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Bone & Joint Research
Vol. 9, Issue 7 | Pages 341 - 350
1 Jul 2020
Marwan Y Cohen D Alotaibi M Addar A Bernstein M Hamdy R

Aims. To systematically review the outcomes and complications of cosmetic stature lengthening. Methods. PubMed and Embase were searched on 10 November 2019 by three reviewers independently, and all relevant studies in English published up to that date were considered based on predetermined inclusion/exclusion criteria. The search was done using “cosmetic lengthening” and “stature lengthening” as key terms. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles. Results. A total of 11 studies including 795 patients were included. The techniques used in the majority of the patients were classic 3- or 4-ring Ilizarov fixator (267 patients; 33.6%) and lengthening over nail (LON) (253 patients; 31.8%), while implantable lengthening nail (ILN) was used in the smallest number of patients (63 patients; 7.9%). Mean end lengthening achieved was 6.7 cm (SD 0.6; 1.5 to 13.0), and the mean follow-up duration was 4.9 years (SD 2.1; 41 days to 7 years). Overall, the mean number of problems, obstacles, and complications per patient was 0.78 (SD 0.5), 0.94 (SD 1.0), and 0.15 (SD 0.2), respectively. The most common problem and obstacle was ankle equinus deformity, while the most common complications were deformation of the regenerate after end of treatment and subtalar joint stiffness/deformity. Conclusion. Cosmetic stature lengthening provides favourable height gain, patient satisfaction, and functional outcomes, with low rate of major complications. Clear indications, contraindications, and guidelines for cosmetic stature lengthening are needed. Cite this article: Bone Joint Res 2020;9(7):341–350


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 31 - 31
1 Apr 2022
Guichet J Clementi D Deromedis B
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Introduction. Cosmetic lengthening is currently growing, raising Ethical concerns. In cosmetic lengthening, the psychological benefit vs process and risks is not quantified in publications. We designed a prospective longitudinal study for evaluating quantitatively the psychological PROMs of patients with cosmetic lengthening and value its interest. Materials and Methods. Forty five cosmetic patients were operated on with the G-Nail with full weight-bearing, and sports: M/F 34/11, age 29.3±11.5 year-old, Gain 79 mm (range 86–187). All undertook preoperative preparation, psychological tests, post-operating training (lengthening period, twice daily) and a specific psychological program. No patient presented sequels. Questionnaires were provided before and 40.0 month after surgery (scale 0–10) with: Psychological suffering, Happiness in Life (HiL), Quality of Live (QoL), Self-Esteem, Self-Image, Self-Confidence, Professional, Family, Friends and Sexual Relations, Sexual Attraction. Average, SD of changes and T-Test (unequal variances) were computed. Results. Improvements were greater for self-Image (+54%, p 1.21×10. −12. ) raising from an initial value of 5.44 (+/− 1.62) to 8.40 +/− 1.20), Self-esteem, Self-confidence and HiL or over (p between 1.7×10. —7. and 1.8×10. −10. ), QoL (+22%, p 8.1×10. −5. ), Professional relationships (+20%, p 4.2×10. −5. ), Family relationships (+12%, p 0.003), Friendship (+11%, p 0.002), Sexual Attraction (+24%, p 1.0×10. −5. ), Sexual relationships (+19%, p 0.001) and psychological suffering due to the statue decreased by 53% (p 0.0002). Conclusions. Within the protocols used, patients improved strongly their Psychological Health, with +44% of their self-image, self-esteem and self-confidence. With a reliable technique and strong programs for supporting recovery both physically and psychologically, cosmetic surgery can benefit strongly to patients


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_5 | Pages 9 - 9
23 Apr 2024
Ramlawi AA McClure P Assayag M
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Introduction. The practice of limb lengthening using intramedullary nails has surged in popularity in recent years. Our study explores the relationship between femur lengthening and overall height gain in adults undergoing cosmetic limb lengthening with telescoping magnetic intramedullary lengthening nails (MILNs). Materials & Methods. Demographic information, pre- and postoperative radiographic data, and secondary outcomes, such as mechanical angles and sagittal alignment, were analyzed for 42 adult femurs MILNs (PRECICE 2, NuVasive, Inc.). Height was assessed with a digital stadiometer. Limb lengthening was defined as the amount of nail distraction seen on a calibrated weight bearing X-ray at consolidation. mLDFA, mMPTA, MAD, AMA, and femoral sagittal bow were evaluated as secondary outcomes. Results. Mean starting height was 163.5 cm (SD 10.4, range 137–179) Post -lengthening mean height increased to 171.1 cm (SD 10.1, range 146.7–185.3). Average height gain was 7.5 cm (SD 1.3 cm, range 5.1–9.5). Average femoral lengthening was 7.3 cm (SD 1.14, range 4.1–10.1). There were no statistically significant difference between height gain and femur lengthening. Secondary outcomes showed reductions in femoral sagittal bow and AMA. Conclusions. We conclude that measuring femur lengthening is a reliable and accurate method of measuring gained height in deformity-free patients undergoing limb lengthening. We further reason that straightening of both femoral and spinal sagittal bow counteracts potential lengthening loss over the anatomical axis, versus mechanical axis lengthening


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_8 | Pages 8 - 8
1 May 2018
Giotikas D
Full Access

Introduction. Distraction histogenesis is utilised for cosmetic reasons in patients with constitutional short stature, achondroplasias, or height dysphoria. One of the considerations of patients and surgeons alike, is the preservation of aesthetically acceptable body proportions after the lengthening i.e which segment of the lower limb to lengthen and by how much, in order to preserve the patient's proportions within -or as close as possible to- the normal range of human body proportions. Sound anthropometric data on the normal range of the human body proportions is currently lacking. The aim of this study is to calculate the normal range of the ratio between the lengths of the lower limb, upper limb, femur, tibia, stature and trunk. Methods. Data form standardized measurements of the lengths of the tibia, femur, arm, stature, lower limb, upper limb was obtained from a sample population of 6068 healthy men and women servicing in the US Army. The mean, median, range and standard deviation were calculated for the following ratios of lengths: whole lower limb/leg, Stature/leg, Whole lower limb/thigh, Stature/thigh, Siting height/whole lower limb, Stature/Whole lower limb, Arm Span/Stature, Whole upper limb/Whole lower limb. Results. The ratios show normal distribution. Results are presented separately for men and women for the total sample population and for subgroups based on ethnic origin (White, Black, Hispanic and Asian). Discussion. This study is one of the first to provide specific anthropometric data from a large sample population relevant to the evidence-based preoperative planning and patient counselling before cosmetic limb lengthening procedures


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 166 - 166
1 May 2011
Thaler M Krismer M Liebensteiner M Bach C
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Study Design: A prospective study evaluated patients’, orthopaedists’ and not affected children of the same age ratings’ of preoperative and postoperative cosmesis in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. The cosmetic result based on a questionnaire was compared to clinical and radiological parameters. There was no correlation between the SAQ and objective clinical and radiologic parameters at all, whereas clinical and radiological parameters showed good correlation. We recommend to standardly evaluate the cosmetic outcome as after scoliosis correction surgery. Introduction: Improving cosmesis is an important goal in scoliosis surgery. Patients’ satisfaction with the cosmetic outcome is essential in their evaluation of the surgical result. However, only few efforts were made in the past to investigate the cosmetic outcome. We performed a a prospective study evaluated patients’, orthopaedists’ and not affected children of the same age ratings’ of preoperative and postoperative cosmesis in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. The cosmetic result based on a standardized questionnaire (SAQ, spinal appearance questionnaire) was compared to clinical and radiological parameters. Patient sample: Preoperative and postoperative photographs were taken from 32 patients (22 female, 10 male, average age 14.6 years) preoperatively and postoperatively in a standardized manner. Materials: The photographs were assessed by use of a modified SAQ. In addition radiological measurements were performed like the cobb angles of the main curves in the coronal and sagittal plane, plumb line deviation, shoulder inequality and pelvic obliquity. The clinical investigation included the measurements of shoulder asymmetry, pelvic obliquity, rip and lumbar hump, plumb line deviation, breast asymmetry and the postoperative evaluation of the scar. Results: The items general appearance, body shape, rib hump, and shoulder inequality of the SAQ improved most (p< 0.025). The patients judged the cosmetic result better than surgeons and healthy children (on average: 11 out 15 parameters of the SAQ improved) The surgeons came to the worst judgement (only 5 of 15 parameters improved). The interrater correlation of the surgeons was poor (ICC< 0.58). There was no correlation between the SAQ and objective clinical and radiologic parameters at all, whereas clinical and radiological parameters showed good correlation. Conclusion: As shown in our results objective clinical and radiological parameters do not correlate with the evaluation of the cosmetic result. Therefore we recommend to establish the evaluation of the cosmetic outcome as standard investigation after scoliosis correction surgery


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 226 - 226
1 May 2006
Rafee A Mittal D Smith R
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Background: To assess the cosmetic advantage of costotomy at the angle of the ribs on the convexity of a curve in the management of Adolescent Idiopathic scoliosis. Whilst modem segmental correction produces gratifying improvement in Cobb-angle and, to some extent rotation, rib asymmetry often remains as a concern for patients. Performing costotomy at the angle of the rib at the same time as corrective surgery can improve the cosmetic appearance significantly. It avoids any further scars or surgery, and is associated with minimal complications, the main one being pneumothorax and the requirement of a chest drain. Methods: Retrospective review of 50 patients. This has been a standard practice and this presentation reports on 50 patients treated in Preston with a variety of corrective devices; we have assessed results radiologically, with cosmetic acceptability by the patient and surface topographical analysis. Results: Significant improvement occurs at the time of costotomy as the ribs drop from their arched position after the coronal deformity has been improved. Conclusion: The addition of costotomy at the time of primary surgery for Adolescent Idiopathic Scoliosis leads to minimal complications. Significant improvement occurs at the time of costotomy as the ribs drop from their arched position after the coronal deformity has been improved. This is maintained in the post-operative period by moulding of the brace


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 371 - 371
1 Jul 2010
Chee Y Teoh K Shortt N Porter D
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Introduction: We conducted a prospective study on 29 patients comparing the medium-term outcome between intramedullary nail fixation and plate fixation in paediatric forearm fractures.

Materials and Methods: The criteria were patients who had a nail (10) or plate fixation (19) for a single or both bones forearm fracture between 2004 and 2006. All these patients were recalled following ethical approval for assessment of their grip strength using a hand dynamometer, forearm and elbow range of movements, scar assessment, POSNA outcome questionnaire and new radiographic views of the forearms.

Results: Mean age of 10.4 years for both groups (4–16), All fractures were caused by low velocity falls. Grip strength is reduced in 83% of patients, comparable in both groups. Elbow flexion is more reduced in the plating group but more reduction in extension in the nailing group. The reduction in forearm pronation (69% of patients) and supination (61%) were comparable in both groups. Using the ‘Manchester scar proforma’; the plating group scored worse with 14/21; nail 11/21. ‘POSNA outcome questionnaire’ score showed the nailing group had 90% excellent or good result and plating group 74%. The moderate and poor POSNA outcome (26% plate, 10% nail) were associated with pain, restricted rotation, bad scarring and difficulty lifting heavy objects. Nails were removed after bony healing but all plates were left in situ. Complete remodeling of forearm bones were seen in all radiographs in both groups. One case of non-iatrogenic ulnar nerve injury and two cases of wound infection were noted; all made full recovery.

Conclusion: The medium-term outcome at 2.5 years following either fixation method is generally comparable and good. The obvious differences were; a higher (better) POSNA score in the nailing group, larger scar formation in plating, elbow extension restriction in nailing and elbow flexion restriction in plating group. Factors that were comparable were grip strength, forearm rotation and radiographic remodeling and outcome.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_13 | Pages 35 - 35
1 Nov 2021
Hartland A Islam R Teoh K Rashid M
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Introduction and Objective. There remains much debate regarding the optimal method for surgical management of patients with long head of biceps pathology. The aim of this study was to compare the outcomes of tenotomy versus tenodesis. Materials and Methods. This systematic review and meta-analysis was registered on PROSPERO (ref: CRD42020198658). Electronic databases searched included EMBASE, Medline, PsycINFO, and Cochrane Library. Randomized controlled trials (RCTs) comparing tenotomy versus tenodesis were included. Risk of bias within studies was assessed using the Cochrane risk of bias v2.0 tool and the Jadad score. The primary outcome included patient reported functional outcome measures pooled using standardized mean difference (SMD) and a random effects model. Secondary outcome measures included visual analogue scale (VAS), rate of cosmetic deformity (Popeye sign), range of motion, operative time, and elbow flexion strength. Results. 751 patients from 10 RCTs demonstrated (369 tenotomy vs 382 tenodesis) were included in the meta-analysis. Pooled analysis of all PROMs data demonstrated comparable outcomes between tenotomy vs tenodesis (SMD 0.17 95% CI −0.02 to 0.36, p=0.09). Sensitivity analysis comparing RCTs involving patients with and without an intact rotator cuff did not change the primary outcome. Secondary outcomes including VAS, shoulder external rotation, and elbow flexion strength did not reveal any significant difference. Tenodesis resulted in a lower rate of Popeye deformity (OR 0.27 95% CI 0.16 to 0.45, p<0.00001). Conclusions. Aside from a lower rate of cosmetic deformity, tenodesis yielded no measurable significant benefit to tenotomy for addressing pathology in the long head of biceps. This finding was irrespective of the whether the rotator cuff was intact


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_7 | Pages 64 - 64
4 Apr 2023
Hartland A Islam R Teoh K Rashid M
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There remains much debate regarding the optimal method for surgical management of patients with long head of biceps pathology. The aim of this study was to compare the outcomes of tenotomy versus tenodesis. This systematic review and meta-analysis was registered on PROSPERO (ref: CRD42020198658). Electronic databases searched included EMBASE, Medline, PsycINFO, and Cochrane Library. Randomized controlled trials (RCTs) comparing tenotomy versus tenodesis were included. Risk of bias within studies was assessed using the Cochrane risk of bias v2.0 tool and the Jadad score. The primary outcome included patient reported functional outcome measures pooled using standardized mean difference (SMD) and a random effects model. Secondary outcome measures included pain (visual analogue scale VAS), rate of Popeye deformity, and operative time. 860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included in the meta-analysis. Pooled analysis of all PROMs data demonstrated comparable outcomes between tenotomy vs tenodesis (SMD 0.14, 95% CI −0.04 to 0.32; p=0.13). Sensitivity analysis comparing RCTs involving patients with and without an intact rotator cuff did not change the primary outcome. There was no significant difference for pain (VAS). Tenodesis resulted in a lower rate of Popeye deformity (OR 0.29, 95% CI 0.19 to 0.45, p < 0.00001). Tenotomy demonstrated a shorter operative time (MD 15.21, 95% CI 1.06 to 29.36, p < 0.00001). Aside from a lower rate of cosmetic deformity, tenodesis yielded no measurable significant benefit to tenotomy for addressing pathology in the long head of biceps. A large multi-centre clinical effectiveness randomised controlled trial is needed to provide clarity in this area


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_16 | Pages 32 - 32
19 Aug 2024
Caplash G Caplash Y Copson D Thewlis D Ehrlich A Solomon LB Ramasamy B
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Few surgical techniques to reconstruct the abductor mechanism of the hip have been reported, with outcomes reported only from case reports and small case series from the centres that described the techniques. As in many of our revision THA patients the gluteus maximus was affected by previous repeat posterior approaches, we opted to reconstruct the abductor mechanism using a vastus lateralis to gluteus medius transfer. We report the results of such reconstructions in seven patients, mean age 66 (range, 53–77), five females, presenting with severe abductor deficiency (MRC grade 1–2). Five patients had previous revision THA, two with a proximal femoral replacement, one patient had a primary THA after a failed malunited trochanteric fracture, and one patient had a native hip with idiopathic fatty infiltration of glutei of >90%. All patients had instrumented gait analysis, and surface electromyography (EMG) of the glutei, TFL, and vastus muscles simultaneously before surgery and at each post-op follow-up. Postoperatively, patients were allowed to weight bear as tolerated and were requested to wear an abduction brace for the first six weeks after surgery to protect the transfer. All patients improved after surgery and reached an abductor power of 3 or more. All patients walked without support six months after surgery and were satisfied with the result. Abductor function continued to improve beyond one year of follow-up, and some patients reached an abductor power of 5. EMG demonstrated that the transferred vastus lateralis started firing synchronously with gluteus medius after three months post-surgery, suggesting adaptation to its new function. No knee extension weakness was recorded. One patient complained of lateral thigh numbness and was dissatisfied with the cosmetic look of her thigh after surgery. Our preliminary results are encouraging and comparable with those achieved by the originators of the technique


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 11 - 11
1 Apr 2022
Baumgart R
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Introduction. Fully implantable distraction nails are frequently used for lengthening of the lower leg. What are the indications for humerus lengthening and which results can be expected?. Materials and Methods. The humerus as the best healing bone in the human body is suitable for lengthening with a nail as well but the indications are rare in comparison with the lower legs. Especially when driving a car or when working on a tablet length discrepancy of the arms of more than 4–5cm may cause severe hardening of the cervical muscles and induce chronical pain in the upper spine. Results. A distraction nail (FITBONE) was used in 5 cases for humerus lengthening. The nail was inserted in all cases from proximal. The mean age of the patients was 34 years. The mean lengthening amount was 58mm (55–100). In one case the system was exchanged to reach the desired length. There was no infection, no radial nerve irritation and no chronical shoulder pain. The system was removed in 4 cases in an average of 15 months the other nail will be removed soon as well. Conclusions. The preliminary results of our 5 cases demonstrate, that the FITBONE device is advantageous for lengthening the humerus, if the initial length is sufficient for implantation. In comparison with the use of external fixators the functional outcome, the comfort of treatment and the cosmetic result is amazing


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 12 - 12
1 Apr 2022
Baumgart R
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Introduction. Fully implantable systems are used commonly only after maturity. What are indications to use fully implantable systems at the femur even in children?. Materials and Methods. Implantable lengthening nails (FITBONE) were used retrograde at the femur in minimal invasive technique to correct a limb length discrepancy of >6 cm. In 5 cases a relevant deformity was corrected in the same surgery. In all cases a final step of lengthening was planned at the femur and at the tibia with fully implantable devices at maturity. Results. 18 patients with the medium age of 10,3 years (8–14) were treated. In 17 cases the goal of lengthening was achieved without any complication. In one case of proximal femoral deficiency lengthening had to be stopped because of increasing tendency of knee joint luxation. Bone formation occurred circular around the nail in all cases. Full load bearing was possible in the average after 2,2 days/mm. No technical problems occur. In one case induced deformity in the lateral plane was observed which was corrected at the final step. At the end of treatment functional and cosmetical result was perfect in all cases. Conclusions. Fully implantable motorized distraction nails are a favorable option for lengthening and deformity correction of the femur even for children older than 10 years to correct limb length discrepancy of more than 6 cm. The treatment has a low pain level, is comfortable and nearly no scars are visible


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 15 - 15
1 Apr 2022
Belousova E Pozdeev A Sosnenko O
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Introduction. Deformations of forearm with different degree of expression and functional restrictions of upper limb in children with hereditary multiple exostosis are formed in almost 80% of the cases. The question of indications for the selection and conduct of surgical procedure remains controversial, existing treatment methods and post-operative recovery methods for children need to be improved. Materials and Methods. The long-term outcomes of surgical treatment of 112 patients diagnosed with “Hereditary Multiple Exostosis” (HME) aged from 2 till 17 years old were researched. Evaluation of surgical treatment results was carried out in accordance with complaints, functional condition of the forearm, radiographs (taking into account reference lines and angles). Depending on the variant of deformation, the following surgical operations were performed: resection of bone-cartilage exostoses (in 20.5%); correction of forearm deformation with external fixator (in 79.5). In 14 cases, for a more accurate correction of deformity a hexapod frame was used. Results. Differentiated approach provided “good” anatomical and functional results in 55.6%; “satisfactory” results in 40.2%; “unsatisfactory” results in 4.2%. Postoperative complications in the form of non-union, pseudoarthrosis, delayed consolidation or neurological disorders were in 6.2%. Conclusions. The choice of surgical treatment is determined by the variant and severity of deformation. This approach allows to improve cosmetic and functional condition of forearm and adjacent joints. The use of hexapod allows to increase accuracy of correction of physiological axis of forearm bones


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 42 - 42
1 Apr 2022
Guichet J Chekairi A Stride M
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Introduction. The Patient's Dream is not to stay in hospital even overnight, including in limb lengthening. We developed the ‘Hyper Fast Track Protocol’ (HFTP) in 2015 to fasten recovery and shorten hospital stay. Materials and Methods. The protocol included surgical stab incisions, use of weight bearing lengthening nails (G-Nail), intramedullary saw, a specific anaesthesia care (blood hypo-pressure, tranexamic acid, low hydration), absence of early anticoagulants, systematic vascular US controls, but early motion (hip and knee Ext/Fle, leg raise, horizontal ‘scissors’), walking, stairs, bike, clicking (maneuvers to lengthen), early discharge, along with other patient's parameters. Timing and exercises reps were registered. Protocols improved over time. Means ± SD are computed. Results. Forms were analysed in 112 patients (unilateral 7, dwarfism 2, cosmetic 103). Besides patients operated in the afternoon (18), physio sessions initiated (h:mm) in average 0:46 ± 0:19 after awakening in operative room, for a duration of 2:15 ± 0:46. No DVT was noted on US nor clinically. In 2016, hospitalisation averaged 2.88 nights, decreasing to 2.07 in 2017, then to 1.07 from 2020. In late 2020 and in 2021, we had several patients in Daycare only, even in bilateral lengthening. In late 2021, we could discharge a patient after walking, full motion and exercises 3.5 hours after awakening from bilateral surgery. Conclusions. With continuous result monitoring and constant improvement of Care, walking, stairs, clicks and biking are fully feasible within 3h of surgery awakening, with discharge on the same day, using specific protocols


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_1 | Pages 14 - 14
1 Jan 2022
Chotai N Green D Zurgani A Boardman D Baring T
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Abstract. Aim. The aim of this study was to present the results of treatment of displaced lateral clavicle fractures by an arthroscopically inserted tightrope device (‘Dogbone’, Arthrex). Methods. We performed a retrospective series of our patients treated with this technique between 2015 and 2019. Patients were identified using the ‘CRS Millennium’ software package and operation notes/clinic letters were analysed. We performed an Oxford Shoulder Score (OSS) on all the patients at final follow-up. Our electronic ‘PACS’ system was used to evaluate union in the post-operative radiographs. Results. We treated 26 patients with displaced lateral clavicle fractures between 2015 and 2019. There were 4 patients who were treated with a ‘dogbone’ and supplementary plate fixation and the remaining 22 were treated with a ‘dogbone’ alone. Radiological union was seen in 22 (84%) patients. The mean Oxford Shoulder Score (OSS) was 46. Apart from one patient who required removal of the superior endobutton and knot under local anaesthetic there was no other secondary surgery. There were no cases of infection, nerve injury or frozen shoulder. Conclusions. Arthroscopic ‘dogbone’ treatment of lateral clavicle fractures is a safe, cosmetically friendly technique with promising high rates of fracture union and return to normal function. We recommend its use over the more conventional treatment of a hook plate


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 7 - 7
1 May 2021
Hogg J Madan S
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Introduction. Torsional malalignment syndrome (TMS) is a unique combination of rotational deformities in the lower limb, often leading to severe patellofemoral joint pain and disability. Surgical management of this condition usually consists of two osteotomies in each affected limb, with simultaneous correction of both femoral anteversion and external tibial torsion. However, we believe that a single supratubercular osteotomy followed by tibial derotation with the Taylor Spatial Frame (TSF) can be used to provide a significant improvement in both appearance and function. Materials and Methods. This is a retrospective case analysis in which we will be reviewing 16 osteotomies performed by one surgeon between 2006 and 2017. The study includes 11 patients with a mean age of 16.7 ± 0.8 years. Pre and post-operatively, patients were fully evaluated through history and physical examination, and CT rotational profiling. Statistical analyses were performed in order to determine whether or not any observed clinical or cosmetic improvements were statistically significant. Results. The results show significant improvements in scores reported on post-operative functional assessment, with mean Oxford Knee Score (OKS) increasing by 18.3 and mean Kujala Anterior Knee Pain Scale (AKPS) also increasing by 31.4. In addition to this, post-operative clinical assessment showed a reduced thigh-foot angle (TFA) in all cases, by a mean value of 31.9o. The angle of the transmalleolar axis (TMA) was successfully reduced in 14/16 cases, by a mean value of 8.6o. Statistical analysis showed all of these results to be statistically significant where p<0.05. Conclusions. The results show that supratubercular osteotomy, followed by gradual correction with TSF, can be used to provide a significant improvement in both appearance and function for patients suffering from TMS


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 469 - 469
1 Aug 2008
Dix-Peek S Breckon C Hoffman E
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Forearm lengthening in children is controversial. Paley (1990) and Peterson (1994) advocate aggressive treatment of the deformity for cosmetic and functional reasons. Scoenecker (1997) has shown that mature patients are comfortable with their appearance and functional deficit. We reviewed 8 forearm lengthenings performed in 8 children in the 14 year period from 1991 to 2004. Five patients had ulnar shortening (osteochondromata = 4, growth arrest due to trauma = 1). Of the three patients with radial shortening, one was due to a congenital short radius and two following growth arrest (post trauma and meningococcal septicemia). The shortening resulted in a cosmetically unacceptable ulnar or radial tilt with absent radial or ulnar deviation of the wrist and decreased supination and/or pronation. One patient with a proximal ulnar osteochondroma had a dislocation of the radial head with cubitus varus. Excision of the osteochondroma was done 6 months prior to lengthening. Lengthening was accomplished with two Ilizarov rings and a distal corticotomy for radial and proximal for ulnar shortening. Reduction of the dislocated radial head was achieved with an olive wire. Associated procedures were: hemiepiphyseal stapling of the distal radius for an increased radial articular angle in 3 patients with osteochondroma, and corrective osteotomy of the distal radius in 1 patient with growth arrest. The average lengthening obtained was 23 mm (range 13–40 mm) with an average lengthening index of 1.45 months per cm. At an average follow-up of six years (range 2–15 years; 7 to maturity) all patients were satisfied with the cosmetic improvement and had full radial and ulnar deviation. Except for two patients the supination/pronation was improved. We concluded the forearm lengthening is warranted for cosmetic and functional reasons


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 110 - 110
1 Feb 2003
McMurtry IA Bennett GC
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A vertical scapular osteotomy was first described by Wilkinson in 1980. We report six children with a mean age of 9 years 6 months at operation (range 4–16). Mean abduction pre-operatively was 77 degrees (range 70–160 degrees). Cosmetically all were Cavendish grade three except one grade four. Five of the six had associated abnormalities of the cervical spine (three Klippel-Feil and one hemivertebra) and four had omovertebral bars. One boy had a full range of movement pre-op and had a cosmetic correction. One girl had a preceding Erbs palsy which had resolved completely prior to surgery. Mean follow-up is five years (range 1–12 years). All patients have an excellent cosmetic result, four graded Cavendish one, two graded two, and one grade three. Mean abduction improved to 148 degrees and mean improvement was 77 degrees. Sprengel’s deformity presents significant cosmetic and functional deficits. We have found the vertical scapular osteotomy as described by Wilkinson a simple and reliable procedure with predictably good results. With regards to the omovertebral bone, we concur that its presence has no influence on functional outcome. Cosmetically, when clothed, the result is excellent, with the shoulders level. Undressed, however, asymmetry is still obvious with a truncated shoulder girdle and persistence of some webbing or fullness in the base of the neck. This appears more marked when an omovertebral bone was present. We conclude that a vertical scapular osteotomy is a reliable operation for improving shoulder girdle function, but that cosmetic objectives must be reliable


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 19 - 19
1 Mar 2006
von Campe A Vienne P
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Background: Distal metatarsal osteotomy is indicated for correction of mild to low-moderate symptomatic hallux valgus deformity and has shown good to excellent functional and cosmetic results. Original chevron osteotomy and its modifications are the most used distal metatarsal osteotomies. These techniques have limitations for correction of greater deformities. Objective: To describe a new reversed L-shaped (ReveL) distal metatarsal osteotomy through minimal invasive technique to treat mild to severe hallux valgus deformities and to analyze the functional and cosmetic results of this procedure after at least two years follow-up. Methods: Between November 2002 and March 2004, a ReveL osteotomy through single medial short approach was performed by 95 patients (120 feet) of an average age of 53 years (range 16 to 79). Overall complications, hallux valgus and I–II intermetatarsal angle corrections were analysed. 28 patients (36 feet) were clinically and radiologically reviewed with a mean follow-up of 33 months (range 25 to 42). Results: 89% of the patients were satisfied or very satisfied with the cosmetic result. The average AOFAS score increased from 56 points preoperatively to 91 points at mean follow-up. There were no nonunion or avascular necrosis. The mean correction of the hallux valgus angle was 11° and 5 ° for the I–II intermetatarsal angle. There was no significant loss of correction of hallux valgus angle and I–II intermetatarsal angle between first postoperative assessment and follow-up. At least two years after the procedure, the force developped at the forefoot at push-off was still decreased compared to a normal population, particularly on the first metatarsal and on the big toe. Conclusions: Good and very good functional and cosmetic results were obtained after Revel osteotomy for correction of symptomatic hallux valgus up to 60° of deformity in our series. There was no significant loss of correction after two years follow-up. The reduced forces on the first metatarsal head and on the first toe had no negative influence on the final subjective and objective result


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 196 - 196
1 Mar 2003
Dowling F Goldberg C Moore D Fogarty E
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Introduction: Historically, the spinal curvature of adolescent idiopathic scoliosis was considered a life-threatening occurrence, which would result in early death from cardio-respiratory compromise. Consequently, corrective surgery had the primary intention of preventing this unacceptable outcome: cosmetic improvement was considered to be certainly important, but not the prime objective of the treatment. More recent work (e.g. Branthwaite MA. (1986) Br.J.Dis.Chest. 80:360–369) has shown that, while significant deformity presenting in early childhood does carry this outlook, those with an adolescent onset should not be significantly affected in this way. Consequently, any surgery recommended is primarily cosmetic, to improve the deformity when it is unacceptable to the patient and her parents. This, of necessity, changes the criteria by which treatment outcome should be assessed. Scoliosis surgery has generally been judged by the correction in Cobb angle and, more recently, the derotation of vertebrae. However, it is well known that neither factor accurately expresses cosmesis, the criterion by which the patient will judge the operation. Surface topography attempts to quantify the external appearance of a patient and so the cosmetic effect of surgery. Since 1995, when a surface topographic system (Quantec) was acquired by this department, 61 patients were operated for adolescent idiopathic scoliosis, of whom 35 underwent anterior release and posterior fusion for rigid thoracic curves. Methods and Results: Pre- and post-operative radiographs were compared with topographic results from the same periods and with the latest scan at last review. The mean pre-operative Cobb angle was 74.5° and, postoperatively was 40.7°, a mean correction of 45.4% and was statistically significant (p< .001). This was accompanied by statistically significant reductions in upper and middle topographic spinal angles (p=0.001), an increase in thoracic kyphosis (p< 0.05), a decrease in lumbar lordosis (p=0.001), lower rib hump (p< 0.05), Suzuki hump sum (a measure of back asymmetry, p=0.001) and posterior trunk asymmetry score (POTSI, a measure of trunk balance, p=0.003). At final follow-up a mean of 2.2 years later, topographic spinal angles and POTSI maintained their improvement, still being statistically significantly less than their pre-operative values. Thoracic kyphosis, lumbar lordosis, rib hump and Suzuki hump sum had returned towards pre-operative levels and no longer showed statistically significant differences. Conclusions:This confirms previous reports of the recurrence of the rib-hump. In conclusion, after two-stage spinal fusion for adolescent idiopathic scoliosis, significant improvement in cosmetic appearance can be achieved. However, over time certain aspects of the original deformity, particularly distortion of the back surface (rib hump or asymmetry) recurs