The results of the current study showed that IEF technique had a notable incidence of pin-tract infection, joint contracture, and shorthening related to treatment of the delayed union. The UTN technique had the disadvantage of a posttraumatic osteomyelitis and delayed union requiring additional surgery. We believe that the decision to use IEF or UTN should be made on a case-by-case basis.
The pathology of congenital pseudoarthrosis of tibia is an enigma and the treatment is challenging. Despite achieving union of the pseudoarthrosis, these patients may have compromised function secondary to residual deformities. The purpose of this study is to analyze the prevalence of these deformities, the morbidity caused by them, and the methods to overcome the problems. Sixteen patients who had a successful union were retrospectively reviewed. Clinically, the following parameters were assessed: pain, joint stiffness, and limb length discrepancy (LLD). Anteroposterior and lateral lower extremity radiographs were performed to analyze (1) union of the tibia and fibula, (2) deformity of the tibia, (3) degree of ankle valgus, (4) degree of calcaneus of the os calcis, (5) LLD, and (4) refracture. The average follow-up was 16 years from the first and 8 years from the last surgical procedure. Residual deformities included valgus of tibia (average 11.4 degrees) and procurvatum (average 19.4 degrees) deformities of the tibia or valgus deformity of the ankle (average 21.3 degrees) and calcaneus of the os calcis (average 46 degrees). There were 9 refractures in 8 patients. Nine patients had an LLD (average 3.5 cm). The study demonstrates that careful follow-up of these patients is necessary and residual problems are to be treated as they occur.
The purpose of this study is to analyze lower extremity dynamic malalignment during gait using a 3-dimensional kinematics and kinetics in 13 children (3-17 years old) with achondroplasia and to compare measurements of alignment and malrotation between gait, radiographic, and clinical measures. Gait analysis in the coronal plane showed a varus malalignment of the knee (19 +/- 13 degrees) and variable tibial torsion abnormalities (13 [internal] +/- 15.7 degrees). Radiographs also showed knee varus malalignment (16 +/- 9 degrees); however, there was poor correlation with gait analysis measures (P > 0.05). In the sagittal plane, radiographs showed genu recurvatum deformity (23.5 +/- 13.2 degrees), although the sagittal plane knee kinematics were normal. Kinetic analyses of the knee showed high internal knee valgus moments (external varus moments, 0.48 +/- 0.25 N m/kg), which were significantly different from the normal population (P < 0.05). In conclusion, there is a 3-dimensional, complex, dynamic deformity of the lower extremity present in children with achondroplasia. We recommend a very careful assessment of the limb focusing on both the static and dynamic varus deformity and tibial torsion using a combination of radiographic, clinical, and gait analysis.
A percutaneous supramalleolar osteotomy with multiple drill holes and closed osteoclasis was used to correct rotational deformities of the tibia in patients with cerebral palsy. The technique is described and the results in 247 limbs (160 patients) are reported. The mean age at the time of surgery was 10.7 years (4 to 20). The radiographs were analysed for time to union, loss of correction, and angulation at the site of the osteotomy. Bone healing was obtained in all patients except one in a mean period of seven weeks (5 to 12). Malunion after loss of reduction at the site of the osteotomy developed in one tibia. Percutaneous supramalleolar osteotomy of the tibia is a safe and simple surgical procedure.
The difference between the curves of femur and the contemporary femoral nails implicates the inadequacy of the design of such nails for the Caucasian race living in Anatolia. Therefore, such nails should be revised accordingly to prevent the above-mentioned complications.
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