Dataset Information

One-stage Surgical Treatment of Simultaneous Osteotomy and Asymmetric Lengthening on Short Femur with Severe Deformity of Genu Valgus.

ABSTRACT: This study aimed to discuss the effects of one stage surgical treatment by simultaneous osteotomy and asymmetric lengthening by Ilizarov external fixator on short femur with severe deformity of genu valgus. A total of 12 cases with unilateral deformities treated by simultaneous osteotomy and Ilizarov asymmetric lengthening on short femur with severe deformity of genu valgus were retrospectively analyzed from January 2006 to April 2015. The affected limbs were 2.5-11?cm (5.2?cm on average) short, the femorotibial angle was 135°-158° (146.3° on average), and the ankle interval was 15-43?cm (24.7?cm on average). The Paley method was used to determine the osteotomy plane (distal femur) of genu valgus. According to this standard, the bone union results were as follows: 11 had excellent and 1 had good, where 7 patients had excellent and 5 had good functional outcomes. One stage surgical treatment by simultaneous osteotomy and asymmetric lengthening on short femur with severe deformity of genu valgus was considered to be an effective and reliable method with better osteotomy union, less trauma and fewer complications.

SUBMITTER: Xu HF

PROVIDER: S-EPMC6565623 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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One-stage Surgical Treatment of Simultaneous Osteotomy and Asymmetric Lengthening on Short Femur with Severe Deformity of Genu Valgus.

Xu Hui-Fa HF Xu Chao C Sha Jia J Yan Ya-Bo YB Li Chao C Liu Zhi-Chen ZC Huang Lu-Yu LY Lei Wei W

Scientific reports 20190613 1

This study aimed to discuss the effects of one stage surgical treatment by simultaneous osteotomy and asymmetric lengthening by Ilizarov external fixator on short femur with severe deformity of genu valgus. A total of 12 cases with unilateral deformities treated by simultaneous osteotomy and Ilizarov asymmetric lengthening on short femur with severe deformity of genu valgus were retrospectively analyzed from January 2006 to April 2015. The affected limbs were 2.5-11 cm (5.2 cm on average) short, ...[more]

PMID: 31197215

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Project description:IntroductionMagnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the MILN (PRECICE®) has been in use since 2011 but had limitations (50-75 lb) in post-operative weight bearing. A new stainless-steel version of the MILN (STRYDE®) allows 150-250 lb of post-operative weight bearing. The aim is to compare the outcomes of using these two different MILNs for both unilateral and bilateral femoral lengthening.MethodsA single-center, retrospective cohort study was conducted in which patients' records were reviewed from the period from January 2017 to March 2020. A total of 66 femoral lengthening procedures were included in the study and were divided into two groups: STRYDE® group (30 femora) and PRECICE® group (36 femora). Outcomes assessed were the 6-months post-operative Limb Deformity-Scoliosis Research Society (LD-SRS) Score, adjacent joint range of motion (ROM), average distraction rate, bone healing index (BHI), and complications.ResultsNo statistically significant difference was found between the two groups in regard to the (LD-SRS) score, hip ROM, or knee ROM. Statistically significant differences were found between the two groups in regard to BHI (average of 0.84 months/cm and 0.67 months/cm for STRYDE® and PRECICE®, respectively) and distraction rate (average of 0.6 mm/day and 0.9 mm/day for STRYDE® and PRECICE®, respectively). No mechanical nail complications were reported in the STRYDE® group compared to three events of nail failure in the PRECICE® group. One femur in the PRECICE® group needed BMAC injection for delayed healing compared to four femurs in the STRYDE® group.ConclusionThe STRYDE® MILN yields comparable functional results to those of PRECICE® MILN and shows fewer mechanical nail complications. However, STRYDE® MILN requires a slower distraction rate and yields slower healing (larger BHI).Level of evidenceLevel III, Therapeutic study.

Project description:BackgroundCalcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction.MethodsBetween 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score.ResultsPre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees (P < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees (P < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees (P < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees (P < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months-11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference (P = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence.ConclusionSymptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided.Level of evidenceLevel IV, retrospective study.

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Project description:BackgroundThe traditionally recommended fixed valgus cutting angle (VCA) of 3° is used as the standard method in total knee arthroplasty (TKA) for valgus deformity. The accuracy of distal femur cutting can be affected by the type of valgus deformity because the intramedullary rod for distal femoral resection can become impinged on the femoral cortex. The purpose of this study is to analyze the accuracy and precision of a VCA of 3° in mechanical alignment in TKA for valgus deformity, based on the type of the deformity.MethodsTKAs with a fixed VCA of 3° performed in 110 intra-articular and 102 juxta-articular valgus knees were retrospectively reviewed. The age (65.8 vs. 66.1 years), sex (female: male =78/32 vs. 70/32), body mass index (26.0 vs. 26.0), and severity of deformities (valgus 12.1 vs. valgus 12.5) were not significantly different (P>0.647). The mechanical-lateral-distal-femoral angle (mLDFA) and anatomical-mechanical-axis angle (AMA-A) were evaluated. The adjusted-VCA (aVCA) was defined as the maximum angle within the range without the intramedullary rod impinging on the femoral cortex. The proportion of well-aligned femoral component (mLDFA <90°±3°) was assessed. The correlation between AMA-A-3° or aVCA-3° and postoperative mLDFA-90° was analyzed.ResultsDespite the larger AMA-A in the juxta-articular group (6.2° vs. 6.8°, P<0.001), the aVCA was lesser in the juxta-articular group (5.4° vs. 4.1°, P<0.001). The mLDFA was more varus in the intra-articular group (91.7° vs. 90.6°, P<0.001) postoperatively. The proportion of well-aligned femoral component was higher in the juxta-articular group (85.3% vs. 70%, P=0.009). Postoperative mLDFA-90° was moderately correlated with aVCA-3° (r=0.301, r=387), but weakly correlated with AMA-A-3° (r=0.274, r=294) in both groups.ConclusionsAlthough a fixed VCA of 3° is a reliable method in achieving mechanical alignment in valgus deformity, it can be more appropriate in juxta-articular deformity than in intra-articular deformity. The aVCA is a more reasonable predictor of femoral component alignment than the AMA-A, considering the femoral cortex impingement of the intramedullary rod.

Dataset Information

One-stage Surgical Treatment of Simultaneous Osteotomy and Asymmetric Lengthening on Short Femur with Severe Deformity of Genu Valgus.

Publications

One-stage Surgical Treatment of Simultaneous Osteotomy and Asymmetric Lengthening on Short Femur with Severe Deformity of Genu Valgus.

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