Objective To investigate the effectiveness of lateral closing wedge osteotomy for treatment of traumatic cubitus varus deformity in children. Methods Between July 1996 and June 2010, 20 cases of traumatic cubitus varus deformity after humeral supracondylar fracture were treated by lateral closing wedge osteotomy. There were 13 boys and 7 girls, aged from 7 to 14 years (mean, 10.6 years). The left elbow was involved in 12 cases and right elbow in 8 cases. Thirteencases had received closed reduction, percutaneous Kirschner wire fixation, and external fixation in other hospital, and 7 cases misdiagnosed as elbow luxation and soft tissue injury had given external fixation. Cubitus varus deformity occurred at 2-12 years after injury. Preoperatively, the elbow range of motion (ROM) in flexion and extension was 100-150° (mean, 133.0°) and 0-24° (mean, 11.7°), respectively. The angle of cubitus varus deformity was 20-50° (mean, 32.1°). Results All incisions healed by first intention, and no related complication occurred. A total of 17 patients were followed up 1-14 years (mean, 5 years). X-ray films revealed that bone union was achieved in all cases within 5-8 weeks after operation (mean, 6 weeks). The deformity of cubitus varus was corrected in all cases. At last follow-up, the elbow ROM in flexion and extension was 110-150° (mean, 135.9°) and 0-27° (mean, 12.9°), respectively. According to Jupiter et al. elbow score system, the results were excellent in 14 cases, good in 2 cases, and fair in 1 case; the excellent and good rate was 94.1%. One patient underwent recurrence at 1 month after removal of the Kirschner wire, and lateral closing wedge osteotomy was performed again after 1 year. Conclusion Lateral closing wedge osteotomy is a safe and effective surgical procedure in correcting traumatic cubitus varus deformity in children, which is easy to operate and can be effective in reducing the complications.
Objective To introduce operation skill of the spinal wedge osteotomy by posterior approach for correction of severe rigid scol iosis and to discuss the selection of the indications and the range of fusion and fixation. Methods Between July 1999 and January 2009, 23 patients with severe rigid scol iosis were treated with spinal wedge osteotomy by posterior approach, including 16 congenital scol iosis, 5 idiopathic scol iosis, and 2 neurofibromatosis scol iosis. There were 11 males and 12 females with a median age of 15 years (range, 8-29 years). Two patients had previous surgery history. The Cobb’s angles of scol iosis and kyphosis before operation were (85.39 ± 13.51)° and (56.78 ± 17.69)°, respectively. The mean spinal flexibil ity was 14.4% (range, 4.7%-22.5%). The trunk shift was (15.61 ± 4.89) mm. The preoperative CT or MRI showed bony septum in the canal in 2 patients. Results The mean operative time was 241 minutes and the mean blood loss was 1 452 mL. The average fused vertebrae were 10.7 segaments (range, 8-14 segaments). The follow-up ranged from 1 to 4 years with an average of 2 years and 6 months. The postoperative Cobb’s angle of scol iosis was (38.70 ± 6.51)°, the average correction rate was 54.7%. The postoperative Cobb’s angle of kyphosis was (27.78 ± 6.01)°, the average correction rate was 51.0%. The trunk shift was improved to (4.69 ± 1.87) mm, the increased height was 5.2 cm on average (range, 2.8-7.7 cm). The Cobb’s angle of scol iosis was (41.57 ± 6.80)° with an average 2.9° loss of correction at the final follow-up; the Cobb’s angle of kyphosis was (30.39 ± 5.94)° with an average 2.6° loss of correction at the final follow-up; the trunk shift was (4.78 ± 2.00) mm at the final follow-up. There were significant differences (P lt; 0.05) in the Cobb’s angles of scol iosis and kyphosis and the trunk shift between preoperation and postoperation, between preoperation and last follow-up. Four cases had pedicle fracture, 1 had L1 nerve root injury, 2 had superior mesenteric artery syndrome, 1 had exudates of incision, and 2 had temporary dysfunction of both lower extremity. Conclusion Spinal wedge osteotomy by posterior approach is a rel iable and safe surgical technique for correcting severe rigid scol iosis. With segmental pedical screw fixation, both the spinal balance and stabil ity can be restored.
To investigate the operative technique of treating Freiberg’s disease with dorsal wedge osteotomy and absorbable pin fixation, and to evaluate the cl inical outcome. Methods From June 2005 to June 2007, 8 patients with Freiberg’s disease were treated, including 2 males and 6 females aged 16-66 years old (average 36 years old). X-ray films revealed osteosclerosis, collapse of the metatarsal head and ischemic necrosis of the second metatarsal head. According toSmill ie classification system, there were 4 cases of stage II, 3 of stage III and 1 of stage IV. The duration of symptoms was 6-36 months (average 19 months). After dorsal wedge osteotomy, the metatarsal heads were rotated to reconstrust the joint surface, then 3-4 pieces of absorbable pin 1.5 mm in length were implanted for fixation. Results All wounds healed by first intention, and no early postoperative compl ications occurred. Five patients were followed for 11-35 months (average 14 months) and had significant pain rel ief. At 3 months after operation, the dorsal-flexion of metatarsophalangeal joint was improved by 0-50° (average 21°), and the plantar-flexion was increased by 0-10° (average 5°). X-ray films showed that solid union of the osteotomy was achieved in all patients at 8-13 weeks after operation (average 10 weeks). Average shortening of metatarsal was 1.7 mm (range 1.3-2.0 mm). All patients returned to sports and recreational activities at 4 months after operation, except one case of stage IV who had constant swelling and stiffness in the joint and was improved at 12 months after operation. Conclusion Dorsal wedge osteotomy in complex with absorbable pin fixation is an effective procedure for stage II and III Freiberg’s disease, because it is capable of reconstructing the metatarsophalangeal joint effectively, allowing early joint motion and avoiding a second operation.
ObjectiveTo evaluate the effectiveness of spinal wedged osteotomy and total hip arthroplasty (THA) for treatment of kyphosis and severe hip flexion contracture caused by ankylosing spondylitis (AS). MethodsBetween December 2008 and November 2011,25 patients (37 hips) with kyphosis and severe hip flexion contracture caused by AS were treated.There were 22 males and 3 females,aged 29-38 years (mean,35.6 years).The disease duration was 8-16 years (mean,13.2 years).Of them,18 cases had complete limitation of hip motion,and 16 cases had severe spine deformity (Cobb's angel ≥60°).All 25 cases underwent spinal wedged osteotomy at first,and then received THA after 8 weeks.The effectiveness was evaluated by Harris hip score,range of motion (ROM) of the hip,visual analogue scale (VAS) score,Cobb's angle,and information and data exchange system (IDES) criteria for aseptic loosening,respectively. ResultsThe patients were followed up 12-14 months (mean,13 months).Spondylolisthesis (Ⅱ degree) occurred in 1 case spinal after wedged osteotomy,and was corrected after second operation.No vascular injury or spinal cord injury was observed.Bony fusion was obtained at osteotomy ends at 6 months after operation.The Cobb's angle was significantly corrected from (83.5±10.4)° preoperatively to (25.4±5.5)° (t=24.63,P=0.00) 12 months postoperatively.One case had traction injury of the femoral nerve after THA,and the muscle function recovered at 9 months after operation.According to IDES criteria,up-displacement of cup (<5 mm) was observed in 1 patient,who had no obvious clinical symptoms; periacetabular osteolysis occurred in 1 patient,with no displacement of cup.No obvious radiolucent was seen in 37 hips.The Harris hip score was significantly improved from (26.87±4.23) preoperatively to (85.92±6.04) (t=28.72,P=0.00) 3 months postoperatively; the VAS score was significantly decreased from (6.71±1.14) preoperatively to (2.31±0.82) (t=42.26,P=0.00) 3 months postoperatively; and the flexion-extension ROM of the hip was significantly improved to 60-100° (mean,72.0°) at post-operation,and the abduction ROM of the hip was improved to 20-40° (mean,28.7°). ConclusionSpinal wedged osteotomy combined with THA is an efficient treatment for kyphosis and severe hip flexion contracture caused by AS.
ObjectiveTo compare the dorsiflexion osteotomy (DO) and implant arthroplasty (IA) in terms of clinical and radiographic outcomes for patients with advaced Freiberg disease.MethodsA clinical data of 25 cases of Freiberg disease, who were admitted between July 2012 and July 2016 and met selection criteria, was retrospectively reviewed. According to the Smillie classification, all patients were classified as stage Ⅳ-Ⅴ. Among them, 13 cases were treated with DO (DO group) and 12 cases were treated with IA (IA group). No significant difference was found between the two groups in gender, age, side of the affected metatarsophalangeal (MTP) joint, location, Smillie classification, disease duration, and preoperative visual analogue scale (VAS) score, range of motion of the affected MTP joints, and the American Orthopedic Foot and Ankle Society (AOFAS) score (P>0.05). Total costs for index admissions were compared between the two groups. Clinical outcomes were evaluated in accordance with the VAS score, AOFAS score, and the range of motion of the affected MTP joints.ResultsAll incisions of the two groups healed by first intention. The follow-up time was 12-30 months (mean, 17 months) in DO group and 12-24 months (mean, 16 months) in IA group. The total cost of index admission was significantly higher in IA group than that n DO group (t=2.742, P=0.011). The AOFAS scores, VAS scores, and range of dorsiflexion and plantar flexion at last follow-up were significantly improved when compared with preoperative value in the two groups (P<0.05). There was no significant difference in all indexes between the two groups (P>0.05). X-ray film examination showed that the osteotomy healed within 8-12 weeks (mean, 9.5 weeks) after operation in DO group. None of the patients experienced internal fixator and implant related complications postoperatively.ConclusionDO and IA can provide significant improvement in pain and motion of the MTP joints for advanced Freiberg disease. But the DO may be the more economical method.
ObjectiveTo summarize the technique and effectiveness of double metatarsal osteotomy for treating severe hallux valgus with increased distal metatarsal articular angle (DMAA).MethodsBetween June 2014 and December 2017, 64 patients (94 feet) of severe hallux valgus with an increased DMAA were treated with the double metatarsal osteotomy (distal metatarsal Reverdin osteotomy+proximal metatarsal open wedge osteotomy) combined with Akin osteotomy and soft tissue surgery to correct the deformity. There were 10 males (15 feet) and 54 females (79 feet) with an average age of 44.5 years (range, 26-66 years), including 34 of unilateral foot and 30 of bilateral feet. The Maryland metatarsophalangeal joint score of the American Orthopaedic Foot and Ankle Society (AOFAS) was 54.3±7.4 and the visual analogue scale (VAS) score was 6.0±2.0. The pre- and post-operative AOFAS score, VAS score, DMAA, hallux valgus angle (HVA), first-second intermetatarsal angle (1-2IMA), and the first metatarsal length (FML) were recorded and compared.ResultsAll incisions healed by first intention. All patients were followed up 12-15 months, with an average of 13.2 months. The complications occurred in 4 feet, including 1 foot of hallux stiffness, 1 foot of numbness at the edge of the wound, 1 foot of metastatic metatarsalgia, and 1 foot of metatarsal bone necrosis. At 1 year after operation, the Maryland metatarsal joint score of AOFAS was 89.2±7.4, showing significant difference compared with preoperative score (t=18.427, P=0.000); and the effectiveness was rated as excellent in 78 feet, good in 12 feet, poor in 3 feet, and bad in 1 foot, with an excellent and good rate of 95.7%. The VAS score was 1.5±2.0, showing significant difference compared with the preoperative score (t=10.238, P=0.000). The X-ray films showed that the osteotomies achieved bony healing at 3 months after operation. There were significant differences (P<0.05) in HVA, 1-2IMA, and DMAA between preoperation and 6 months and 1 year after operation; but no significant difference was found in FML between preoperation and 1 year after operation (t=0.136, P=0.863).ConclusionFor the patients with severe hallux valgus with increased DMAA, the double metatarsal osteotomy can significantly relieve the clinical symptoms and improve the imaging parameters with less postoperative complications.
ObjectiveTo investigate effectiveness of picture archiving and communication systems (PACS) in lateral wedge osteotomy for cubitus varus deformity in teenagers.MethodsA clinical data of 16 teenagers with cubitus varus deformity between July 2014 and July 2016 was retrospectively analyzed. All patients were treated with lateral wedge osteotomy and fixed with plate. Before operation, the osteotomy design (the osteotomy angle and length) was done in the PACS, including the carrying angle of healthy limb and the varus angle of affected side. There were 10 males and 6 females, with an average age of 11.4 years (range, 10-17 years). The disease duration ranged from 2 to 10 years (mean, 5.6 years). The preoperative X-ray film showed that the supracondylar fractures of the humerus had all healed, and 9 cases had internal rotation deformity; the varus angle of the affected side was 19.5°-33.5°. After operation, the fracture healing and cubitus varus deformity correction were observed by X-ray films, the elbow function was evaluated by Mayo scoring, and the elbow range of motion was detected.ResultsThere was no significant difference between the actual intraoperative osteotomy angle and length and the preoperative design (P>0.05). The hospital stay was 2-8 days, with an average of 4.5 days. No complication such as incision infection or ulnar nerve injury occurred. All 16 cases were followed up 12-18 months, with an average of 14 months. X-ray films showed that the osteotomy healed at 2-7 months after operation, with an average of 2.5 months. The internal fixators were removed within 8-14 months after operation (mean, 12.0 months). X-ray films measurement showed that the carrying angle of the affected side recovered to (10.3±2.0)° at 1 day after operation, which was not significantly different from that of the healthy side [(10.6±1.5)°] before operation (t=0.480, P=0.637). The carrying angle of the affected side was (9.8±2.6)° at 1 year after operation, which was not significantly different from that of the healthy side [(10.4±1.6)°] at the same time point (t=0.789, P=0.438). At 1 year after operation, the ranges of flexion and extension of affected side were (131.6±8.4)° and (6.4±2.6)°, respectively; and the ranges of flexion and extension of healthy side were (134.2±6.3)° and (5.9±2.2)°, respectively. There was no significant difference between the healthy and affected sides (t=1.143, P=0.262; t=0.587, P=0.561). The elbow joint function at 1 year after operation evaluated by Mayo scoring standard rated as excellent in 9 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 93.7%.ConclusionBefore lateral wedge osteotomy, the PACS is used to design the osteotomy angle and length, which can guide the operation and make the osteotomy more accurate and simple.