-
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 -
American Journal of Veterinary Research Dec 2000To compare transfixation and standard full-limb casts for prevention of in vitro displacement of a mid-diaphyseal third metacarpal osteotomy site in horses. (Comparative Study)
Comparative Study
OBJECTIVE
To compare transfixation and standard full-limb casts for prevention of in vitro displacement of a mid-diaphyseal third metacarpal osteotomy site in horses.
SAMPLE POPULATION
6 forelimbs from 6 horses euthanatized for reasons not related to the musculoskeletal system.
PROCEDURE
A 30 degrees osteotomy was performed in the mid-diaphysis of the third metacarpal bone. Two 4.5-mm cortical bone screws were placed across the osteotomy site to maintain alignment during casting. Two 6.35-mm Steinmann pins were placed from a lateral-to-medial direction in the distal aspect of the radius. A full-limb cast that incorporated the pins was applied. An extensometer was positioned in the osteotomy site through a window placed in the dorsal aspect of the cast, and after removal of the screws, displacement was recorded while the limb was axially loaded to 5,340 N (1,200 lb). Pins were removed, and the standard full-limb cast was tested in a similar fashion.
RESULTS
The transfixation cast significantly reduced displacement across the osteotomy site at 445 N (100 lb), 1,112 N (250 lb), 2,224 N (500 lb), and 4,448 N (1,000 lb), compared with the standard cast.
CONCLUSION AND CLINICAL RELEVANCE
A full-limb transfixation cast provides significantly greater resistance than a standard full-limb cast against axial collapse of a mid-diaphyseal third metacarpal osteotomy site when the bone is placed under axial compression. Placement of full-limb transfixation casts should be considered for the management of unstable fractures of the third metacarpal bone in horses.
Topics: Animals; Cadaver; Casts, Surgical; Diaphyses; Forelimb; Fracture Fixation, Intramedullary; Horses; Metacarpus; Orthopedic Fixation Devices; Osteotomy
PubMed: 11131611
DOI: 10.2460/ajvr.2000.61.1633 -
Clinical Biomechanics (Bristol, Avon) Dec 2023High tibial osteotomy surgery is a widely successful joint-preserving procedure which alters the hip-knee-ankle axis which can delay the progression of osteoarthritis;...
BACKGROUND
High tibial osteotomy surgery is a widely successful joint-preserving procedure which alters the hip-knee-ankle axis which can delay the progression of osteoarthritis; however, conventional osteotomy surgical procedures do not adequately control the posterior tibial slope. This study aimed to determine the key variables influencing posterior tibial slope during high tibial osteotomy and provide a simple means of implementing the findings during pre-operative planning.
METHODS
A virtual cohort of twenty-eight proximal tibia geometries of knee osteoarthritis patients was used in the study. Firstly, absolute posterior tibial slope values were contrasted using anatomical and posterior mechanical axis measurement approaches. Secondly, the influence of variables affecting posterior tibial slope change during osteotomy surgery was investigated using 3D preoperative planning surgical simulation and analytical modelling.
FINDINGS
There was a poor correlation (R = 0.38) between the different clinical measurements of posterior tibial slope; with an average of 7.0 ± 1.3° and 14.8 ± 2.2° respectively. An analytical solution for the change in posterior tibial slope was derived based on the hinge axis angle and the osteotomy opening angle. For three different opening angles (6°, 9° and 12°) and seven different hinge axis orientations (-30° to +30°), the results obtained were identical for the analytical model and the 3D preoperative planning.
INTERPRETATION
This study determined that the key variables affecting posterior tibial slope during high tibial osteotomy are the osteotomy opening angle and the hinge axis orientation. The derived formula provides a simple means of determining the change in posterior tibial slope resulting from a particular surgical approach.
Topics: Humans; Tibia; Knee Joint; Osteoarthritis, Knee; Knee; Osteotomy
PubMed: 37922607
DOI: 10.1016/j.clinbiomech.2023.106125 -
AJNR. American Journal of Neuroradiology Apr 2018Global 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... (Review)
Review
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.
Topics: Female; Humans; Male; Osteotomy; Radiologists; Retrospective Studies; Scoliosis; Spine; Treatment Outcome
PubMed: 29191868
DOI: 10.3174/ajnr.A5444 -
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 -
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 -
Journal of Orthopaedic Surgery (Hong... 2022Hallux valgus (HV) is a common foot deformity for which several corrective surgical procedures, with different osteotomy sites, have been reported. The purpose of the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hallux valgus (HV) is a common foot deformity for which several corrective surgical procedures, with different osteotomy sites, have been reported. The purpose of the present study was to systematically review randomized (RCTs) or controlled (CCTs) clinical trials and perform meta-analysis on outcomes of different osteotomy sites of the first metatarsal.
METHODS
An extensive literature search was conducted in PubMed and the Cochrane Library from January 1983 to July 2020. Studies were identified using the terms "hallux valgus" and "osteotomy". We included RCTs or CCTs comparing different locations of osteotomy for the first metatarsal bone (distal vs. mid-shaft, distal vs. proximal, and mid-shaft vs. proximal). The surgical outcomes included postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale (VAS) score, perioperative complications and recurrence of deformity. We enrolled 10 studies with a total of 793 feet in the qualitative synthesis following full-text screening.
RESULTS
A majority of patients included in the enrolled trials showed mild to moderate deformity, with mean HVA <40°. Out of the 10 enrolled studies; six compared distal osteotomies with mid-shaft osteotomies and showed no significant differences in the surgical outcomes between the scarf and chevron groups; three RCTs compared distal osteotomies with proximal osteotomies with conflicting results, one RCT showed the superiority of proximal osteotomy while the other two RCTs showed equivalent outcomes; one study that compared between mid-shaft and proximal osteotomies showed equivalent outcomes between the groups.
CONCLUSION
For the management of mild to moderate HV deformity, we found no significant clinical and radiological differences between patients treated with scarf and chevron osteotomies. Further controlled trials comparing different sites of osteotomies for moderate to severe HV deformity are needed.
Topics: Hallux; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Treatment Outcome
PubMed: 35836406
DOI: 10.1177/10225536221110473 -
Medicine Feb 2020In this retrospective observational study, I aimed to report long-term follow-up results of femoral varus osteotomy in the treatment of Perthes disease patients who were... (Comparative Study)
Comparative Study Observational Study
Long-term follow-up results of femoral varus osteotomy in the treatment of Perthes disease, and comparison of open-wedge and closed-wedge osteotomy techniques: A retrospective observational study.
In this retrospective observational study, I aimed to report long-term follow-up results of femoral varus osteotomy in the treatment of Perthes disease patients who were between 6 and 8 years old at the onset of the disease with Herring B and C hip involvement. I also aimed to compare 2 different osteotomy techniques: open-wedge and closed-wedge femoral varus osteotomies.Patients with Perthes disease treated with femoral varus osteotomies were invited for final examination. Twenty two hips of 19 patients were evaluated. Mean follow-up period was 15.2 years. Patients were divided into 2 homogenous groups according to femoral osteotomy technique. In Group A (12 hips) open-wedge osteotomy, and in Group B (10 hips) closed-wedge osteotomy was performed.There were 15 male (78.9%) and 4 female (21.1%) patients. The median age at the onset of the disease was 7 years in Group A and B. The mean follow-up period was 16.2 years in Group A, and 11.4 years in Group B. According to Stulberg classification 5 hips (22.7%) were healed as Class I, 4 hips (18.2%) were healed as Class II, 12 hips (55.5%) were healed as Class III, and 1 hip (4.6%) was healed as Class IV. Also in Group A 4 hips (33.3%) were healed as Class I or II, 7 hips (58.3%) were healed as Class III, and 1 hip (8.3%) was healed as Class IV; in Group B 5 hips (50.0%) were healed as Class I or II, and 5 hips were healed as Class III (50.0%). There was no significant difference between the groups. According to Iowa scale, mean values were 92.6 in Group A and 92.4 in Group B. There was no significant difference between the groups. At the final follow-up mean center-edge angles of Group A and B were 16 and 22, the difference was significant.Long-term follow-up results showed that femoral varus osteotomy was an effective treatment method in Perthes disease patients who were between 6 and 8 years old with Herring B and C hip involvement at the onset of the disease. Hip joint congruency was obtained with femoral varus osteotomies, and closed-wedge osteotomy served more favorable center-edge angle results.
Topics: Child; Female; Humans; Legg-Calve-Perthes Disease; Male; Osteotomy; Retrospective Studies; Treatment Outcome
PubMed: 32049801
DOI: 10.1097/MD.0000000000019041 -
International Orthopaedics Feb 2010New developments in osteotomy techniques and methods of fixation have caused a renewed interest in closing wedge osteotomies of the tibia and femur in the treatment of... (Review)
Review
New developments in osteotomy techniques and methods of fixation have caused a renewed interest in closing wedge osteotomies of the tibia and femur in the treatment of gonarthrosis. The rationale, definition and techniques of closing wedge tibial and femoral osteotomies in the treatment of gonarthrosis are discussed. The principal indications include unicompartmental medial and much less so, varus knee gonarthrosis and unicompartmental lateral or valgus knee gonarthrosis with a well-maintained range of motion in patients who are physiologically young. Newer techniques have provided more rigid fixation and improved accuracy of correction.
Topics: Age Factors; Arthroplasty; Contraindications; Femur; Humans; Knee Joint; Osteoarthritis, Knee; Osteotomy; Pain; Postoperative Complications; Range of Motion, Articular; Tibia
PubMed: 19830426
DOI: 10.1007/s00264-009-0883-1 -
Journal of Oral and Maxillofacial... Nov 2021Three-dimensional (3D) assessment of orthognathic surgery is often time consuming, relies on manual re-identification of anatomical landmarks or is limited to...
PURPOSE
Three-dimensional (3D) assessment of orthognathic surgery is often time consuming, relies on manual re-identification of anatomical landmarks or is limited to non-segmental osteotomies. The purpose of the present study was to propose and validate an automated approach for 3D assessment of the accuracy and postoperative outcome of segmental bimaxillary surgery.
METHODS
A semi-automatic approach was developed and validated for virtual surgical analysis (VSA) of segmental bimaxillary surgery using a pair of pre- and postoperative (2 weeks) cone-beam computerized tomography (CBCT) scans. The output of the VSA, the accuracy of the surgical outcome, was calculated as 3D translational and rotational differences between the planned and postoperative movements of the individual bone segments. To evaluate the reliability of the proposed VSA, intra-class correlation coefficients (ICC) were calculated at a 95% confidence interval on measurements of 2 observers. The VSA was deemed reliable if the ICC was excellent (> 0.80) and the absolute difference of the repeated intra- and inter-observer translational and rotational measurements were significantly lower (p < 0.05) than a hypothesized clinical relevant threshold of 1 voxel (0.45 mm) and 1 degree, respectively.
RESULTS
A total of 10 subjects (6 male; 4 women; mean age 24.4 years) with skeletal class 2 and 3, who underwent segmental bimaxillary surgery, 3-piece Le Fort I, bilateral sagittal split osteotomy and genioplasty, were recruited. The intra- and inter-observer reliability was excellent, ICC range [0.96 - 1.00]. The range of the mean absolute difference of the repeated intra- and inter-observer translational and rotational measurements were [0.07 mm (0.05) - 0.20 mm (0.19)] and [0.11˚ (0.08) - 0.63˚ (0.42)], respectively. This was significantly lower than the hypothesized clinical relevant thresholds (P < .001).
CONCLUSION
The validation showed that the VSA has excellent reliability for quantitative assessment of the postoperative outcome and accuracy of segmental bimaxillary surgery.
Topics: Adult; Cone-Beam Computed Tomography; Female; Humans; Imaging, Three-Dimensional; Male; Orthognathic Surgery; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Reproducibility of Results; Young Adult
PubMed: 34245697
DOI: 10.1016/j.joms.2021.06.003