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PubMed1980

Tibial torsion calculated by computerised tomography and compared to other methods of measurement.

A new method for the measurement of tibial torsion using computerised transverse tomography is presented. Its accuracy is equal to that of cadaveric skeletal measurement. This method may be used in patients with unilateral post-traumatic torsional deformities, especially when these are combined with genu varum or valgum. The study of torsional aberrations in connection with congenital abnormalities of the foot is of further interest.

Bone Diseases↗
PubMed1997

Anatomical factors associated with overuse sports injuries.

Overuse injuries develop when repetitive stress to bone and musculotendinous structures damages tissue at a greater rate than that at which the body can repair itself. A combination of extrinsic factors, such as training errors and environmental factors, and intrinsic or anatomical factors, such as bony alignment of the extremities, flexibility deficits and ligamentous laxity, predispose athletes to develop overuse injuries. Malalignant of the lower extremity, including excess femoral anteversion, increased Q angle, lateral tibial torsion, tibia vara, genu varum or valgum, subtalar varus and excessive pronation are frequently cited as predisposing to knee extensor mechanism overuse injuries. These and other forms of malalignment have also been implicated in iliotibial band syndrome, medial tibial stress syndrome, lower extremity stress fractures and plantar fasciitis. Muscle inflexibility aggravates and predisposes to the development of a variety of overuse injuries, especially those occurring in children and adolescents, including the traction apophysitises. Flexibility deficits may be improved by an appropriate stretching programme. Unfortunately, lower extremity malalignment is less amenable to intervention. Orthotics are often prescribed to improve lower extremity alignment. However, studies have not shown that orthotics have any effect on knee alignment and, while they can alter subtalar joint alignment, the clinical benefit of this remains unclear. Awareness of anatomical factors that may predispose to overuse injuries allows the clinician to develop individual prehabilitation programmes designed to decrease the risk of overuse injury. In addition, the clinician can advise the athlete on the importance of avoiding extrinsic factors that may also predispose to overuse injury.

Arm↗
PubMed1998

Biomechanical risk factors for exercise-related lower limb injuries.

There is a significant risk of injury when undertaking physical activities. Abnormal biomechanics of the lower limb has been implicated as a causative factor for injury. Although there have been a large number of studies in this field, many lack consistency of definitions and methodology. A large number of these studies have been retrospective, and it is often impossible to identify the baseline population. The evidence suggests that limitation of range of ankle dorsiflexion, limitation of range of hip eversion, excessive joint laxity, leg length discrepancy, an excessively supinated or pronated foot, excessively high or low arches of the foot and a large Q-angle are risk factors for injury. On the other hand, there is little convincing evidence that an abnormal range of ankle plantar flexion, genu varum or valgum or undue muscle tightness may be potential risk factors. All of these biomechanical abnormalities need further evaluation as potential risk factors for injury. Any trials undertaken must endeavour to define and describe their methods fully, and ensure that their results are reproducible.

Ankle Joint↗
PubMed1977

Lateral widening of epiphyseal plates in knees of children with bowed legs.

Five children are described in whom genu varum was associated with widening of the lateral segment of epiphyseal growth plates at the knees. The proximal end of one tibia was involved in three cases and the distal end of one femur in two. This finding is thought to represent an epiphyseal diastasis caused by the low grade chronic stress of the bow leg deformity.

Adolescent↗
PubMed1989

Answer please. Blount's disease: tibia vara.

Infantile tibia vara, although uncommon compared to normal physiologic bowing, is significant due to the resultant progressive deformities if not diagnosed early. The key radiographic finding is medial tibial metaphyseal beaking and fragmentation. Although the etiology is unclear, it appears to be an acquired growth disturbance of the proximal medial tibial epiphysis, ossification center, and metaphysis rather than any type of avascular necrosis. The Langenskiöld six-stage classification is useful for the diagnostic, prognostic, and treatment staging of the disease. The adolescent form is less common and less severe with only slight irregular thickening of the physis present on radiograph. The MDA appears to be the most reproducible method for measuring angular deformities in both variants of the disease. Treatment of the infantile stages I or II consists of observation and bracing. Stage III or IV disease in children over age 3 years with more than 5 degrees of varus angulation should be treated with corrective valgus osteotomy. Stages V or VI may require repeated surgical treatment with multiple osteotomies and possible contralateral epiphysiodesis. The adolescent form frequently requires surgery when there is significant physical impairment related to the severe genu varum.

Child↗
PubMed1999

Rickets in two hand-reared polar bear (Ursus maritimus) cubs.

Two polar bear (Ursus maritimus) cubs born at the Denver Zoological Gardens were abandoned by a primiparous mother. Lethargic and extremely chilled, the cubs were transported to the zoo hospital for intensive care and hand rearing. Both cubs developed rickets. Dietary changes were instituted, and both cubs completely recovered with the exception of a bowed right femur (genu varum) in the female cub.

Alkaline Phosphatase↗
PubMed1998

[High tibial osteotomy combined with autogenous periosteal graft for osteoarthritis of knee].

The osteoarthritis of knee is a common disorder but no always to be treated satisfactorily. Between 1988 and 1992, the method, a high tibial osteotomy to correct the genu varum combined with autogenous periosteal or perichondrial graft to deal with the chondromalacia patella was used. Thirty-two patients (51 knees) were treated by this method and the patients were followed up for an average of 5.1 years. The excellent and good results were obtained in 90.2%. This method was obviously better than any other simple high tibial osteotomy. Therefore, this method was considered to be effective for treatment of osteoarthritis of knee with varum deformity and chondromalcia patella.

Female↗
PubMed2000

Practical primary pediatric orthopedics.

Pediatric orthopedic problems often puzzle the primary health provider and worry families. A thorough orthopedic history and examination by the primary care provider is all that is necessary to determine whether a problem requires further evaluation and referral. This article addresses a practical approach to common orthopedic problems, assessment, and management strategies from the specialist perspective. A general description of developmental dysplasia of the hip, foot misalignments, tibial torsion, toe-walking, genu varum (bowlegs), growing pains, sprains and fractures, and the child with a limp is provided. Management strategies before and after orthopedic referral are presented.

Child↗
PubMed2000

Nutritional rickets: report of four cases diagnosed at orthopaedic evaluation.

Nutritional rickets, the classic form of vitamin D-deficiency rickets, is rarely seen in the setting of modern medicine. We report four cases of nutritional rickets diagnosed at the time of orthopedic evaluation at our institutions during a 3-year period. All patients were referred by their pediatricians for evaluation of bowlegs. All children lived in a northern climate. Three were black and one was white. Prolonged breast-feeding and an unusual diet were identified as the underlying cause in our cases. Genu varum, seen in the setting of relative short stature and low weight, with a consistent social history, should raise the suspicion for nutritional rickets. The continued prevalence of this disease entity must be recognized in both the primary care and the orthopedic surgery setting. Vitamin D supplementation and enhanced sunlight exposure serve as effective prophylaxis and treatment of this disease.

Child, Preschool↗
PubMed2000

[False popliteal aneurysm after tibial osteotomy: a case report].

A 55-year-old man developed a pseudoaneurysm of the popliteal artery after tibial valgization osteotomy performed for degenerative genu varum. A tourniquet was used for the procedure. A wedge osteotomy was performed two centimeters under the joint line; the correction angle was ten degrees. Immediately after the end of the procedure, the distal pulses disappeared for ten minutes. Doppler exploration of the arterial network did not demonstrate any anomaly. Ten days postoperatively, the patient complained of sudden onset pain in the knee and tension in the popliteal fossa. Arteriography demonstrated a pseudo-aneurysm of the popliteal artery. The lesion caused an interruption of arterial flow and was successfully treated by emergency resection and suture.

Aneurysm, False↗
PubMed2001

Transmission of human immunodeficiency virus through bone transplantation: a case report.

Human immunodeficiency virus (HIV) can be transmitted through tissue or organ transplantation. Since 1988, eight cases of bone transplantation-associated HIV infection have been reported. We describe a 34-year-old woman with osteoarthritis, who was hospitalized in 1996 because of painful locomotion and deformity in the right knee. An old fracture of the femur and genu varum in the right knee was repaired by open reduction and internal fixation, with allogeneic bone transplantation for defect reconstruction. Five months later, she presented at another hospital with pain and swelling of the right thigh, where screening for HIV was positive. The transmission was tracked to a 50-year-old man with no history of HIV screening, from whom the femoral head was procured when he underwent a hip replacement for left femoral neck fracture. This is the first reported case of HIV infection through bone transplantation in Taiwan, and the preventable nature of this transmission should be underscored.

Adult↗
PubMed2001

[Epiphyseal distal torsion of the femur in osteoarthritic knees. A computed tomography study of 75 knees with medial arthrosis].

PURPOSE OF THE STUDY: We used computed tomography (CT) to measure external torsion of the distal femur preoperatively in patients with osteoarthritic knees presenting genu varum in order to assess the correlation between femoral distal external torsion (FDET) and radiological or epidemiological data obtained during the general preoperative work-up. MATERIAL AND METHODS: Seventy-five knees were studied in 38 patients. Mean age was 70.4 years; there were 13 men and 25 women. The degree of external torsion of the distal femur was defined as the angle measured on the CT-scan between a line drawn tangent to the most posterior part of the condyles and the epidondylar line drawn from the lateral epicondyle to the most prominent point of the medial epicondyle. This angle was compared with the angle of the epiphyseal tibial varum measured on the anteroposterior radiograph and the overall deviation of the lower limb (HKA), and with the angle between the mechanical axis and the femoral shaft axis (HKS). We assessed the effect of gender and sex and looked for correlations between the FDET angle and measurements made on standard radiographs. Student's t test was used compare the FDET angle by sex and side. The alpha risk was set at 5%. RESULTS: The FDET angle measured a mean 5.36 +/- 1.87 degrees (0-9 degrees ). We did not find any correlation between the FDET angle and tibial epiphyseal varum or HKS angles. A weak statistical correlation between the FDET and the HKA angles had no clinical value. Finally, the FDET angle was not correlated with sex or side. DISCUSSION: Computed tomography provides reliable and reproducible measurements. Our work clearly demonstrated the wide interindividual variability of the FDET angle. We were unable to identify any measurement on standard radiographs allowing an indirect prediction of the FDET angle. CONCLUSION: Our findings suggest that measuring the FDET angle on preoperative CT-scans in candidates for total hip arthroplasty can be useful for adapting the angle of rotation for the femoral component to each patient.

Adult↗
PubMedDate not supplied

External rotation contracture of the extended hip. A common phenomenon of infancy obscuring femoral neck anteversion and the most frequent cause of out-toeing gait in children.

External rotation contracture of the extended hip is common in young infants, decreasing progressively with growth so that it appears to be present in less than 5 per cent of the children over age 18 months. Persistence of the external rotation contracture was the main cause of toeing-out gait in this study. Femoral neck anteversion, as a cause of internal rotation posturing of the limb, does not become clinically recognizable until complete resolution of the external rotation contracture of the hip has occurred, that is, usually after 18 months of age. Femoral neck retroversion was not present clinically in any of the patients examined, and so appears to be quite rare. Approximately 80 per cent of children under 18 months of age who toe-in have internal tibiofibular torsion; most of these also have significant talar neck adductus! Approximately 70 per cent of children over age 2 years who toe-in have excess femoral neck anteversion as the cause. Approximately 75 per cent of the children with metatarsus adductus deformity have coexistent internal tibial torsion and talar neck adductus; only 25 per cent of children with internal tibial torsion have coexistent metatarsus adductus deformity. Physiologic genu varum usually occurs prior to 2 years of age and physiologic genus valgum usually occurs after 2 years of age.

Bone Diseases↗
PubMedDate not supplied

Relative tibial and femoral varus as a predictor of progression of varus deformities of the lower limbs in young children.

Many young children present to pediatric orthopaedic surgeons with genu varum and mild beaking of the medial metaphysis on x-ray. Predicting whether these deformities will progress is challenging. In addition, there is no consensus as to whether these children should all be classified as having Blount disease. To avoid this latter problem, the authors included in this study all children presenting with bowed legs, regardless of diagnosis. With the aim of improving the ability to predict progression, the authors tested the hypothesis that patients with progression have more tibial than femoral varus. The authors reviewed 173 varus limbs of 98 patients younger than 4 years old. The authors determined the angular deformity in both femur and tibia by measuring the angles between their mechanical axes and the transverse axis of the knee, and determined the contribution of tibial deformity as a percentage of the total (%DT). The metaphyseal-diaphyseal angles of the tibia (MDA) were also measured to compare the value of that test with the %DT. There were 22 limbs with progressive and 141 limbs with resolving varus. Both the MDA and %DT were significantly different between groups. Tibial varus was found to exceed femoral varus in all patients with progression and also in several patients whose deformity resolved spontaneously. Although more specific and more sensitive than the MDA, the %DT is a good, but not perfect, predictor of progression. However, all patients in this series with both a %DT >50% and an MDA of 16 degrees or greater went on to progress. Using both of these tests together may therefore provide the surgeon with a reliable indicator of the children who would benefit from surgical correction.

Bone Malalignment↗
PubMed1999

[A surgical treatment of early partial closure of the epiphysial plate].

OBJECTIVE: To introduce the technique of epiphysiolysis and epiphysis grafting in the treatment of early partial closure of the epiphysial plate in children, and evaluate its effect. METHODS: Retrospective study was performed in 10 cases of cubitus varus and valgus, or genu varum and valgum due to early partial closure of the epiphysial plate, 6 cases received simple cuneiform osteotomy, and 4 cases received epiphysioloysis and epiphysis grafting. RESULTS: Clinical outcoming after 6-month to 5-year's follow-up showed 1 case deformity of recurrence and 2 cases of non-isometric limb after simple osteotomy, while no recurrence and isometric limb after epiphysiolysis and epiphysis grafting. CONCLUSION: Epiphysiolysis and epiphysis grafting may effectively prevent the recurrence of postoperative deformity, and restore the longitudinal growth of limb.

Bone Diseases↗
PubMedDate not supplied

[Tibial osteotomy in the treatment of static gonarthrosis].

Results of 35 cases of subcondylar tibial osteotomy performed for static osteo-arthritis of the knee from 1072-75 are reported. The surgical procedure consists of an oblique osteotomy followed by the removal of a wedge of bone with an internal or external base depending on the presence of "genu valgum" or "genu varum" respectively. Bone ends are united by screws. Major advantages of this operation are solid bony union of the osteotomy sections by screws and simplicity of execution.

Aged↗
PubMed2002

[Utilization of a porous alumina ceramic spacer in tibial valgus open-wedge osteotomy: fifty cases at 16 months mean follow-up].

PURPOSE OF THE STUDY: The aim of this work was to study the behavior of an inert porous alumina ceramic spacer used with a plate fixation for open-wedge tibial valgus osteotomy in patients with osteoarthritis of the knee and genu varum. MATERIAL AND METHODS: The population included 50 patients who underwent surgery between October 1994 and December 2000. There were 31 women and 19 men, mean age 55 years at surgery (26 right knees and 24 left knees). Patients were reviewed at 3 weeks, 6 weeks, 3 months, 6 months, and one year, then every 2 years. Clinical and radiological data were available for all patients. RESULTS: Mean follow-up was 16 months. Two patients were lost to follow-up at 5 and 6 months. The results of the open-wedge tibial osteotomy were in agreement with the usual outcome reported in the literature concerning pain relief, functional recovery, joint motion, angle correction, and good preservation of the clinical and radiological result. Three fracture lines were observed on the lateral tibial plateau but did not affect final outcome or angle correction. There was however one case with loss of correction due to fracture of the screws. Radiographically, at 6 months, there were 9 thin lucent lines around the spacer (24%) which did not affect final outcome. Bone healing was achieved at 3 months on the average in all cases except 2 (4%) where healing was achieved at 8 and 13 months. DISCUSSION: The porous alumine spacer is a reliable biocompatible and mechanically stable element helpful for achieving bone healing. Integration into bone tissue was radiographically satisfactory. There were no specific complications related to use of the spacer.

Adult↗
PubMed2003

[Xenograft-related complications after filling valgus open wedge tibial osteotomy defects].

PURPOSE OF THE STUDY: The purpose of this study was to assess clinical tolerance and radiological and histological changes observed after using a safe bovine xenograft (Lubboc) to fill open wedge defects after tibial osteotomy for valgisation in patients with medial femoro-tibial degeneration. MATERIAL AND METHODS: Thirty-one valgus open wedge tibial osteotomies were filled with a xenograft (Lubboc) and fixed with an epiphyseal plate in 16 women and 13 men, mean age 55 years two months. All patients had medial femorotibial degeneration with genu varum. Mean varus deviation was 6 degrees. RESULTS: At two years six months follow-up, five patients had developed a local complication: three cases of non-infected discharge and two infections. Among the other 26 cases, the radiographic evolution of the xenograft was similar to that described for autologous grafts but for seven cases, a lucent line persisted, isolating the graft. A biopsy was obtained in fifteen patients during the material removal procedure. Cell infiltration was absent in nine grafts. DISCUSSION: In light of the large number of local complications and the unpredictable nature of the radiological and histological outcome xenografting should be discontinued.

Biocompatible Materials↗