scholarly journals Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use

2021 ◽  
Vol 6 (8) ◽  
pp. 658-668
Author(s):  
J. Javier Masquijo ◽  
Cristian Artigas ◽  
Julio de Pablos
Keyword(s):  
Patellofemoral Instability ◽  
Tension Band ◽  
Angular Deformity ◽  
Flexion Deformity ◽  
Growth Modulation ◽  
History Of ◽  
Ankle Valgus ◽  
Established Technique ◽  
Fixed Flexion Deformity ◽  
Angular Deformities

Growth modulation (GM) with tension-band plates (TBPs) by tethering part of the growth plate is an established technique for the correction of angular deformities in children, and it has increasingly supplanted more invasive osteotomies. Growth modulation with TBPs is a safe and effective method to correct a variety of deformities in skeletally immature patients with idiopathic and pathological physes. The most common indication is a persistent deformity in the coronal plane of the knee exceeding 10°, with anterior and/or lateral joint pain, patellofemoral instability, gait disturbance, or cosmetic concerns. GM has also shown good results in patients with fixed flexion deformity of the knee and ankle valgus. This paper reviews the history of the procedure, current indications, and recent advances underlying physeal manipulation with TBPs. Cite this article: EFORT Open Rev 2021;6:658-668. DOI: 10.1302/2058-5241.6.200098

scholarly journals Heterotopic Ossification of Brachialis Muscle

2005 ◽  
Vol 5 ◽  
pp. 834-834
Author(s):  
Jacob George
Keyword(s):  
Alkaline Phosphatase ◽  
Heterotopic Ossification ◽  
Flexion Deformity ◽  
Range Of Movement ◽  
Middle Segment ◽  
X Ray ◽  
Anterior Aspect ◽  
Brachialis Muscle ◽  
History Of ◽  
Fixed Flexion Deformity

A 13-year-old girl with seizure disorder presented with 90º fixed flexion deformity of right elbow. She had history of encephalitis, 2 years ago, from which she recovered completely except for the deformity of the elbow. Plain X-ray revealed extensive ossification of the brachialis muscle from its origin at the lower anterior aspect of the humerus to its insertion at the coronoid process of the ulna. The alkaline phosphatase value was 500 IU. The middle segment of the ossified mass was surgically excised. The mobility of the elbow was restored and she achieved a range of movement between 45–120º.

scholarly journals Subcutaneous Calcification and Fixed Flexion Deformity of the Right Elbow Joint in a Child with a GNAS Mutation, the First Case Report

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Hussain Alsaffar ◽  
Najya Attia ◽  
Senthil Senniappan
Keyword(s):  
Case Report ◽  
Parathyroid Hormone ◽  
Elbow Joint ◽  
Flexion Deformity ◽  
First Case ◽  
History Of ◽  
The Right ◽  
Subcutaneous Calcification ◽  
Gnas Mutation ◽  
Fixed Flexion Deformity

Introduction: The art of medicine glorifies when a clinician listens carefully to the patient’s story, gives a thorough examination, performs appropriate investigations, and finally links findings together to reach a definite diagnosis. An interesting case was reported here, highlighting the integration of different symptoms and manifestations with some relevant biochemical investigations to reach a final diagnosis. To the best of our knowledge, fixed flexion deformity, as a complication of subcutaneous calcification, has not been previously reported in a child with Albright hereditary osteodystrophy (AHO). Case Presentation: A 2.5-year-old boy was born at term with a birth weight of 3.5 kg (-0.49 SDS). The child was referred to a general pediatrician with a history of right elbow joint swelling noticed initially at six months of age. He then developed the limitation of right upper arm movement, which slowly progressed afterward. The patient had no history of trauma. At nine months of age, he was diagnosed with hypothyroidism, preceded by cold skin, dry hair, and constipation. At nine years of age, he presented with a fixed flexion deformity of the right elbow, associated with markedly limited joint movement and symmetrical hands with hyperpigmented knuckles of right metacarpal bones. Subcutaneous masses were felt along the right forearm, showing tenderness on palpation. Investigations revealed elevated serum parathyroid hormone and normal calcium, indicating parathyroid hormone resistance. Further genetic testing revealed GNAS mutation. The child was obese throughout his childhood. Conclusions: This case report describes an obese child with subcutaneous calcification that led to fixed flexion deformity of the elbow, starting at an incredibly early age. Hypothyroidism and pseudohypoparathyroidism raised the suspicion of AHO, which was later confirmed by genetic testing. This is the first case report on fixed flexion deformity in a patient with GNAS mutation (c.719-1G > A Chr20: 57484737) in West Asia.

scholarly journals Operative Treatment of Fixed Flexion Deformity of Elbow by Anterior Release: A Case Report

2020 ◽  
Vol 58 (231) ◽  
Author(s):  
Abhishek Kumar Thakur ◽  
Nabees Man Singh Pradhan ◽  
Pramod Devkota ◽  
Bidur Gyawali ◽  
Prabhav Majgaiyan Pokhrel
Keyword(s):  
Range Of Motion ◽  
Plaster Cast ◽  
Flexion Deformity ◽  
Posterior Aspect ◽  
Susceptibility Artifacts ◽  
Post Operative Period ◽  
History Of ◽  
One Year ◽  
Fixed Flexion Deformity

A 20-year-old male presented to our OPD with stiffness in his right elbow. He gave a history of sustaining a fracture around the same elbow when he was 4 years old. He was treated operatively for the same. In the post-operative period, he did not undergo any physiotherapy. On examination, he had a fixed flexion deformity in his right elbow with a range of motion between 90 and 110 degrees. X-ray did not show any bony abnormalities and MRI revealed susceptibility artifacts in posterior aspect. The elbow was approached anteriorly releasing all the soft tissue contractures. The elbow was immobilised in extension in a plaster cast for 4 weeks. The patient was under regular physiotherapy after plaster removal in the post-operative period. At one year follow up, he has an elbow range of motion between 20 and 120 degrees.

New approach to cervical flexion deformity in ankylosing spondylitis

2000 ◽  
Vol 93 (2) ◽  
pp. 283-286 ◽  
Author(s):  
Sarah E. Duff ◽  
Paul L. Grundy ◽  
Steven S. Gill
Keyword(s):  
Ankylosing Spondylitis ◽  
Spinal Curvature ◽  
Flexion Deformity ◽  
New Approach ◽  
Content Type ◽  
Axis Of Rotation ◽  
History Of ◽  
Fixed Flexion Deformity ◽  
Experience Difficulty ◽  
Fine Print

✓ The treatment of cervical fixed flexion deformity in ankylosing spondylitis presents a challenging problem that is traditionally managed by a corrective cervicothoracic osteotomy. The authors report a new approach to this problem that involves performing a two-level osteotomy at the level of maximum spinal curvature, thereby achieving complete anatomical correction in a one-stage procedure. This 48-year-old woman with ankylosing spondylitis presented with a 30-year history of progressive neck deformity that left her unable to see ahead and caused her to experience difficulty eating, drinking, and breathing on exertion. On examination, she exhibited a 90° fixed flexion deformity of the cervical spine, which was maximum at C-4; this was confirmed on imaging studies. A two-level osteotomy was performed at C3–4 and C4–5 around the area of maximum spinal curvature, and the deformity was corrected by extending the head on its axis of rotation through the uncovertebral joints. The spine was stabilized using a Ransford loop. An excellent anatomical position was achieved, as was complete correction of the deformity. A two-level midcervical osteotomy performed at the level of maximum spinal curvature in ankylosing spondylitis enables complete correction of severe fixed flexion deformity in a single procedure. Preservation of the uncovertebral joints allows smooth and safe correction of the deformity about their axis of rotation.

Trigger Finger Treatment by Ulnar Superficialis Slip Resection (U.S.S.R.)

2004 ◽  
Vol 29 (4) ◽  
pp. 368-373 ◽  
Author(s):  
D. LE VIET ◽  
I. TSIONOS ◽  
M. BOULOUEDNINE ◽  
D. HANNOUCHE
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Trigger Finger ◽  
Flexion Deformity ◽  
Full Extension ◽  
History Of ◽  
Flexor Digitorum ◽  
Fixed Flexion Deformity ◽  
A1 Pulley

Surgical release of the A1 pulley for treatment of trigger finger normally produces excellent results. However, in patients with long-standing disease, there may be a persistent fixed flexion deformity of the proximal interphalangeal joint. This is sometimes due to a degenerative thickening of the flexor tendons and may be treated by resection of the ulnar slip of flexor digitorum superficialis tendon. One hundred seventy-two patients (228 fingers) who had undergone this procedure were reviewed at a mean follow-up of 66 months. Mean pre-operative fixed flexion deformity of the proximal interphalangeal joint was 33°. All but eight fingers were improved by surgery and there was an average gain of 26° in passive extension (7° residual fixed flexion deformity) of the proximal interphalangeal joint. Full extension was attained in 141 of the 228 fingers, and in all 101 fingers with a pre-operative loss of passive extension of 30° or less. This technique is indicated for patients with loss of passive extension in the proximal interphalangeal joint and a long history of triggering.

Use of Implant-Mediated Guided Growth With Tension Band Plate in Skeletally Immature Patients With Knee Pathology: A Retrospective Review

2021 ◽  
pp. 155633162110107
Author(s):  
Bridget K. Ellsworth ◽  
Alexandra H. Aitchison ◽  
Peter D. Fabricant ◽  
Daniel W. Green
Keyword(s):  
Retrospective Review ◽  
Deformity Correction ◽  
Patellofemoral Instability ◽  
Tension Band ◽  
Angular Deformity ◽  
Skeletally Immature ◽  
Guided Growth ◽  
Increased Risk ◽  
Knee Pathology

Background: Skeletally immature patients with coronal plane angular deformity (CPAD) may be at increased risk for intra-articular pathology and patellofemoral instability (PFI). These patients may be candidates for implant-mediated guided growth (IMGG) procedures with tension band plates to address CPAD in addition to procedures for concomitant knee pathology. However, there are limited data on performing these procedures simultaneously. Questions/Purpose: We sought to demonstrate the feasibility of combined procedures to address both knee pathology and concomitant CPAD using IMGG in skeletally immature patients. Methods: We conducted a retrospective review of skeletally immature patients who underwent IMGG and concomitant surgery for anterior cruciate ligament reconstruction, osteochondritis dissecans repair, meniscus pathology, or PFI at a single institution by 2 surgeons between 2008 and 2019. Data on demographics, surgical details, follow-up, and complications were recorded. Deformity correction was assessed in a subset of eligible patients. Results: Of 29 patients meeting inclusion criteria, deformity correction was assessed in a subset of 17 patients (15 valgus, 2 varus). At final follow-up, 16 of 17 patients had mechanical tibiofemoral (mTFA) angles of <5° of varus or valgus. One patient developed “rebound” valgus >5° after plate removal. Conclusions: The IMGG performed in the setting of treating intra-articular knee pathology is feasible and should be considered for skeletally immature patients with CPAD undergoing surgery for concomitant knee pathology.

scholarly journals Temporary hemiepiphysiodesis using an eight‐plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhen-Zhen Dai ◽  
Zhen-Peng Liang ◽  
Hao Li ◽  
Jing Ding ◽  
Zhen-Kai Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Deformity Correction ◽  
Genu Valgum ◽  
Angular Deformity ◽  
Screw Loosening ◽  
Logistic Regression Models ◽  
The Mean ◽  
Low Incidence ◽  
Angular Deformities

Abstract Background Temporary hemiepiphysiodesis (TH) using an eight-Plate implant is one of the most common surgeries used for the correction of coronal angular deformities around the knee in adolescents. However, few studies have focused on children aged less than 10 years treated with TH using an eight-Plate implant. The purpose of this study was to investigate the efficacy, correction velocity, and complications of TH with an eight-Plate implant as well as the occurrence of rebound and risk factors in this population. Methods This retrospective study included a total of 135 physes (101 knees) from 66 children (mean age of 4.69 years old, range from 1 to 10 years old) who underwent TH with an eight-Plate implant to correct coronal genu angular deformities in our hospital. Related clinical factors were recorded and analysed by multivariable linear and logistic regression models. Results The mean deformity correction period was 13.26 months, and the mean follow-up after eight-Plate removal was 12.71 months. In all, 94.06% (95/101 knees) of the genu angular deformities were completely corrected. Non-idiopathic genu angular deformity was found to be an independent risk factor for deformity correction failure (odds ratio (OR) = 2.47). The femoral correction velocity was significantly higher than the tibial correction velocity (1.28° vs. 0.83° per month, p < 0.001). After adjustment for other factors, younger children had higher correction velocities in the distal femur; however, genu valgum and idiopathic deformities were associated with higher correction velocities in the proximal tibia. In addition, we found three (3/101, 2.97%) knees with genu valgum that experienced rebound after removal of the eight-Plate, while five (5/101, 4.95%) knees with non-idiopathic genu angular deformity experienced screw loosening. No other complications were found, and non-idiopathic deformity was the only risk factor for complications (OR = 3.96). No risk factor was found for rebound in our study. Conclusions TH using an eight-Plate implant is an effective procedure for coronal genu angular deformities with a low incidence of complications and rebound in patients younger than 10 years old. For this population, TH using an eight-Plate should be considered as soon as the deformity stops responding to conservative treatments. The parents of children younger than 10 years of age with non-idiopathic deformities should be informed preoperatively that the deformity may be prone to correction failure or screw loosening after eight-Plate implantation.

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