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Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 September 2023) | Viewed by 15460

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Dr. Lukas Zak

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Guest Editor

Department for Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
Interests: deformity correction; bone lengthening; trauma surgery; knee surgery

Special Issue Information

Dear Colleagues,

Damaged joints and bones after orthopedic injuries are not just painful, they can also severely impact lifestyle and mobility. If primary procedures fail, surgical procedure is commonly the only effective solution to restore the joint or the bone for treatment of pain and functional issues. Reconstructive orthopedic and trauma surgeons may perform a wide range of operations.

As Ilizarov fixators are still the gold-standard in deformity correction, multiple new developments have appeared. Smart ring fixators, new computer aided planning, intramedullary devices and individualized 3D-printed cutting blocks for corrective osteotomies facilitate bone lengthening and deformity correction.

For this Special Issue titled “Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb”, we would like to invite authors to submit their original papers and to share their innovative and novel techniques in this field of interest. Review articles are welcome to summarize the established treatment methods.

Dr. Lukas Zak
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

bone reconstruction
bone lengthening
limb reconstruction
limb lengthening
joint reconstruction
pseudarthrosis
nonunion
lower limb

Published Papers (7 papers)

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Research

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14 pages, 8240 KiB

Open AccessArticle

Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients

by Andrea Laufer, Adrien Frommer, Georg Gosheger, Gregor Toporowski, Jan Duedal Rölfing, Carina Antfang, Robert Roedl and Bjoern Vogt

J. Clin. Med. 2023, 12(8), 3022; https://doi.org/10.3390/jcm12083022 - 21 Apr 2023

Cited by 2 | Viewed by 1286

Abstract

Leg length discrepancies (LLD) are frequently associated with coronal malalignment. Temporary hemiepiphysiodesis (HED) is a well-established procedure for the correction of limb malalignment in skeletally immature patients. For treatment of LLD > 2 cm, lengthening with intramedullary devices gains increasing popularity. However, no studies have investigated the combined application of HED and intramedullary lengthening in skeletally immature patients. This retrospective single-center study evaluated the clinical and radiological outcomes of femoral lengthening with an antegrade intramedullary lengthening nail combined with temporary HED performed in 25 patients (14 females) between 2014 and 2019. Temporary HED through the implantation of flexible staples of the distal femur and/or proximal tibia was either performed prior (n = 11), simultaneously (n = 10) or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4). The median initial LLD was 39.0 mm (35.0–45.0). Twenty-one patients (84%) presented valgus and four (16%) showed varus malalignment. Leg length equalization was achieved in 13 of the skeletally mature patients (62%). The median LLD of the eight patients with residual LLD > 10 mm at skeletal maturity was 15.5 mm (12.8–21.8). Limb realignment was observed in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group. Combining antegrade femoral lengthening and temporary HED is a viable option to correct LLD and coronal limb malalignment in skeletally immature patients; however, achieving limb length equalization and realignment may be difficult in cases of severe LLD and angular deformity, in particular. Full article

(This article belongs to the Special Issue Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb)

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10 pages, 5808 KiB

Open AccessArticle

Comparison of Intramedullary Magnetic Nail, Monolateral External Distractor, and Spatial External Fixator in Femur Lengthening in Adolescents with Congenital Diseases

by Szymon Pietrzak, Dariusz Grzelecki, Tomasz Parol and Jarosław Czubak

J. Clin. Med. 2021, 10(24), 5957; https://doi.org/10.3390/jcm10245957 - 18 Dec 2021

Cited by 1 | Viewed by 2508

Abstract

The aim of this study is to evaluate the course of the treatment and clinical and functional outcomes of femur lengthening in adolescents with congenital disorders by the application of different surgical methods. This retrospective study comprised 35 patients (39 procedures). A total of 11 patients underwent femur lengthening with the use of the intramedullary magnetic nail (IMN) Precise 2 (NuVasive, San Diego, CA, USA), 7 patients (11 procedures) with the use of the monolateral external distractor Modular Rail System (MRS) (Smith and Nephew, Memphis, TN, USA), and 17 with the use of the computer-assisted external fixator Taylor Spatial Frame (TSF) (Smith and Nephew, Memphis, TN, USA). The inclusion criteria were as follows: (1) congenital femoral length deficiency without any axial deformities and (2), independently of the finally applied treatment, the technical possibility of use of each of the analyzed methods. The distraction index did not differ significantly between the groups (p = 0.89). The median lengthening index was the lowest in the IMN group (24.3 d/cm; IQR 21.8–33.1) and statistically different in comparison to the MRS (44.2 d/cm; IQR 42–50.9; p < 0.001) and the TSF groups (48.4 d/cm; IQR 38.6–63.5; p < 0.001). Similarly, the consolidation index in the IMN group (12.9 d/cm; IQR 10.7–21.3) was statistically lower than that in the MRS (32.9 d/cm; IQR 30.2–37.6; p < 0.001) and the TSF (36.9 d/cm; IQR 26.6–51.5; p < 0.001) groups. This study indicates that IMN is a more valuable method of treatment for femoral length discrepancy without axial deformity than MRS and TSF in complication rate and indexes of lengthening and consolidation. Full article

(This article belongs to the Special Issue Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb)

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14 pages, 2581 KiB

Open AccessArticle

Computed Tomography in Limb Salvage and Deformity Correction—3D Assessment, Indications, Radiation Exposure, and Safety Considerations

by Lukas Zak, Thomas M. Tiefenboeck and Gerald E. Wozasek

J. Clin. Med. 2021, 10(17), 3781; https://doi.org/10.3390/jcm10173781 - 24 Aug 2021

Cited by 3 | Viewed by 2473

Abstract

Computed tomography (CT) is an essential tool in orthopedic surgery but is known to be a method with that entails radiation exposure. CT increases the risk of developing fatal cancer, which should not be underestimated. However, patients with bone defects and/or deformities must frequently undergo numerous investigations during their treatment. CT is used for surgical planning, evaluating callus maturation, alignment measurement, length measurement, torsion measurement, and angiography. This study explores the indications in CT scans for limb lengthening and deformity correction and estimates the effective radiation dose. These results should help avoid unnecessary radiation exposure by narrowing the examination field and by providing explicit scanning indications. For this study, 19 posttraumatic patients were included after the bone reconstruction of 21 lower limbs. All patients underwent CT examinations during or after treatment with an external ring fixator. The mean effective dose was 3.27 mSv, with a mean cancer risk of 1:117,014. The effective dose depended on the location and indication of measurement, with a mean dose of 0.04 mSv at the ankle up to 6.8 mSv (or higher) for vascular depictions. CT evaluation, with or without 3D reconstruction, is a crucial tool in complex bone reconstruction and deformity treatments. Therefore, strict indications are necessary to reduce radiation exposure—especially in young patients—without compromising the management of their patients. Full article

(This article belongs to the Special Issue Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb)

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10 pages, 880 KiB

Open AccessArticle

Poor Correction Capacity of Preexisting Ankle Valgus Deformity after Total Knee Arthroplasty

by Han-Ting Shih, Wei-Jen Liao, Kao-Chang Tu, Cheng-Hung Lee, Shih-Chieh Tang and Shun-Ping Wang

J. Clin. Med. 2021, 10(16), 3624; https://doi.org/10.3390/jcm10163624 - 17 Aug 2021

Cited by 1 | Viewed by 2505

Abstract

This study investigated the differences in ankle alignment changes after TKA in patients with varying preexisting ankle deformities. We retrospectively examined 90 knees with osteoarthritis and varus deformity in 78 patients who underwent TKA. Preoperative and postoperative radiographic parameters were analyzed. According to their preexisting ankle deformity, patients were assigned to the valgus or varus group. Overall, 14 (15.6%) cases were of preoperative valgus ankle deformity; the remainder were of preoperative varus ankle deformity. Hip–knee–ankle angle (HKA), tibial plafond–ground angle (PGA), and talus–ground angle (TGA) all exhibited significant correction in both groups; however, tibial plafond–talus angle (PTA) and superior space of ankle joint (SS) only changed in the varus group. The median PTA and SS significantly decreased from 1.2° to 0.3° (p < 0.001) and increased from 2.5 to 2.6 mm (p = 0.013), respectively. Notably, ∆PTA positively correlated with ∆HKA in the varus group (r = 0.247, p = 0.032) but not in the valgus group. Between-group differences in postoperative PTA (p < 0.001) and ∆PTA (p < 0.001) were significant. The degree of ankle alignment correction after TKA differed between patients with preexisting varus and valgus ankle deformities. TKA could not effectively correct the preexisting ankle valgus malalignment. Full article

(This article belongs to the Special Issue Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb)

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Review

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18 pages, 4112 KiB

Open AccessReview

Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement

by Duo Wai-Chi Wong, James Chung-Wai Cheung, Jia-Guo Zhao, Ming Ni and Zu-Yao Yang

J. Clin. Med. 2023, 12(4), 1384; https://doi.org/10.3390/jcm12041384 - 9 Feb 2023

Cited by 2 | Viewed by 3514

Abstract

While hallux valgus (HV) surgeries are useful for correcting skeletal alignment problems, their effects on plantar load, which reflects forefoot functions, are less understood. The objective of this study is to conduct a systematic review and meta-analysis on the plantar load change after HV surgeries. A systematic search of Web of Science, Scopus, PubMed, CENTRAL, EMBASE, and CINAHL was performed. Studies that assessed the pre- and post-operative plantar pressure of HV patients undergoing surgeries and reported load-related parameters over the hallux, medial metatarsal, and/or central metatarsal regions were included. Studies were appraised by using the modified NIH quality assessment tool for before-after study. Studies suitable for meta-analysis were pooled with the random-effects model, using the standardized mean difference of the before-after parameters as an effect measure. Twenty-six studies containing 857 HV patients and 973 feet were included for the systematic review. Meta-analysis was conducted on 20 of them, and most studies did not favor HV surgeries. Overall, HV surgeries reduced the plantar load over the hallux region (SMD −0.71, 95% CI, −1.15 to −0.26), indicating that forefoot function worsened after surgeries. For the other five outcomes, the overall estimates were not statistically significant, indicating that surgeries did not improve them either. There was substantial heterogeneity among the studies, which in most cases could not be resolved by pre-planned subgroup analyses by surgical classification, year of publication, median age of patients, and length of follow-up. Sensitivity analysis removing lower-quality studies showed that the load integrals (impulse) over the central metatarsal region significantly increased (SMD 0.27, 95% CI, 0 to 0.53), indicating that surgeries increased the risk of transfer metatarsalgia. There is no solid evidence that HV surgeries could improve forefoot functions from a biomechanical point perspective. Currently available evidence even suggests that surgeries might reduce the plantar load over the hallux and adversely affect push-off function. The reasons behind and the effectiveness of alternative surgical methods warrant further investigation. Full article

(This article belongs to the Special Issue Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb)

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Other

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17 pages, 1021 KiB

Open AccessSystematic Review

Recurrence and Complication Rates of Surgical Treatment for Blount’s Disease in Children: A Systematic Review and Meta-Analysis

by Marco Ramella, Alessandro Depaoli, Grazia Chiara Menozzi, Giovanni Gallone, Tosca Cerasoli, Gino Rocca and Giovanni Trisolino

J. Clin. Med. 2023, 12(20), 6495; https://doi.org/10.3390/jcm12206495 - 12 Oct 2023

Viewed by 912

Abstract

Background: Blount’s disease is a growth disorder of the proximal tibia that causes progressive genu varum in children. Surgical treatment is recommended if the deformity worsens, but which intervention is best remains controversial. This study aims to identify factors influencing outcomes and determine the most effective surgical approach. Methods: A systematic review was conducted of studies published before January 2022. Results: In total, 63 retrospective studies with CEBM IIIb/IV levels were included (1672 knees in 1234 patients). The most commonly reported treatment was acute correction via osteotomy (47%), followed by hemiepiphysiodesis (22%) and gradual correction (18%). Combined procedures were reported in 13% of cases. The overall recurrence rate was 18%, with a significant difference when comparing the recurrence rates after gradual correction with those after hemiepiphysiodesis (7% and 29%, respectively). Major complications beyond recurrence were observed in 5% of cases. A meta-analysis of the available raw data showed a significantly increased recurrence rate (39%) among treated children who were between 4.5 and 11.25 years of age and were followed for a minimum follow-up of 2.5 years. Conclusions: Overall, poor evidence with which to establish an optimal treatment for Blount’s disease was found. This study remarked on the need for early diagnosis, classification, and treatment of infantile tibia vara, since a significant rate of recurrence was found in neglected cases. Full article

(This article belongs to the Special Issue Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb)

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14 pages, 2616 KiB

Open AccessPerspective

Corrective Osteotomies in Severe Non-Idiopathic Lower Limb Alignment Disorders in the Aspect of Future Joint Endoprosthesis—A Perspective Study

by Kamil Kołodziejczyk, Michał Saganek, Adam Czwojdziński, Rafał Garlewicz, Marcin Złotorowicz and Jarosław Czubak

J. Clin. Med. 2023, 12(19), 6380; https://doi.org/10.3390/jcm12196380 - 6 Oct 2023

Viewed by 1000

Abstract

The aim of this study was to retrospectively evaluate the effectiveness of corrective osteotomies in lower limb axis disorders at different levels of non-idiopathic (post traumatic, developmental, post-septic) etiology. A total of 50 patients were divided into three groups: A—thigh segment alignment disorder (24 patients); B—tibia segment alignment disorder (18 patients); C—thigh and tibia segment alignment disorder (8 patients). Radiological evaluation of digital lower limb postural X-ray was performed laterally and for AP, and included mLPFA, mLDFA, MAD, CORA coronal and sagittal plane parameters for the femur segment and mMPTA, mLDTA, MAD, CORA coronal and sagittal plane for the tibia segment. Clinical assessment was based on the LLFI. The mean follow-up was 55.8 months (12–86). Improvements in the radiological parameters and statistical significance were achieved for all measurements in all groups (p < 0.05). The most common plane of deformation was the coronal plane (varus/valgus), followed by the transverse (rotational) and sagittal planes (procurvatum/recurvatum). In this study, we examined 29 post-traumatic deformities and 21 other etiologies. Improvements in the LLFI score performance after corrective osteotomies were observed in all three groups. Corrective osteotomies are a safe and useful but challenging method of preserving joints in cases of post-traumatic, developmental or post-septic lower limb alignment disorders. Full article

(This article belongs to the Special Issue Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb)

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