Aims. The aim of this study was to assess the safety and clinical outcome of patients with a femoral shaft fracture and a previous complex post-traumatic femoral malunion who were treated with a clamshell osteotomy and fixation with an intramedullary nail (IMN). Methods. The study involved a retrospective analysis of 23 patients. All had a previous, operatively managed, femoral shaft fracture with malunion due to hardware failure. They were treated with a clamshell osteotomy between May 2015 and March 2020. The mean age was 42.6 years (26 to 62) and 15 (65.2%) were male. The mean follow-up was 2.3 years (1 to 5). Details from their medical records were analyzed. Clinical outcomes were assessed using the quality of correction of the
Aims. Eight-plates are used to correct varus-valgus
Aims. Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. Methods. A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Results. Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer
Aims. A conventional arthroscopic capsuloligamentous repair is a reliable surgical solution in most patients with scapholunate instability. However, this repair does not seem to be sufficient for more advanced injuries. The aim of this study was to evaluate the functional results of a wide arthroscopic dorsal capsuloligamentous repair (WADCLR) in the management of severe scapholunate instability. Methods. This was a prospective single-centre study undertaken between March 2019 and May 2021. The primary outcome was the evaluation of the reduction of the radiological
Salter-Harris II fractures of the distal tibia affect children frequently, and when they are displaced present a treatment dilemma. Treatment primarily aims to restore alignment and prevent premature physeal closure, as this can lead to angular
Aims. The aim of this retrospective cohort study was to assess and investigate the safety and efficacy of using a distal tibial osteotomy compared to proximal osteotomy for limb lengthening in children. Methods. In this study, there were 59 consecutive tibial lengthening and deformity corrections in 57 children using a circular frame. All were performed or supervised by the senior author between January 2013 and June 2019. A total of 25 who underwent a distal tibial osteotomy were analyzed and compared to a group of 34 who had a standard proximal tibial osteotomy. For each patient, the primary diagnosis, time in frame, complications, and lengthening achieved were recorded. From these data, the frame index was calculated (days/cm) and analyzed. Results. All patients ended their treatment with successful lengthening and deformity correction. The frame index for proximal versus distal osteotomies showed no significant difference, with a mean 48.5 days/cm (30 to 85) and 48.9 days/cm (28 to 81), respectively (p = 0.896). In the proximal osteotomy group, two patients suffered complications (one refracture after frame removal and one failure of regenerate maturation with subsequent valgus deformity) compared to zero in the distal osteotomy group. Two patients in each group sustained obstacles that required intervention (one necessitated guided growth, one fibula lengthening, and two required change of wires). There was a similar number of problems (pin-site infections) in each group. Conclusion. Our data show that distal tibial osteotomies can be safely employed in limb lengthening for children using a circular frame, which has implications in planning a surgical strategy; for example, when treating a tibia with shortening and distal
Aims. Children with spinal dysraphism can develop various musculoskeletal
Aims. To assess if congenital foot
Aims. This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction?. Methods. A total of 45 patients with a thoracic AIS which needed surgical correction and fusion were included in a prospective study. All patients underwent pulmonary function testing (PFT) and low-dose biplanar radiographs both preoperatively and one year after surgery. The following measurements were recorded: forced vital capacity (FVC), slow vital capacity (SVC), and total lung capacity (TLC). Rib cage volume (RCV), maximum rib hump, main thoracic curve Cobb angle (MCCA), medial-lateral and anteroposterior diameter, and T4-T12 kyphosis were calculated from 3D reconstructions of the biplanar radiographs. Results. All spinal and thoracic measurements improved significantly after surgery (p < 0.001). RCV increased from 4.9 l (SD 1) preoperatively to 5.3 l (SD 0.9) (p < 0.001) while TLC increased from 4.1 l (SD 0.9) preoperatively to 4.3 l (SD 0.8) (p < 0.001). RCV was correlated with all functional indexes before and after correction of the
We reviewed 42 consecutive children with a supination
Aims. To benchmark the radiation dose to patients during the course of treatment for a spinal
Aims. Preoperative talar valgus
Aims. To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele. Methods. We reviewed 12 consecutive patients (7M:5F; mean age 12.4 years (9.2 to 16.8)) including demographic details, spinopelvic parameters, surgical correction, and perioperative data. We assessed the impact of surgery on patient outcomes using the Spina Bifida Spine Questionnaire and a qualitative questionnaire. Results. The mean follow-up was 5.4 years (2 to 14.9). Nine patients had kyphoscoliosis, two lordoscoliosis, and one kyphosis. All patients had a thoracolumbar
Aims. The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback
Aims. There is little information about how to manage patients with a recurvatum
Aims. The aim of this study was to identify the risk factors for adverse events following the surgical correction of cervical spinal
Valgus knee
Collateral ligament release is advocated in total
knee arthroplasty (TKA) to deal with significant coronal plane
Aims. The aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head
Aims. The routine use of dual-mobility (DM) acetabular components in total hip arthroplasty (THA) may not be cost-effective, but an increasing number of patients undergoing THA have a coexisting spinal disorder, which increases the risk of postoperative instability, and these patients may benefit from DM articulations. This study seeks to examine the cost-effectiveness of DM components as an alternative to standard articulations in these patients. Patients and Methods. A decision analysis model was used to evaluate the cost-effectiveness of using DM components in patients who would be at high risk for dislocation within one year of THA. Direct and indirect costs of dislocation, incremental costs of using DM components, quality-adjusted life-year (QALY) values, and the probabilities of dislocation were derived from published data. The incremental cost-effectiveness ratio (ICER) was established with a willingness-to-pay threshold of $100 000/QALY. Sensitivity analysis was used to examine the impact of variation. Results. In the base case, patients with a spinal
Correction of valgus
Aims. The aim of this study was to quantify the risk of developing cancer from the exposure to radiation associated with surgery to correct limb
Aims. To present our experience of using a combination of intra-articular
osteotomy and external fixation to treat different
Femoroacetabular impingement is a cause of hip pain in adults and is potentially a precursor of osteoarthritis. Our aim in this study was to determine the prevalence of bilateral
It has been suggested that a supramalleolar osteotomy can return the load distribution in the ankle joint to normal. However, due to the lack of biomechanical data, this supposition remains empirical. The purpose of this biomechanical study was to determine the effect of simulated supramalleolar varus and valgus alignment on the tibiotalar joint pressure, in order to investigate its relationship to the development of osteoarthritis. We also wished to establish the rationale behind corrective osteotomy of the distal tibia. We studied 17 cadaveric lower legs and quantified the changes in pressure and force transfer across the tibiotalar joint for various degrees of varus and valgus
The
Fixed flexion
We carried out 123 consecutive total ankle replacements in 111 patients with a mean follow-up of four years (2 to 8). Patients with a hindfoot
In a prospective study over 11 years we assessed the relationship between neonatal
We retrospectively reviewed the records of 1150
computer-assisted total knee replacements and analysed the clinical
and radiological outcomes of 45 knees that had arthritis with a
pre-operative recurvatum
Progressive angular
We studied 11 patients with checkrein
Our study describes the clinical outcome of total ankle replacement (TAR) performed in patients with moderate to severe varus
A discussion of the essential
Proximal osteotomies for forefoot
Talonavicular and subtalar joint fusion through
a medial incision (modified triple arthrodesis) has become an increasingly
popular technique for treating symptomatic flatfoot
We present the results of the surgical correction of lower-limb
One of the objectives of knee replacement is to correct flexion
We report the results of using a combination of fixator-assisted nailing with lengthening over an intramedullary nail in patients with tibial
1. The nature of paralytic
Twenty complex tibial
1. Deformities of the foot in children with myelomeningocele are described and classified. The results of a policy of operative correction of
Rocker bottom
Charcot neuro-osteoarthropathy (CN) of the midfoot
presents a major reconstructive challenge for the foot and ankle
surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and
recommended for patients who have a
1. Paralytic dislocation of the hip in spina bifida generally requires reduction and iliopsoas transfer. The muscle transfer ensures that the hip remains reduced, lessens the need for calipers and prevents progressive flexion
We evaluated scapular dysplasia and malposition in 15 patients with the Sprengel
A consecutive series of 23 patients (25 ankles) with osteoarthritis of the ankle and severe varus or valgus
Valgus
1. A series of 106 central slip injuries has been reviewed. 2. Although the boutonnière
The exceptionally high prevalence of diastrophic dysplasia in Finland has enabled us to analyse the foot
A 64-year-old man presented with a severe
1 . A classification of Madelung's
We reviewed 31 patients at a mean of five years after mallet
We report the treatment in 17 patients of 27 angular
A pronation
Adults with
We determined the frequency, rate and extent
of development of scoliosis (coronal plane deformity) in wheelchair-dependent
patients with Duchenne muscular dystrophy (DMD) who were not receiving
steroid treatment. We also assessed kyphosis and lordosis (sagittal
plane deformity). The extent of scoliosis was assessed on sitting anteroposterior
(AP) spinal radiographs in 88 consecutive non-ambulatory patients
with DMD. Radiographs were studied from the time the patients became
wheelchair-dependent until the time of spinal fusion, or the latest assessment
if surgery was not undertaken. Progression was estimated using a
longitudinal mixed-model regression analysis to handle repeated
measurements. Scoliosis ≥ 10° occurred in 85 of 88 patients (97%), ≥ 20° in
78 of 88 (89%) and ≥ 30° in 66 of 88 patients (75%). The fitted
longitudinal model revealed that time in a wheelchair was a highly
significant predictor of the magnitude of the curve, independent
of the age of the patient (p <
0.001). Scoliosis developed in
virtually all DMD patients not receiving steroids once they became
wheelchair-dependent, and the degree of
Sixty patients with congenital
Patients with acetabular dysplasia commonly undergo
peri-acetabular osteotomy after skeletal maturity to reduce the risk
of the late development of osteoarthritis. Several studies have
suggested that
Patients with spina bifida cystica commonly have significant disability from a combination of valgus
We reviewed the results of a selective à la carte soft-tissue release operation for recurrent or residual
We reviewed 36 cases of forearm
Hip displacement, common in patients with cerebral palsy (CP), causes pain and hinders adequate care. Hip reconstructive surgery (HRS) is performed to treat hip displacement; however, only a few studies have quantitatively assessed femoral head sphericity after HRS. The aim of this study was to quantitatively assess improvement in hip sphericity after HRS in patients with CP. We retrospectively analyzed hip radiographs of patients who had undergone HRS because of CP-associated hip displacement. The pre- and postoperative migration percentage (MP), femoral neck-shaft angle (NSA), and sphericity, as determined by the Mose hip ratio (MHR), age at surgery, Gross Motor Function Classification System level, surgical history including Dega pelvic osteotomy, and triradiate cartilage status were studied. Regression analyses using linear mixed model were performed to identify factors affecting hip sphericity improvement.Aims
Methods
At our institution surgical correction of symptomatic
flat foot
We reviewed the results of anterior hip release for fixed flexion
Joint
1. Correction of equinus
We reviewed 24 feet in 15 patients who had undergone talectomy for recurrent equinovarus
We report a prospective case-controlled study which compared the outcome of knee replacement in seriously deformed and slightly deformed knees. There were 51 knees with varus or valgus
Equinus
Segmental vessel ligation during anterior spinal surgery has been associated with paraplegia. However, the incidence and risk factors for this devastating complication are debated. We reviewed 346 consecutive paediatric and adolescent patients ranging in age from three to 18 years who underwent surgery for anterior spinal
In Japan, osteoarthritis (OA) of the hip secondary
to acetabular dysplasia is very common, and there are few data concerning
the pathogeneses and incidence of femoroacetabular impingement (FAI).
We have attempted to clarify the radiological prevalence of painful
FAI in a cohort of Japanese patients and to investigate the radiological findings.
We identified 176 symptomatic patients (202 hips) with Tönnis grade
0 or 1 osteoarthritis, whom we prospectively studied between August
2011 and July 2012. There were 61 men (65 hips) and 115 women (137
hips) with a mean age of 51.8 years (11 to 83). Radiological analyses
included the α-angle, centre–edge angle, cross-over sign, pistol
grip
We performed limb lengthening and correction of
Spasm or contracture of gastrocnemius causes an equinus
1. The indications for talectomy in the treatment of equinovarus
We describe three patients who developed gross calcaneus
We reviewed our experience of tibialis anterior transfer and anterior release for calcaneus
In a consecutive series of 124 children with spina bifida we found that 220 (89%) of the 248 feet were deformed: 70 had a calcaneus
The Madelung
Comparisons were made between 54 children with resolving congenital talipes equinovarus
Somatosensory evoked potentials (SSEPs) measure the conduction pathways from the periphery to the brain and can demonstrate the site of neurological impairment in a variety of locomotor conditions. SSEPs were studied in 44 children (64 feet) with surgically corrected club feet. Four children had unreproducible responses, 18 showed abnormal recordings and 22 showed normal responses. In a further 31 feet (21 children) subjected to motor electrophysiological tests, 16 (52%) were abnormal. Overall, 44 of 95 feet (46%) showed abnormal SSEPs or motor electrophysiological tests. Neurological abnormality was related both to the severity of the
We report two cases with windswept
Between July 2000 and April 2004, 19 patients with bilateral spastic cerebral palsy who required an assistive device to walk had combined lengthening-transfer of the medial hamstrings as part of multilevel surgery. A standardised physical examination, measurement of the Functional Mobility Scale score and video or instrumented gait analysis were performed pre- and post-operatively. Static parameters (popliteal angle, flexion
The aims of this study were to determine the effect of osteophyte excision on deformity correction and soft tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA). A total of 492 consecutive, cemented, cruciate-substituting TKAs performed for varus osteoarthritis were studied. After exposure and excision of both cruciates and menisci, it was noted from operative records the corrective interventions performed in each case. Knees in which no releases after the initial exposure, those which had only osteophyte excision, and those in which further interventions were performed were identified. From recorded navigation data, coronal and sagittal limb alignment, knee flexion range, and medial and lateral gap distances in maximum knee extension and 90° knee flexion with maximal varus and valgus stresses, were established, initially after exposure and excision of both cruciate ligaments, and then also at trialling. Knees were defined as ‘aligned’ if the hip-knee-ankle axis was between 177° and 180°, (0° to 3° varus) and ‘balanced’ if medial and lateral gaps in extension and at 90° flexion were within 2 mm of each other.Aims
Methods
The occurrence of "windswept deformity" in the legs of otherwise healthy African children in the second or third year of life is illustrated by three typical case histories. The usual causes of epiphysial abnormality were absent in these and other similar patients seen recently in central Nigeria. It is suggested that an unrecognised hereditary dysplasia of bone, possibly of local geographical distribution and associated with a phase of epiphysial instability due to rapid growth, might underlie the sudden onset of this striking
Two cases of lateral meningocele and spinal
We present a method of visualising spinal
We have used the Ilizarov technique for severe flexion
We used the Ilizarov method in seven patients with severe congenital radial club hands who had had previous wrist surgery, to correct residual shortening and bowing of the ulna together with recurrent wrist
The correction of angular
Spasm or contracture of the gastrocnemius muscle is predominantly responsible for the equinus
One-stage femoral lengthening is thought to have an unacceptably high complication rate and is not widely practised. We reviewed 17 patients after one-stage lengthening for femoral shortening with associated angular or rotational
We have measured the three-dimensional patterns of carpal
The purpose of this study was to evaluate the
long-term outcome of adults with spina bifida cystica (SBC) who
had been treated either operatively or non-operatively for scoliosis
during childhood. We reviewed 45 patients with a SBC scoliosis (Cobb angle ≥ 50º)
who had been treated at one of two children’s hospitals between
1991 and 2007. Of these, 34 (75.6%) had been treated operatively
and 11 (24.4%) non-operatively. After a mean follow-up of 14.1 years
(standard deviation (. sd. ) 4.3) clinical, radiological and
health-related quality of life (HRQOL) outcomes were evaluated using
the Spina Bifida Spine Questionnaire (SBSQ) and the 36-Item Short Form
Health Survey (SF-36). Although patients in the two groups were demographically similar,
those who had undergone surgery had a larger mean Cobb angle (88.0º
(. sd. 20.5; 50.0 to 122.0); versus 65.7º
(. sd. 22.0; 51.0 to 115.0); p <
0.01) and a larger mean clavicle–rib
intersection difference (12.3 mm; (. sd. 8.5; 1 to 37); versus 4.1
mm, (. sd. 5.9; 0 to 16); p = 0.01) than those treated non-operatively.
Both groups were statistically similar at follow-up with respect
to walking capacity, neurological motor level, sitting balance and
health-related quality of life (HRQOL) outcomes. Spinal fusion in SBC scoliosis corrects coronal
We treated 47 patients with a mean age of 57 years (22 to 88) who had a proximal humeral fracture in which there was a severe varus
Two girls with congenital postural
Five children with chronic renal failure and severe rachitic
We investigated fixed flexion
We studied 24 children (40 feet) to demonstrate that a physiotherapist-delivered Ponseti service is as successful as a medically-led programme in obtaining correction of an idiopathic congenital talipes equinovarus