Lateral Opening-Wedge Distal Femoral Osteotomy Made Easy: Tips and Tricks

A lateral opening-wedge distal femoral osteotomy is useful to offload the lateral tibiofemoral compartment for focal chondral defects or isolated lateral compartment arthritis. Although beneficial for these lateral compartment disorders, a distal femoral osteotomy requires careful forethought to optimize correction accuracy and safety. We recommend the following for effective execution of a distal femoral osteotomy: (1) Plan the desired correction preoperatively while accounting for an individual patient’s anatomy and femoral width. (2) Perform an iliotibial band Z-lengthening for large deformity corrections to not overconstrain the lateral structures. (3) Use the plate to help guide the level of the osteotomy, which will facilitate bony contact after the osteotomy and decrease plate prominence. (4) Perform the osteotomy with a saw anteriorly and an osteotome posteriorly for safety and stop the osteotomy approximately 1 cm short of the far cortex. (5) Fashion tricortical wedge grafts at the height of the planned correction to maintain reduction and facilitate plate placement. (6) Control the plate position to lie optimally at the level of the osteotomy, ensuring it is not proud and is parallel with the femoral shaft. With these presurgical and intraoperative steps, a lateral opening-wedge distal femoral osteotomy can be performed effectively

Osteochondral Allografts: Pearls to Maximize Biologic Healing and Clinical Success

We present an evidence-based approach to optimize the biologic incorporation of osteochondral allografts: (1) The donor graft is gradually rewarmed to room temperature to reverse the metabolic suppression from cold storage. (2) The graft is harvested while submerged in saline to limit thermal necrosis. (3) Subchondral bone depth is preferred at 4 to 6 mm depth (total plug depth ∼5-8 mm including articular cartilage) to reduce graft immunogenicity and to promote incorporation. (4) The bone is prepared with grooves/beveling to decrease impaction forces, increase access to subchondral deep zones during preparation, and promote graft-host interface healing. (5) High-pressure pulsed lavage is used to reduce antigenicity by removing marrow elements. (6) Pressurized carbon dioxide following pulsed lavage further reduces marrow elements and improves graft porosity for orthobiologic incorporation. (7) Orthobiologic substances (e.g., concentrated bone marrow aspirate) may enhance incorporation on imaging and result in greater osteogenic potential. (8) A suture is placed behind the graft to facilitate removal and repositioning; atraumatic graft insertion without high impaction forces maintains chondrocyte viability. These evidence-based pearls for osteochondral allograft handling optimize metabolic activity, reduce thermal necrosis, reduce antigenicity with removal of marrow elements, enhance biologic potential, and maintain chondrocyte viability to optimize biologic healing and clinical success

Charge distribution in chromium and vanadium catecholato complexes: X-ray absorption spectroscopic and computational studies

Copyright © 2006 American Chemical SocietyTransition-metal complexes with redox-active catecholato ligands are of interest as models of bioinorganic systems and as potential molecular materials. This work expands our recent X-ray absorption spectroscopic (XAS) studies of Cr(V/IV/III) triscatecholato complexes (Levina, A.; Foran, G. J.; Pattison, D. I.; Lay, P. A. Angew. Chem., Int. Ed. 2004, 43, 462-465) to a Cr(III) monocatecholato complex, [Cr(tren)(cat)]+ (tren = tris(2-aminoethyl)amine, cat = catecholato2-), and its oxidized analogue, as well as to a series of V(V/IV/III) triscatecholato complexes ([VL3]n-, where L = cat, 3,5-di-tert-butylcatecholato2-, or tetrachlorocatecholato2-, and n = 1-3). Various oxidation states of these complexes in solutions were generated by bulk electrolysis directly in the XAS cell. Increases in the edge energies and pre-edge absorbance intensities in XANES spectra, as well as decreases in the average M-O bond lengths (M = Cr or V) revealed by XAFS data analyses, are consistent with predominantly metal-based oxidations in both the Cr(V/IV/III) and V(V/IV/III) triscatecholato series, but the degree of electron delocalization between the metal ion and the ligands was higher in the case of Cr complexes. By contrast, oxidation of [Cr(III)(tren)(cat)]+ was mainly ligand-based and led to [Cr(III)(tren)(sq)]2+ (sq = semiquinonato-), as shown by the absence of significant changes in the pre-edge and edge features and by an increase in the average Cr-O bond length. The observed differences in electron-density distribution in various oxidation states of Cr and V mono- and triscatecholato complexes have been discussed on the basis of the results of density functional calculations. A crystal and molecular structure of (Et3NH)2[V(IV)(cat)3] has been determined at 25 K and the same complex with an acetonitrile of crystallization at 150 K.Carsten Milsmann, Aviva Levina, Hugh H. Harris, Garry J. Foran, Peter Turner, and Peter A. La