Search

Abstract Background Femoral head varus triggers poor clinical prognosis in intertrochanteric fracture patients with proximal femoral nail antirotation (PFNA) fixation. Studies present that changes in nail position and screw insertion angles will affect fixation stability, but the biomechanical significance of these factors on the risk of femoral head varus has yet to be identified in PFNA fixed patients. Methods Clinical data in PFNA fixed intertrochanteric fracture patients have been reviewed, the relative position of intermedullary nail has been judged in the instant postoperative lateral radiography. Regression analyses have been performed to identify the effect of this factor on femoral head varus. Corresponding biomechanical mechanism has been identified by numerical mechanical simulations. Results A clinical review revealed that ventral side nail insertion can trigger higher risk of femoral head varus, corresponding numerical mechanical simulations also recorded poor fixation stability in models with ventral side nail insertion, and changes in the trajectory of anti-rotation blade will not obviously affect this tendency. Conclusions Ventral side insertion of intramedullary nail can trigger higher risk of femoral head varus in PFNA fixed patients by deteriorating the instant postoperative biomechanical environment, and changes in blade trajectory cannot change this tendency biomechanically. Therefore, this nail position should be adjusted to optimize patients’ prognosis.

Objective: The medial closing-wedge distal femoral varus osteotomy (MCW-DFVO) was an excellent operation for painful valgus lateral unicompartmental osteoarthritic (OA) knee, especially in the young patient. Originally, it requires a medial approach that has more precarious. On top of that, releasing of the iliotibial band that is the deforming force needs added incision. Therefore, this study aims to describe the modified surgical technique of MCW-DFVO that uses a lateral approach and lateral plating to treat the valgus OA knee. Additionally, we also reveal the outcomes of our technique as the case series. Materials and Methods: Ten patients (12 knees) who underwent MCW-DFVO via a lateral approach were retrospectively reviewed. The inclusion criteria were age 18-60 years, isolated lateral compartmental OA knee (Kellgren-Lawrence grade 3-4), no significant patellofemoral pain, and range of motion (ROM) > 90 degrees. We excluded the inflammatory joint disease, unstable knee (femorotibial joint subluxation > 1 cm), and prior surgical procedure. Demographic data, pre- and postoperative ROM, radiographic outcomes, complications, and survivorship were recorded. Results: The mean age, body mass index, and preoperative ROM were 55.3 ± 4.0 years, 25.4 ± 3.7 kg/m2 and 113.3 ± 11.5 degrees, respectively. The preoperative mechanical femorotibial angle was 162.3 ± 4.8 degrees, and the final post-operative alignment was 182.3 ± 2.6 degrees. Overall mean operative time of this technique was 92.5 ± 26.7 minutes. During the mean follow-up period of 8.3 ± 3.1 years, all osteotomy were united and the final postoperative ROM was decreased to 108.8 ± 11.7 degrees. One knee required plate removal due to hardware irritation, and another knee required subsequent total knee arthroplasty at 1 and 8.5 years after MCW-DFVO, respectively. The survivorship of this technique was 91.7% at the mean survival time of 13.8 years (95% confidence interval, 11.9 – 15.7 years). Conclusion: This study proposed the modified surgical technique of MCW-DFVO via a lateral approach. This technique provided the excellent correction angle, union rate and survivorship.

Background: Legg-Calvé-Perthes disease is a significant topic in pediatric orthopedics due to its high incidence and often unclear prognosis. Both conservative and surgical treatments are widely practiced today, aiming primarily to contain the femoral head, reduce stress on the affected avascular zone, and minimize loss of sphericity of the femoral head. The aim of this study is to evaluate the clinical results in early age patients with Perthes disease which undergo femur osteotomy in a single institution. Materials and Methods: A retrospective study involving 81 hips in 79 patients was conducted at a single institution. Inclusion and exclusion criteria were set. Patients with a primary diagnosis of Legg-Calvé-Perthes disease were operated on – varus femoral osteotomy was done in all patients. The patients were classified using the Stulberg and Herring classifications, and were divided into three main groups depending on the disease severity preoperatively. Clinical and radiographic results were collected and analyzed. Results: Poor clinical outcomes (Stulberg III, IV, V) were observed in 47% of the patients. There was a direct correlation between the degree of poor outcomes and the age at onset of the disease. The average limb length discrepancy was 0.9 cm (range: 0.0–2 cm), with 23 patients having a discrepancy greater than 1 cm. Twelve patients required contralateral epiphysiodesis in the knee area to equalize limb length. Conclusions: Patients with Hering B and B/C, as well as Stulberg I and II stages over the age of six, have excellent outcomes following varus femoral osteotomy. Unsatisfactory and poor results are observed in patients with Hering and Stulberg IV and V grade hip joints. The early onset of the disease, as well as the lack of a unified treatment protocol, necessitate further and more in-depth studies in this area.

Background: Various fixation techniques have been described for the osteotomy for correction of cubitus Varus. K- wiring was used in the past for fixation. However rates of fixation failure and pin track infection were high. Fixation with two screws and a figure of eight wiring provides a stable fixation in children younger than 15 years. We used a modified lateral approach and figure of eight construct with two screws and evaluated the outcome of the results. Methods: 35 patients out of the total 54 patients who underwent modified French osteotomy between January 2013 to December 2021 were evaluated in a retrospective manner. Patients were evaluated using the modified Mayo elbow performance scoring system. Results: There were 22 males and 13 females in the study group. We had excellent result in 16 cases, good outcome in 13 cases and fair outcome in 6 of our cases. Superficial infection was seen in three patients and four patients had occasional negligible pain. There were no loss of correction and fixation failures in our study. Conclusion: Modified French osteotomy using Two screws and figure of eight wiring is a simple and safe procedure that gives excellent outcomes. A careful preoperative planning, careful surgical technique and stable fixation are key to achieve excellent and good functional outcomes. Key words: French osteotomy, Carrying angle, Cubitus Varus.

Abstract A short keel-cortex distance (KCD), especially to the posterior cortex, is a potential risk factor for tibial plateau fracture after Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). This study aimed to evaluate the effect of tibial component alignment in the coronal plane and tibial proximal morphology on the KCD. Included in this study were 51 patients scheduled for primary Oxford medial unicompartmental knee arthroplasty (UKA). The anterior and posterior KCD were preoperatively assessed using 3D simulation software with the component set perpendicular to the tibial mechanical axis (neutral), 3° valgus, 3° varus, and 6° varus, relative to neutral alignment. We evaluated the existence of overhanging medial tibial condyle where the medial eminence line, the line including the medial tibial eminence parallel to the tibial axis, passes outside of the tibial shaft. In all component alignments, patients with a medial overhanging condyle had significantly shorter posterior KCD than those without. In patients with a medial overhanging condyle, the posterior KCD significantly increased when the tibial component was placed in 3° varus (4.6 ± 1.5 mm, P = 0.003 vs neutral, P

Abstract Bone resection is highly valued in total knee arthroplasty (TKA), but how to determine the amount of distal femur resection is still controversial. The purpose of this study was to explore how to use lateral condyle as a reference for distal femoral osteotomy in TKA. Magnetic resonance imaging (MRI) and Radiographic images from 118 nonarthritic subjects and 123 osteoarthritis (OA) subjects were used to assess the cartilage wear pattern of the distal femur in varus knees. Measurements were performed on three-dimensional reconstruction after virtual bone cutting. The difference between the resection amount of distal (0°) and posterior (90°) was calculated when the medial condyle was used as a reference in OA patients. The osteotomy amount on lateral was calculated in nonarthritic subjects when the medial condylar osteotomy was consistent with the thickness of the implants. In 43% of OA patients, there was > 1 mm difference between the 0° and 90° in medial condyle cartilage, and no difference was observed in lateral. When using medial condyle as a reference for osteotomy, there was a difference of 1.3 ± 0.56 mm between the resection amount of 0° and 90°, and the difference was 0.24 ± 0.27 mm when using lateral condyle. Statistical analysis showed that there was a linear correlation between the resection amount of lateral condyle and mechanical lateral distal femoral angle (mLDFA) in nonarthritic subjects (r = 0.845, p

Corrective osteotomy for cubitus varus deformity can be approached both via triceps splitting approach as well as paratricipital approach. The aim of our study was to compare the functional outcome after triceps splitting and paratricepetal approach for corrective osteotomy in cubitus Varus deformities. None of the previous studies have compared the approaches head to head when dealing with osteotomy for cubitus varus deformities. This is a retrospective study done on cases operated between January 2001 and December 2015. A total of 40 patients presented with cubitus varus deformity. Exclusion criteria removed 10 patients from the study. Of the 40 patients, 22 patients had been operated with a triceps splitting approach while 18 patients had been operated with a paratricepetal approach. In all the cases stabilization was done using internal fixation. Postoperative immobilization consisted of above elbow slabs or cast for a duration of three weeks. The length of duration for which follow up was available for all the cases was two years. Retrospectively data was extracted. Morrey’s system of functional assessment of outcome had been primarily used by the surgeons to assess the outcomes. Other than this, an osteotomy that corrected the humeral – ulnar angle to less than 10 degrees of the contralateral side was considered a good result. Our final data consisted of 40 cases. All the twenty-two cases in group A were fully satisfied with cosmetic results, but one case in group B had complaints related to cosmetic appearance due to excessive lateral condylar prominence. In group A, there was no pain in seventeen, mild pain in three, moderate pain in two cases and none had severe pain. In group B, there was no pain in fifteen, mild pain in two, moderate pain in one case and none had severe pain. No case had instability in the coronal plane. Till date, neither triceps-splitting nor paratricepetal approach is considered superior to the other approach. Mostly, the experience of the surgeon and the type of fracture determine the preferred incision to be employed. As compared to triceps splitting approach, paratricepetal approach results in better functional outcomes, triceps strength, elbow ROM and less extension contracture in the final follow up.

Introduction:This study evaluated the effect of both postoperative residual varus alignment and the amount of correction in lower limb alignment (LLA) on postoperative functional outcomes of total knee arthroplasty TKAs in patients with preoperative varus deformity.Methods:Two-hundred and fifty-two knees of 209 patients who underwent a TKA for treating varus gonarthrosis were retrospectively reviewed in the study. Patients were then divided into the three groups according to the postoperative hip-knee-ankle angle (HKAA): the neutral group (NG) (HKAA: 183°-177°); the mild varus group (HKAA: 176.9°-174°); and the severe varus group (HKAA 10°). Pre- and post-operative functional outcomes were compared among the groups.Results:There were no significant differences in the postoperative Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale (VAS) scores between the mild and NGs (p=0.99, p=0.62, and p=0.33, respectively). The severe group showed lower postoperative KSS, WOMAC, and higher VAS scores compared to other two groups (p10° had higher WOMAC and lower VAS scores than the other patients (p=0.008 and p=0.002, respectively).Conclusion:Postoperative mild varus deformity is not associated with poorer clinical and functional outcomes; however, a postoperative severe varus deformity following TKA can cause a significant deterioration in postoperative clinical and functional outcomes in patients with preoperative varus osteoarthritis.

Abstract Objective We investigated the effect of disease stage, patient's age and final contour of femoral head on acetabulum contour following varus derotation osteotomy of proximal femur (VDRO) in unilateral Perthes's disease. Methods The study is a retrospective analysis of case records of 23 children aged ≥6 years with unilateral Perthes' disease who underwent primary VDRO procedure for containment. Acetabular index (AI) and center edge angle (CEA) were calculated bilaterally in preoperative and follow-up radiographs and compared statistically. Results There were 15 boys and 8 girls. Six hips were in Ib, 8 in IIa and 9 in IIb modified Waldenström stage while undergoing VDRO. The mean age at surgical intervention was 8.7 years. The mean follow-up duration was 3.5 years. All femoral heads were healed at final follow-up and the final Stulberg grades were I = 3, II = 8, III = 7, IV = 5. A significant acetabular dysplasia on the affected side was present preoperatively. At follow-up, the patients operated had significantly raised AI and reduced CEA. There was no significant acetabular remodeling of the affected hips at follow-up even in children operated at younger age (< 8 years) or early stages (stage Ib or IIa). The acetabulum remodeling did not correspond to the final Stulberg grade as well. Conclusion Acetabulum was found involved in early stages of Perthes' disease. Varus derotation femoral osteotomy for the diseased hip showed no significant improvement in acetabular dysplasia even when operated in early disease stages or younger age group. Residual acetabular changes were also noted even with favorable Stulberg grades.

Abstract HTO has proven to be a cost-effective surgical procedure in the treatment of KOA, but few investigations have studied radiological changes and clinical effectiveness of OWHTO in geriatric patients. 76 patients were recruited in this retrospective study. According to the age, patients were divided into two groups (≤ 60, Group “Young”; > 60, Group “Geriatric”). Demographic data, radiological imaging and postoperative complications were analyzed. Kellgren–Lawrence grade (K–L), weight-bearing line ratio (WBLR); posterior tibial slope angle (PTS); American knee score (AKS); Western Ontario and McMaster Universities Arthritis Index (WOMAC) and visual analog scale (VAS) were introduced to estimate the clinical outcome of OWHTO. There were 18 male and 58 female patients in the present study with a mean age of 58.5 ± 9.2 years (ranges from 40 to 82 years); the average age was 51.4 ± 4.1 years and 67.3 ± 4.9 years for group Y and G respectively, 44.7% and 31.5% patients were older than 60 and 65 years. BMI for the 76 patients was 26.6 ± 3.2 kg/m2, and geriatric patients were more likely accompanied by one or more comorbidities (70.6 vs. 45.2%). There were 34 and 42 patients in group Geriatric and group Young respectively, and no significant difference of MPTA, WBLR, PTS and WOMAC, VAS, AKS and ROM between the two group (P > 0.05) were found. After more than a two-year follow-up period, postoperative WBLR, AKS, WOMAC and VAS were much more desired than preoperative, and no significant difference of these variables between the young and geriatric group (P > 0.05), however, elderly patients were more likely to suffer from a longer bone union time. OWHTO can avoid geriatric patients from undergoing secondary knee surgery in the short term, however the survival rate of OWHTO in geriatric patients should be ultimately clarified by different studies.

Optimal ligament balance is crucial for successful total knee arthroplasty (TKA), which is a standard procedure for managing end-stage knee osteoarthritis. However, the reported values of ligament balance vary due to different methodologies and population differences, which requires further studies. This study aimed to investigate the varus-valgus ligament balance in healthy knees of Japanese individuals and its relationship with lower limb alignment. The studyanalyzed64 knees from 33 healthy young adults using stress radiographs to measure varus-valgus laxity. The mechanical hip-knee-ankle angle, medial proximal tibial angle, and lateral distal femoral angles were determined using digital long-leg radiographs. Varus and valgus laxities were compared, and the relationship between ligament balance and alignment parameters was analyzed. Mean varus laxity (3.6°± 1.3°) was significantly greater than mean valgus laxity(2.9°± 1.0°) (p

Materials and methods: A case of a child at the age of 1 year and 8 months with a secondary single-sided hallux varus has been treated at the University Hospital of Active Treatment in Orthopaedics “Prof. B. Boytchev.” The deformity if caused by two anomalies: polysyndactyly and the presence of a medially located, additional secondary ossification center of the first metatarsal bone. The diagnosis is clinical at time of birth and radiologic at the age of 1 year, when the ossification center is already visible. The operative treatment is a combined technique of the reconstructive methods of McElvenny and Farmer, with modification of the same accordingly to the specific case. The assessment of the postoperative results is on the basis of changes in the angle, formed by the longitudinal axes of the first proximal phalanx and the fifth metatarsal bone, and with a scale from 1 to 10 for grading the aesthetic and functional effect of the operation (according to the parents of the child). Results: The follow-up of the patient was carried out during the stay at the clinic, on the 2nd and 3rd week, on the 6th and 12th months post-operatively. A correction of the medial deviation of the toe was achieved. The angle between the proximal phalanx and the fifth metatarsal bone decreased from 66.7° to 12.5° on the 12th post-operative month. Conclusion: In the case described, the combined techniques of reconstruction of the toe are effective in correcting the angle of the deformation caused by the preaxial polysyndactyly. Our end result is similar to the results of other authors using the same operative techniques in different combinations and/or alone. We recommend that the operation should be performed at the age between 9 and 12 months with the combined techniques of McElvenny and Farmer.

Introduction: Legg-Calve-Perthes disease is a juvenile idiopathic aseptic, non-inflammatory, osteonecrosis of immature hip in which the blood supply of femoral epiphysis is not sufficient and the bone dies provisionally followed by a subchondral fracture, fragmentation, revascularization and remodeling. It is associated with both substantial hip pain and dysfunction during the disease process as well as later in adulthood. The goals of treatment are to decrease pain, reduce the loss of hip motion, and prevent or minimize permanent femoral head deformity. In the current study, authors evaluated the outcome of proximal femoral varus derotation osteotomy in children with Legg-Calve-Perthes disease. Material & Methods: All the children (up to 16 years) presenting with Perthes disease, of both sex and willing to get enrolled in the study and were managed by proximal femoral varus derotation osteotomy were included in the study. Evaluation were done in terms of clinical symptoms and signs, Harris hip score and radiologically with X-rays. Results: The study results indicated improvement in pain, limp, abduction, internal rotation and Harris Hip Score which was statistically significant in the study subjects. Conclusion: According to this study, proximal femoral varus derotation osteotomy is an acceptable method for management of patients with Legg-Calve-Perthes disease in all age group of patients. This surgery led to decrease in pain, limping, and increase in range of motion.

Proximal femoral osteotomies are one of the most commonly used surgical techniques and play an important role in the spatial correction of the hip joint in a number of pediatric orthopedic disorders such as Legg-Calve-Perthes disease, Slipped capital femoral epiphysis, Developmental dysplasia of the hip, osteoarthritis, etc.14,21,23,28,30,31 The development of orthopaedic osteosynthesis for fixation of bone fragments includes the use of Kirschner wires, intraosseous nail plates, AO-plates with fixed angle, external fixators, etc. Over time, many of the techniques and osteosynthesis materials have fallen into disuse and have remained only of historical significance. The purpose of this study is to follow how osteosynthesis fixation devices for varus osteotomies in the proximal femur have historically evolved and developed from the beginning to the present.

We present a 69-year-old male with osteoarthritis of a varus mechanically aligned left knee that developed delayed arterial thrombosis after primary total knee arthroplasty (TKA) requiring stenting and subsequent trans-metatarsal amputation. This case is unique since initial presentation involved neurologic instead of ischemic changes. We also performed a literature review of arterial injuries in primary TKA. This case highlights the importance of maintaining a high clinical suspicion for vascular insult in patients undergoing correction of varus malalignment with initial complaints of neurologic dysfunction.

Abstract The aim of this study is to investigate the association between the hip abduction angle (HAA) and lower limb alignment as well as the clinical assessments in open-wedge high tibial osteotomy (OWHTO) patients. A total of 90 patients who underwent OWHTO were included. The demographic characteristics and clinical assessments (the Visual Analogue Scale for activities of daily living, the Japanese knee osteoarthritis measure, the Knee injury and Osteoarthritis Outcome Score, the Knee Society score, the Timed Up & Go (TUG) test, the single standing (SLS) test and muscle strength) were recorded. The patients were divided into two groups according to the HAA at 1 month after operation: the HAA (−) group (HAA

Spondyloepiphysal dysplasia congenita (SEDc) is a rare autosomal dominant genetic disorder. Femoral head ossification delay and the proximal femur varus deformity i.e. coxa vara (CV) are the major features of SEDc. The accepted treatment is a valgus femoral osteotomy. The data on hip surgery in SEDc are scarce. In our database from 2006 to 2020, there were 6 SEDc patients. Four patients had surgery on 8 hips. Surgical treatment was indicated due to progressive CV deformity i.e. a decreasing neck-shaft angle (NSA), pain, limited hip abduction, and gait disturbances. In three patients, a novel surgical treatment was applied – a greater trochanter apo-physiodesis using “Eight-plate”. The patients were evaluated clinically and radiologically. The median age at first surgery was 6.3 years (range, 3.2 to 9.5 y) and the median follow-up period was 7 years (range, 5.6 to 14 y). The postoperative NSA was significantly improved with a mean increase of 13 degrees (P

Background. Arthrosis of the knee joint is one of the most common diseases in elderly patients with the varus deformity. One of the treatment methods is corrective osteotomy. Aims: optimization of the diagnosis of deformities in patients with gonarthrosis, improvement of the technique of operation and postoperative control of the main reference lines and angles, assessment of the correction results, analysis of complications. Methods. A retrospective clinical study was conducted. 39 patients were observed, in whom 78 operations were performed on both legs simultaneously. In all the cases, tibia osteotomies and osteosynthesis with the Ilizarov apparatus were used. All the patients underwent an X-ray study of the legs along the entire length with the identification of the main reference lines and angles. Results. In all the cases, it was possible to normalize the position of the mechanical axis and the angle of orientation of the knee joint. After the surgery, the wounds were not sutured to prevent compartment syndrome. The correction was performed in a single-stage manner in elderly patients, gradually in young patients. The period of fixation with the Ilizarov apparatus was 16.6 3.1 weeks. Conclusions. The Ilizarov method has significant advantages: low invasiveness, stable fixation, absence of foreign bodies to the end of treatment. This allows us to recommend it for a wider use in patients with gonarthrosis and varus deformity.

Background and objective: Perthes disease is a condition in which a self-limiting avascular problem affects the capital epiphysis of the femur with a variable course and outcomes. There are patients who definitely benefit from different treatment courses, either surgical or non-surgical, but better with surgical. This study aimed is to determine the outcome of varus derotational osteotomy procedure in the management of Perthes disease. Methods: In this retrospective study, which was conducted in the orthopedic department of Erbil teaching hospital, 21 patients (22 hips) with Perthes` disease were enrolled over the period of 10- years, from 2008 to 2018. Varus derotational osteotomy to proximal femur was done for all 22 hips affected by Perthes disease in different radiological stages. Results: Among the patients, 81.0% were males and right side of the hip was the most predominant (52.4%) affected side. Partial limitation of hip movements with +ve Trendelenburg sign were the main clinical findings (52.4%), especially among those aged ≤8 years, males and left side affected patients (54.5%, 72.7%, and 63.6%, respectively). Subluxation and metaphyseal resorption were the main radiological findings of the head of the femur (36.4% and 31.8%, respectively). Radiological stages of the patients mainly showed early fragmentation, late fragmentation, and early healing stages (27.3%, 27.3%, and 22.7%, respectively). Postoperatively, 59.0% of the patients had a good prognosis (Stulberg grades 1 and 2), while 31.9% had a fair prognosis. Those aged ≤8 years had a better prognosis with a significant statistical association between Stulberg classification and those with lateral pillar B & B/C and early three radiological stages (P = 0.01 and 0.005). Conclusion: Open wedge varus femoral osteotomy is the treatment of choice and gives good results. The strongest predictor of outcomes is Stulberg classification in relation to age, lateral pillar classification, and preoperative radiological stages of the disease.

Introduction: Lateral closing wedge osteotomy is an accepted correction method for cubitus varus deformity. The techniques used to fix the osteotomy mostly lead to either angulation or loss of correction during the final tightening of the Stainless Steel (SS) wire at the osteotomy site. The records for patients undergoing two modifications in a conventional modified French Osteotomy were analysed. Four wires, two proximal and two distal to the osteotomy site for precision and guided compression over the other additional Kirschner wire (K-wire) at the osteotomy site, were the two modifications in these patients. Aim: To analyse the functional outcome of cubitus varus deformity in children treated with technical modifications of modified French osteotomy. Materials and Methods: This was a retrospective cohort study done at the Department of Orthopaedics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. The study duration was three years (from April 2019 to April 2022). A total of 34 cubitus varus deformity patients were included in this study who were operated with lateral closing wedge-modified French osteotomy with technical modification by K-wires. The patients were followed-up for a minimum of six months. The results were analysed using Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Flynn’s criteria. Statistical Package for the Social Sciences (SPSS) version 21.0 was used and p-value

Abstract Magnetic resonance imaging (MRI) is commonly used to assess traumatic and non-traumatic conditions of the knee. Due to its complex and variable anatomy, the posterolateral corner (PLC)—often referred to as the joint’s dark side—remains diagnostically challenging. We aimed to render the diagnostic evaluation of the PLC more functional by combining MRI, varus loading, and image post-processing in a model of graded PLC injury that used sequential transections of the lateral collateral ligament, popliteus tendon, popliteofibular ligament, and anterior cruciate ligament. Ten human cadaveric knee joint specimens underwent imaging in each condition as above, and both unloaded and loaded using an MR-compatible device that standardized loading (of 147 N) and position (at 30° flexion). Following manual segmentation, 3D joint models were used to computationally measure lateral joint space opening for each specimen, configuration, and condition, while manual measurements provided the reference standard. With more extensive ligament deficiency and loading, lateral joint spaces increased significantly. In conclusion, varus stress MRI allows comprehensive PLC evaluation concerning structural integrity and associated functional capacity. Beyond providing normative values of lateral compartment opening, this study has potential implications for diagnostic and surgical decision-making and treatment monitoring in PLC injuries.

An important causative factor in osteoarthritis (OA) is the abnormal mechanical stress-induced bone remodeling of the subchondral bone. β2-adrenergic receptor (Adrb2) plays a major role in mechanical stresses that induce bone remodeling. The medial tibial plateau (MTP) and lateral tibial plateau (LTP) of patients with varus Knee osteoarthritis (KO) bear different mechanical stresses. The present study aimed to investigate the expression of Adrb2 in medial tibial plateau subchondral bone (MTPSB) and lateral tibial plateau subchondral bone (LTPSB) in patients with varus KO. A total of 30 tibial plateau samples from patients undergoing total knee arthroplasty for varus KO and MTPSB and LTPSB were studied. Statistical analysis was performed using paired sample t-tests. Safranin O-Fast Green staining and Micro-computed tomography showed significant differences in the bone structure between MTPSB and LTPSB. Tartrate-resistant acid phosphatase (TRAP)-positive cell density in MTPSB was higher than that in LTPSB. Immunohistochemistry, reverse transcription-quantitative polymerase chain reaction, and Western blot analysis revealed that compared to LTPSB, the levels of Adrb2, tyrosine hydroxylase (TH), and osteocalcin increased significantly in MTPSB. Double-labeling immunofluorescence showed Adrb2 was present in the majority of TRAP-positive multinuclear cells of the MTPSB. The expression of Adrb2 and TH was significantly higher in MTPSB than in LTPSB, confirming the involvement of these molecules in the development of OA.

Abstract Cubitus varus deformity is the most common late complication of malunited supracondylar fracture that requires corrective osteotomy and fixation. From 2009 to 2017, 40 consecutive patients with cubitus varus deformity were included. Twenty patients underwent the conventional closing-wedge osteotomy (conventional group), while the other twenty patients underwent the 3D-printed model and osteotomy template osteotomy (3D-printed template group). The functional outcome was evaluated using the Mayo Elbow Performance Index (MEPI) Score and Flynn criteria. There were no statistically significant differences were observed regarding the humerus-elbow-wrist angle and tilting angle between the two groups, both preoperatively and postoperatively at 24 months. No statistically significant differences were observed regarding the elbow ROM (127.0 ± 4.7° VS 128.9 ± 3.8°) and MEPI score (93.5 ± 3.3 VS 94.3 ± 4.1) between the groups. All patients were satisfied both cosmetically and functionally as per the Flynn criteria and MEPI score. The conventional osteotomy and 3D-printed model and osteotomy template techniques both met the treatment requirements of cubitus varus deformity. The 3D-printed template technique showed better osteotomy accuracy, but no significant advantage regarding the functional and cosmetic results than conventional osteotomy.

Introduction/Objective. The aim of this paper was to examine proportion of patients with arterial abnormalities of feet due to age and severity degree of pes metatarsus varus (PMV), and to evaluate the treatment duration and outcome. Methods. The prospective longitudinal study included 240 patients with congenital PMV classified into three age groups: group < 3 months of life (Group 1), group 3–9 months (Group 2), and group 9–12 months (Group 3). Three categories of PMV were analyzed: mild/moderate/severe. Groups with arterial anomalies (Group A) and without (Group B) were analyzed. Clinical outcome was graded as: good/satisfactory/poor. Results. There is statistically significant difference in distribution of children regarding age and severity degree on first visit and presence of feet arterial abnormalities (p < 0.01). For Group A, younger children had longer physical therapy, while for Group B, older children had longer duration of physical therapy. Same trend applies as severity degree of foot deformity increase. In Group A, the most frequent treatment outcome was poor (for Group 1 – 46.7%; Group 2 – 60%; Group 3 – 62%), while in Group B for Group 1 and Group 2 it was frequently good (Group 1 – 90%; Group 2 – 40%), and for Group 3 frequently satisfactory (Group 3 – 53.3%). Conclusion. In children with PMV it might be advisable to perform ultrasound evaluation of arterial structure of feet, and particularly in cases were such deformity is more severe.

Objective: To determine the angulation of the distal femoral axis - femoral mechanical axis and the coronal femoral bowing in varus OA knees. This information is necessar, because the routine distal femoral valgus cut can potentially lead to error in post-operative alignment. Methods: Hip to ankle standing radiographs were ordered in 160 varus OA patients (200 limbs). The mean age of the patients was 63.8 years. In addition, 50 limbs of young volunteers with an average age of 28.8 years, were also studied for comparison. The distal femoral axis-femoral mechanical axis angle, femoral bow, and other angles were determined and compared between two groups. Results: Mean distal femoral axis-mechanical axis angle was 7.0o ± 1.5o and mean femoral bow was 2.4o ± 2.6o in patients compared to 5.7o ± 0.5o and 0.3o ± 0.5o respectively, in controls. The varus deformity significantly correlated with femoral bowing. Thirty-five (17.5 percent) of OA limbs showed a distal femoral axis-mechanical axis angle of more than 9o and there were 42 OA limbs (21%) that had significant (> 3o) femoral bowing. Conclusion: These findings have implications in deciding the optimum valgus angle at which to perform distal femoral resection during TKA in varus OA knee.

Background: Proximal humerus shortening and varus can occur secondary to neonatal shoulder septic arthritis and focal fibrocartilage dysplasia. Valgus osteotomy of the proximal humerus compensates for a little bite of shortening, and improves the shoulder joint's range of motion. Case Report: In this study, we present two patients with severe proximal humerus deformity following glenohumeral septic arthritis. Both of them underwent valgus osteotomy, and had a satisfactory result in terms of range of motions and cosmesis at five years follow-up. Conclusion: Treatment of varus deformity of proximal humerus is challenging issue. There are few reports of surgical treatment. Sever varus deformity of proximal humerus impacts the motion of shoulder. We reported a novel method of valgus osteotomy of proximal humerus in patients with severe varus deformity secondary to neonatal septic arthritis and long-term clinical follow-up.

Background and Objective: Genu varus is a deformity in frontal plane that in weight bearing position whiles the medial malleolus’s touch each other, the medial knee epicondyles far from each other. Genu varus is very prevalent in soccer players. This study was done to evaluate the effect of using knee brace and lateral wedge on muscular activity amplitude in male soccer players with genu varus during running. Methods: This quasi-experimental study was done on 15 right-footed male soccer players with genu varus and 15 healthy soccer players. A wireless electromyography system with eight pairs of bipolar Ag/AgCl surface electrodes (20 mm center-to-center distance; input impedance of 100 MΩ; and common-mode rejection ratio of >110 dB) was used to record the activity of the tibialis anterior, gastrocnemius medialis, biceps femoris, semitendinosus, vastus lateralis, vastus medialis, and rectus femoris, and gluteus medius muscles of the right leg. Electromyography data were recorded by sampling rate of 1000 Hz in selected muscles during running at five conditions including: control, 10 degrees lateral wedge, 15 degrees lateral wedge, simultaneous using 30 degrees brace and 10 degrees lateral wedge, and simultaneous using 30 degree brace and 15 degrees lateral wedge. Results: Treatment intervention had reduction effect on muscular amplitude of biceps femoris and vastus lateralis during push-off phase (P

Abstract The present study aimed to quantify and visualize the degenerative patterns of the distal tibia and fibula due to ankle osteoarthritis (OA). We analyzed differences in tibial and fibular surface deviation between sides of patients with unilateral varus ankle OA (medial talar tilt > 4°) by registering each surface model to the mirror image of corresponding bone. Computed tomography images of both feet of 33 patients (OA: 22, control: 11) were examined. Statistically significant surface depression of approximately 2.5 mm on the anterior articular surface of the medial malleolus, and surface elevation of approximately 1 mm on the anterodistal edge of the tibiofibular joint and the lateral malleolus were observed in OA patients. These bone degenerations were found to be correlated with those on the other side of the ankle joint, the medial margin of the talar trochlea and the lateral articular surface of the talus, respectively. In contrast, the amount of bone depression on the plafond was smaller than previously anticipated. Such quantitative information about stereotypical patterns of bone degeneration in ankle OA would contribute to better understanding of the development of ankle OA and possible therapeutic interventions.

Background and Objective: Genu varus deformity is associated with changes of lower limb muscle co-contraction and running economy. This study was done to evaluate the effect of using of brace in three different knee flexion angles on running economy and lower limb muscular co-contraction in individuals with genu varus. Methods: This quasi-experimental study was done on active soccer male students including 15 healthy subjects (average age of 22.86±1.55 years) and 15 subjects with genu varus (average age of 22.13±1.80 years). The amount of electrical activity of the muscles (tibialis anterior, medial gastrocnemius, vastus medialis, vastus lateralis, rectus femoris, biceps femoris, semi-tendinosus) were recorded by electromyography system during four conditions of with and without using knee brace. After that, directed and general co-contraction was computed during running. The angles of brace were 15, 30, and 60 degrees. The values of VO2 max were recorded using of gas analyzer system to compute running economy. Results: The ratio of respiratory exchange was significantly more in the genu varus group than healthy group (P

Abstract For pre-operative osteoarthritis (OA) patients with varus knee, previous studies showed inconsistent results. Therefore, we conducted this study to better identify the association of Hospital for Special Surgery (HSS) score and mechanical alignment. 44 patients (51 knees) with constitutional varus knee caused by combined deformities (LDFA (lateral distal femoral angle) > 90°and MPTA (medial proximal tibial angle)

The “risotto phenomenon” is a rare pathologic finding, mostly seen as a nonspecific response to chronic inflammation around the shoulder joint- subacromial and subdeltoid bursitis, rheumatoid arthritis, sero-negative inflammatory arthritis, septic arthritis and tuberculous arthritis. A few scientific reports associate rice body formation with the use of different type of osteosynthesis, bony anchors and bioabsorbable sutures. They are usually an incidental asymptomatic finding, requiring no specific treatment, but could be symptomatic demanding surgical excision. We present the clinical case of a 17-year- old female patient with a “risotto bursitis” of the great trochanter bursa, documented during planned surgical removal of a locking compression plate after proximal femoral varus osteotomy for bilateral developmental dysplasia of the hip treatment.

Introduction: The use of treadmills and sports equipment is on the rise due to long stay at home because of the progression of Coronavirus Disease (COVID-19), and hence, tendency of individuals to exercise at home. Common movement patterns in non-contact anterior cruciate ligament (ACL) injuries include decreased knee flexion accompanied by increased knee valgus angles. Therefore, the aim of this study is to investigate the maximum angles of knee varus and flexion when walking on positive, negative, and zero treadmill inclinations.Materials and Methods: 29 subjects within the age range of 18-28 years were selected and divided into two groups of healthy (weight: 58.95 ± 8.58, height: 163.14 ± 3.95, intermalleolar distance: 0.46 ± 0.40) and genu valgum (weight: 61.60 ± 5.56, height: 161.80 ± 5.50, intermalleolar distance: 6.95 ± 2.51). The parameters of maximum angles of knee varus and flexion when walking on -10, zero, +10% treadmill inclinations were calculated using three-dimensional motion analysis system. The data were processed in Cortex and MATLAB softwares and analyzed using mixed repeated measure at the significant level of P < 0.050.Results: The results of this study showed that the highest values of maximum angles of knee varus and flexion were observed at -10% inclination. In addition, the maximum varus angle did not differ significantly between the positive and zero inclinations, but the maximum flexion angle showed a significant difference between these two inclinations.Conclusion: Since walking on negative inclinations inclines the knee angle in the frontal plane toward the varus and increases the flexion angle and decreases the load exerted on the ACL, this type of walking can be more effective in rehabilitating people with genu valgum.

Objective To compare the effect of stable supportive to flat flexible walking shoes on medial tibiofemoral contact force (MTCF) in people with medial knee osteoarthritis and varus malalignment. Design This was a randomized cross-over study. Twenty-eight participants aged ≥50 years with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional full-body motion, ground reaction forces and surface electromyograms from twelve lower-limb muscles were acquired during six speed-matched walking trials for flat flexible and stable supportive shoes, tested in random order. An electromyogram-informed neuromusculoskeletal model with subject-specific geometry estimated bodyweight (BW) normalized MTCF. Waveforms were analyzed using statistical parametric mapping with a repeated measures analysis of variance model. Peak MTCF, MTCF impulse and MTCF loading rates (discrete outcomes) were evaluated using a repeated measures multivariate analysis of variance model. Results Statistical parametric mapping showed lower MTCF in stable supportive compared to flat flexible shoes during 5–18% of stance phase (p = 0.001). For the discrete outcomes, peak MTCF and MTCF impulse were not different between the shoe styles. However, mean differences [95%CI] in loading impulse (-0.02 BW·s [-0.02, 0.01], pConclusions Stable supportive shoes reduced MTCF during loading stance and reduced loading impulse/rates compared to flat flexible shoes and therefore may be more suitable in people with medial knee osteoarthritis and varus malalignment. Trial registration Australian and New Zealand Clinical Trials Registry (12619000622101).

BackgroundGenu varus (GV) is a common deformity characterized by leg bending, which seriously threatens human health. At present, there is no definite conclusion to explain the cause of genu varus. The purpose of this study is to systematically review and meta-analysis the effectiveness and scientific basis of the clinical efficacy of customized orthopedic insoles on genu varus and hope to provide a reference for future research in this field.MethodsThe following electronic databases will be searched from inception to January 2022: Pubmed, Cochrane Library, MEDLINE, EMBASE, Web of Science, Weipu, Wanfang Data, and CNKI. Randomized controlled trials (RCTs) were collected to examine the effect of lateral wedge-shaped orthopedic insole on patients with genu varus. We will consider inclusion, select high-quality articles for data extraction and analysis, and summarize the intervention effect of lateral wedge orthotic insoles on patients with genu varus. Two reviewers will screen titles, abstracts, and full texts independently according to inclusion criteria; Data extraction and risk of bias assessment were performed in the included studies. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X8 will be applied in selecting the study, Review Manager 5.3 will be applied in analyzing and synthesizing.ResultsThe results will provide evidence for judging the effect of lateral wedge-shaped orthopedic insole on patients with genu varus.ConclusionOur study will provide reliable evidence for the effect of lateral wedge-shaped orthopedic insole on patients with genu varus.Trail registrationINPLASY registration number: INPLASY202190002 https://www.google.com/search?client=firefox-b-d&q=INPLASY202190002.

Background Previous investigations on valgus knee bracing have mostly used the external knee adduction moment. This is a critical limitation, as the external knee adduction moment does not account for muscle forces that contribute substantially to the medial tibiofemoral contact force (MTCF) during walking. The aims of this pilot study were to: 1) determine the effect of a valgus knee brace on MTCF; 2) determine whether the effect is more pronounced after 8 weeks of brace use; 3) assess the feasibility of an 8-week brace intervention. Methods Participants with medial radiographic knee OA and varus malalignment were fitted with an Össur Unloader One© brace. Participants were instructed to wear the brace for 8 weeks. The MTCF was estimated via an electromyogram-assisted neuromuscular model with and without the knee brace at week 0 and week 8. Feasibility outcomes included change in symptoms, quality of life, confidence, acceptability, adherence and adverse events. Results Of the 30 (60% male) participants enrolled, 28 (93%) completed 8-week outcome assessments. There was a main effect of the brace (pConclusion Although significant, reductions in the peak MTCF and MTCF while wearing the knee brace were small. No effect of time on MTCF was observed. Although there were numerous minor adverse events, feasibility outcomes were generally favourable. Trial registration Australian and New Zealand Clinical Trials Registry (12619000622101).

Background: We aimed to better understand the outcomes/complications of pie-crusting technique using blade knife during total knee arthroplasty (TKA) in patients with knee genu varum deformity. Materials and Methods: A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. English and Persian language articles were considered on the use of pie-crusting technique during TKA in patients with knee genu varum/varus deformity using related keywords and Medical Subject Headings terms with reported postoperative complications and outcomes. Results: Primary search resulted in 81 studies of them 9 included in our study (ages ranged: 19 years to 62 years). No perioperative complications and/or any significant differences between pie-crusting and control group were observed. Except for two studies that found no significant positive effect for the use of pie-crusting, other studies found pie-crusting a useful and promising technique. Four studies found significant improvement in pie-crusting group compared to control in terms of functional Knee Society Score (KSS), range of motion (ROM), medial gap, and the knee-specific KKS. Three records found no significant differences in terms of functional KSS, ROM; however, they reported fewer use of constrained inserts or a reasonable correction of femoral tibial angle. No serious complications were reported. Conclusions: Due to the inconsistency of the results on the efficiency and outcomes of pie-crusting, we cannot make a firm conclusion and more high-quality studies are needed in this regard. However, this method can be considered as a safe method which depends on the skill of surgeon.

Background: The cubitus varus is the most common long term complication of the supra-condylar fractures of the humerus in children .Though the deformity is considered to be more of cosmetic in nature, recent studies have also described an associated morbidity .In the past the incidence of the cubitus varus following the supra condylar fractures ranged from 9% to 58%.However with the use of the modern methods of management of the fractures, the incidence has decreased. Several methods of correction of the cubitus varus have been in vogue. They differ mostly in their approach and the methods of fixation. Objective: To evaluate the modified French osteotomy technique. Methods: 14 patients in the age group of 7 and 23 were operated for correction of cubitus varus deformity, at a primary orthopedic care hospital in rural Telangana and followed up for mean period 2.4 years. We used a slight modification of the modified French technique and found it to be of advantage in our series. Results: Our results were graded as per the functional grading used by Bellimore.79% of our patients showed excellent results. Our results compare favorably with the results from the other series. Conclusion: The modified French osteotomy is simple safest and most stable osteotomy which can be performed by orthopedic surgeons with the basic knowledge of the patho-anatomy and biomechanics of the deformity, with favorable and comparable results.

Le pied bot varus équin (PBVE) invétéré est une attitude vicieuse du pied qui ne repose plus sur le sol par ses points d'appui normaux mais par son bord externe et sa pointe. Lorsque cette attitude vicieuse persiste longtemps, elle évolue vers des déformations ostéoarticulaires importantes à l'âge adulte. Le PBVE fixé constitue une bonne indication d'arthrodèse tibio-calcanéenne. Celle-ci permet dans la majorité des cas d'obtenir un appui plantigrade indolore et stable. Le but de ce travail est d'évaluer les résultats cliniques et radiologiques de l'astragalectomie avec adhèse tibiocalcanéenne. Nous rapportons une série de 3 cas d'arthrodèse tibio-calcanéenne pour déformation grave de l'arrière-pied associant un varus et un équin important et gênant chez l'adulte. Les résultats étaient jugés satisfaisants avec un appui plantigrade indolore et stable. Avec fusion de l'arthrodèse a 90 jours, sans inégalité pour le cas bilatéral et un raccourcissement de 2cm compensé par une semelle a droite pour le cas unilatéral. Dans les déformations importantes et fixées de la cheville et du PBVE, l'arthrodèse tibio-calcanéenne permet dans la majorité des cas d'obtenir un appui plantigrade indolore et stable sans risque vasculaire, ni cutané.

Background: The cubitus varus deformity is one of the most common late complications of fracture supracondylar area of humerus in children. Various corrective osteotomies are used of which lateral closed wedge osteotomy is commonly done which has its own disadvantages like lateral condylar prominence, difficulty in achieving correction and limitation of movement. Dome osteotomy is a versatile technique to achieve correction of deformity in all planes and to overcome these above complications. The aim of this study was to evaluate the results of dome osteotomy for correction of post-traumatic cubitus varus deformity of elbow in children. Materials and Methods: The study included 18 children between 6-13 years of age of both sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity. After appropriate pre- operative assessment, dome osteotomy was done by posterior approach. In pre and post operative x-ray carrying angle and lateral condylar prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated. Results: In this study of 18 patients, 12 were males and 6 were females. The age ranged from 6-13 yrs with average of 8.4yrs. The average correction of carrying angle was from -22.4 degree to +10 degree. LCPI changed post operatively ranging from -8.6% to +3.25%, average -2.9%. There were no significant complications. Fifteen patients had excellent outcome and 3 had good outcome. Conclusion: The results in our study concluded that dome osteotomy for cubitus varus is safe and effective method and give cosmetically more acceptable elbow.