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Factors affecting angular deformities of the knees in Nigerian children--Ilorin experience.

44 children with angular knee deformities were studied at the University of Ilorin Teaching Hospital from September 1994 to December, 1997. There were 19 males (43.2%) and 25 females (56.8%). The commonest age range was 0-5 years age range (81.5%). Bilateral angular deformities are more common than unilateral angular deformities. Windswept deformities accounted for 16 cases(36.4%), bilateral Genu Varum accounted for 15 cases (34.0%), and unilateral Genu Valgum, 8 cases (18.2%). It was found in the study that 40 cases (90.9%) were from urban communities while 4 cases (9.1%) were from rural communities. The angular knee deformities affect both Christian and Moslem children alike; however, the environmental factor is the restriction of children indoors which is a serious factor in the causation of Nutritional Rickets. Angular deformities of the knee were far more common amongst urban dwellers than in children from rural area (Ratio 10:1) while involvement of both knees (88.6%) simultaneously is also more common than single knee involvement (11.4%). Some of the objectives of the investigation were to find out the implications of the angular deformities to parents and children; and ways to prevent occurrence were also discussed in this paper.

Adolescent↗

[Osteotomy at knee level for young patients with gonarthrosis].

Young patients with gonarthrosis that does not respond adequately to conservative therapy can be treated by corrective osteotomy. Osteoarthritis of one compartment more often has a mechanical aetiology than osteoarthritis of the entire knee. Patients with osteoarthritis of the medial compartment often have a genu varum (bow-legs) while patients with osteoarthritis of the lateral compartment often have a genu valgum (knock-knees). The goal of corrective osteotomy is to transfer the load bearing to the normal compartment, which will reduce the symptoms and permit arthroplasty to be postponed. In retrospective studies, the procedure resulted in less pain, improved knee function or postponement of knee arthroplasty in 28-87% of the patients. Possible complications include pseudarthrosis, thromboembolism, contracture of the patellar tendon, paresis of the N. peroneus, compartment syndrome. The outcome of osteotomy for gonarthrosis depends on careful patient selection, the stage of osteoarthritis, and the achievement and maintenance of the correction of the load axis that was calculated before the operation.

Arthroplasty, Replacement, Knee↗

Gait and function after intra-articular arthrodesis of the hip in adolescents.

BACKGROUND: Patients who have had a hip arthrodesis have been reported to have pain in the back and the knee due to an altered gait. There is little information about the specific compensatory mechanisms that are adopted when walking. The purpose of this study was to objectively define gait adaptations after an arthrodesis of the hip and to correlate the kinematic findings with pain and other patient outcomes. METHODS: Nine patients who had had an arthrodesis of the hip at an average age of thirteen years and five months (range, ten years and nine months to sixteen years and eleven months) were evaluated with gait analysis and muscle strength-testing and completed a questionnaire related to pain and function. The average duration of follow-up was eight years and ten months (range, two years and one month to thirteen years and ten months). The frequency of the postoperative visits varied. Seven patients were adults at the time of the study and were called back specifically for the study. RESULTS: All patients had decreased cadence and step lengths. The kinematic findings included decreased dorsiflexion of the ipsilateral ankle, hyperextension of the ipsilateral knee during the stance phase, and a tendency toward increased genu valgum during gait. In normal gait, there is no genu varum or valgum during the stance phase. The patients had an average (and standard deviation) of 7 +/- 4 degrees of genu valgum. Pelvic and lumbar motion in the sagittal plane was excessive in all patients. Strength-testing revealed clinically relevant weakness in the ipsilateral quadriceps in all patients, with a difference of more than 20 percent between the two extremities in six patients. The gastrocnemius. soleus muscle was stronger on the side with the fused hip in six patients. The questionnaire, designed by Harris in 1969 and completed by the patients at the time of the gait analysis, revealed back pain in seven patients. The questionnaire was administered only once. The functional outcome as measured with use of the same questionnaire worsened as the duration of follow-up increased. CONCLUSIONS: The gait analysis showed excessive motion in the lumbar spine and the ipsilateral knee in all nine patients. This abnormal motion led to pain as the duration of follow-up increased, and all patients who had been followed for four or more years after the arthrodesis complained of back pain. We hypothesized that excessive motion for an extended duration can lead to back pain. The preferred position of the hip for the arthrodesis was 20 to 25 degrees of flexion, neutral abduction-adduction, and neutral rotation.

Adolescent↗

[Computer-assisted knee arthroplasty: comparison with a conventional procedure. Results of 50 cases in a prospective randomized study].

PURPOSE OF THE STUDY: The aim of this work was to compare the radiographic findings after two techniques for total knee arthroplasty, one using a computer-assisted approach and the other a conventional approach. MATERIAL AND METHODS: Between January 1998 and April 1999, we conducted a prospective study randomizing 25 patients for conventional surgery (group A) and 25 for computer-assisted surgery (group B). All patients volunteered to participate in this study and gave their written informed consent. There were 35 women and 15 men, mean age 69.5 years (range 47-85). The two groups were comparable for age, gender, height, weight, orthopedic history, etiology and preoperative mobility. The preoperative hip-knee angle (HKA) was also comparable between the two groups. Mean HKA was 175 degrees, i.e. 5 degrees varus (range 162 degrees (18 degrees varus) to 210 degrees (30 degrees valgus)). Genu varum was found in 80 p. 100 of the patients in group A and in 76 p. 100 in group B, genu valgum in 16 p. 100 in group A and 24 p. 100 in group B. The same operator performed all the procedures) with the same type ok prosthesis for all patients. The goal of the operation was to position the prosthesis to produce an HKA of 180 +/- 3 degrees, a femoral angle of 90 degrees (from the mechanical axis), a tibial angle of 90 degrees and a posterior tibial slope of 0 degrees (tibial plateau at 90 degrees to the lateral tibial axis). Statview 5 PC was used for the statistical analysis. Comparisons between groups were made with the Student's t test to compare means when the validity conditions were met. RESULTS: The patients were reviewed by two surgeons, independently of the operator and the designers of the computer-assistance program. Mean duration of the procedure was longer in group B (102 mn versus 70 mn, p<0.001). There was no statistically significant difference in mean postoperative bleeding (group A=380 cc, group B=480 cc). The postoperative HKA was 181.2 +/- 2.72 degrees in group A and 179.04 +/- 2.53 degrees in group B (p > 0.05). The HKA was between 177 degrees and 183 degrees in 75 p. 100 of the patients in group A and in 84 p. 100 of those in group B. Implantation of the femoral component showed a mean angle of 91.12 +/- 2.07 degrees in group A and 89.56 +/- 1.61 degrees in group B (p=0.048). The mean tibial angle was 90.167 +/- 1.61 degrees in group A and 89.5 +/- 1.34 degrees in group B (p=0.11). On the lateral view, the femoral component was at 90 degrees to the mechanical axis in 16/21 patients in group B. These data were missing in group A. The posterior tibial slope was 90.76 +/- 2.19 degrees in group A and 89.44 +/- 2.14 in group B (p=0.18). CONCLUSION: Computer-assisted surgery for total knee arthroplasty was found to provide remarkably reliable results. Once the "growing pains" of this new material have been mastered, all surgeons should be able to expect an improvement in the positioning of prosthetic implantations.

Aged↗

Endemic fluorosis in Rajasthan.

Chronic fluoride (F) toxicity in the form of osteo-dental fluorosis was observed in both sexes of children and adults from ten villages viz., Bhavanpura, Dovada, Genhuwara, Gokulpura, Hathai, Kahela, Mandav, Nalwara, Pratappura and Samota located in the vicinity of alive F mines of Dungarpur district (Rajasthan) where F concentration in drinking waters varied from 1.2 to 8.9 ppm. At 1.7 and 6.1 mean F concentrations, 70.6% and 100.0% of children (< 18 years) and 68.0% and 100.0% adults, respectively, were found to be affected with dental fluorosis of varying grades. No much sex difference was seen in prevalence of dental fluorosis. Both prevalence and severity of dental mottling were found to be increased with increasing of F concentration and were found maximum in the 17-22 years age group. At these same F concentrations, 7.4% and 37.7% adults (> 21 years) were showing evidence of skeletal fluorosis, respectively. Although, skeletal fluorosis was also found in children with low prevalence (5.2%) but at high F concentration (4.8 ppm). The prevalence of skeletal fluorosis was relatively higher in males and increased with higher F level and age. Deformities such as crippling, kyphosis, invalidism and genu-varum were observed frequently in higher age group subjects (> 48 years) at a F concentration of 3.3 ppm. None of fluorotic individuals revealed evidence of genu-valgum syndrome and goitre (thyroidism). Radiological findings of other deformities in fluorotic subjects were also found. The distribution of F and endemic fluorosis in different districts of Rajasthan state have also been reviewed.

Adolescent↗

Osteotomy of the knee: is there a seat at the table?

Osteotomy is an alternative treatment for unicompartmental osteoarthritis of the knee. In genu varum, a high valgus closing wedge osteotomy is preferred, with overcorrection by 5 degrees. Complications and poor outcomes can be overcome by incomplete osteotomy with careful preoperative planning, precise use of cutting jigs, compression fixation, and early mobilization and weight bearing. Patella baja is related to postoperative immobilization, and unicompartmental arthroplasties are more difficult to revise because of bone loss. Supracondylar femoral osteotomy is preferred for genu valgum using a lateral opening wedge with a toothed plate, allowing easy access to the lateral compartment of the knee. Osteotomy, far from being obsolete, has an increasing role in joint resurfacing procedures.

Humans↗

Lateral approach without ligament release in total knee arthroplasty: new concepts in the surgical technique.

A lateral approach without ligament release was performed in 475 primary total knee arthroplasties (TKAs) in 344 patients and 50 revision TKAs in 39 patients. Deformities of the genu varum or valgum were corrected by accurate bone cut; no ligament releases were required other than to achieve adequate exposure. A lateral approach allowed both self-centering of the extensor mechanism and knee closure in complete flexion. Better range of motion was achieved. More than 90 degree active flexion usually occurred 3 days postoperatively. Postoperative roentgenograms showed all knees had good varus and valgus stability, which was sustained with time, except 1 with late genu recurvatum due to inadequate polyethylene thickness and the other with a broken tibial base plate. Complications such as disruption of patellar blood supply and knee instability, more frequently observed in the medial approach with ligament release, did not occur. The results suggest that this new technique is safe and may give better outcomes.

Arthroplasty, Replacement, Knee↗

New form of spondyloepimetaphyseal dysplasia (SEMD) in Jewish family of Iraqi origin.

We report a distinct type of spondyloepimetaphyseal dysplasia seen in 2 sibs and their second cousin, characterized by early onset severe short stature, small chest, and distended abdomen. They had short neck, severe lumbar lordosis, and marked genu varum due to fibular overgrowth and joint laxity. Radiographically, the patients had platyspondyly, initially noted during the first years of life, with central hypoplasia of the vertebral bodies. At a later age, the vertebrae appear squared with mild interpedicular narrowing. The long bone changes, which at early age resemble those seen in achondroplasia, later include general metaphyseal irregularities and significant epiphyseal ossification delay. These patients present a previously undescribed form of spondyloepimetaphyseal dysplasia, most probably transmitted as an autosomal recessive tract.

Child↗

Knee stabilization in patients with medial compartment knee osteoarthritis.

OBJECTIVE: Individuals with medial knee osteoarthritis (OA) experience knee laxity and instability. Strategies aimed at muscle stabilization may influence the long-term integrity of the joint. This study sought to determine how individuals with medial knee OA respond to a rapid valgus knee movement, to investigate the relationship between muscle-stabilization strategies and knee instability. METHODS: Twenty-one subjects with medial knee OA and genu varum and 19 control subjects were tested. Subjects stood with the test limb on a movable platform, comprising a plate that translated laterally to rapidly stress the knee's medial periarticular structures and create a potentially destabilizing sensation at the knee joint. Knee motion and muscle responses were recorded. Subjects rated the condition of their knee with a self-report questionnaire about knee instability during daily activities. RESULTS: Prior to plate movement, the OA subjects demonstrated more medial muscle co-contraction than did controls (P = 0.014). Following plate movement, the OA subjects shifted less weight off the test limb (P = 0.013) and had greater medial co-contraction (P = 0.037). OA subjects without knee instability had higher co-contraction of the vastus medialis medial hamstrings than did those who reported having instability that affected their daily activities (P = 0.038). More knee stability correlated positively with higher co-contraction of the vastus medialis medial hamstrings prior to plate movement (r = 0.459, P = 0.042). CONCLUSION: Individuals with medial knee OA attempt to stabilize the knee with greater co-contraction of the medial muscle in response to laxity that appears on the medial side of the joint only. This strategy presumably contributes to higher joint compression and could exacerbate joint destruction, and therefore needs to be altered to slow or stop the progression of the OA disease process.

Compartment Syndromes↗

The subchondral bone plate.

Pauwels (1965) and subsequent workers in the same field have shown that the distribution of the subchondral density within a joint surface can serve as a parametric measurement which reflects the main stress acting on a joint. Our own investigations on anatomical specimens have demonstrated that this subchondral mineralization does indeed show regular distribution patterns from which conclusions about the mechanical situation within an individual joint may be drawn. Since radiographical densitometry and histological methods are only available for determining the adaptive reaction of the bone to the particular mechanical situation in a joint after death, the information obtained applies only to an end situation and tells us nothing about the development of the changes with time. Furthermore, investigations carried out on human specimens by radiographical densitometry mostly apply to samples of a particular age, since such specimens can be acquired only from departments of pathology, forensic medicine or anatomy. The functional reactions of the bone tissue to repeated long-term changes in the loading--lengthy immobilization and subsequent remobilization, for instance, or heavy loading over a considerable period of time--cannot be followed by any ordinary method in experimental animals, since the death of the animal is a prerequisite for the precise quantitative examination of the bone tissue. This applies also to attempts to follow the process by means of animal experiments. CT OAM has been developed as a method which, based on CT, can provide a surface representation of the 3-D density distribution in the joints of living subjects. Comparative studies were carried out to establish and confirm the validity of the procedure. These have shown (1) that the results obtained from anatomical specimens are identical with those obtained in the living; (2) that secondary CT sections are suitable for evaluation and that the spectrum of joint surfaces examined can be extended to include the whole joint (if this were not so, effects caused by the apparatus--particularly the partial-volume effect--would render the procedure impossible); and finally (3) that the distribution of the Hounsfield density within the subchondral bone represents the distribution of the mineralization. The mineralization patterns found by us in different joints of normal subjects have shown that these patterns can be brought into line with current models of joint mechanics. The radiocarpal joint, for instance, has revealed the various types of loading occurring within physiological limits. Information has also been obtained about the age-related changes taking place in the hip, wrist and ankle joints. The increase of the total mineralization in gymnasts can be related to the qualitative and quantitative adaptation to an increased peak loading, and reduced mineralization to a lengthy reduction in use during, for instance, postoperative immobilization. In groups of patients with various diseases of mechanical origin (shoulder instability, malalignment of the main axis, defective repositioning of healed fractures, rupture of the rotator cuff, meniscectomy or rupture of the anterior cruciate ligament), a pattern of mineralization is found which is different from the normal picture. These findings reflect the abnormal mechanical situation. The mineralization pattern of the femoropatellar joint has revealed the differing etiologies of medial and lateral cartilage damage and the examination of patients with lunatomalacia has made it possible to recognize a genetic disposition. The postoperative comparison of the mineralization patterns of patients with genu varum who have undergone a correction osteotomy and the results of animal experiments on various procedures for reconstructing the anterior cruciate ligament or a primary replacement of the meniscus, have produced results which make it possible to judge the success or failure of the operation. (ABSTRACT TRUNCATED)

Calcification, Physiologic↗

[Symptoms and therapy of spontaneous osteonecrosis of the medial femoral condyle in elder patients (author's transl)].

The author reports on symptoms, therapy and results of a follow-up of 17 patients with the rare disease of osteonecrosis of the medial femoral condyle. The therapy depends on the extend of the necrosis, the axis of the leg and the results of scintigraphy or scintimetry and arthrography or arthroscopy. Small necroses can be treated conservatively, but in case of a genu varum a valgus-osteotomie should be performed. Bigger necroses are bored or bolted combined with a valgus-osteotomie, if necessary. Extensive osteonecroses can only be treated by partial endoprosthesis or autologue bone-cartilage-transplantation.

Aged↗

Cartilage-hair hypoplasia--clinical manifestations in 108 Finnish patients.

Cartilage-hair hypoplasia is an autosomal recessive metaphyseal chondrodysplasia with short-limbed short stature, hypoplastic hair, and defective immunity and erythrogenesis. We have analysed the clinical outcome of 108 Finnish patients. Birth length was below -2.0 SD in 70% of the patients; the adult heights ranged from -11.4 SD to -5.2 SD. The sitting height percentage was increased in all but 4 patients. Six patients had normal hair. Increased ligamentous laxity was present in 95%, limited extension of the elbows in 92%, increased lumbar lordosis in 85%, thoracal deformity in 68%, genu varum in 63% and scoliosis in 21% of the patients. Defective cellular immunity had been observed in 88% and increased susceptibility to infections in 56% of the patients. Six patients had died of primary infections. The incidence of malignancies was 6%. Childhood anaemia had occurred in 79% of the patients. It was usually mild, but severe in 14 patients. Hirschsprung disease had been observed in 8, anal stenosis in 1 and oesophageal atresia in 1 patient. The intrafamilial variation of the syndrome was considerable as studied in 16 sibships.

Body Height↗

Endemic chronic fluoride toxicity and dietary calcium deficiency interaction syndromes of metabolic bone disease and deformities in India: year 2000.

Epidemiological studies during 1963-1997 were conducted in 45,725 children exposed to high intake of endemic fluoride in the drinking water since their birth. Children with adequate (dietary calcium > 800 mg/d) and inadequate (dietary calcium < 300 mg/d) calcium nutrition and with comparable intakes of fluoride (mean 9.5 +/- 1.9 mg/d) were compared. The toxic-effects of fluoride were severe and more complex and the incidence of metabolic bone disease (rickets, osteoporosis. PTH bone disease) and bony leg deformities (genu valgum, genu varum, bowing, rotational and wind-swept) was greater (> 90%) in children with calcium deficiency as compared to < 25% in children with adequate calcium who largely had osteosclerotic form of skeletal fluorosis with minimal secondary hyperparathyroidism. The syndrome of skeletal fluorosis and associated metabolic bone disease and deformity is a unique clinical entity classified as a variant of osteosclerotic form of skeletal fluorosis. This syndrome chiefly results from the biological impact of excess fluoride, low calcium, high PTH and 1,25 (OH)2D3 separately and through their interactions on bone structure and metabolism as studied by radiology, bone scanning, bone histomorphometry and relevant metabolic and endocrine laboratory investigations. Metabolically active and vascular bones of children accumulate fluoride at faster and greater rate than adults (at the sites of active growth). In calcium deficient children the toxic effects of fluoride manifest even at marginally high (> 2.5 mg/d) exposures to fluoride. Fluoride toxicity also exaggerates the metabolic effects of calcium deficiency on bone. The findings strongly suggest that children with calcium deficiency rickets reported in the literature should be re-investigated for possible fluoride interactions. Deep bore drinking water supply with fluoride < 0.5 ppm and improvement of calcium nutrition provide 100% protection against the toxic effects of fluoride and are recommended as the cost effective and practical public health measures for the prevention and control of endemic fluorosis.

Adolescent↗

The therapeutic approach to osteoarthritis.

Ideally, treatment is based on etiology, if possible on pathophysiology, and in practice on anatomical and clinical findings. A systematic search for the etiological factors of osteoarthritis (OA) shows that the various mechanisms are frequently associated. Etiological treatments are rare. We may mention acetabular tectoplasty in hip dysplasia with minimal joint space narrowing. Valgus osteotomy would also be indicated for early medial tibiofemoral OA in genu varum if we had definite proof that, if left untreated, this deformity inevitably leads to clinically severe OA. This is not the case. One of the limitations of this etiological treatment lies in the fact that we do not know which patients are at risk of developing painful OA. Instead, certain risk factors for OA are known, so that primary and secondary prevention of the disease is possible. While age, sex and genetic predisposition are not amenable to preventive action, the same does not apply to the following factors: obesity, sports, and occupational activity. Thanks to in vitro studies of cultured normal and osteoarthritic chondrocytes and to experimental models of OA in animals, the pathophysiological mechanisms of OA are beginning to be better known. The prospect thus arises of "therapeutic manipulations" of precise pharmacological targets, even if it is still too soon to speak of true pathophysiological treatment of this disease. For instance, various interventions along the IL-1 pathway can be envisaged and have all been tested in animals. In practice, treating OA means taking into consideration its various signs: pain which appears to be mechanical and more or less chronic, joint stiffness, instability, effusion, and--the consequence of these symptoms--the professional, social and personal handicap of the patient. The treatment of OA must be approached from a global perspective, associating whenever possible symptomatic treatment, disease-modifying treatment, education and rehabilitation. In other words, the treatment of OA requires an overall approach, associating pharmacological and non-pharmacological modalities.

Aging↗

[Correction of the leg axis after epiphyseal fracture and progressive abnormal growth of the proximal tibia].

Development of an angular deformity around the knee joint, following a posttraumatic premature epiphyseal closure is a rare but serious complication. We present a case report of this complication following a proximal tibial epiphyseal injury in a 9 year old child initially treated conservatively with plaster immobilization. Subsequently, partial closure of epiphysis on medial side resulted in genu varum of 20 degrees, which was treated with medial open wedge osteotomy of the proximal tibia combined with resection of a segment from the proximal fibula, and a percutaneous epiphysiodesis of the proximal tibia and fibula. At three years follow up, the child had shortening of the leg by 1 cm, but no angular deformity. Significance of regular follow-up after an epiphyseal injury to detect the condition and role of operative management with various modalities is discussed.

Casts, Surgical↗

Valgus high tibial osteotomy. Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee.

A matched-pair comparative analysis was done comparing outcomes between a Coventry-type closing wedge valgus high tibial osteotomy (HTO) and an HTO using an Ilizarov apparatus. Thirty patients were treated with a mean follow-up interval of 28.1 months. Functional outcomes were evaluated using the Western Ontario and McMaster University (WOMAC) osteoarthritis index. Clinical and radiographic assessment of the index knee, complications, and over-all satisfaction of the patients were assessed. The procedures were performed between 1994 and 1997. The two groups were equal with respect to baseline demographics - age, sex, body mass index, smoking status. The patients undergoing an Ilizarov HTO had a significantly greater decrease in pain and increase in function at final follow-up assessment. Eleven of the 15 patients in the Ilizarov group were satisfied with the procedure compared to five in the closing wedge HTO group. The treatment of medial compartment osteoarthritis in genu varum of the knee with an Ilizarov apparatus produces outcomes that are comparable to the standard lateral closing wedge osteotomy.

Female↗

Severe bone deformities in young children from vitamin D deficiency and fluorosis in Bihar-India.

A case-control study was undertaken to understand the etiopathology of the bone deformities among young children in a fluoride-affected village of the Bihar State. Two villages were selected: one village with high fluoride in drinking water (7.9 +/- 4.15 ppm), and the other village with normal levels of fluoride (0.6 +/- 0.31 ppm) as the control village. The source of drinking water was bore wells in both the villages. Two hundred and forty subjects from 54 households (HHs) of the high-fluoride village (HFV) and 1443 subjects from 197 HHs of the control village were selected for the study. Dental mottling (DM) was observed in 50% and skeletal deformities of various forms were observed in 20% of the total population of HFV, whereas, in the control village, DM was 6% and skeletal deformities were absent. The prevalence of both, DM and skeletal deformities was high in the younger age group of 1.5 to 14 years. Genu valgum, genu varum, bowing of tibia, saber shin, and widening of the lower ends of long bones at the wrist were the typical skeletal deformities observed among affected children in the HFV. X-rays of the children with deformities revealed varying degrees of bending of bones and enlargement of epiphyseal ends of metaphyses with fraying of bone and ligamental calcification. A survey indicated significantly low calcium and high phosphorus intake among the population of the HFV as compared to that of the control village, possibly resulting from low intake of milk and high intake of potatoes, respectively. The mean urinary fluoride level was significantly higher in the children of the HPV, both with and without deformities, as compared to that of the control village. The mean serum 25 OHD3 (25 Hydroxy Vitamin D) and calcium levels were significantly lower and alkaline phosphatase activity was significantly higher among the children with deformities as compared to those without deformities from the HFV and the control village. Serum intact parathyroid hormone (IPTH) levels were high in children both with and without deformities in the HFV as compared to those in the control village. No significant differences were observed in the concentration of serum and urinary creatinine, and Cu, and Mg levels between the HFV and the control village. It can be concluded that some of the children from the HFV manifested severe bone deformities (rickets), which were confirmed by the existence of low serum calcium and vitamin D levels.

Adolescent↗

Unicompartmental osteoarthritis of the knee: an innovative osteotomy.

Thirty patients with unicompartmental osteoarthritis of the knee and genu varum deformity ranging from 2 degrees to 15 degrees were treated with high tibial osteotomy by using a medial open wedge, stabilized and distracted with our fixator. Pain relief and correction of deformity were achieved in all except two cases.

Aged↗