Clinical Outcomes and Long-term Survivorship After Osteochondral Autologous Transfer Combined With Valgus High Tibial Osteotomy: An Analysis After 19 Years With 56 Patients.

BACKGROUND: Osteochondral defects of the medial femoral condyle combined with varus malalignment in young and active patients are a debilitating condition, which can result in early osteoarthritis. Osteochondral autologous transfer (OAT) combined with valgus high tibial osteotomy (HTO) might therefore be a comprehensive solution to maintain long-term knee function. PURPOSE/HYPOTHESIS: The purpose of this study was to report clinical results and survivorship after combined OAT and valgus HTO for symptomatic osteochondral defects of the medial femoral condyle in the setting of varus malalignment at a long-term follow-up. It was hypothesized that undergoing combined OAT and valgus HTO would produce favorable clinical results along with a low rate of conversion to arthroplasty. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients treated between 1998 and 2008 with combined valgus HTO and OAT for deep osteochondral defects of the medial femoral condyle and concomitant varus malalignment >2° without meniscal repair/transplantation, osteoarthritis, or ligamentous instability/reconstruction were included. The survival rates of this combined procedure were evaluated. Failure was defined as conversion to knee joint arthroplasty during the follow-up period. Patient-reported outcomes were collected pre- and postoperatively, including the Lysholm score, visual analog scale score, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale score, and subjective level of satisfaction (scale 0-10). RESULTS: Of 74 patients who were included for 10-year follow-up, 3 had died. A total of 15 patients were lost to follow-up, so 56 patients could be reevaluated, for a follow-up rate of nearly 80%. The mean age at surgery was 38.8 ± 9.9 years (range, 19.9-62.4 years), and the mean follow-up time was 18.9 ± 3.0 years (median, 18.8 years; range, 14.1-24.8 years). The survival rates were 87% at 10 years, 86% at 15 years, and 77% at 19 years after surgery. At final follow-up, the Lysholm score showed a mean increase of 39 points (95% CI, 25.4-50.0 points; P < .001) from 40 points to 79 points, representing a significant improvement. Overall, 96% of patients surpassed the minimal clinically important difference (MCID) for the Lysholm score. The visual analog scale score decreased by a mean of 4.8 points (range, 5-10 points) from 7.5 points to 2.7 points (P < .001), and 80% of patients surpassed the MCID. The mean Tegner Activity Scale score was 4.5 ± 1.6, and the mean KOOS subscale scores at final follow-up were as follows: Pain: 81 ± 21 (range, 19-100), Symptoms: 80 ± 22 (range, 21-100), Activities of Daily Living: 85 ± 21 (range, 18-100), Sports: 68 ± 32 (range, 0-100), and Quality of Life: 67 ± 28 (range, 0-100). Overall, 78% of the patients were satisfied with the results of the operation. CONCLUSION: The combination of OAT and valgus HTO presents a viable treatment option for patients affected by osteochondral defects of the medial femoral condyle and concurrent varus malalignment. A sustained and substantial improvement in clinical outcomes, significantly reduced pain severity, and a high rate of long-term survivorship can be anticipated in the long-term follow-up.

Enhancing precision and safety in dental surgery - the advantages of piezosurgery.

Piezosurgery in dentistry is an innovative surgical technique utilizing ultrasonic vibrations to precisely cut bone tissue while minimizing damage to surrounding soft tissues. This method is particularly advantageous for delicate procedures in oral and maxillofacial surgery, including bone graft harvesting, sinus lifts, and tooth extractions. Piezosurgery operates on the principle of piezoelectricity, discovered by Jacques and Pierre Curie in the 19th century, where a piezoelectric crystal converts oscillating electric fields into mechanical vibrations. Devices used in piezosurgery generate ultrasonic frequencies (25-30 kHz) that enable linear vibrations and controlled cutting, selective for mineralized tissues.The technology offers significant benefits over conventional surgical methods, including improved visibility, precise and smooth cuts, and a reduced risk of soft tissue damage. Clinical applications of piezosurgery demonstrate its effectiveness in preserving vital cells such as osteoblasts and osteocytes, promoting faster healing, and better osseointegration of implants. Specialized inserts and operating modes enhance its versatility for various surgical needs. Piezosurgery has shown to lower postoperative complications and enhance patient safety in complex procedures like sinus lifts and bone splitting. This advanced surgical technique represents a significant improvement in dental and oral surgery, offering enhanced precision, safety, and clinical outcomes, ultimately improving the standard of care and patient satisfaction.

Application of a customized 3D-printed osteotomy guide plate for tibial transverse transport.

Enhance the efficiency of tibial transverse transport by employing customized 3D-printed osteotomy guide plates and striving to improve precision through CT evaluation for enhanced guide design. 17 diabetic foot patients were treated with the plate for tibial transverse transport. Preoperatively, we collected DICOM data from the affected tibia's CT and designed the geometric parameters of the tibial cortical bone window. A customized 3D-printed osteotomy guide plate was then fabricated using 3D printing technology. Postoperative X-ray and CT evaluations, conducted at two and five weeks post-surgery, assessed five crucial geometric parameters of the bone window. Measurements included the distance from the upper edge of the tibial cortical bone window to the tibial plateau, the distance from the anterior edge of the tibial cortical bone window to the bone ridge, the height of the tibial cortical bone window, the center-to-center distance between the 4.0 mm diameter Schanz pin and the osteotomy Kirschner pin, and the center-to-center distance of the 4.0 mm diameter Schanz pin. These measured parameters were subsequently compared to the preoperative design parameters. The Clinical trial registration number is ChiCTR2400087174. CT measurements showed no significant differences (P > 0.05) from preoperative design parameters across the five evaluated aspects. The average osteotomy duration was 35 ± 15 min with no bone window fractures. The bone window aligned effectively with the tibial shaft, achieving complete incorporation after distraction. A 4 to 8-month postoperative follow-up confirmed full healing of the tibial surgical wound and diabetic foot wounds. Utilizing customized 3D-printed osteotomy guide plates in tibial transverse bone transport surgery enables accurate translation of preoperative virtual designs into real-time procedures, enhancing surgical efficiency and quality.

Oblique Dorsiflexion Osteotomy of the Distal Tibia for Fixed Ankle Equinus: Surgical Technique.

Aim: There are significant challenges in the treatment of a severe rigid ankle equinus caused by a flat-topped talus, arthrogryposis, burn sequelae, or extensive scarring. Conventional approaches, such as soft tissue releases, often fail due to joint incongruence or compromised soft tissues, thereby necessitating supramalleolar osteotomies. The classic transverse supramalleolar osteotomy (TSO) of the distal tibia can lead to secondary anterior translation of the centre of rotation of the ankle and alters mechanical and anatomical axes. An alternative technique involves an oblique closing wedge osteotomy of the distal tibia, with a fulcrum near the ankle joint. This technical note delineates the planning parameters and procedural steps for the oblique dorsiflexion osteotomy of the distal tibia (ODODT). Method: Using an anterior approach to the distal tibia, the "alpha angle," which determines the size of the closing wedge required for the foot to be plantigrade, is resected with a fulcrum at the most posterior part of the ankle joint, ensuring that the posterior cortex remains intact. The inclination of this resected wedge is planned preoperatively and is referred to as the "beta angle." This aims to equalise the lengths on both sides of the osteotomy. For osteotomy fixation, 2 or 3 cannulated screws in lag mode are employed. Postoperatively, a short cast boot is used for 6 weeks. Results: The ODODT is a salvage solution for severe rigid ankle equinus when first-line foot and ankle procedures are impractical due to tibiotalar incongruence or poor soft tissues. Advantages include minimal translation of the centre of rotation of the ankle, excellent stability when the posterior cortex remains intact, avoidance of large internal fixation devices, and cost-effectiveness, making it suitable for low-resource settings. How to cite this article: Olleac R, Farfan F, Acosta L, et al. Oblique Dorsiflexion Osteotomy of the Distal Tibia for Fixed Ankle Equinus: Surgical Technique. Strategies Trauma Limb Reconstr 2024;19(2):104-110.

The Outcome of Corrective Transverse Osteotomy in Paediatric Tibia Vara.

Background: Tibia vara is a three-dimensional deformity of the proximal tibia, varus, internal tibial torsion and procurvatum. It is an uncommon deformity with the surgical management varied. This study describes the outcomes of tibia vara management using a corrective transverse osteotomy in one centre. Materials and methods: A retrospective cohort study was conducted involving eight patients with tibia vara (ten tibias). Consent was obtained for treatment using an acute corrective osteotomy. Measurements of Drennan's angle, the tibiofemoral angle (TFA) and the procurvatum angle were measured preoperatively and postoperatively both just after surgery and at 1 year. A validated questionnaire-the Knee Outcome Survey of Activity Daily Living (KOS-ADL)-was utilised to assess clinical function and outcome. Also recorded were the intraoperative and postoperative complications, the radiological lower limb alignments, the union rate and the recurrence of deformity. Results: There were eight patients involved in this study with a total of ten tibias (six with unilateral tibias and two with bilateral tibias). The mean age of the patients was 11.3 years old (ranging from 8 to 15 years old) with most males (five males and three females). The affected tibias were 6 right sided and 4 left sided. Measurements of Drennan's angle, the TFA and the procurvatum angle were used to determine lower limb alignment preoperatively, postoperatively (immediate post-surgery) and at 1-year follow-up. Functional parameters were measured using the KOS-ADL. A descriptive analysis between the preoperative and postoperative variables was done. The mean for Drennan's angle was 21.6 (±5.2) preoperatively, 3.6 (± 2.3) postoperatively and 4.9 (±2.8) at 1-year follow-up. The TFA was improved from 22.6 (±6.1) preoperatively to 3.5 (±2.8) postoperatively and 4.4 (±2.0) at 1-year follow-up. The procurvatum angle was improved preoperatively from 8.20 (±7.5) to 2.40 (±2.5) postoperatively and 2.20 (±2.5) at 1-year follow-up. At the latest follow-up, the ADLS mean score was 98.5 (±2.6) while the SAS mean score was 97.5 (±3.3). The mean length follow-up period was 2 years (ranging from 1 year to 3 years). None of the patients developed postoperative complications with all achieving union without deformity recurrence in the period of observation. Conclusion: This study revealed that acute correction via a corrective transverse osteotomy of the tibia is a safe and effective method in treating tibia vara. How to cite this article: Irwan MA, WH Chan, Anuar Ramdhan MI, et al. The Outcome of Corrective Transverse Osteotomy in Paediatric Tibia Vara. Strategies Trauma Limb Reconstr 2024;19(2):111-117.

Medial Closing Wedge High Tibial Osteotomy Accurately Corrects Genu Valgum without Iatrogenic Deformity or Complications: A Consecutive Series of Thirty-one Procedures.

Introduction: Angular deformities of the tibia and femur lead to mechanical axis deviation (MAD) of the lower limb and malorientation of the joints adjacent to the deformity. The current study analyses the outcomes of using a medial closing wedge high tibial osteotomy (MCWHTO) for the management of genu valgum with high medial proximal tibial angle (MPTA), and combined MCWHTO with lateral opening-wedge distal femoral osteotomy (LOWDFO) in the setting of concomitant genu varum with low lateral distal femoral angle (LDFA). Methods: There were 18 high tibial osteotomy (HTO)-only and 13 combined HTO + distal femoral osteotomy (DFO) procedures performed. The primary radiographic outcome variables included postoperative MPTA and MAD (in mm). The accuracy of MAD correction was expressed as a percentage. The postoperative posterior proximal tibial angle (PPTA) and limb length discrepancy (LLD) were also measured as secondary radiographic outcome variables. The clinical outcome variables included intraoperative surgical complications (e.g., hinge fracture), all-causes for revision, union rate, time to union, and postoperative knee range of motion. Functional outcomes used included the LDSRS, PROMIS, and EuroQOL scores. Results: The mean preoperative MPTA was 92.9° (SD = 1.81, range: 88-96). After surgical correction, the mean MPTA was 86.0° (SD = 1.80, range: 83-90) (p < 0.0001). The mean preoperative MAD was 32.5 mm (SD = 20.16, range: 10-77) lateral to the centre of the knee joint. The mean postoperative MAD was 2.44 mm medial to the centre of the joint (SD = 7.13, range: 13 medial - 15 lateral) (p < 0.0001). The mean change in MAD achieved through surgical correction was 38.16 mm (SD = 17.94, range: 13-77). The accuracy of MAD correction was 96.1% (SD = 0.06%, range: 81.25-100%). The time to unassisted WB was a mean of 75 days (SD = 44.5, range: 44-242).There was a single stable hinge fracture and one case of chronic regional pain syndrome diagnosed. There were no cases of non-union and no indications for revision surgery in any case. Conclusion: Medial closing wedge high tibial osteotomy is an effective surgical procedure for the management of genu valgum deformity. The MPTA, LDFA, and MAD can be accurately corrected without significantly altering PPTA or limb length. It may be combined with open lateral distal femoral osteotomy for cases with femoral and tibial contributions to deformity without significantly impacting clinical outcomes. Functional outcomes, specifically relating to self-image are significantly improved after the MCWHTO has been performed. How to cite this article: Sheridan GA, Page BJ, Greenstein MD, et al. Medial Closing Wedge High Tibial Osteotomy Accurately Corrects Genu Valgum without Iatrogenic Deformity or Complications: A Consecutive Series of Thirty-one Procedures. Strategies Trauma Limb Reconstr 2024;19(2):82-86.

Surgical approach to congenital nasal dermoid sinus cyst in adult with external rhinoplasty and endoscopic approach: a case report.

Introduction and importance: Nasal dermoid sinus cysts (NDSCs) are rare congenital nasal lesions which typically arise in early childhood. Complete surgical excision is the only therapy, and many approaches have been used according to the location and the extension of the mass. Several studies have advocated external rhinoplasty and endoscopy. Case presentation: A 21-year-old female presented with a mass on the root of the nose, which appeared since childhood, and enlarged after puberty. Investigations including imaging revealed a lobulated mass extending from the osteocartilaginous junction towards the nasion, affecting the left lateral nasal wall. And its upper pole was resting on the floor of the left frontal sinus. Complete resection was performed using external rhinoplasty and endoscopy approaches, which improved esthetic results. Lateral osteotomy was used to compensate for the lateral nasal bone loss by narrowing the width of the nose. After 10 weeks of follow-up, no complications occurred, and the patient was satisfied with the cosmetic results. Clinical discussion: Nasal dermoid sinus cysts are congenital midline nasal lesions that can present as an isolated mass, or associated with intracranial extension. External rhinoplasty and endoscopy approaches are recommended for complete excision of NDSCs extending to the anterior skull base, especially when there is no intracranial involvement or in case of small intracranial extension. These two methods allow for repairing bone defects of the anterior skull base and improve esthetic results. However, in cases of large intracranial extension, craniotomy is preferred. Conclusion: The surgical approach used in the treatment of nasal dermoid sinus cysts should be a minimally invasive technique that reduces bone morbidity and provides good cosmetic results.

Successful Management of a Neglected Talonavicular Joint Dislocation Using Corrective Osteotomy and Subtalar Fixation: A Case Report.

The complete loss of articular relationships between the talus and navicular bone is known as talonavicular joint (TNJ) dislocation. Medial dislocation of the TNJ is more common than lateral dislocation. Lateral dislocation is usually associated with a fracture of the calcaneocuboid joint. Surgeons encounter difficulties when treating these dislocations. It occurs following high-energy trauma and is managed with immediate closed reduction of the joint and immobilization, but some complicated cases require open reduction and fixation to achieve alignment, strength, and function. This case report describes a six-month-old neglected case of TNJ dislocation managed with corrective osteotomy and subtalar fixation. Fusion of the talonavicular and talocalcaneal joints was performed. This procedure had a satisfactory outcome, as the patient was completely relieved of pain.

In-house CAD/CAM fabricated repositioning guide in maxillary repositioning after Le Fort I osteotomy.

OBJECTIVE: This study aimed to compare the accuracy of two transferring methods, which are the intermediate splint made by computer-aided design (CAD)/computer-aided manufacturing (CAM) and the customized maxillary repositioning guide for orthognathic surgery. MATERIALS AND METHODS: Patient data regarding virtual surgical simulations were collected. For analyzing the accuracy, the postoperative cone-beam computed tomography and preoperative simulation data were superimposed. The x, y, and z coordinates were obtained at three landmarks in the maxillary dentition, and the linear and angular differences between the surgical simulation and the actual surgery were evaluated. RESULTS: Thirty-three patients were included in this study, 16 in the splint group and 17 in the guide group. One coordinate in the guide group and nine in the splint group showed errors of >2 mm, with a statistically significant difference. There was no significant difference between the two groups in the three-dimensional error distance at each reference point. In most measurements, the interquartile range of the guide group showed a narrower distribution than that of the splint group. CONCLUSION: It is more advantageous to use a customized maxillary repositioning guide than an intermediate splint made via CAD/CAM to obtain an accuracy within the 2 mm discrepancy range.

Evaluation of soft tissue profile changes around the nose and upper lip following maxillary anterior alveolar osteotomy with Wassmund and Wunderer technique in Japanese.

PURPOSE: The extent to which maxillary anterior alveolar osteotomy alters the facial profile remains unclear. The present study retrospectively analyzed and evaluated changes in maxillary anterior fragments and soft tissue from the nose to upper lip from pre- to postoperatively in patients who underwent the Wassmund and Wunderer (WW) technique. METHODS: Thirty-seven Japanese patients with maxillary prognathism underwent orthognathic surgery with the WW technique were retrospectively included in the present study. Changes in both hard- and soft-tissue landmarks and correlations between both tissues were evaluated using lateral cephalograms taken immediately before and ≥6 months after orthognathic surgery. RESULTS: The maxillary anterior segment showed predominantly posterior movement, with only slight upward movement. Posterior shift and lingual inclination of the maxillary anterior teeth were prominent. As for soft tissues, the change in the nasal tip was small and posterior change was large in the subnasal and upper lip areas. Nasolabial angle, nasal height, and inclination of nasal tip increased, while upper lip protrusion, nasal tip angle, and philtrum length decreased. Correlations were found between posterior changes in hard tissues and posterior changes in soft tissues. Among these, posterior changes and lingual inclination of the maxillary anterior teeth strongly correlate with posterior changes of the upper lip. CONCLUSION: Posterior shift of the maxillary anterior segment using the WW technique is useful because it can greatly improve the protrusion of the upper lip while minimizing nasal morphological changes, and the positioning of the maxillary anterior teeth may be an important key factor.

Neglected Ipsilateral Non-Union Neck of Femur with Shaft of Femur Non-Union in A Young Patient and Its Management - A Rare Case Report.

Introduction: The incidence of ipsilateral neck of femur fracture with the shaft of femur going for non-union is not known. Management of this concomitant non-union can be a daunting task in terms of fixation strategy and its outcome. Case Report: In this article, we report a case of a 25-year-old male with ipsilateral neck of femur with shaft non-union. We have done open reduction and dual plating with bone grafting for the shaft of the femur followed by valgus subtrochanteric osteotomy with dynamic hip screw and impaction bone grafting for the neck of femur non-union. Conclusion: The main principle in treating the neck of femur non-union is biomechanical correction of shear forces into compression forces by valgus correction and impaction bone grafting aids fracture healing. Dual plating with bone grafting gives optimal results in shaft non-union.

How does cruciate ligament rupture treatment affect range of motion in dogs?

This study aimed at evaluating the changes in passive range of motion (ROM) of the stifle joint associated with cranial cruciate ligament (CCL) rupture in dogs and assessing whether the surgical treatment carried out on the affected joints affected additional changes. A retrospective cohort study design was used. The clinical records of dogs treated with tibial tuberosity advancement (TTA), tibial plateau leveling osteotomy (TPLO) and tight rope (TR) were reviewed as were the extension angle (EA), flexion angle (FA) and lameness. The data recorded at T0, before surgery, were compared with the data at 1 month and 6 months post-surgery. The data were classified as normal or abnormal. The main results obtained one month after surgery indicated that dogs treated with TTA showed a significant worsening of flexion (the FA was abnormal in 69.6% of dogs at T0 and 80.4% at T1 with p = 0.0208). Dogs treated with TPLO achieved asignificant improvement in extension (the EA was normal in 16.7% of dogs at T0 and in 33.3% at T1 with p < 0.0001), and in flexion (the FA was normal in 23.8% of dogs at T0 and 43.5% at T6 with p = 0.0434). The dogs treated with TR showed a significant worsening of extension (the EA was abnormal in 68.8% of dogs at T0 and in 81.3% at T1 with p = 0.0024). Six months post-surgery, the ROM value was not normal in 100% of the stifle joints; however, the lameness significantly improved with each procedure. This study confirmed the influence of surgical procedures on changes in ROM and provided useful indications for planning therapy to improve and speed up the postoperative rehabilitation process in dogs.

Preoperative Joint Line Convergence Angle as an Indicator of Clinical Outcomes and Accuracy of Alignment Correction After Double-Level Osteotomy.

Background: The relationship between postoperative alignment and clinical outcomes after double-level osteotomy (DLO) has not been clarified. Purpose: To examine the radiological and clinical outcomes after DLO and specifically evaluate the influence of the joint-line convergence angle (JLCA) on the accuracy of alignment correction and surgical outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 74 knees in 51 patients (mean age, 61.0 years) who underwent DLO for varus osteoarthritic knees and who had a minimum of 2 years of follow-up. The target hip-knee-ankle angle (HKAA) for the intended limb alignment was set to 1° valgus. The lateral distal femoral angle, medial proximal tibial angle, JLCA, and HKAA were measured on preoperative and postoperative radiographs. Outliers in alignment correction were defined as a deviation of ≥3° from the originally intended HKAA. Clinical outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). In the data analysis, the influence of the radiological parameters on the postoperative outcomes was statistically assessed. Results: Radiological and clinical evaluation at 2-year follow-up showed significant improvement from preoperative values (P < .001). The HKAA was corrected from 13.4°± 3.0° varus preoperatively to 0.5°± 2.8° varus at 2 years, indicating a slight undercorrection. Regarding clinical outcomes, significant pre- to postoperative improvement was found on the KOOS (from 185.0 ± 71.2 to 387.9 ± 70.5; P < .001). Overall, 22 of the 74 knees (29.7%) were deemed to be outliers at the 2-year follow-up (19 knees [25.7%] in undercorrection, 3 knees [4.1%] in overcorrection). Postoperative KOOS values were significantly worse in the outliers than in the nonoutliers (344.4 ± 77.7 vs 405.8 ± 59.3; P < .001), and both pre- and postoperative JLCA was significantly larger in the outlier group. The receiver operating characteristic curve analysis indicated a preoperative cutoff JLCA of 6.0° for predicting postoperative alignment outliers. Conclusion: A preoperative JLCA of ≥6° was found to be a significant prognostic factor affecting the radiological and clinical outcomes after DLO for varus osteoarthritic knees by compromising the accuracy of deformity correction, resulting in suboptimal postoperative alignment.

Effective bone healing after corrective osteotomy in a patient with FGF23-related hypophosphatemic disease using short-term burosumab treatment.

Hypophosphatemic rickets is a rare metabolic bone disease caused by renal phosphate wasting, leading to impaired bone mineralization. We present a case of a boy with fibroblast growth factor 23 (FGF23)-related hypophosphatemic rickets who did not achieve callus consolidation after six months of conventional therapy with phosphate and active vitamin D following corrective osteotomy. After one month of therapy with an FGF23 antibody (burosumab), the patient demonstrated significant improvement and no longer required a walking aid. Following six months of burosumab therapy, the bone had nearly fully healed. This report is the first to address the short-term use of burosumab therapy to promote bone healing after orthopedic surgery. Our findings further emphasize the clinical advantages and short-term applications of burosumab in FGF23-related hypophosphatemic diseases, especially for patients undergoing orthopedic surgery.

Positions of the Mandibular Foramen and Canal in Different Skeletal Classes and Implications for Bilateral Sagittal Split Osteotomy.

Objectives: To evaluate the positions of the mandibular foramen (MF) and mandibular canal (MC) between different skeletal classes to highlight the implications for bilateral sagittal split osteotomy (BSSO). Methods: A cross-sectional study was performed using cone-beam computed tomography on 90 patients classified into classes I, II and III. Linear measurements were performed on multiplanar reconstructions as follows: from the MF to the edge of the mandibular ramus (1), to the mandibular notch (2), to the ramus width (3) and to the occlusal plane (4); and from the MC to the alveolar crest (A), to the lower border of the mandible (B) and to the mandibular buccal cortical bone (C). Mandibular thickness (D), width (E) and height (F) of the MC were measured. Intra-class correlation coefficient (ICC) checked the reliability. Two-way ANOVA and Tukey's test were used to compare measurements and classes. Results: Linear measurements 2 presented a statistically significant difference between classes I and II. There was no statistically significant difference between the classes and measurements B, C, D, E and F. Linear measurements A were shorter in class III than in class II. Conclusions: Although most measurements suggest that the BSSO technique does not need to be modified for each skeletal class, measurements from the MF to the mandibular notch in class II and from the MC to the alveolar crest on distal of the second molars in class III could help surgeons to recognize critical regions.

A Novel Method of Fixation and Stabilization of the Nasoendotracheal Tube for Maxillary Osteotomies: The Head Cap Technique.

Purpose: To propose a novel technique of fixation and stabilization of the nasoendotracheal tube for maxillary osteotomies. Method: The technique utilizes a flexible Portex north pole endotracheal tube size 6, elastic adhesive tape, a catheter mount and a head cap made of cloth in the fixation and stabilization of the nasoendotracheal tube for maxillary osteotomies. Result: It is a simple method of fixation and stabilization of the nasoendotracheal tube, particularly for maxillary osteotomies that essentially eliminates distortion of the nasal, labial and perinasal areas and facilitates good nasolabial control during maxillary osteotomies. Conclusion: This technique is simple, safe and versatile and may be employed for maxillary osteotomies.

Establishing an optimal central sensitization inventory cut-off value affecting postoperative outcomes of osteotomy around the knee.

BACKGROUND: Central sensitization has a significant effect on pain after osteotomy around the knee (OAK). The central sensitization inventory (CSI) score is considered disease specific, and the appropriate cut-off values for OAK are unclear. The purpose of this study was to establish the optimal CSI cut-off value affecting the postoperative outcomes of OAK based on the postoperative knee injury and osteoarthritis outcome score (KOOS). METHODS: Patients who underwent OAK for medial compartment knee osteoarthritis were included. The postoperative KOOS symptoms, pain, and activities of daily living (ADL) were categorized into two groups (score ≥80 each for symptoms, pain, and ADL, and score <80 for any of the three) and were used as factors to calculate receiver operating characteristic curves and the area under the curve with the CSI score. Cut-off values were calculated using the Youden index and the threshold value closest to the upper left corner. Subsequently, logistic multivariate analysis was performed using the KOOS and the obtained CSI cut-off values and other variables. RESULTS: A total of 173 patients were included in this study. The area under the curve of the model was 0.801 (95 % confidence interval, 0.74-0.87), and a CSI score of 12 was determined as the cut-off value. Logistic multivariate analysis based on the cut-off value showed that only the CSI score (odds ratio, 9.79; 95 % CI, 4.47-21.4; P < 0.01) was significant. CONCLUSIONS: The optimal CSI cut-off value affecting the postoperative outcomes of OAK calculated using the postoperative KOOS was 12, which was supported by multivariate analysis results. Central sensitization assessment with an appropriate cut-off value would allow a more personalized treatment approach and may contribute to a better postoperative outcome.

Zigzag tenotomy of the extensor hallucis longus through minimally invasive surgery in cadaveric specimens: description of a new technique.

BACKGROUND: Lengthening of the extensor hallucis longus (EHL) is performed to address various forefoot pathologies. The retraction of this tendon is strongly associated with the Hallux Abductus Valgus (HAV) deformity. Minimally Invasive Surgery (MIS) lengthening of the EHL is carried out in combination with other surgical techniques for HAV bone realignment. It is performed without ischemia, using local anesthesia and sedation if required by the patient. One of the advantages of this technique is immediate ambulation with a postoperative shoe without the need for a cast. The objective of the research was to demonstrate the efficacy and safety of the minimally invasive technique for lengthening the tendon in patients with HAV. MATERIALS AND METHODS: The procedures were performed on 11 fresh cryopreserved cadaveric feet. HAV surgery was performed through dorsomedial and dorsolateral portals for Reverdin-Isham, Akin and adductor tenotomy. In addition, EHL tendon elongation was performed using the Beaver 67 MIS scalpel through an incomplete zigzag tenotomy. The specimens used did not present any type of disease nor had they undergone previous surgeries that could affect the technique. First, the plantar flexion of the metatarsophalangeal joint was measured with a goniometer to establish the degrees of this joint before proceeding with the technique, the tenotomy was performed and remeasured and finally the osteotomy was performed. In addition, an anatomical dissection of cadaveric specimens was performed and various anatomical and surgical relationships were analyzed and measured. RESULTS: The data indicate that, after performing zigzag tenotomy, there is an average improvement of 13.91 degrees in plantar flexion. CONCLUSIONS: The study confirms the effectiveness and safety of elongating the extensor hallucis longus tendon of the hallux using minimally invasive surgery. The zigzag technique for tendon elongation may be considered a viable minimally invasive treatment option for addressing tendon hyperextension in patients with HAV.

Clinical and radiological outcomes of flexible flatfoot correction with double calcaneal osteotomy.

BACKGROUND: Although double calcaneal osteotomy (medial displacement calcaneal osteotomy with lateral column lengthening) is widely regarded as an effective treatment option for flexible flatfoot, limited studies have extensively analyzed the degree of deformity correction in three dimensions following double calcaneal osteotomy. This study was performed to evaluate the radiographic and clinical effectiveness of double calcaneal osteotomy to correct flexible flatfoot deformities. METHODS: Thirty-one patients who had 44 symptomatic flexible flatfeet and underwent double calcaneal osteotomy were examined retrospectively with a mean follow-up of 50 months. Visual analog scale, foot and ankle activity measure, and other clinical data were obtained from medical records. Various radiographic variables for assessing flatfoot and osteoarthritic change in tarsal joints were analyzed from weightbearing radiographs. RESULTS: Clinical scores and radiographic variables were significantly improved postoperatively. The mean values of medial sliding and lateral lengthening were 7.6 and 8.7 mm, respectively. No osteoarthritic changes were observed. CONCLUSIONS: Double calcaneal osteotomy could be used to correct flatfoot deformities effectively and sustainably and provide symptomatic relief and patient satisfaction. LEVEL OF EVIDENCE: Level 4, retrospective case series.

Effects of condylar neck inclination and counterclockwise rotation on the stress distribution of the temporomandibular joint.

Three different kinds of condylar inclination were manually modelled anteriorly inclined condylar neck, vertical condylar neck, and posteriorly inclined condylar neck. Three different maxillary impactions were simulated to evaluate the effect of counterclockwise rotation. The von Misses stresses of the disc, compressive stresses of the glenoid fossa, and compressive stresses of the condyle were the highest in the models with posteriorly inclined neck and lowest in the models with vertical condylar neck design. Stresses of the temporomandibular joint increase with the counterclockwise rotation of the maxilla-mandibular complex. The posteriorly inclined neck should be considered a risk factor for condylar resorption with increased counterclockwise rotation.