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BACKGROUND: In recent years, with the development of 3D printing, surgical surgery has become personalized and accurate. 3D printed guide template technique can realize preoperative planning and intraoperative navigation, making surgery more accurate. In clinical orthopedic surgery for moderate and severe stiff scoliosis, there is still a problem that the accuracy of screw placement is not high, resulting in screw loosening and even nerve complications. There are few studies on 3D printed guide template technique to guide screw placement in surgery for severe stiff scoliosis. OBJECTIVE: To evaluate the clinical effect of the 3D printed guide template technique combined with multiple posterior derotation in the treatment of severe rigid scoliosis. METHODS: The clinical data of six patients with severe scoliosis undergoing 3D printed guide template technique of pedicle screw combined with multiple posterior derotation were retrospectively analyzed. There were 3 males and 3 females, with a mean age of (18.17±3.49) years (range, 15-23 years). The changes of parameters related to lateral bending were analyzed at postoperative 2 weeks and 18 months, and the results were obtained by statistical analysis. RESULTS AND CONCLUSION: (1) The operation time was 280-540 minutes (mean 340.83±102.20 minutes). The intraoperative blood loss was 1 000-4 000 mL (mean 2 000.00±1 073.70 mL). The fixed segments were 9-14 vertebral bodies (mean 11.83±1.72), and no screw loosening occurred during the operation. (2) All patients were followed up. At postoperative 2 weeks, the anteroposterior and lateral radiography of the whole spine showed that the cobb angle, the distance between the vertical line of C7 on the coronal plane and the median line of S1, the distance between the vertical line of C7 in the sagittal plane and the posterior edge of S1, apical vertebral translation, thoracic kyphosis, and lumbar lordosis were significantly corrected. The average correction rate of the cobb angle in the main curve was 62.22%. After 18 months of follow-up, there was no significant change in all parameters compared with 2 weeks after operation; the orthopedic effect was satisfactory, and there was no infection or internal fixation fracture. (3) There was one case of delayed wound healing; scar healing appeared after dressing change treatment; no neurological complications occurred. (4) The results show that the 3D print-guide template combined with multiple posterior rod derotation technique is safe and effective in the treatment of severe rigid scoliosis, and the correction effect is satisfactory. [ABSTRACT FROM AUTHOR]

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Background. Congenital radioulnar synostosis (CRUS) may have a negative impact on the function of the upper limb and cause disability. The main aim of the surgical treatment is to correct the forearm position for diminishing functional limitations. The study aimed to analyze the variety of surgical methods for correction of the pronation forearm deformity in children with congenital radioulnar synostosis based on the literature data. Methods. We have searched publications in eLIBRARY, PubMed (MEDLINE), Ovid, ScienceDirect, Google Scholar databases. The analysis has included the age at surgery, indications for surgery, the target functional forearm position, the time of consolidation of the forearm bones, the frequency of neurovascular complications. Results. Most authors considered subjective complaints as the main indication for surgical treatment, while some researchers recommended taking into account the forearm hyperpronation position. The median age of the surgical treatment was 5.17 years (3.25-9.46). The medians of the recommended forearm positions for unilateral CRUS were 0-10 of pronation for the dominant, and 0-12.5 of supination for the non-dominant limb; with bilateral cases 0-17.5 pronation for the dominant and 0-12 supination for the non-dominant limb. Median of the osteotomy consolidation time varied from 6 to 8 weeks. The maximal time of forearm bone consolidation was significantly higher (p = 0.024) in the group with osteotomies through the synostosis site. Though the target forearm position was achieved in all cases, the number of complications in the proximal osteotomy group was statistically significantly different (p0.01). The chances of neurovascular complications were 20.5 times higher in the group of patients who underwent osteotomy through the synostosis (95% CI: 2.7-155.6). Conclusions. The problem of surgical treatment of children with CRUS in the world medical practice remains relevant despite the wide range of proposed methods. The development of an algorithm regarding the need for surgical treatment and its methodology requires further high-quality research.

The aim of this study was to analyze a novel digital technique to quantify the distal tooth displacement and derotation angle produced by the Carriere Motion Appliance (CMA). Twenty-one patients with a class II molar and canine relationship underwent orthodontic treatment with CMA. All patients were exposed before (STL1) and after the CMA placement (STL2), submitted to a digital impression, and afterwards, data were uploaded to specific cephalometric software to allow automatic mesh network alignment of the STL digital files. Subsequently, the distal tooth displacement of the upper canines and first upper molars, as well as the derotation angle of the first upper molars were analyzed using the Pearson correlation coefficient (ρ). Repeatability and reproducibility were analyzed using Gage R&R statistical analysis. An increase in canine displacement was correlated with an increase in contralateral canine displacement (ρ = 0.759; p < 0.000). An increase in canine displacement was correlated with an increase in molar displacement (ρ = 0.715; p < 0.001). An increase in upper first molar displacement was correlated with an increase in the contralateral upper first molar displacement (ρ = 0.609; p < 0.003) and the canine displacement (ρ = 0.728; p < 0.001). The distal tooth displacement showed a repeatability of 0.62% and reproducibility of 7.49%, and the derotation angle showed a repeatability of 0.30% and reproducibility of 0.12%. The novel digital measurement technique is a reproducible, repeatable, and accurate method for quantifying the distal tooth displacement of the upper canine and first upper molar, as well as the derotation angle of the first upper molars after using CMA. [ABSTRACT FROM AUTHOR]

Purpose: Hybrid constructs with sublaminar bands have recently regained popularity as an alternative to all-screw construct for correction of adolescent idiopathic scoliosis (AIS). The aim of this study is to evaluate the ability of hybrid constructs with sublaminar bands to achieve a tridimensional correction of the scoliotic deformity. Our hypothesis is that hybrid construct with sublaminar bands are able to achieve a substantial derotation of the apical vertebrae, while preserving the thoracic kyphosis. Methods: A prospective evaluation of 50 consecutive cases (41 F, 9 M, mean age 14.7 ± 2 years) of AIS correction with hybrid construct was performed. In all cases, sublaminar bands were used at the apex of the main curve on concave side. All patients underwent pre and postoperative X-rays with EOS System, with full 3D reconstruction. Spinopelvic parameters and axial rotation of the vertebrae were measured pre and postoperatively. Results: 2.7 ± 0.9 mean sublaminar bands were used per patient. Mean correction of deformity was 50 ± 9.5%. on the coronal plane. The mean axial rotation of the apical vertebra went from 18° ± 11.5° preoperatively to 9.4° ± 7.2° postoperatively (p < 0.001) with a mean derotation of 47.7%. Thoracic kyphosis went from 32.1° ± 18° preoperatively to 37.3° ± 13.1° postoperatively (p < 0.05). No intraoperative complications due to sublaminar bands were recorded. Conclusions: Hybrid construct with sublaminar band have been showed to be safe and effective in deformity correction and in maintaining or restoring thoracic kyphosis. This study showed that with sublaminar bands applied at the curve apex a substantial derotation of the apical vertebrae can be achieved. [ABSTRACT FROM AUTHOR]

Background: Dental anomalies usually lead to complicated decisions having to be made in terms of the orthodontic treatment of permanent dentition; tooth rotation is the most common of these irregularities. The prevalence rate of this phenomenon is 2.1–5.1% in patients who have not received orthodontic treatment. Purpose: This case report aimed to manage the complete bilateral rotation of maxillary canines with couple force by using a Nance appliance modification. Case: A 17-year-old male patient came in wanting to straighten his teeth. He complained about his bilateral canines, which were not in a normal position. There was an impacted left maxillary second premolar and an ectopically erupted right maxillary first premolar. He also had protrusions in the upper and lower anterior teeth and crowding in the lower anterior teeth as well as upper and lower midline deviations. Case Management: A clinical examination showed a class I relationship between the dental and cephalometry measurements and highlighted a class I skeletal pattern. The upper right first premolar was extracted and the left second premolar had undergone an odontectomy to allay protrusion and correct crowding. Bilaterally rotated upper canines were derotated using a modified Nance appliance and an elastomeric chain with couple force. Conclusion: The success of the orthodontic treatment was influenced by the specific nature of the patient’s dental and medical history, extraoral and intraoral examination, diagnosis and treatment planning, which was followed by a systematic approach to treatment. The Nance appliance modification reduced the total treatment time by achieving controlled anchorage and derotation of the canines.

Torsional deformities of the lower limb are common in children with cerebral palsy (CP)-determining gait problems. The mechanisms underlying transverse plane gait deviations arise from a combination of dynamic and static factors. The dynamic elements may be due to spasticity, contractures and muscle imbalances, while the static ones may result from excessive femoral anteversion, which decreases the efficiency of the hip abductors by reducing the muscular lever arms. A therapeutic approach has been identified in multi-level functional surgery for the lower limb. Treating the malalignments of the lower limb with femoral or tibial derotation provides optimal results, especially when supported by adequate biomechanical planning. This planning requires an integrated static-dynamic approach of morphological and functional evaluation, based on radiological measurements, physical examination and gait analysis. Instrumented gait analysis has been confirmed as essential in the evaluation and surgical decision making process for children affected by CP with transverse plane deformities. Computational simulations based on musculoskeletal models that integrate patient-specific CT morphological data into gait analysis can be used for the implementation of a surgical simulation system in pre-operative planning to test the possible effects of the different surgical treatment options on the torsional defects of the lower limbs. Recently, a computer-aided simulation process has been implemented in the preoperative planning of complex osteotomies for limb deformities in children. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software. The aim of this study is to integrate the patient-specific CT musculoskeletal model with morphological data and gait analysis data, with the personalized calculation of kinematic and kinetic parameters, which allow us to generate an "avatar" of the patient for a more in-depth evaluation of the gait abnormalities. The computational simulation platform proposed provides a realistic movable musculoskeletal model in a virtual environment, with the possibility of planning and monitoring the effects of virtual three-dimensional surgical corrections. [ABSTRACT FROM AUTHOR]

Introduction: Despite the fact that osteotomies around the knee represent well-established treatment options for the redistribution of loads and forces within and around the knee joint, unforeseen effects of these osteotomies on the remaining planes and adjacent joints are still to be defined. It was, therefore, the aim of this study to determine the influence of a distal femoral rotation osteotomy on the coronal limb alignment and on the ischiofemoral space of the hip joint. Materials and methods: Long-leg standing radiographs and CT-based torsional measurements of 27 patients undergoing supracondylar rotational osteotomies of the femur between 2012 and 2019 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy site. The hip–knee–ankle angle (HKA), the mechanical lateral distal femur angle (mLDFA), and the ischiofemoral space were measured. Comparison between means was performed using the Wilcoxon–Mann–Whitney test. Results: Twenty-seven patients underwent isolated supracondylar external rotation osteotomy to reduce the overall antetorsion of the femur. The osteotomy resulted in a 2.4° ± 1.4° mean increase in HKA and 2.4 mm ± 1.7 mm increase in the ischiofemoral space (p < 0.001). Conclusion: Supracondylar external rotation osteotomy of the femur leads to valgisation of the coronal limb alignment and increases the ischiofemoral space. This is resultant to the reorientation of the femoral antecurvature and the femoral neck. When planning a rotational osteotomy of the lower limb, this should be appreciated and may also aid in the decision regarding osteotomy site. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the clinical outcomes of derotational osteotomy followed by plate fixation at the radius and ulna for the treatment of congenital proximal radioulnar synostosis.MethodsA total of 10 eligible patients (12 forearms) with congenital proximal radioulnar synostosis were admitted to our institution from January 2013 to January 2016 and treated by radioulnar derotational osteotomy followed by plate fixation. There were 5 males and 5 females with an average age of 5.4 ± 2.0 (3–9) years old. The average forearm position was 56.67 ± 14.36° (range, 40°–80° pronation) in pronation before surgery. According to the classification system of Cleary and Omer, 3 forearms were categorized as type II, 7 as type III, and 2 as type IV. The pre- and postoperative forearm function was recorded and evaluated by the Failla scoring system.ResultsAll included patients were successfully followed up for an average time of 73.90 ± 8.24 months (range, 61–84 months). The mean achieved correction of the forearm was 53.33° ± 12.67° (range, 35°–70°). The average final position was 3.33° ± 14.98° (range, 20° of supination to 25° of pronation) in pronation. Bony union was achieved in a mean of 10.38 ± 1.25 weeks (range, 8.4–12.3 weeks) with no loss of correction. There were no incidences of nonunion, osteomyelitis, or neurologic or circulatory complications. The preoperative functional results were good in 1 forearm, fair in 8 forearms and poor in 3 forearms. In terms of final follow-up functional evaluations, 3 forearms were excellent, 6 forearms were good, and 3 forearms were fair.ConclusionsCongenital proximal radioulnar synostosis can be successfully treated using derotational osteotomy and plate fixation of the radius and ulna, which is an effective method with fewer postoperative complications and expected clinical outcomes.

Gastric volvulus is a rare condition whose incidence remains largely unknown. Unless actively considered by healthcare providers, the diagnosis of gastric volvulus, which can lead to significant morbidity and mortality, may be overlooked. This condition can manifest in either acute or chronic forms, presenting with diverse symptoms. Notably, the presence of a hiatal hernia alongside persistent vomiting despite initial antiemetic therapy should raise suspicion for gastric volvulus, even if the patient appears clinically stable. Acute gastric volvulus is usually managed surgically. Here, we describe the case of an elderly male who was diagnosed with acute gastric volvulus and was treated conservatively with endoscopy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Akiki et al.)

Background: The intertrochanteric fracture is a frequently occurring fracture, often attributed to osteoporosis in older populations. Recently, there has been a proposal to perform early surgical fixation on elderly patients to facilitate early rehabilitation. This approach has been shown to have a beneficial effect in lowering comorbidities. The study aims to compare the efficacy of the twin screw derotation type cephalomedullary nail with that of the single helical blade type cephalomedullary nail in the management of unstable intertrochanteric fractures., Methodology:  The research sample included patients from the orthopedic outpatient and emergency departments of Adesh Medical College and Hospital, Ambala Cantt, India, who were scheduled for surgery for unstable intertrochanteric femur fractures. The patients were categorized into two groups according to the kind of implant they were given: either a twin screw derotation cephalomedullary nail or a single helical blade cephalomedullary nail. The functional result was evaluated by comparing the modified Harris hip score (HHS). Patients with unstable intertrochanteric fractures, including reverse oblique fractures and fractures with posteromedial comminution, as well as patients who provided consent, were included in this study., Results:  Thirteen individuals received treatment with proximal femoral nail antirotation (PFNA2), whereas 19 individuals received treatment with proximal femoral nail (PFN). The mean age in the PFNA2 group was 69.51, whereas the mean age in the PFN group was 70.804. There were three patients in the PFNA2 group and five patients in the PFN group who had a tip apex distance of more than 25 mm. According to the Cleveland index, nine patients in the PFNA2 group and eight patients in the PFN group had an implant location that was not optimum. Four patients in the PFNA2 group and seven patients in the PFN group had a neck shaft angle difference of more than 10° between their undamaged and operated sides. The mean HHS was 74.55 for the PFNA2 group and 69.88 for the PFN group. The PFNA2 group exhibited four problems, whereas the PFN group had five issues., Conclusion:  The study found that both implants offer similar functional outcomes, with adherence to specific radiological parameters optimizing results. While both face similar challenges with osteoporosis, there was no notable distinction between them. Notably, the PFNA2 group showed superior outcomes in perioperative morbidity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Central Ethical Committee of Adesh Medical College and Hospital, Ambala Cantt issued approval RES/AMC/RAD/2024-5. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Thusoo et al.)

Introduction: Since the first description by William Ladd, the Ladd's procedure has been the surgery of choice for the correction of malrotation. The laparoscopic Ladd's procedure is becoming popular with the advent of minimal access surgery and is described in the literature. Various techniques of the Ladd's procedure have been described but none of them describes the stepwise technique for derotation of volvulus which is the most difficult and confusing part of the surgery. We describe 'steering wheel' technique for easy derotation of volvulus associated with malrotation. Method: A total of 62 patients were diagnosed to have an intestinal malrotation between 2010 and 2017. All cases which had complete non-rotation with a midgut volvulus were reviewed. Out of these, 48 patients were operated with open technique and 14 patients were subjected to the laparoscopic correction. Technique: Using three-port technique, stepwise derotation of volvulus is done which simulates the rotation of steering of car at an acute turn and has been described in four simple steps. This technique also stresses the importance of the release of Ladd's band before derotation. Results: Of 62 patients diagnosed with malrotation, 14 (22.6%) patients underwent the laparoscopic Ladd's procedure. The mean age was 26 + 8 months, mean weight was 10 + 2 kg and included eight males (57%) and six females (43%). There was only one (7.14%) conversion to open technique, due to a huge dilatation of duodenum causing difficulty in dissection in a patient with malrotation without volvulus. The laparoscopic Ladd's procedure took an average time of 70 ± 15 min. Conclusion: The laparoscopic 'steering wheel' derotation technique is easy and provides a stepwise description of the laparoscopic derotation of volvulus associated with malrotation in children.

Torsional deformities of the lower limb are common in children with cerebral palsy (CP)-determining gait problems. The mechanisms underlying transverse plane gait deviations arise from a combination of dynamic and static factors. The dynamic elements may be due to spasticity, contractures and muscle imbalances, while the static ones may result from excessive femoral anteversion, which decreases the efficiency of the hip abductors by reducing the muscular lever arms. A therapeutic approach has been identified in multi-level functional surgery for the lower limb. Treating the malalignments of the lower limb with femoral or tibial derotation provides optimal results, especially when supported by adequate biomechanical planning. This planning requires an integrated static-dynamic approach of morphological and functional evaluation, based on radiological measurements, physical examination and gait analysis. Instrumented gait analysis has been confirmed as essential in the evaluation and surgical decision making process for children affected by CP with transverse plane deformities. Computational simulations based on musculoskeletal models that integrate patient-specific CT morphological data into gait analysis can be used for the implementation of a surgical simulation system in pre-operative planning to test the possible effects of the different surgical treatment options on the torsional defects of the lower limbs. Recently, a computer-aided simulation process has been implemented in the preoperative planning of complex osteotomies for limb deformities in children. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software. The aim of this study is to integrate the patient-specific CT musculoskeletal model with morphological data and gait analysis data, with the personalized calculation of kinematic and kinetic parameters, which allow us to generate an “avatar” of the patient for a more in-depth evaluation of the gait abnormalities. The computational simulation platform proposed provides a realistic movable musculoskeletal model in a virtual environment, with the possibility of planning and monitoring the effects of virtual three-dimensional surgical corrections.

The development of dark pro‐aggregation‐induced‐emission luminogens (pro‐AIEgens) based on the solid‐state intramolecular motion–caused quenching effect has been rarely reported in biochemical analysis. Herein, an azo‐conjugated pro‐AIEgen derived from tetraphenylethene is constructed. Due to the active molecular motion of the azo bond, it retains a nonemissive property in both solution and solid forms. The obtained pro‐AIEgen can be internalized by living cells and undergo reductase‐modulated derotation under hypoxia to emit light. It shows increasing fluorescence when the intracellular oxygen concentration becomes lower, making it a potential probe to sense the hypoxic environment. The present probe can also visualize the hypoxic environment created by photodynamic therapy treatment.

Elongation-de-rotation-flexion (EDF) casting is a popular treatment for early-onset-scoliosis (EOS). However, casting every 2 to 3 months using general anesthesia may affect cognitive function.[1,2] Aims of this study: 1) to develop a new orthosis for EOS treatment based on EDF technique (EDFO) and traction frame; 2) to evaluate emerging radiographic results from treatment. Mehta’s EDF serial casting method and AMIL traction frame were used to manually correct the spine for 3D trunk scan. Afterward, a digital spinal model was created and helped design the EDFO with CAD/CAM technology. Radiographic measurements included Cobb angle, RVAD, and thoracic height and width. Six patients (2 girls; 4 boys) diagnosed with idiopathic EOS were enrolled in the study. EDFO was applied at mean 36.5 months of age, after final EDF casting. The average major Cobb angle stabilized after treatment. Average RVAD increased. The average normalized thoracic width at last EDFO out-of-brace was less than prior to EDFO. The new asymmetric EDFO offers an alternative to serial casting and TLSO. EDFO is considered a cost-effective, safer, more breathable, removable, and less invasive modality. [ABSTRACT FROM AUTHOR]

Since 2013, an elongation bending derotation brace (EBDB) has been developed and applied to EOS in our institution. The goals of the study were: 1) to compare radiographic changes before the use of EBDB (Pre-B), in brace (IB), and after the use of EBDB (Post-B) in a minimal two year follow-up; 2) to determine the compliance with the EBDB. Thirteen children diagnosed with an infantile scoliosis (IS) were retrospectively recruited. Under general anesthesia in the OR, child was placed on a Spica casting table, and the spine was manipulated by stockinet straps. Then 3D child’s torso was scanned, the EBDB was designed and manufactured for exact fitting to the torso in the corrected position using CAD/CAM technology.1 Mean age at start of EBDB was 2 years and 6 months. Average followup was 36 months. Compliance showed a mean 19 hours per day (14 to 23 hours). Pre-treatment Cobb angle was 40°, in brace 22°, and out of brace 28° (p<0.05). Axial vertebral rotation (AVR) by Nash-Moe method improved from 30% before treatment to 21% in brace and 19% at the end of visit (p<0.05). Kyphosis was significantly increased from 16° (Pre-B) to 32° (Post-B) (P<0.05). However, there was reduction of Rib-vertebral angle difference (RVAD) from 23° (Pre-B) to 11° (Post-B) (P>0.05). A cascade of EBDB effectively corrects and stabilizes the 3D spinal deformities in infantile. Thus the EBDB is considered as a successful modality in the treatment of IS children. [ABSTRACT FROM AUTHOR]

Purpose: Osteotomies represent well-established treatment-options for the redistribution of loads and forces within and around the knee-joint. Effects of these osteotomies on the remaining planes and adjacent joints are not fully understood. The aim of this study was to determine the influence of a distal-femoral-rotation-osteotomy on the coronal alignment of the ankle. It was hypothesized that supracondylar-external-rotation-osteotomy of the distal femur leads to a change in the coronal orientation of the ankle joint. Methods: Long-leg standing radiographs and CT-based torsional measurements of 27 patients undergoing supracondylar-rotational-osteotomy of the femur between 2012 and 2019 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy-site. The hip-knee-ankle-angle (HKA), the mechanical-lateral-distal-femur-angle (mLDFA), and Tibia-Plafond-Horizontal-Orientation-Angle (TPHA) around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann–Whitney test. Results: Twenty-seven patients with high femoral antetorsion (31.3° ± 4.0°) underwent supracondylar-external-rotation-osteotomy. The osteotomy led to a reduced antetorsion (17.4 ± 5.1; p < 0.001) and to a valgisation of the overall limb-alignment. The HKA decreased by 2.4° ± 1.4° (p < 0.001). The TPHA decreased by 2.6° (p < 0.001). Conclusions: Supracondylar external rotation osteotomy of the femur leads to lateralization of the weight bearing line at the knee and ankle due to valgisation of the coronal limb alignment. The mobile subtalar joint has to compensate (inversion) for the resulting valgus orientation of the ankle to ensure contact between the foot and the floor. When planning a rotational osteotomy of the lower limb, this should be appreciated – especially in patients with a preexisting valgus alignment of the lower extremities or restricted mobility in the subtalar joint. [ABSTRACT FROM AUTHOR]

Purpose: There are distinct differences in strategy amongst experienced surgeons from different 'scoliosis schools' around the world. This study aims to test the hypothesis that, due to the 3-D nature of AIS, different strategies can lead to different coronal, axial and sagittal curve correction. Methods: Consecutive patients who underwent posterior scoliosis surgery for primary thoracic AIS were compared between three major scoliosis centres (n = 193). Patients were treated according to the local surgical expertise: Two centres perform primarily an axial apical derotation manoeuvre (centre 1: high implant density, convex rod first, centre 2: low implant density, concave rod first), whereas centre 3 performs posteromedial apical translation without active derotation. Pre- and postoperative shape of the main thoracic curve was analyzed using coronal curve angle, apical rotation and sagittal alignment parameters (pelvic incidence and tilt, T1–T12, T4-T12 and T10-L2 regional kyphosis angles, C7 slope and the level of the inflection point). In addition, the proximal junctional angle at follow-up was compared. Results: Pre-operative coronal curve magnitudes were similar between the 3 cohorts and improved 75%, 70% and 59%, from pre- to postoperative, respectively (P < 0.001). The strategy of centres 1 and 2 leads to significantly more apical derotation. Despite similar postoperative T4-T12 kyphosis, the strategy in centre 1 led to more thoracolumbar lordosis and in centre 2 to a higher inflection point as compared to centre 3. Proximal junctional angle was higher in centres 1 and 2 (P < 0.001) at final follow-up. Conclusion: Curve correction by derotation may lead to thoracolumbar lordosis and therefore higher risk for proximal junctional kyphosis. Focus on sagittal plane by posteromedial translation, however, results in more residual coronal and axial deformity. [ABSTRACT FROM AUTHOR]

Abstract Purpose Osteotomies represent well‐established treatment‐options for the redistribution of loads and forces within and around the knee‐joint. Effects of these osteotomies on the remaining planes and adjacent joints are not fully understood. The aim of this study was to determine the influence of a distal‐femoral‐rotation‐osteotomy on the coronal alignment of the ankle. It was hypothesized that supracondylar‐external‐rotation‐osteotomy of the distal femur leads to a change in the coronal orientation of the ankle joint. Methods Long‐leg standing radiographs and CT‐based torsional measurements of 27 patients undergoing supracondylar‐rotational‐osteotomy of the femur between 2012 and 2019 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy‐site. The hip‐knee‐ankle‐angle (HKA), the mechanical‐lateral‐distal‐femur‐angle (mLDFA), and Tibia‐Plafond‐Horizontal‐Orientation‐Angle (TPHA) around the ankle were measured. Comparison between means was performed using the Wilcoxon‐Mann–Whitney test. Results Twenty‐seven patients with high femoral antetorsion (31.3° ± 4.0°) underwent supracondylar‐external‐rotation‐osteotomy. The osteotomy led to a reduced antetorsion (17.4 ± 5.1; p

Study Design: Retrospective.Objective: To evaluate the effect of preoperative rod shape on 3D spinal deformity correction.Summary Of Background Data: Differential rod contouring is a surgeon-dependent process based on an estimate of 3D deformity correction sought and the flexibility of the spine. An objective measure to this otherwise subjective scoliosis correction technique is lacking.Methods: A series of adolescent idiopathic scoliosis (AIS) patients with right, thoracic major curves, preoperative rod contour tracings, and EOS imaging was evaluated. All patients underwent posterior spinal fusion with 5.5 mm steel rods contoured prior to insertion. 3D reconstructions were generated pre- and postoperatively using sterEOS software (EOS Imaging) and imported into MATLAB (Mathworks) for analysis. A new measurement of the maximum perpendicular distance from the preinsertion concave rod contour to the preoperative 3D sagittal spinal reconstruction was defined as rod to 3D spine distance (RSD). Linear regressions were used to identify relationships between pre and postoperative parameters, including RSD and 3D thoracic kyphosis.Results: Ninety-nine patients were included. Average preoperative concave rod angle decreased from (48 ± 10°) preoperatively to 26 ± 6° postoperatively (P < 0.001) for an average flattening of ∼20°. Average convex rod angle increased from 30 ± 6° to 34 ± 5° (P < 0.001). Average preoperative thoracic curve magnitude and apical vertebral rotation were 57 ± 8° and 16 ± 5° and decreased to 11 ± 6° and 5 ± 6° (P < 0.001). Average 2D and 3D thoracic kyphosis increased from 19 ± 14° and 2 ± 12° to 27 ± 6° and 22 ± 5° (P < 0.001). Preoperative RSD strongly correlated with 3D thoracic kyphosis change (P < 0.001, r = 0.796, R = 0.633).Conclusion: On average, the concave rod flattened ∼20° after connection to the spine. Similarly, kyphosis increased ∼20° following rod insertion. A strong correlation was identified between RSD and 3D thoracic kyphosis restoration. This novel 3D parameter can guide the degree of concave rod bend necessary to achieve a desired increase in thoracic kyphosis in AIS.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

Introduction: Since the first description by William Ladd, the Ladd's procedure has been the surgery of choice for the correction of malrotation. The laparoscopic Ladd's procedure is becoming popular with the advent of minimal access surgery and is described in the literature. Various techniques of the Ladd's procedure have been described but none of them describes the stepwise technique for derotation of volvulus which is the most difficult and confusing part of the surgery. We describe 'steering wheel' technique for easy derotation of volvulus associated with malrotation. Method: A total of 62 patients were diagnosed to have an intestinal malrotation between 2010 and 2017. All cases which had complete non-rotation with a midgut volvulus were reviewed. Out of these, 48 patients were operated with open technique and 14 patients were subjected to the laparoscopic correction. Technique: Using three‑port technique, stepwise derotation of volvulus is done which simulates the rotation of steering of car at an acute turn and has been described in four simple steps. This technique also stresses the importance of the release of Ladd's band before derotation. Results: Of 62 patients diagnosed with malrotation, 14 (22.6%) patients underwent the laparoscopic Ladd's procedure. The mean age was 26 + 8 months, mean weight was 10 + 2 kg and included eight males (57%) and six females (43%). There was only one (7.14%) conversion to open technique, due to a huge dilatation of duodenum causing difficulty in dissection in a patient with malrotation without volvulus. The laparoscopic Ladd's procedure took an average time of 70 ± 15 min. Conclusion: The laparoscopic 'steering wheel' derotation technique is easy and provides a stepwise description of the laparoscopic derotation of volvulus associated with malrotation in children. [ABSTRACT FROM AUTHOR]

Purpose: A medial patellofemoral ligament reconstruction (MPFL) with an additional derotational femoral osteotomy is suggested for patients suffering from patellar instability and an increased internal femoral torsion (IT). This biomechanical study investigated whether an isolated MPFL reconstruction could restore patellofemoral biomechanics for 10° and 20° relatively increased internal femoral torsion.Methods: Eight fresh-frozen cadaver knees were tested on a specially designed knee simulator, which bend the knee from 0° to 90° flexion. Patellar motion (tilt and shift) and patellofemoral pressure (pressure shift, mean and peak pressure) were evaluated for 0°, 10° and 20° of IT with a native and reconstructed MPFL.Results: An isolated MPFL reconstruction, compared to a native MPFL with the same femoral torsion showed a significant medial shift of the center of force (10° IT p < 0.001; 20° IT p = 0.02) and patella shift (10° and 20° IT p < 0.001) but no significant change in patella tilt (10° IT n.s.; 20° IT n.s.) for 10° and 20° IT. There was a significant medial shift in the center of force for 10° IT (10° IT p = 0.04) and a non-significant lateral shift for 20° IT (20° IT n.s.) in comparison to the native MPFL with 0° of femoral torsion. Patella shift was directed medially for 10° IT (10° IT p = 0.002). In knee flexion angles up to 30°, the patella remained more lateral for 20° IT and showed a different motion pattern (20° IT n.s.). Patella tilt showed a significant lateral tilt for 10° and 20° IT (10° IT p = 0.01; 20° IT p = 0.002).Conclusion: MPFL reconstruction as an isolated therapy only appears to be reasonable for 10° increased IT. While for an increased IT of 20°, a lateralizing force vector remains and an additional femoral derotational osteotomy is recommendable. These findings may assist surgeons in the decision making of surgical procedures in patients suffering from patella instability. [ABSTRACT FROM AUTHOR]

The objective was to assess deformity correction and bone-screw force associated respectively with concave manipulation first, convex manipulation first, and different differential rod contouring configurations. Instrumentation scenarios were computationally simulated for 10 AIS cases with mean thoracic Cobb angle (MT) of 54±8°, apical vertebral rotation (AVR) of 19±2° and thoracic kyphosis of 21±9°. Instrumentations with major correction maneuvers using the concave side rod were first simulated; instrumentations with major correction maneuvers using the convex side rod were then simulated. Simulated correction maneuvers were concave/convex rod translation followed by apical vertebral derotation and then convex/concave rod translation. There were no significant differences in deformity corrections and bone-screw forces between concave rod translation first and convex rod translation first with differential rod contouring. Increasing differential rod contouring angle and concave rod diameter improved AVR correction and increased the TK and bone-screw forces; the effect on the MT Cobb angle was not clinically significant. [ABSTRACT FROM AUTHOR]

Background: Correcting the scoliosis and stabilizing the spine in the corrected position is the basis of treatment for adolescent idiopathic scoliosis (AIS). Spinal instrumentation and derotation are the principle steps of surgery for any type of AIS. A perspicuous understanding needs to be attained regarding derotation maneuvers in practice; therefore, we intend to compare radiological outcomes following concave and convex rod derotation maneuvers to analyze their efficacy to correct selective Lenke's Type-1 scoliosis. Materials and Methods: Retrospectively, 88 patients with Lenke's Type-1 scoliosis who were operated with selective thoracic instrumentation were divided into two groups depending on the derotation side. Preoperative radiographs were analyzed for curve angles, thoracic apical vertebral translation, apical vertebral rotation, and coronal/sagittal balance. Postoperative and followup assessment was focused on curve correction. Correction rate of main thoracic (MT) curve and its corresponding loss of correction at final followup are calculated. Results: Concave group (n = 40; age 13.8 ± 1.9) and the convex group (n = 48; Age 14.3 ± 2.4) showed similar demographic characteristics. Postoperative and followup parameters showed no significant difference. Correction rate of MT curve between both groups (concave group = 69.2 ± 10.5%; convex group = 66 ± 12.8%; P = 0.20) was similar. There was minimal loss of correction at final followup among both groups (concave group = 2.2° ±5.4°; Convex group = 1.5° ± 4.8°; P = 0.52). Conclusion: The study results showed similar sustained satisfactory correction of flexible Lenke's type 1 scoliotic curves irrespective of the derotation maneuver used. Adequate correction, thereby restoring balance was predominantly perceived among the entire sample. Hence, convex derotation can be considered equally effective as that of concave derotation for achieving adequate correction of selective Lenke's Type-1 scoliosis. [ABSTRACT FROM AUTHOR]

Malrotation of the mid gut is the most common congenital anomaly which might be present in infants, children or adults at various point of time in the form of acute intestinal obstruction or intestinal ischaemia with caecal or midgut volvulus or with chronic abdominal pain. Annular pancreas is a rare congenital anomaly which is consists of a rim of pancreatic tissue which encircles the second part of duodenum either partially or completely. Annular pancreas may be asymptomatic for a very long period of time before presenting with vomiting or features of intestinal obstruction. Here, we are presenting a case of a 36-year-old adult female patient presented to us with intractable vomiting, generalised weakness with no previous history of any symptoms, who was diagnosed as mid gut volvulus which eventually turned out to be malrotation of mid gut and with incidental finding of annular pancreas.

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Copyright of Stomatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The application of vertebral body derotation (DVBD) is still controversial by now; the purpose of this prospective cohort study was to compare comprehensive outcomes between segmental DVBD and simple rod derotation (SRD) especially in main thoracic adolescent idiopathic scoliosis. Methods: 36 patients in DVBD group and 45 patients in SRD group were with a 2-year follow-up. Among them, 19 DVBD patients and 16 SRD patients received CT scan examinations. Results: There were no significant difference between the groups in preoperative main thoracic Cobb, apical vertebral rotation and rib hump. Apical vertebral rotation measured from CT scans was 9.7° ± 2.0° versus 15.3° ± 2.4° ( p < 0.001) postoperatively in the DVBD and SRD patients, respectively. At 2-year follow-up, the main thoracic Cobb was 14.2° ± 1.6° versus 14.7° ± 1.7° ( p = 0.18), rib hump was 6.4° ± 3.8° versus 6.8° ± 3.1° ( p = 0.60) in DVBD group and SRD group. Patients' assessments of both groups were improved in Spinal Appearance Questionnaire (SAQ) and Scoliosis Research Society-22 Questionnaire (SRS-22), but showed no significant difference at follow-up ( p = 0.47 and 0.60). Conclusion: Although segmental DVBD showed excellent radiographic correction of axial spinal deformity postoperatively, there was no more correction of clinical rib hump or better patients' assessment than SRD at follow-up in our data. [ABSTRACT FROM AUTHOR]

Purpose: In recent years, authors have described novel derotation techniques for surgery in adolescent idiopathic scoliosis. These methods include direct vertebral body derotation (DVD) and vertebral coplanar alignment (VCA). By improved derotation it is hoped that there is further reduction in rib hump prominence and corresponding improvement in patients' quality of life. This paper aims to evaluate studies reporting outcomes from DVD and VCA techniques to assess if these methods lead to superior radiographic vertebral derotation, rib hump correction on surface measurements or patient-reported outcomes compared to traditional derotation manoeuvres using similar instrumentation. Method: Literature review. Results: Fifteen reports were identified. Most comparative studies represent class three or four data. DVD and VCA techniques have been shown to reduce apical vertebral rotation by 37-63 %. Few studies compare DVD/VCA techniques with traditional methods. Most DVD/VCA reports with pedicle screw instrumentation have reported superior radiographic derotation on CT compared with conventional techniques. Despite this the majority of studies have found similar corrections of rib hump measurements between DVD/VCA techniques and cantilever or global derotation methods. There is no evidence that DVD/VCA techniques allow greater correction of significant rib hump deformity without an adjuvant thoracoplasty. No studies to date have used patient-reported outcomes prospectively or demonstrated clinically meaningful differences retrospectively between DVD/VCA and conventional techniques. Conclusions: There is little evidence to recommend the widespread adoption of DVD/VCA techniques. Whilst there is some weak evidence to suggest that novel techniques may improve radiographic measures, there is little to suggest that they offer patients improved correction of clinical rib hump or quality of life compared to established techniques. Further well-designed prospective studies are needed in this area. [ABSTRACT FROM AUTHOR]

Distortion of the axis and shortening of the limbs result in multiple musculoskeletal pathologies. Rotation disorders should also be included among the disorders of the axis of the lower limb. In the case of rotational distortion, only derotation osteotomy can effectively correct torsion-associated deformations. Rotational distortion correction is accompanied by translational displacement and torsion, which results in more complex biomechanics. Using the pedobarographic platform, it is possible to evaluate static and dynamic posture and gait, percentage of body weight distribution on the lower limbs, and balance. Physiological gait and distribution of weight on the lower extremities are symmetrical. Balance is one of the determinants of proper biomechanics of the musculoskeletal system. An important aspect of treatment evaluation is pedobarographic assessment of balance and body weight distribution on the lower extremities ratio. The aim of this work was to evaluate the pedobarographic assessment of body weight distribution on the lower limbs and balance in patients with derotation corticotomies using the Ilizarov method. The study examined a group of 56 patients, who underwent derotation corticotomy using the Illizarov method between 1996 and 2012 at the Clinic of Orthopaedics and Traumatology of the Musculoskeletal System in Wrocław. The control group consisted of 54 patients, who were treated with correctional derotation-free corticotomy using the Ilizarov. Distribution of body weight on the lower limbs and balance were assessed with the pedobarographic platform. Following derotation corticotomy, the amount of body weight placed on the operated limb by subjects from the study group averaged 47.81%, 52.19% in the case of the healthy limb. These differences were not statistically significant. The difference between the average percentage of body weight placed on the diseased and healthy limb in the study group and the controls were not found to be statistically significant. There were no statistical differences in the average length of the gravity line or in the average surface area of the center of gravity position between the study and control groups. Balanced distribution of body weight on the lower limbs was achieved following derotation corticotomies using the Ilizarov method. Derotation corticotomies performed with the Ilizarov method allow for achieving normalization of body weight distribution on the lower limbs and balance, with values similar to those resulting from Ilizarov method derotation-free osteotomy. [ABSTRACT FROM AUTHOR]

Purpose: To report the method, outcome, and complications with Ilizarov external fixation for correction of congenital radioulnar synostosis with fixed forearm pronation greater than 60°. Methods: We treated 4 patients with an average age of 11 years (range, 9–13 y). Three patients had bilateral deformity and 1 had deformity of the right forearm only. All forearms were classified as type 3 according to Cleary and Omer. Indications were severe (> 90°) bilateral pronation deformity in 3 patients, with a mean preoperative pronation deformity of 100° (range, 90° to 110°), whereas 1 patient had unilateral right forearm deformity treated for cultural reasons. All patients underwent osteotomy at the level of the synostosis and gradual correction of the deformity using an Ilizarov external fixation device. Results: Mean supination position of the forearms after the correction was 15° (range, 0° to 30°). Two patients experienced neurapraxia of the radial nerve attributed to acute initial partial correction of the deformity in the operating room; the correction was returned to its original position, resulting in complete neurological recovery. One patient experienced a pin track infection, which we treated successfully with oral antibiotics. Conclusions: Our small series demonstrated the ability to gradually correct forearm rotation deformities greater than 90° using Ilizarov external fixation devices. Type of study/level of evidence: Therapeutic IV. [ABSTRACT FROM AUTHOR]

Background: The principles of treatment of congenital dislocation of hip in old children are different than those of infants and neonates. The purpose of this study is to evaluate the radiographic and functional results of one-stage treatment (open reduction, femoral shortening derotation, and Salter's osteotomy) of DDH in older children. Materials and Methods: Between January 2005 and June 2010, 25 patients (30 hips) underwent one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy for the treatment of DDH. Preoperatively, they were classified according to the Tönnis class. Clinical outcomes were assessed using the modified McKay's criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic assessment was made using Severin's scoring method to measure the centre-edge angle and dysplasia. Results: The mean age at the time of operation was 3.9 years (range 1.6--8 years), and the average duration of followup was 4.1 years (range 2--7.6 years). The McKay's score was excellent in 13 hips, good in 14 hips, fair in 2, and poor in 1 hip. The Severin's class I and II was found in 25 (83.3%) hips at the time of final evaluation as compared to none at the time of presentation. Conclusions: Young children having DDH can safely be treated with an extensive one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy, without increasing the risk of AVN. Early diagnosis and intervention is the successful treatment of patients suffering from DDH. [ABSTRACT FROM AUTHOR]

Purpose: We sought to clarify the effect of applying derotation maneuvers in the correction of adolescent idiopathic scoliosis (AIS) on the sagittal plane. Methods: We retrospectively queried a large, multicenter, prospectively collected database for patients who underwent surgical correction of AIS. All patients had at least 2 years of follow-up and documentation as to whether or not a derotation maneuver was performed during surgery. All patients underwent posterior spinal fusion with pedicle screw constructs. Patients who underwent concurrent anterior procedures were excluded. Results: A total of 323 patients were identified, of whom 66 did not have direct vertebral body derotation (DVBD) maneuvers applied during the deformity correction. The remaining 257 had a vertebral body derotation maneuver performed during their surgical correction. Although no significant differences were identified between the two groups when comparing pre-op and post-op thoracic kyphosis using T2-12 and T5-12 endplates, the absolute change in angulation measured from T2-12 was significantly different between the two groups. Postoperatively, the derotation group had a mean decrease in thoracic kyphosis of 5.1 ± 15.3° as compared to 10.8 ± 18.9° in the control group, P = 0.03. Conclusion: Although patients in both groups had decreased mean thoracic kyphosis postoperatively, application of DVBD in the correction of scoliosis did not additionally worsen the sagittal profile. [ABSTRACT FROM AUTHOR]

The article presents a biomechanical analysis of the thoracic spine derotational torque via pedicle screws (PS) instrumentation. The study loaded to failure four groups of thoracic segments of different PS constructs to stimulate left to right derotational force in an idiopathic dextrorotary thoracic scoliosis curve. It concludes that based on the failed single T4 PSs on the medial and lateral side, the greater torque and lesser risks of PS breach is possible through linked constructs.

The three-dimensional correction of severe rigid scoliosis has been improved by segmental pedicle screw instrumentation. However, there can be significant difficulty related to the use of a rigid rod, especially in the apex region of severe scoliosis. This study is a retrospective matched cohort study to evaluate the advantages of Nitinol shape memory alloy (SMA) rod-based correction by comparing the clinical and radiographic results obtained from using a temporary SMA rod and those from a standard rod in the correction of severe scoliosis. From May 2004 to September 2006, patients with matched curve type, ages at surgery, operative methods and fusion levels in our institute and instrumented with either SMA rods ( n = 14) or traditional correction techniques ( n = 16) were reviewed. In SMA group, the SMA rods served as a temporary intraoperative tool for deformity correction and were replaced by standard rods. The blood loss at surgery averaged 778 ± 285 ml in the traditional group and 585 ± 188 ml in the SMA group ( P < 0.05). Operative time averaged 284 ± 53 min in the SMA group and 324 ± 41 min in the traditional group ( P < 0.05). In the SMA group, the preoperative major curve was 92.6° ± 13.7° with a flexibility of 25.5 ± 7.3% was corrected to 29.4° ± 5.7° demonstrating a 68.4% immediate postoperative correction. In the traditional group, the preoperative major curve was 88.6° ± 14.6° with a flexibility of 29.3 ± 6.6% was corrected to 37.2° ± 7.3° demonstrating a 57.8% immediate postoperative correction. There was a statistic difference between the SMA group and traditional group in correction rate of the major thoracic curve. In the SMA group, one case suffered from deep infection 2 months postoperatively. In the traditional group, 6 of 16 cases suffered pedicle screw pull out or loosening during placement of the standard rod at the apex vertebrae on the concave side. In three cases, the mono-axial pedicle screws near the apex were abandoned and in five cases replaced with poly-axial pedicle screws. This study shows that the temporary use of SMA rod may reduce the operative time, blood loss, while improve the correction of the coronal plane when compared with standard techniques. [ABSTRACT FROM AUTHOR]

The treatment of adolescent idiopathic scoliosis has evolved substantially over the years. Early designs, such as the Harrington rod, corrected coronal deformity but failed to account for normal sagittal alignment. Cotrel-Dubousset instrumentation allowed for better control of sagittal contours such as thoracic kyphosis and lumbar lordosis while maintaining coronal deformity correction. However, rotational control of scoliosis remained poor. Modern instrumentation systems with pedicle screws allow for the first time the possibility of true rotational correction, but this requires more than simple rod derotation maneuvers. Instead, a method of directly applying rotational force to a screw that has 3-column purchase is required in order to effect a derotation of individual vertebra. This is accomplished through the advent of direct vertebral rotation devices. We describe the technique to use these devices to perform rotational correction of scoliotic deformities later in the text. [Copyright &y& Elsevier]

This paper describes an approach to image modelling using interscale phase relationships of wavelet coefficients for use in image estimation applications. The method is based on the dual tree complex wavelet transform, but a phase rotation is applied to the coefficients to create complex "derotated" coefficients. These derotated coefficients are shown to have increased correlation compared to standard wavelet coefficients near edge and ridge features allowing improved signal estimation in these areas. The nature of the benefits brought by the derotated coefficients are analyzed and the implications for image estimation algorithm design noted. The observations and conclusions provide a basis for design of the denoising algorithm in [1]. [ABSTRACT FROM AUTHOR]

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Copyright of Trauma und Berufskrankheit is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)