Osteotomy

Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. The authors discuss a suitable approach to help guide surgical treatment, including decompression, instrumented posterior spinal fusion, anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy.

Surgical techniques for the management of hallux rigidus include cheilectomy, Keller resection arthroplasty, arthrodesis, Silastic implantation, phalangeal or metatarsal osteotomy, capsular arthroplasty, partial or total joint replacement, interposition arthroplasty. However, the optimal management is controversial. We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 2 November 2010. Sixty-nine articles published in peer reviewed journals were included in this comprehensive review. Cheilectomy and first metatarsal or phalangeal corrective osteotomy may provide better outcome for patients with early and intermediate hallux rigidus (Stages I-II), while arthrodesis or arthroplasty are indicated to manage more severe conditions. The Coleman Methodology Score showed great heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment and generally low methodological quality. Definitive conclusions on the use of these techniques for routine management of patients with hallux rigidus are not possible. Given the limitations of the published literature, especially the extensive clinical heterogeneity, it is not possible to compare outcomes of patients undergoing different surgical procedures and determine clear guidelines. To assess whether benefits from surgery, validated and standardized measures should be used to compare the outcomes of patients undergoing standard surgical procedures. There is a need to perform appropriately powered randomized clinical trials of using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up .2 years.

It was the aim of the present prospective study to quantify the gain in height of implant sites by endoscopically controlled osteotome sinus floor elevations (ECOSFE) with simultaneous implant placement and to report the number of sinus membrane perforations. Materials and Methods: From October 1999 to December 2000, of 92 sinus floor elevations, 18 were carried out endoscopically controlled with an osteotome technique. As augmentation material, ␤-tricalcium phosphate (␤-TCP) or autogenous bone was used; 22 implants were placed. Results: The residual height of the alveolar crest in the posterior maxilla was 6.8 ± 1.6 mm on average. The implant lengths ranged from 10 to 16 mm (mean implant length 12.2 ± 1.4 mm). They were significantly larger than the residual height of the alveolar crests (P < .0005). Elevation of the sinus floor with an osteotome had to be supported by conventional sinus floor elevation instruments after a mean elevation of 3.0 ± 0.8 mm to prevent perforation of the sinus membrane. However, 1 perforation occurred, which was repaired with a periosteal patch. At stage 2 surgery, 2 implants were removed because of mobility. Endoscopic control revealed one case in which ␤-TCP could be found within the sinus; another case showed areas of polypoid mucosa on the sinus floor. Discussion: With the ECOSFE, perforations of the sinus membrane can be visualized; however, they cannot be avoided. Although this technique is less invasive than the lateral window technique, it cannot be recommended as a standard procedure in the posterior maxilla because of the large amount of additional equipment needed and the technically demanding procedure. Conclusion: The use of the ECOSFE should be confined to scientific trials.

Objectives To evaluate the ability of an alignment jig/saw guide to reproduce appropriate osteotomy positions in the tibial plateau leveling osteotomy (TPLO) in the dog. Methods Lateral radiographs of 65 clinical TPLO procedures using an alignment jig and freehand osteotomy performed by experienced TPLO surgeons using a 24 mm radial saw blade between Dec 2005-Dec 2007 and Nov 2013-Nov 2015 were reviewed. The freehand osteotomy position was compared to potential osteotomy positions using the alignment jig/ saw guide. The proximal and distal jig pin holes on postoperative radiographs were used to align the jig to the bone; saw guide position was selected to most closely match the osteotomy performed. The guide-to-osteotomy fit was categorized by the distance between the actual osteotomy and proposed saw guide osteotomy at its greatest offset (1 mm = excellent; 2 mm = good; 3 mm = satisfactory; >3 mm = poor). Results Sixty-four of 65 TPLO osteotomies could be matched satisfactorily by the saw guide. Proximal jig pin placement 3-4 mm from the joint surface and pin location in a craniocaudal plane on the proximal tibia were significantly associated with the guide-to-osteotomy fit (P = 0.021 and P = 0.047, respectively). Clinical Significance The alignment jig/saw guide can be used to reproduce appropriate freehand osteotomy position for TPLO. Furthermore, an ideal osteotomy position centered on the tibial intercondylar tubercles also is possible. Accurate placement of the proximal jig pin is a crucial step for correct positioning of the saw guide in either instance.

A variety of surgical osteotomy procedures have been described for the bunionette deformity.Metatarsal osteotomies narrow the forefoot, maintain the length of the metatarsal, and preserve function of the metatarsophalangeal joint. Distal metatarsal osteotomies produce less correction and reduce postoperative disability; however, they pose a risk of inadequate correction because of the small width of the fifth metatarsal head and transfer lesions if shortened or dorsiflexed excessively. The sliding oblique metaphyseal osteotomy described by Smith and Weil (without fixation) and later by Steinke (with fixation) is easy to perform and provides good cancellous bone contact. Fixation is sometimes difficult and bone healing can take a few months owing to the unstable construct of this osteotomy. Kitaoka described a distal chevron osteotomy, which provides lateral pressure relief and reduced plantar pressure. This osteotomy is currently the most common procedure used; however, it may prove...

Osteotome techniques are used as a less invasive alternative to the lateral window osteotomy to increase the volume of bone in the posterior maxilla. Implants may be placed simultaneously for four to six months after performing osteotome-mediated sinus floor elevation, depending upon the residual crestal bone remaining beneath the sinus floor. This article describes the clinical indications and techniques for localized internal sinus elevation using osteotomes. The incorporation of this minimally invasive crestal approach to sinus augmentation into the clinical practice results in increased case acceptance with reduced treatment duration, trauma and cost.

Thirty nine surgical hallux valgus corrections in 32 adolescents (7 bilateral) performed between 1994 and 2001 were retrospectively studied. The mean age at the time of surgery was 14.2 years. The operation consisted of a proximal dome osteotomy of the first metatarsal, excision of the medial protuberance, lateral capsular and adductor release, and distal medial soft tissue plication. The patients were followed for an average of 42 months (range 32 to 62). Post-operative evaluation was based on the duPont bunion rating score. The result was excellent in 11 feet, good in 22 cases, fair in 5 and poor in 1 case. Using subjective criteria of the duPont score, such as cosmesis and discomfort, a satisfactory result was achieved in 35 feet (90%). Our opinion is that correction of the angle between the 1st and 2nd metatarsal as well as preservation of the length of the first metatarsal are of crucial importance in the surgical treatment of adolescent hallux valgus.

To determine whether implant density impact three-dimensional deformity correction in posterior spinal fusion (PSF) without Ponte osteotomies (POs) for patients with Lenke 1 and 2 adolescent idiopathic scoliosis (AIS). Overview of Literature: Currently, the optimal pedicle screw (PS) density for flexible moderate-sized thoracic AIS curve correction is still controversial. There are limited data regarding the impact of implant density on three-dimensional correction in PSF without the use of PO for thoracic AIS surgery. Methods: A database of patients with AIS with Lenke 1 and 2 curves treated with PSF without PO and instrumented with PSs and ≥2-year follow-up was reviewed. The preoperative, immediate, and final follow-up postoperative radiographs were analyzed. The correlation between PS density and the following factors were determined: major curve correction (MCC), correction index (CI; MCC/ curve flexibility), kyphosis angle change, and rib index (RI) correction. Then, patients were divided into low-density (LD) and highdensity (HD) groups according to mean PS density for the entire cohort (1.5 PS per level). Demographics and radiographic and clinical outcomes were compared between groups. Results: The study included 99 patients with Lenke 1 and 23 patients with Lenke 2 AIS. The average MCC was 67.2%. There was no correlation between screw density and these parameters: MCC (r=0.10, p=0.26), CI (r=0.16, p=0.07), change in T2-T12 kyphosis angle (r=−0.13, p=0.14), and RI correction (r=−0.09, p=0.37). Demographic and preoperative radiographic parameters were similar between the LD and HD groups. At the latest follow-up, there were no differences between the two groups in regard to MCC, CI, change in T2-T12 kyphosis angle, RI correction, and Scoliosis Research Society-30 scores (all p>0.05). Conclusions: This study revealed no significant correlation between screw density and curve correction in any planes. HD construct may not provide better deformity correction in patients with flexible and moderate thoracic AIS undergoing PSF without PO.

The purpose of this systematic review was to assess the survival of implants placed in augmented sinuses on a medium- to long-term basis, and identify factors affecting implant survival such as surgical technique, bone grafts, and timing of implant placement. A literature search up to July 2016 was performed to identify prospective clinical studies on sinus floor augmentation in conjunction with implant placement with a minimum follow-up of 3 years. Meta-analytic methods were implemented to calculate implant survival rates and relative risks (RR) for failure and the effect of surgical technique, use of bone graft, graft type, use of membrane, mean residual bone height, and timing of implant insertion. A total of 17 clinical trials (1 randomized and 16 prospective nonrandomized) were included, which pertained to 637 patients (at least 48% male) and 1,610 implants placed after sinus floor augmentation with the osteotome (transalveolar) or lateral window approach. The pooled implant su...

Rotational step-cut osteotomy for treatment of metacarpal and phalangeal malunion Metacarpal and phalangeal mahmion after fracture or replantation frequently causes rotational deformities with scissoring during digital flexion. Transverse osteotomy at the metacarpal base has been advocated for derotation, but this only partially corrects scissoring resulting from phalangeal malunion. We describe the results of rotational step-cut osteotomies at the site of malunion. There were twenty-three osteotomies in eighteen patients; seven metacarpal and sixteen in the proximal phalanx. The value of the technique is supported by the results; speedy healing of bone, satisfactory alleviation of deformity, and a useful gain in range of motion in many patients.

A long-term retrospective review of a long oblique distal osteotomy of the fifth metatarsal for correction of a tailor's bunion deformity is presented. The technique, results, and follow-up of this procedure are described. The long oblique distal osteotomy was performed on 25 feet on 16 patients. Follow-up ranged from 11 to 110 months with an average of 64.4 months. The average preoperative intermetatarsal 4-5 angle and lateral deviation angle improved from 10.88°and 4.24°, respectively, to 5.52°and Ϫ4.24°p ostoperatively, respectively. A modified scoring scale for lesser metatarsal procedures was used, showing an average postoperative score of 94 out of 100 possible points. Subjectively, 96% (24 of 25) of feet that underwent surgery were rated as excellent or good. Complications included one patient with paresthesias, one soft-tissue infection, and 2 patients had irritation from screws. The authors conclude that the long oblique distal osteotomy is a viable alternative in the correction of tailor's bunion deformity.

Our aim was to evaluate the long-term outcomes of prosthetic treatment and orbital expansion in the management of microphthalmia syndromes. We did a retrospective single-centre study of all cases of microphthalmia treated between 1989 and 2010. The patients were divided into three groups: isolated microphthalmia, microphthalmia associated with micro-orbitism, and complex microphthalmia syndrome. To evaluate the results a score was computed for each patient by assessing the length of the palpebral fissure, the depth of the conjunctival fornix, and local complications together with an evaluation of the satisfaction of patients and their families. Forty-four children were included (27 boys and 17 girls). Twenty-seven had unilateral microphthalmia (61%) and 17 bilateral microphthalmia (39%). Twelve patients were lost to follow up. The mean duration of follow-up was 12 years (range 4-21). Management involved an ocular conformer in only 31 patients (71%). The treatment was deemed satisfactory in all except 10 children. Surgical treatment with orbital expansion permitted good symmetry of the orbital cavities with a final mean difference of 9% (range 3-17) compared with the initial 16.8% (range 13.6-20.3). The prosthetic treatment gives satisfactory results. Despite limited indications and difficult follow-up, our experience emphasises the value of surgical treatment for severe micro-orbitism.

Objective-To describe outcome after an alternative unilateral approach to the thoracolumbar spine for dorsal laminectomy. Study Design-Retrospective clinical study. Animals-Dogs (n ¼ 14) with thoracolumbar spinal cord compression. Methods-Thoracolumbar spinal cord compression was lateral (6 dogs), dorsal (4), and dorsolateral (4) caused by subarachnoid (7) and synovial cysts (2) and intradural-extramedullary neoplasia (5). All dogs were treated by dorsal laminectomy with osteotomy of the spinous process using a unilateral paramedian approach. The contralateral paraspinal muscles were not stripped from the spinous process and the osteoligamentous complexes were preserved. Retraction of the spinous process and muscles to the contralateral side resulted in complete visualization of the dorsal vertebral arch thereby allowing dorsal laminectomy to be performed. Results-No technique complications occurred. Approximately 75% exposure of the spinal cord (dorsal and lateral compartments) was achieved providing adequate visualization and treatment of the lesions. Transient deterioration of neurologic state occurred in 5 dogs because of extensive spinal cord manipulation. At long-term follow-up, 6 dogs were normal, 6 had clinical improvement, and 2 were unchanged. Conclusion-Dorsal laminectomy after osteotomy and retraction of the spinous process may be considered in canine patients with dorsal, dorsolateral, or lateral compression to facilitate adequate decompression of the spinal cord. Clinical Significance-This surgical technique offers an alternative approach to the thoracolumbar spine and spinal cord by a modified dorsal laminectomy that preserves the paraspinal muscle integrity on the contralateral side.

Introduction The narrow correlation between sagittal alignment parameters and clinical outcomes has been widely established, demonstrating that improper sagittal alignment is a clinical condition that is associated with increased pain and limitations in patients' functional ability. Indication Lumbar pedicle subtraction osteotomy (PSO) is indicated in the treatment of large sagittal (more than 25°o f rigid loss of lordosis) deformities of the lumbar spine or its combination with coronal deformity, especially when they are rigid. Indication should be based on careful assessment of the severity of symptoms, functional impairment, functional expectations of the patient, general clinical condition and surgical and anesthesiological team experience. Risk should be carefully assessed and discussed to obtain appropriate informed consent. Surgical procedure Surgical planning includes selection of the safest levels for the upper and lower instrumented vertebra, site of the osteotomy, modality of fixation, and, most importantly angular value of the correction goal (target lumbar lordosis). Failure to adequately obtain the necessary amount of sagittal correction is the most frequent cause of failure and reoperation. Conclusion PSO is a valuable surgical procedure in correction of severe hypolordosis (=relative kyphosis) in the lumbar spine. It is a demanding procedure for the surgeon, the anesthesiologist and the intensive care team. Although its complication rate is high, it has a substantial positive impact in the quality of life of patients, including the elderly.

Background Lumbar and thoracolumbar deformity in the adult is a condition with impairment of health status that can need surgical treatment. In contrast with adolescent deformity, where magnitude of the curve plays a significant role in surgical indication, the aspects relevant in adult deformity are pain and dysfunction that correlate with segment degeneration and imbalance. Previous classifications of adult deformity have been of little use for surgical planning. Methods Chart review and classification of radiographic and clinical findings. A classification of degenerative disc disease based on distribution of diseased segments and balance status of the spine is presented. Results Four main categories are presented: Type I (limited nonapical segment disease), Type II (limited apical segment disease), Type III (extended segment disease-apical and nonapical), Type IV (imbalanced spine: IVa, sagittally imbalanced; IVb, sagittally and coronally imbalanced). Discussion and conclusion Types I and II can be treated by fusion of a selective area of the curve. Type III needs fusion of all the extension of the coronal curve. Type IV usually needs aggressive corrective procedures, frequently including posterior tricolumnar osteotomies. This classification permits interpreting the extension and magnitude of the disease and can help establish a surgical plan regarding selective fusion and methods of sagittal correction. Future research is needed to validate the classification.

BACKGROUND Distal radius reconstruction after en bloc tumor resection remains a surgical challenge. Although several surgical techniques, either reconstructing the wrist or achieving a stable arthrodesis, have been described, it is unclear to what degree these restore function. DESCRIPTION OF TECHNIQUE: We describe an updated technique making use of a tibia cortical strut autograft (TCSA) to perform a functional arthrodesis from the remaining radius to the first carpal row. This, in theory, could lead to less donor site morbidity while resulting in a stable but functional and pain-free arthrodesis of the wrist. METHODS: Between 1987 and 2010 we reconstructed the wrists of 17 patients using a TCSA arthrodesis (six primary and three revisions), seven with an osteoarticular allograft, three using an ulnar translocation, and one with a fibula autograft. Median age at diagnosis was 24 years (range, 9-58 years) and minimum followup was 2.7 years (median, 13.8 years; range, 2.7-24.5 years)...

Purpose The surgical treatment of a large complex odontoma in the mandibular angle is reported. Four possible surgical approaches to remove a benign tumor in the mandibular angle are discussed. Patient A two-stage surgical treatment was chosen; first, removing most part of the lesion and preserving the second molar, decreasing the risk of a pathological mandibular fracture. A maxillo-mandibular fixation for a period of 4 weeks was used. The patient was oriented to maintain a soft diet. The second surgical stage occurred 3 months after the first one due to the significant bone consolidation observed, reducing the possibility of a mandibular fracture. The remaining lesion and the second molar were then completely removed. Conclusions This case demonstrates the value of the tridimensional computed tomography in treatment planning prior to any definitive surgery. A computed tomography should be made in every case of intraosseous lesion in order to establish the intraosseous extent of the tumor, cortical perforation, and soft tissue involvement for precise guidance for the surgical planning. It is recommended that the surgeon considers excision by an intraoral, lingual approach when indicated, and in two stages, when an extremely thin mandibular base is present.

The purpose of this study was to analyze the morphologic changes of the airway in obstructive sleep apnea (OSA) patients by helical computed tomography (CT) scanning following maxillomandibular advancement (MMA) surgery. Twenty consecutive OSA patients treated with MMA from 2000 to 2003 at the University of Alabama at Birmingham Hospital and diagnosed by polysomnography (PSG) were included in this study. The criteria for this study were MMA surgery, pre- and postoperative helical CT scan, and PSG. Lateral (LAT) and anterioposterior (AP) airway dimensions were measured from the level of the hard palate to the hyoid using helical CT scans. There was enlargement of LAT and AP diameters for all patients at all levels. LAT dimensions were enhanced greater than AP in the retroglossal region. MMA results in significant increase in both AP and LAT airway dimensions.

Rhinoplasty is one of the most common facial plastic procedures performed in the Hispanic/mestizo ethnic group. Today, emphasis is placed on ethnic and cultural backgrounds, definition of facial and nasal characteristics, and a clear understanding of patients&#39; desires. This article highlights the different types of problems encountered in mestizo patients. It describes a graduated approach to the nose whereby support structures of the nose are strengthened by careful placement of sutures and grafts, trying to achieve greater definition and support without necessarily making the nose look bigger.

Superior repositioning of the maxilla via maxillary ostectomy has proved to be useful method of treating patients with vertical maxillary excess. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower facial height, contour-deficient chin, and either Class I or Class II malocclusion. We have used this procedure as routine treatment for vertical maxillary excess over the past 5 years. Timing of the surgery is not so important in non-open-bite patients, and the procedure can be done with equal success before any orthodontic intervention, during orthodontic treatment, and following all orthodontic procedures. Timing is primarily dependent upon the orthodontist&#39;s desires. Since the surgery can produce a much simpler orthodontic problem, thus reducing treatment time and allowing a better over-all result, we recommend that it be done as early in treatment as possible. Clinically, the over-all improvement in facial appear...

The aim of this report is to present the scientific rationale for considering maxillomandibular advancement as the surgical treatment of choice in selected patients with obstructive sleep apnea syndrome; review the treatment planning that will identify those patients who would benefit from this procedure; review the surgical techniques; and review the patient outcomes after maxillomandibular advancement surgery. Patients with obstructive sleep apnea syndrome who have demonstrable retropositioning of the maxilla and mandible should be informed of maxillomandibular advancement as the primary surgical treatment for obstructive sleep apnea syndrome.

Torsional deformities of the tibia are common in children, but in the majority both the torsion and the associated disturbance of gait resolve without intervention. There are, however, a significant number of children and adults with neuromuscular disease who present with ...

Magnitude and location of acetabular bone defects dictate the type of reconstruction required. For the majority of reconstructions, a porous-coated hemispheric shell secured to host bone with multiple screws is the implant of choice. This reconstruction is feasible provided at least 50% of the implant contacts host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. An uncemented cup can be placed at a &quot;high hip center.&quot; Alternatively, the acetabular cavity can be progressively reamed to accommodate extra-large cups. Oblong cups, which take advantage of the oval-shaped cavity resulting from many failed acetabular components, can also be used. The success of these cementless techniques depends on the degree and location of bone loss and on the presence of pelvic discontinuity.

Accurate calibration of the medio-lateral axis of the femur is crucial for clinical decision making based on gait analysis. This study proposes a protocol utilizing biplanar radiographs to provide a reference medio-lateral axis based on the anatomy of the femur. The biplanar radiographs allowed 3D modelling of the bones of the lower limbs and the markers used for motion capture, in the standing posture. A comprehensive analysis was performed and results from biplanar radiographs were reliable for 3D marker localization (±0.35mm) and for 3D localization of the anatomical landmarks (±1mm), leading to a precision of 1° for the orientation of the condylar axis of the femur and a 95% confidence interval of ±3° after registration with motion capture data. The anatomical condylar axis was compared to a conventional, marker-based, axis and three functional calibration techniques (axis transformation, geometric axis fit and DynaKAD). Results for the conventional method show an average differ...

To evaluate the feasibility of anterior maxillary segmental distraction (AMSD) to correct maxillary hypoplasia and severe dental crowding in cleft lip and palate (CLP) patients, 7 patients (average age 16.4 years) with maxillary hypoplasia, shortened maxillary dental arch length and severe anterior dental crowding secondary to CLP were selected for this study. After anterior maxillary segmental osteotomy, 3 patients were treated using bilateral internal distraction devices, and 4 patients were treated using rigid external distraction devices. Photographs and radiographs were taken to review the improvement in facial profile and occlusion after distraction. An average 10.25 mm anterior maxillary advancement was obtained in all patients after 10-23 days of distraction and 9-16 weeks of consolidation. The sella-nasion-point A (SNA) angle increased from 69.5 degrees to 79.6 degrees. Midface convexity was greatly improved and velopharyngeal competence was preserved. The maxillary dental ...

L'ostéotomie de l'olécrâne est largement utilisée pour la reconstruction des fractures bicondyliennes de l'humérus distal (type 13-C de la classification AO), mais il existe une controverse du fait des complications non négligeables inhérentes à cette voie d'abord. L'objectif de ce travail est d'étudier les conséquences anatomiques et fonctionnelles de cette technique d'exposition du coude. Il s'agit d'une étude rétrospective sur une période continue de sept ans. Ont été retenus pour cette étude les patients âgés de plus de 15 ans, qui avaient présenté une fracture bicondylienne (type C de l'AO) de la palette humérale ostéosynthésée à travers une ostéotomie de l'olécrâne. Nous avons revu et évalué 14 patients traités et suivis dans le service. Il s'agissait de neuf hommes et cinq femmes âgés en moyenne de 34 ans avec des extrêmes de 17 et 70 ans. Selon la classification AO, nous avons retrouvé 14 fractures réparties de la façon suivante : trois type C1, sept type C2 et quatre type C3. L'ouverture du foyer existait dans deux cas. L'ostéotomie a été réalisée dans tous les cas à l'aide d'un ostéotome de façon extra-articulaire sur six olécrânes et intra-articulaire dans huit cas ; la réparation a toujours été faite par un haubanage. L'évaluation reposait sur des critères anatomiques et fonctionnels (Mayo Elbow Performance Score). Aucun cas de paralysie radiale ou ulnaire n'a été retrouvé. Trente-six pour cent (36 %) des synthèses olécrâniennes étaient de mauvaise qualité. Il n'a été retrouvé qu'un seul cas de pseudarthrose olécrânienne. Aucun cas de calcifications hétérotopiques n'a été retrouvé ; en revanche, il existait un cas (7 %) d'arthrose du coude. Sur le plan fonctionnel, nous avons obtenu 36 % d'excellents résultats, 28,5 % de bons résultats, 7 % de résultats moyens et 28,5 % de mauvais résultats. L'ostéotomie de l'olécrâne est une technique de choix pour l'exposition des surfaces articulaires lors de la reconstruction des fractures de la palette humérale. Les complications peuvent être évitées grâce à une technique rigoureuse.

Background Tumors of the fibula comprise only 2.5% of primary bone lesions. Patients with aggressive benign tumors in the proximal fibula may require en bloc resection. Peroneal nerve function, knee stability, and recurrence are substantial concerns with these resections. The incidence and fate of these complications is not well-known owing to the small numbers of patients in previous reports. Questions/purposes We therefore analyzed the incidence of peroneal nerve palsy, knee stability, and local recurrence following surgical treatment of benign proximal fibula tumors. Methods We retrospectively reviewed the charts of 120 patients (121 tumors) with histologically confirmed aggressive benign tumors of the proximal fibula. There were 56 males and 64 females with an average age of 24 years (range, 2-64 years). The most common diagnosis was osteochondroma (38%) followed by giant cell tumor (19%). Pain (94%), palpable mass (39%), and peroneal nerve symptoms (12%) were the most common presenting symptoms. Of the 121 tumors, 56 (46%) underwent en bloc resection. The minimum followup was 2 years (mean, 9 years; range 2 to 49 years; median, 7.4 years).

Osteotomy is the surgical cutting of bone. Some obstacles to laser osteotomy have been melting, carbonisation and subsequent delayed healing. New cooled scanning techniques have resulted in effective bone cuts without the strong thermal side effects, which were observed by inappropriate irradiation techniques with continuous wave and long pulsed lasers. With these new techniques, osteotomy gaps histologically healed with new bone formation without any noticeable or minimum thermal damage. No significant cellular differences in bone healing between laser and mechanical osteotomies were noticed. Some studies even suggest that the healing rate may be enhanced following laser osteotomy compared to conventional mechanical osteotomy. Additional research is necessary to evaluate different laser types with appropriate laser setting variables to increase ablation rates, with control of depth, change in bone type and damage to adjacent soft tissue. Laser osteotomy has the potential to become incorporated into the armamentarium of bone surgery.

The purpose of this study was to compare the mechanical properties of 3 osteotomies often used for hallux rigidus. Maximum load, failure energy, stiffness, and fracture pattern were determined for 3 different test models as well as a control group. Twenty-eight first metatarsal polyurethane sawbone models were equally divided into 4 groups. The osteotomy groups tested consisted of a Youngswick, sagittal V, and modified Weil-type osteotomy of the first metatarsal. Each osteotomy was fixated with a 2.7-mm cortical screw, all 16 mm in length, and a small diameter smooth wire, both placed perpendicular to the osteotomy. Each model was then loaded to failure in a servo-hydraulic material testing machine. Results for maximum load to failure for all 4 constructs showed a mean range of 15.1 to 33.7 N, a mean energy to failure ranging from 0.04 to 0.8 J, and stiffness from 1.5 to 3.4 N/mm. Significant differences in peak load and stiffness (P ϭ .015 for peak load, P ϭ .025 for stiffness) were found between the sagittal V group versus the control and between the modified Weil and sagittal V group (P ϭ .037 for peak load, P ϭ .017 for stiffness). There were no significant differences in the energy to failure between the 4 groups (P Ͼ .083). These findings suggest that the sagittal V osteotomy construct was significantly weaker and less stiff than the modified Weil.

The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis. A total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments. In the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preop...

A new approach to expose the nasopharynx and the paranasopharyngeal space is described. The maxilla, severed from its bony connections, is swung laterally to provide exposure of the nasopharynx. Tumors in the nasopharynx and the paranasopharyngeal space can be adequately resected and tubings for afterloading brachylherapy can be positioned accurately during surgery. The blood supply of the maxilla is from the attached cheek flap and masseter muscle. Three illustrative cases are presented. The wounds in all of them healed primarily with minimal morbidity. The only disadvantage is the development of mild trismus, which responded to conservative treatment. HEAD & NECK 1991; 13~200-207

One of the complications following hallux valgus surgery is lesser metatarsalgia. Although first metatarsal shortening or elevation has been implicated, we have found that limitation of plantarflexion of the first metatarsophalangeal joint can also lead to this problem. Using a Musgrave Footprint computerized analysis, our findings concurred with those of Holmes, revealing that, at the propulsive phase of gait, the greatest amount of pressure falls under the second metatarsal head, followed by the hallux and first metatarsal head, respectively. It stands to reason that decreased power under the hallux will lead to an increased load under the second metatarsal head and lesser metatarsals. Typically, passive range-of-motion exercises have been proposed following hallux valgus surgery, but this technique does not address postoperative loss of power of the great toe segment. Using the same principle of strengthening the quadriceps following knee surgery, we have developed a simple technique that patients can perform themselves without the additional cost of physical therapy.

SummaryThe aim of this study was to evaluate the feasibility of the double pelvic osteotomy (DPO) (osteotomy of the ilium and pubis) to treat clinical cases of hip dyplasia in young dogs instead of performing a triple pelvic osteotomy (TPO) (osteotomy of the ilium, pubis, and ischium). Candidates for DPO were 4.5- to nine-month-old dogs with coxofemoral joint subluxation and laxity, indicative of susceptibility to future development of severe hip dysplasia. The angle of reduction (AR) and angle of subluxation (AS) with Ortolani&#39;s sign, Norberg angle (NA), percentage of femoral head (PC) covered by the acetabulum, and the pelvic diameters and their relationships were measured clinically and radiographically before and after surgery. The surgical technique was similar to the TPO technique, but excluded ischiatic osteotomy. A DPO was carried out in 53 joints of 34 dogs AR and AS values immediately postoperatively and at the oneand two-month follow-up examinations were significantly...

Purpose Reverse shoulder arthroplasty (RSA) can restore active elevation in rotator-cuff-deficient shoulders. However, RSA cannot restore active external rotation. The combination of latissimus dorsi transfer with RSA has been reported to restore both active elevation and external rotation. We hypothesised that in the combined procedure, harvesting the latissimus dorsi with a small piece of bone, leads to good tendon integrity, low rupture rates and good clinical outcome. Methods Between 2004 and 2010, 13 patients (13 shoulders) were treated with RSA in combination with latissimus dorsi transfer in a modified manner. The mean follow-up was 65.4 months, and the mean age at index surgery was 71.1 years. All patients had external rotation lag sign and positive hornblower's sign, as well as radiological signs of cuff-tear arthropathy (Hamada 3, 4 or 5) and fatty infiltration grade 3 according to Goutallier et al. on magnetic resonance imaging (MRI). The outcome measures included the Constant Murley Score, University of California-Los Angeles (UCLA) shoulder score, Simple Shoulder Test (SST), visual analogue scale (VAS) and the Activities of Daily Living Requiring External Rotation (ADLER) score. Tendon integrity was evaluated with dynamic ultrasound. All patients were asked at final follow-up to rate their satisfaction as excellent, good, satisfied or dissatisfied. Results The overall mean Constant-Murley Shoulder Outcome Score (CMS) improved from 20.4 to 64.3 points (p <0.001). Mean VAS pain score decreased from 6.8 to 1.1 (p <0.001)., mean UCLA score improved from 7.9 to 26.4 (p <0.001), mean SST score improved from 2.3 to 7.9 (p <0.001) and mean postoperative ADLER score was 26 points. The average degree of abduction improved from 45°to 129°(p <0.001), the average degree of anterior flexion improved from 55°to 138°(p <0.001) and the average degree of

The aim of the present study was to compare dynamics of the bone healing process after different types of osteotomies. In total, 24 Wistar rats were subjected to different types of osteotomy performed with standard steel bur, piezosurgery, contact, and non-contact Erbium:yttrium-aluminum-garnet (Er:YAG) laser ablation. The animals were randomly divided into four groups, to be euthanized immediately after the procedure, or at 1, 2, or 3 weeks after surgery. The obtained bone samples were analyzed by scanning electron microscopy (SEM). Immediately after surgery, there were significant differences in the appearance of the bone defects, with presence of bone fragments and debris after standard steel bur preparation, compared with the clean smooth walls and relatively sharp edges in all other groups. The initial bone formation in defects prepared by piezosurgery was observed to be the most rapid. After 3 weeks, all bone defects were completely restored; although, differences in the heali...

This article describes a design of osseous chin surgery based on the principle of the tenon and mortise. This modification allows for precision of movement, ease of repositioning, and adaptation of rigid skeletal stabilization of mobilized osseous segments in the chin. With this technique, the inferior border of the mandible can be moved superiorly, inferiorly, anteriorly, posteriorly, or transversely or in any combination of these directions.

Background/Aim. Postoperative condylar position is a substantial concern in surgical correction of mandibular prognathism. Orthognathic surgery may change condylar position and this is considered a contributing factor for early skeletal relapse and the induction of temporomandibular disorders. The purpose of this study was to evaluate changes in condylar position, and to correlate angular skeletal measurements following bimaxillary surgery. Methods. On profile teleradiographs of 21 patients with mandibular angular and linear parametres, the changes in condylar position, were measured during preoperative orthodontic treatment and 6 months after the surgical treatment. Results. A statistically significant difference in values between the groups was found. The most distal point on the head of condyle point (DI) moved backward for 1.38 mm (p = 0.02), and the point of center of collum mandibulae point (DC) moved backward for 1.52 mm (p = 0.007). The amount of upward movement of the point...

Objective-To evaluate the effect of cold compression therapy (CCT) on postoperative pain, lameness, range of motion of the stifle joint, and swelling following tibial plateau leveling osteotomy (TPLO) in dogs. Design-Randomized, blinded, placebo-controlled clinical trial. Animals-34 client-owned dogs with unilateral deficiency of a cranial cruciate ligament undergoing TPLO. Procedures-Dogs were assigned to 2 groups. Group 1 (n = 17 dogs) received CCT in the 24-hour period following TPLO. Group 2 (n = 17 dogs) received no CCT. Degree of lameness, range of motion, and circumference of the stifle joint were measured before surgery and 1,14, and 28 days after surgery. A modified composite Glasgow pain scale, visual analogue scale, and pain threshold score were used to evaluate signs of pain before surgery and 1,14, and 28 days after surgery. Logistic regression and linear regression analysis were used to compare the measured variables. Results-No complications were observed, and all dogs tolerated CCT. Use of CCT resulted in lower values for the visual analogue scale and Glasgow pain scale and lower pain threshold scores; lower lameness scores; less swelling; and an increased range of motion 24 hours after surgery. At 14 days after surgery, there were no significant differences between groups. At 28 days after surgery, too few data sets were available for comparison. Conclusions and Clinical Relevance-CCT decreased signs of pain, swelling, and lameness and increased stifle joint range of motion in dogs during the first 24 hours after TPLO.