scholarly journals Clinical Outcome of Medial Opening Wedge Osteotomy with T-Locking Plate : Two Years Follow-Up

2014 ◽  
Vol 8 (1) ◽  
pp. 50-56
Author(s):  
W Kongcharoensombat
Keyword(s):  
Clinical Outcome ◽  
Locking Plate ◽  
Wedge Osteotomy ◽  
Opening Wedge

scholarly journals Effect of the additional first ray osteotomy on hindfoot alignment after calcaneal osteotomy for the correction of mild-to-moderate adult type pes plano-valgus

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668474
Author(s):  
Jun Young Choi ◽  
Seong Mu Cha ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Adult Type ◽  
Hindfoot Alignment ◽  
Calcaneal Osteotomy ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
First Ray ◽  
Pes Plano Valgus

Purpose: To determine the effect of the additional first ray osteotomy on hindfoot alignment for the correction of pes plano-valgus. Methods: Data obtained from 37 consecutive patients recruited from 2006 to 2014 who underwent medial displacement calcaneal osteotomy (MDCO) alone (group H) or MDCO followed by medial cuneiform opening wedge osteotomy (MCOWO) (group HF) with a minimum 1-year follow-up were reviewed retrospectively. The mean follow-up periods were 34 and 32 months. Results: Degree of decrease of Talonavicular coverage angle (TNCA) via surgery or postoperative TNCA on standing foot AP radiographs were not significantly different between group H and HF ( p = 0.287). The calcaneal pitch angle and medial cuneiform height on the standing foot lateral radiographs was significantly increased after operation in group HF ( p = 0.01), there was a significant difference with group H as well ( p = 0.033). In group HF, the Meary’s angle was significantly decreased after operation, a significant difference compared to group H ( p = 0.009). Hindfoot alignment angle on the hindfoot alignment view was decreased after operation in both groups but was not significantly different between both groups ( p = 0.410). Hindfoot alignment ratio was also increased after the operation in both groups, but was not different between two groups ( p = 0.783). Conclusion: The additional first ray osteotomy using MCOWO had no correctional power for hindfoot correction, although it caused improvement in some radiographic parameters.

scholarly journals One year follow-up of a case series using the iBalance medial opening wedge HTO system and an accelerated rehabilitation program

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0018
Author(s):  
Kaushik Hazratwala
Keyword(s):  
Clinical Outcome ◽  
Tibial Slope ◽  
Rehabilitation Program ◽  
Significant Loss ◽  
Opening Wedge ◽  
Loss Of Correction ◽  
Accelerated Rehabilitation ◽  
Significant Difference ◽  
Clinically Significant

Objectives: To investigate the clinical outcome and postoperative alignment changes changes to following computer navigated medial opening wedge HTO using the iBalance HTO system Methods: We performed a prospective observational series at a single centre of 20 consecutive patients undergoing computer navigated high tibial osteotomy by a single surgeon. The surgical device used to maintain the osteotomy was the Arthrex iBalance® HTO system. We compared preoperative and postoperative ROM, WOMAC, Lysholm, IKDC, alignment and the inferred tibial slope. We also measured the tibiofemoral angle on long leg weight bearing plain radiographs at 2 weeks, 6 weeks, 3 months and 1 year and calculated any change from the initial correction measured at 2 weeks to asses any loss of correction over 1-year time frame. We also correlated clinical outcome with loss of correction. Results: Regarding intraoperative results, the mean navigated correction to HKA was 5.4°±1.3°. No significant change was found to the knee sagittal angle posteroperatively (pre op mean 0.1°±4.4°, post op mean 0.81°±5.1°; p> 0.05). No significant change was found to the post operative ROM (pre op mean 125.4°±41.5°, post op mean 123.9°±34.4°; p> 0.05). The IKDC, Lysholm and WOMAC scores showed a significant difference, between 6 week to 3 months and 3 months to 6 months follow-up. After this time point scores did not show and statistical significant difference. The IKDC, Lysholm and WOMAC scores all demonstrate a general improvement over 12 months. One patient had to be removed from the study, as he had a lateral cortex breach at three months, and was converted to a TKR. There was a significant loss of correction between 2 weeks and 6 weeks, and again a significant loss of correction between 6 weeks and 3 months. However, the average loss of correction was measured radiographically to be 1.6°±1.7°, between 2 week and 12 month postoperative follow-up. Though this may be statistically significant, it is not clinically significant when compared to PROMs. We divided the loss of correction into greater than 1.5° and less than 1.5° and compared them to measured PROMs at all time points. We found no significant correlation between increased loss of correction and poorer PROM scores. Conclusion: Computer assisted iBalance medial opening wedge HTO with accelerated rehabilitation program does radiographically show loss of correction over 12 months. However it is not clinically significant when compared to PROMs. ROM and inferred tibial slope is preserved.

scholarly journals Clinical comparison between two stabilization methods in distal tibial angular deviation corrected by the CORA method

2020 ◽  
Vol 48 ◽  
Author(s):  
Caio Afonso Dos Santos Malta ◽  
Leonardo Augusto Lopes Muzzi ◽  
Larissa Teixeira Pacheco ◽  
Daniel Munhoz Garcia Perez Neto ◽  
Vanessa Matos Pires ◽  
...  
Keyword(s):  
Bone Healing ◽  
Locking Plate ◽  
Wedge Osteotomy ◽  
Angular Deviation ◽  
Complication Rates ◽  
Closed Wedge ◽  
Pelvic Limb ◽  
The Right ◽  
Bone Deformities

Background: Angular deformity is characterized by the deviation of part of the bone that can occur in three different planes, frontal, sagittal and transverse. Trauma on physeal plates is the most common cause of angular deviations of the limbs in dogs. Currently the CORA (Center of Rotation of Angulation) methodology is the best way to evaluate and surgically correct these deformities. The objective of this study is to describe the surgical procedures performed to treat the uniapical valgus deviation affecting both tibial bones in a dog, comparing the outcomes of hybrid external skeletal fixator used in the right pelvic limb in relation to the locking plate used in the left pelvic limb.Case: A 10-month old Border Collie dog was attended at the University Veterinary Hospital with history of lameness and deviation of both pelvic limbs. In the orthopedic examination, it was possible to identify bilateral valgus deviation in the region of the tibio-tarsal joints and moderate lameness, with absence of pain or joint crepitation. Radiographic examination showed that the deformity was only uniapical in the frontal plane, affecting both tibial bones of the dog. Signs of osteoarthrosis were not observed and the preoperative examinations were within the normal limits for the species. The deformities were corrected in two surgical times starting with the procedure in the right tibia, which appeared to be clinically worse. Due to the fact that it was a bilateral affection and there was not a healthy pelvic limb to obtain the normal angles values of this dog, for planning according to the CORA methodology, the values of the tibial mechanical angles for dogs of similar size were taken from the literature. For surgical correction of the right tibia, a closed wedge osteotomy was performed following the second rule of Paley, with bone stabilization using type IB hybrid external skeletal fixator (ESF). The radiographic follow-up was done every 30 days postoperatively, however at 60 days the dog presented with severe lameness and the ESF had to be removed due to the breaking of one of the wires that composed the ring of the hybrid system. The limb continued to be treated by external bandages and total bone healing occurred at 210 days after surgery. Only after the complete recovery of the right limb, the left pelvic limb was operated and was also corrected by closed wedge osteotomy from the second Paley's rule. However, the bone stabilization was achieved with the use of a T-shaped locking plate. Radiographic follow-up was performed every 30 days postoperatively and at 60 days the osteotomy gap was already consolidated and the dog showed good weight bearing in the pelvic limbs without signs of lameness or pain.Discussion: Currently, it is indicated that bone deformities in small animals should be corrected using the CORA methodology. The hybrid ESF is one of the most commonly used fixation systems for bone stabilization after corrective osteotomies due to great versatility, however, the reported complication rates are relatively high. The locking plates with special shapes, such as the "T" plate used in this study, provide the stable fixation of osteotomies with limited bone stock, as they allow the introduction of larger number of screws per area. Thus, this latter type of implant becomes advantageous for the correction of bone deformities close to the joints. It is concluded that CORA methodology is really effective in the planning of corrective surgeries of angular deviations in dogs. In this case report, the resulting tibial angles after the surgical corrections were within the normal range for healthy dogs of similar size. However, the use of locking plate provided better results with early bone healing and fewer complications than the type IB hybrid ESF.

Treatment of pes varus using locking plate fixation in seven Dachshund dogs

2012 ◽  
Vol 25 (03) ◽  
pp. 231-238 ◽  
Author(s):  
T. Nicetto ◽  
A. Vezzoni ◽  
A. Piras ◽  
R. Palmer ◽  
M. Petazzoni
Keyword(s):  
Locking Plate ◽  
Corrective Osteotomy ◽  
Distal Tibia ◽  
Varus Deformity ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Implant Complications ◽  
Radiographic Measurements ◽  
Locking Plate System ◽  
Plate System

SummaryObjectives: To describe the surgical treatment of pes varus in Dachshund dogs by medial opening wedge osteotomy of the distal tibia stabilized with a locking plate system and to retrospectively report the clinical and radiographic outcomes.Materials and methods: Lameness in nine limbs of seven Dachshund dogs with pes varus deformity was treated with corrective osteotomy at or near the centre of rotation of angulation as defined by the intersection of the proximal and distal mechanical axes determined on caudo-cranial radiographs. Outcomes evaluated included comparison of preand postoperative radiographic measurements of frontal angulation and lameness assessment.Results: Lameness resolved in eight limbs and improved in one limb. All osteotomies healed and no implant complications were detected. Mean preoperative radiographic measurements were: mechanical medial proximal tibial angle (mMPTA) = 91.1° (range 87.6°-95°), mechanical medial distal tibial angle (mMDTA) = 62.1° (range 51.9°-69.6°). Mean postoperative measurements were: mMPTA 92.4° (range 78°-97.5°), mMDTA 81.8° (range 76°-87°). Measurable undercorrection was common, though seldom visually or functionally evident.Clinical significance: Pes varus deformity in Dachshunds can be treated by medial opening wedge osteotomy of the distal tibia stabilized with a locking plate system. Care to preserve the lateral cortex of the osteotomy may help avoid under-correction.

Addition–subtraction osteotomy with ligamentoplasty for symptomatic trapezial dysplasia with metacarpal instability

2012 ◽  
Vol 37 (2) ◽  
pp. 138-144 ◽  
Author(s):  
J. F. Goubau ◽  
P. Ackerman ◽  
D. Kerckhove ◽  
P. Van Hoonacker ◽  
B. Berghs
Keyword(s):  
Analogue Scale ◽  
Ligament Reconstruction ◽  
Wedge Osteotomy ◽  
Trapeziometacarpal Joint ◽  
Opening Wedge ◽  
The Past ◽  
Bony Anatomy ◽  
Radiological Changes

Trapeziometacarpal instability with trapezial dysplasia is a disabling condition long before the radiological changes of osteoarthritis appear. In dysplastic joints surgical soft tissue correction fails to prevent the instability, requiring a correction of the bony anatomy. We combined two techniques described in the past, an abduction osteotomy of the first metacarpal and an opening wedge osteotomy of the trapezium, to which we added a ligament reconstruction. The combination of both osteotomy techniques restores the anatomy and centres the forces acting across the joint. We have done this procedure 21 times since 2003 in 18 patients. Seventeen thumbs were reviewed prospectively with a mean follow-up of 39 (range 16–65) months. Mean QuickDASH improved by 33.9 points, the key pinch improved by 1.8 kg and the grip strength improved by 8.7 kg. The visual analogue scale for pain improved from 7.9 preoperatively to 2 postoperatively. This technique preserves the trapeziometacarpal joint, allowing other techniques to be used if painful arthritis should develop in the middle to long term.

scholarly journals Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michael Zyskowski ◽  
Markus Wurm ◽  
Frederik Greve ◽  
Sebastian Pesch ◽  
Francesca von Matthey ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Locking Plate ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Outcome Parameter ◽  
Distal Fibula ◽  
Plate Group ◽  
Group I ◽  
Group Ii

Abstract Background In the modern western world appraisal of economical points such as treatment and disability after trauma present a financial burden. In this context open reduction internal fixation techniques allowing for early full weight bearing might not only improve the clinical outcome but also shorten the period of disability in working life. The aim of the study was to analyze whether ORIF of ankle fractures using either a standard semitubular plate or a new polyaxial locking plate system result in a better clinical outcome. Methods In this prospective study, all patients with distal fibula fractures (AO 44 B1.1, B1.2, B1.3), with indication for surgery were included. Patients were randomized to either the DePuy Synthes® one-third semitubular plate (Group I) or NEWCLIP TECHNICS, Active Ankle® polyaxial locking plate (Group II). Primary outcome parameter was function of the ankle joint, assessed by the Olerud and Molander ankle score, Foot and Ankle outcome score and Karlsson and Peterson Scoring System for Ankle function. Secondary outcome parameter were postoperative complications. Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations were considered as minor and deep wound infection, material loosening, loss of reduction were regarded as major complications requiring revision surgery. Clinical and radiological follow-up were performed 6 and 12 weeks, 6 months and 1 year postoperatively. Results Fifty-two patients (31 W/21 M) with a mean age of 43 yrs. (range 22–64 yrs.) were enrolled. Seven patients (13.5%) were excluded, so that 45 patients were available for follow up. Twenty-five patients were treated with DePuy Synthes® one-third semitubular plate (55.6%; group I) while 20 patients received an anatomically preformed polyaxial locking plate (44.4%, group II). Four minor complications occurred in Group I (16%) compared to two minor complications in group II (10%). Significant better clinical results regarding OMAS (p < 0.02, < 0.04), KPSS (p < 0.04) and FAOS (p < 0.02, < 0.03) were observed 6 and 12 weeks after surgery in group II. Conclusions The results of the presented study demonstrate a significant better clinical functional outcome in the early postoperative follow-up in patients treated with a polyaxial locking plate. Furthermore, our data show that ORIF using polyaxial locking plates in combination with an early postoperative weight bearing presents a safe, stable treatment option for ankle fractures so that patients benefit especially in the early stages of recovery. Trial registration Registered 20 April 2020, retrospectively on ClinicalTrails.gov (NCT04370561).

scholarly journals Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis

2020 ◽  
Vol 1 (7) ◽  
pp. 346-354
Author(s):  
Arne Ekeland ◽  
Tor Kjetil Nerhus ◽  
Sigbjørn Dimmen ◽  
Stig Heir
Keyword(s):  
Survival Rates ◽  
Scoring Systems ◽  
Functional Results ◽  
Functional Improvement ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Knee Oa ◽  
One Year ◽  
Sport And Recreation

Aims To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with opening wedge osteotomy relieving the pressure on the osteoarthritic part of the knee. Methods In all, 49 patients (52 knees) with a mean age of 47 years (31 to 64) underwent high tibial osteotomies (HTO), and 24 patients with a mean age of 48 years (31 to 62) low femoral osteotomies (LFO) with opening wedge technique due to medial, respectively lateral knee OA with malalignment. All osteotomies were stabilized with a Puddu plate and bone grafting performed in the same time period (2000 to 2008). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) pre-operatively and at six months, and at one, two, five, and ten years postoperatively. The knee OA was graded according to the Ahlbäck and Kellgren-Lawrence radiological scoring systems. Results The mean angular corrections were 8.0° (4° to 12°) for the HTO and 9.6° (4° to 20°) for the LFO. Both the pre-operative KOOS and the osteoarthritic gradings were similar for the two patient groups. The five subscores of KOOS increased significantly during the postoperative period (p < 0.001 to 0.029) levelling out after one year in both groups. The KOOS subscore symptoms was significantly higher for patients with HTO than those with LFO at all follow-up times, for sport and recreation in the period one to five years, and for pain and quality of life at two to five years (p < 0.001 to 0.009). Eight HTOs (15%) and five LFOs (21%) were converted to total knee arthroplasty after mean 6.7 years (2.0 to 9.8) and 5.4 years (4.0 to 8.0) respectively. The ten-year osteotomy survival rates were 88% for the HTO and 79% for the LFO (p = 0.745). Conclusion Patients with unicompartmental knee OA improved after a corrective opening wedge osteotomy, but four of the five subscores of KOOS were significantly higher for those with medial than those with lateral OA in most of the ten-year follow-up period. Cite this article: Bone Joint Open 2020;1-7:346–354.

scholarly journals Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Giovanni Romeo ◽  
Alberto Bianchi ◽  
Vincenzo Cerbone ◽  
Matteo Maria Parrini ◽  
Francesco Malerba ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Bone Allograft ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Metallic Implant ◽  
Radiographic Outcomes ◽  
Clinical Scores ◽  
Medial Cuneiform ◽  
Forefoot Varus

Adult flatfoot is a common pathology characterized by multiplanar deformity involving hindfoot, midfoot, and forefoot. Various surgical techniques have been described for the treatment but may not adequately correct the fixed forefoot varus component. Residual forefoot supination can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, also known as a Cotton osteotomy. Thus, the aims of this study were to compare clinical, radiological, and functional outcome after Cotton osteotomy, in patients treated with bone allograft or metallic implant. Consequently, 36 patients treated with opening wedge osteotomy of the medial cuneiform for forefoot varus were studied retrospectively. Patients were divided into two groups: the bone allograft group (HBG) (n=18) and the metallic implant group with BIOFOAM® Cotton Wedges (TTW) (n=18). Radiographic assessment and clinical scores including American Orthopaedic Foot and Ankle Society score, Foot Function Index, and visual analogue scale for pain were collected before operation and the last follow-up. The difference between baseline and follow-up for both groups was statistically significant for all the clinical scores and radiographic angles (p < 0.05). Most participants (92%) were very satisfied after surgery. Our results showed that Cotton osteotomy with a metallic implant provided both good clinical and radiographic outcomes comparable with bone allograft.

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