CORRECTIVE OSTEOTOMY AND LOCAL BONE GRAFTING FOR EXTRA-ARTICULAR MALUNION OF THE PROXIMAL PHALANX

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 399-403
Author(s):  
John T. Capo ◽  
Ben Shamian ◽  
Philip K. Lim
Keyword(s):  
Bone Graft ◽  
Hand Function ◽  
Corrective Osteotomy ◽  
Proximal Phalanx ◽  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Opening Wedge ◽  
Local Bone ◽  
Dual Plating ◽  
Osteotomy Technique

Corrective osteotomies are often utilised to treat finger deformities that may occur due to a phalangeal malunion. Rotational or angular malalignment, in addition to shortening of the digit may negatively affect hand function and be aesthetically displeasing. Thorough preoperative examination of the malunion and its associated deformities is crucial in determining the type of osteotomy technique to be used. Osteotomies can create bony defects that need to be filled with bone graft or some type of graft substitute. We describe an opening wedge osteotomy with local cancellous bone graft combined with dual plating to treat a dorsal angular deformity in a proximal phalangeal malunion.

TRAPEZOID ROTATIONAL BONE GRAFT OSTEOTOMY FOR METACARPAL AND PHALANGEAL FRACTURE MALUNION

2007 ◽  
Vol 32 (3) ◽  
pp. 282-288 ◽  
Author(s):  
F. C. YONG ◽  
S. H. TAN ◽  
B. P. B. TOW ◽  
L. C. TEOH
Keyword(s):  
Bone Graft ◽  
Corrective Osteotomy ◽  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Opening Wedge ◽  
Metacarpal Head ◽  
Bone Length ◽  
Double Osteotomy ◽  
Bone Shortening ◽  
Phalangeal Fracture

Metacarpal and phalangeal fracture malunions with significant angulation deformity are associated with bone shortening, prominence of the metacarpal head in the palm or pseudoclaw deformity and may be symptomatic. If so, they may need corrective osteotomy procedures. Conventional methods of closing, or opening, wedge osteotomy do not restore the length of the bone exactly. Simultaneous correction of the angular deformity and restoration of bone length can be addressed by a trapezoid rotational bone graft osteotomy. A double osteotomy is done and the segment of bone is rotated and re-inserted as a bone graft. This was done successfully in four metacarpal and two phalangeal fracture malunions with angulation deformities.

scholarly journals Comparison of osteotomy technique and jig type in completion of distal femoral osteotomies for correction of medial patellar luxation

2017 ◽  
Vol 30 (01) ◽  
pp. 28-36 ◽  
Author(s):  
Lisa Piras ◽  
Bruno Peirone ◽  
Derek Fox ◽  
Matteo Olimpo
Keyword(s):  
Clinical Significance ◽  
Frontal Plane ◽  
Transverse Plane ◽  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Femoral Bone ◽  
Radiographic Assessment ◽  
Opening Wedge ◽  
Different Types ◽  
Osteotomy Technique

SummaryObjectives: Femoral osteotomies are frequently completed to correct malalignment associated with patellar luxation. The objectives of this study were to compare the use of: 1) two different types of jig; and 2) different types of osteotomy in the realignment of canine femoral bone models which possessed various iterations of angular deformity.Methods: Models of canine femora possessing distal varus, external torsion and a combination of varus and torsion underwent correction utilizing two alignment jigs (Slocum jig and Deformity Reduction Device) and either a closing wedge ostectomy (CWO) or an opening wedge osteotomy (OWO). Post-correctional alignment was evaluated by radiographic assessment and compared between groups.Results: The use of the Slocum jig resulted in frontal plane overcorrection when used with CWO in models of femoral varus, and when used with OWO in models of femoral varus and external torsion when compared to other techniques. The Deformity Reduction Device tended to realign the frontal plane closer to the post-correction target value in all angulation types. The use of both jigs resulted in undercorrection in the transverse plane in models with varus and torsion.Clinical significance: Jig selection and osteotomy type may lead to different post-correctional alignment results when performing distal femoral osteotomies. Whereas OWO allows accurate correction when used with either jig to address frontal plane deformities, the Deformity Reduction Device can be utilized with both CWO and OWO to correct torsion-angulation femoral deformities to optimize frontal plane alignment.

Long-term results following osteotomy of the thumb delta phalanx in Rubinstein–Taybi Syndrome

2009 ◽  
Vol 35 (4) ◽  
pp. 296-301 ◽  
Author(s):  
A. Jain ◽  
S. Rehman ◽  
G. Smith
Keyword(s):  
Corrective Osteotomy ◽  
Proximal Phalanx ◽  
Rare Condition ◽  
Long Term Results ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Radial Deviation ◽  
The Mean ◽  
Delta Phalanx

Rubinstein–Taybi Syndrome is a rare condition affecting 1:125,000 children. It is associated with short broad radially deviated thumbs, secondary to a delta proximal phalanx of the thumb. We undertook a retrospective review of seven children (13 thumbs) with Rubinstein–Taybi syndrome whose thumbs were treated using a corrective osteotomy to the delta phalanx over a 13 year period. The types of osteotomy used in the series were reverse wedge osteotomy, opening wedge osteotomy and dome shaped osteotomy. The mean preoperative radial deviation of thumbs was 68° (range 45–85°). At follow up five of the 13 thumbs demonstrated some residual radial deviation. All recurrences occurred in the dome shaped osteotomy group. Our data suggest that surgery is effective in correcting the deformity, but there is a risk of incomplete correction or recurrence. Despite the recurrence the mean postoperative deformity was significantly better than preoperatively and the majority of patients families subjectively reported good function. No patient in our series has yet undergone further corrective surgery.

Outcomes of Opening Wedge Osteotomy to Correct Angular Deformity in Clinodactyly

2014 ◽  
Vol 39 (9) ◽  
pp. e18-e19
Author(s):  
Samantha L. Piper ◽  
Charles A. Goldfarb ◽  
Lindley Wall
Keyword(s):  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Opening Wedge

Opening wedge phalangeal osteotomy for correction of Wassel type IV-D thumb duplication

2019 ◽  
Vol 52 (02) ◽  
pp. 147-150
Author(s):  
Kun Wang ◽  
Fangxin Ai ◽  
Pan Zhou ◽  
Zhiwei Liu ◽  
Zhenbing Chen ◽  
...  
Keyword(s):  
Metacarpophalangeal Joint ◽  
Suture Technique ◽  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Opening Wedge ◽  
Type Iv ◽  
Pull Out ◽  
Thumb Duplication ◽  
The Right ◽  
Pull Out Suture

Abstract Background Thumb duplication is one of common anomalies of the hand. Among of Wassel type IV subtypes, type IV-D duplication with a zigzag deformity is most challenging for reconstructing. Several factors may affect the surgical outcomes. This study aimed to present an opening wedge osteotomy at proximal phalangeal neck for treating type IV-D duplication. Methods Data from 14 patients are presented in this study. Eight patients had duplication of the right thumb, and six left thumb. After removal of radial supernumerary thumb, a snug collateral ligament was repaired to correct angular deformity of metacarpophalangeal joint (MCP). Angular deformity of the interphalangeal (IP) joint was corrected by an opening wedge osteotomy at the proximal phalangeal neck. A wedge bone from ablated thumb was grafted to correct the malalignment. IP joint was further stabilized by plication of the ulnar capsule. The relocation of radial part of FPL to the center of distal phalangeal base by use of pull-out suture technique Results After surgery, the angulations of the IP joints and the MCP joints were improved. Bone union was observed in all patients. According to the Japanese Society for Surgery of the Hand evaluation form, twelve cases were rated good, 2 cases fair. Stability of IP and MCP joints was good in all cases. The active ROM of IP was less in residual thumb than in normal thumb. Small nails were observed in some patients. Conclusions Although the reconstructed thumbs were smaller than normal counterparts, they were aligned and with stable joints. The opening wedge osteotomy at proximal phalangeal neck could improve realignment of IP joint and prevent reoccurrence of deformity over time.

scholarly journals Joint-Preserving Surgery for Hyperextension Deformity of the Hallux Interphalangeal Joint in a Patient with Rheumatoid Arthritis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Takumi Matsumoto ◽  
Yuki Shimizu ◽  
Song Ho Chang ◽  
Taro Kasai ◽  
Jun Hirose ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Joint Preserving Surgery ◽  
Medial Cuneiform

Interphalangeal hyperextension is one of the major hallux deformities in patients with rheumatoid arthritis; however, there is yet no established surgical method for this deformity. We here present the case of a 69-year-old female patient with rheumatoid arthritis who developed hallux interphalangeal hyperextension and painful callosity on the plantar hallux accompanied by limited dorsiflexion at the metatarsophalangeal joint. Lateral weight-bearing radiograph of the foot revealed misalignment of the medial column and hallux, including a collapsed medial arch, elevated first metatarsal, plantar flexion and deviation of the proximal phalanx, and hyperextension of the distal phalanx. The foot was successfully treated and became symptom-free with opening wedge osteotomy of the medial cuneiform, plantar and proximal translation of the metatarsal head, and tenotomy of the extensor hallucis longus. This case suggests that reconstruction of the sagittal alignment of the medial column and hallux through a combination of osteotomy and soft tissue intervention could be an optional treatment for interphalangeal hyperextension.

scholarly journals Outcomes of Opening Wedge Osteotomy to Correct Angular Deformity in Little Finger Clinodactyly

2015 ◽  
Vol 40 (5) ◽  
pp. 908-913.e1 ◽  
Author(s):  
Samantha L. Piper ◽  
Charles A. Goldfarb ◽  
Lindley B. Wall
Keyword(s):  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Opening Wedge ◽  
Little Finger

Corrective osteotomy for malunited metacarpal fractures: long-term results of a novel technique

2015 ◽  
Vol 40 (8) ◽  
pp. 840-845 ◽  
Author(s):  
K. Karthik ◽  
R. Tahmassebi ◽  
R. S. Khakha ◽  
J. Compson
Keyword(s):  
Plate Fixation ◽  
Hand Function ◽  
Corrective Osteotomy ◽  
Long Term Results ◽  
Wedge Osteotomy ◽  
Dominant Hand ◽  
Level Of Evidence ◽  
Metacarpal Fractures

Symptomatic malunited metacarpal fractures can significantly affect hand function. We retrospectively reviewed the results of our technique of corrective osteotomy in 14 malunited metacarpal fractures (12 patients) with an average age of 30 years (range 18–49) from January 2005 to December 2011. The dominant hand was involved in nine patients and all except one were male. The malunited metacarpals demonstrated mean dorsal apex angulation of 43° (range 33°–72°) with apparent metacarpal shortening. All except three cases had rotational deformity. All patients underwent surgical correction of the deformity using our described technique of closing wedge osteotomy using temporary intramedullary K-wire and plate fixation. At a mean follow-up of 46 months (range 12–78), the DASH scores improved significantly ( p < 0.001). All our patients scored ‘excellent’ according to the Büchler criteria and at final follow-up had returned to pre-injury work and sports activities. Our technique is safe, easily performed and can be adapted to correct a range of deformities. Level of evidence: Level IV

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