scholarly journals Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110466
Author(s):  
Jörg Harrer ◽  
Max Schenke ◽  
Christoph Lutter ◽  
Jörg Dickschas ◽  
Matthias Feucht ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Varus Deformity ◽  
Joint Line ◽  
Full Weight Bearing ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Partial Weight Bearing ◽  
Angle Stable ◽  
Angle Stable Plate ◽  
Partial Weight

Background: Lower extremity alignment-correcting procedures for unicompartmental osteoarthritis are experiencing a rapid rise. Medial open-wedge high tibial osteotomy (MOW-HTO) thereby represents the most common technique among osteotomies but is limited in cases of severe malalignment. Some cases make a double-level osteotomy necessary. Indications: If planning of malalignment correction using a MOW-HTO results in a mechanical medial proximal tibial angle (mMPTA) of more than 93° (causing an oblique joint line), double-level osteotomy is indicated to avoid nonphysiological knee kinematics. Technique Description: After clinical examination and detailed analysis of malalignment (full-weight-bearing long-leg radiograph: hip-knee-angle [HKA], mMPTA, mechanical lateral distal femoral angle [mLDFA], joint line convergence angle [JLCA]), as well as individualized planning of the correction, the surgical procedure starts with an arthroscopy to evaluate the cartilage conditions and eventually treat intraarticular pathologies. Then, the femoral supracondylar correction is performed (closed wedge, biplanar osteotomy [ to increase bony healing]) according to the presurgical planning by resecting the osteotomy wedge with the measured length. K-wires are placed to check the correction. An angle-stable plate is used for osteosynthesis. The wedge taken out will be used as bone stock for the MOW-HTO afterward. The biplanar open-wedge tibial osteotomy is then performed subsequently using a medial tibial approach and an angle-stable plate. Opening of the osteotomy is then performed and double checked with intraoperative fluoroscopy using an alignment rod. Postoperative partial weight bearing for 6 weeks is recommended. Results: In recent literature, only few publications report on results of double-level osteotomies. Babis et al reports that it is a valuable procedure for patients with large varus deformity. Nakayama et al noted a significant improvement in patient-registered clinical outcomes in early postoperative evaluation of 20 patients. Schröter et al reports on 37 knees and findings include good clinical results, despite progressive osteoarthritis. Discussion/Conclusion: In cases of severe malalignment, adequate axis correction may require a double-level osteotomy. Exact preoperative planning is essential. Results reported in recent publications are promising. By splitting 1 large correction into 2 smaller ones, complications like hinge fracture and delayed bone healing are lowered.

scholarly journals Supplemental cerclage wiring in angle stable plate fixation of distal tibial spiral fractures enables immediate post-operative full weight-bearing: a biomechanical analysis

2020 ◽  
Author(s):  
Sabrina Sandriesser ◽  
Stefan Förch ◽  
Edgar Mayr ◽  
Falk Schrödl ◽  
Christian von Rüden ◽  
...  
Keyword(s):  
Geriatric Patients ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Full Weight Bearing ◽  
Early Weight Bearing ◽  
Angle Stable ◽  
Angle Stable Plate ◽  
Partial Weight

Abstract Purpose Distal tibial fractures generally require post-operative weight-bearing restrictions. Especially geriatric patients are unable to follow these recommendations. To increase post-operative implant stability and enable early weight-bearing, augmentation of the primary osteosynthesis by cerclage is desirable. The purpose of this study was to identify the stabilizing effects of a supplemental cable cerclage following plate fixation of distal tibial spiral fractures compared to solitary plate osteosynthesis. Methods In eight synthetic tibiae, a reproducible spiral fracture (AO/OTA 42-A1.1c) was stabilized by angle stable plate fixation. Each specimen was statically loaded under combined axial and torsional loads to simulate partial (200 N, 2 Nm) and full (750 N, 7 Nm) weight-bearing. Tests were repeated with supplemental cable cerclage looped around the fracture zone. In a subsequent stepwise increased dynamic load scenario, construct stiffness and interfragmentary movements were analyzed. Results With supplemental cable cerclage, construct stiffness almost tripled compared to solitary plate osteosynthesis (2882 ± 739 N/mm vs. 983 ± 355 N/mm; p < 0.001). Under full weight-bearing static loads, a supplemental cerclage revealed reduced axial (− 55%; p = 0.001) and shear movement (− 83%; p < 0.001), and also lowered shear movement (− 42%; p = 0.001) compared to a solitary plate under partial weight-bearing. Under dynamic loads supplemental cerclage significantly reduced axial (p = 0.005) as well as shear movements (p < 0.001). Conclusion Supplemental cable cerclage significantly increases fixation stiffness and reduces shear movement in distal tibial spiral fractures. This stabilizing effect enables from a biomechanical point of view immediate mobilization without any weight-bearing restrictions, which may improve the quality of care of orthopedic patients and may trigger a change towards early weight-bearing regimes, especially geriatric patients would benefit from.

scholarly journals Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

2021 ◽  
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Matthias Meyer ◽  
Günther Maderbacher ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enhanced Recovery ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Fill Ratio ◽  
Stem Subsidence ◽  
Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

scholarly journals Femoral neck stress fracture in a young female recruit: case report

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 16 ◽  
Author(s):  
Hélder Fonte ◽  
Ricardo Rodrigues-Pinto
Keyword(s):  
Femoral Neck ◽  
Stress Fracture ◽  
Early Recognition ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Imaging Studies ◽  
Partial Weight Bearing ◽  
Military Recruit ◽  
Femoral Neck Stress Fracture ◽  
Partial Weight

Introduction: Femoral neck stress fractures are uncommon and depending on their location, can be at high risk for non-union and significant morbidity.  Their prevalence is higher among runners and military recruits, and women seem to be at higher risk. Methods: A 27-year-old female, who was enrolled in military recruit, reported left side groin pain after a strenuous running exercise. Due to persistent pain an X-Ray was ordered, which revealed no signs of acute lesions. Further imaging studies with CT scan and MRI identified a compression-type femoral neck stress fracture. Results: The patient was submitted to conservative treatment consisting of restricting from full weight-bearing. Six weeks after she initiated partial weight-bearing, becoming asymptomatic at seven months. Follow-up imaging studies revealed union of the fracture. Discussion: This diagnosis should be considered when evaluating military and athlete populations. Early recognition of these injuries is crucial because complication and morbidity rates are high.

scholarly journals Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis

2020 ◽  
Vol 140 (12) ◽  
pp. 1947-1954
Author(s):  
Johannes Becker ◽  
M. Winkler ◽  
C. von Rüden ◽  
E. Bliven ◽  
P. Augat ◽  
...  
Keyword(s):  
Acetabular Fracture ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Acetabular Fractures ◽  
Full Weight Bearing ◽  
Acetabular Cup ◽  
Partial Weight Bearing ◽  
Quadrilateral Plate ◽  
Stable Conditions ◽  
Partial Weight

Abstract Introduction Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. Methods Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch–Schneider reinforcement cage (BSRC) (n = 6). Results During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). Conclusions The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.

scholarly journals Early full weight bearing is safe in open-wedge high tibial osteotomy

2010 ◽  
Vol 81 (2) ◽  
pp. 193-198 ◽  
Author(s):  
Justus-Martijn Brinkman ◽  
Joan WH Luites ◽  
Ate B Wymenga ◽  
Ronald J van Heerwaarden
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals Displaced Femoral Neck Stress Fracture in a 7-year-old Child: A Case Report

2020 ◽  
Vol 1 (1) ◽  
pp. 68-72
Author(s):  
Raymond Massaad ◽  
Said El Orra ◽  
Mohammed Dabbous ◽  
Ali Ibrahim ◽  
Antonella Massaad
Keyword(s):  
Case Report ◽  
Femoral Neck ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Radiographic Images ◽  
Femoral Neck Stress Fracture ◽  
Displaced Fracture ◽  
Partial Weight

Background: Stress fracture of the femoral neck is rare in children. Its differential diagnosis includes muscle strain, synovitis, infection, dysplasia, etc. Since physicians rarely see this type of fracture in children, they often overlook it or misdiagnose it.  Case Report: A seven-year-old girl presented to our service with right groin pain following a fall on her right hip 15 days ago. Pelvic and knee radiographs of her right limb showed a fracture line with sclerosis at the femoral neck. Magnetic-resonance imaging (MRI) confirmed the diagnosis of a stress fracture of the femoral neck. We opted for conservative management and gave the patient analgesics and limited weight-bearing with the help of crutches for eight weeks. Three weeks after her first visit, the patient presented with severe limping and inability to bear weight on her right leg. Right hip radiographic imaging showed a varus displaced fracture of the femoral neck, which we managed surgically with an open reduction and internal fixation using plate and screws, followed by immobilization of the right hip with a hip spica cast. Six weeks following the surgery, the patient had no complaints, and the radiographic images showed an appropriate reduction and signs of union. The patient was allowed to start partial weight-bearing for a further six weeks before proceeding to full weight-bearing. Conclusion: Our case emphasizes the importance of considering femoral neck stress fracture in children, through a thorough clinical evaluation and imaging analysis, especially for those carrying classical risk factors. Failure to do so can complicate the disease course and may lead to a displaced fracture requiring more invasive and timely management.

scholarly journals Lateral Plantar Arch Reconstruction Using Vascularized Fibula Osteocutaneous Flap

2021 ◽  
Vol 4 (6) ◽  
pp. 01-05
Author(s):  
Srivatsa M Shet ◽  
Subin Joseph ◽  
Kader Kalathinga ◽  
Hafiz Muhammed Koyappathody ◽  
Srikant Aruna Samantaray ◽  
...  
Keyword(s):  
Road Traffic ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Post Surgery ◽  
Vascularized Fibula ◽  
One Stage Reconstruction ◽  
Arch Reconstruction ◽  
Partial Weight ◽  
Osteocutaneous Flap

A Sixteen-year-old male had a road traffic accident resulting in crush and loss of lateral two metatarsals of the left foot. The Lateral plantar arch was reconstructed with a vascularized fibula osteocutaneous flap. Flap survived and partial weight-bearing was started by 3 months and full weight-bearing was started 6-months post-surgery. At a 16-month follow-up patient had a normal gait and integrity of the lateral plantar arch was maintained. Vascularized fibula osteocutaneous flap is an excellent option for one-stage reconstruction of the lateral arch of the foot and gives satisfactory results in terms of functions of foot and in avoiding long-term morbidity.

scholarly journals The actual knee function was not influenced by joint line obliquity after open-wedge high tibial osteotomy

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 4 ◽  
Author(s):  
Mitsuaki Kubota ◽  
Youngji Kim ◽  
Taisuke Sato ◽  
Junichiro Yamaguchi ◽  
Ryuichi Ohno ◽  
...  
Keyword(s):  
Muscle Strength ◽  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Joint Line ◽  
Knee Function ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Radiological Parameters ◽  
Joint Line Obliquity ◽  
Wedge High Tibial Osteotomy

Purpose: Excessive joint line obliquity (JLO) after open-wedge high tibial osteotomy (OWHTO) induces detrimental stress on the articular cartilage. The purpose of this article is to assess the correlation between JLO and the clinical results after OWHTO. Methods: 68 patients were followed up for more than 1 year. JLO was assessed using a long-leg standing anteroposterior radiograph. The knee osteoarthritis outcome score (KOOS) and KSS (Knee Society score) objective knee score were assessed as clinical scores. The Weight-bearing line ratio (WBLR), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint line convergence angle (JLCA) were assessed as radiological parameters. The timed up-and-go (TUG) test and single-leg standing (SLS) test were performed, and the isometric muscle strength of the quadriceps and hamstrings was assessed to evaluate the knee function. The primary outcomes were the correlations between the JLO and the clinical score, radiological parameters and knee function after OWHTO. The secondary objective of this study was to detect the factor with the greatest influence on JLO. Results: There were significant correlations between the postoperative JLO and the KOOS in the subcategories of pain, activities of daily living (ADL), and sports and recreation (r = −0.311, −0.302, −0.282, p = 0.011, 0.014, 0.022, respectively). However, the postoperative JLO was not significantly correlated with the KSS, knee function, or muscle strength. The preoperative LDFA and postoperative MPTA were factors influencing increased JLO after OWHTO. Discussion: There was no significant correlation between the JLO and the actual knee function. The preoperative LDFA and postoperative MPTA were factors that influenced the increase in JLO after OWHTO.

scholarly journals Outcome of Intramedullary Interlocking Nailing in the Management of Gustillo-I Diaphyseal Fracture of Tibia

2021 ◽  
pp. 161-166
Author(s):  
Santosh Kumar ◽  
Faheem Ahmed Memon ◽  
Siraj Ahmed Butt ◽  
Shakeel Ahmed Memon ◽  
Iftikhar Ahmed Memon ◽  
...  
Keyword(s):  
Road Traffic ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Type I ◽  
Diaphyseal Fracture ◽  
Partial Weight Bearing ◽  
Interlocking Nailing ◽  
Traumatic Fracture ◽  
Surgery Department ◽  
Partial Weight

Objective: To evaluate the outcome of intramedullary interlocking nailing in the management of Gustillo-I diaphyseal fracture of tibia. Study Design: This is an observational study. Setting: Study carried out at Orthopaedic Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2018 to February 2021. Materials & Methods: 72 consecutive patients of Gustillo Type-I diaphyseal fracture of tibia. All patients age between 18-60 years with traumatic fracture like Gustillo Type-I diaphyseal fracture of tibia were included in this study. Patients reported chest, abdominal and head trauma with neurovascular deficit were excluded. Patients were prepared for surgery after relevant investigation and radiographs. Results: Out of 72 patients included in this study 11.11% were female (N=8) and 88.88% male (N=64); with mean age was 38.26±8.20 years (Range 18 to 60 years). Road traffic accident was common cause of tibia fracture (Gustillo Type-I). Postoperative mean union time of tibial fractures were 9.9±3. 2 week.Postoperatively started partial weight bearing associated with help of two axillary crutches. The patients walking with partial weight bearing allowed at 4.1±1.12 weeks. While patients walking with full weight bearing allowed at 10.8±2.4 weeks. Postoperatively 11(15.27%) patients were complaining of pain. Wound infection observed in 7(9.72%) cases. Clinically excellent results were found in 24(33.33%) patients, while good results remained in 30(41.66%) patients and fairs in 18(25%) patients.   Conclusion: We conclude that interlocking intra-medullary nailing may be considered as a suitable option for treatment of Gustilo-I diaphyseal fracture of tibia.

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