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PubMed1992

Tibial rotational osteotomy for idiopathic torsion. A comparison of the proximal and distal osteotomy levels.

A retrospective analysis was done of 52 rotational tibial osteotomies (RTOs) performed on 35 patients with severe idiopathic tibial torsion. Thirty-nine osteotomies were performed at the proximal or midtibial level. Thirteen were performed at the distal tibial level with a technique previously described by one of the authors. Serious complications occurred in five (13%) of the proximal and in none of the distal RTOs. For severe and persisting idiopathic tibial torsion, the authors recommend correction by RTO at the distal level. Proximal level osteotomy is indicated only when a varus or valgus deformity required concurrent correction.

Bone Diseases↗
PubMed2005

The effect of pelvic osteotomy plate type on axial rotation of the acetabular segment in the triple pelvic osteotomy.

OBJECTIVE: The purpose of this study is to evaluate the changes in structural anatomy of cadaver pelves, with specific emphasis on axial rotation, resulting from the application of TPO plates differing by type, angle and orientation. SAMPLE POPULATION: Nine cadaver pelves procedure: The degree of axial rotation was determined for three different pelvic osteotomy plate types, four different plate angles and two different orientations of the same plate. RESULTS: The observed degree of axial rotation was significantly different than the degree of axial rotation predicted by the plate angle for each group except the Rooks pelvic osteotomy plate. CONCLUSIONS/CLINICAL RELEVANCE: In the triple pelvic osteotomy the final degree of axial rotation may be significantly different than the predetermined plate angle.

Acetabulum↗
PubMedDate not supplied

Treatment of skewfoot by multiple lesser tarsal osteotomies and calcaneal osteotomy.

A 9-year-old male with bilateral skewfoot deformity underwent corrective surgery consisting of multiple abductory, lesser tarsal osteotomies, and medial displacement L-shaped calcaneal osteotomy. The author prefers this surgical approach because it minimizes shortening of the lateral column without limiting the amount of transverse plane correction. The calcaneal osteotomy offers excellent stability in the sagittal plane without limiting frontal or transverse plane correction.

Calcaneus↗
PubMedDate not supplied

Mau osteotomy: an alternative procedure to the closing abductory base wedge osteotomy.

The authors analyzed the postoperative results of the closing abductory wedge osteotomy and the Mau osteotomy for the reduction of metatarsus primus adductus deformity in terms of radiographic position of the first metatarsal. A review of 21 Mau osteotomies was performed. Data were collected on preoperative and long-term postoperative x-rays to evaluate first metatarsal shortening and elevation.

Bone Screws↗
PubMed1995

Neurological complications of high tibial osteotomy--the fibular osteotomy as a causative factor: a clinical and anatomical study.

A clinical study of 105 upper tibial osteotomies was undertaken to investigate the incidence, pathology and outcome of perioperative neurological deficit. Motor weakness and/or sensory deficit occurred in 21 patients (20%) and in half of these the deficit was permanent. For descriptive purposes the fibula was divided into four zones. The occurrence of a neurological deficit was clearly related to the level of the fibular osteotomy. An anatomical explanation is proposed for this complication, based on cadaveric studies. Due to unacceptably high levels of complications it is recommended that the fibular osteotomy should not be performed in zones II and III (from just below the fibular head to 15 cm distal to this level).

Female↗
PubMed1996

Open wedge high tibial osteotomy using fractioned drill osteotomy: a surgical modification that lowers the complication rate.

We investigated retrospectively 132 cases of open wedge high tibial osteotomy using an external fixation device, concentrating on the rate of neurological complications. One group of patients underwent surgery according to the conventional technique (n = 89). The rate of transient neurological complications was 15.7%; 7 months after surgery the rate of persistent deficits was 12.4%. For the second group (n = 43) a modified surgical technique was used that lowered the complication rate significantly (transient deficits 14%, persistent deficits 4.7%). In the modified technique the osteotomy is not performed in the conventional way using an oscillating saw but through consecutive drill holes of increasing diameter followed by osteoclasis. The lower complication rate in the second group is mainly due to the less extensive approach that leads to a smaller number of postoperative tibialis anterior syndromes (type B lesion). No differences were found with type C lesions (extension deficit of D1). No complete peroneal nerve palsy (type A) occurred in either group. We conclude that the reduction of neurological complications in group 2 is related to the less extensive approach of the proposed technique.

Adult↗
PubMed2003

Progressive collapse of transposed necrotic area after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head induces osteoarthritic change. Mid-term results of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head.

INTRODUCTION: Osteonecrosis of the femoral head is usually progressive, and once collapse of the femoral head develops, joint destruction almost invariably follows. Therefore, for partial osteonecrosis of the femoral head, various types of osteotomies have been developed in an attempt to save the femoral head and maintain the natural function of the hip joint. MATERIALS AND METHODS: We reviewed 25 hips in 21 patients for a mean follow-up period of 6.4 years after Sugioka's transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head. RESULTS: The clinical results were excellent or good in 20 hips (80%), and radiological success was observed in 15 hips (60%) with an absence of both collapse of the newly established weight-bearing area of the femoral head and narrowing of the joint space. Progressive collapse of the transposed necrotic area was noted in 10 hips (40%), and of these 10 hips, narrowing of the joint space was observed in 7 (70%) at follow-up. A significant correlation was demonstrated between progressive collapse of the transposed necrotic area and narrowing of the joint space. Growth of an osteophyte of the femoral head was observed postoperatively in 16 hips (64%), particularly at anterior and lateral sites of the femoral head. CONCLUSIONS: Though collapse of a new weight-bearing area can be prevented, progressive collapse of the transposed necrotic area induces anterior joint instability, giving rise to osteoarthritic change. It is therefore concluded that prevention of the collapse of the transposed necrotic area is important for satisfactory long-term results.

Adult↗
PubMed2004

Transitional joint effusion in the mandibular prognathic surgery patient: intraoral vertical ramus osteotomy versus sagittal split ramus osteotomy.

PURPOSE: The purpose of this study was to examine the cause of joint effusion (JE) appearing postoperatively in the temporomandibular joint (TMJ) of patients with mandibular prognathism on T2-weighted magnetic resonance (MR) images. PATIENTS AND METHODS: MR imaging was performed before and after surgery in 30 TMJs of 15 subjects with mandibular prognathism who underwent intraoral vertical ramus osteotomy (IVRO) and in 20 TMJs of 10 subjects with mandibular prognathism who underwent sagittal split ramus osteotomy (SSRO). The preoperative MR imaging was performed 1 month before surgery, and postoperative MR imaging was performed during maxillomandibular fixation. RESULTS: Preoperatively, none of SSRO and IVRO groups had JE. Postoperatively, 12 TMJs (40%) of the IVRO group and only 1 TMJ (5%) of the SSRO group had JE. As for the TMJs in the IVRO group, on MR imaging, the degree of downward movement of the condyle after surgery was larger in TMJs with JE (3.8 +/- 2.3 mm) than in TMJs without JE (1.8 +/- 1.6 mm). JE diminished within about 4 months after removal of the maxillomandibular fixation. CONCLUSION: JE appearing postoperatively in the TMJ of patients with mandibular prognathism might be relation to the degree of downward movement of the condyle.

Adolescent↗
PubMed2005

Change in condylar long axis and skeletal stability following sagittal split ramus osteotomy and intraoral vertical ramus osteotomy for mandibular prognathia.

PURPOSE: The purpose of this study was to compare postsurgical time course changes in condylar long axis and skeletal stability between sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO). PATIENTS AND METHODS: Of 40 Japanese patients with a diagnosed jaw deformity, 20 underwent IVRO without internal fixation and 20 underwent SSRO with rigid internal fixation. The time course change in condylar long axis and skeletal stability were assessed with axial, frontal, and lateral cephalograms. RESULTS: A significant difference in the rotation direction of condylar long axis was seen in horizontal axial cephalogram images (P <.01). In Pog-N perpendicular to SN, the IVRO group showed gradual decrease, although SSRO group showed gradual increase in lateral cephalogram (P <.05). CONCLUSION: The present results suggest a significant difference between SSRO and IVRO in time course changes in proximal segment including condyle and distal segment.

Adolescent↗
PubMed2006

Neurosensory alteration in the lower lip and chin area after orthognathic surgery: bilateral sagittal split osteotomy versus inverted L ramus osteotomy.

PURPOSE: This study investigated neurosensory disturbances in patients after orthognathic surgery in relation to differences in mandibular splitting methods and degree of surgical skill. PATIENTS AND METHODS: Forty-five patients who had undergone bilateral sagittal split ramus osteotomies (SSRO), and 21 (group L) who had undergone intraoral inverted L ramus osteotomies (ILRO), were examined for postsurgical neurosensory disturbances. Twenty-two (group S1) of the SSRO patients were treated by 11 surgeons who had little experience, and the others (23 patients; group S2) were treated by 2 skilled surgeons who had considerable experience. One of the 2 skilled surgeons was the only surgeon carrying out the ILRO procedure. The neurosensory tests employed included light touching using a Semmes-Weinstein monofilament tester (SW tester), electrical stimulation, and a questionnaire to determine changes in subjective sensations, at the time of each sensory evaluation. Neurosensory examinations were carried out bilaterally (132 sides) at 1, 3, 6, and 12 months after surgery. RESULTS: More patients showed abnormal thresholds for the 2 measurement techniques in the SSRO group than in the ILRO group, and furthermore there were more such patients in group S1 than in group S2, at each measurement point. At 6 months after surgery, the number of patients with reduced sensitivity was significantly higher in group S1 than in group L (P < .05). In the SSRO group at each measurement point, the thresholds for the lower lip and chin were unrelated to the set-back (or advance) distance. By contrast, in group L only at the 1-month evaluation point, the thresholds for the lower lip and chin were significantly raised in patients whose setback distances were larger than average (P < .05). CONCLUSIONS: Postsurgical neurosensory disturbances of the lower lip and chin occur more frequently in SSRO patients treated by surgeons having little experience than in those treated by skilled surgeons, although the difference is not significant. Long-term prognosis for resolution of postsurgical neurosensory disturbances is better in ILRO patients than in SSRO patients. Although the width of movement of the split bone fragments has an influence on postsurgical neurosensory disturbances immediately after ILRO, the relationship becomes less obvious with time.

Adult↗
PubMed1997

Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone.

The purpose of this prospective study was to determine whether or not abrasion arthroplasty promotes cartilage regeneration in osteoarthritic (OA) knees with eburnation. Patients with OA knees were divided into a group of 51 knees treated by osteotomy with abrasion arthroplasty (Group A) and another group of 37 knees treated by osteotomy alone (Group B). Regeneration of cartilage was compared between the groups both arthroscopically and histologically. The Outerbridge classification was used for arthroscopic grading with Grade 0 being normal and Grade IV representing eburnation. On arthroscopic examination, around 12 months after surgery, Group A showed a significantly higher incidence of Grade II repair (a smooth articular surface and small fissures) and a lower incidence of Grade IV repair than Group B on both the femoral (P < .001) and tibial (P < .01) joint surfaces. Age was the only factor influencing the grade of tibial cartilage in Group A. Histological examination showed that 64% of the regenerated tissue studied consisted of fibro-cartilage at around 12 months after surgery. There was no difference in the clinical outcome at 2 to 9 years postoperatively between Groups A and B.

Age Factors↗
PubMed1996

[New metacarpal osteotomy: metacarpal cervicocapital shortening osteotomy of the rheumatoid hand].

Volar dislocation of the four long fingers is a common situation in rheumatoid hands. Surgical reduction is rather difficult because of soft tissue retraction, especially interosseous muscles, and requires large releases. The authors propose the use of Weil's osteotomy, initially described in foot surgery. This is an oblique cervico-capital osteotomy which shortens the metacarpal bone, fixed by two screws. This makes soft tissue release less extensive and facilitates relocation of the extensor tendon. Two cases are reported.

Aged↗
PubMed1993

Facial palsy after sagittal split osteotomies. A survey of 1747 sagittal split osteotomies.

Facial nerve palsy following a sagittal split osteotomy is a rare but serious complication. The incidence of facial nerve injury in a group of 1747 patients who had undergone a bilateral sagittal split osteotomy (3494 sagittal splits) was determined and proved to be 0.26% (9 cases). The case histories of 2 patients are presented, and the etiology, diagnosis, treatment and prevention of this complication are discussed.

Adult↗
PubMedDate not supplied

Plantar opening-wedge osteotomy of cuneiform bones combined with selective plantar release and dwyer osteotomy for pes cavovarus in children.

Neurological pes cavovarus is a challenging deformity to treat during childhood. Based on physiopathology, we propose the following original surgical procedure. Plantar-opening wedge osteotomy of the three cuneiform bones, preceded by selective plantar release, corrects forefoot pronation which is the primum movens of the deformity, and corrects the cavus at its apex. A calcaneal valgisation closing wedge osteotomy, is indicated if pre-operative planning revealed subtalar joint stiffness, incompatible with secondary hind foot realignment in valgus. The follow-up had to be at least 5 years or to reach skeletal maturity. Twenty-six children (36 feet) satisfied these criteria. Mean age at surgery was 10.3 years old. All the children had a neurological disease which was progressive for 65% of them (75% of the feet). Mean follow-up was 6.9 years. This treatment was effective, with a mean percentage of cavus correction of 74%, reaching 100% for 31% of the feet. Complete or partial cavus correction was still observed at last follow-up for 75% of the feet. At last follow-up, global result was satisfactory in 63.9% and non satisfactory in 36.1% of feet. Flat-foot was observed, of minor type, in only 2 cases. Apart from triple arthrodesis, iterative surgery relative to residual deformity (foot adduction, plantar sticking of the first metatarsal head) was indicated for 4 feet (11%). A triple arthrodesis was required in 12 cases (33%). In conclusion, this treatment provides mid-term satisfactory correction of the cavus and may allow avoiding triple arthrodesis at skeletal maturity.

Adolescent↗
PubMed2006

Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle.

OBJECTIVE: To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO). STUDY DESIGN: Retrospective clinical study. ANIMALS: Fifteen client-owned dogs (18 stifle joints). METHODS: Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. RESULTS: Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. CONCLUSIONS: Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. CLINICAL RELEVANCE: TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.

Animals↗
PubMed1990

Keller's arthroplasty and Mitchell osteotomy: a comparison with first metatarsal osteotomy of the long-term results for hallux valgus deformity in the younger female.

We have made a retrospective comparison between the results of 37 Keller's arthroplasties and 36 distal transverse first metatarsal osteotomies performed in female patients between the ages of 25 and 50 years, for the treatment of hallux valgus. The choice of operation depended on the policy of the consultant responsible for treatment, but analysis of the preoperative findings showed that the two groups were similar, allowing comparative assessment of Keller's procedure in the younger middle-aged patient. All patients were assessed 3 to 5 years after operation using an objective scoring system of symptoms, clinical examination, anteroposterior standing radiographs and walking footprints from a Harris Beath mat. The results following a Keller's arthroplasty were excellent in 7 (19%), good in 22 (60%), poor in 6 (16%), and needed revision in 2 cases (5%). In the osteotomy group, 11 (30.5%) were excellent, 19 (52.5%) were good, 5 (14%) were poor, and 1 (3%) required revision.

Adult↗
PubMed1996

Pemberton pelvic osteotomy and varus rotational osteotomy in the treatment of acetabular dysplasia in patients who have static encephalopathy.

Forty-four patients (fifty-two hips) who had static encephalopathy and acetabular dysplasia were managed with a Pemberton osteotomy as part of a comprehensive operative approach. Thirty-three patients had quadriplegia and were unable to walk; the remaining eleven patients had diplegia and could walk. The age at the time of the operation ranged from four years and five months to sixteen years and five months, as an open triradiate cartilage is a prerequisite for the Pemberton procedure. Concomitant operative procedures included a varus rotational osteotomy in fifty of the involved hips, a soft-tissue release in thirty-seven hips, and an open reduction in thirteen hips. The mean center-edge angle preoperatively was -11 degrees (range, -80 to 17 degrees), which improved to a mean of 27 degrees (range, 5 to 62 degrees) at the time of the latest follow-up. The mean duration of follow-up was four years (range, two years to eight years and eight months). At the time of writing, none of the hips had redislocated but one hip had subluxated. Eight of the hips had been painful preoperatively, but none of these was painful at the time of the most recent follow-up. One patient who had not had pain in the hip preoperatively had pain at the time of the follow-up evaluation. There were no complications attributable to posterior uncovering of the hip. The age of the patient at the time of the operation had no discernible effect on the result.

Acetabulum↗