Hemicallotasis for correction of varus deformity of the proximal tibia using a unilateral external fixator

Background  

Gradual correction of varus deformity of the proximal tibia is generally accepted and produces good results. However, most studies have used circular external fixators, which are complex and cause patient discomfort. This study was undertaken to determine the efficacy of hemicallotasis with a unilateral external fixator for correction of varus deformity of the proximal tibia.     

The windblown hand: correction of the complex clasped thumb deformity.

The complex clasped thumb deformity associated with a windblown hand requires correction of three distinct deficits: an adduction contracture of the thumb-index web space, a flexion-volar subluxation contracture of the thumb metacarpophalangeal joint, and severe hypoplasia of the superficial thenar muscles. Severe contractures of the thumb web space are best released by an extensive soft-tissue release and skin coverage with a large, dorsal ration-advancement flap. The thumb metacarpophalangeal joint flexion contracture is corrected by an extensive soft-tissue release, often accompanied by metacarpophalangeal joint fusion. An opponensplasty substitutes for the lack of thenar muscle. Correction of all of the deficits is required to achieve good thumb function.     

Osteotomy of the neck of the humerus for traumatic varus deformity

Seven patients had osteotomy for traumatic varus deformity of the humeral neck following fracture. Indications for the operations were limited active abduction and forward flexion of the arm. The result was good in five cases.     

Osteotomy of the neck of the humerus for traumatic varus deformity

Seven patients had osteotomy for traumatic varus deformity of the humeral neck following fracture. Indications for the operations were limited active abduction and forward flexion of the arm. The result was good in five cases.     

下颌升支矢状劈开术联合快速正畸矫治下颌前突畸形的术后护理

目的:探讨下颌升支矢状劈开截骨联合快速正畸矫治下颌前突畸形的术后心理干预和口腔及牙弓夹板管理的护理效果。方法:选择本科室2008年1月～2011年12月治疗的103例应用此手术方法矫治下颌前突的患者均采用心理干预和口腔及牙弓夹板的管理。结果:103例患者对术后效果满意且没有出现术后并发症。结论:完善的口腔及牙弓夹板管理,可预防感染,防止并发症;术后心理干预可提高患者对手术的满意度。     

Osteotomy for congenital elevation of the scapula (Sprengel's deformity)

We report 12 consecutive cases of vertical scapular osteotomy to correct Sprengel's deformity, performed during a 16-year period, with a mean follow-up of 10.4 years. The mean increase in abduction of the shoulder was 53 degrees . The cosmetic appearance improved by a mean of 1.5 levels on the Cavendish scale. Neither function nor cosmesis deteriorated with time. We recommend the procedure for correction of moderate deformities with a functional deficit.     

Femoral deformity in tibia vara

BACKGROUND: Previous studies have suggested that compensatory valgus deformity of the femur is common in patients with tibia vara, or Blount disease. The availability and routine use of standing long-cassette radiographs of the lower extremities to assess angular deformities has allowed quantitative evaluation of this hypothesis. METHODS: The cases of all patients with tibia vara, two years of age or older, seen at our institution prior to treatment, over a thirteen-year period, were reviewed. Seventy-three patients with a total of 109 involved lower limbs were identified and were classified as having either infantile tibia vara (thirty-seven patients with fifty-six involved limbs) or late-onset tibia vara (thirty-six patients with fifty-three involved limbs). Standardized standing radiographs of the lower extremity were examined to assess the deformity at the distal part of the femur and the proximal part of the tibia by measuring the lateral distal femoral angle and the medial proximal tibial angle. RESULTS: The distal part of the femur in the children with infantile tibia vara either was normal or had mild varus deformity, with a mean lateral distal femoral angle of 97 degrees (range, 82 degrees to 129 degrees). The mean medial proximal tibial angle in these children was 72 degrees (range, 32 degrees to 84 degrees). Older children with infantile tibia vara were noted to have little distal femoral deformity, with no more than 4 degrees of valgus compared with either normal values or the contralateral, normal limb. Children with late-onset tibia vara had a mean lateral distal femoral angle of 93 degrees (range, 82 degrees to 110 degrees) and a mean medial proximal tibial angle of 73 degrees (range, 52 degrees to 84 degrees). On the average, the varus deformity of the distal part of the femur constituted 30% (6 degrees of 20 degrees) of the genu varum deformity in these patients. CONCLUSIONS: Patients with infantile tibia vara most commonly had normal alignment of the distal parts of the femora; substantial valgus deformity was not observed. Distal femoral varus constituted a substantial portion of the genu varum in children with late-onset disease. When correction of late-onset tibia vara is planned, the surgeon should be aware of the possibility that distal femoral varus is a substantial component of the deformity.     

Corporeal penile plication for correction of erectile penile deformity.

Penile curvature causing functional impairment of sexual intercourse is uncommon but a number of patients are significantly inconvenienced by this condition. Seven patients who had marked erectile deviation were treated with surgical plication for their penile deformity. Mean follow-up was 16 months (range 3-48 months) and no postoperative complications were encountered. In six cases the penis has remained straight. In one patient recurrence of deformity occurred 12 months after corporeal plication. The simplicity of the corporeal plication technique with the low incidence of associated complications makes it an attractive surgical alternative for the treatment of penile erectile deformity.     

Principles of deformity correction

Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 19, No 4 (April), 2003: pp 446–450     

Acquired valgus deformity of the tibia in children

Nine cases of acquired valgus deformity following injury to the proximal tibial metaphysis in children are presented. The deformity is of a dual nature, involving both angular deformity and longitudinal overgrowth. The angular component reaches a maximum within 2 years after the injury. There is some indication that the angular component will remain static or spontaneously correct if treated nonoperatively. Treatment intervention in the majority of the cases has precluded an analysis of the natural history of the longitudinal overgrowth. Early intervention in the form of corrective osteotomy during the growth years has resulted in an unacceptably high rate of recurrence of both components of the deformity. Nonoperative treatment seems to be the treatment of choice for the angular component of valgus deformity following proximal tibial fracture in children. Significant longitudinal overgrowth may be corrected with appropriately timed epiphysiodeses calculated from observed growth rates and skeletal maturational patterns.     

牵引成骨技术治疗颌面畸形

目的 探讨应用口外颌骨牵引成骨装置治疗颌面畸形。方法 使用自行设计制作的口外颌骨牵引成骨装置和上颌杠杆式牵引支架分别水平延长下颌骨，水平快速前移上颌骨，垂直延长下颌骨升支，水平延长下颌骨颏部，用以矫正小下颌畸形，下颌骨颏部外伤性骨缺损，小颌偏颌畸形，半侧前面肥大畸形，咬合平面倾余和唇腭裂术后上颌后缩等，共11例。结果 4例不同类型下颌骨牵引成骨，其中有1例在牵引过程中1根克氏针发生松动，旋转，最终将克氏针取出。1例下颌升支垂直牵引4根克氏针发生轻度弯曲，7例唇腭裂上颌后缩行Le Fort Ⅰ型截骨快速牵引成骨中有1例固定期后1个月出现对刃合并有轻度开咬合。最终11例治疗效果满意。结论 口外颌骨牵引成骨装置治疗下颌骨复杂畸形。Le Fort Ⅰ型截骨快速牵引成骨治疗唇腭裂术后上颌后缩是一种安全简便效果可靠的有效方法。