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Medicine Jan 2022Whether femoral varus derotational osteotomy (VDRO) alone or a combination of femoral and pelvic osteotomies should be performed for hip dislocation in nonambulatory...
Whether femoral varus derotational osteotomy (VDRO) alone or a combination of femoral and pelvic osteotomies should be performed for hip dislocation in nonambulatory children with cerebral palsy (CP) remains controversial. Few studies have reported radiographical results after the surgical treatment in nonambulatory children with CP. This study aimed to assess the results and determine predictors indicating progressive hip subluxation and redislocation after VDRO without pelvic osteotomy. We retrospectively analyzed 22 hips in 15 nonambulatory children with CP. All patients underwent VDRO without pelvic osteotomy and were followed up for at least 5 years. The mean follow-up period was 7.3 ± 1.9 years. In radiological assessments, we investigated migration percentage (MP), center-edge angle, neck-shaft angle, teardrop distance, break in Shenton's line (SL), sharp's angle, acetabular ridge angle (ARA), and the change ratio of MP (Change MP). We classified patients with an MP of <40% at final follow-up in the Good group and those with an MP of ≥40% in the Poor group. The Good group included 10 children (14 hips), and the Poor group included 8 children (8 hips). No preoperative differences were found in the means of all the radiographical parameters. However, MP was significantly different between the groups from 1 year postoperatively. ARA showed improvement 5 years after surgery in the Good group. Change MP in the Good group was maintained from immediately after surgery to the final follow-up. Multivariate logistic regression analyses revealed that preoperative break in SL and Change MP immediately after surgery were parameters to predict MP at the final follow-up. In the receiver operating characteristic analysis, the cut-off values were estimated to be 19.2 mm for preoperative SL and 79.0% for Change MP immediately after surgery. Within 7.3 years of follow-up, 63.6% of the patients who underwent VDRO without pelvic osteotomy had good results. Preoperative SL and postoperative Change MP can be considered as predictors of postoperative subluxation and/or dislocation.
Topics: Cerebral Palsy; Child; Female; Follow-Up Studies; Hip Dislocation; Humans; Joint Dislocations; Male; Osteotomy; Retrospective Studies; Treatment Outcome
PubMed: 35060529
DOI: 10.1097/MD.0000000000028604 -
Orthopaedic Surgery Jun 2024The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended... (Review)
Review
The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) statement guidelines for scope reviews. The literature was obtained from various full-text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty-two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis.
Topics: Humans; Osteotomy; Toes; Postoperative Complications
PubMed: 38693601
DOI: 10.1111/os.14061 -
BMC Musculoskeletal Disorders Nov 2022Intra-articular malunions of the finger can lead to deformity and loss of function and can be treated with intra-articular corrective osteotomies. The aim of this study...
BACKGROUND
Intra-articular malunions of the finger can lead to deformity and loss of function and can be treated with intra-articular corrective osteotomies. The aim of this study was to evaluate radiographic joint congruency, feasibility and functional outcome of three-dimensional (3D) printed patient-specific instrumentation (PSI) for corrective osteotomies at the trapeziometacarpal and finger joints.
METHODS
Computer-tomography (CT) scans were acquired preoperatively for standard 3D planning, which was followed by calculation of cutting planes and the design of individualized bone surface contact drilling, sawing and reposition guides. Follow-up CT scans and clinical examinations (range of motion, grip strength) were performed. Postoperative complications were documented and patient-reported outcome measurements were assessed (Single Assessment Numeric Evaluation (SANE) score, brief Michigan Hand Questionnaire (MHQ)).
RESULTS
Ten patients (mean age 28.4 ± 12.8,range 13.8-51.3) years) were included with a mean follow-up of 21 ± 18 (3-59) months including seven osteotomies at the trapeziometacarpal or metacarpophalangeal joints and three at the proximal interphalangeal joint (PIP). All radiographic follow-up examinations showed the planned correction with good joint congruency and regular osseous consolidation. At the latest follow-up, the range of motion (ROM) increased and the average grip strength recovered to the level of the contralateral side. No postoperative complication was detected. The mean SANE score improved from 44 ± 23 (0-70) to 82 ± 12 (60-90) after a mean of 72 ± 20 (44-114) months. The mean postoperative brief MHQ was 92 ± 8 (71-98).
CONCLUSION
The use of 3D PSI in treating intra-articular malunions at the trapeziometacarpal and finger joints restored articular congruency accurately. ROM and grip strength improved postoperatively comparable to the healthy contralateral side and patient-reported outcome measures improved after medium-term follow-up.
Topics: Humans; Infant; Child, Preschool; Fractures, Malunited; Metacarpal Bones; Finger Joint; Osteotomy; Range of Motion, Articular
PubMed: 36348352
DOI: 10.1186/s12891-022-05946-x -
BMC Musculoskeletal Disorders Mar 2022To assess the preoperative planning of visualized simulative surgery (VSS) and clinical outcomes based on computer-aided design (CAD) and 3D reconstruction for proximal...
PURPOSE
To assess the preoperative planning of visualized simulative surgery (VSS) and clinical outcomes based on computer-aided design (CAD) and 3D reconstruction for proximal femoral varus osteotomy of DDH.
METHODS
A total of 31 consecutive patients (23 females and 8 males) with DDH who underwent proximal femoral varus osteotomy were retrospectively reviewed between June 2014 and July 2018. Patients were divided into conventional group (n = 15) and VSS group (n = 16) according to different surgical methods. In VSS group, 16 consecutive patients who underwent proximal femoral varus osteotomy were evaluated preoperatively with the aid of VSS. The VSS steps included morphological evaluation of DDH, simulated reconstruction of proximal femoral varus osteotomy, and the implantation of locking compression pediatric hip plate (LCP-PHP). Meanwhile, the osteotomy degrees, surgery time, and radiation exposure were compared between the two groups.
RESULTS
The average follow-up time was 33.5 months (range, 24 to 46 months). The varus angle for proximal femoral varus osteotomy was 24.2 ± 1.1° in VSS group and 25.1 ± 1.0° in conventional group (P = 0.4974). The surgery time was 31.0 ± 4.5 mins in VSS group and 48.2 ± 7.3 mins in conventional group, while radiography was 5.0 ± 1.5 times in VSS group and 8.3 ± 2.4 times in conventional group. There was a statistical significance in surgery time and radiography (P < 0.0001) when compared with the conventional group.
CONCLUSION
The VSS can greatly decrease surgery time and radiation exposure for proximal femoral varus osteotomy, which could also be a tool to train young doctors to improve surgical skills and academic communication.
Topics: Child; Computer Simulation; Female; Femur; Humans; Male; Osteotomy; Radiography; Retrospective Studies
PubMed: 35346154
DOI: 10.1186/s12891-022-05219-7 -
European Journal of Orthopaedic Surgery... Aug 2023This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial... (Meta-Analysis)
Meta-Analysis Review
Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis.
PURPOSE
This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR.
METHODS
A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant.
RESULTS
Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found.
CONCLUSION
ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Anterior Cruciate Ligament; Knee Joint; Anterior Cruciate Ligament Injuries; Tibia; Osteotomy; Anterior Cruciate Ligament Reconstruction; Retrospective Studies
PubMed: 36308547
DOI: 10.1007/s00590-022-03419-4 -
BMC Veterinary Research Dec 2021The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial... (Comparative Study)
Comparative Study
Comparison of tibial anatomical-mechanical axis angles and patellar positions between tibial plateau levelling osteotomy (TPLO) and modified cranial closing wedge osteotomy (AMA-based CCWO) for the treatment of cranial cruciate ligament disease in large dogs with tibial plateau slopes greater than...
BACKGROUND
The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) > 30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed 2 months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after 2 months.
RESULTS
Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05-0.8); CCWO 0.22 (0.05-0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P = 0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76-6.98°); CCWO 100% cranial to the AA and 0° (- 1.34-0.65°); control group 5% caudal to the AA and 0.99° (0-3.39°)). At 8 weeks, PLT grade differed significantly in the two operated groups (P = 0.000) (TPLO 40% 0-2, 20% 2-4, 40% > 4; CCWO 98.8% 0).
CONCLUSIONS
TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results 2 months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA > 30°.
Topics: Animals; Anterior Cruciate Ligament; Dogs; Osteotomy; Retrospective Studies; Tibia
PubMed: 34861875
DOI: 10.1186/s12917-021-03094-3 -
Journal of ISAKOS : Joint Disorders &... Apr 2022Tibial tubercle osteotomy (TTO) is indicated to treat patellofemoral (PF) malalignment and chondral disease refractory to conservative treatment. However, there are no... (Review)
Review
IMPORTANCE
Tibial tubercle osteotomy (TTO) is indicated to treat patellofemoral (PF) malalignment and chondral disease refractory to conservative treatment. However, there are no systematic reviews describing TTO outcomes in chondral damages without instability.
AIM
The aims of this study were to (1) assess the quality of the published studies, (2) identify indication for TTO to treat PFP with chondral disease without instability, (3) evaluate the most common TTO techniques, (4) evaluate the clinical outcomes, and (5) evaluate TTO's complication and failure rates.
EVIDENCE REVIEW
In December 2020, a literature search was performed applying the following criteria: (1) peer-reviewed Level 1-4 studies; (2) English language; (3) human subjects with clinical and/or radiological outcomes; (4) TTO alone or associated with minor cartilage procedure (only drilling, no instability); (5) minimum follow-up 12 months, minimum 10 patients; and (6) no more than 20% of drop-out rate. Data from studies were collected and described with weighted averages and standard deviations.
FINDINGS
A total of 18 Level 4 studies were included. The average Coleman Methodology Score was 61.5 points (range 48-81). A total of 851 patients (892 knees) were included, with 64.8% of female patients. The weighted average follow-up was 49.1 months (range 12-128.5). Indication for TTOs was poorly described. The main technique used was anteromedialisation (60.4%). In 27.7% of the cases, TTO was associated with lateral release. Different scoring systems were used to evaluate outcomes, with significant improvements. The average rate of good/excellent results was 78.7% (range 57%-100%). Fifteen studies described the complication rate (9.9%), whereas only four reported the failure rate (6.2%).
CONCLUSION AND RELEVANCE
TTOs performed to treat PF malalignment associated with chondral disease without instability provided good clinical outcomes, with acceptable complication/failure rates. However, high-level studies are necessary because of studies' heterogeneity regarding patellofemoral malalignment and chondral disease treatment.
STUDY DESIGN AND LEVEL OF EVIDENCE
Systematic review.
LEVEL OF THE STUDY
Level IV, systematic review of Level IV studies.
Topics: Cartilage; Cartilage Diseases; Female; Humans; Osteotomy; Radiography; Tibia
PubMed: 35546438
DOI: 10.1016/j.jisako.2021.10.002 -
Orthopaedic Surgery Apr 2021To observe the changes in the concentrations of circulating peripheral blood mesenchymal stem cells (PBMSCs) in Sprague Dawley (SD) rats and explore the pattern of...
OBJECTIVES
To observe the changes in the concentrations of circulating peripheral blood mesenchymal stem cells (PBMSCs) in Sprague Dawley (SD) rats and explore the pattern of changes in PBMSCs during the process of distraction osteogenesis.
METHODS
SD rats were randomly divided into the osteotomy with lengthening group (lengthening group), the osteotomy without lengthening group (osteotomy group), and the blank control group (control group). Each group included 24 rats. Percutaneous pinning with external fixation of the left femur was carried out in lengthening group and osteotomy group, but control group received no surgical treatment. On day 5 after operation, continuous traction was carried out at a rate of 0.25 mm/d in lengthening group, while no traction was carried out in osteotomy group. Peripheral blood was collected from all rats on days 1, 3, 7, and 16 after the start of traction. PBMSCs were isolated by density gradient centrifugation. CD105, CD34, and CD45 were selected as cell surface markers. The concentration of PBMSCs was detected by flow cytometry and compared between groups at different time points. X-ray films were taken during and after the operation to observe whether the osteotomy end was pulled and the growth and mineralization of the new bone in the osteogenic area of the femur. Color ultrasound was used to monitor the width of the distraction space, the formation of new bone, and the blood supply of soft tissue around the distraction.
RESULTS
All rats were able to tolerate the operation well, and the external fixation was firm and reliable. X-ray showed that, in lengthening group, the distraction space of femur gradually widened and new bone gradually formed in the distraction space; after 8 weeks, the samples were taken out, which showed that the new bone tissue in the lengthened area healed well. In osteotomy group, the average healing time of osteotomy was (7.12 ± 0.78) weeks. Ultrasonic examination showed that after the end of traction, the high echo callus shadow was seen in the traction space, and the blood flow signal was obviously rich at an earlier stage. In lengthening group and osteotomy group, the average concentrations of PBMSCs (3.02% ± 0.87% vs 2.95% ± 0.74%, respectively) were significantly increased in the early stage after osteotomy, and the average concentrations of PBMSCs on days 3, 7, and 16 after the start of traction were 5.34% ± 1.13% vs 3.28% ± 1.22%; 6.41% ± 1.05% vs 3.16% ± 0.92%; and 5.94% ± 1.23% vs 1.48% ± 0.52%, respectively. The concentration of PBMSCs in peripheral blood of lengthening group and osteotomy group was the same at osteotomy stage, and the difference between the two groups was not statistically significant (P > 0.05). After that, compared with lengthening group, the concentration of PBMSCs in osteotomy group gradually decreased and maintained at a certain level; the difference between the two groups was statistically significant (P < 0.05).
CONCLUSIONS
Distraction osteogenesis of femur can significantly increase PBMSCs in SD rats and participate in the process of bone formation.
Topics: Animals; Disease Models, Animal; External Fixators; Femur; Male; Mesenchymal Stem Cells; Osteogenesis, Distraction; Osteotomy; Rats; Rats, Sprague-Dawley
PubMed: 33565272
DOI: 10.1111/os.12823 -
Archives of Orthopaedic and Trauma... Feb 2023The aim of this study was to compare the fixation stability and complications in patients undergoing periacetabular osteotomy (PAO) with either K-wire or screw fixation. (Comparative Study)
Comparative Study
AIMS
The aim of this study was to compare the fixation stability and complications in patients undergoing periacetabular osteotomy (PAO) with either K-wire or screw fixation.
PATIENTS AND METHODS
We performed a retrospective study to analyze a consecutive series of patients who underwent PAO with either screw or K-wire fixation. Patients who were treated for acetabular retroversion or had previous surgery on the ipsilateral hip joint were excluded. 172 patients (191 hips: 99 K-wire/92 screw fixation) were included. The mean age at the time of PAO was 29.3 years (16-48) in the K-wire group and 27.3 (15-45) in the screw group and 83.9% were female. Clinical parameters including duration of surgery, minor complications (soft tissue irritation and implant migration) and major complications (implant failure and non-union) were evaluated. Radiological parameters including LCE, TA and FHEI were measured preoperatively, postoperatively and at 3-months follow-up.
RESULTS
Duration of surgery was significantly reduced in the K-wire group with 88.2 min (53-202) compared to the screw group with 119.7 min (50-261) (p < 0.001). Soft tissue irritation occurred significantly more often in the K-wire group (72/99) than in the screw group (36/92) (p < 0.001). No group showed significantly more implant migration than the other. No major complications were observed in either group. Postoperative LCE, TA and FHEI were improved significantly in both groups for all parameters (p = < 0.0001). There was no significant difference for initial or final correction for the respective parameters between the two groups. Furthermore, no significant difference in loss of correction was observed between the two groups for the respective parameters.
CONCLUSION
K-wire fixation is a viable and safe option for fragment fixation in PAO with similar stability and complication rates as screw fixation. An advantage of the method is the significantly reduced operative time. A disadvantage is the significantly higher rate of implant-associated soft tissue irritation, necessitating implant removal.
LEVEL OF EVIDENCE
III, retrospective trial.
Topics: Female; Humans; Male; Acetabulum; Bone Screws; Hip Joint; Osteotomy; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 34406508
DOI: 10.1007/s00402-021-04112-7 -
The International Journal of Medical... Oct 2022Traditional bone surgery using saws and chisels is associated with direct contact of instruments with the bone causing friction, heat and pressure and hence, damaging...
INTRODUCTION
Traditional bone surgery using saws and chisels is associated with direct contact of instruments with the bone causing friction, heat and pressure and hence, damaging the bone and the surrounding soft tissues.
METHOD
Cold ablation laser osteotomy offers new possibilities to perform corrective osteotomies in the field of bone surgery. We introduce the technology of navigated cold ablation robot-guided laser osteotomy, present potential applications, and preliminary pre-clinical cadaver test results in the field of hand-, wrist- and forearm surgery.
RESULTS
The cadaver tests showed first promising results for corrections in all planes and axes using different cutting patterns.
CONCLUSION
Cold ablation laser osteotomy seems to be a feasible new method to perform osteotomies in the field of hand-, wrist- and forearm surgery. Primary osseous stability could be achieved using various cutting patterns which could lead to reduction of the amount of hardware required for osteosynthesis. Further tests are required to proof the latter and precision.
Topics: Cadaver; Feasibility Studies; Forearm; Humans; Lasers; Osteotomy; Robotics; Wrist
PubMed: 35770622
DOI: 10.1002/rcs.2438