scholarly journals Efficacy Comparison of Three Kinds of Distal Tibial Hemiepiphyseal Implants in the Treatment of Postoperative Ankle Valgus of Congenital Pseudarthrosis of the Tibia

2021 ◽  
Author(s):  
Xiongke Hu ◽  
Anping Li ◽  
Kun Liu ◽  
Haibo Mei
Keyword(s):  
Internal Fixation ◽  
Cortical Bone ◽  
Valgus Deformity ◽  
Bone Screw ◽  
Correction Rate ◽  
Congenital Pseudarthrosis ◽  
Correction Effect ◽  
Ankle Valgus ◽  
Screw Group

Abstract Background: Congenital pseudarthrosis of the tibia is a complex and serious disease in orthopedics which often requires multiple operations for treatment. Postoperative ankle valgus deformity is easily seen after the operation of congenital pseudarthrosis of the tibia. The aim of this study is to retrospectively evaluate the safety of three different implants for treating postoperative ankle valgus after congenital pseudarthrosis of the tibia.Methods: A total of 41 patients with postoperative ankle valgus after congenital pseudarthrosis of the tibia from December 2010 to July 2019 were selected. Out of these 41 patients, 23 patients were treated with “U”-shaped tension screw, 10 patients were treated with hollow screw and 8 patients were treated with cortical bone screw. The evaluation index was tibiotalar angle. The general data, preoperative, postoperative and final follow-up imaging data were recorded, and the deformity correction rate and complications were compared. Results: all the patients were performed with postoperative follow-up visit for at least 12 months (31 months on average). In the “U”-shaped tension screw group, the preoperative tibiotalar angle was (74.8±4.8°), the tibiotalar angle was (85.8±4.5°) when the internal fixation was removed; in the hollow screw group, the average preoperative tibiotalar angle was (72.2±6.1°), the average tibiotalar angle was (88.4±5.1°) when the internal fixation was removed; in the cortical bone screw group, the average preoperative tibiotalar angle was (75.1±4.2°), the average tibiotalar angle was (88.4±5.1°) when the internal fixation was removed. The correction effect of the “U”-shaped tension screw group was better than that of the other two groups, but the difference was not significant (the correction rate of the “U”-shaped tension screw group was 0.71°/month, with that of in the hollow screw group and cortical bone screw group being 0.64°/month and 0.61°/month respectively, P＞0.05). One case of internal fixation complication was reported in the hollow screw group; two cases of missing correction effect were reported, one in cortical bone screw group and one in hollow screw group; and two cases showing symptom of wound pain were reported in the “U”-shaped screw group. Conclusion: Ankle valgus is a common postoperative complication of congenital tibial pseudarthrosis. Temporary hemiepiphyseal is an effective treatment for postoperative ankle valgus deformity of congenital pseudarthrosis of the tibia in children. Through comparison, the "U"-shaped tension screw provides relatively better orthopedic results and has a lower rate of internal fixation complications.

DISI DEFORMITY AND POST-OPERATIVE SYMPTOMS OF SCAPHOID NON-UNION

Hand Surgery ◽  
1999 ◽  
Vol 04 (02) ◽  
pp. 117-124 ◽  
Author(s):  
T. Wada ◽  
M. Aoki ◽  
M. Usui ◽  
S. Ishii
Keyword(s):  
Internal Fixation ◽  
Grip Strength ◽  
Bone Grafting ◽  
Open Reduction ◽  
Average Duration ◽  
Bone Screw ◽  
Non Union ◽  
Significant Difference ◽  
Corticocancellous Bone Grafting

The correlation between the residual dorsal intercalated segmental instability (DISI) deformity and symptoms of the wrist was investigated in 20 patients with healed scaphoid non-union who had open reduction and bone grafting. In seven patients, inlay corticocancellous bone grafting (modified Russe procedure) was performed. In four of the seven patients, an additional Herbert bone screw was used for internal fixation. The remaining 13 patients were treated with open reduction, anterior bone grafting, and internal fixation with Herbert bone screw. Average duration of follow-up period after operation was 20 months (range, 6 to 57 months). The average extension-flexion arc of the injured wrists was 129°, which was 31° less than that of the uninjured wrists. The average grip strength of the injured wrists was 89% of that of the uninjured wrist. Before the operation, all 20 patients were symptomatic and complained of wrist pains. Post-operatively, three patients experienced mild pains and only one complained of moderate wrist pains. Post-operative radiolunate angle ranged from 0° to 34° (average 10°). DISI deformity remained uncorrected in eight patients. Post-operative symptoms were compared amongst the eight patients who had DISI deformity and 12 patients who had no deformity. There was no significant difference in range of motion, grip strength, and incidence of pain between these two groups of patients. The presence of DISI deformity after bone grafting for a symptomatic scaphoid non-union was not predictive of post-operative symptoms of the wrist.

scholarly journals The association between fibular status and frontal plane tibial alignment post-union in congenital pseudarthrosis of the tibia

2021 ◽  
pp. 1-9
Author(s):  
Huajun Deng ◽  
Haibo Mei ◽  
Enbo Wang ◽  
Qiwei Li ◽  
Lijun Zhang ◽  
...  
Keyword(s):  
Frontal Plane ◽  
Valgus Deformity ◽  
Level Of Evidence ◽  
Length Discrepancy ◽  
Congenital Pseudarthrosis ◽  
Significant Difference ◽  
Intramedullary Rod ◽  
Grade 3 ◽  
Ankle Valgus ◽  
Tibial Valgus

Purpose Controversy exists regarding fibular status related to tibial alignment after congenital pseudarthrosis of the tibia (CPT) achieves union. We aimed to determine whether fibular status affected frontal plane tibial alignment post-CPT union. Methods Between January 2010 and December 2013, we followed 36 patients treated using a combined surgical technique (mean 6.6 years (2.2 to 9.4)). Outcome measures comprised medial proximal tibial angle, tibial diaphyseal angulation, lateral distal tibial angle (LDTA), relative intramedullary rod length and relative fibula length discrepancy. Results The frequency of proximal tibial valgus deformity and ankle valgus deformity were significantly lower in the fibular integrity group than in the fibular un-integrity group (proximal tibial valgus deformity: 2/17 versus 11/19; p = 0.006; ankle valgus deformity: 10/17 versus 18/19; p = 0.016). The mean LDTA was notably higher in the fibular integrity group than in the fibular un-integrity group (81.2° (sd 6.7°) versus 71.3° (sd 6.6°); p < 0.001). A statistically significant difference was observed in relative fibula length discrepancy between patients with fibular integrity (0.06 (0 to 0.11); Malhotra grade 0, n = 6; Malhotra grade I, n = 11) and those without (0.24 (0.01 to 0.36); Malhotra grade 2, n = 2; Malhotra grade 3, n = 17; p < 0.001). Ankle valgus deformity had a significant positive correlation with proximal tibial valgus deformity (r = 0.402; p = 0.015). Patients with an intact and normal length fibula had a lower frequency of ankle valgus deformity than those with an intact but shortening fibula (1/6 versus 9/11; p = 0.035). Conclusion Shortening or pseudarthrosis of the fibula was associated with ankle valgus and proximal tibial valgus deformities post-CPT union. Level of evidence III

scholarly journals Application of the “telescopic rod” in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yaoxi Liu ◽  
Ge Yang ◽  
Guanghui Zhu ◽  
Qian Tan ◽  
Jiangyan Wu ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intramedullary Fixation ◽  
Limb Length ◽  
Combined Surgery ◽  
Congenital Pseudarthrosis ◽  
Intramedullary Rod ◽  
Ankle Valgus ◽  
Primary Union ◽  
Tibial Valgus

Abstract Background The current surgical treatment of choice is the combination surgical technique, involving tibial intramedullary fixation to maintain the mechanical axis and mechanical stability of tibial pseudarthrosis. In traditional combined surgery, the Williams rod is often used. Long-term intramedullary fixation of the foot and ankle will affect the ankle joint function of children. The intramedullary rod is relatively shorter due to the growth of the distal tibia. In addition, there are some complications such as epiphyseal bone bridge and high-arched foot. The use of a telescopic intramedullary rod may avoid these complications. Purposes To investigate the initial effect of the “telescopic rod” in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children. Methods A retrospective study including 15 patients with Crawford type IV CPT who were treated using a combined surgical technique and the telescopic rod from January 2017 to May 2018. The average age at the time of surgery was 43.3 months (16–126 months). Of the 15 patients, 7 had proximal tibia dysplasia and 12 exhibited neurofibromatosis type 1. The combined surgical technique using the telescopic rod included the excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov’s fixator, tibia-fibular cross union, and wrapping autogenic iliac bone graft. The incidence of refracture, ankle valgus, tibial valgus, and limb length discrepancy (LLD) in patients were investigated. Results All patients achieved primary union with an average follow-up time of 37.3 months (26–42 months). The mean primary union time was 4.5 months (4.0–5.6 months). Nine cases showed LLD (60%), with an average limb length of 1.1 cm (0.5–2.0 cm). Ankle valgus, proximal tibial valgus, telescopic rod displacement, and epiphyseal plate tethering occurred in 1 case (6.6%) (18°), 3 cases (20%) (10°, 5°, and 6°, respectively), 6 cases (40%), and 2 cases (13%), respectively. There were no refractures during the follow-up periods. Conclusion Although there are complications such as intramedullary rod displacement while using the telescopic rod in a combined surgery, the primary healing rate of congenital pseudarthrosis of the tibia in children is high.

Fixation of the Chevron Osteotomy Utilizing Absorbable Polydioxanon Pins

1995 ◽  
Vol 16 (6) ◽  
pp. 346-350 ◽  
Author(s):  
Henry N. Small ◽  
W. Grant Braly ◽  
Hugh S. Tullos
Keyword(s):  
Internal Fixation ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Advantages And Disadvantages ◽  
Alternative Method ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity

The Chevron osteotomy has become popular for the treatment of hallux valgus deformity. Displacement of the osteotomy is a known complication. Many methods of internal fixation have previously been reported to prevent the displacement and each has inherent advantages and disadvantages. An alternative method of fixation, utilizing absorbable polydioxanon pins, is presented in this article. Between April 1989 and April 1990, 71 procedures were performed on 50 patients. At 1-year follow-up, there were no complications or infections. Review of the osteotomy after surgery and at 1 year revealed no fractures or displacements, and no pins required removal. Internal fixation utilizing absorbable polydioxanon pins appears to have significant benefits when compared with metallic fixation.

scholarly journals Hemiepiphysiodesis Using a Transphyseal Screw at the Medial Malleolus for the Treatment of Ankle Valgus Deformity

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110614
Author(s):  
Rhett Macneille ◽  
Joshua Chen ◽  
Lee Segal ◽  
William Hennrikus
Keyword(s):  
Average Rate ◽  
Case Series ◽  
Valgus Deformity ◽  
Institutional Review Board ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Institutional Review ◽  
Average Change ◽  
Ankle Valgus

Background: The purpose of this study is to report outcomes of transphyseal screw hemi-epiphysiodesis at the medial malleolus for the treatment of valgus ankle deformity. Methods: An institutional review board–approved retrospective review was done of 24 patient charts. Lateral distal tibial angle (LDTA) was measured preoperatively and at final follow-up. Results: The average change in LDTA was 8.3 degrees (SD 4.9 degrees; range 0-19 degrees). The average rate of correction was 0.4 degrees per month (SD 0.3; range 0-1.4). Conclusion: Medial malleolar transphyseal screw hemiepiphysiodesis is a simple, effective, and safe treatment for valgus ankle deformity in skeletally immature children. Level of Evidence: Level IV, case series.

scholarly journals Self-made wire-rope button plate: A novel option for the treatment of distal tibiofibular syndesmosis separation

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902097521
Author(s):  
Xiang-Ke Wei ◽  
Guang-Wu Jing ◽  
Yang Shu ◽  
Jie Tong ◽  
Jin-Hua Wang
Keyword(s):  
Internal Fixation ◽  
Wire Rope ◽  
The Self ◽  
Tibiofibular Syndesmosis ◽  
Cortical Screw ◽  
Distal Tibiofibular Syndesmosis ◽  
Plate Group ◽  
Significant Difference ◽  
Screw Group

Objective: To compare the clinical effect of the self-made wire-rope button plate and cortical screw in the treatment of the distal tibiofibular syndesmosis separation. Methods: Total 26 patients with distal tibiofibular syndesmosis separation were treated with internal fixation with a self-made wire-rope button plate and cortical screw. They were divided into a self-made wire-rope button plate group and cortical screw group. self-made wire-rope button plate group: 12 cases of inferior tibiofibular syndesmosis were reconstructed by self-made wire-rope button plate. Cortical screw group: 14 cases of inferior tibiofibular syndesmosis were reconstructed by cortical screw. The follow-up data of 2, 6, 12 weeks and 6 and 12 months after operation were collected. Results: There was no significant difference in operative time, the amount of intraoperative bleeding and postoperative complications between the two groups (P > 0.05). Comparison of postoperative complications: There was no loosening and rupturing of internal fixation in the self-made wire-rope button plate group. In the cortical screw group, the rupture of screws was found in 1 case, which occurred in the 10th weeks after the operation, and the broken screws were removed after 1 year with other internal fixations. Within 12 weeks of reoperation to remove the internal fixation rate: There was a significant difference in the rate of reoperation to remove the internal fixation within 12 weeks (p < 0.05). At the last follow-up, the AOFAS score of the ankle joint were 94 ± 4.79 in the self-made wire-rope button plate group and 92.8 ± 6.73 in the cortical screw group. There was no significant difference (P > 0. 05). Conclusion: The self-made wire-rope button plate and cortical screw can effectively treat the separation of the tibiofibular syndesmosis. It provides a new choice for the treatment of inferior tibiofibular syndesmosis.

Pullout Strength of Screws in Foal Third Metacarpal Bone after Overdrilling a 4.5 mm Hole

1998 ◽  
Vol 11 (04) ◽  
pp. 200-204 ◽  
Author(s):  
K. Kelly ◽  
G. S. Martin ◽  
D. J. Burba ◽  
S. A. Sedrish ◽  
R. M. Moore
Keyword(s):  
Cortical Bone ◽  
Metacarpal Bone ◽  
Pullout Strength ◽  
Cancellous Screw ◽  
Bone Screw ◽  
Screw Insertion ◽  
Holding Power ◽  
Cortical Screw ◽  
Metaphyseal Bone

SummaryThe purpose of the study was to determine and to compare the in vitro pullout strength of 5.5 mm cortical versus 6.5 mm cancellous bone screws inserted in the diaphysis and metaphysis of foal third metacarpal (MCIII) bones in threaded 4.5 mm cortical bone screw insertion holes that were then overdrilled with a 4.5 mm drill bit. This information is relevant to the selection of a replacement screw if a 4.5 mm cortical screw is stripped during orthopaedic surgery. In vitro pullout tests were performed in two independent cadaver studies, each consisting of 12 foal MCIII bones. Two 4.5 mm cortical screws were placed either in the mid-diaphysis (study 1) or distal metaphysis (study 2) of MCIII bones. The holes were then overdrilled with a 4.5 mm bit and had either a 5.5 mm cortical or a 6.5 mm cancellous screw inserted; screw pullout tests were performed at a rate of 0.04 mm/s until screw or bone failure occurred.The bone failed in all of the tests in the diaphyseal and metaphyseal bone. The holding power for 6.5 mm cancellous screws was significantly (p <0.05) greater than for 5.5 mm cortical screws in both the diaphysis and metaphysis. There was not any difference in the holding power of screws in either the diaphysis or the metaphysis between proximal and distal screw holes.If a 4.5 mm cortical bone screw strips in MCIII diaphyseal or metaphyseal bone of foals, a 6.5 mm cancellous screw would provide greater holding power than a 5.5 mm cortical screw.In order to provide information regarding selection of a replacement screw if a 4.5 mm cortical screw is stripped, the in vitro pullout strength was determined for 5.5 mm cortical and 6.5 mm cancellous screws inserted in third metacarpal diaphyseal and metaphyseal bone of foals in which threaded 4.5 mm cortical bone screw insertion holes had been overdrilled with a 4.5 mm bit. The holding power of the 6.5 mm cancellous screw was significantly greater than the 5.5 mm cortical screw in both the diaphysis and metaphysis of foal third metacarpal bone. Thus, it appears that if a 4.5 mm cortical screw is stripped during orthopaedic surgery in foals, a 6.5 mm cancellous screw would provide superior holding power.

Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

2020 ◽  
Author(s):  
Hongfeng Sheng ◽  
Weixing Xu ◽  
Bin Xu ◽  
Hongpu Song ◽  
Di Lu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Theoretical Basis ◽  
New Technology ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

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