Outcomes of Evans Versus Hintermann Calcaneal Lengthening Osteotomy for Flexible Flatfoot.

BACKGROUND: Evans (E) and Hintermann (H) lateral lengthening calcaneal osteotomies (LLCOTs) are commonly used to correct flexible flatfoot deformities. Both methods are well accepted and produce good clinical results. The aim of this study was to compare the postoperative outcomes of both osteotomies. METHODS: We retrospectively examined 53 patients with flatfoot deformities, who received surgery between October 2008 and March 2014. Seventeen E-LLCOT and 36 H-LLCOT procedures were performed during this time period, with a mean follow-up of 67.7 ± 20.6 and 40 ± 12.9 months, respectively. Data were collected using clinical and radiological examination, as well as clinical scores (Foot and Ankle Outcome Score [FAOS], University of California at Los Angeles [UCLA] activity score, numerical rating scale [NRS], and the Short-Form 36-item Health Survey [SF-36]) during regular follow-up. RESULTS: For both groups of patients, the FAOS score, pain-NRS, and SF-36 improved significantly following surgery ( P < .05). The talus-second metatarsal angle, talonavicular coverage, and naviculocuneiform overlap showed significant correction ( P < .05). Postoperatively, radiographic degenerative changes were detected in the calcaneocuboid (CC) and subtalar joint in both groups of patients: 41% and 18% after E-LLCOT compared with 25% and 14% after H-LLCOT, although these changes did not have any clinical relevance ( P < .05). No secondary arthrodesis was necessary. There were no significant differences in the clinical or radiological outcome parameters when compared between the 2 groups. CONCLUSION: Both surgical techniques resulted in a significant improvement of clinical outcome scores and led to good radiological correction of flatfoot deformities. It appears that the CC joint develops less degenerative changes following the H-LLCOT procedure. LEVEL OF EVIDENCE: Level III, comparative series.

Non-invasive extendible endoprostheses for limb reconstruction in skeletally-mature patients.

We describe the application of a non-invasive extendible endoprosthetic replacement in skeletally-mature patients undergoing revision for failed joint replacement with resultant limb-length inequality after malignant or non-malignant disease. This prosthesis was developed for tumour surgery in skeletally-immature patients but has now been adapted for use in revision procedures to reconstruct the joint or facilitate an arthrodesis, replace bony defects and allow limb length to be restored gradually in the post-operative period. We record the short-term results in nine patients who have had this procedure after multiple previous reconstructive operations. In six, the initial reconstruction had been performed with either allograft or endoprosthetic replacement for neoplastic disease and in three for non-neoplastic disease. The essential components of the prosthesis are a magnetic disc, a gearbox and a drive screw which allows painless lengthening of the prosthesis using the principle of electromagnetic induction. The mean age of the patients was 37 years (18 to 68) with a mean follow-up of 34 months (12 to 62). They had previously undergone a mean of six (2 to 14) open procedures on the affected limb before revision with the non-invasive extendible endoprosthesis. The mean length gained was 56 mm (19 to 107) requiring a mean of nine (3 to 20) lengthening episodes performed in the outpatient department. There was one case of recurrent infection after revision of a previously infected implant and one fracture of the prosthesis after a fall. No amputations were performed. Planned exchange of the prosthesis was required in three patients after attainment of the maximum lengthening capacity of the implant. There was no failure of the lengthening mechanism. The Mean Musculoskeletal Tumour Society rating score was 22 of 30 available points (18 to 28). The use of a non-invasive extendible endoprosthesis in this manner provided patients with good functional results and restoration of leg-length equality, without the need for multiple open lengthening procedures.

Limb lengthening and deformity correction in children using hexapodal external fixation: preliminary results for 36 cases.

Limb deformities in children can be corrected using different techniques, notably external fixation following the Ilizarov principles. However, correction can be difficult in cases of multiple deformities. In 1994, Charles Taylor developed a new computer-assisted hexapodal external fixator system to treat these pathologies, the Taylor Spatial Frame. The objective of this study was to evaluate the results obtained with this technique in treating lower-limb deformities in children. Thirty-six patients were included in this prospective study, with a mean age of 11.1 years. The etiologies were distributed into six groups: congenital pathologies in 17 cases, fractures in five cases, post-traumatic pathologies in two cases, postinfectious sequelae in three cases, achondroplasia in three cases, and other causes in the last six cases. A total of 67 deformities in the three spatial planes were found in the entire group of patients. The procedure consisted of lengthening, correcting the axis, or both simultaneously. All the patients were managed with the same protocol: placement of an external fixator, AP and lateral X-rays, and planning of the correction using dedicated software. In this group of 36 patients, the fixator was worn for a mean 183 days; when lengthening was performed, a mean 4.3cm was gained with a healing index of 38.2 days/cm. Of the 67 initial deformities, 91% were corrected. The most frequently encountered complications were a superficial infection in 22.2% of the cases; one deep infection was also noted as well as three bone regenerate fractures. Use of this computer-assisted fixation system seems effective in treating complex deformities of the limbs in children, and allows treating several deformities simultaneously.

Hemimelia paraxial peronea. Tratamiento mediante elongación ósea con distractores Orthofix. (Comunicación preliminar) / Peroneal paraxial hemimelia. Distraction bone lengthening by Orthofix external fixator. Preliminary report

Se analizan 9 pacientes portadores de hemimelias de diversos grados algunas con ausencia total de peroné y de los dos últimos rayos del pie y otras con hipoplasia del peroné, sin lesión de los rayos del pie. Se hace análisis clínico y radiológico de la presencia o no de las deformidades previas para establecer medidas prequirúrgicas como son deformidad del talón en valgo con angulación anterior de la tibia; contractura en flexión de la rodilla y equino del tobillo. En base a la edad cronológica y edad ósea se prevé el crecimiento a futuro de las extremidades para identificar si requiere elongaciones subsecuentes. Se identifican zonas de riesgo para la colocación de los clavos así como para el sitio de la osteotomía y en caso de la angulación de la tibia se realiza corrección de ésta durante la colocación del distractor. Se comparan observaciones obtenidas en nuestra clínica de alargamiento óseo de nuestro Servicio de Ortopedia, con las observaciones de otros autores de reportes internacionales

Alargamiento óseo con el fijador del Dr. Espinosa. Experiencia de 5 años en el Instituto Nacional de Pediatría / Bone lenghtening by Espinosa external fixator. Experience of 5 years of National Institute of Pediatrics

Objetivo: Determinar el porcentaje del alargamiento óseo en pacientes con discrepancia de miembros pélvicos, con respecto al miembro contralateral, al terminar el tratamiento con el fijador del Dr. Espinosa. Estudio retrospectivo, descriptivo, longitudinal y observacional. Departamento de Ortopedia Pediátrica del Instituto Nacional de pediatría, del primero de julio de 1995 al 24 de febrero de 1996. Se seleccionaron los expedientes clínicos y radiológicos de los pacientes elongados por discrepancia de miembros inferiores con el fijadro de Epinosa, en el lapso citado, que fueron intervenidos quirúrgicamente en el Instituto. En dichos pacientes se investigó: edad, discrepancia con respecto al miembro contralateral, lapso transcurrido, consolidación obtenida y complicaciones. Doce pacientes cumplieron con los criterios de selección del estudio. Su edad promedio fue de once años y medio, con una desviación estándar (ñ DE) de dos años 7 meses, La discrepancia observada fue de 7.07 (ñ 2.33) cm. Los pacientes estuvieron 9 meses y medio (ñ 2 meses) en tratamiento y se obtuvo el 96.4 por ciento (ñ 4.6) del alargamiento deseado. En 7 casos no hubo complicaciones. Se presentó pie equino en 3 pacientes; en otro caso pseudoartrosis y mala alineación en otro. Los pacientes en los que permaneció más tiempo el fijador, estaban en una percentila menor de talla. Sin embargo, en todos los pacientes se logró una adecuada consolidación

Anormalidades congénitas del fémur / Congenital absence of the radius

Los pacientes con anormalilades congénitas del fémur presentan múltiples problemas que difícilmente son vistos por un cirujano ortopedista en forma individual. En este estudio se analizan el tratamiento de 62 anomalías congénitas del fémur en 60 pacientes, tratados en el Hospital Shriner para Niños Lisiados, de la Ciudad de México, en el periodo comprendido entre enero de 1982 y diciembre de 1991. Para todos los pacientes se utilizó la clasificación de Pappas. Los pacientes de la clase I a la VI se identifican al nacimiento, y todos requieren de tratamiento protésico. Los pacientes de las clases VII a la IX se deben evaluar en forma individual y decidir cuáles son candidatos para igualar la longitud de las extremidades. Independientemente de la clasificación se debe individualizar el tratamiento; esto depende de las malformaciones asociadas en la extremidad pélvica (hemimelia paraxial longitudinal, hipoplasia tibial y/o peronea, etc.)

Fracturas, falta de unión y alargamientos óseos: tratamiento por FED / Fractures, union defect and bone lengthening: treatment by DEF

Presentación descriptiva de una experiencia que se viene trabajando desde 1977 -más de mil intervenciones- para el tratamiento de fracturas abiertas, pseudoartrosis, alargamientos, transporte óseo, fracturas de cadera, fracturas de pelvis, corrección de deformidades y otros, utilizando variedades de montajes externos. Se complementa con un breve análisis clínico de los resultados en los logros de la reducción, de la inmovilización, del proceso consolidante así como del manejo y evolución de los tejidos blandos. En la técnica operatoria se emplea un (a) `tracto compresor' para cualquiera de las opciones como medio auxiliar transitorio y/o, (b) `conjuntos desechables' con los cuales se conforma el fijador, aparato que porta el paciente hasta el final del tratamiento. Para un área económicamente deprimida, con esta alternativa que denominamos `Fijación Externa Descartable' (FED), hemos solucionado el problema de la disponibilidad de los medios para hacer tratamientos por fijación externa en todo su ámbito, al alcance cotidiano tanto en el pequeño pueblo como en la gran ciudad

Distraction osteogenesis of a congenital amputation at the elbow.

A case is described demonstrating the effectiveness of distraction osteogenesis for the lengthening of a short below elbow congenital amputation. To our knowledge this technique has not been previously used in a patient with a congenital amputation. The surgical technique of corticotomy and postoperative lengthening is detailed. The result converted the level of patient performance from elbow disarticulation to functional below elbow status.