Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of ...Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of different internal fixations in open-wedge HTO using the two currently available locking plates. Methods: Eight paired fresh-frozen cadaveric lower extremities were vertically embedded in steel boxes. The axial compression load was applied to the legs using the mechanical testing machine. The axial compression load test from 0 N to 550 N and the failure test were performed before and after HTO. One side of the leg of a specimen was fixed with the Puddu locking plate and the other side was fixed with the TomoFix plate to compare the two plates using the same specimen. A mode of failure and vertical displacement of the medial and lateral parts of the tibia at the osteotomy gap was recorded using a video camera in the failure test. The load–displacement data were analyzed to calculate stiffness, failure load, and displacement at failure. Results: The mean failure load was 1471.4 N and 1692.3 N and total vertical displacement at failure was 3.1 mm and 2.9 mm with the Puddu and TomoFix plates, respectively. During axial compression loading, displacements mainly occurred at the lateral osteotomy gap, while the medial gap was well preserved. No significant differences were observed in the failure load, displacement, or mode of failure between the two plates. Conclusions: The Puddu and TomoFix plates had similar biomechanical properties in open-wedge HTO. The results indicated reliable stability after open-wedge HTO without fibular osteotomy.展开更多
Background: Biplanar medial opening wedge high tibial osteotomy (MOWHTO) is a treatment method that allows adequate correction of symptomatic varus knee deformity. However, MOWHTO tends to decrease patellar height and...Background: Biplanar medial opening wedge high tibial osteotomy (MOWHTO) is a treatment method that allows adequate correction of symptomatic varus knee deformity. However, MOWHTO tends to decrease patellar height and increase the posterior tibial slope, which can affect the knee joint stability. Objective: The aim of this study was to describe the technique of biplanar MOWHTO and fixation by TomoFix plate, as well as to evaluate the accuracy of the planned correction and the postoperative tibial slope. Patients and Methods: This prospective cohort study was conducted on patients who presented with varus knee deformity and underwent biplanar MOWHTO and fixation by TomoFix plate during the period from March 2016 to March 2017. Assessment of patients included pre- and postoperative Knee and function scores, mechanical femorotibial angle (mFTA), posterior tibial slope angle (pTSA), range of motion (ROM) and radiological evaluation of the healing of the osteotomy site. Results: The recruited patients were 13 (8 men and 5 women), with average age 31.7 years old. The knee and functional scores improved from the preoperative mean of 45 and 41 to the postoperative mean of 85 and 72 points, respectively. The average knee flexion was 115 degrees, which at the final follow-up remained unchanged except for one case. The mean preoperative mFTA was 13.5°varus and decreased post-operatively to a mean of 3°valgus. The average postoperative follow-up period was 12 months (10 - 18 M). Conclusion: The biplanar MOWHTO allows preservation of posterior tibial slope while correcting the varus knee adequately.展开更多
Background: complex proximal tibial fractures (Types V & VI of Schautzker classification) are the major problems in orthopedic surgery and associated with high complication rates. There are many alternatives in tr...Background: complex proximal tibial fractures (Types V & VI of Schautzker classification) are the major problems in orthopedic surgery and associated with high complication rates. There are many alternatives in treatment of these fractures. Aim: to evaluate the results of double plating with single anterior incision in complex proximal tibial fractures (Types V& VI of Schautzker classification).Methods and Materials: 22 patients (16 males and 6 females) with Types V and VI of Schautzker classification of proximal tibial fractures (14 cases were Type V and 8 cases were Type VI) were treated by double plating with single anterior incision method between May 2006 and May 2011. The bony and functional outcome was evaluated according to Knee Society Score. Results: According to Knee Society Score, the results were as follows: excellent in 19 patients (86.4%), good in 2 patients (9.1%), fair in 1 patient (4/5%), and poor in no patient (0%).Conclusion: the double plate fixation with single anterior incision is the best, effective and simple procedure in treatment of complex proximal tibial fractures (Types V and VI of Schautzker classification).展开更多
Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resecti...Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone(genu varum) will result in persistence of the internal tibial torsion(the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount's disease. Both coronal and axial deformities were corrected in this patient. We propose this combination(rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount's disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.展开更多
文摘Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of different internal fixations in open-wedge HTO using the two currently available locking plates. Methods: Eight paired fresh-frozen cadaveric lower extremities were vertically embedded in steel boxes. The axial compression load was applied to the legs using the mechanical testing machine. The axial compression load test from 0 N to 550 N and the failure test were performed before and after HTO. One side of the leg of a specimen was fixed with the Puddu locking plate and the other side was fixed with the TomoFix plate to compare the two plates using the same specimen. A mode of failure and vertical displacement of the medial and lateral parts of the tibia at the osteotomy gap was recorded using a video camera in the failure test. The load–displacement data were analyzed to calculate stiffness, failure load, and displacement at failure. Results: The mean failure load was 1471.4 N and 1692.3 N and total vertical displacement at failure was 3.1 mm and 2.9 mm with the Puddu and TomoFix plates, respectively. During axial compression loading, displacements mainly occurred at the lateral osteotomy gap, while the medial gap was well preserved. No significant differences were observed in the failure load, displacement, or mode of failure between the two plates. Conclusions: The Puddu and TomoFix plates had similar biomechanical properties in open-wedge HTO. The results indicated reliable stability after open-wedge HTO without fibular osteotomy.
文摘Background: Biplanar medial opening wedge high tibial osteotomy (MOWHTO) is a treatment method that allows adequate correction of symptomatic varus knee deformity. However, MOWHTO tends to decrease patellar height and increase the posterior tibial slope, which can affect the knee joint stability. Objective: The aim of this study was to describe the technique of biplanar MOWHTO and fixation by TomoFix plate, as well as to evaluate the accuracy of the planned correction and the postoperative tibial slope. Patients and Methods: This prospective cohort study was conducted on patients who presented with varus knee deformity and underwent biplanar MOWHTO and fixation by TomoFix plate during the period from March 2016 to March 2017. Assessment of patients included pre- and postoperative Knee and function scores, mechanical femorotibial angle (mFTA), posterior tibial slope angle (pTSA), range of motion (ROM) and radiological evaluation of the healing of the osteotomy site. Results: The recruited patients were 13 (8 men and 5 women), with average age 31.7 years old. The knee and functional scores improved from the preoperative mean of 45 and 41 to the postoperative mean of 85 and 72 points, respectively. The average knee flexion was 115 degrees, which at the final follow-up remained unchanged except for one case. The mean preoperative mFTA was 13.5°varus and decreased post-operatively to a mean of 3°valgus. The average postoperative follow-up period was 12 months (10 - 18 M). Conclusion: The biplanar MOWHTO allows preservation of posterior tibial slope while correcting the varus knee adequately.
文摘Background: complex proximal tibial fractures (Types V & VI of Schautzker classification) are the major problems in orthopedic surgery and associated with high complication rates. There are many alternatives in treatment of these fractures. Aim: to evaluate the results of double plating with single anterior incision in complex proximal tibial fractures (Types V& VI of Schautzker classification).Methods and Materials: 22 patients (16 males and 6 females) with Types V and VI of Schautzker classification of proximal tibial fractures (14 cases were Type V and 8 cases were Type VI) were treated by double plating with single anterior incision method between May 2006 and May 2011. The bony and functional outcome was evaluated according to Knee Society Score. Results: According to Knee Society Score, the results were as follows: excellent in 19 patients (86.4%), good in 2 patients (9.1%), fair in 1 patient (4/5%), and poor in no patient (0%).Conclusion: the double plate fixation with single anterior incision is the best, effective and simple procedure in treatment of complex proximal tibial fractures (Types V and VI of Schautzker classification).
文摘Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone(genu varum) will result in persistence of the internal tibial torsion(the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount's disease. Both coronal and axial deformities were corrected in this patient. We propose this combination(rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount's disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.
