Articles: tibia-surgery.
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Osteotomies have a role in the active patient with degenerative joint disease of the medial or lateral knee who, for reasons of age or activity level, is not yet a good candidate for prosthetic arthroplasty. Recognition and treatment of malalignment associated with ligamentous instability is essential if long-term good outcomes are to be expected from ligamentous reconstruction. ⋯ This review examines the use of osteotomies about the knee in the athletic patient. Indications, contraindications, preoperative planning, surgical techniques, and complications are reviewed.
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Ortop Traumatol Rehabil · May 2010
Tibio-talo-calcaneal arthrodesis by a retrograde intramedullary nail.
The paper presents the results of tibio-talo-calcaneal fusions using Retrograde Nailing System and Bone Grafting. ⋯ 1- Arthrodesis should be considered only after all conservative treatments fails; it is one of the most challenging surgical procedures that must be undertaken with care in order to provide the best possible outcome. 2- Thorough evaluation and examination will help the surgeon to find the correct indication and identify patients who are not suitable for the procedure. It is crucial to assess the vascular and neurological status and to obtain weight-bearing radiographs (possibly CT) of the ankle to evaluate the deformity. 3- The optimal position of the ankle is in neutral flexion, 0-5 degrees valgus, and 10 degrees external rotation, similar to the contralateral foot and posterior translation of the talus under the tibia (5mm). 4- Tibio-talo-calcaneal fusion with retrograde nailing and bone grafting is a successful salvage procedure in severe ankle and hind foot arthrosis with deformity.
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High tibial osteotomy is technically demanding. Risks include injury to the popliteal neurovascular bundle. The present goal was to further define this risk. ⋯ To perform a safe osteotomy, the knee should be positioned in 90 degrees of flexion with the saw angled less than 30 degrees from the coronal plane. A protective device deep to the popliteus may protect against popliteal injury.
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Comparative Study
Biomechanical comparison of blade plate and intramedullary nail fixation for tibiocalcaneal arthrodesis.
Tibiocalcaneal arthrodesis is an uncommon salvage procedure used for complex problems of the ankle and hindfoot. A biomechanical evaluation of the fixation constructs of this procedure has not been studied previously. The purpose of this study was to compare intramedullary nail to blade plate fixation in a deformity model in fatigue endurance testing and load to failure. ⋯ The ankle arthrodesis intramedullary nail provides greater stiffness for fixation in tibiocalcaneal arthrodesis, which may improve healing.
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Knee Surg Sports Traumatol Arthrosc · Feb 2010
Randomized Controlled TrialEffect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study.
Open-wedge high tibial osteotomy (HTO) is becoming increasingly popular for the treatment of varus gonarthrosis in the active patient. The various implants used in HTO differ with regard to its design, the fixation stability and osteotomy technique. It is assumed that the combination of a plate fixator with a biplanar, v-shaped osteotomy supports bone healing. ⋯ However, biplanar osteotomy increased the fixation stability significantly in AP and rotational planes when a short spacer plate was used. Clinically, the biplanar osteotomy promotes bone healing regardless of the implant used. Biomechanically, biplanar osteotomy is advantageous for shorter plate designs to increase primary stability of the bone-implant construct.