gruber, Rudolf; Merten, Hans Albert; Schliephake, Henning

    2006-01-01

    Frontoorbital advancement has become a standard method both to increase intracranial volume and to improve facial appearance in patients with syndromal or nonsyndromal craniosynostosis. Relevant complications of this procedure include severe hemorrhage and trauma to intracranial, orbital, or facial soft tissues, which mostly arise during the process of bone exposure or osteotomy. To minimize the risk of soft tissue injury and to increase the precision of the osteotomy, the authors applied a piezoelectric osteotome for frontoorbital advancement in 15 patients with craniosynostosis seen consecutively (mean age 11.3 months). They demonstrated that this new device can cut cranial bones using ultrasonic microvibrations created by piezoelectric effects. In all patients, this instrument allowed an easy and precise handling during osteotomy with a reduced amount of trauma to adjacent soft tissues and with no complications. Although the time required for piezoelectric osteotomy was longer compared with conventional techniques, the total operation time remained approximately the same because the preparation requirements are less extensive. Postoperatively, bone regeneration was uneventful. The authors conclude that this new technique of piezoelectric osteotomy is a valuable tool for craniofacial reconstructive surgery in pediatric patients.

  19. Dynamic analysis of maxillary perfusion during Le Fort I osteotomy using indocyanine green.

    Science.gov (United States)

    Salman, S; Fattahi, T; Fernandes, R; Steinberg, B

    2018-02-02

    The aim of this study was to evaluate the dynamic perfusion of the maxilla during various stages of a Le Fort I osteotomy using indocyanine green (ICG) dye angiography. This was a retrospective evaluation of patients who underwent a Le Fort I osteotomy. ICG was used to assess perfusion at specific time points during the procedure. Twenty-four patients underwent a Le Fort I osteotomy with dynamic perfusion ICG angiography. Statistically significant differences in perfusion were noted at all three locations assessed between preoperative (T0), post down-fracture (T1), and postoperative (T2) time points. When controlling for mean arterial pressure, statistically significant differences were noted at all three locations assessed between T0 and T1, and between T0 and T2. There were no statistically significant differences in patient age, heart rate, preservation or sacrifice of the descending palatine arteries, or conventional vs. segmental Le Fort I osteotomies across T0, T1, and T2. In conclusion, there was a statistically significant decrease in perfusion, as assessed by intraoperative dynamic angiography, to the anterior maxilla following maxillary down-fracture. Patient age, conventional vs. segmental Le Fort I osteotomy, changes in mean arterial pressure and/or heart rate, and preservation of the descending palatine vessels had no statistically significant effect on perfusion. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. L5 pedicle subtraction osteotomy for high-grade isthmic spondylolisthesis.

    Science.gov (United States)

    Radcliff, Kristen E; Jakoi, Andre M

    2015-04-01

    To the authors' knowledge, this is the first article to present a pedicle subtraction osteotomy in the lumbar spine to correct and stabilize a high-grade isthmic spondylolisthesis, which poses many challenges with regard to treatment options and outcomes. The optimal surgical treatment for high-grade spondylolisthesis is controversial, but the goals of treatment are to stabilize the affected spinal levels and to decompress the neural elements. A pedicle subtraction osteotomy is a reconstructive procedure that addresses fixed sagittal imbalance by increasing lumbar lordosis through posterior spinal column shortening. The authors report a 46-year-old patient with chronic, progressively worsening back and leg radiculopathy accompanied by sagittal plane malalignment and for which a pedicle subtraction osteotomy was performed. The procedure yielded stabilization of the patient's lumbar spondylolisthesis and sagittal plane alignment was restoration. At 3 months postoperatively, the patient's pain had fully resolved and her motor and neurologic examination exhibited no deficits. At 24 months postoperatively, she was still symptom-free and ambulating without assistance. This report is the first documented successful pedicle subtraction osteotomy in the treatment of high-grade spondylolisthesis. This report indicates that certain patient populations may be amenable to pedicle subtraction osteotomy as a treatment option for pathology involving high-grade isthmic spondylolisthesis. Copyright 2015, SLACK Incorporated.

  1. [How to make your own custom cutting guides for both mandibular and fibular stair step osteotomies?

    Science.gov (United States)

    Rem, K; Bosc, R; De Kermadec, H; Hersant, B; Meningaud, J-P

    2017-12-01

    Using tailored cutting guides for osteocutaneous free fibula flap in complex mandibular reconstruction after cancer resection surgery constitutes a substantial improvement. Autonomously conceiving and manufacturing the cutting guides within a plastic surgery department with computer-aided design (CAD) and three-dimensional (3D) printing allows planning more complex osteotomies, such as stair-step osteotomies, in order to achieve more stable internal fixations. For the past three years, we have been producing by ourselves patient-tailored cutting guides using CAD and 3D printing. Osteotomies were virtually planned, making the cutting lines more complex in order to optimize the internal fixation stability. We also printed reconstructed mandible templates and shaped the reconstruction plates on them. We recorded data including manufacturing techniques and surgical outcomes. Eleven consecutive patients were operated on for an oral cavity cancer. For each patient, we planned the fibular and mandibular stair-step osteotomies and we produced tailored cutting guides. In all patients, we achieved to get immediately stable internal fixations and in 10 patients, a complete bone consolidation after 6 months. Autonomously manufacturing surgical cutting guides for mandibular reconstruction by free fibula flap is a significant improvement, regarding ergonomics and precision. Planning stair-step osteotomies to perform complementary internal fixation increases contact surface and congruence between the bone segments, thus improving the reconstructed mandible stability. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. The poor quality and reliability of information on periacetabular osteotomy on the internet in Japan.

    Science.gov (United States)

    Takegami, Yasuhiko; Seki, Taisuke; Amano, Takafumi; Higuchi, Yoshitoshi; Komatsu, Daigo; Nishida, Yoshihiro; Ishiguro, Naoki

    2017-08-01

    Although many patients use the internet to access health-related information, the quality and the reliability of the information is highly inconsistent. Periacetabular osteotomy (PAO) is one of the surgical procedures for hip dysplasia. However, medical information on PAO is limited on the internet. This study aims to evaluate the quality and reliability of information available on PAO on the internet in Japan. A web search was conducted on two search engines for the following terms: "hip osteotomy," "pelvic osteotomy," and "osteotomy for hip preservation" in Japanese. In total, we found 120 websites. To determine the quality and reliability of information on each website, we used the Health on the Net Foundation (HON) score, the Brief DISCERN score, and an osteotomy-specific content (OSC) score. After eliminating duplicate websites, we reviewed 49 unique websites. Only three websites (6.1%) had good reliability, as indicated by their HON scores. Twelve websites (24.4%) had good-quality information, as measured by their Brief DISCERN scores. As evaluated by their OSC scores, physician websites were found to be biased toward etiology and surgical indication and did not provide information on the complications of procedures. Non-physician websites were generally insufficient. The information about PAO on the internet is, therefore, unreliable and of poor-quality for Japanese patients.

  3. Unilateral zygomatic hypoplasia correction by L-shaped zygomatic osteotomy with natural coral.

    Science.gov (United States)

    Su, Ruowei; Gui, Lai; Liu, Jianfeng; Niu, Feng; Chen, Ying; Wang, Meng

    2015-05-01

    Zygomatic osteotomy is a common method of zygomatic hypoplasia correction. Natural coral is considered to be a good bone substitute. Few studies on unilateral zygomatic hypoplasia correction by zygomatic osteotomy with natural coral have been reported. This study was performed to evaluate the clinical morphological results and surgical outcomes of unilateral zygomatic hypoplasia correction by L-shaped zygomatic osteotomy with natural coral. From 1996 to 2012, a total of 42 patients with hypoplastic zygomas treated by L-shaped zygomatic osteotomy with natural coral were included in this study. Based on facial analysis results and x-ray and CT measurements, the degradation of natural coral, new bone formation, and clinical outcomes were observed and recorded. All surgical procedures achieved satisfactory results without complications. During the stabilization period of about 12 to 15 months, all natural coral blocks were completely degraded and replaced by new bone. Good mechanical strength and continuity of the new bone and good zygomatic asymmetry were achieved in each patient. No recurrence was observed during the follow-up period. L-shaped zygomatic osteotomy with natural coral is an effective method of unilateral zygomatic hypoplasia correction.

  4. The biplanar open wedge high tibial osteotomy preserving the tibial tubercle.

    Science.gov (United States)

    Hopwood, Sam; Khan, Wasim; Agarwal, Sanjeev

    2016-11-01

    High tibial osteotomy (HTO) is a treatment option for relatively young patients with isolated medial compartment arthritis of the knee. Medial open wedge osteotomies allow easier control of correction, but can lead to patella infera as a result of distalization of the tibial tubercle. This retrospective study reports results of a biplanar tibial tubercle preserving HTO, designed to preserve patellar height. The study is a retrospective analysis of 12 consecutive patients (11 men, 1 woman) average age 39.6 years who underwent the procedure between 2009 and 2012. A biplanar open wedge tibial osteotomy was performed and stabilised with a medial locking plate. Patients were allowed full weight bearing at 6 weeks. Preoperative and postoperative function was recorded on the Oxford knee score, Lysholm score and Tegner activity scale. Minimum follow up was 26 months. All patients had healing of the osteotomy with no delayed union. Eleven patients reported improvement in symptoms with an average preoperative Oxford score of 26 and postoperative score of 39 out of 48. The Lysholm score improved from 58 to 72 out of 100. There was one point improvement in Tegner activity scale. There was no statistical difference in patellar height before and one year after surgery. The correction in varus averaged 8.3°. The biplanar High tibial Osteotomy allows preservation of patellar height, while achieving desired varus correction. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  5. Virtual Planning of a Complex Three-Part Bimaxillary Osteotomy

    Directory of Open Access Journals (Sweden)

    Chiara Di Blasio

    2017-01-01

    Full Text Available In maxillofacial surgery, every patient presents special