Correction of Posttraumatic Medial Growth Arrest of the Distal Tibia in Adolescents

2021 ◽  
pp. 193864002110291
Author(s):  
Pavel Kotlarsky ◽  
Khaled Abu Dalu ◽  
Mark Eidelman
Keyword(s):  
Ankle Joint ◽  
Distal Tibia ◽  
Growth Arrest ◽  
Treatment Protocol ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Leg Length ◽  
Joint Orientation ◽  
Distal Fibula ◽  
Case Series Study

Background Partial growth arrest of the medial part of the distal tibial physis following fractures that penetrated the epiphysis is relatively common. We present the results of treatment, based on a protocol of supramalleolar tibial and fibular osteotomy for ankle alignment correction, and contralateral epiphysiodesis of distal tibia and fibula to balance leg length discrepancy (LLD). Methods This case series study describes the results of 7 patients with a median age of 14 years (range = 10-15 years) who were operated in our institution. All were treated by closed or open reduction and internal fixation after Salter-Harris (SH) types 3 and 4 fractures of the distal tibia. All patients had a partial medial growth arrest, distal tibial varus, relative overlengthening of the distal fibula, and slight leg shortening. Treatment Protocol Contralateral distal tibial and fibular epiphysiodesis to prevent significant LLD, completion of closure of the ipsilateral epiphysis, supramalleolar osteotomy of the distal tibia and fibula, and insertion of a triangular wedge cortical allograft into the tibial osteotomy creating a normal ankle joint orientation. The osteotomy was supported by a medial anatomically contoured locking plate. The fibula was fixed with an intramedullary wire. Results All patients had uneventful healing of the osteotomy after 6 weeks. At the latest follow-up (mean 3 years, range 1.5-5 years), 6 out of 7 patients reached maturity, and the lateral distal tibial angle was within normal limits. The LLD in all patients was less than 8 mm. Conclusions Our protocol provides anatomic correction with the restoration of the ankle joint and prevents the progression of LLD. Levels of Evidence: Level IV

Ankle Salvage Following Nonunion of Distal Tibia Fractures

2018 ◽  
Vol 39 (10) ◽  
pp. 1210-1218 ◽  
Author(s):  
Giovanni Lovisetti ◽  
Alexander Kirienko ◽  
Charles Myerson ◽  
Ettore Vulcano
Keyword(s):  
Ankle Joint ◽  
Distal Tibia ◽  
Case Series ◽  
Bone Transport ◽  
Radiographic Evaluation ◽  
Leg Length ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Close Proximity ◽  
American Orthopaedic

Background: Nonunions of the distal tibia in close proximity to the ankle joint can be a challenge to treat. The purpose of this study was to evaluate radiographic and clinical outcomes of patients who underwent ankle-sparing bone transport for periarticular distal tibial nonunions. Methods: Twenty-one patients underwent ankle-sparing bone transport between January 2006 and July 2016. The mean age of the patients was 48.6 years, and 71% (15/21) were male. Patients were followed for an average of 14.6 months (range, 10.6-17.7 months), with an average of 8.6 months in-frame. Thirteen of 21 patients had infected nonunions. Primary endpoints included time to union and American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: All fractures achieved union. Mean time to union was 37.4 weeks. Mean AOFAS score was 86.3 points (range, 37-100). A score of 37 was observed in 1 patient with preexisting Charcot foot. Radiographic evaluation at 6 months revealed a mean lateral distal tibial angle of 89.2 degrees and a mean anterior distal tibial angle of 76 degrees. Leg length discrepancy was less than 1.2 cm in all patients. Superficial pin infection was observed in 7 patients, and operative wound infection at the level of bone resection was observed in 3 patients. Conclusion: The ankle-sparing bone transport technique was an effective alternative to bone graft and arthrodesis for the treatment of periarticular nonunions of the distal tibia and was safe for use in patients with infected nonunions in close proximity to the ankle joint. Level of Evidence: Level IV, case series.

scholarly journals Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome

2017 ◽  
Vol 63 (5) ◽  
pp. 422-426 ◽  
Author(s):  
Yahia Abuowda ◽  
Raquel Sousa Almeida ◽  
Ana Alves Oliveira ◽  
Petra Pego ◽  
Cristina Santos ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Case Series ◽  
Tissue Loss ◽  
Repeated Treatment ◽  
Digital Ulcers ◽  
Case Series Study ◽  
Clinical Description ◽  
Soft Tissue Loss

Summary Introduction: In systemic sclerosis (SSc), digital ulcers (DU) are debilitating and recurrent. They are markers of prognosis and are associated with disability and mortality. Treatment strategies have been developed to block the proposed mechanisms of this complication. Objective: Clinical description of a population of SSc patients with DU, treatment, complications and outcome. Method: Analysis of 48 SSc patients meeting 2013 ACR-EULAR criteria, followed between 1999-2015; 13 patients had DU. Treatment protocol applied included cycles of 21 days of alprostadil, which can be repeated in the absence of DU healing. After DU healing, bosentan was initiated. Results: DU healing was achieved with intravenous prostanoid in 12 patients; seven patients required repeated treatment for DU healing. Twelve patients were later treated with bosentan; three of them experienced recurrence of DU, while one was anti-B2-GPI positive. Four patients had soft tissue loss and three other suffered digital amputation, these being late diagnosis. Conclusion: Younger patients and early referrals had better outcomes. Endothelin receptor antagonist toxicity should be monitored, particularly in patients previously exposed to hepatotoxic drugs.

scholarly journals Deformity progression in congenital posteromedial bowing of the tibia: a report of 44 cases.

2020 ◽  
Author(s):  
Giovanni Luigi Di Gennaro ◽  
Giovanni Gallone ◽  
Edgar Alejandro Martinez Vazquez ◽  
Leonardo Marchesini Reggiani ◽  
Costantina Racano ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Distal Tibia ◽  
Case Series ◽  
Limb Lengthening ◽  
Limb Length Discrepancy ◽  
Progressive Increase ◽  
Valgus Deformity ◽  
Radiographic Evaluation ◽  
Tibial Osteotomy ◽  
Spontaneous Correction

Abstract Background Congenital posteromedial bowing of the tibia (CPMBT) is an ultra-rare defect present at birth, characterized by shortened bowed leg, and ankle deformity. We described a single institution experience in the management of CPMBT Methods We identified 44 CPMBT in 44 children. The age at presentation was 5.5 ± 5.6 years and the mean age at the final review was 10.1 ± 4.8 years. Radiographic evaluation included the antero-posterior and lateral inter-physeal angle (AP-IPA and L-IPA), the limb length discrepancy (LLD), the morphology of the distal tibia and the lateral distal tibial angle (LDTA). During the study period, 26 children underwent surgical treatment. Results The estimated curves showed a progressive spontaneous correction of both AP-IPA and L-IPA during growth, but a progressive increase of the LLD. The L-IPA showed a more predictable behaviour while the AP-IPA showed a scattered correction, with a wider variation of the estimated final angle. The final LDTA was 83.4° ± 5.2° and was correlated with the L-IPA. Among the 26 children which underwent surgical treatment, 23 cases had limb lengthening, 1 case had contralateral epiphysiodesis, 1 child underwent tibial osteotomy, 1 patient was treated by hemiepiphysiodesis of the distal tibia to address ankle valgus deformity. Conclusions To date, we reported the largest case series of CPMBT. Nevertheless, further studies are needed to understand which is the best strategy to address this ultra-rare deformity during childhood.

scholarly journals Efficacy and safety of radioiodine treatment of Graves’ disease in children and adolescents

2017 ◽  
Vol 13 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Pavel O. Rumiantsev ◽  
Marina S. Sheremeta ◽  
Alexey V. Kiyaev ◽  
Luydmila A. Kurmyshova ◽  
Olga A. Chikulaeva
Keyword(s):  
Children And Adolescents ◽  
Treatment Protocol ◽  
Case Series ◽  
Active Phase ◽  
Research Centre ◽  
Radiology Department ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Case Series Study

There are three methods in treatment of Graves’ disease in children and adolescents – antithyroid drugs, surgery and radioiodine therapy (RIT). However, treatment protocol of children and adolescents doesn’t exist. In the present case series study we have evaluated the effectiveness and safety of RIT in children and adolescents. We have observed totally 25 patients in age 11–17 years old (mean 14.8 years) with Graves’ disease. Ten patients were treated with RIT in Endocrinology Research Centre (Moscow) in 2016 year with activities 550–920 MBq. Follow-up period varied 6–11 months in this subgroup. The second subgroup (15 patients) was treated in radiology department in Nijniy Tagil rural hospital (Ural region) in the period 2005–2012 years. Follow-up period varied 3.5–11.5 years (mean 8.5 years). RIT was executed in all patients without any complications, direct or long-term. In two patients having endocrine ophtalmopathy in non-active phase it was no any signs of worsening in result of RIT. In 17 (68%) of 25 patients the hypothyroidism occurred through 6 months. In one case – euthyroidism. In remain 7 observations the hyperthyroidism recurred. Patient subgroups didn’t differ in mean age, gender ratio, thyroid size and autoantibodies to TSH receptor levels, but were differed in treatment 131I activities (subset from ERC – 550–920 MBq; subset from Nijniy Tagil – 168–400 MBq). However the treatment efficacy did not differ significantly (p = 0.99): 68% and 73%, accordingly. In conclusion, RIT of Graves’ disease in a safe and effective method of treatment for hyperthyroidism in children and adolescents. It’s necessary to prolong study in numerous patients cohort, longer-lasting follow-up period as well as to improve RIT efficiency.

scholarly journals Thromboembolic Events Secondary to Endoscopic Cyanoacrylate Injection: Can We Foresee Any Red Flags?

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Yujen Tseng ◽  
Lili Ma ◽  
Tiancheng Luo ◽  
Xiaoqing Zeng ◽  
Yichao Wei ◽  
...  
Keyword(s):  
Literature Review ◽  
Adverse Events ◽  
Treatment Protocol ◽  
Case Series ◽  
Gastric Varices ◽  
Patient Treatment ◽  
High Morbidity ◽  
Retrospective Case ◽  
Case Series Study ◽  
Severe Adverse Events

Background. Gastric varices (GV) are associated with high morbidity and mortality in patients with portal hypertension. Endoscopic cyanoacrylate injection is the first-line recommended therapy for GV obliteration. This study aims to explore the reason behind related adverse events and better prevent its occurrence. Methods. A retrospective case series study was conducted from January 1, 2013, to December 31, 2016, to identify patients who experienced severe adverse events secondary to endoscopic cyanoacrylate injection. A literature review of similar cases was performed on two medical databases, Medline and Embase. Results. A total of 652 patients underwent cyanoacrylate injection at our center within the study duration. Five cases of severe adverse events related to the use of tissue adhesives were identified. Detailed clinical presentation, patient treatment, and outcomes were reviewed and analyzed. Twenty-seven similar cases were identified based on the literature review providing further insight into the study. Conclusion. Although rare in incidence, systemic embolism associated with cyanoacrylate injection is often fatal or debilitating. This report may raise awareness in treatment protocol, including the necessity of preoperative angiographic studies, to avoid similar adverse events in clinical practice.

Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block

2020 ◽  
Author(s):  
Shinichiro Okimura ◽  
Atsushi Teramoto ◽  
Kota Watanabe ◽  
Satoshi Nuka ◽  
Tomoaki Kamiya ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Case Series ◽  
Internal Fixator ◽  
Radiographic Evaluation ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Case Series Study ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy

AbstractWe developed a new internal fixator: a rigid T-shaped plate with locking screws and wedge-shaped spacer block for high tibial osteotomy. The purpose of the present study was to evaluate the radiographic outcome of opening-wedge high tibial osteotomy (OWHTO) using this new internal fixator. Sixty OWHTOs were performed in patients with medial compartment osteoarthritis and varus deformity (28 males and 23 females). Patients' mean age was 60.4 years. Preoperative and postoperative radiographs were obtained. The paired t-test was used to evaluate the differences over time with respect to radiographic variables. Union of the osteotomy gap was obtained in all patients, and no implant breakage was found. On anterior–posterior radiographs, a significant difference was observed (p < 0.01) between the preoperative and postoperative mean values of femorotibial angles (179.6 ± 3.2 vs. 170.6 ± 2.5 degrees), weight-bearing line ratios (23.8 ± 13.5 vs. 60.5 ± 11.5%), anatomical medial proximal tibial angles (84.8 ± 2.5 vs. 91.0 ± 2.6 degrees), and joint line coverage angles (3.6 ± 2.0 vs. 2.4 ± 1.7 degrees). On lateral radiographs, posterior tibial slopes were 11.5 ± 3.9 degrees preoperatively and 12.2 ± 4.0 degrees postoperatively (p < 0.01), and Insall–Salvati ratios were 1.04 ± 0.12 preoperatively and 1.06 ± 0.13 postoperatively (p = 0.24). Performing OWHTO using a new internal fixator with a wedge-shaped spacer achieves adequate correction of lower limb alignment without implant-related complications. This is a Level IV, case series study.

scholarly journals Modified oblique high tibial osteotomy with minimal fixation for correction of adolescent tibia vara: a prospective case series study

2020 ◽  
pp. 1-6
Author(s):  
Ahmad Saeed Aly ◽  
Ahmed Refaat Abdelhamid Alsabir ◽  
Hesham Ahmad Fahmy ◽  
Tamer A. Fayyad
Keyword(s):  
High Tibial Osteotomy ◽  
Sagittal Plane ◽  
Case Series ◽  
Varus Deformity ◽  
The Body ◽  
Tibial Osteotomy ◽  
Tibia Vara ◽  
Level Of Evidence ◽  
Case Series Study ◽  
Prospective Case Series

Purpose To assess the reliability and efficacy of the modified oblique high tibial osteotomy for correction of complex deformity in adolescent tibia vara. Methods A total of 19 patients (25 legs) with adolescent tibia vara were enrolled in this study. There were 16 male (84.2%) and three female (15.8%) patients who had modified Rab oblique osteotomy with minimal fixation performed. The age of the patients at time of surgery ranged from 12 years to 30 years (mean 17.23 (sd 5.27)). The body mass index ranged from 22 kg/m2 to 42 kg/m2 (mean 32.05 (sd 6.13)). All patients were followed up for over two years (mean 3.4; 2 to 5). Results The femoro-tibial angle was improved from -34° to -12° (mean -20.04° (sd 5.24°) preoperatively and from -12° to 7°, postoperatively (mean 2.04° (sd 4.07)). Medial deviation of the mechanical axis corrected from 38 mm to 125 mm (mean 76.13 (sd 23.29)) preoperatively to 0 mm to 36 mm (mean 5.74 (sd 7.3)) postoperatively. The time needed to achieve union ranged from eight weeks to 16 weeks (mean 10.2 (sd 2.42)). According to the Lysholm functional knee score scale, there were 15 excellent (78.9%), two good (10.5%), one fair (5.2%) and one poor (5.2%) after correction of the deformity. Conclusion Modified Rab osteotomy with minimal fixation by two or three screws shows promising results with good correction of varus deformity (coronal plane), internal torsion (axial plane) and procurvatum (sagittal plane), in management of adolescent tibia vara with minimal morbidity and complications. Level of evidence IV

scholarly journals Osteochondroma of the Distal Tibia Leading to Deformity and Stress Fracture of the Fibula - A Case Report

2021 ◽  
Vol 20 (2) ◽  
pp. 173-176
Author(s):  
Chander Mohan Singh ◽  
Mohit Thapa Magar ◽  
Ajay Deep Sud
Keyword(s):  
Case Report ◽  
Ankle Joint ◽  
Stress Fracture ◽  
Distal Tibia ◽  
Distal Fibula ◽  
Gait Disturbances

Osteochondromas seldom arise from the interosseous border of the distal tibia and may progress to involve the distal fibula. We present the case of a 14-year-old teenager with a stress fracture of the distal fibula, secondary to an osteochondroma arising from the distal tibia. Early excision of this deforming distal tibial osteochondroma was necessary in order to avoid a progressive deformity which would affect the biomechanics of the ankle joint resulting in gait disturbances.

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