Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures

The purpose of this study is to compare the cut-out rate and sliding distance associated with limb length inequality between operations using a standard non-sliding lag screw versus those using a non-sliding lag screw with U-blade (RC) in the Gamma3 nail. This is a retrospective review of two case series involving different lag screws for the Gamma3 nail. Propensity score matching analysis was used to adjust the confounding factors. A comparative analysis of 304 patients who treated with Gamma3 nail with either a standard non-sliding lag screw or a U-Blade (RC) lag screw was performed. Between 2014 and 2018, 152 patients were treated with U-blade (RC) lag screws, and these patients were matched with those treated with standard lag screws. There was no significant difference in cut-out rate between groups. However, additional use of anti-rotation U-blade (RC) could significantly decrease lag screw sliding, with the group treated with U-Blade (RC) lag screws exhibiting shorter sliding, especially in AO/OTA31 A2 and A3 fractures. Also, in A2 and A3 fractures, the mean lag screw sliding distance was greater than that seen in A1 fractures in both groups. These findings can help trauma surgeons choose the proper implant to reduce leg length inequality.

SCHANZ OSTEOTOMY A FADING ART

The pelvic support osteotomy is a useful surgical procedure for the salvage of damaged hips of patients in whom arthrodesis or hip arthroplasty are not appropriate either surgically or nancially. It is a procedure that has much to offer the adolescent or young adult who has painful limping, restriction of hip motion and early onset fatigue to walking as a consequence of hip destruction from AVN, TB hip, old neglected dislocation of hip, neglected acetabulum fracture or persistent severe hip dysplasia. A successful pelvic support osteotomy reduces limp by reducing the Trendelenburg lurch and compensating the limb length inequality. It provides stability by taking support on the hemipelvis and facilitates a more energy-efcient gait. In this article, the authors present their own experience with palliative Schanz osteotomy.

Prevalence and Degree of Lower Limb Inequality in Asymptomatic Young Adult Nigerians

Objective: The development of right and left lower limbs start at the same time and subsequent serial growth occurs simultaneously however at adulthood, small but usually functionally negligible differences exist in their lengths. This study set out to find out the prevalence and degree of lower limb length inequality (LLI) amongst young adult Nigerians with grossly normal lower limbs. Methods: Full length and segmental lengths of one hundred and three healthy young adult Nigerians of different ethnic groups were measured using the direct clinical method. Results: The overall prevalence of LLI was 89.3% while the rate for male and female was 96.2% and 82.4% respectively. The LLI range was 0.5 - 2.5 cm with majority being less than 2.0 cm. The LLI was significantly higher in male (1.18 ± 0.83 vs 0.75±0.60 cm). Side for side, the male limb is significantly longer than that of the female. The thigh girth was significantly wider in the female while there was no difference in the leg girth between male and female. The males were found to be significantly taller than the females. Inter-ethnic comparison of the various parameters did not reveal any significance difference. Conclusion: Anatomical lower limb inequality is very common amongst young adult Nigerians without any gross musculoskeletal but it is not obvious.

Acute effect of foot orthotics on drag area and perceived comfort in cyclists affected by an anatomic asymmetry in time trial position

The aim of this study was to analyse the acute effect of biomechanical foot orthotics on drag area (ACd) and perceived comfort in elite cyclists affected by a lower limb length inequality (LLLI) in TT position. Twenty-nine cyclists performed two discontinuous incremental exercises (before and after orthopaedic correction) using their personal TT bicycle and equipment on a 250-m indoor velodrome. The ACd was unchanged in both the test group (TG) (‑0.5%, p = 0.707) and the control group (CG) (-1.4%, p = 0.276), whereas the perceived comfort was improved in the TG (+6.2%, p = 0.002) and stabilised in the CG (+0.7%, p = 0.546), after the fitting of the foot orthotics. Pelvis movements were decreased (small effect size) in the TG (-6.2%, p = 0.093, ES = 0.251), whereas they were increased (small effect size) in the CG (+5.2%, p= 0.159, ES = 0.215). TT position was slightly improved by compensating for a LLLI, as the ACd was stabilised and the level of comfort was improved. Thus, cyclists affected by a LLLI are recommended to compensate with foot orthotics in order to improve their level of comfort and consequently their performance in TT position.

Limb length discrepancy after total hip arthroplasty: a systematic review

<p class="abstract">Correcting limb length inequality without compromising hip stability is one of the major intraoperative challenges in Total hip arthroplasty (THA) as it is a major cause of patient dissatisfaction and litigation against surgeon. Surgeons performing THA should aim to minimize Limb Length Discrepancy (LLD), and therefore should adopt a reliable method of doing so. Thus a reproducible technique which effectively reduces postoperative LLD without increasing operative time and is easy to apply is a need of time. Although various preoperative and intraoperative techniques are described in literature, none is universally applicable and is without limitations. We are presenting a review of 50 articles on limb length discrepancy after total hip arthroplasty, its implications and several techniques to avoid it. We suggest that every effort should be made to minimise postoperative Limb Length Discrepancy by combined use of preoperative and intraoperative techniques.</p>

Congenital Posteromedial Bowing of the Tibia: A Single Center Experience

Summary Congenital posteromedial bowing of the tibia (CPMBT) is a rare congenital anomaly of the lower limbs. The aim of the present study was to analyze our experience in the treatment of CPMBT. A retrospective study of patients treated for CPMBT in the period January 2000 – June 2016 was performed. In the observed period, six patients were treated (five girls and one boy), with predominance of the right tibia involvement (5:1). The initial treatment included a series of corrective casts (4-9) applied in all patients, followed by removable splints and physiotherapy. Four children with residual angulation of tibia after walking age were prescribed ankle-foot orthosis (AFO) as a prevention of pathological fractures. Both posterior and medial angulation correct over time. Mean initial shortening was 11 mm. At the last follow-up visit, mean shortening was 23.33mm. Three patients had lower limb shortening of more than 2 cm. In two of them, with shortening of 27 mm and 35 mm, Ilizarov lengthening was performed. In one girl, we performed lengthening over titanium elastic nails. In the other girl, after lengthening, circular frame was exchanged with a locking plate to reduce fixator wearing time. There were no major complications of treatment. Patients were followed up for 2-12 years (mean 6.83 years). None of them reached skeletal maturity yet. Primary manifestation of CPMBT – angulation of tibia and fibula as well as calcaneovalgus deformity usually correct spontaneously or with conservative measures. However, limb length inequality, as a consequence of CPMBT, progresses with growth and may require surgical correction in some children. Therefore, all children with CPMBT should be followed up until skeletal maturity.