Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study.

Open-wedge high tibial osteotomy (HTO) is becoming increasingly popular for the treatment of varus gonarthrosis in the active patient. The various implants used in HTO differ with regard to its design, the fixation stability and osteotomy technique. It is assumed that the combination of a plate fixator with a biplanar, v-shaped osteotomy supports bone healing. So far, there are no biomechanical studies that quantify the stabilizing effect of a biplanar versus uniplanar osteotomy. We hypothesized that a significant increase in primary stability of bone-implant constructs is achieved when using a biplanar as opposed to a uniplanar osteotomy. Twenty-four fresh-frozen human tibiae were mounted in a metal cylinder, and open-wedge osteotomy (12 mm wedge size) was performed in a standardized fashion. Proximal and distal tibial segments were marked with tantalum markers of 0.8 mm diameter. Two different plates with locking screws were used for fixation: a short spacer plate (group 1, n = 12) and a plate fixator (group 2, n = 12). In six specimens of each group, a biplanar V-shaped osteotomy with a 110 degrees angulated anterior cut behind the tuberosity parallel to the ventral tibial shaft axis was performed. In the remaining six specimens of each group, a simple uniplanar osteotomy was performed in an oblique fashion. Axial compression of the tibiae was performed using a material testing machine under standardized alignment of the loading axis. Load-controlled cyclical staircase loading tests were performed. The specimens were radiographed simultaneously in two planes together with a biplanar calibration cage in front of a film plane with and without load after each subcycle. Radiostereometry allowed for serial quantification of plastic and elastic micromotion at the osteotomy site reflecting the stability provided by the combination of implant and osteotomy technique. No significant additional stabilizing effect of a biplanar osteotomy in craniocaudal and mediolateral plane was found. However, additional stability was achieved in anteroposterior (AP) and all rotational planes in those specimens fixated with a short spacer plate. In this biomechanical set-up with axial load, the additional stabilizing effect of a biplanar osteotomy did not come into effect in the presence of a long and rigid plate fixator. However, biplanar osteotomy increased the fixation stability significantly in AP and rotational planes when a short spacer plate was used. Clinically, the biplanar osteotomy promotes bone healing regardless of the implant used. Biomechanically, biplanar osteotomy is advantageous for shorter plate designs to increase primary stability of the bone-implant construct.

The athlete's foot: the grey zone behind the ankle.

Posterior ankle and heel pain is common among athletes. The most common injury in this region is that of the Achilles tendon. However, besides the Achilles tendon, pain can originate from a retrocalcaneal bursitis, posterior impingement syndrome, os trigonum syndrome, or flexor hallucis longus tenosynovitis. These pathologies often caused by overuse, but can also occur after trauma. With careful examination, and the help of MRI imaging, the distinction can be made among these pathologies and the more common Achilles tendon problems. Like most overuse injuries, the majority of cases of retrocalcaneal bursitis, posterior impingement, flexor hallucis longus tenosynovitis respond to conservative treatment. However, when this fails, open or arthroscopic surgery can be proposed. Arthroscopy is less aggressive than open surgery, with the added advantage of less patient morbidity, less post-operative pain, and early functional rehabilitation. It is becoming the surgery of choice, especially among athletes.

Dupuytren's disease: outcome of the proximal interphalangeal joint in isolated fifth ray involvement.

In this study of 38 patients, we assessed the clinical result following surgical treatment of Dupuytren's disease with isolated fifth ray involvement, particularly with respect to the proximal interphalangeal joint. Three surgical techniques were used: limited fasciectomy, segmental fasciectomy and dermofasciectomy. At a mean follow-up time of 53.6 months, there were no residual deformities nor recurrences in the metacarpophalangeal joint. At the proximal interphalangeal joint, there was an overall improvement of 45 degrees in movement with a residual flexion deformity avering 30 degrees. The recurrence rate in this series was 39%. There was no significant difference in residual deformity or recurrence rate between the various surgical techniques used. Fifth ray involvement in Dupuytren's disease remains a surgical challenge, especially at the proximal interphalangeal joint. Residual deformity and recurrence rate remain high, irrespective of the surgical technique used.

Osteoblastoma of the proximal ulna, an unusual cause of ulnar wrist pain. A case report.

During the diagnostic investigation of a patient with ulnar wrist pain, a hot spot in the proximal ulna was revealed on the technetium scintigram, which was found on radiographs to correspond to an osteolytic lesion in the proximal ulna. The lesion was resected and the histological diagnosis was an osteoblastoma. The wrist symptoms disappeared after resection of the lesion in the proximal ulna.

Benign fibrous histiocytoma of the posterior arch of C1 in a 6-year-old boy: a case report.

STUDY DESIGN: Presented is a unique case report of a rare bone tumor: a benign fibrous histiocytoma (BFH) located in the posterior arch of C1 in a 6-year-old child. OBJECTIVE: To describe a benign fibrous histiocytoma of bone and the differential diagnostic considerations based on the authors' case report. SUMMARY OF BACKGROUND DATA: A BFH is a rare tumor composed of varying degree of fibroblast-like spindle cells, foam cells, and multinucleated giant cells. Approximately 86 cases have been reported in literature. Its exact nature remains somewhat controversial. A lesion may be designated a benign fibrous histiocytoma based on clinical, radiographic, and microscopic criteria. MATERIALS AND METHODS: The clinical symptoms, plain radiographs, computerized tomography (CT), magnetic resonance images (MRI), bone scintigraphy, and histologic section of the lesion are discussed, evaluated, and compared with other benign bone lesions. RESULTS: This case is, to the best of the authors' knowledge, the first benign fibrous histiocytoma to be reported in the cervical spine of a child. Various benign lesions such as nonossifying fibroma, giant-cell tumor, fibrous dysplasia, aneurysmal bone cyst, osteoblastoma, and eosinophilic granuloma are included in the differential diagnosis. CONCLUSION: Benign fibrous histiocytoma is a rare skeletal tumor. Because of this and its nonpathognomonic microscopic features, the diagnosis can be somewhat troublesome. However, by systematically reviewing patient's symptoms, tumor location, and radiographic and microscopic characteristics, other benign lesions can be eliminated. The diagnosis of a BFH is one of exclusion.