PURPOSE OF THE STUDY: Temporary hemiepiphyseodesis using figure-eight plates is currently one of the main surgical techniques to correct axial deformities of lower limbs in paediatric patients. Comprehensive analysis, correct indication and monitoring of treatment are the basic prerequisites for successful therapy. The aim of the study was to analyse parameters that could become an alternative to standard parameters used nowadays, namely the inserted screw angle (SA), and a new parameter - condylar ratio (CR). MATERIAL AND METHODS: The study included 47 patients treated at the Department of Paediatric Surgery, Orthopaedics and Traumatology at the University Hospital in Brno between 2014 and 2021 and diagnosed with idiopathic bilateral axis deviation of lower limbs, namely genu valgum. After having met the inclusion criteria, the patients underwent a clinical check-up, and long leg radiographs were also obtained. Anthropometric parameters (age, sex, BMI, intermalleolar distance (IMD)), duration of treatment as well as radiographic parameters - mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), SA and CR, and their derived parameters expressing the change per unit time and defined as a rate of correction (r-mLDFA, r-mMPTA, r-SA, r-CR) were recorded. The obtained values were subsequently statistically analysed, namely by comparing the pretreatment and posttreatment values and through correlation analysis. RESULTS: The mean age of the population was 11.4 years, BMI 26.9 and IMD 14.1. The mean duration of treatment in the study population was 13.9 months. A significant difference was established between the pretreatment and posttreatment values of all measured radiographic parameters (p<.05). A significant correlation was identified between r-mLDFA and r-SA (p=.002), while no significant correlation was found between r-mLDFA and r-CA or between r-CA and r-SA (p=.650; p=.884). DISCUSSION: Comprehensive evaluation of the treatment of axial deformities of lower limbs and its optimization are crucial for successful therapy. In addition to the standard mechanical or even anatomical parameters assessing the axis deviation of lower limbs, the authors seek to evaluate also other parameters that may provide a new insight into the deformity or offer additional benefits such as reduced radiation exposure. Such a parameter is for instance the angle of inserted screws in the eight-figure plate system, although there is a difference in opinion among the authors. In our study, we concluded that it is the change in the screw angle that significantly correlates with the mechanical axis of the femur, and thus, under certain circumstances, can become a monitoring parameter. Contrarily, the condylar ratio is a newly introduced quantity which in our study did not show any significant correlation with the mechanical axis of the femur, although a significant change before and after therapy was observed. CONCLUSIONS: A significant correlation was established between the rate of change in screw angle and r-mLDFA, which may, under certain circumstances, serve as a parameter for treatment evaluation, with the advantage of reduced radiation exposure since the assessment requires one scan of the knee joints under loading only. On the other hand, though, no significant correlation was established between the CR as the newly defined parameter and r-mLDFA, which is why it can only be considered as a complementary parameter rather than a decisive one. KEY WORDS: temporary hemiepiphysiodesis, growth plate, genua valga, screw angle, correlation.
- MeSH
- dítě MeSH
- femur chirurgie abnormality diagnostické zobrazování MeSH
- genua valga * chirurgie MeSH
- kostní destičky * MeSH
- kostní šrouby * MeSH
- lidé MeSH
- mladiství MeSH
- rentgendiagnostika metody MeSH
- tibie chirurgie abnormality diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Congenital tibial deficiency is a rare developmental skeletal disorder. When the surgical treatment fails the amputation and/or prosthesis is needed. Recent studies of prosthetic gait present only data for acquired case of prosthetic gait, mainly measured in comfortable self-selected speed, which does not reflect changes visible only during higher demands conditions i.e. faster gait. Prosthetic gait of acquired cases (i.e. traumatic amputation) differs from normal gait mostly in gait asymmetry (GA). However, it was not yet studied in a developmental case of prosthetic gait. In this case study, GA changes in different speed of walking with ankle-foot prosthesis were identified for unilateral congenital tibial deficiency in a young healthy man. Selected joint kinematic, spatial-temporal, and kinetic gait parameters were collected using 3D motion capture system and treadmill with force plate simultaneously. Mean values, SD, and symmetry indexes were calculated in different walking speeds and descriptively analyzed. Results show developmental prosthetic gait specific pattern and GA in most of the measured gait parameters. Kinematic parameters of joint angular ranges register decreasing GA with increasing gait speed on intact limb side. Spatial-temporal parameters present decreasing GA with increasing speed on the prosthetic limb side for double support and step duration. Kinetic parameters show increasing GA on intact limb in all parameters, except loading rate which decrease with increasing speed. In the case of congenital tibial deficiency, gait pattern, GA and compensatory mechanisms differ to the acquired prosthetic gait and depend on walking speed. These findings complete the missing point in prosthetic gait research and may serve as a base for further research of differences between developmental and acquired cases of prosthetic gait patterns.
- MeSH
- analýza chůze * MeSH
- biomechanika MeSH
- dospělí MeSH
- ektromelie genetika terapie MeSH
- fibrózní dysplazie kosti genetika terapie MeSH
- kineziologie aplikovaná MeSH
- lidé MeSH
- protézy a implantáty * MeSH
- rychlost chůze MeSH
- tibie abnormality MeSH
- výzkum MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
- MeSH
- ektromelie rehabilitace MeSH
- lidé MeSH
- lyžování MeSH
- mladý dospělý MeSH
- ortézy nohy (od hlezna dolů) MeSH
- protetické prostředky MeSH
- protézy - design MeSH
- tibie abnormality MeSH
- vrozené deformity dolní končetiny * rehabilitace MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Because there is limited information concerning the cruciate ligaments in proximal femoral focal deficiency, knee arthroscopy was used to identify the changes of cruciate ligaments and their relation to the different types of this deficiency. METHODS: Knee arthroscopy was performed in 21 consecutive patients with deficiency types III, IV, VII-IX using the Pappas classification. A new classification of the knee was created. It contains types I, II, III according to the findings of the anterior cruciate ligament (ACL) (type I: normal, type II: hypoplasia, type III: aplasia) and 3 subtypes A, B, C according to the findings of the posterior cruciate ligament (PCL) (type A: normal, type B: hypoplasia, type C: aplasia), respectively. Instrumented and radiologic drawer testing was provided additionally in 2010. RESULTS: The changes of the cruciate ligaments were found in all but 1 patient. Type I was found in only 2 patients. In 1, both cruciate ligaments were intact (type IA). In the other patient, the ACL was intact, but the PCL was absent (type IC). Hypoplastic ACLs (type II) were found in 4 patients, namely in 3 patients with normal PCLs (type IIA), whereas in 1 patient the PCL was absent (type IIC). In the majority of patients, the ACLs completely failed (type III, 15 patients). Absence of both cruciate ligaments was found in 8 patients (type IIIC). PCLs were intact in 4 patients (IIIA) or were hypoplastic in 3 patients (IIIB), respectively. Instrumental drawer testing was not reliable in patients of our group. Radiologic testing showed a posterior shift of the tibia in the majority of patients on the affected side. Anterior and posterior drawer tests were increased in a majority of patients, but did not directly correlate to the presence/absence of cruciate ligaments. CONCLUSIONS: Variable changes of the cruciate ligaments were found in all but 1 patient with proximal femoral focal deficiency. These changes were not related to the type of Pappas classification. Despite the lower clinical relevance of the changes in majority of patients, imaging of cruciate ligaments is recommend before lengthening of the extremity to avoid dislocation of the knee. LEVEL OF EVIDENCE: I - Testing of previously developed diagnostic criteria in series of consecutive patients.
- MeSH
- artroskopie metody MeSH
- dítě MeSH
- femur abnormality radiografie MeSH
- kolenní kloub patologie radiografie MeSH
- lidé MeSH
- ligamentum cruciatum anterius patologie radiografie MeSH
- ligamentum cruciatum posterius patologie radiografie MeSH
- mladiství MeSH
- předškolní dítě MeSH
- tibie abnormality MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
At pre-school age, there is a possibility to treat severe varosity and/or valgosity of legs by orthoses. The three points force effect of the orthosis partially corrects the pathologic defect of the leg. If the orthosis is intermittently used for a long time the correction is permanent. Step by step correction of bone deformities are based on remodelling of growth epiphyses and bones that are caused by orthotic bending pre-stressing. According to Huter-Volkmann's law, the oblique loading regulates the growth of epiphyseal plates of long bone into the direction of the pressure result and the bone remodelling process is started: it means that the bone grows at the tensile part of growth epiphyses more quickly than at pressure one and gradually eliminates the varosity and/or valgosity defect. The knowledge of stress values for starting of the bone remodelling process is principal for clinical praxis. The values of pre-stressing cannot be increased by starting the remodelling process from the ethical point of view but it can be judged on its starting according to the success of the treatment. The aim of this article is to study the bone, ligament stress state and deformations of successful treatment. Method and calculation algorithm of stress state and deformation that are necessary for the starting of the remodelling process at the knee region were verified on a group of eight patients that were fitted by orthoses with bending pre-stressing. The space models of the knee, femur and tibia were composed with the help of X-ray, CT and MRI scan. The calculation algorithm was implemented on a PC and the program can be easily applied at clinical praxis.
- MeSH
- algoritmy MeSH
- bérec abnormality patofyziologie radiografie MeSH
- biologické modely MeSH
- biomechanika MeSH
- dítě MeSH
- femur abnormality patofyziologie radiografie MeSH
- financování organizované MeSH
- lidé MeSH
- ligamenta fyziologie MeSH
- mechanický stres MeSH
- remodelace kosti fyziologie MeSH
- tibie abnormality patofyziologie radiografie MeSH
- výztuhy MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
The authors analyse the first results of correction surgery for limb-length inequality and rotational and angular deformities of the tibia using the Taylor spatial frame in combination with the Ilizarov external fixator in three patients. The shortening of the tibia, 65 mm on the average (55, 60 and 80 mm, respectively), was due to tibial hemimilia in two patients and traumatic epiphyseolysis of the distal tibia in one patient. Distraction at a rate of 1 mm/day was controlled three-times a day on two contralateral struts. It started on the seventh day after osteotomy in all three patients. On the second post-operative day, rehabilitation started with standing up and walking with crutches. The additional fixation of the heel and foot was removed at 3 months after distraction was terminated so that ankle exercise would be possible. No serious complications were recorded. The average distraction index was 0.91 and the average tibial lengthening was 65 mm. Callus consolidation was achieved at 131 days after the end of distraction phase. Approximately at 10 months post-operatively, the patients reported full weight-bearing of the extremity.
- MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- nestejná délka dolních končetin chirurgie MeSH
- osteogeneze pomocí distrakčního aparátu přístrojové vybavení MeSH
- tibie abnormality chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- amputace MeSH
- dítě MeSH
- femur abnormality chirurgie MeSH
- lidé MeSH
- protetické prostředky MeSH
- radius abnormality chirurgie MeSH
- tibie abnormality chirurgie MeSH
- vrozené deformity končetin chirurgie klasifikace MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
Autor zevrubně zpracoval všechnu dostupnou literaturu pojednávající o vzácné vrozené klinické jednotce „vrozené posteromedial n í angulaci tibie a fibuly". Kongenitální kyfoskolióza bérce je synonymem pro stejnou chorobu. Na rozdíl od jiných angulací bérce je výše uvedená klinická jednotka charakterizována spontánní remodelací deformity kostí. Persistuje pouze zkratek postiženého bérce. Ve studii jsou popsány čtyři vlastní pozorování. V jednom případě bylo nutno korigovat valgózní deformitu nožky v 8. měsíci věku. Angulace bérce se u všech čtyřech dětí z větší části před třetím rokem věku spontánně vyrovnala. Dokumentace je i podložena vývojovou řadou rtg-snímků v obou projekcích. Medialní složka angulace přetrvává delší dobu než složka dorzální. Diskrepance délky dolních končetin je u našich případů, u kterých nebyl ukončen růst, v rozmezí 2-4 cm.
The author has based his article on all available literature dealing with a rare congenital clinical unit "congenital posteromedial angulation of tibia and fibula". Congenital kyphoscoliosis of tibia is a synonym for the same disease. In contrast to other angulations of the tibia and fibula the above mentioned clinical unit is characterized by a spontaneous remodeling of the bone deformity. Persisting is only the shortening of tibia. The author describes in the study his own follow-up of four cases. In one case it was necessary to correct valgus deformity of tibia in 8th month of age. Angulation in all four children spontaneously corrected itself before the 3rd year of age. Documentation is supplemented with a developmental series of x-rays in both projections. The medial component of angulation persists longer than the dorsal component. Discrepancy of the length of lower limbs in our cases where the growth has not finished yet ranges between 2-4 cm.
