Idiopathic Rotational Abnormalities of the Lower Extremities in Children and Adults

Gruskay, Jordan A.; Fragomen, Austin T.; Rozbruch, S. Robert

doi:10.2106/jbjs.rvw.18.00016

Cited by 34 publications

(38 citation statements)

References 124 publications

(151 reference statements)

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“…This may be due to observer-related measurement differences or errors or ascribed to either true racial differences or due to cultural practices such as back-carrying impacting the smaller Q-angles observed in Setswana-speaking children, which necessitates further research. Clinical measurement of torsion angles, especially the AVA, is often avoided, due to difficulties experienced in the reliable evaluation thereof [39,40]. We found greater AVA and smaller TTA in the Setswana population than reported for European children.…”

Section: Discussioncontrasting

confidence: 47%

“…Decreases in TTAs (toward internal TT) were noted in those with increased internal TT, with age [36]. Significantly lower AVAs, which decreased with an increase in age, were reported in European children [31,32,[35][36][37]39] in comparison to Setswana-speaking children. This might be attributed to the low validity of Craig's test to clinically measure the AVA, as suggested by Souza and Powers [40], or an actual occurrence in the Setswana-speaking population.…”

Section: Discussionmentioning

confidence: 79%

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The Profile and Development of the Lower Limb in Setswana-Speaking Children between the Ages of 2 and 9 Years

Aswegen

Czyż

Moss

2020

IJERPH

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Profile data on normal lower limb development and specifically tibiofemoral angle development in black, Setswana-speaking South African children are lacking. This study aimed to provide profiles on the development of the tibiofemoral angle, hip anteversion angle and tibial torsion angles in two- to nine-year-old children. Measurements of the tibiofemoral angle, intercondylar distances or intermalleolar distances, quadriceps-angle, hip anteversion- and tibial torsion angle were clinically obtained from 691 healthy two- to nine-year-old children. Two-year-old children presented with closest to genu varum at −3.4° (±3.4°). At three years, a peak of −5.7° (±2.3°) genu valgum was seen, which plateaued at −4.5° (±2.1°) at age nine years. Intermalleolar distance results support tibiofemoral angle observations. Small quadricep-angles were observed in the two-year-old group, (−3.81° ± 3.77°), which increased to a mean peak of −9.2° (±4.4°) in nine-year-olds. From the age of four years old, children presented with neutral tibial torsion angles, whilst two- and three-year-olds presented with internal tibial torsion angles. Anteversion angles were the greatest in three-year-olds at 77.6° ± 13.8° and decreased to a mean angle of 70.8° ± 6.9° in nine-year-olds. The tibiofemoral angle developed similarly to those tested in European, Asian and Nigerian children, but anteversion- and internal tibial torsion angles were greater in the Setswana population than angles reported in European children. Our findings indicate that lower limb development differs in different environments and traditions of back-carrying may influence the development, which requires further investigation.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 79%

The Profile and Development of the Lower Limb in Setswana-Speaking Children between the Ages of 2 and 9 Years

Aswegen

Czyż

Moss

2020

IJERPH

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“…Examples include planned prophylactic tarsal tunnel decompression in patients with severe distal tibial or ankle varus deformities undergoing bony correction, 16 prophylactic ulnar nerve decompression in patients with severe elbow contractures undergoing arthroscopic releases 17 and PPND in patients with severe valgus deformity or rotational deformities undergoing bony correction around the knee. 12 Patients with non-compliant soft tissues (due to scar tissue or previous trauma) are at the highest risk of nerve palsy after correction. Similarly, patients without correctable valgus on examination may pose the highest risk of PN palsy after TKA and, therefore, had a planned PPDN at the time of TKA.…”

Section: Discussionmentioning

confidence: 99%

“… 8 , 11 In the field of limb lengthening and deformity correction, the role of PPND has been embraced for those patients at high risk at the time of acute deformity corrections around the knee. 11 , 12 The goal of this study is to report our experience with the use of PPND at the time of TKA in high-risk patients.…”

Section: B Ackgroundmentioning

confidence: 99%

The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty

Rozbruch¹,

Makhdom²,

Hamilton³

2022

Strategies in Trauma and Limb Reconstruction

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A bstract Background Common peroneal nerve (PN) palsy after total knee arthroplasty (TKA) is a serious complication. Although many authors suggest delayed or immediate PN decompression after TKA in these patients, little is known about the role of prophylactic peroneal nerve decompression (PPND) at the time of TKA. The aim is to report the results of PPND in high-risk patients at the time of TKA. Materials and methods A multi-institutional retrospective study review of nine patients (10 knees) who underwent PPND at the time of TKA was conducted. Patients who had severe valgus deformities (≥15° of femorotibial angle and not fully correctable by examination under anaesthesia) with or without flexion contractures were included. PPND was performed through a separate 3–4-cm incision at the time of TKA. The demographics, preoperative and postoperative anatomical and mechanical alignments, range of motion, operation time, postoperative neurological function and complications were recorded. Results All patients had a completely normal motor and sensory neurological function postoperatively and no complications related to PPND were reported. All patients followed the standard physical therapy protocol after TKA without modifications. The mean preoperative femorotibial angle was 20° (range 15–33°) and the mean postoperative femorotibial angle was 6.3° (range 5–9°) ( p = 0.005). The mean preoperative flexion contracture was 9 (range 0–20) and the mean residual contracture was 1.2° (range 2–5°) ( p = 0.006). Conclusion PPND at the time of TKA is an option to minimise the risk of PN palsy in high-risk patients. This approach can be considered for patients undergoing TKA in selected high-risk patients with a severe valgus deformity. How to cite this article Makhdom A, Hamilton AA, Rozbruch SR. The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty. Strategies Trauma Limb Reconstr 2022;17(1):38–43.

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“…Die Tibia hingegen ist bei Geburt in der Regel nicht torquiert, dreht sich jedoch bis zum Alter von 4-6 Jahren belastungsbedingt auf ca. 20-25 ° Außentor sion [17]. In all diesen Phasen können folglich Entwicklungsstörungen auf treten, die in Fehlstellungen resultieren.…”

Section: Entwicklung Von Deformitäten Der Unteren Extremitätunclassified

Angeborene und idiopathische Deformitäten: Immer ein Arthroserisiko?

et al. 2019

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ZusammenfassungArthrotische Gelenkveränderungen weisen eine Vielzahl an Ursachen auf. Ist eine eindeutige Zuordnung nicht möglich, spricht man von primären Arthrosen, hingegen kann die Entwicklung sekundärer Arthrosen auf konkrete Risikofaktoren zurückgeführt werden. Einen Großteil davon bilden angeborene und idiopathische Fehlstellungen, die auch als präarthrotische Deformitäten bezeichnet werden. Eine sekundäre Arthrose manifestiert sich in der Regel bereits in deutlich jüngerem Lebensalter als ein primärer Gelenkverschleiß, gerade deshalb ist die rechtzeitige Diagnosestellung von entscheidender Bedeutung. Angeborene und idiopathische Deformitäten bleiben meist lange asymptomatisch, was die Diagnostik deutlich erschwert. In den letzten Jahren hat die Früherkennung häufiger Deformitäten jedoch stark an Bedeutung gewonnen, wie man am Beispiel der Sonografie zur Beurteilung der Hüftreifung im Rahmen der kindlichen Vorsorgeuntersuchung erkennen kann. Je nach Art der Deformität ist sowohl eine konservative, als auch eine operative Therapie möglich. Dabei spielt der richtige Zeitpunkt für den Therapiebeginn eine wichtige Rolle, denn sowohl ein Abwarten des Spontanverlaufs wie bei auffälligen frontalen Beinachsen, aber auch eine sofortige Behandlung wie bei der Hüftdysplasie können lege artis sein. Zu den häufigsten operativen Maßnahmen zählen die Wachstumslenkung und die Umstellungsosteotomie. Ziel der Therapie ist die Reduktion des Arthroserisikos auf das der Durchschnittsbevölkerung durch Wiederherstellung anatomisch und biomechanisch korrekter Stellungsverhältnisse. Folglich handelt es sich bei der Behandlung von präarthrotischen Deformitäten um präventive, gelenkerhaltende Maßnahmen, die in der Regel schonender und komplikationsärmer sind, als ein späterer endoprothetischer Gelenkersatz. Die Gefahr eines verspäteten Behandlungsbeginns ist die Notwendigkeit (aufwendigerer) operativer Interventionen.

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Idiopathic Rotational Abnormalities of the Lower Extremities in Children and Adults

Cited by 34 publications

References 124 publications

The Profile and Development of the Lower Limb in Setswana-Speaking Children between the Ages of 2 and 9 Years

The Profile and Development of the Lower Limb in Setswana-Speaking Children between the Ages of 2 and 9 Years

The Role of Prophylactic Peroneal Nerve Decompression in Patients with Severe Valgus Deformity at the Time of Primary Total Knee Arthroplasty

Angeborene und idiopathische Deformitäten: Immer ein Arthroserisiko?

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