9 research outputs found
One-stage Metatarsal Lengthening by Allograft Interposition: A Novel Approach for Congenital Brachymetatarsia
Background Congenital brachymetatarsia, a shortened
metatarsal bone, can be corrected surgically by callus
distraction or one-stage lengthening using bone graft.
Questions/purposes We asked whether one-stage metatarsal
lengthening using metatarsal homologous bone graft
could improve forefoot function, lead to metatarsal healing,
restore metatarsal parabola, and improve cosmetic
appearance.
Patients and Methods We retrospectively reviewed 29
patients (41 feet) in whom we lengthened 50 metatarsals.
Surgery consisted of a transverse proximal osteotomy of
the metatarsal shaft and interposition of a metatarsal
homologous bone graft (average, 13 mm long) fixed with
an intramedullary Kirschner wire. Minimum followup was
3 years (mean, 5 years; range, 3–11 years).
Results Bone union was achieved in all cases. The mean
preoperative American Orthopaedic Foot and Ankle Society
score was 37 points (range, 28–53 points) and the mean
postoperative score was 88 points (range, 74–96 points), with
an average improvement of 51 points. Radiographically, the
mean gain in length was 13 mm (range, 10–15 mm), and the
mean percentage increase was 23%.
Conclusions One-stage metatarsal lengthening using
interposition of metatarsal homologous bone graft to correct
congenital brachymetatarsia has low morbidity for the
patient, limited complications, short recovery times, and
restores forefoot anatomy.
Level of Evidence Level IV, therapeutic study. See
Guidelines for Authors for a complete description of levels
of evidence
Surgical Treatment of A2-2 A2-3 Intertrochanteric Fractures by Total Hip Arthroplasty in Old Osteoporotic Patients
Fixation of Winged Scapula in Facioscapulohumeral Muscular Dystrophy
Objective: To verify if stabilizing the scapulothoracic joint without arthrodesis could lead to functional improvement of shoulder range of motion and clinical improvement of winged scapula, we incorporated four additional patients into our previous analysis to determine if the results obtained were long lasting, and to compare this fixation with the other techniques described in the literature, balancing the benefits with the complications
Sagittal Segmental Alignment as Predictor of Adjacent-Level Degeneration After a Cloward Procedure
Aseptic Forearm Nonunions Treated by Plate and Opposite Fibular Autograft Strut
Forearm nonunion frequently changes the relationship between the radius and ulna and may lead to impairment of forearm function. We propose a new surgical technique for aseptic forearm nonunions combining a fibular cortical autograft strut with a metal plate and a fibular intercalary autograft in cases with a segmental bone defect. We retrospectively reviewed 20 patients with a mean age of 31 years (range, 17–48 years) at the time of surgery. Minimum followup was 12 years (mean, 14 years; range, 12–21 years). There were no intraoperative or postoperative complications. At last followup, all forearm bones had remodeled. The mean visual analog pain scale was 1 (range, 0–3). Forearm function improved; there were no radiographic signs of ankle arthritis at followup. Surgical treatment of aseptic forearm nonunions by combining a massive fibular cortical autograft strut with a plate and associating a fibular intercalary autograft in case of a segmental bone defect led to bone healing, improved forearm function, and a durable outcome with long-term followup
Rupture of the tibialis posterior tendon in a closed anklefracture: a case report
Rupture of the tibialis posterior tendon may occur during a trauma in pronation-external rotation of the foot or, less commonly, during a direct trauma of the ankle. When an isolated fracture of the medial malleolus is present, it is more likely that a direct trauma has occurred. A 36-year-old man with a non-displaced medial malleolar fracture was evaluated. Repair of the tendon and reduction of the fracture were performed. Twenty-four months after the operation, the fracture was completely healed, the patient was asymptomatic, he had a normal ankle range of motion, and the function and strength of the tibialis posterior tendon were equal to those on the contralateral side. Early surgical repair of the tibialis posterior tendon combined with malleolar fracture reduction is recommended to avoid progression to a plano-valgus foot
Scapulopexy of winged scapula secondary to facioscapulohumeral muscular dystrophy
Facioscapulohumeral muscular dystrophy is an hereditary disease that causes weakness of the scapulothoracic muscles and leads to winged scapula. Patients with facioscapulohumeral muscular dystrophy are unable to sustain shoulder abduction or flexion and are limited in daily activities. We retrospectively reviewed nine patients (18 procedures) who had scapulothoracic fixation without arthrodesis (scapulopexy). The technique consists of repositioning the scapula over the rib cage and fixation to four ribs with metal wires. We assessed improvement in range of motion of the shoulder, maintenance of the correction with time, and cosmetic and functional results. The average age of the patients at surgery was 25.2 years (range, 15-35 years), and there were no major complications. The average followup was 9.9 years (range, 3-16 years). All patients had complete resolution of the winged scapula and improved range of motion. Arm abduction increased from an average of 68.3 degrees (range, 45 degrees-90 degrees) preoperatively to 96.1 degrees (range, 60 degrees-120 degrees) postoperatively. Arm flexion increased from an average of 57.2 degrees (range, 45 degrees-90 degrees) preoperatively to 116.1 degrees (range, 80 degrees-180 degrees) postoperatively. The position of the scapula obtained by surgery was maintained with time, and the patients had satisfactory cosmetic results. Level of Evidence: Therapeutic study, Level IV. See the Guidelines for Authors for a complete description of levels of evidenc