A reciprocating ledge technique in closing wedge osteotomy for genu valgum in adolescents.
(3/20)
PURPOSE: To describe a technique that preserves anterior and posterior alternate ledges in a closing wedge osteotomy. METHODS: Five patients aged 14 to 19 years underwent a closing wedge osteotomy for genu valgum in 8 limbs using a reciprocating ledge technique. A unicortical wedge of bone was removed, with the anterior and posterior cortices spared. The anterior cortex at the proximal level and the posterior cortex at the distal level were cut through. With a wobbling action, the osteotomy site was rotated, and the distal fragment externally rotated. Manual force was applied to close the osteotomy site ensuring overlapping of the reciprocal ledges. The distal fragment was translated laterally to prevent club deformity. The osteotomy site was held with one or 2 staples. Stability was tested by flexion and extension of knee. RESULTS: All 8 limbs attained bone union within 12 weeks, and full range of motion within a mean of 13 (range, 12-15) weeks. The mean correction of the tibiofemoral angle was 13 degrees. At a mean follow-up of 12 months, all patients were pain-free and none developed club deformity. CONCLUSION: Sparing reciprocal ledges in a closing wedge osteotomy for genu valgum may increase stability in the flexion-extension axis, enable early range-of-motion exercises, and facilitate early bone union. (+info)
Klinefelter's syndrome with renal tubular acidosis: impact on height.
(4/20)
A 19-year-old Indian man presented with a history of proximal muscle weakness, knock knees and gynaecomastia. On examination he had features of rickets and bilateral small testes. Karyotyping revealed a chromosomal pattern of 47,XXX, confirming the diagnosis of Klinefelter's syndrome. He was also found to have hyperchloraemic metabolic acidosis with hypokalaemia, hypophosphataemia, phosphaturia and glycosuria, which favoured a diagnosis of proximal renal tubular acidosis. Patients with Klinefelter's syndrome typically have a tall stature due to androgen deficiency, resulting in unfused epiphyses and an additional X chromosome. However, this patient had a short stature due to associated proximal renal tubular acidosis. To the best of our knowledge, this is the second case of Klinefelter's syndrome with short stature due to associated renal tubular acidosis reported in the literature. This report highlights the need to consider other causes when patients with Klinefelter's syndrome present with a short stature. (+info)
Varus and valgus alignment and incident and progressive knee osteoarthritis.
(5/20)
Management of knee osteoarthritis presenting with tibial stress fractures.
(8/20)
Stress fractures of the tibia secondary to tibial deformities from osteoarthritis are rare, and may be difficult to manage. We treated two patients with stress fractures of the proximal tibial diaphyses over a period of two years. Both patients had osteoarthritis of the knee; one with genu valgus deformity and the other, genu varus deformity. The former patient also had a distal tibial fracture and had previously undergone open reduction and internal fixation. The stress fractures of both the patients had been treated conservatively by nonoperative means, but their fractures failed to unite. They then underwent a modular total knee prosthesis with a long tibial stem extension, and subsequently, their fractures united. Both patients recovered uneventfully. (+info)