Mid-Term Follow Up Results of Subtalar Distraction Arthrodesis Using a Double Bone-Block for Calcaneal Malunion

PURPOSE: This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. MATERIALS AND METHODS: From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. RESULTS: The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8degrees in talocalcaneal angle, 5.1degrees in talar declination angle and 5.3degrees in talo-first metatarsal angle. CONCLUSION: Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis.

Desfechos clínicos de tratamento cirúrgico de más uniões ou não consolidadas do tálus / Clinical outcomes of surgical treatment for talar malunions and nonunions

Objetivo: apresentar nossas experiências no tratamento de más uniões ou não consolidações talares. Método: entre janeiro de 2000 e setembro de 2009, 26 pacientes com má união ou nãounião depois de fraturas do tálus foram submetidos a tratamento cirúrgico de acordo com os diferentes tipos de deformidade talar. Os desfechos do tratamento foram avaliados pela escala tornozelo-retropé da AOFAS, assim como por radiografias simples. Resultados: 20 pacientes ficaram disponíveis para acompanhamento por 30 (24 a 60) meses. Não houve problema de cicatrização ou infecção das feridas e foram obtidas uniões sólidas em todos os pacientes. As uniões radiológicas foram atingidas em tempo médio de 14 (faixa de 12 a 18) semanas. O tempo médio para concluir o apoio de carga foi 16 (faixa de 14 a 20) semanas. O escore AOFAS médio aumentou significantemente de 36,2 (27 a 43) para 85,8 (74 a 98). Conclusão: as intervenções cirúrgicas das fraturas mal-unidas ou não consolidadas dos tálus podem produzir resultados satisfatórios e o procedimento apropriado deve ser adotado, de acordo com diferentes tipos de deformidades pós-traumáticas. Nível de Evidência: IV, Estudo Retrospectivo.

Objective: To present our experiences of treating talar malunions and nonunions. Method: between January 2000 and September 2009, 26 patients with malunions or nonunions after talar fractures underwent surgical treatment according to different types of talar deformities. The treatment outcomes were evaluated using AOFAS ankle-hindfoot scale as well as plain radiographs. Results: 20 patients were available for follow-up for 30 (range, 24 to 60) months. No wound healing problems or infections occurred and solid unions were achieved in all patients. Radiological unions were achieved at a mean time of 14 (range, 12 to 18) weeks. The mean time to complete weight-bearing was 16 (range, 14 to 20) weeks. The mean AOFAS score increased significantly from 36.2 (range, 27 to 43) to 85.8 (range, 74 to 98). Conclusion: surgical interventions for malunions and nonunions after talar fractures can bring about satisfactory outcomes, and the appropriate procedure should be adopted according to different types of posttraumatic deformities. Level of Evidence: IV, Retrospective Study.

TMJ total joint prosthesis for condylar fracture malunion / Prótesis articular total de ATM para malunión de fractura condilar

In the international literatura exist some information related to temporomandibular joint (TMJ) involvement in condylar fracture malunion; the treatment is variated being executed with a bone reconstruction, ramus vertical osteotomy or condilar plate. This case demonstrates that TMJ replacement with prosthetic joint is technically possible and appropriate in the case of malunion of condylar fracture.

La literatura internacional presenta información asociada a la mal unión de fracturas condilares de laarticulación temporo mandibular; el tratamiento es variado siendo ejecutado con reconstrucciones óseas, osteotomía vertical de rama mandibular o instalación de placas con forma condilar. Este caso demuestra que el reemplazo de ATM con prótesis articular es técnicamente posible y apropiado en casos de malunion de fracturas condilares.

Pauwel's osteotomy and osteosynthesis in patients. with non-union of femoral neck fractures

To evaluate the results of Pauwel's ostetotomy and oseosynthesig in patients with non union of femoral neck fractures. This Study was conducted in the Orthopaedic Unit, Nishtar Hospital, Multan during the period of 1989-1998. A total of 30 patients were included in the study. Thirty cases of neglected fracture neck of femur treated in Nishtar Hospital Multan from 1989-1998. Five patients were treated first with traction where greater trochanter migrated a way up to bring it down to the proper level. Then osteotomy was done. In 25 cases Pauwels' osteotomy was primarily done and fixed with 120-degree osteotomy plate. This is a reliable method of dealing with non-union of the Fracture neck of the femur in young adults

New implant and technique for valgus osteotomy with dynamic osteotomy plate

With the increased rate of orthopedic trauma especially proximal femur, neck femur fractures, non-union, malunion and hip osteoarthritis; and the increased production of instrumentation, we designed a new implant for valgus osteotomy with dynamic osteotomy plate. This implant overcomes a lot disadvantages occurred with the other implants. The aim of this work is to present this implant and its results in treating union problems [nonunion and malunion] in proximal femur and neck femur fractures. 30 patients with different hip problems were included in this study. From April 2000 to May 2005. 12 females and 18 males. Their age ranged from 21 to 68 years old. All patients submitted to a period of follow up [x-rays and clinical evaluation]. This study reported a significant results in early union, correction of the deformity and good hip range of movement with the use of the valgus osteotomy dynamic plate. In conclusion there is a marvelous results and better outcomes with use of this implant. This paper had been presented in: The 1st SGH group international orthopedic conference Riyadh, KSA in sept. 2002. The annual international congress of the EOA in nov. 2001 Heliopolis Sheraton Cairo Egypt. And the author was awarded

Biological fixation of complex fractures of tibia and femur with the use of standard plates and specially designed plates

Tibial and femoral fractures of high velocity injuries are managed in our department following principles of internal fixator with high rate of union, good surgical outcome regarding alignment, reduction and function with specially constructed plate making the reconstructive interlocking system of little interest. The radiological follow up shows earlier union with callus formation. The technique is simple and percutaneous under x-ray control. In late follow up there is preservation of the anatomy and respect of subtrochantric region. The number of cases is increasing now almost over a period of time of 5 years including different types of femoral and tibial fractures fresh and old and as we gained more experience we had extended the indications of biological fixation to include cases with mal and non-union. This paper had been presented,discussed and accepted in: The annual international congress of the EOA in december 2003 Mena House, Cairo, Egypt. And the author was awarded

Cubitus varus--correction by distraction osteogenesis.

Cubitus varus deformity in thirty children was corrected by gradual medial opening wedge osteotomy. The osteotomy was stabilized and distracted by simple external fixator-cum-distractor. The patients of both sexes and age from 6 to 14 years, had varus deformity from 17 degrees to 43 degrees. We achieved good to excellent results in 28 cases as regards to correction of deformity and range of motion at elbow joint. None of the cases had neurological deficit or permanent stiffness. One case had fair result due to under-correction and another case had a poor result as osteotomy united before correction. The main complication faced was superficial pin-site infection particularly in summer season and a in fatty children but was managed by good pinsite dressing and care. The technique has been found to be quite effective, technically simple, cosmetically acceptable and with little, if any, lazy S deformity.

Como planejar osteotomias corretivas para fraturas consolidadas com desvios angular e rotacional, com um único corte de serra / Planning corrective osteotomies for consolidated fractures with angular and torsion deformity, using a single bone cut

É apresentada metodologia simplificada de planejamento e confecçao de osteotomia corretiva para deformidades secundárias a fraturas e cirurgias, com consolidaçao em mau alinhamento angular e torsional, mediante um único corte de serra.