Transzygomatic Approach to Skull Base: History, Evolution, and Possibility of a Simple Modification.

The surgical approaches to anterior, middle, and lateral skull base have evolved drastically, transcending from an era of oblivion to well-defined and systematically executed, state-of-the-art, refined surgery. The transzygomatic approach, which was developed to access the nasopharynx, has been applied to versatile locations of skull base pathology, with continuous evolution and modification of the osteotomies and skin flaps involved. A simple modification is proposed which could help reach a compromise between the wide exposure provided by the hemicoronal incision and the minimally invasive preauricular approach.

History of spinal osteotomy.

Spinal deformity is one of the oldest known diseases with descriptions documented many of the earliest civilizations. Historical treatments have had little efficacy, especially in adults. However, in the modern era, there has been a rapid expansion of new technologies and surgical techniques aided by advances in supportive care that now allow the spinal surgeon to have powerful tools to correct spinal deformity. In this manuscript, we review the origins of spinal deformity surgery and the development of spinal instrumentation. The focus of the manuscript is to review the relationship of these developments to the implementation of spinal osteotomies for deformity correction.

John Rhea Barton: the birth of osteotomy.

Osteotomy is one of the most common surgical procedures performed everyday all over the world. This technique dates back to the first half of nineteenth century and to the fundamental contribution made by Pennsylvania Hospital surgeon John Rhea Barton (1794-1871), who can be considered the pioneer of modern osteotomies; this paper focuses on his life and career highlights with a description of the first corrective osteotomies for hip and knee ankylosis (documented in two fundamental papers whose original pictures are here reproduced). The success of osteotomy as a current surgical approach to treat several orthopaedic conditions is confirmation of the importance of this procedure in the orthopaedic discipline and prompted an investigation into the pioneering mind who introduced it.

Osteotomy around the knee: evolution, principles and results.

PURPOSE: This article summarises the history and evolution of osteotomy around the knee, examining the changes in principles, operative technique and results over three distinct periods: Historical (pre 1940), Modern Early Years (1940-2000) and Modern Later Years (2000-Present). We aim to place the technique in historical context and to demonstrate its evolution into a validated procedure with beneficial outcomes whose use can be justified for specific indications. MATERIALS AND METHODS: A thorough literature review was performed to identify the important steps in the development of osteotomy around the knee. RESULTS: The indications and surgical technique for knee osteotomy have never been standardised, and historically, the results were unpredictable and at times poor. These factors, combined with the success of knee arthroplasty from the 1980s onward, led to knee osteotomy being regarded as an irrelevant surgical option by many surgeons. Despite its fluctuating reputation, this article demonstrates the reasons for the enduring practice of osteotomy, not least because achieving the appropriate alignment is now recognised as the foundation step when planning any surgical intervention. CONCLUSIONS: With appropriate patient selection, accurate pre-operative planning, modern surgical fixation techniques and rapid rehabilitation, osteotomy around the knee is now an effective biological treatment for degenerative disease, deformity, knee instability and also as an adjunct to other complex joint surface and meniscal cartilage surgery. LEVEL OF EVIDENCE: V.

[Clubfoot treatment through the ages: the Ponseti method in comparison to other conservative approaches and operative procedures]. / Klumpfußbehandlung im Wandel der Zeit: Die Ponseti-Methode im Vergleich zu anderen konservativen Therapieansätzen sowie operativen Verfahren.

Clubfoot is one of the most common congenital deformities of the musculoskeletal system with incidence rates ranging from 0.6 to 6.8 per 1,000 live births. The treatment of clubfoot historically belongs to one of the oldest orthopedic therapies. By the end of the nineteenth century redressement with various tools, such as clamps, braces and casts was the standard treatment of clubfoot. Through further development of operational capabilities and the fact that soft tissue structures show amore resistant reaction to pressure and strain than the surrounding cartilage and bone, operative therapy was favored in the late twentieth century. Surgical correction involves the release of contracted capsular and ligamentous structures to varying degrees and the lengthening of tendons.In 1963 Ponseti published his method. He recognized that the internal rotation and plantar flexion of the calcaneus is the key deformity. However, his method first became known worldwide at the turn of the millennium as long-term results of release operations showed stiff scar healing and the risk of over-correction as problems in these operations.Many comparative studies have shown the superiority of the Ponseti method regarding invasiveness, primary correction rate, functional outcome and recurrence rate in both idiopathic and non-idiopathic clubfoot. In this article the current literature regarding this will be presented as well as prominent landmarks in the development of clubfoot treatment.

Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results.

Recently, the bony anatomy of the proximal tibia has gained strong interest, particularly in the cruciate ligament deficient knee. Regarding the anterior cruciate ligament (ACL), several studies outlined that a steep tibial slope (≥12 degrees) contributes to early failures after ACL reconstruction. As a consequence, the first clinical reports are available on slope reducing osteotomies in revision ACL surgery. Vice versa, biomechanical as well as clinical reports suggest that a flat slope increases the load on the posterior cruciate ligament (PCL) and might contribute to a poor result after PCL reconstruction. Since many decades, slope increasing anterior open wedge osteotomies are used to treat a symptomatic genu recurvatum. The aim of the current report is to describe different surgical techniques and report our first clinical experience of an anterior open wedge osteotomy as a sole procedure in chronic PCL deficient knees with a flat tibial slope. In six cases, a mean preoperative slope of 3.7 degrees (range = 2-5 degrees) was increased to a mean of 11.5 degrees (range = 9-13 degrees). There was one case with a delayed bone healing, which was successfully treated without loss of correction by revision internal fixation and bone grafting.

The classic: Chapter XVIII. Operative treatment in chronic articular ostitis. 1884.

This Classic article is a reprint of the original work by Virgil P. Gibney, Chapter XVIII. Operative Treatment in Chronic Articular Ostitis. An accompanying biographical sketch of Virgil P. Gibney, MD, is available at DOI 10.1007/s11999-009-1166-2 . The Classic Article is (c)1884 and is abridged from Gibney VP. Operative treatment in chronic articular ostitis. In: The Hip and Its Diseases. New York, NY, London, UK: Bermingham & Co; 1884:388-402.

Harvey Cushing's experience with cranial deformity.

Surgery for cranial deformity was associated with significant surgical morbidity during the early part of the 20th century. For this reason, Harvey Cushing was initially not in favor of surgical treatment of craniosynostosis. Later in his career, Cushing began to operate on these children, although it never became a major focus of his practice. Several examples of his patients with cranial deformity are presented, and his limited role in the development of this field is discussed.

Dega Transiliac Pelvic Osteotomy: the History of Surgical Technique Development.

BACKGROUND: Wiktor Dega originally described the surgical technique of transiliac osteotomy in 1969 in the Polish Orthopaedics and Trauma Surgery Journal. Its worldwide popularity spread just after it was presented in English by Grudziak and Ward in 2001 [1]. This paper aims to describe the development of the technique by Wiktor Dega's team. MATERIAL AND METHODS: An analysis of original papers published by Dega between 1929-1974 was performed to clarify the chronology of development of the technique. RESULTS: Dega's interest in developmental dysplasia of the hip (DDH) had begun as early as 1929, when he presented in Vilnius a paper about the aetiology and pathogenesis of the disease. The concept of transiliac osteotomy had been initially based on König's idea of shelf procedure. Dega called this procedure plastic surgery of the acetabular roof and performed it between 1927 and 1930. In 1964, Dega published a paper that described the basic concept of DDH treatment with a pelvic osteotomy termed supraacetabular semi-circular osteotomy. This procedure differed from transiliac osteotomy because it did not involve cutting the inner cortex of the ilium. In 1968 the first 'technically proper' transiliac osteotomy was performed and then described in 1969. In 1974, Dega emphasized that both the outer and inner iliac walls should be osteotomized in the transiliac osteotomy. CONCLUSION: The political situation of the 1950s and the 1960s made it difficult to freely exchange views and clinical experiences between the Western and Eastern political camps. Despite this, Wiktor Dega became a precursor of effective surgical treatment in DDH worldwide.

The True Ponte Osteotomy: By the One Who Developed It.

STUDY DESIGN: Technique and applications. OBJECTIVES: To define the anatomy, biomechanics, indications, and surgical technique of the true Ponte osteotomy. SUMMARY OF BACKGROUND DATA: The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. It has become a widely applied technique in various types of spine deformities and a frequent topic of presentations at meetings and in scientific articles. Several of them offer unquestionable evidence of an incorrect execution, with consequently distorted outcomes and erroneous conclusions. A clearing up became essential. METHODS: Our original experience is based on a series of 240 patients with thoracic hyperkyphosis operated in the years 1969-2015, at first with a standard posterior Harrington technique and then by using the Ponte osteotomy with different instrumentations. A series of 78 of them, operated in the years 1987-1997, who had Ponte osteotomies at every level, is presented. RESULTS: The average preoperative kyphosis has been corrected from 80° (range 61°-102°) to 31° (range 15°-50°) by a substantial posterior shortening. CONCLUSIONS: A number of publications use the term Ponte osteotomy loosely for by far incomplete resections and mixing it up with Smith-Petersen's osteotomy. The true Ponte osteotomy is capable of producing marked flexibility in extension, flexion and rotation, justifying its wide use in thoracic deformities, mainly in scoliosis. An exact performance of the osteotomy with adequate bony resections, including the laminae, is an absolute condition to take full advantage of its properties. LEVEL OF EVIDENCE: Level IV, therapeutic study.

History of osteochondral allograft transplantation.

Osteochondral defects or injuries represent the most challenging entities to treat, especially when occur to young and active patients. For centuries, it has been recognized that such defects are almost impossible to treat. However, surgeons have never stopped the effort to develop reliable methods to restore articular cartilage and salvage the endangered joint function. Osteochondral allograft transplantation in human was first introduced by Eric Lexer in 1908. Since that era, several pioneers have been worked in the field of osteochondral allotransplantation, presenting and developing the basic research, the methodology and the surgical techniques. Herein we present in brief, the history and the early clinical results of osteochondral allograft transplantation in human.

History of Spine Deformity in Turkey.

Spine deformities are among the most important spinal disorders, affecting health-related life quality. Although there are some studies in past centuries, most spine deformity-related studies and research has started in the last century. Many surgical techniques, performed between 1960 and 1990, made scoliosis a touchable pathology. These techniques started with Harrington"s system, wiring techniques, pedicle screw techniques, and all other universal techniques. Anterior and 360 degree techniques contributed to this process. The use of spinal osteotomies, and recent technologies such as magnetic rods, intraoperative neuromonitoring added much to the body of knowledge of literature and improved the outcome. Advancement has not been limited to surgery only and diagnostic advancements had also impact to this process. Surgical techniques performed in the west have been performed soon in our countries. Currently almost all surgical techniques for treatment of spine deformities can be performed in our country. This article reviews historical aspects related to the diagnosis and treatment of spine deformities in Turkey.

Triple osteotomy of the innominate bone. 1973.

In forty-five patients, twenty-three with congenital dislocations and the rest with paralytic or other disturbances, this new displacement osteotomy of the hip joint was done when other iliac osteotomies were considered ineffective. The patients, seven to seventeen years old, were followed two to ten years. Of the fifty-two procedures, forty were satisfactory. Most of the unsatisfactory results were in cases of myelodysplasia, peroneal atrophy, and cerebral palsy.

Günther Cohn-Stock, M.S., D.D.S., father of maxillary orthognathic surgery.

The life of Dr. Cohn-Stock is traced and the development of the anterior maxillary osteotomy is described.

Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results.

The Scarf osteotomy has proven to be a versatile and powerful procedure to correct various degrees of hallux valgus deformity. Through modifications of bone-cut lengths and in combination with a phalangeal osteotomy, most hallux valgus deformities can be addressed. In cases of extreme hypermobility of the first ray or arthrosis of the first metatarsocuneiform joint, the Lapidus operation may be more appropriate. Hallux valgus rigidus or hallux valgus with severe rheumatoid joint disease usually requires alternative procedures. The results of the Scarf osteotomy compare favorably with the results reported for other popular bunion surgeries. When choosing a procedure, the clinician should consider that the Scarf osteotomy allows the patient to ambulate postoperatively without a cast or the use of crutches, to return to bathing and a closed athletic shoe in one week, and to have bilateral surgery, which maintains cost-effectiveness and returns the patient to his or her desired lifestyle more quickly. It has been said that surgery is both a science and an art. The author often believes that bunion surgery is more art than science, hence the success of so many procedures in one surgeon's hands and the failure in another's hands. The Scarf bunionectomy is a technically demanding procedure that has a large learning curve. Once mastered, however, the Scarf bunionectomy can provide a predictable and satisfying outcome for both patient and foot surgeon.

Distal osteotomy for bunionectomy and hallux valgus correction.

Distal osteotomies are the original osteotomies performed in the first metatarsal for bunion surgery. Many of these can be fashioned to improve an abnormal DMAA. Correction of an abnormally wide first-second IM angle is a goal of the newer procedures. Lateral transposition at the osteotomy site first performed by Mitchell helps accomplish this goal. The chevron modification improves stability and offers sufficient correction for mild-to-moderate deformities. Fixation is recommended after metatarsal osteotomy. The distal chevron procedure has been associated with lower degrees of correction, but the risk of transfer metatarsalgia is minimized. Shortening is less likely compared with some distal osteotomies but can occur. Advanced age is not a contraindication for distal metatarsal osteotomy. Avascular necrosis is highly unusual after this procedure.