BACKGROUND: Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature. METHODS: Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up. RESULTS: The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p < 0.001). Radiological results showed that all osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p < 0.001) at the final follow-up. The femoral neck shaft angle was improved from 93.7° to 129.9° (p < 0.001) at the final follow-up. Shortening of the affected limb was corrected from 2.8 cm to 1.3 cm (p < 0.001) at the last follow-up. No major serious complications were recorded in the present study. CONCLUSIONS: Intertrochanteric valgus osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara. With careful planning, it can result in a low complication rate and insignificant or minimal recurrence rate.
*Bone Plates ; Child ; Child, Preschool ; Coxa Vara/*surgery ; Female ; Femur Neck/*surgery ; Follow-Up Studies ; *Fracture Fixation, Internal/instrumentation/methods/statistics & numerical data ; Humans ; Male ; *Osteotomy/methods/statistics & numerical data

BACKGROUND: The goal of this study was to compare simple radiographic findings and clinical results according to residual ulnar variance following ulnar shortening for ulnar impaction syndrome. METHODS: Forty-five cases of ulnar impaction syndrome, which were treated with ulnar shortening from 2005 to 2008, were studied retrospectively. Group I included 13 cases with positive residual variance after ulnar shortening and group II included 32 cases with negative variance after shortening. The presence of a lunate cystic lesion both preoperatively and at final follow-up and assessments of wrist function based on the modified Mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, as well as the Chun and Palmer score were evaluated. RESULTS: A cystic lesion of the lunate was present in 4 cases preoperatively and the size decreased in 2 cases at final follow-up in group I, and in 10 and 5 cases, respectively, in group II. No statistical difference was observed between the groups. The modified Mayo wrist score, DASH score, as well as the Chun and Palmer score improved significantly in both groups. No significant differences were observed between the two groups in terms of the proportion of positive cystic lesions at final follow-up or the functional scores. CONCLUSIONS: After ulnar shortening, the degree of radiological change in the cystic lunate lesions and clinical improvement did not differ significantly between the groups with unintended residual positive and negative variance after shortening.
Adult ; Aged ; Bone Cysts/surgery ; Bone Diseases/*radiography/*surgery ; Female ; Health Status Indicators ; Humans ; Lunate Bone/surgery ; Male ; Middle Aged ; Osteotomy/*methods ; Retrospective Studies ; Statistics, Nonparametric ; Ulna/*radiography/*surgery

BACKGROUND: Numerous metatarsal osteotomies have been developed for the treatment of Freiberg's disease. The purpose of this study was to evaluate the clinical outcomes of modified Weil osteotomy in the treatment of Freiberg's disease. METHODS: From November 2001 to July 2008, nineteen patients (twenty feet), treated surgically for Freiberg's disease, were included in this study. The average age of the patients was 33.6 years (range, 17 to 62 years), the mean follow-up period was 71.6 months (range, 41 to 121 months). Clinical outcomes were evaluated according to visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the patients' subjective satisfaction and range of motion (ROM) of metatarsophalangeal (MTP) joint. In the radiologic evaluation, initial metatarsal shortening by Freiberg's disease compared to opposite site, metatarsal shortening after modified Weil osteotomy compared with preoperative radiography and term for radiologic union were observed. RESULTS: VAS showed improvement from 6.2 +/- 1.4 to 1.4 +/- 1.5 at last follow-up (p < 0.0001). Points of AOFAS score increased from 63.3 +/- 14.9 to 80.4 +/- 5.6 (p < 0.0001). ROM of MTP joints also improved from 31.3 +/- 10.1 to 48.3 +/- 13.0 degrees at last follow-up (p < 0.0001). According to Smillie's classification system, there was no significant improvement of VAS, AOFAS score and ROM between early stages (stage I, II, and III) and late stages (stage IV and V). Out of twenty cases, nineteen (95%) were satisfied, reporting excellent or good results. CONCLUSIONS: Modified Weil osteotomy is believed to be a useful method for the treatment of Freiberg's disease, not only in the early stages but also in the late stages. It relieves pain and improves function via shortening of metatarsals and restoration of MTP joint congruency.
Adolescent ; Adult ; Female ; Humans ; Male ; Metatarsal Bones/pathology/radiography/surgery ; Metatarsus/abnormalities/pathology/radiography/surgery ; Middle Aged ; Osteochondritis/*congenital/pathology/radiography/surgery ; Osteotomy/*methods ; Pain Measurement ; Range of Motion, Articular ; Statistics, Nonparametric ; Treatment Outcome

To evaluate the efficacy and safety of modified pedicle subtraction osteotomy for treatment of thoracolumbar old fracture with kyphosis.
 Methods: From January 2003 to January 2013, 58 patients of thoracolumbar kyphosis, who underwent modified pedicle subtraction osteotomy, were reviewed. Among them, 45 cases underwent initial operation and 13 cases underwent revision surgery. Preoperative and postoperative kyphotic Cobb's angle, score of back pain, as well as the incidence of complication were accessed by using visual analogue scale (VAS) and Oswestry disability index (ODI).
 Results: Mean follow-up duration was 42 months (range, 24-60 months). Average operative time was 258 min (range, 190-430 min), while average bleeding was 950 mL (range, 600-1 600 mL). All the patients were significantly improved in function and self-image, and achieved kyphosis correction with 17.9°± 4.3°. VAS of low back pain was decreased by 3.1±0.6; ODI was dropped by 25.3%±5.5%. 3 patients (5.2%) suffered anterior thigh numbness and got recovery after 3 months of follow-up. Complications happened in 19 patients, including 12 with cerebrospinal fluid leak, 4 with superficial wound infection, and 3 with urinary tract infection. All these complications were managed properly and none of them underwent reoperation.
 Conclusion: Modified pedicle subtraction osteotomy is a safe and effective technique for the treatment of old fracture with kyphosis.
Back Pain ; surgery ; Blood Loss, Surgical ; statistics & numerical data ; Cerebrospinal Fluid Leak ; epidemiology ; Female ; Follow-Up Studies ; Fractures, Bone ; complications ; surgery ; Humans ; Hypesthesia ; etiology ; Kyphosis ; etiology ; surgery ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Operative Time ; Osteotomy ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Reoperation ; statistics & numerical data ; Retrospective Studies ; Surgical Wound Infection ; epidemiology ; Thoracic Vertebrae ; injuries ; surgery ; Treatment Outcome ; Urinary Tract Infections ; epidemiology

PURPOSE: Dyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC. MATERIALS AND METHODS: The amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64). RESULTS: All but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0degrees on tibiae and 10.0degrees on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation. CONCLUSION: We believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint.
Adolescent ; Bone Diseases, Developmental/*surgery ; Child ; *External Fixators ; Female ; Femur/abnormalities/surgery ; Humans ; Leg Length Inequality/surgery ; Lower Extremity Deformities, Congenital/*surgery ; Male ; Middle Aged ; Osteochondrosis/congenital/surgery ; Osteogenesis, Distraction/*instrumentation/methods/statistics & numerical data ; Osteotomy ; Tibia/abnormalities/surgery ; Treatment Outcome ; Young Adult