Outcomes of Joint Preservation Surgery in Valgus Ankle Arthritis Without Deltoid Ligament Insufficiency

Background: To date, information about the role of proximal alignment correction in treating nontraumatic valgus ankle arthritis is limited. This study aimed to report outcomes of realignment surgery, including supramalleolar correction in valgus arthritic ankles without evidence of deltoid ligament insufficiency. Methods: Thirteen patients (13 ankles) who underwent joint preservation surgery for valgus ankle arthritis without evidence of deltoid ligament insufficiency were reviewed. Medial opening wedge supramalleolar osteotomy ( n = 11) and varization supramalleolar dome osteotomy ( n = 2) were performed to realign the hip-knee-ankle-hindfoot axis. Concomitant hindfoot correction was accompanied with either medial displacement calcaneal osteotomy ( n = 8) or subtalar arthrodesis ( n = 5). Pain, functional outcome (Foot Function Index [FFI]), radiographic arthritis grade (grades 0-4), 9 plain radiographic parameters, and 2 weightbearing computed tomography parameters were evaluated pre- and postoperatively. All patients completed a minimum 2-year follow-up. Results: Preoperatively, 10 ankles (77%) demonstrated a varus tibial plafond, and 3 ankles (23%) demonstrated a valgus or neutral tibial plafond. Postoperatively, radiographic arthritis grade improved in all except 1 patient, and the mean talar tilt angle improved from 5.5 to 1.7 degrees. The mean pain score (visual analog scale) decreased significantly from 7.3 to 2.5 ( P < .05), and the mean FFI improved significantly from 57.7 to 18.6 ( P < .001). None of the patients underwent conversion to joint-sacrificing procedures at the latest follow-up. Conclusion: This study demonstrated a possible relationship between lower limb malalignment and valgus ankle arthritis. Realignment surgery, including supramalleolar osteotomies, which straightens the mechanical axis and decreases the slope of the tibial plafond, may be a reasonable approach in joint preservation of valgus ankle arthritis without deltoid ligament insufficiency. Level of Evidence: Level IV, case series.

Corrective Osteotomy in cubitus varus deformity in children: A prospective study

Background and Aim: Cubitus varus deformity is the most common late complication aftersupracondylar fracture of the distal humerus in children, incidence varying from 4% to 58%. Thepresent study was done to evaluate the results of dome osteotomy. Material and Methods: Thisprospective study was conducted in a tertiary care hospital over 16 months. In all patients humerus-elbow wrist angle was measured on both sides and the correction needed was calculated. The lateralcondyle prominence index (LCPI) was calculated by anteroposterior view radiographs of thedeformed and the normal elbow in full extension by (AB-BC)/AC. Dome osteotomy with para tricepsapproach was used. Pre and post-operative carrying angle of elbow, range of motion and lateralprominence indices were compared. Results: The age of patients ranged from 3 to 15 years with amean age of 8.47±3.14 years. Preoperative carrying angle of normal side ranged from 80 to 140and that of effected side ranged from -23 to -13 and the difference was statistically significant(p<0.05). LCPI ranged from -8.4 to 5.9%. The majority of cases had LCPI >2.7%. As compared to,an improvement in carrying angle at defect side was observed to be 28.41±2.15 which wassignificant (p<0.05). At baseline mean LCPI was 0.39±3.87% which changed to -0.86±3.47%, themean change of this was significant (p=0.01). baseline Conclusion: Dome osteotomy is a relativelytechnically demanding technique for correction of cubitus varus deformity but with a betterfunctional outcome without being associated with lateral condyle prominence.

Madelung Deformity: Surgical Correction with Radial Dome Osteotomy

Madelung deformity is a rare wrist malformation caused by a growth disturbance of the palmar and ulnar part of the distal radial physis. The aim of this study is to evaluate the outcome of radial dome osteotomy in patients affected by Madelung deformity. The endpoint of this operation is to improve the orientation of the articular surface of the radius, so as to support to the carpal bones. Between 2017 and 2019, in our clinic, 4patients were treated using this technique. Post-operative pain was evaluated using the NRS. Functional outcomes were assessed through evaluation of ROM, grip strength via Jamar dynamometer and using DASH questionnaire. The aesthetic defects were estimated using a section of the Michigan Hand Outcome Questionnaire. Correction of deformities was evaluated on post-operative RX using McCarrol Criteria. Were also analyzed the accuracy and tolerance of the plates used.

Single-stage Distal Radius Dome Osteotomy with Ulnar Diaphyseal Shortening and Distal Ulnar Epiphysiodesis in A Case of Manus Valgus Deformity Secondary to Post-Traumatic Physeal Growth Arrest – A Case Report

Introduction: Distal radius physeal growth arrest in children secondary to trauma is a rare complication. Various modalities of surgical treatment exist. Correction of severe deformity by a single-stage surgery is rare in current literature. We describe a case of surgically treated post-traumatic manus valgus deformity in an adolescent female with a satisfactory surgical outcome. Case Report: A 13-year-old right-hand dominant girl presented to us with a painless, gradually progressive left wrist deformity for the past 3 years. She sustained a left wrist injury 3.5 years back for which she received native treatment. She was able to do most of her daily activities and cosmetic disability was her primary concern. She had a 20° fixed radial deviation deformity with further radial deviation up to 60°. Forearm rotation was from 70° supination to 60° pronation. Her pre-operative Mayo Modified Wrist Score was 25/10/10/25/70 (Pain/Satisfaction/Range of motion/Grip strength/Total). Radiologically, there was the obliteration of lateral distal radial physis with overgrowth of medial physis. Distal ulnar physeal overgrowth led to positive ulnar variance. Radiologically, the magnitude of deformity was 43° manus valgus (+24° radial inclination). We performed dome osteotomy at distal radius metaphysis with distal radius plating through modified Henry approach. Simultaneous ulnar diaphyseal shortening osteotomy with plate fixation was done through a dorsal approach and distal ulnar epiphysiodesis was done by physeal drilling to prevent future overgrowth. At 13 months follow-up, the wrist has clinically no deformity and radiologically 5° manus valgus (+24° radial inclination). Both the osteotomy sites have united and ulnar variance is restored. Now, her ulnar deviation was 20° and radial deviation was 30°. Her forearm rotational arc was maintained. Mayo Modified Wrist Score was 25/25/10/25/85 (Pain/Satisfaction/Range of motion/Grip strength/Total) with no hindrance of daily activity.

Effect of Proximal Dome and Distal Chevron Osteotomies on Plantar Pressures and Radiographic and Functional Outcomes in Hallux Valgus Surgery: A Retrospective Analysis

Background No detailed comparative studies have been performed regarding plantar pressure changes between proximal dome and distal chevron osteotomies. This study aimed to compare radiographic and plantar pressure changes after distal chevron and proximal dome osteotomies and to investigate the effect of radiographic and plantar pressure changes on clinical outcomes. Methods This study included 26 and 22 patients who underwent distal chevron and proximal dome osteotomies, respectively. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scores were used to evaluate pain and functional outcomes. Hallux valgus angle, intermetatarsal angle, talar–first metatarsal angle, and calcaneal inclination angle were measured in the evaluation of radiographic outcomes. Preoperative and postoperative plantar pressure changes were evaluated. Results There were no statistically significant differences between the two groups in age, body mass index, or AOFAS forefoot and VAS scores. In the proximal dome group, the pressure measurement showed significant lateralization of the maximal anterior pressure point in the forefoot (P &lt; .001). In addition, the postoperative calcaneal inclination angle was significantly lower (P = .004) and the talar–first metatarsal angle was significantly higher (P &lt; .001) in the proximal dome group. Postoperative transfer metatarsalgia was observed in one patient (3.8%) in the distal chevron group and five (22.7%) in the proximal dome group (P &lt; .05). Conclusions Proximal dome osteotomy led to more lateralization of the maximum anterior pressure point, decreased calcaneal inclination angle and first metatarsal elevation, and related higher transfer metatarsalgia.