scholarly journals The effects of residual hip deformity on coronal alignment of the lower extremity in patients with unilateral slipped capital femoral epiphysis

2018 ◽  
Vol 12 (6) ◽  
pp. 599-605
Author(s):  
H. Ucpunar ◽  
S. K. Tas ◽  
Y. Camurcu ◽  
H. Sofu ◽  
M. Mert ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Skeletal Maturity ◽  
Slipped Capital Femoral Epiphysis ◽  
Orientation Angle ◽  
Joint Line ◽  
Leg Length ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Neck Shaft Angle ◽  
Retrospective Comparative Study

Purpose The aim of our explorative study was to compare the differences in the coronal alignments of the hip, knee and ankle on the slip side and non-slip sides in patients with slipped capital femoral epiphysis (SCFE). Methods The study group consisted of 28 patients. On the full-length standing radiographs, measurements of articulo-trochanteric distance (ATD), neck-shaft angle (NSA), femoral offset, hip-knee-ankle axis, femur-tibial angle, mechanical axis deviation ratio (MAD-r), anatomical medial proximal femoral angle (aMPFA), mechanical lateral proximal femoral angle (mLPFA), anatomical lateral distal femoral angle (aLDFA), mechanical lateral distal femoral angle (mLDFA), knee joint line congruency angle, mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), ankle joint line orientation angle (AJOA), and leg length discrepancy (LLD) were performed. The data from the slip side were compared with those from the non-slip side. Results At skeletal maturity, there were significant differences between the slip side and non-slip side in ATD (p <0.001), NSA (p <0.001), MAD-r (p <0.001), aMPFA (p <0.001), aLDFA (p = 0.03), mLDFA (p = 0.04), mLDTA (p = 0.02), AJOA (p <0.001) and LLD (p<0.001). Conclusion Residual deformity in the proximal femur after epiphyseal slip and premature epiphysiodesis could cause changes in the coronal alignment of the lower extremity. We can add lower extremity alignment examination to follow-up protocol to rule out secondary problems in patients with SCFE. Level of Evidence Level III, retrospective comparative study

scholarly journals Acetabular morphology in slipped capital femoral epiphysis: comparison at treatment onset and skeletal maturity

2018 ◽  
Vol 12 (5) ◽  
pp. 444-453 ◽  
Author(s):  
D. A. Maranho ◽  
A. Davila-Parrilla ◽  
P. E. Miller ◽  
Y.-J. Kim ◽  
E. N. Novais ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Skeletal Maturity ◽  
Slipped Capital Femoral Epiphysis ◽  
Alpha Angle ◽  
Width Ratio ◽  
Acetabular Coverage ◽  
Neck Shaft Angle ◽  
Factors Associated ◽  
Acetabular Morphology

Purpose To investigate changes in acetabular morphology during the follow-up of slipped capital femoral epiphysis (SCFE) and search for factors associated with acetabular dysplasia at skeletal maturity. Methods We evaluated 108 patients with unilateral SCFE (mean age at slip, 12.3 years sd 1.7) to skeletal maturity, with a minimum follow-up of two years (median 4.5 years; interquartile range 3.2 to 6.2). Acetabular parameters obtained from initial and most recent radiographs included the lateral centre-edge angle (LCEA), Tönnis angle (TA) and acetabular depth-width ratio (ADR). Acetabular dysplasia was considered for LCEA < 20° or TA > 10°. Femoral parameters consisted of the most recent head diameter, neck-shaft angle, neck length, articulotrochanteric distance and alpha angle. Results At SCFE onset, the affected hip showed a slightly lower LCEA (26.4° sd 6.1° versus 27.3° sd 5.7°; p = 0.01) and ADR (330 sd 30 versus 340 sd 30; p < 0.001) compared with the uninvolved hip. At final follow-up, the affected hip showed lower LCEA (24.5° sd 7.6° versus 28.8°sd 6.6°; p < 0.001) and ADR (330 sd 40 versus 350 sd 40; p < 0.001), and TA was larger (5.5° sd 5.4° versus 2.3° sd 4.2°; p < 0.001) compared with the uninvolved hip. Acetabular dysplasia was observed in 27 (25%) of 108 hips with SCFE. Femoral head overgrowth, age at slip and SCFE severity were independent factors associated with acetabular dysplasia (p < 0.05). Conclusion Acetabular coverage and depth are not increased in SCFE, and the acetabular coverage tends to decrease up to skeletal maturity. A potential disturbance in the acetabular growth and remodelling exists mainly for young children with severe SCFE, and a potential for acetabular insufficiency may be observed at the diagnosis and follow-up of SCFE. Level of Evidence Prognostic Level IV

scholarly journals Tension band plating is less effective in achieving equalization of leg length

2018 ◽  
Vol 12 (6) ◽  
pp. 629-634 ◽  
Author(s):  
W.-C. Lee ◽  
H.-K. Kao ◽  
W.-E. Yang ◽  
C.-H. Chang
Keyword(s):  
Bone Growth ◽  
Skeletal Maturity ◽  
T Test ◽  
Tension Band ◽  
Leg Length Discrepancy ◽  
Length Ratio ◽  
Leg Length ◽  
Level Of Evidence ◽  
Short Side ◽  
Length Discrepancy

Purpose Little data is available on the efficiency of different implants for epiphysiodesis. The purpose of this study is to compare the efficacy between plates and staples in decreasing leg-length discrepancy. Methods A retrospective review of 19 children who underwent temporary epiphysiodesis of the legs was conducted, with a minimum of two years of follow-up. The bone length and length ratio to the short side were measured at six months, one year and two years postoperatively. The change in discrepancy was compared between staples and plates by an independent t-test, and the shortest time to a significant decrease in discrepancy was determined using a paired t-test. Results Ten patients underwent 13 staple procedures in nine femurs and four tibias for a 2.8-cm discrepancy at age 11.8 years, and nine patients underwent 14 plate procedures in seven femurs and seven tibias for a 3.1-cm discrepancy at age 12.4 years. Patients were followed up to skeletal maturity, except two. The use of staples decreased the discrepancy in the bone ratio from +4.8% to +1.2% in two years, and the use of plates decreased this ratio from +5.1% to +3.3% in two years. The change in the length ratio was significantly greater after stapling. Six months were required after stapling before the first significant decrease in discrepancy; it took two years after plating. Conclusions This study showed a significantly lower efficacy for decreasing leg-length discrepancy by tension band plating. Orthopaedic surgeons should be aware of the limitations of using plates for suppressing bone growth. Level of Evidence: III

scholarly journals Short knee radiographs can be inadequate for estimating TKA alignment in knees with bowing

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Sung-Mok Oh ◽  
Seong-Il Bin ◽  
Jae-Young Kim ◽  
Bum-Sik Lee ◽  
Jong-Min Kim
Keyword(s):  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Full Length ◽  
Control Group ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Femorotibial Angle ◽  
Total Knee ◽  
Retrospective Comparative Study ◽  
Femoral Bowing

Abstract Purpose The aim of this study was to compare the discrepancy of alignment categorization in total knee arthroplasty (TKA) between the anatomical femorotibial angle (aFTA) measured on short knee radiographs and the mechanical hip–knee–ankle axis angle (mHKA) measured on full-length radiographs in knees with and without bowing. Methods From January 2014 to June 2017, 107 of 526 osteoarthritic knees at our hospital were found to have femoral or tibial bowing. Bowing was defined as a femoral bowing angle (FBA) > 3° or < − 3° or a tibial bowing angle (TBA) > 2° or < − 2° in full-length preoperative radiographs. Among 419 knees without bowing, we selected 107 knees as a control group using propensity-score matching. Postoperative alignments were categorized by aFTA in short knee radiographs and mHKA in full-length radiographs into neutral (2° ≤ aFTA≤7°, − 3° ≤ mHKA≤3°), varus (aFTA< 2°, mHKA<− 3°), and valgus (aFTA> 7°, mHKA> 3°) alignments. We compared the categorization of alignments between knees with and without bowing using the McNemar test and used logistic regression to find factors for the alignment discordance. Results Coronal alignment was discordant in 26.2% of the knees with bowing and 13.1% of the knees without bowing (p < 0.001). FBAs were a significant factor affecting the discordance of alignment categorization (OR = 1.152, 95%CI 1.038–1.279, p = 0.008). Conclusion Short knee radiographs are insufficient for estimating coronal alignment after TKA, particularly in knees with femoral bowing. Level of evidence: III Retrospective comparative study.

scholarly journals Long-term results and comparison of the Green-Anderson and multiplier growth prediction methods after permanent epiphysiodesis using Canale’s technique

2019 ◽  
Vol 13 (4) ◽  
pp. 423-430
Author(s):  
K. Burger ◽  
S. Farr ◽  
J. Hahne ◽  
C. Radler ◽  
R. Ganger
Keyword(s):  
Sagittal Plane ◽  
Skeletal Maturity ◽  
Frontal Plane ◽  
Long Term Results ◽  
Prediction Methods ◽  
Leg Length ◽  
Level Of Evidence ◽  
Growth Prediction ◽  
Expected Effect ◽  
Final Effect

Purpose The aim of the study was to evaluate the accuracy and radiographic outcomes of Canale’s method in patients with idiopathic leg-length discrepancy (LLD) following percutaneous epiphysiodesis. The accuracy of two common growth prediction methods was assessed. Methods A total of 18 patients with 26 affected bones (eight distal femur, two proximal tibia, five combined) were clinically and radiologically analyzed after reaching skeletal maturity. We compared the final effect of epiphysiodesis at maturity with the expected effect of epiphysiodesis before surgery; these measures were calculated using the Green-Anderson and multiplier methods, respectively. We furthermore compared pre- and postoperative frontal and lateral plane radiographs. Results The average LLD was 21.2 mm before surgery and 7.9 mm after epiphysiodesis. The final effect of both methods was not significantly different compared with the expected effect of epiphysiodesis before surgery. However, the prediction by the Green-Anderson method was closer to the definitive epiphysiodesis effect. The frontal plane radiographic deformity parameters did not change significantly after epiphysiodesis. The postoperative sagittal plane radiographic deformity parameters were in the normal range. Conclusion The Canale technique is a reliable method to reduce LLD in children. With regards to growth prediction, the Green-Anderson method using bone age seems to be more accurate than the multiplier method using chronological age. However, a relative over-estimation was observed with both methods in several cases, which might result in an insufficient correction. Level of Evidence IV, Therapeutic study

scholarly journals Assessing the Ankle Joint Line Level Before and After Total Ankle Arthroplasty With the “Joint Line Height Ratio”

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988435
Author(s):  
Thos Harnroongroj ◽  
Amelia Hummel ◽  
Scott J. Ellis ◽  
Carolyn M. Sofka ◽  
Kristin C. Caolo ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Joint Line ◽  
Total Ankle Arthroplasty ◽  
Height Ratio ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Important Principle ◽  
Radiographic Measurements ◽  
Retrospective Comparative Study ◽  
Line Level

Background: Restoring the joint line is an important principle in total knee arthroplasty. However, the effect of joint line level on patient outcomes after total ankle arthroplasty (TAA) remains unclear, as there is no established method for measuring ankle joint level in TAA. The objective of this study was to develop a reliable radiographic ankle joint line measurement method and to compare ankle joint line level measured pre-TAA, post-TAA, and in nonarthritic ankles. Methods: A total of 112 radiographic sets were analyzed. Each set included weightbearing anteroposterior radiographs of the operative ankle taken preoperatively, 1-year postoperatively, and of the contralateral ankle. Measurements of vertical intermalleolar distance (VIMD) and vertical joint line distance (VJLD) at pre-TAA, post-TAA, and of the contralateral ankle were recorded by 2 authors on 2 separate occasions. The ratio of VJLD to VIMD was defined as the joint line height ratio (JLHR). Reliability of measurements and correlation between VIMD and VJLD were assessed. Pre-TAA, nonarthritic contralateral ankle, and post-TAA JLHR were compared and considered significantly different if P <.05. Results: The inter- and intrarater reliability of radiographic measurements was excellent ( r > 0.9). There were strong positive correlations of VIMD and VJLD, r = 0.809 (pre-TAA)/0.756 (post-TAA), P < .001. Mean (SD) pre-TAA, nonarthritic contralateral ankle, and post-TAA JLHRs were 1.54 (0.31), 1.39 (0.26), and 1.62 (0.49), respectively. Pre- and post-TAA JLHRs were significantly higher compared to the nonarthritic contralateral ankle ( P < .05). JHLR was not significantly different between pre- and post-TAA ( P = .15). Conclusion: The JLHR was reliable and could be a clinically applicable method for assessing ankle joint line level in patients undergoing TAA. End-stage ankle arthritis demonstrated elevated joint line level compared with nonarthritic ankles, and the joint line level post-TAA remained elevated compared with nonarthritic ankles. Further studies are needed to understand the effect of joint line elevation on clinical outcomes after TAA. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098207
Author(s):  
Sachin Allahabadi ◽  
Favian Su ◽  
Drew A. Lansdown
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Achilles Tendon ◽  
Sports Medicine ◽  
Direct Consequence ◽  
National Basketball Association ◽  
Return To Play ◽  
Level Of Evidence ◽  
Cartilage Injuries ◽  
Women's National Basketball Association

Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.

scholarly journals Supracondylar rotation osteotomy of the femur influences the coronal alignment of the ankle

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Christian Konrads ◽  
Marc-Daniel Ahrend ◽  
Myriam R. Beyer ◽  
Ulrich Stöckle ◽  
Sufian S. Ahmad
Keyword(s):  
Subtalar Joint ◽  
Distal Femur ◽  
External Rotation ◽  
Weight Bearing ◽  
Orientation Angle ◽  
Osteotomy Site ◽  
Limb Alignment ◽  
Coronal Alignment ◽  
Rotational Osteotomy ◽  
Rotation Osteotomy

Abstract Purpose Osteotomies represent well-established treatment-options for the redistribution of loads and forces within and around the knee-joint. Effects of these osteotomies on the remaining planes and adjacent joints are not fully understood. The aim of this study was to determine the influence of a distal-femoral-rotation-osteotomy on the coronal alignment of the ankle. It was hypothesized that supracondylar-external-rotation-osteotomy of the distal femur leads to a change in the coronal orientation of the ankle joint. Methods Long-leg standing radiographs and CT-based torsional measurements of 27 patients undergoing supracondylar-rotational-osteotomy of the femur between 2012 and 2019 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy-site. The hip-knee-ankle-angle (HKA), the mechanical-lateral-distal-femur-angle (mLDFA), and Tibia-Plafond-Horizontal-Orientation-Angle (TPHA) around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann–Whitney test. Results Twenty-seven patients with high femoral antetorsion (31.3° ± 4.0°) underwent supracondylar-external-rotation-osteotomy. The osteotomy led to a reduced antetorsion (17.4 ± 5.1; p < 0.001) and to a valgisation of the overall limb-alignment. The HKA decreased by 2.4° ± 1.4° (p < 0.001). The TPHA decreased by 2.6° (p < 0.001). Conclusions Supracondylar external rotation osteotomy of the femur leads to lateralization of the weight bearing line at the knee and ankle due to valgisation of the coronal limb alignment. The mobile subtalar joint has to compensate (inversion) for the resulting valgus orientation of the ankle to ensure contact between the foot and the floor. When planning a rotational osteotomy of the lower limb, this should be appreciated – especially in patients with a preexisting valgus alignment of the lower extremities or restricted mobility in the subtalar joint.

scholarly journals Operational experience of the Dutch helicopter emergency medical services (HEMS) during the initial phase of the COVID-19 pandemic: jeopardy on the prehospital care system?

2021 ◽  
Author(s):  
Quinten G. H. Rikken ◽  
Sarah Mikdad ◽  
Mathijs T. Carvalho Mota ◽  
Marcel A. De Leeuw ◽  
Patrick Schober ◽  
...  
Keyword(s):  
The Netherlands ◽  
Initial Phase ◽  
Prehospital Care ◽  
Operational Experience ◽  
Level Of Evidence ◽  
Historical Cohort ◽  
Significant Difference ◽  
One Year ◽  
Retrospective Comparative Study ◽  
Global And Local

Abstract Purpose The SARS-CoV-2 virus has disrupted global and local medical supply chains. To combat the spread of the virus and prevent an uncontrolled outbreak with limited resources, national lockdown protocols have taken effect in the Netherlands since March 13th, 2020. The aim of this study was to describe the incidence, type and characteristics of HEMS and HEMS-ambulance ‘Lifeliner 1’ dispatches during the initial phase of the COVID-19 pandemic compared to the same period one year prior. Methods A retrospective review of all HEMS and HEMS-ambulance ‘Lifeliner 1’ dispatches was performed from the start of Dutch nationwide lockdown orders from March 13th until May 13th, 2020 and the corresponding period one year prior. Dispatch-, operational-, patient-, injury-, and on-site treatment characteristics were extracted for analysis. In addition, the rate of COVID-19 positively tested HEMS personnel and the time physicians were unable to take call was described. Results During the initial phase of the COVID-19 pandemic, the HEMS and HEMS-ambulance was requested in 528 cases. One year prior, a total of 620 requests were received. The HEMS (helicopter and ambulance) was cancelled after deployment in 56.4% of the COVID-19 cohort and 50.7% of the historical cohort (P = 0.05). Incident location type did not differ between the two cohorts, specifically, there was no significant difference in the number of injuries that occurred at home in pandemic versus non-pandemic circumstances. Besides a decrease in the number of falls, the distribution of mechanisms of injury remained similar during the COVID-19 study period. There was no difference in self-inflicted injuries observed. Prehospital interventions remained similar during the COVID-19 pandemic compared to one year prior. Specifically, prehospital intubation did not differ between the two cohorts. The rate of COVID-19 positively tested HEMS personnel was 23.1%. Physicians who tested positive were unable to take call for a mean of 25 days (range 8–53). Conclusion A decrease in the number of deployments and increase in the number of cancelled missions was observed during the COVID-19 study period. No major differences in operational- and injury characteristics were found for HEMS and HEMS-ambulance dispatches between the initial phase of the COVID-19 pandemic in the Netherlands and the same period one year prior. These findings highlight the importance of continued operability of the HEMS, even during pandemic circumstances. Level of evidence III, retrospective comparative study.

Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity

2021 ◽  
pp. 107110072098290
Author(s):  
Elijah Auch ◽  
Nacime Salomao Barbachan Mansur ◽  
Thiago Alexandre Alves ◽  
Christopher Cychosz ◽  
Francois Lintz ◽  
...  
Keyword(s):  
Case Control Study ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Spearman Correlation ◽  
Foot Deformity ◽  
Weak Correlation ◽  
Level Of Evidence ◽  
Valgus Instability ◽  
Retrospective Comparative Study ◽  
Control Study

Background: Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. Methods: In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm2). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant. Results: Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% ( P < .001) in FAO and 10.4 mm2 ( P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 ( P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm2. Conclusion: To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm2. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening. Level of Evidence: Level III, retrospective comparative study.

Sign in / Sign up

Export Citation Format

Share Document