RESUMO
CASE: A 16-year-old boy presented with a recurrent distal femur aneurysmal bone cyst accompanied by a combined sagittal knee deformity (20° of femoral antecurvatum and 26.8° of tibial recurvatum) and limb shortening. After preoperative planning, the treatment involved new intralesional curettage, phenolization, and bone allograft filling. Additional procedures included distal extension femoral osteotomy with plate fixation, and proximal tibial osteotomy with, gradually corrected through a hexapod frame. At 2-year follow-up, lower limbs exhibited normoalignment and equal length. CONCLUSION: Complex knee deformities may occur with tumoral lesions around the knee but can be effectively addressed through double osteotomy and application of a hexapod frame.
Assuntos
Cistos Ósseos Aneurismáticos , Deformidades Articulares Adquiridas , Masculino , Humanos , Adolescente , Cistos Ósseos Aneurismáticos/complicações , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/cirurgia , Deformidades Articulares Adquiridas/complicações , Deformidades Articulares Adquiridas/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fêmur/anormalidades , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Articulação do Joelho/cirurgiaRESUMO
Posttraumatic cubitus varus is a multiplanar deformity that results from an improperly reduced supracondylar humerus fracture. The prevention of posttraumatic cubitus varus hinges on the stable restoration of all 3 columns of the distal humerus while avoiding malrotation. The collapse of any column leads to varying degrees of deformity in the coronal, sagittal, and/or axial plane. The purpose of this article is to explain the pattern of the deformity and use this to summarize preventative tactics for avoiding its described sequelae. We also summarize, illustrate, and present case examples for the various osteotomies used to correct the deformity, and speculate future directions.
Assuntos
Lesões no Cotovelo , Articulação do Cotovelo , Fraturas do Úmero , Osteotomia , Humanos , Fraturas do Úmero/cirurgia , Fraturas do Úmero/complicações , Osteotomia/métodos , Articulação do Cotovelo/cirurgia , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , CriançaRESUMO
An estimated 10 to 15% of total knee arthroplasties (TKAs) are implanted for a diagnosis of arthritis when a valgus deformity is present. There are various techniques and considerations that must be considered for a successful TKA in a patient with a valgus deformity. This article provides a detailed summary of the anatomy, pathology, bone preparation, soft tissue management, implant selection, and complications when performing a TKA in a patient with valgus deformity.
Assuntos
Artrite , Artroplastia do Joelho , Deformidades Articulares Adquiridas , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Artrite/cirurgia , Deformidades Articulares Adquiridas/cirurgia , Osteoartrite do Joelho/cirurgiaRESUMO
OBJECTIVES: The primary objective of the present study is to compare the radiographic outcomes and complications of two different techniques for lateral closing-wedge osteotomy in pediatric patients with cubitus varus. METHODS: We retrospectively identified patients treated at five tertiary care institutions: 17 underwent the Kirschner-wire (KW) technique, and 15 patients were treated with the mini external fixator (MEF) technique. Demographic data, previous treatment, pre- and postoperative carrying angle (CA), complications and additional procedures were recorded. Radiographic evaluation included assessment of the humerus-elbow-wrist angle (HEW), and the lateral prominence index (LPI). RESULTS: Patients treated with both KW and MEF achieved significant improvements in clinical alignment (mean pre-op CA -16 ± 6.1 degrees to mean post-op 8.9 ± 5.3 degrees, P < 0.001). There were no differences in final radiographic alignment or radiographic union time; however, time to achieve full elbow motion was faster in the MEF group (13.6 versus 34.3 weeks, P = 0.4547). Two patients (11.8%) in the KW group experienced complications, including one superficial infection and one failed correction that required unplanned revision surgery. Eleven patients in the MEF group underwent a planned second surgical procedure for hardware removal. CONCLUSIONS: Both fixation techniques are effective at correcting cubitus varus in the pediatric population. The MEF technique may have the advantage of shorter recovery of elbow range of motion but may require sedation for hardware removal. The KW technique may present a slightly higher complication rate.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Humanos , Criança , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/cirurgia , Osteotomia/métodos , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Amplitude de Movimento ArticularRESUMO
Objective: To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents. Methods: The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient's upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint. Results: The operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones ( P<0.05). Except for the extension range of motion of the healthy elbow joint ( P<0.05), there was no significant difference in other indicators between the two sides ( P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%. Conclusion: Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Deformidades Congênitas dos Membros , Masculino , Feminino , Humanos , Adolescente , Pré-Escolar , Criança , Cotovelo , Fraturas do Úmero/cirurgia , Estudos Retrospectivos , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Articulação do Cotovelo/cirurgia , Osteotomia/métodos , Cabeça do Úmero , Amplitude de Movimento Articular , Computadores , Resultado do TratamentoRESUMO
BACKGROUND: Cubitus varus deformity is a complex 3-dimensional deformity. Various osteotomies have been introduced to correct this deformity, however, there is no consensus on the best procedure to correct the deformity while avoiding complications. In this retrospective study, we used a modified inverse right-angled triangle osteotomy to treat 22 children with posttraumatic cubitus varus deformity. The primary objective was to evaluate this technique by presenting its clinical and radiologic results. METHODS: Twenty-two consecutive patients with a cubitus varus deformity underwent a modified reverse right-angled triangle osteotomy between October 2017 and May 2020 and were then followed for a minimum of 24 months. We evaluated its clinical and radiologic results. Functional outcomes were assessed using Oppenheim criteria. RESULTS: The average follow-up period was 34.6 months (range, 24.0 to 58.1 months). The mean range of motion was 4.32 degrees (range, 0 degrees to 15 degrees)/122.73 degrees (range, 115 degrees to 130 degrees) (hyperextension/flexion) before surgery and 2.05 degrees (range, 0 degrees to 10 degrees)/127.27 degrees (range, 120 degrees to 145 degrees) at the final follow-up. There were significant ( P < 0.05) differences between the flexion and hyperextension angles before surgery and at the final follow-up. Based on Oppenheim criteria, results were excellent for 20, good for 2, and none of the patients had poor results. The mean humerus-elbow-wrist angle improved from 18.23 degrees (range, 10 degrees to 25 degrees) varus preoperatively to 8.45 degrees (range, 5 degrees to 15 degrees) valgus postoperatively ( P < 0.05). The mean of the preoperative lateral condylar prominence index was 3.52 (range, 2.5 to 5.2) and the average postoperative lateral condylar prominence index was -3.28 (range, -1.3 to -6.0). All patients were pleased with the overall appearance of their elbows. CONCLUSIONS: The modified reverse right-angled triangle osteotomy can precisely and stably correct the deformity in the coronal and sagittal planes, we recommend this technique as a simple, safe, and reliable correction of cubitus varus deformity. LEVEL OF EVIDENCE: Level IV; case series; therapeutic studies-investigating the results of treatment.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Deformidades Congênitas dos Membros , Humanos , Criança , Cotovelo , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Osteotomia/métodos , Articulação do Cotovelo/cirurgia , Deformidades Congênitas dos Membros/complicações , Amplitude de Movimento ArticularRESUMO
OBJECTIVE: To investigate the clinical efficacy of picture archiving and communication system (PACS) and Photoshop assisted isosceles triangle osteotomy and Kirschner wire fixation with tension band in the treatment of cubitus varus in children. METHODS: The clinic data of 20 children with cubitus varus treated with isosceles triangle osteotomy of distal humerus and Kirschner wire fixation with tension band from October 2014 to October 2019, were retrospectively analyzed. There were 13 males and 7 females, aged from 3.2 to 13.5 years old, the median age was 6.65 years old. PACS system was applied for the osteotomy design preoperatively, simulating and measuring the side length of isosceles triangle osteotomy. Then, Photoshop system was used to simulate the preoperative and postoperative osteotomy graphics, which could guide precise osteotomy during operation. RESULTS: All the 20 patients were followed up for 20 to 24 months, with a median of 22.5 months. At the last follow-up, the carrying angle of the affected limb was 5 ° to 13 °, with a median of 8.3 °. The clinical efficacy was evaluated according to the Flynn elbow function score:excellent in 16 cases, good in 2 cases, and fair in 2 cases. CONCLUSION: The treatment of cubitus varus in children by isosceles triangle osteotomy and Kirschner wire fixation with tension band assisted by PACS and Photoshop system has shown good clinical outcome.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Masculino , Feminino , Humanos , Criança , Pré-Escolar , Adolescente , Fraturas do Úmero/cirurgia , Fios Ortopédicos , Estudos Retrospectivos , Úmero/cirurgia , Resultado do Tratamento , Articulação do Cotovelo/cirurgia , Osteotomia , Deformidades Articulares Adquiridas/cirurgia , Amplitude de Movimento ArticularRESUMO
BACKGROUND: Fractures around the elbow are common in children. Their management remains challenging. Inadequate treatment often leads to malunion, causing growth disturbance or avascular necrosis. This can develop into cubital axis deformities. This study evaluated our modified supracondylar dome osteotomy technique for acute correction of posttraumatic cubital axis deformities in adolescent patients. METHODS: Eighteen cases of posttraumatic cubital axis deformity that underwent acute correction through supracondylar dome osteotomy in our department between 2012 and 2019 were retrospectively evaluated. The radiologic results were measured through the carrying angle. The clinical functional outcomes were assessed using the Mayo Elbow Performance Index. RESULTS: No neurovascular injuries occurred and there was no notable loss of muscular strength or functional deficiencies in any of the patients. Symmetrical cubital axes were achieved in all cases. All cases were consolidated in a timely matter and no malunion was observed upon consolidation. Besides 1 case of hardware damage caused by a severe fall due to heavy alcohol intoxication, there was no correction loss, no secondary displacement, and no implant-related discomfort. None of the patients were left with a limited range of motion or reduced weight-bearing capacity. An excellent level of elbow functionality was achieved in all cases, with an average Mayo Elbow Performance Index of 97.8. CONCLUSIONS: The supracondylar dome osteotomy technique showed promising results in both radiologic outcomes and clinical performance, with a low complication rate. The dome-shaped osteotomy allows simultaneous multiplanar correction of not only varus or valgus deformities but also additional extension or flexion deformities. This technique also enables translation of the distal fragment in the frontal plane, which contributes to a more balanced anatomic geometry of the distal humerus. We consider the posterior triceps-splitting approach to be a safe technique that preserves muscle strength and improves the cosmetic appearance of the surgical scar. We recommend a cast-free plate fixation to allow early movement after surgery. We believe any residual deformities that present 18 months after the initial trauma should be addressed through surgical correction before clinical symptoms become apparent to avoid the chronic manifestation of functional deficiencies. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Criança , Humanos , Adolescente , Deformidades Articulares Adquiridas/cirurgia , Fraturas do Úmero/cirurgia , Fraturas do Úmero/complicações , Estudos Retrospectivos , Osteotomia/métodos , Articulação do Cotovelo/cirurgia , Amplitude de Movimento Articular/fisiologia , Resultado do TratamentoRESUMO
The results of conventional corrective procedures remain suboptimal for severe cubitus varus deformities (> 30°) in children. We present the results of shortening dome osteotomy for the correction of such deformities. PATIENTS AND METHODS: We present retrospective review of prospectively collected data of 18 patients (11 boys and 7 girls) who underwent shortening dome osteotomy between January 2011 and December 2019 for severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture. The procedure involved the removal of convexo-concave bone (5-8 mm wide) between the two domes. Humero-ulnar angles, lateral condylar prominence index (LCPI), and elbow range of movements were recorded preoperatively and postoperatively. RESULTS: Mean age was 7.5 years (range 5 years-11 years). Indication for surgery was poor cosmesis in all the patients and tardy ulnar nerve symptoms in three patients. Mean preoperative humero-ulnar angle was 26.1° varus (range 22°-34°), while it was 7.1° valgus (range 0°-12°) for contralateral normal elbow. They were followed for a mean duration of 2.2 years (range 12 months-5.8 years). The mean postoperative valgus angle achieved was 7.3° (range 2°-12°) as total angular correction achieved was 34.4° (range 30°-44°) (p < 0.001). Radiological healing was observed in all the patients at mean duration of 7.1 weeks (range 5 weeks-9 weeks). Mean preoperative and postoperative LCPI were - 2.4 (range +4.7 to - 10.5) and - 1.7 (range +4.5 to - 5.1), respectively (p = 0.595). Three patients had pin tract infections and two of them responded to aseptic dressings and oral antibiotics, while another required early pin removal and additional protection in splint. All patients regained preoperative arc of motion within 6 months after the procedure. CONCLUSION: Shortening dome osteotomy is a safe and effective method for correcting severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture in children.
Assuntos
Articulação do Cotovelo , Fraturas Mal-Unidas , Fraturas do Úmero , Deformidades Articulares Adquiridas , Masculino , Feminino , Humanos , Criança , Pré-Escolar , Fraturas do Úmero/cirurgia , Resultado do Tratamento , Deformidades Articulares Adquiridas/complicações , Deformidades Articulares Adquiridas/cirurgia , Amplitude de Movimento Articular/fisiologia , Articulação do Cotovelo/cirurgia , Osteotomia/métodos , Fraturas Mal-Unidas/diagnósticoRESUMO
BACKGROUND: Humeral osteotomy is the best method for treatment of severe cubitus varus in children. Many osteotomy methods have been developed in the past. In this study, we describe a novel corrective technique by applying the principles described by Paley involving lateral osteotomy using Kirschner wires (K-wires). Vertices of the osteotomy should be located at the center of rotation of angulation. The anatomical and mechanical axes can be corrected with precision. PATIENTS AND METHODS: In this retrospective study, 21 patients (17 male, 4 female) who fulfilled the study criteria and underwent lateral closing osteotomy for cubitus varus deformity from July 2015 to October 2017 were included into the study. The osteotomy line of all patients was designed according to Paley's principles. An isosceles triangle template was made according to the design preoperatively. The lateral osteotomy was made with the assistance of C-arm radiographs. The osteotomy was fixed by K-wires laterally. Patients were followed up, and elbows were evaluated by radiography and using the Mayo Elbow Performance Index (MEPI) score. RESULTS: The mean correction angle obtained was 32.33°±2.83°. According to the MEPI score assessment, 19 of the 21 patients had an excellent outcome and two had a good outcome. Two patients complained of conspicuous scars; however, no further cosmetic surgery was performed. The range of motion was 135.0° preoperatively and 133.7° postoperatively, showing no significant difference (p = 0.326). None showed evidence of neurovascular injury or complained of prominence of the lateral humerus. CONCLUSION: Paley's principles for correcting cubitus varus deformity in children are effective and reliable for treating such a condition. LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Fraturas do Úmero , Deformidades Articulares Adquiridas , Criança , Humanos , Masculino , Feminino , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Cotovelo , Fraturas do Úmero/complicações , Fraturas do Úmero/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Osteotomia/métodosRESUMO
OBJECTIVES: In this case series, we aimed to evaluate the clinical and radiographic outcomes of the patients with infrafossal fracture of the humerus and to evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. PATIENTS AND METHODS: Between January 2005 and July 2020, the clinical data and radiographs of 2,443 children who were treated due to distal humerus fracture were retrospectively analyzed. A total of six patients (5 males, 1 female; mean age: 6.7±2.6 years, range, 3 to 11 years) treated due to an infrafossal fracture of the humerus were included. Radiographic measurements, such as Baumann's angle, lateral capitellohumeral angle, and carrying angle of the elbow, were performed. At the final follow-up, elbow joint range of motion (ROM) was measured, functional scores of the elbow and upper extremity were assessed. Complications were also recorded. RESULTS: The mean follow-up was 62.8±47.4 (range, 20 to 140) months. Two patients underwent open and three underwent closed reduction and internal fixation by different surgeons. One of the patients was treated with a long-arm cast. There was no major elbow ROM limitation. There was no significant deterioration in the lateral capitellohumeral and elbow carrying angles of the patients. Baumann's angle was normal for all the patients; however, it could not be measured in two patients, as their epiphyses were closed. Four patients had an excellent MEPS and two patients a good MEPS. The QuickDASH scores were low in all patients. There were two patients with cubitus varus who were treated surgically using lateral closing-wedge corrective osteotomy. CONCLUSION: Infrafossal fracture of the humerus is a fracture type which is different from supracondylar and transcondylar fractures and has not been previously reported in the literature. Despite the cubitus varus developed in two of our patients, functionally satisfactory results were achieved in all patients at the end of the treatment. Due to the risk of developing cubitus varus, patients with infrafossal fracture of the humerus should be followed closely until the end of adolescence. Although the current study is very limited in terms of being a guide for the treatment, it may contribute to the literature in terms of defining a new fracture subtype.
Assuntos
Fraturas do Úmero , Deformidades Articulares Adquiridas , Masculino , Adolescente , Criança , Humanos , Feminino , Pré-Escolar , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Fraturas do Úmero/complicações , Deformidades Articulares Adquiridas/complicações , Deformidades Articulares Adquiridas/cirurgia , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Úmero/diagnóstico por imagem , Úmero/cirurgiaRESUMO
BACKGROUND: Cubital tunnel syndrome can be caused by overtraction and dynamic compression in elbow deformities. The extent to which elbow deformities contribute to ulnar nerve strain is unknown. Here, we investigated ulnar nerve strain caused by cubitus valgus/varus deformity using fresh-frozen cadavers. METHODS: We used six fresh-frozen cadaver upper extremities. A strain gauge was placed on the ulnar nerve 2 cm proximal to the medial epicondyle of the humerus. For the elbow deformity model, osteotomy was performed at the distal humerus, and plate fixation was performed to create cubitus valgus/varus deformities (10°, 20°, and 30°). Ulnar nerve strain caused by elbow flexion (0-125°) was measured in both the normal and deformity models. The strains at different elbow flexion angles within each model were compared, and the strains at elbow extension and at maximum elbow flexion were compared between the normal model and each elbow deformity model. However, in the cubitus varus model, the ulnar nerve deflected more than the measurable range of the strain gauge; elbow flexion of 60° or more were considered effective values. Statistical analysis of the strain values was performed with Friedman test, followed by the Williams' test (the ShirleyâWilliams' test for non-parametric analysis). RESULTS: In all models, ulnar nerve strain increased significantly from elbow extension to maximal flexion (control: 13.2%; cubitus valgus 10°: 13.6%; cubitus valgus 20°: 13.5%; cubitus valgus 30°: 12.2%; cubitus varus 10°: 8.3%; cubitus varus 20°: 8.2%; cubitus varus 30°: 6.3%, P < 0.001). The control and cubitus valgus models had similar values, but the cubitus varus models revealed that this deformity caused ulnar nerve relaxation. CONCLUSIONS: Ulnar nerve strain significantly increased during elbow flexion. No significant increase in strain 2 cm proximal to the medial epicondyle was observed in the cubitus valgus model. Major changes may have been observed in the measurement behind the medial epicondyle. In the cubitus varus model, the ulnar nerve was relaxed during elbow extension, but this effect was reduced by elbow flexion.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Doenças Musculoesqueléticas , Deformidades Congênitas das Extremidades Superiores , Cadáver , Cotovelo , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/cirurgia , Deformidades Articulares Adquiridas/complicações , Deformidades Articulares Adquiridas/cirurgia , Doenças Musculoesqueléticas/complicações , Nervo UlnarRESUMO
In this study, we evaluated the clinical outcome of neutral wedge osteotomy assisted with the center of rotation of angulation (CORA) method of distal humerus anatomical axis for the treatment of cubitus varus deformity in children. From 2016 to 2019, 20 children with cubitus varus deformity after supracondylar fracture of the humerus were enrolled. Standard anteroposterior radiograph of the humerus was taken preoperatively. The CORA point and angulation angles were obtained by measuring the proximal and distal humerus anatomical axis. During the operation, neutral wedge osteotomy was performed to correct the varus deformity. The Baumann angle and the carrying angle were used to evaluate the correction effect of the distal humeral varus deformity. The average age of the patients was 7.8 years. Patients were followed up for an average of 29.3 months (range, 24-36 months). The average interval between surgery and injury was 12 months. The mean preoperative Baumann angle and carrying angle were 99° (90°-115°) and -14° (range, -10° to -30°), respectively. At the last follow-up, the mean Baumann angle and carrying angle was 76° (70°-80°) and 13.6° (10°-18°), respectively, with 16 cases showing excellent outcome and 4 cases showing good outcome. Our results indicated that the neutral wedge osteotomy assisted with CORA method of distal humerus anatomical axis showed good clinical outcomes in the treatment of cubitus varus deformity in children and is worthy of clinical application. The level of evidence is IV.
Assuntos
Lesões no Cotovelo , Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Deformidades Congênitas dos Membros , Doenças Musculoesqueléticas , Criança , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
Con la osteotomía en un solo nivel, se puede lograr la corrección del eje de la extremidad en pacientes con deformidades combinadas femoral y tibial, pero de forma simultánea generará una alteración patológica de oblicuidad de la interlínea articular, lo que conducirá a elongación ligamentaria, inestabilidad, degeneración condral y, en última instancia, comprometerá su sobrevida y los resultados funcionales. En virtud del análisis de la literatura más reciente, podemos concluir que existe un número significativo de pacientes que requieren de un procedimiento combinado para lograr un objetivo biomecánico óptimo. La finalidad de una osteotomía en doble nivel alrededor de la rodilla consiste en restablecer la anatomía normal, descargar el compartimiento afectado, normalizar los ángulos mecánicos y la orientación de la interlínea articular. Los ejes fisiológicos pueden restablecerse a través de un análisis preoperatorio exhaustivo, respetando principios biomecánicos y fijación estable con placas bloqueadas. Es un procedimiento demandante y con indicaciones en evolución, que progresivamente se ha instaurado como una alternativa de tratamiento justificada en estudios clínicos y biomecánicos para el manejo de deformidades severas alrededor de la rodilla.
With single-level osteotomy, correction of the limb axis in patients with combined femoral and tibial deformities can be achieved. This correction, however, will generate a pathological alteration in the joint line oblicuity, leading to ligament elongation, instability, joint degeneration and, ultimately, it will compromise the longevity and functional results of the correction. By analyzing the most recent literature, we can conclude that there is a significant number of patients who require a combined procedure to achieve an optimal biomechanical goal. The purpose of a double-level osteotomy around the knee is to restore normal anatomy, unload the affected compartment, normalize the mechanical angles and the orientation of the joint line. Physiological axes can be reestablished by means of a thorough preoperative analysis, observing the biomechanical principles and stable fixation with locked plates. It is a demanding procedure with increasing indications, which has progressively been established in clinical and biomechanical studies as a justified treatment alternative for the management of severe deformities around the knee.
Assuntos
Humanos , Osteotomia/métodos , Deformidades Articulares Adquiridas/cirurgia , Articulação do Joelho/fisiopatologia , Tíbia/cirurgia , Fenômenos Biomecânicos , Deformidades Articulares Adquiridas/fisiopatologia , Fêmur/cirurgiaRESUMO
OBJECTIVE: To explore clinical effect of three-dimensional(3D) printing combined with distal humerus osteotomy for children with cubital varus deformity. METHODS: From January 2017 to January 2020, 17 cubital varus deformity children treated with distal humerus osteotomy were retrospective analysis, included 11 boys and 6 girls, aged from 5 to 11 years old with an average of (7.8±1.7) years old. A model of affected side elbow joint was made by 3D printing technique before operation, pre-operation was performed on the model. Three-dimensional model was successfully used for distal humeral osteotomy during operation. Carrying angle, flexion and extension angle of elbow joint were compared before and six months after operation, and Flynn scoring criteria was used to evaluate clinical effect. RESULTS: All children were followed up for 6 to 12 months with an avergae of (9.6±1.7) months. One child occurred wound infection and healed completely after dressing change. No complications such as nonunion, internal fixation and nerve injury occurred. Carrying angle of affected limb was improved from (-20.8±2.4)°before operation to (7.2±2.3)°at 6 months after operation (P<0.01). Angle of affected elbow joint extension improved from (-5.6±3.9)° before opeation to(-2.6±2.1)°at 6 months after operation (P<0.01). There was no significant difference in extension angle of elbow joint between preopertaion and postopertaion at 6 months (P>0.05). While there was no difference in elbow joint function on the healthy side and affected side at 6 months after opertaion (P>0.05). According to Flynn scoring criteria, 13 patients got excllent results and 4 moderate. CONCLUSION: Three-dimensional printing combined with distal humerus osteotomy in treating elbow varus deformity could receive satisfactory clinical effect, which could accurately assist correction of cubital varus deformity, restore physiological structure and function of elbow joint.
Assuntos
Lesões no Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Doenças Musculoesqueléticas , Criança , Pré-Escolar , Cotovelo , Feminino , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Masculino , Doenças Musculoesqueléticas/complicações , Osteotomia/métodos , Impressão Tridimensional , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Various corrective osteotomy techniques have been described in the literature for correcting paediatric cubitus varus. But we are still in search of the perfect technique that gives maximum possible deformity correction and cosmetic appearance that satisfies parents with minimal complications. We compared the outcomes of two technically sound osteotomy techniques having minimal postoperative lateral condyle prominence described in the literature. RESEARCH QUESTION: Is modified reverse step-cut osteotomy (MRSO) better in terms of clinical, radiological, and cosmetic outcomes than Yun's reverse V osteotomy (RVO) in pediatric cubitus varus deformity correction? METHODS: In total, 20 children with unilateral cubitus varus resulting from malunited supracondylar humerus fractures were included. Randomization was done by computer-generated random slips. A total of ten cases each were operated by MRSO and RVO techniques, respectively. Clinical, radiological, and cosmetic appearance assessments were done at the final two year follow-up and compared between the two groups. RESULTS: The mean age of children in the MRSO and RVO groups is 9.9 years (3-16) and 8.6 years (3-16), respectively. The mean pre-operative carrying angle in the deformed elbow of MRSO and RVO group was - 20.5° and - 19.5°, respectively, and the mean pos-toperative carrying angle in the corrected elbow of MRSO and RVO group was + 6.8° and + 6.5°, respectively. Regarding the lateral prominence index (LPI), a positive correlation was noted between pre-operative and post-operative periods with a value of 0.855 and 0.844 (p value: 0.001 and 0.03, respectively) in both MRSO and RVO groups, respectively. However, the change was statistically not significant when compared between the two groups (p = 0.63). There was no statistically significant difference (p > 0.05) when the clinical, radiological, and cosmetic outcomes were compared between the groups at final follow-up. CONCLUSION: The surgeon can choose either one of these techniques based on their expertise since the results of both the techniques are comparable in terms of clinical, radiological, and cosmetic outcomes.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Doenças Musculoesqueléticas , Adolescente , Criança , Pré-Escolar , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Estudos Prospectivos , Amplitude de Movimento ArticularRESUMO
BACKGROUND: Tardy ulnar nerve palsy is a common late complication of traumatic cubitus valgus. At present, the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus is still controversial, whether these two problems can be corrected safely and effectively in one operation is still unclear. To investigate the supracondylar shortening wedge rotary osteotomy combined with in situ tension release of the ulnar nerve in the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus. METHODS: Between 2012 and 2019, 16 patients who had traumatic cubitus valgus deformities with tardy ulnar nerve palsy were treated with simultaneous supracondylar shortening wedge rotary osteotomy and ulnar nerve in situ tension release. we compared a series of indicators of preoperative and postoperative follow-up for at least 24 months, (1) elbow range of motion; (2) the radiographic correction of the preoperative and postoperative humerus-elbow-wrist angles; (3) the static two-point discrimination and grip strength; and (4) the preoperative and postoperative DASH scores of upper limb function. The minimum follow-up was 24 months postoperative (mean, 33 months; range, 24 ~ 44 months). RESULTS: The mean ROM was improved from 107 ° preoperatively to 122 ° postoperatively (P = 0.001). The mean preoperative elbow wrist angle was 24.6 °, and the mean postoperative humerus-elbow wrist angle was 12.1 ° (P < 0.001). The average grip strength and static two-point discrimination improved from 21 kgf and 8 mm to 28 kgf and 4.0 mm (P < 0.001 and P < 0.001, respectively). The ulnar nerve symptoms were improved in all patients except one. The mean HASH score improved from 29 to 16 (P < 0.001). CONCLUSION: Supracondylar shortening wedge rotary osteotomy combined with in situ tension release of ulnar nerve is an effective method for the treatment of traumatic cubitus valgus with tardy ulnar nerve palsy, which restored the normal biomechanical characteristics of the affected limb and improved the elbow joint function.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Neuropatias Ulnares , Deformidades Congênitas das Extremidades Superiores , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/cirurgia , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/cirurgia , Neuropatias Ulnares/diagnóstico por imagem , Neuropatias Ulnares/etiologia , Neuropatias Ulnares/cirurgiaRESUMO
Cubitus varus deformity is the most common late complication of malunited supracondylar fracture that requires corrective osteotomy and fixation. From 2009 to 2017, 40 consecutive patients with cubitus varus deformity were included. Twenty patients underwent the conventional closing-wedge osteotomy (conventional group), while the other twenty patients underwent the 3D-printed model and osteotomy template osteotomy (3D-printed template group). The functional outcome was evaluated using the Mayo Elbow Performance Index (MEPI) Score and Flynn criteria. There were no statistically significant differences were observed regarding the humerus-elbow-wrist angle and tilting angle between the two groups, both preoperatively and postoperatively at 24 months. No statistically significant differences were observed regarding the elbow ROM (127.0 ± 4.7° VS 128.9 ± 3.8°) and MEPI score (93.5 ± 3.3 VS 94.3 ± 4.1) between the groups. All patients were satisfied both cosmetically and functionally as per the Flynn criteria and MEPI score. The conventional osteotomy and 3D-printed model and osteotomy template techniques both met the treatment requirements of cubitus varus deformity. The 3D-printed template technique showed better osteotomy accuracy, but no significant advantage regarding the functional and cosmetic results than conventional osteotomy.
Assuntos
Fraturas Mal-Unidas , Fraturas do Úmero , Deformidades Articulares Adquiridas , Deformidades Congênitas dos Membros , Cotovelo , Fraturas Mal-Unidas/complicações , Fraturas Mal-Unidas/cirurgia , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/cirurgia , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Osteotomia/métodos , Impressão Tridimensional , Amplitude de Movimento ArticularRESUMO
Cubitus varus is the most common complication following a pediatric humeral supracondylar fracture. No reports are available on the result of hemiepiphysiodesis to correct this deformity. We report the use of a transphyseal crossed cannulated screw (Metaizeau technique) in five very young children (mean 3 years and 7 months). No correction was observed after a mean of 3 years and 10 months of follow-up. The low growing capacity of the distal humeral physis makes corrective osteotomy the procedure of choice for cubitus varus deformity correction in children.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Deformidades Congênitas dos Membros , Criança , Pré-Escolar , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Epífises/cirurgia , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Úmero/diagnóstico por imagem , Úmero/cirurgia , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Deformidades Congênitas dos Membros/complicações , Osteotomia/métodosRESUMO
The term cubitus varus describes the inward inclination of the supinated forearm on the extended elbow. The deformity manifests clinically as a decreased carrying angle, decreased range of motion (ROM) along with a cosmetically unsightly appearance. The aim of the present study was to evaluate the technique of compression-distraction osteogenesis using the Ilizarov apparatus in the management of patients with post-traumatic cubitus varus deformity. The objectives were to study the impact of this method on the ROM, the Humerus Elbow Wrist (HEW) angle as well as the Lateral Prominence Index. A total of 32 patients who presented with a cubitus varus deformity of ≥10° at the elbow were retrospectively analyzed using data retrieved from a computerized hospital database. All patients had undergone a mini-incision subperiosteal osteotomy followed by application of an Ilizarov frame. Cinico-radiological follow-up was carried out at regular intervals until union was achieved and yearly thereafter. The mean time to union was 11 weeks. The mean follow-up period ranged from 2 to 12 years (mean 4.0 years). Results were graded as excellent in 25 cases (78.1%), good in 2 (6.3%) and poor in 5 case (15.6%) using the grading system of Oppenheim. The mean HEW angle at final follow-up improved from 20° of varus to 6° of valgus. The mean flexion/extension improved from 121°/-3° preoperatively to 125°/-4° at final follow-up. The Mayo Elbow Performance scores at final follow-up were excellent in 23 cases, good in 7 and fair in 2. Complications encountered included superficial pintract infections in three cases, lateral condylar prominence in one case, loss of terminal flexion in three cases and valgus over-correction in one case.