scholarly journals Inversed V-shaped High Tibial Osteotomy for Severe Varus Deformity due to Blount Disease: A Case Report

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Seiju Hayashi ◽  
Kazuhiro Tsukisaka ◽  
Tatsunori Aoki ◽  
Atsushi Okuhara
Keyword(s):  
Case Report ◽  
High Tibial Osteotomy ◽  
Varus Deformity ◽  
Osteotomy Site ◽  
Angular Deformity ◽  
Tibial Osteotomy ◽  
Genu Varum ◽  
Highly Active ◽  
Severely Obese ◽  
Blount Disease

Introduction: Blount disease is a growth disorder of the medial proximal tibial physis causing a multi-planar deformity of the lower limb. Several types of surgical approaches have been described for the correction of angular deformity including external fixation, opened-/closed- wedge high tibial osteotomy (HTO), and tibial condylar valgus osteotomy. However, they are associated with various disadvantages such as limb length discrepancy, risk of infections, and delayed union at the osteotomy site, especially in cases of severe varus deformity. Case Report: We report a case of a 16-year-old boy with unilateral severe genu varum caused by Blount disease. Considering that the current case, the patient was severely obese and a highly active young boy with severe unilateral genu varum, with the epiphyseal line almost closed, and with no abnormalities with respect to the intra-articular anatomical structures, inverted V-shaped HTO was applied. After the treatment, the boy was not only able to perform his daily activities but was also able to participate in sports quite early. Although the required correction angle was quite large, inverted V-shaped HTO successfully corrects the deformity with minimal disadvantages Conclusion: Inverted V-shaped HTO would be selected as one of the effective treatments for a severely obese, young, and highly active patient suffering from severe genu varum caused by Blount disease. Keywords: Blount disease, genu varum, obesity, high tibial osteotomy (HTO), inverted V-shaped high tibial osteotomy (iVHTO).

scholarly journals Medial Opening Wedge High Tibial Osteotomy Fixation with Short Plate without any Graft, Synthetic Material or Spacer

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0016
Author(s):  
Faik Türkmen ◽  
Cem Sever ◽  
Burkay Kutluhan Kacıra ◽  
Mehmet Demirayak ◽  
Mehmet Ali Acar ◽  
...  
Keyword(s):  
Bone Graft ◽  
High Tibial Osteotomy ◽  
Varus Deformity ◽  
Bone Grafts ◽  
Osteotomy Site ◽  
Osteoarthritis Of The Knee ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Synthetic Materials ◽  
Wedge High Tibial Osteotomy

Objectives: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee relocates to the lateral compartment with this procedure. A gap occurs on the proximal tibia during the correction of varus deformity. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing nonunion or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials. Methods: We evaluated 41 MOWHTOs performed between 2009 and 2012 with no use of bone grafts, synthetic materials or spacers. Age of the patients ranged from 43 to 67. Thirty five of the patients were female and 3 of them were male. The follow-up time was 6 months. Results: There were no any non-unions or loss of correction. The mean bone union time was 12,8 weeks. No major complications were seen. Conclusion: The results of our study has shown that achieve satisfactory results can be obtained in MOWHTO without using any bone graft, synthetic materials or spacer.

The Effect of Lateral Cortex Disruption and Repair on the Stability of the Medial Opening Wedge High Tibial Osteotomy

2005 ◽  
Vol 33 (10) ◽  
pp. 1552-1557 ◽  
Author(s):  
Bruce S. Miller ◽  
William O. P. Dorsey ◽  
Cari R. Bryant ◽  
John C. Austin
Keyword(s):  
High Tibial Osteotomy ◽  
Torsional Stiffness ◽  
Osteotomy Site ◽  
Axial Stiffness ◽  
Control Group ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Lateral Cortex ◽  
Wedge High Tibial Osteotomy ◽  
Tibial Cortex

Background Medial opening wedge high tibial osteotomy is gaining popularity as a treatment option for medial compartment degenerative disease in the young, active patient. One of the potential technical pitfalls of this procedure is inadvertent disruption of the lateral tibial cortex during distraction at the osteotomy site. Purpose (1) To investigate the effect of lateral cortex disruption on stability during medial opening wedge high tibial osteotomy and (2) to evaluate 3 different methods of repair of the disrupted lateral cortex. Study Design Controlled laboratory study. Methods A total of 50 validated replicate tibias were evaluated in a medial opening wedge high tibial osteotomy model. Specimens were divided into 5 groups: (1) control, or intact lateral cortex (n = 10); (2) disrupted lateral cortex (n = 10); (3) lateral cortex repaired with 1 staple (n = 10); (4) lateral cortex repaired with 2 staples (n = 10); and (5) lateral cortex repaired with a periarticular plate and screws (n = 10). Specimens were placed in compression and torsion under physiologic loads, and stiffness and micromotion were calculated. Results Disruption of the lateral cortex resulted in a 58% reduction in axial stiffness and a 68% reduction in torsional stiffness compared to control specimens (P<. 05). Disruption of the lateral cortex also resulted in increased micromotion at the osteotomy site. All 3 methods of repair of the lateral cortex restored stiffness and micromotion values to those of the control group (P<. 05). Conclusions Instability at the osteotomy site may contribute to the high rate of delayed union or nonunion associated with medial opening wedge high tibial osteotomy. Repair of the lateral tibial cortex by each of these techniques restored stability to the osteotomy site in this replicate tibia model and might be effective in clinical use. However, more studies are needed to further explore the relationship between lateral cortex disruption and patient outcomes in the clinical setting before definitive conclusions can be drawn.

scholarly journals Biomechanical evaluation of high tibial osteotomy plate with internal support block using finite element analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247412
Author(s):  
Jesse Chieh-Szu Yang ◽  
Kuan-Yu Lin ◽  
Hsi-Hsien Lin ◽  
Oscar K. Lee
Keyword(s):  
Finite Element ◽  
High Tibial Osteotomy ◽  
Tibial Plateau ◽  
Bone Plate ◽  
Osteotomy Site ◽  
Tibial Osteotomy ◽  
Sit To Stand ◽  
Internal Support ◽  
Locking Screw ◽  
Tomofix Plate

Background/Objective High tibial osteotomy (HTO) is a common treatment for medial knee arthrosis. However, a high rate of complications associated with a plate and a significant loss of correction have been reported. Therefore, an internal support block (ISB) is designed to enhance the initial stability of the fixation device that is important for successful bone healing and maintenance of the correction angle of the osteotomy site. The purpose of this study was performed to examine if an internal support block combined with a plate reduces the stress on the plate and screw area. Methods Finite element models were reconstructed following three different implant combinations. Two loading conditions were applied to simulate standing and initial sit-to-stand postures. Data analysis was conducted to evaluate the axial displacement of the posteromedial tibial plateau, which represents the loss of the posteromedial tibial plateau in clinical observation. Moreover, the stresses on the bone plate and locking screws were evaluated. Results Compared to the TomoFix plate, the ISB reduced the axial displacement by 73% and 76% in standing and initial sit-to-stand loading conditions, respectively. The plate with an ISB reduced stress by 90% on the bone plate and by 73% on the locking screw during standing compared to the standalone TomoFix plate. During the initial sit-to-stand loading condition, the ISB reduced the stress by 93% and 77% on the bone plate and the locking screw, respectively. Conclusion The addition of the PEEK block showed a benefit for structural stability in the osteotomy site. However, further clinical trials are necessary to evaluate the clinical benefit of reduced implant stress and the internal support block on the healing of the medial bone tissue.

scholarly journals Rotational Changes in the Distal Tibial Fragment Relative to the Proximal Tibial Fragment at the Osteotomy Site after Open-Wedge High-Tibial Osteotomy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Takahiro Sasaki ◽  
Yasushi Akamatsu ◽  
Hideo Kobayashi ◽  
Shota Mitsuhashi ◽  
Shuntaro Nejima ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Distal Tibia ◽  
Osteotomy Site ◽  
Tibial Rotation ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Rotational Angle ◽  
Correction Angle ◽  
Wedge High Tibial Osteotomy ◽  
Flange Angle

The present study is aimed at assessing the changes in tibial rotation at the osteotomy site after an open-wedge, high-tibial osteotomy (OWHTO) and analysing the factors that affect rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the same site. This study involved 53 patients (60 knees; 16 males and 37 females) with medial osteoarthritis (OA) who underwent OWHTO and preoperative and 3-month postoperative computed tomography (CT) scans. Rotational angles of the distal tibia were measured using Stryker OrthoMap 3D by comparing preoperative and postoperative CTs. The mean rotational angle yielded an external rotation of 2.9 ° ± 4.8 ° . There were 17 knees with internal rotations, 37 knees with external rotations, and one knee with no rotation. The rotational angle significantly correlated with the resultant change in the femorotibial angle (correction angle) and the angle between the ascending and transverse osteotomy lines on the anterior osteotomised surface on which a flange was formed with the distal tibial osteotomised surface (flange angle). The flange angle affected the rotation, but it may have been affected by our surgical technique. The rotational angle did not significantly correlate with the change in the angle of the posterior tibial slope or body mass index. There were significant correlations between the rotational angle and correction angle ( r = 0.42 , p < 0.05 ). Additionally, the rotational angle correlated with the flange angle ( r = − 0.41 , p < 0.05 ).

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