Quantitative assessment of the morphology of the pig's head used as a model in surgical experimentation. Part 1: Methods of Measurements.
Thirty-two surface measurements were described for assessment of the effect of complex surgical operations on the skeleton of the face in pigs. The methods of measurements imitate those of anthropometry. The surface measurements can complement cephalometry with data about the changes in the soft tissue and thus improve the documentation of the effect of surgery. This paper can help in the evaluation of complicated osteotomy procedures using the pig as the animal model, for facial reconstruction research in humans. (+info)
Long-term results of spherical acetabular osteotomy.
We have examined the effect of the Wagner spherical acetabular osteotomy on preserving the joint in 38 hips with a mean follow-up of 17 years. At the time of the initial operation, 55% of patients had clinical symptoms and 30 joints showed minimal or absent radiological signs of osteoarthritis. At follow-up, 54% of patients had a good functional result. The osteotomy improved the mean centre-edge angle from -3 degrees to +15 degrees, the mean anterior centre-edge angle to 23 degrees and the acetabular head index to 75%. The obliquity of the acetabular roof decreased from 28 degrees to 16 degrees. One patient improved, but 14 deteriorated with joint degeneration. Of these, one progressed because of postoperative deep-tissue infection and five due to undercorrection. One patient needed total joint replacement after 14 years. At 17 years after operation, Wagner osteotomy had prevented progression of secondary arthritis in 63% of cases. (+info)
Fractures of the posteromedial process of the talus. A report of two cases.
The authors present two cases of fractures of posteromedial process of talus. One was treated conservatively and the other by excision. The appearances of the CT scans, the therapeutic options and the mechanisms of injury are discussed. (+info)
The orthopaedic aspects of multiple epiphyseal dysplasia.
Five cases of multiple epiphyseal dysplasia (MED) were treated from 1985-1996 at the Orthopaedics and Trauma Department of SSK Izmir Educational Hospital. Four patients were female and one was male. The pedigrees of the first two female patients had the same features of inter-related marriages. The patients have been followed up for 5.5-11 years (average of 7.5 years). Surgical operations were mostly required in the lower limbs. Problems in the hips required adductor myotomy, the Soutter procedure, total hip replacement, and pertrochanteric extension osteotomy. Management of the knees required supracondylar shortening and extension osteotomy of the femur, high tibial extension osteotomy, debridement of the knee joint with removal of osteophytes, ogleotomy of the patellar lengthening of the knee flexors and posterior capsulotomy. Interphalangeal arthrodesis for hammer toes, extension osteotomy of the head of the first metatarsals, and Kellers operation were carried out in the foot. In the upper limb decompression and anterior transposition of the ulnar nerve, debridement of the elbow joint, extension and valgus osteotomy of the distal radius, and extension osteotomy of the head of the first metacarpal were required. (+info)
Malunion in the lower limb. A nomogram to predict the effects of osteotomy.
Nomograms derived from mathematical analysis indicate that the level of malunion is the most important determinant of changes in the moment arm of the knee, the plane of the ankle and alterations in limb length. Testing in five patients undergoing reconstruction showed a mean error of postoperative limb length of 2.2 mm (SD 0.8 mm), knee moment arm of 4.7 mm (SD 3.3 mm) and ankle angle of 2.6 degrees (SD 2.3 degrees). These nomograms provide the information required when assessing whether a particular degree of angulation may be accepted. (+info)
Anatomical changes in the pelvis after modified Chiari pelvic osteotomy.
Although plain X-ray analysis is able to reveal anatomical changes in the frontal plane of the pelvis after Chiari pelvic osteotomy involving medial displacement (medialization) in the distal fragment and lateral displacement (lateralization) in the proximal fragment, changes in the horizontal or sagittal plane can not be discerned. Here, I have investigated three dimensional changes in the pelvis using CT in 22 patients before and after Chiari pelvic osteotomy. The various changes were investigated. Medialization in the distal fragment (average 0.4 cm) occurred in the 14 cases and to a slight extent in the other 8 cases. Also anterior or posterior displacement, and anterior rotation occurred in the distal fragment. Lateralization in the proximal fragment (average 0.8 cm) occurred in 19 cases and to a slight extent in the other 3 cases. Furthermore, the acetabular coverage over the femoral head, assessed by superimposing the acetabular region over the femoral head, improved by about 30% of the anterior half of femoral head and by about 20% of the posterior half of femoral head. It is suggested that the acetabular coverage over the femoral head is most affected by lateralization in the proximal fragment. (+info)
Core cutter for harvesting cortical bone grafts for reconstructions of the ossicular chain.
Cortical bone autografts have been used to reconstruct the ossicular chain for more than 30 years. We describe a core cutter burr which facilitates the rapid harvesting of grafts which are suitable for a number of different types of reconstruction. The use of these grafts to reconstruct different defects of the ossicular chain is also presented. (+info)
Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment.
OBJECTIVES: Three operative techniques have been described to correct thoracolumbar kyphotic deformity (TLKD) resulting from ankylosing spondylitis (AS) at the level of the lumbar spine: opening wedge osteotomy, polysegmental wedge osteotomies, and closing wedge osteotomy. Little knowledge exists on the indication for, and outcome of these corrective lumbar osteotomies. METHODS: A structured review of the medical literature was performed. RESULTS: A search of the literature revealed 856 patients reported in 41 articles published between 1945 and 1998. The mean age at time of operation was 41 years, male-female ratio 7.5 to 1. In 451 patients an open wedge osteotomy was performed. Polysegmental wedge osteotomies were performed in 249 patients and a closing wedge osteotomy in 156 patients. Most of the studies primarily focus on the surgical technique. Technical outcome data were poorly reported. Sixteen reports, including 523 patients, met the inclusion criteria of this study, and could be analysed for technical outcome data. The average correction achieved with each surgical techniques ranged from 37 to 40 degrees. Loss of correction was mainly reported in patients treated by open wedge osteotomy and polysegmental wedge osteotomies. Neurological complications were reported in all three techniques. The perioperative mortality was 4%. Pulmonary, cardiac and intestinal problems were found to be the major cause of fatal complications. CONCLUSION: Lumbar osteotomy for correction of TLKD resulting from AS is a major surgery. The indication for these lumbar osteotomies as well as the degree of correction in the lumbar spine has not yet been established. Furthermore, there is a need for a generally accepted clinical score that encompasses accurate preoperative and postoperative assessment of the spinal deformity. The results of this review suggest that the data from the literature are not suitable for decision making with regard to surgical treatment of TLKD resulting from AS. (+info)