Surgical correction of cubitus varus in children with a lateral closing-wedge osteotomy: a comparison between two different techniques.

OBJECTIVES: The primary objective of the present study is to compare the radiographic outcomes and complications of two different techniques for lateral closing-wedge osteotomy in pediatric patients with cubitus varus. METHODS: We retrospectively identified patients treated at five tertiary care institutions: 17 underwent the Kirschner-wire (KW) technique, and 15 patients were treated with the mini external fixator (MEF) technique. Demographic data, previous treatment, pre- and postoperative carrying angle (CA), complications and additional procedures were recorded. Radiographic evaluation included assessment of the humerus-elbow-wrist angle (HEW), and the lateral prominence index (LPI). RESULTS: Patients treated with both KW and MEF achieved significant improvements in clinical alignment (mean pre-op CA -16 ± 6.1 degrees to mean post-op 8.9 ± 5.3 degrees, P < 0.001). There were no differences in final radiographic alignment or radiographic union time; however, time to achieve full elbow motion was faster in the MEF group (13.6 versus 34.3 weeks, P = 0.4547). Two patients (11.8%) in the KW group experienced complications, including one superficial infection and one failed correction that required unplanned revision surgery. Eleven patients in the MEF group underwent a planned second surgical procedure for hardware removal. CONCLUSIONS: Both fixation techniques are effective at correcting cubitus varus in the pediatric population. The MEF technique may have the advantage of shorter recovery of elbow range of motion but may require sedation for hardware removal. The KW technique may present a slightly higher complication rate.

Conceptos actuales en osteotomías en doble nivel alrededor de la rodilla / Current concepts in double-level osteotomies around the knee

Con la osteotomía en un solo nivel, se puede lograr la corrección del eje de la extremidad en pacientes con deformidades combinadas femoral y tibial, pero de forma simultánea generará una alteración patológica de oblicuidad de la interlínea articular, lo que conducirá a elongación ligamentaria, inestabilidad, degeneración condral y, en última instancia, comprometerá su sobrevida y los resultados funcionales. En virtud del análisis de la literatura más reciente, podemos concluir que existe un número significativo de pacientes que requieren de un procedimiento combinado para lograr un objetivo biomecánico óptimo. La finalidad de una osteotomía en doble nivel alrededor de la rodilla consiste en restablecer la anatomía normal, descargar el compartimiento afectado, normalizar los ángulos mecánicos y la orientación de la interlínea articular. Los ejes fisiológicos pueden restablecerse a través de un análisis preoperatorio exhaustivo, respetando principios biomecánicos y fijación estable con placas bloqueadas. Es un procedimiento demandante y con indicaciones en evolución, que progresivamente se ha instaurado como una alternativa de tratamiento justificada en estudios clínicos y biomecánicos para el manejo de deformidades severas alrededor de la rodilla.

With single-level osteotomy, correction of the limb axis in patients with combined femoral and tibial deformities can be achieved. This correction, however, will generate a pathological alteration in the joint line oblicuity, leading to ligament elongation, instability, joint degeneration and, ultimately, it will compromise the longevity and functional results of the correction. By analyzing the most recent literature, we can conclude that there is a significant number of patients who require a combined procedure to achieve an optimal biomechanical goal. The purpose of a double-level osteotomy around the knee is to restore normal anatomy, unload the affected compartment, normalize the mechanical angles and the orientation of the joint line. Physiological axes can be reestablished by means of a thorough preoperative analysis, observing the biomechanical principles and stable fixation with locked plates. It is a demanding procedure with increasing indications, which has progressively been established in clinical and biomechanical studies as a justified treatment alternative for the management of severe deformities around the knee.

Artroplastia total de rodilla en genu valgo severo: Seguimiento de 5 a 14 años / Total knee arthroplasty in severe genu valgum. Five to 14 years follow-up

Introducción: El deseje en valgo es una deformidad compleja, con alteracion osea y de partes blandas. Se han descrito numerosas tecnicas quirurgicas que detallan la secuencia de liberacion de las estructuras posterolaterales y la necesidad de utilizar implantes constrenidos. El reemplazo total de rodilla para el genu valgo es un desafio para el ortopedista. Los objetivos fueron evaluar nuestros resultados en el tratamiento quirurgico del genu valgo severo y detallar la tecnica quirurgica empleada. Materiales y Métodos: Se establecio una clasificacion clinico-radiologica y se discriminaron los casos con genu valgo severo. Se evaluaron 42 reemplazos totales de rodilla en 39 pacientes (seguimiento promedio 9.2 anos). Se utilizo el Knee Society Score como parametro de evaluacion clinica. Para la evaluacion radiografica, se conto con la radiografia de mejor calidad del ultimo control. El analisis de supervivencia contemplo la necesidad de revision por cualquier causa y por falla mecanica. Resultados: El Knee Society Score fue, en promedio, de 83,3, con franca mejoria en los parametros dolor y rango de movilidad. Se utilizaron implantes constrenidos en el 16,7% de los casos. El angulo posoperatorio promedio fue de 5,9°. Hubo dos revisiones, con una supervivencia protesica por falla mecanica del 97,6%. No hubo revisiones por causa infecciosa. Conclusiones: Se requiere de un minucioso examen fisico y radiografias preoperatorias. La decision de utilizar implante constrenido se toma durante la cirugia. Es importante la apropiada liberacion de partes blandas. Al margen de la tecnica quirurgica empleada, el requerimiento de protesis constrenida es bajo. Recomendamos nuestra tecnica, pues se trata de un procedimiento poco demandante con resultados alentadores a mediano y largo plazo. Nivel de Evidencia: IV

Introduction: Valgus malalignment is a complex, multiplanar deformity characterized by bone alterations and soft-tissue abnormalities. Several surgical techniques have been described for valgus knee, and the sequence of tight lateral structure release and the need of constrained prosthesis were addressed. Total knee arthroplasty in valgus deformity remains a surgical challenge for orthopaedic surgeons. The objectives of the study were to evaluate our mid- and long-term results in the surgical treatment of severe valgus disease, and to describe the applied surgical technique. Methods: A clinical-radiological classification was developed, and patients treated for severe genu valgum were discriminated. We retrospectively evaluated 42 total knee arthroplasties in 39 patients, with an average follow-up of 9.2 years. Knee Society Score was used for clinical evaluation, and the last control best quality radiograph was considered for radiographic evaluation. Survival analysis contemplated the need for revision for any reason and for mechanical failure. Results: Postoperative average Knee Society Score was 83.3, with marked improvement in pain and range of motion parameters. Constrained implants were used in 16.7% of cases. Postoperative alignment was on average 5.9°. Two patients underwent revision surgery, having achieved a prosthetic survival for mechanical failure of 97.6%. We did not have any revision due to infection. Conclusions: A meticulous physical examination and proper preoperative radiographs are mandatory. The decision to use a constrained device is taken during surgery. Appropriate soft-tissue release is extremely important. Despite the surgical technique, the use of a constrained prosthesis is limited. We recommend our technique as a low-demanding procedure, with encouraging mid- and long-term results. Level of Evidence: IV

A Simple Dual-Planar Osteotomy to Correct Cubitus Varus Deformity in Children.

OBJECTIVES: To report the outcomes when performing a dual-planar osteotomy of the distal humerus via a posterior approach for gunstock deformity in children. DESIGN: A retrospective review. SETTING: Penn State Hershey Pediatric Bone and Joint Institute. PATIENTS/PARTICIPANTS: Sixteen patients were reviewed. The average patient age was 8 years (range, 5-13 years). INTERVENTION: A complete dual-planar closing wedge osteotomy was performed with the patient in the prone position via a posterior triceps-splitting approach. Fixation with buried smooth K wires was utilized. MAIN OUTCOME MEASUREMENTS: Valgus correction obtained, final elbow range of motion, radiographic and clinical correction of the deformity, the patient's satisfaction, and elbow function were evaluated. RESULTS: Preoperative radiographs showed the average humeral-ulnar angle (HUA) was 17 degrees of varus (range, 10-26 degrees varus). The average wedge removed wallow-up clinical exam demonstrated that the carrying angle was in valgus in 15 cases and neutral in 1 case. The average carrying angle was 5 degrees of valgus (range, 0-11 degrees valgus). The average hyperextenss 25 degrees (range, 20-40 degrees). Duration of follow-up averaged 51 months (range, 12-126 months). Final foion deformity improved from 9 degrees preoperatively to 1 degree postoperatively. Outcomes were classified by the grading scale described by Oppenheim: 14 cases had excellent results and 2 cases had good results. CONCLUSIONS: This method provides clear visualization and excellent correction of the deformities. The posterior scar is cosmetically acceptable. We recommend this technique for the treatment of gunstock deformity in children. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Surgery for Jaccoud Arthropathy: A Systematic Review.

INTRODUCTION: Jaccoud arthropathy (JA) is characterized by the presence of joint deformities similar to those seen in rheumatoid arthritis but generally with a "reversible" pattern. The etiopathogenic mechanisms are not known, and its therapeutical approach has been regarded as disappointing. The aim of the present study was to perform a systematic review of the literature on the scientific evidence of the surgical procedures for JA. METHODS: The MEDLINE, LILACS, and Scielo databases were searched using the following keywords: "systemic lupus erythematosus," "rheumatic fever," "Jaccoud arthropathy," "deforming arthropathy," "surgery," and their corresponding terms in Portuguese and Spanish. The search period was between 1966 and 2014. RESULTS: Only 7 articles fulfilled the inclusion criteria, and a total of 58 patients underwent surgical procedures for JA. Such studies were limited to small case series, there was no uniform definition of the outcome, and the follow-up time varied largely. CONCLUSIONS: There is no consensus on the best approach for the surgical procedures in patients with JA, who are the best candidates to undergo this, and when to indicate the procedure.

Rate of Correction and Recurrence of Ankle Valgus in Children Using a Transphyseal Medial Malleolar Screw.

BACKGROUND: Transphyseal medial malleolar screw (TMMS) hemiepiphysiodesis is an effective treatment for ankle valgus in children. There is limited evidence on the effect of age and diagnosis on the rate of correction as well as the deformity recurrence after screw removal. The purpose of this study was to determine (1) the rate of correction of ankle valgus after hemiepiphysiodesis using a TMMS, (2) the effects of clinical diagnosis and age at surgery on the rate of correction, and (3) the rate of valgus recurrence after TMMS removal. METHODS: In this retrospective study we included 16 male and 21 female patients (63 ankles) with an average age at surgery of 11.0 years (range, 5.4 to 14.8 y) who underwent TMMS hemiepiphysiodesis for the treatment of ankle valgus. There was a mean radiographic follow-up of 1.6 years (range, 0.4 to 4.9 y) before screw removal. For subjects who received screw removal (43 ankles), the average time from insertion to removal of the screw was 1.4 years (range, 0.4 to 5.2 y). Valgus deformity was assessed on anteroposterior ankle radiographs by measurement of tibiotalar angle. Linear mixed effects models were used to determine rates of correction and valgus recurrence. RESULTS: The average rate of correction in tibiotalar angle was 0.37±0.04 degrees per month (P<0.001). Clinical diagnosis and age at surgery significantly affected the amount of postoperative correction in tibiotalar angle (P<0.05). Eighteen of 22 ankles (81.8%) demonstrated recurrence of ankle valgus after screw removal. The average recurrence rate in patients who underwent screw removal was 0.28±0.08 degrees per month (22 ankles, P=0.002). CONCLUSIONS: This study supports the effectiveness of the TMMS hemiepiphysiodesis for treating pediatric ankle valgus, but the effects of additional skeletal growth should be considered as the ankle may rebound into valgus after correction and screw removal. The results from this study can help with surgical planning to predict the amount of correction that may be achieved depending on underlying diagnosis and age at surgery. LEVEL OF EVIDENCE: Level IV-retrospective study.

Does the GMFCS level influence the improvement in knee range of motion after rectus femoris transfer in cerebral palsy?

The aim of this study was to evaluate the influence of the Gross Motor Function Classification System (GMFCS) on the outcomes of rectus femoris transfer (RFT) for patients with cerebral palsy and stiff knee gait. We performed a retrospective review of patients seen at our gait laboratory from 1996 to 2013. Inclusion criteria were (i) spastic diplegic cerebral palsy, (ii) GMFCS levels I-III, (iii) reduced peak knee flexion in swing (PKFSw<55°), and (iv) patients who underwent orthopedic surgery with preoperative and postoperative gait analysis. Patients were divided into two groups according to whether they received a concurrent RFT or not at the time of surgery: non-RFT group (185 knees) and RFT group (123 knees). The primary outcome was the overall knee range of motion (KROM) derived from gait kinematics. The secondary outcomes were the PKFSw and the time of peak knee flexion in swing (tPKFSw). We observed a statistically significant improvement in KROM only for patients in the RFT group (P<0.001). However, PKFSw and tPKFSw improved in both groups after surgery (P<0.001 for all analyses). In the RFT group, the improvement in KROM was observed only for patients classified as GMFCS levels I and II. In the non-RFT group, no improvement in KROM was observed in any GMFCS level. In this study, patients at GMFCS levels I and II were more likely to benefit from the RFT procedure.

Osteotomía de apertura anterior de tibia bilateral en recurvatum de rodilla: a propósito de un caso / Anterior tibial osteotomy in bilateral knee recurvatum. Case report

En los recurvatum de rodilla, existen varios métodos de corrección, la osteotomía descripta por Brett y Lexer E. modificada es una opción para su tratamiento. El objetivo de este trabajo es describir la técnica como una solución para los recurvatum de rodilla tibiales y mostrar la evolución de un caso clínico. El paciente presentaba un recurvatum bilateral de rodilla de origen tibial idiopático, con valores angulares de 26 grados a derecha y 20 grados a izquierda de ángulo diafiso-epifisario. Con el objetivo de corregir la deformación para calmar el dolor de características mecánicas por sobrecarga articular y evitar la pérdida del equilibrio articular, se decidió realizar esta técnica. Las cirugías fueron realizadas comenzando con la derecha y un año y medio después la rodilla izquierda. Para la rodilla derecha se logró corregir la deformidad llevando el platillo tibial de 26° de inclinación anterior a 6°. En cuanto a la rodilla izquierda de 20° se corrigió a 0°. Resulta una técnica reproducible, que soluciona los recurvatum de origen tibial epifiso-metafisarios, que no altera la biomecánica del aparato extensor como otras osteotomías. Esta técnica no permite corregir las deformidades diafisarias. Creemos que es una de las mejores opciones para la corrección del recurvatum, que a pesar de no lograr corrección total de la alteración ósea, mejora la función de la rodilla y la sintomatología, sin alterar la mecánica del aparato extensor.

In the knee recurvatum, there are several methods of correction osteotomy, the modified Brett and Lexer E. osteotomy is an option for this type of pathology. The aim of this paper is to describe the technique as a solution to the tibial recurvatum and show the outcome of a case. The patient had a bilateral tibial idiopathic knee recurvatum, with angular values of 26 degrees right and 20 degrees left of diafiso-epiphyseal angle. In order to correct the deformation and release pain secondary to mechanical overload and prevent loss of articular balance, we decided to perform this technique. The surgeries were performed first the right and a year and a half after his left knee. His right knee, we managed to correct the tibial plateau deformity from 26° of anterior tilt, to 6°. As for the left knee was corrected from 20° to 0°. It is a reproducible technique that solves tibial epiphyseal-metaphyseal origin recurvatum, which does not alter the biomechanics of the extensor mechanism as other osteotomies. This technique does not allow correction of diaphyseal deformities. We believe it is one of the best options for the correction of recurvatum, which despite not achieveing full correction of bone alteration improves knee function and symptoms without altering the extensor mechanism.

Osteotomía de apertura anterior de tibia bilateral en recurvatum de rodilla: a propósito de un caso / Anterior tibial osteotomy in bilateral knee recurvatum. Case report

En los recurvatum de rodilla, existen varios métodos de corrección, la osteotomía descripta por Brett y Lexer E. modificada es una opción para su tratamiento. El objetivo de este trabajo es describir la técnica como una solución para los recurvatum de rodilla tibiales y mostrar la evolución de un caso clínico. El paciente presentaba un recurvatum bilateral de rodilla de origen tibial idiopático, con valores angulares de 26 grados a derecha y 20 grados a izquierda de ángulo diafiso-epifisario. Con el objetivo de corregir la deformación para calmar el dolor de características mecánicas por sobrecarga articular y evitar la pérdida del equilibrio articular, se decidió realizar esta técnica. Las cirugías fueron realizadas comenzando con la derecha y un año y medio después la rodilla izquierda. Para la rodilla derecha se logró corregir la deformidad llevando el platillo tibial de 26° de inclinación anterior a 6°. En cuanto a la rodilla izquierda de 20° se corrigió a 0°. Resulta una técnica reproducible, que soluciona los recurvatum de origen tibial epifiso-metafisarios, que no altera la biomecánica del aparato extensor como otras osteotomías. Esta técnica no permite corregir las deformidades diafisarias. Creemos que es una de las mejores opciones para la corrección del recurvatum, que a pesar de no lograr corrección total de la alteración ósea, mejora la función de la rodilla y la sintomatología, sin alterar la mecánica del aparato extensor. (AU)

In the knee recurvatum, there are several methods of correction osteotomy, the modified Brett and Lexer E. osteotomy is an option for this type of pathology. The aim of this paper is to describe the technique as a solution to the tibial recurvatum and show the outcome of a case. The patient had a bilateral tibial idiopathic knee recurvatum, with angular values of 26 degrees right and 20 degrees left of diafiso-epiphyseal angle. In order to correct the deformation and release pain secondary to mechanical overload and prevent loss of articular balance, we decided to perform this technique. The surgeries were performed first the right and a year and a half after his left knee. His right knee, we managed to correct the tibial plateau deformity from 26° of anterior tilt, to 6°. As for the left knee was corrected from 20° to 0°. It is a reproducible technique that solves tibial epiphyseal-metaphyseal origin recurvatum, which does not alter the biomechanics of the extensor mechanism as other osteotomies. This technique does not allow correction of diaphyseal deformities. We believe it is one of the best options for the correction of recurvatum, which despite not achieveing full correction of bone alteration improves knee function and symptoms without altering the extensor mechanism. (AU)

Microartroplastía de superficie y osteotomía tibial de apertura simultánea / Simultaneous resurfacing arthroplasty with open high tibial osteotomy

El compromiso degenerativo articular de la rodilla caracterizado por exposición de hueso subcondral, en pacientes jóvenes y de mediana edad con expectativa de actividad recreacional, es actualmente un desafío para el especialista. Ante el fracaso del tratamiento médico, la indicación terapéutica debe ser fundamentada en el análisis de una serie de factores, destacando las expectativas del paciente: sintomatología dominante, alineación, estabilidad y área lesional. Se presenta un caso de procedimiento reconstructivo de indicación excepcional sobre el cual no se ha hallado referencia publicada. El procedimiento consistió en asociar: a) Reemplazo segmentario de superficie con Arthrosurface NR (“Artroplastia focal de superficie”) con b) Osteotomía de apertura tibial en el mismo acto quirúrgico. Se describe la metodología aplicada para la decisión terapéutica consistente en un análisis sistemático multifactorial.

Microartroplastía de superficie y osteotomía tibial de apertura simultánea / Simultaneous resurfacing arthroplasty with open high tibial osteotomy

El compromiso degenerativo articular de la rodilla caracterizado por exposición de hueso subcondral, en pacientes jóvenes y de mediana edad con expectativa de actividad recreacional, es actualmente un desafío para el especialista. Ante el fracaso del tratamiento médico, la indicación terapéutica debe ser fundamentada en el análisis de una serie de factores, destacando las expectativas del paciente: sintomatología dominante, alineación, estabilidad y área lesional. Se presenta un caso de procedimiento reconstructivo de indicación excepcional sobre el cual no se ha hallado referencia publicada. El procedimiento consistió en asociar: a) Reemplazo segmentario de superficie con Arthrosurface NR (ôArtroplastia focal de superficieö) con b) Osteotomía de apertura tibial en el mismo acto quirúrgico. Se describe la metodología aplicada para la decisión terapéutica consistente en un análisis sistemático multifactorial.(AU)

Distal femoral dome varus osteotomy: surgical technique with minimal dissection and external fixation.

UNLABELLED: The results obtained when employing distal femoral varus osteotomy are variable. Our objective was to describe a surgical technique involving minimal dissection, semicircular osteotomy with external fixation for valgus angular deformities, and early weight bearing. DESIGN: Series of cases. SETTING: Orthopedic Referral Trauma Center. PATIENTS: Sixteen patients with valgus angular deformities of >12°. INTERVENTION: Wedge varus osteotomy, minimal dissection with external fixation using a standard system, multidirectional Newfix. Main outcome measurements included pain, surgical time, knee flexion and extension angles, and assessment of knee function based on the Hospital Special Surgery knee rating scale (HSSkrs). RESULTS: Of 16 patients, 14 were evaluated to the end of the study. When we compared preoperative values with those obtained postoperatively at a mean of 24±2.1months, pain measurement was reduced from 7 to 2.1 (p=0.002), angle of flexion was reduced from 105.4±14.6° to 105.3±11.1° (p=0.06), and angle of extension, from -1.67 to -1.25° (p=0.6), while HSSkrs assessment increased from 67.5±2.7 to 79.4±5 (p=0.003). Two patients were excluded from the study, one due to infection that developed along the trajectory of a screw, and the other patient underwent complete arthroplasty of the knee, which was performed to combat the pain that was not being alleviated. CONCLUSIONS: The technique improves function and reduces pain while facilitating early rehabilitation in 83% of cases.

Classificação angular para protrusão acetabular utilizada no serviço de ortopedia da Faculdade de Medicina do ABC / Angular classification for protrusio acetabuli used in the orthopedic service of Faculdade de Medicina do ABC

Introdução: a protrusão acetabular foi inicialmente descrita por Otto, em 1824. A incidência é maior no sexo feminino e a bilateralidade, mais comum, é maior nas protrusões de etiologia primária. Sotelo-Garza e Charnley definiram uma classificação que considera a distância da parede medial em relação à linha de Kõhler. Objetivo: apresentar a classificação angular para protrusão acetabular e demonstrar sua aplicabilidade. Método: a classificação da Faculdade de Medicina do ABC (FMABC) foi determinada a partir da medida do ângulo P (ângulo de protrusão), formado pela intersecção de três linhas. Foram avaliadas radiografias de bacia em dois grupos de pacientes: o primeiro, com pacientes sem protrusão acetabular, em que foram definidos os valores de normalidade, e o segundo, com pacientes com protrusão acetabular. Destes, foram medidos o ângulo P e o tamanho da protrusão de acordo com Sotelo-Garza e Charnley, sendo os resultados comparados. Dezenove quadris com protrusão foram submetidos à artroplastia total e comparados os valores do ângulo P no pré e pós-operatório. Resultados: o valor médio do ângulo P, em pacientes sem protrusão acetabular, foi -1,22º. No segundo grupo, observou-se semelhança quando foram comparados os valores da classificação FMABC e os da classificação de Sotelo-Garza e Charnley. A comparação entre os valores do ângulo P pré e pós-operatórios resultou em diferença estatisticamente significante (p<0,001). A classificação angular foi dividida em leve, moderada e grave. Conclusões: o ângulo P foi sempre superior a zero nas protrusões acetabulares, os valores numéricos das duas classificações foram estatisticamente significativos, possibilitando a utilização dos mesmos valores da classificação de Sotello-Garza e Charnley para a classificação FMABC, e o uso de enxerto causou uma lateralização do componente acetabular.

Introduction: protrusio acetabuli was first described by Otto, in 1824. Its incidence is higher among women and the bilaterality, more common, is higher in primary etiology protrusions. Sotelo-Garza and Charnley set a classification that considers the distance of the medial wall on the Kõhler's line. Objective: to present the angular classification for protrusio acetabuli and to demonstrate its applicability. Method: the angular classification of Faculdade de Medicina do ABC (FMABC) was determined from the measure of the P angle (angle of protrusion), formed by the intersection of three lines. Pelvis radiographs were evaluated in two groups of patients: the first, with patients without protrusio acetabuli, in which the values of normality were defined, and the second, with patients who presented the disease. We measured, in the second group, the P angle and size of the protrusion according to Sotelo-Garza and Charnley, and the results were compared. Nineteen hips with protrusion were submitted to total hip arthroplasty and the values of the P angle compared in the pre and postoperative. Results: the average value of the P angle, in patients without protrusio acetabuli, was -1.22º. In the second group, a similarity was observed when we compared the values of the FMABC angular classification and the Sotelo-Garza and Charnley classification. The comparison between the values of the pre and postoperative P angle resulted in significant statistical difference (p < 0.001). The angular classification was divided into mild, moderate and severe. Conclusions: the P angle was always greater than zero in protrusio acetabuli, the values of both classifications were statistically significant, allowing the use of the Sotello-Garza and Chanrley classification values for the FMABC classification, and the use of graft lead to a lateralization of the acetabular component.

A new fixation material for open-wedge tibial osteotomy for genu varum.

Varus deformity of the knee is a determining factor in the development of osteoarthrosis of the medial compartment. Open wedge osteotomy corrects the deformity and has quickly become popular due to the fact that the surgical technique can be easily reproduced, it spares loss of bone tissue in the metaphysiary region, and it does not require muscle dissection, reducing the risk of lesion of the fibular nerve. The objective of this study was to evaluate the characteristics of a new fixation implant (Anthony-K plate - France Bloc S.A, CE n0499, ISO 9001, EN 46001), in terms of its clinical improvement, correction of the deformity, and slope alteration. Twenty adult patients with varus deformity were evaluated, and submitted to open wedge high tibial osteotomy using the Anthony plate, between October 2004 and November 2006. The varus deformity was corrected in all cases, and there was a significant increase in the Lysholm score. Correlation analysis has shown that the greater the preoperative varus deformity, the larger the opening wedge used. Also, the greater the initial posterior tibial slope, the larger the final posterior tibial slope (p=0.0168). There were no complications. The Anthony plate can be considered an alternative in the treatment of medial osteoarthrosis of the varus knee, enabling the correction of the deformity and improvement of the clinical picture. It occurs an increase in posterior tibial slope, similar to that observed with other fixation materials. More studies with the Anthony plate are necessary, after these encouraging results.

Stabilization of finger ulnar deviation in rheumatoid arthritis: extensor indicis proprius tenodesis.

Ulnar deviation of fingers in rheumatoid arthritis is a common deformity that can markedly compromise hand function. These deformities also result in an aesthetic impairment that is often troubling to patients. A variety of surgical procedures have been recommended to correct the ulnar deviation, either at the wrist level or at the metacarpophalangeal (MCP) joints. We present a surgical technique that uses the extensor indicis proprius as a tenodesis across the dorsum of the MCP joints of the fingers. The technique can also be used in conjunction with other surgical procedures, including prosthetic replacement arthroplasties of the MCP joints. The procedure has been used in 6 patients. Ulnar deviation averaged 62 degrees preoperatively and 15 degrees postoperatively. All patients have been satisfied with the results.

Osteotomia de Wagner modificada para el tratamiento de la coxa vara infantil: Descripcion de la tecnica y analisis de los resultados / Modified Wagner osteotomy for the treatment of infantile coxa vara deformity: Technique description and analysis of the results

Introducción: Se han descrito múltiples procedimientosquirúrgicos para la corrección de la coxa vara infantil. En los pacientes pequeños la fijación interna es difícil por el tamaño de los fragmentos y la posibilidad de producir el cierre de la fisis. En 1978, Wagner describió una técnica utilizando numerosas clavijas de Kirschner para la estabilización. Sólo un estudio informa los resultados obtenidos con una técnica similar. El objetivo de este trabajo es describir la técnica utilizada y evaluar los resultados clínico- radiográficos obtenidos. Materiales y métodos: Se analizaron 16 osteotomías realizadas en 15 pacientes consecutivos tratados en el período comprendido entre enero de 2000 y enero de 2006. El promedio de edad fue de 6,9 años. El seguimiento promedio fue de 43,3 meses. Se evaluaron parámetros clínicos: dolor, claudicación y signo de Trendelenburg; y radiológicos: ángulo cervicodiafisario (ACD) y ángulo epifisario (AE). Resultados: Las etiologías fueron diversas: seis secuelasde artritis séptica, tres traumáticas, tres condrodisplasias metafisarias, tres displasias epifisarias múltiples y una secuela de displasia del desarrollo de la cadera. En el 82% de los casos mejoró la claudicación y el signo de Trendelenburg.Los valores radiológicos presentaron una mejoríasignificativa: ACD 137,72°; AE 34,33° (p < 0,0005). Conclusiones: En esta serie, la técnica de Wagner modificada permitió una importante mejoría clínica y radiográfica. Es un método sencillo, económico, que proporciona una fijación aceptable sin daño de la fisis.

Genu valgo idiopatico: tratamiento quirurgico en niños y adolescentes / Idiopathic genu valgum: surgical treatment in late childhood and adolescence

Introduccion: Las deformidades en valgo de los miembrosinferiores en niños y adolescentes son un motivo frecuente de consulta en la practica ortopedica. Tienden a considerarse propias de la evolucion regional con el crecimiento y por ello a ser subestimadas. Algunas constituyen una entidad patologica que requiere una minuciosa valoracion de magnitud y evolutividad y pueden ocasionar no solo alteraciones esteticas sino funcionales, por lo cual necesitan un tratamiento específico. Materiales y metodos: Se estudiaron 29 pacientes (58 rodillas) con genu valgo idiopatico tratados quirurgicamente antes de la finalizacion del crecimiento. Se realizo arresto epifisario femoral medial distal (AEFMD) basado en la tecnica de Blount. La indicacion se adopta según la presencia de dolor o dificultad para la marcha, razones esteticas-deformidad o como profilaxis de alteraciones secundarias en la edad adulta. Resultados: Basados en la ausencia de dolor de rodilla, mejoria de la deambulacion, ausencia de mialgias y correccion del deseje en valgo los resultados fueron excelentes y buenos en todos los casos.Conclusiones: El arresto epifisario femoral medial distales un metodo quirurgico adecuado para corregir deformidades en valgo en niños y adolescentes con cartilago de crecimiento permeable. Actua sobre el eje central del problema, es de facil realizacion, poco cruento, no requiere inmovilizacion y permite un pronto retorno a las tareas habituales. (AU)

Genu valgo idiopatico: tratamiento quirurgico en niños y adolescentes / Idiopathic genu valgum: surgical treatment in late childhood and adolescence

Introduccion: Las deformidades en valgo de los miembrosinferiores en niños y adolescentes son un motivo frecuente de consulta en la practica ortopedica. Tienden a considerarse propias de la evolucion regional con el crecimiento y por ello a ser subestimadas. Algunas constituyen una entidad patologica que requiere una minuciosa valoracion de magnitud y evolutividad y pueden ocasionar no solo alteraciones esteticas sino funcionales, por lo cual necesitan un tratamiento específico. Materiales y metodos: Se estudiaron 29 pacientes (58 rodillas) con genu valgo idiopatico tratados quirurgicamente antes de la finalizacion del crecimiento. Se realizo arresto epifisario femoral medial distal (AEFMD) basado en la tecnica de Blount. La indicacion se adopta según la presencia de dolor o dificultad para la marcha, razones esteticas-deformidad o como profilaxis de alteraciones secundarias en la edad adulta. Resultados: Basados en la ausencia de dolor de rodilla, mejoria de la deambulacion, ausencia de mialgias y correccion del deseje en valgo los resultados fueron excelentes y buenos en todos los casos.Conclusiones: El arresto epifisario femoral medial distales un metodo quirurgico adecuado para corregir deformidades en valgo en niños y adolescentes con cartilago de crecimiento permeable. Actua sobre el eje central del problema, es de facil realizacion, poco cruento, no requiere inmovilizacion y permite un pronto retorno a las tareas habituales

Treatment of chronic radial head dislocations in children.

From 1990 to 2005 our department treated nine patients with chronic radial head dislocation by an ulnar osteotomy and indirect reduction by interosseous membrane. The patients varied in age from 2 years and 8 months to 10 years, and the time from the injury to operation ranged from 40 days to 3 years. The range of functional motion and carrying angle was restored in all nine patients, and no complications, such as recurrent dislocation, infection, or neurovascular injury were observed. This technique has proven to be a successful approach to treating such cases, with a low range of complications and good functional results.

Genu valgo idiopatico: tratamiento quirurgico en niños y adolescentes / Idiopathic genu valgum: surgical treatment in late childhood and adolescence

Introduccion: Las deformidades en valgo de los miembrosinferiores en niños y adolescentes son un motivo frecuente de consulta en la practica ortopedica. Tienden a considerarse propias de la evolucion regional con el crecimiento y por ello a ser subestimadas. Algunas constituyen una entidad patologica que requiere una minuciosa valoracion de magnitud y evolutividad y pueden ocasionar no solo alteraciones esteticas sino funcionales, por lo cual necesitan un tratamiento específico. Materiales y metodos: Se estudiaron 29 pacientes (58 rodillas) con genu valgo idiopatico tratados quirurgicamente antes de la finalizacion del crecimiento. Se realizo arresto epifisario femoral medial distal (AEFMD) basado en la tecnica de Blount. La indicacion se adopta según la presencia de dolor o dificultad para la marcha, razones esteticas-deformidad o como profilaxis de alteraciones secundarias en la edad adulta. Resultados: Basados en la ausencia de dolor de rodilla, mejoria de la deambulacion, ausencia de mialgias y correccion del deseje en valgo los resultados fueron excelentes y buenos en todos los casos.Conclusiones: El arresto epifisario femoral medial distales un metodo quirurgico adecuado para corregir deformidades en valgo en niños y adolescentes con cartilago de crecimiento permeable. Actua sobre el eje central del problema, es de facil realizacion, poco cruento, no requiere inmovilizacion y permite un pronto retorno a las tareas habituales.