Tibial rotational osteotomy

Rat tibia fractures are often used in fracture healing studies. Usually the fracture is stabilized with an intramedullary pin, which provides bending stiffness, but little torsional stiffness. The objective of this research was to determine the in vitro torsional rigidity of an osteotomized tibia with and without the fibula, and to determine if this difference influences the healing process in vivo. In vitro eleven rat tibias received an osteotomy, were stabilized with an intramedullary pin, and were tested in internal rotation to determine the torsional rigidity...

PURPOSE: The effect of the rotational alignment of lower extremities on the tibiofemoral contact mechanics is not known. This study was designed to measure the contact area and pressure within medial and lateral tibiofemoral compartments following controlled serial rotational deformities through femoral and tibial shafts. METHODS: Eight lower extremities of fresh frozen cadavers were used. Computed tomography was conducted to measure the rotational profile of the lower extremities...

BACKGROUND: External tibial torsion causes an abnormal axis of joint motion relative to the line of progression with resultant abnormal coronal plane knee moments and affects lever arm function of the foot in power generation at the ankle. However, it is unclear whether surgical correction of the tibial torsion corrects the moments and power. QUESTIONS/PURPOSES: We evaluated whether surgical correction of external tibial torsion in patients with cerebral palsy would correct the abnormal coronal plane knee moments and improve ankle power generation...

In an 18-year review period, 10 patients were identified with debilitating anterior knee pain and severe rotational malalignment of the lower extremity. Eight of the most symptomatic knees in 7 of these patients were treated with a rotational osteotomy of the tibia performed proximal to the tibial tubercle. Six of the 7 patients who fit a previously described spectrum of rotational deformity consisting of mild femoral anteversion, severe external tibial torsion, mild tibia vara, and pes planovalgus deformity, underwent unilateral procedures for external tibial torsion...

A randomized prospective study was undertaken to assess the role of fibular osteotomy in distal tibial derotational osteotomies. Thirty-five patients were randomized to "intact fibula" and "osteotomized fibula" groups. There were no statistically significant differences in the amount of intraoperative derotation, time to weight bear, time to healing, and the amount of correction retained at follow-up between the two groups. Complications in the intact fibula group included one delayed union and one recurrence...

From a chart review of 45 consecutive cases (mean age 8.9 years) of patients who had rotational osteotomies of the tibia alone (group 1, 27 cases) or of both the tibia and fibula (group 2, 18 cases) for torsional deformities of the leg, we compared the length of surgery and postoperative complications. We also describe the surgical technique for tibial osteotomy alone. The most common complication, posterior and varus/valgus angulation at the osteotomy site, was significantly higher in group 2 than in group 1 (p < 0...

Thirteen patients who had a proximal femoral focal deficiency and were treated with a rotational osteotomy of the tibia (Van Nes procedure) were evaluated at an average of five years after operation. Five patients needed a repeat osteotomy of the tibia: four because the limb had spontaneously derotated toward the original position and one because the limb had had insufficient rotation at the time of operation. One patient had a disarticulation at the ankle after the first stage of a planned two-stage procedure because the mother was not happy with the child's appearance...

Despite a tendency for rotational abnormalities of the lower leg in children to improve spontaneously over time, some fail to correct and require corrective derotation osteotomy. In this retrospective study, we report the technique and results of the distal transverse tibial and fibular derotation osteotomy with Kirschner-wire fixation performed in 63 limbs of children with cerebral palsy, clubfoot, idiopathic tibial torsion, and myelomeningocele, as well as other less common conditions. There were no significant infections, neurologic complications, delayed or nonunions, or compartment syndromes as a result of the osteotomy...

Supramalleolar osteotomies are performed to realign the distal tibia and to improve foot and ankle function. This procedure requires a thorough preoperative and intraoperative understanding of limb-deformity parameters and of the center of rotation of angulation method of surgical planning. Radiographic, gait, and clinical analyses along with intraoperative fluoroscopic images are paramount to deformity correction. This article describes the radiographic and clinical analyses and technical considerations in performing a focal dome supramalleolar osteotomy...

We reviewed 20 patients with spina bifida who had had surgical management of tibial torsion. Eight had had bilateral procedures and 12 a unilateral procedure, giving a total of 28 limbs for analysis. We performed closed osteoclasis on seven limbs and tibial osteotomy on 21. In the closed osteoclasis group six limbs (85%) had a good result after an average follow-up of nine years (2 to 22). All limbs developed postoperative anteromedial bowing of the tibia which later remodelled. In the tibial osteotomy group 19 (90%) had a good result...

Twenty percutaneous rotational osteotomies, stabilized with interlock nails, were performed in the lower limbs of 15 skeletally mature adolescents with cerebral palsy to correct rotational deformities. The medical records and radiographs of those patients were retrospectively reviewed. Nineteen osteotomies (95%) in 15 patients healed without major complications. One patient had one tibia (5%) pseudarthrosis, which was successfully treated with additional fibular osteotomy and exchanging the nail. Excluding this case, the average healing time for the femoral and tibial osteotomies was 8 weeks, ranging from 7 to 9 and from 6 to 10 weeks, respectively...

Accurate rotational osteotomy is especially difficult in a triangular bone such as the tibia. A technique using a fibular graft to locate the center of rotation and provide stability has been used in 9 operations with very satisfying results. Average healing time was 7 1/2 weeks. A protractor has been designed to measure the degrees of rotation.

The aims of this study were to determine the influence of external tibial torsion on the effectiveness of the ankle-foot orthoses (AFO) in children with lumbosacral myelomeningocele. Forty patients with normal tibial rotation and 18 patients with excessive external tibial torsion were evaluated with three-dimensional gait analysis at their comfortable walking speed. The group with normal tibial rotation showed significantly greater knee extension and lower mean extension moment compared with the group with external tibial torsion (p < 0...

Rotational deformities of the lower extremities are common in patients with myelomeningocele. In these situations, surgical correction is often necessary. We conducted a retrospective review of eight ambulatory patients with high sacral myelomeningocele and external tibial torsion who underwent 10 distal tibia and fibular internal derotation osteotomies. All patients had an increased valgus knee stress preoperatively. Pre- and postoperative three-dimensional gait analysis was used to evaluate coronal plane knee moments and dynamic sagittal plane knee motion...

BACKGROUND: For children with persistent tibial torsion, a wide variety of osteotomies and fixation methods have been proposed. We set out to compare the outcomes of percutaneous pin fixation versus a plate and screw construct. Our hypothesis was that the pin fixation group would have comparable outcomes without the need for a secondary procedure for implant removal. METHODS: A retrospective chart review was performed. Data were evaluated on patients undergoing a rotational supramalleolar osteotomy over a 10-year span with follow-up to union...

A retrospective analysis was done of 52 rotational tibial osteotomies (RTOs) performed on 35 patients with severe idiopathic tibial torsion. Thirty-nine osteotomies were performed at the proximal or midtibial level. Thirteen were performed at the distal tibial level with a technique previously described by one of the authors. Serious complications occurred in five (13%) of the proximal and in none of the distal RTOs. For severe and persisting idiopathic tibial torsion, the authors recommend correction by RTO at the distal level...

Informed clinical decision making for femoral and/or tibial de-rotation osteotomies requires accurate measurement of patient function through gait analysis and anatomy through physical examination of bony torsions. Validity of gait analysis has been extensively studied; however, controversy remains regarding the accuracy of physical examination measurements of femoral and tibial torsion. Comparison between CT-scans and physical examination measurements of femoral neck anteversion (FNA) and external tibial torsion (ETT) were retrospectively obtained for 98 (FNA) and 64 (ETT) patients who attended a tertiary hospital for instrumented gait analysis between 2007 and 2010...

BACKGROUND: Intoeing gait is frequently seen in developing children, and in most cases it resolves with growth. However, persistent, extreme intoeing gait, due to increased internal tibial torsion, may disrupt gait function. At our institution, children with symptomatic intoeing gait are evaluated per a standardized protocol, which includes quantitative gait analysis. When the primary cause is increased internal tibial torsion, surgical correction by supramalleolar tibial rotational osteotomy is recommended...

A retrospective review was performed of 46 consecutive ambulatory children with cerebral palsy and tibial torsion who underwent 72 distal tibial derotational osteotomies without concomitant fibular osteotomy. The average amount of derotation measured at surgery was 21 +/- 5 degrees. The average change in thigh-foot angle at follow-up was 21 +/- 9 degrees. There were eight perioperative complications (11%): three delayed unions, three superficial wound dehiscences, one case of osteomyelitis, and one superficial pin tract infection...

PURPOSE: The progression of knee osteoarthritis (OA) is determined in part by mechanical effects on local structures. The mechanical influences of limb malalignment on cartilage loss are well known; however, the effect of rotational deformities on knee OA is not yet known. The aim of the current study was to evaluate the effect of tibial rotation on knee medial and lateral compartment contact pressure. METHODS: The left knees of six fresh whole-body cadavers were used in this study...