1/34. Nonunion of tibial stress fractures in patients with deformed arthritic knees. Treatment using modular total knee arthroplasty.In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united. A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis.- - - - - - - - - - ranking = 1keywords = deformity (Clic here for more details about this article) |
2/34. Partial growth plate fusion caused by burn.growth plate fusion is a rare but important complication of burn injury in childhood. Reported cases are all of complete fusion. We present a case of partial fusion of the growth plates secondary to a burn injury, which to our knowledge has not been reported in the literature before. Partial fusion of the growth plate behaves differently as compared with complete fusion, and if treated at an early stage by appropriate surgery limb deformity and long-term disability may be prevented. The importance of early recognition and treatment cannot be overemphasized.- - - - - - - - - - ranking = 0.5keywords = deformity (Clic here for more details about this article) |
3/34. Juvenile Blount's disease: bilateral case with asynchronous onset.We encountered a rare case of bilateral juvenile Blount's disease diagnosed as unilateral at the onset. The patient was a 9-year-old girl who visited our outpatient clinic with pain and deformity in the left knee. Examination of the left knee showed severe varus deformity. Correction of the varus deformity and tibial shortness was carried out at the same time by the callotasis method using an Orthofix external fixator. During follow-up the varus deformity in her right knee gradually progressed. At 18 months after the initial surgery, the right varus deformity and tibial shortness were corrected at the same time by the callotasis method using an Orthofix external fixator; proximal epiphysiodesis was also performed. The coronal-plane alignment of both knees remains good. In cases with bilateral involvement of Blount's disease, the onset of the deformity is usually nearly synchronous. In some cases, however, it begins unilaterally, as with this patient, so it is essential to check both sides by means of tomography or magnetic resonance imaging and not just radiography. Moreover, we must be careful to plan the treatment in such a case so as to anticipate possible leg-length discrepancy problems.- - - - - - - - - - ranking = 3keywords = deformity (Clic here for more details about this article) |
4/34. Recognition of progressive atlanto-occipital dislocation (by a changing neurologic status and clinical deformity).We present a case of progressive atlanto-occipital dislocation, recognized by a new onset of positive neurologic findings. We discuss the anatomic relationship of the lower four cranial nerves to the foramen magnum and the atlanto-occipital joint. The importance of careful assessment of the cranial nerves prior to choosing a treatment algorithm is emphasized.- - - - - - - - - - ranking = 2keywords = deformity (Clic here for more details about this article) |
5/34. arthroplasty in treating knee osteoarthritis and proximal tibia stress fracture.The authors describe two cases of severely angulated tibial non-unions after proximal tibia stress fractures associated with ipsilateral osteoarthritis treated with modular knee endoprosthesis with a long tibial stem to stabilize non-union fragments. During the procedure, no additional osteosynthesis or bone grafting was added. Both non-unions healed after 6 months with no post-operative complications. The authors suggest implantation of modular knee endoprosthesis, as a single procedure, in treatment of proximal tibia non-union after a stress fracture as a result of severe varus/valgus deformity. It provides a solution for osteoarthritis treatment, axis correction and non-union osteosynthesis.- - - - - - - - - - ranking = 0.5keywords = deformity (Clic here for more details about this article) |
6/34. genu valgum secondary to focal fibrocartilaginous dysplasia of the distal femur.We report a case of unilateral genu valgum secondary to focal fibrocartilaginous dysplasia (FFCD) isolated in the posterolateral cortex of the distal femur. This case is the first incidence of a discrete fibrous band occurring in conjunction with a FFCD lesion in the distal posterolateral femur treated with excision of the tether and the overlying periosteum with curettage of the cortical focal fibrocartilaginous defect. Treatment was considered successful with gradual resolution of the 30 degrees valgus deformity over 24 months, and we avoided the necessity of corrective osteotomy and its associated risks. To our knowledge, resolution of genu valgum secondary to FFCD in the distal posterolateral femur after curettage has not been previously described in the literature.- - - - - - - - - - ranking = 0.5keywords = deformity (Clic here for more details about this article) |
7/34. Opening-wedge osteotomy, allografting with dual buttress plate fixation for severe genu recurvatum caused by partial growth arrest of the proximal tibial physis: a case report.Injuries to the proximal tibial physis are among the least common epiphyseal injuries. We present a case of severe genu recurvatum deformity (45 degrees) with leg length discrepancy (4 cm) following a neglected proximal tibial physeal injury incurred 6 years previously. The 16-year-old patient was successfully treated by open-wedge osteotomy, allograft reconstruction, and dual buttress plate fixation. At 3 years' follow-up, the patient was asymptomatic, fully active with a full range of motion (0 - 140 degrees) of the leg, and equal leg lengths. There were no signs of genu recurvatum clinically.- - - - - - - - - - ranking = 0.5keywords = deformity (Clic here for more details about this article) |
8/34. Valgus and varus deformity after wide-local excision, brachytherapy and external beam irradiation in two children with lower extremity synovial cell sarcoma: case report.BACKGROUND: Limb-salvage is a primary objective in the management of extremity soft-tissue sarcoma in adults and children. Wide-local excision combined with radiation therapy is effective in achieving local tumor control with acceptable morbidity and good functional outcomes for most patients. CASE PRESENTATION: Two cases of deformity after wide-local excision, brachytherapy and external beam irradiation for lower-extremity synovial cell sarcoma are presented and discussed to highlight contributing factors, time course of radiation effects and orthopedic management. In an effort to spare normal tissues from the long-term effects of radiation therapy, more focal irradiation techniques have been applied to patients with musculoskeletal tumors including brachytherapy and conformal radiation therapy. As illustrated in this report, the use of these techniques results in the asymmetric irradiation of growth plates and contributes to the development of valgus or varus deformity and leg-length discrepancies. CONCLUSIONS: Despite good functional outcomes, progressive deformity in both patients required epiphysiodesis more than 3 years after initial management. There is a dearth of information related to the effects of radiation therapy on the musculoskeletal system in children. Because limb-sparing approaches are to be highlighted in the next generation of cooperative group protocols for children with musculoskeletal tumors, documentation of the effects of surgery and radiation therapy will lead to improved decision making in the selection of the best treatment approach and in the follow-up of these patients.- - - - - - - - - - ranking = 3.5keywords = deformity (Clic here for more details about this article) |
9/34. The 'anvil' osteophyte-a primary cause of fixed flexion of the knee?Three cases are reported in which clinical presentation was with arthritic symptoms and inability to straighten the knee. An unusually prominent anterior tibial osteophyte, whose shape is remarkably suggestive of a blacksmith's anvil, appeared to be a contributory factor through its apparent impingement with the femoral trochlea at the limit of extension. The osteophyte was radically removed arthroscopically in each case as an isolated gesture, and the patients were followed up with particular emphasis on fixed flexion deformity. At clinical review, after a mean follow-up period of 5.3 years, it was concluded that there had not been a convincing or sustained improvement in knee function, although the fixed flexion deformities had not increased significantly. Our conclusion is that the 'anvil' osteophyte may simply be a part of a more diffuse degenerative process and that it was probably not, in itself, the primary cause of fixed flexion deformity in these cases.- - - - - - - - - - ranking = 1keywords = deformity (Clic here for more details about this article) |
10/34. regeneration of the proximal tibial epiphysis after infantile osteomyelitis: report of three cases with an eight- to 22-year follow-up.We reviewed three infants with destructive osteomyelitis involving the proximal tibial epiphysis at a follow-up of eight to 22 years. All cases showed early radiographic destructive changes in the medial or lateral aspects of the epiphysis and metaphysis. Despite the ominous early appearance of the epiphysis, all cases showed spontaneous re-ossification of the epiphysis with restoration of the tibial condyle and preservation of joint congruity. The patients, however, developed a valgus or varus deformity which was treated satisfactorily with one to three proximal tibial osteotomies. The potential for regeneration of the epiphysis following infantile osteomyelitis of the proximal tibia suggests these cases should be treated expectantly with regard to joint congruity.- - - - - - - - - - ranking = 0.5keywords = deformity (Clic here for more details about this article) |
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