Knee Instability Before and After High Tibial Osteotomy

Knee joints were examined by three-point measurement (Edholm et al. 1976, 1977). the instability in arthrotic joints did not differ significantly from that in normal knees, but the varus/valgus deviation as measured by the three-point technique differed significantly from that in normal knees. After high tibial osteotomy for varus malalignment the instability increased significantly. An increase of more than 2° was associated with significantly poorer subjective results of operation. the findings indicate that shortening of the lateral stabilizing structures of the knee joint should be carried out in connection with high tibial osteotomy for varus malalignment. No upper limit of preoperative instability consistent with a good result of operation was established.     

The effect of both a thoracic trauma and a soft-tissue trauma on fracture healing in a rat model

Background and purpose There is some clinical evidence that fracture healing is impaired in multiply injured patients. Nothing is known, however, about the effects of various types of injuries and their contribution to a possible disturbance of the fracture-healing process. We investigated the effect of a thoracic trauma and an additional soft-tissue trauma on fracture healing in a rat tibia model.

Methods 3 groups of rats were operated: group A with a simple fracture of the tibia and fibula, group B with a fracture and an additional thoracic trauma, and group C with a fracture, thoracic trauma, and an additional soft-tissue trauma. The fracture and the soft-tissue injury were produced by a special guillotine-like device and the thoracic trauma by a blast wave generator.

After one day, the serum level of IL-6 was quantified, and at the end of the study (28 days) the mechanical properties and the callus volume of the healed tibia were determined.

Results Increasing the severity of the injury caused IL-6 levels to more than double 1 day after injury. It halved the load to failure in mechanical tests and led to reduced callus volume after 28 days of healing.

Interpretation Fracture healing is impaired when additional thoracic trauma and soft tissue trauma occurs.     

Ulnar shortening osteotomy for ulnar ideopathic impaction syndrome

Twenty-eight patients were treated by ulnar shortening osteotomy for static or dynamic ulnar impaction syndrome. Ulnar variance was measured on a true anteroposterior radiograph. There were 25 wrists that were too long, two neutral, and one that was short. Bones were shortened by a mean of 3.5 mm. Mean follow-up time was 29 months (range 7–60), all with confirmed consolidation. At final follow-up mean grip strength had improved from 67% to 75%, mean Disabilities of the Arm, Shoulder, and Hand (DASH) score from 40 (range 12–83) to 26 (range 0–61) and mean range of movement from 80% (range 40%–100%) to 88% (range 50%–100%). Smoking, age at operation, type of osteotomy (transverse or oblique), dominance of hand, and sex did not influence consolidation or functionality. Special attention was paid to the anatomy of the distal radioulnar joint and the inclination of the sigmoid notch of the radius. There was no correlation between the anatomy and the functional outcome scores. Mean consolidation time (10 months) (range 2–32) and return to work were longer than in similar studies. Our findings confirm the usefulness of ulnar shortening osteotomy in the relief of ulnocarpal impingement symptoms.     

Cephalometric pharyngeal changes after Le Fort I osteotomy in different types of clefts

Fifty patients with clefts (30 unilateral cleft lip and palate (UCLP), 9 bilateral cleft lip and palate (BCLP), and 11 cleft palate only (CP), mean age 25 years) treated with Le Fort I osteotomy were compared retrospectively from cephalograms taken shortly before operation, and at six months and one year postoperatively. Patients with bimaxillary surgery or previous velopharyngoplasty, or both, were excluded. Maxillary advancement was moderate in all groups. One year postoperatively there was a significant change (73%–90% of the surgical advancement) in the sagittal depth of the nasopharyngeal airway but not in the depth of the oropharyngeal airway, the length of the soft palate or the position of the hyoid bone. The nasopharyngeal airway was largest in the CP group both preoperatively and postoperatively. Eleven patients (7 CP, 4 UCLP) had a velopharyngoplasty after the osteotomy to improve their speech. There was no difference in the nasopharyngeal airway in the patients treated by velopharyngoplasty compared with those not so treated, but they seemed to have the shortest maxillas and the greatest surgical changes vertically.     

Comparison of Complete Distal Release of the Medial Collateral Ligament and Medial Epicondylar Osteotomy during Ligament Balancing in Varus Knee Total Knee Arthroplasty

Background

During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed.

Methods

This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively.

Results

There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely.

Conclusions

Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.     

Endoscopically assisted tunnel approach for minimally invasive corticotomies: a preliminary report

Background: The dental community has expressed low acceptance of traditional corticotomy techniques for corticotomy‐facilitated orthodontics. These procedures are time consuming, entail substantial postoperative morbidity and periodontal risks, and are often perceived as highly invasive. Methods: A total of 114 interdental sites were treated in nine consecutive patients. Under local anesthesia, a tunnel approach requiring one to three vertical incisions per arch (depending on the targeted teeth) was used. Piezosurgical corticotomies and elective bone augmentation procedures were performed under endoscopic assistance. Postoperative cone‐beam computerized tomography evaluation was used to confirm adequate corticotomy depth. Results: Procedures were completed in a mean time of 26 minutes. Follow‐up evaluations revealed no loss of tooth vitality, no changes in periodontal probing depth, good preservation of the papillae, and no gingival recession. No evidence of crestal bone height reduction or apical root resorption was detected. Conclusions: The tunnel approach minimizes soft‐tissue debridement and permits effective cortical cuts. The combination of piezosurgery technique with endoscopic assistance provides a quick, reliable means to design and perform these corticotomies while maximizing root integrity preservation. Moreover, the sites needing bone augmentation are selected under direct vision. Compared to traditional corticotomies, this procedure has manifest advantages in surgical time, technical complexity, patient morbidity, and periodontium preservation.     

Beiträge der Österreichischen Fußchirurgie zum Thema Osteotomien an den distalem Metatarsalia 2-5

Metatarsalgia is a common and well-known problem in the orthopedic office. Since 1916 metatarsal osteotomies are described for the treatment of this pathology. Austrian orthopedic surgeons and Foot & Ankle specialists have worked on this topic. A special focus was on the clinical and biomechanical analysis of the Weil osteotomy. Also, the next step of the evolution of the treatment of metatarsalgia, the DMMO (Distal Metaphyseal Metatarsal Osteotomy) was accompanied with clinical studies. Recent literature shows that if the criteria of indications are respected, the DMMO is a reproducible and safe technique. Since this technique has shown a learning curve, thorough training is necessary.     

经关节截骨治疗陈旧性胫骨平台骨折内翻畸形临床效果

目的探讨经关节截骨治疗陈旧性胫骨平台骨折内翻畸形的临床方式和效果。方法对2012年8月~2015年8月收治的96例陈旧性胫骨平台骨折内翻畸形患者,依据随机数字表法分为研究组(n=48)和对照组(n=48)。对照组患者行切开复位内固定手术治疗,研究组患者经关节截骨治疗。观察两组患者术后X线片并比较两组临床疗效。结果研究组患者的愈合时间及完全负重时间均显著短于对照组(P0.05),但两组患者术后X线片的胫骨平台内翻角及后倾角之间的差异均不显著(P0.05);研究组患者术后膝关节功能恢复优良率[93.8%(45/48)]显著高于对照组[66.7%(32/48),P0.05]。结论经关节截骨治疗陈旧性胫骨平台骨折内翻畸形的临床效果较切开复位内固定手术好。     

Hip range‐of‐motion (ROM) is less than normal after rotational acetabular osteotomy for developmental dysplasia of the hip: A simulated ROM analysis

The optimal reorientation of the acetabulum for developmental dysplasia of the hip (DDH) is unknown in terms of hip range‐of‐motion (ROM). The simulated ROMs of 52 DDHs after rotational acetabular osteotomy (RAO) with several patterns of femoral head coverage and those of 73 normal hips were analyzed using computer models reconstructed from CT images. After RAO with a lateral center edge angle (LCEA) of 30° and an anterior center edge angle (ACEA) of 55° producing coverage similar to that of normal hips, the maximal flexion and maximal internal rotation at 110° flexion with 20° adduction were significantly smaller than those of the normal group. To achieve ROMs after RAO similar to those of the normal group, an LCEA of 30° with an ACEA of 45°, an LCEA of 25° with an ACEA of 45° to 50°, and an LCEA of 20° with an ACEA of 50° could be preferred angles to target, even though they provided smaller coverage than that of normal hips. After RAO producing femoral head coverage similar to that of normal hips, the maximal flexion and the maximal internal rotation at 110° flexion with 20° adduction were significantly smaller than those of the normal group. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:217–223, 2016.     

Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

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.