Dataset Information

New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach.

ABSTRACT: BACKGROUND:Successful surgical treatment of late-presenting infantile tibia vara (ITV) patient requires the correction of oblique deformities. The purpose of this study was to report on a new comprehensive approach to correct and prevent recurrence of these deformities with a single procedure. METHODS:Medical records of 23 consecutive children (7 to 18 y) with advanced ITV (29 knees) were retrospectively reviewed after a mean of 7.3 years postoperatively (range, 2 to 22 y). Indications for the corrective surgery were any child 7 year or older with a varus mechanical axis angle ?10 degrees or a varus anatomic axis angle ?11 degrees and a medial tibial angle (MTA) slope <60 degrees. The deformities were corrected with a dome-shaped osteotomy proximal to the tibial tubercle with a midline vertical extension to the subchondral region of the joint and a lateral hemi-epiphysiodesis. RESULTS:At latest follow-up, means and medians of each tibial radiographic axis measurement improved significantly from preoperative values (P<0.001): mechanical axis angle from 23 degrees to 4 degrees varus, anatomic axis angle from 25 degrees varus to 1 degree valgus, MTA downward slope from 30 to 78 degrees, posterior MTA from 59 to 80 degrees. In total, 79% and 74% had good to excellent results based on radiographic criteria and clinical questionnaire for satisfaction, pain and function, respectively. Two abnormal medial tibial plateau types were described. CONCLUSIONS:This is the first study to use a single-stage double osteotomy performed proximal to the tibial tubercle for the late-presenting ITV for children 7 years of age or older. In addition to the effective correction of the 4 major tibial deformities, a lateral proximal tibial hemi-epiphysiodesis minimizes recurrence of tibia vara. A contralateral proximal tibial epiphysiodesis is recommended for treated skeletally immature patients with unilateral disease. LEVEL OF EVIDENCE:Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.

SUBMITTER: Abraham E

PROVIDER: S-EPMC5498283 | biostudies-literature | 2019 May/Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach.

Abraham Edward E Toby David D Welborn Michelle C MC Helder Cory W CW Murphy Angela A

Journal of pediatric orthopedics 20190501 5

<h4>Background</h4>Successful surgical treatment of late-presenting infantile tibia vara (ITV) patient requires the correction of oblique deformities. The purpose of this study was to report on a new comprehensive approach to correct and prevent recurrence of these deformities with a single procedure.<h4>Methods</h4>Medical records of 23 consecutive children (7 to 18 y) with advanced ITV (29 knees) were retrospectively reviewed after a mean of 7.3 years postoperatively (range, 2 to 22 y). Indica ...[more]

PMID: 30969255

Similar Datasets

Project description:BackgroundDistal tibia allograft reconstruction of the glenoid in shoulder instability has garnered significant attention over the last decade. Prior studies demonstrate significant improvement in all reported patient outcomes albeit the approach is through a subscapularis split. There have not been prior studies evaluating outcomes after lesser tuberosity osteotomy which provides excellent exposure to the anterior glenoid.We hypothesize there is significant improvement in functional outcomes and no deleterious effects after lesser tuberosity osteotomy for distal tibia allograft reconstruction of the glenoid for shoulder instability.MethodsA retrospective review was performed from 2016 of 2019 of patients undergoing distal tibia allograft reconstruction of the glenoid through a lesser tuberosity osteotomy. Patients were indicated if they had recurrent anterior shoulder instability with >20% glenoid bone loss and evidence of an off-track lesion. Clinical, imaging, and operative data were evaluated. Objective follow-up data evaluated at minimum 2 years included radiographs, range of motion, DASH, SANE, VAS, SST, ASES, and Constant scores.ResultsA total of 12 patients were available with average follow-up 28 months, average age 26 years old, and average glenoid bone loss of 33%. The patients demonstrated significant improvement in their clinical outcomes at final follow-up: DASH 42.9-8.9 (P = .004), SANE 32.2-85 (P = .00005), VAS 4.6-1.1 (P = .003), SST 7-11.4 (P = .01), ASES 50.2-90.5 (P = .001), and Constant 37.6-86.2 (P = .01). Range of motion at final follow-up was forward flexion to 161.4° (135-170°), external rotation 49.5° (40-65°), and internal rotation to T12-L1 (T7-L2) vertebral body.ConclusionThe present study demonstrates the effectiveness of a lesser tuberosity osteotomy in exposure of the glenoid for reconstruction with a distal tibia allograft. The functional integrity of the subscapularis is maintained and the patient-reported outcomes are comparable with current literature.

Project description:This paper presents a comprehensive theory for the demographic analysis of populations in which individuals are classified by both age and stage. The earliest demographic models were age classified. Ecologists adopted methods developed by human demographers and used life tables to quantify survivorship and fertility of cohorts and the growth rates and structures of populations. Later, motivated by studies of plants and insects, matrix population models structured by size or stage were developed. The theory of these models has been extended to cover all the aspects of age-classified demography and more. It is a natural development to consider populations classified by both age and stage. A steady trickle of results has appeared since the 1960s, analyzing one or another aspect of age × stage-classified populations, in both ecology and human demography. Here, we use the vec-permutation formulation of multistate matrix population models to incorporate age- and stage-specific vital rates into demographic analysis. We present cohort results for the life table functions (survivorship, mortality, and fertility), the dynamics of intra-cohort selection, the statistics of longevity, the joint distribution of age and stage at death, and the statistics of life disparity. Combining transitions and fertility yields a complete set of population dynamic results, including population growth rates and structures, net reproductive rate, the statistics of lifetime reproduction, and measures of generation time. We present a complete analysis of a hypothetical model species, inspired by poecilogonous marine invertebrates that produce two kinds of larval offspring. Given the joint effects of age and stage, many familiar demographic results become multidimensional, so calculations of marginal and mixture distributions are an important tool. From an age-classified point of view, stage structure is a form of unobserved heterogeneity. From a stage-classified point of view, age structure is unobserved heterogeneity. In an age × stage-classified model, variance in demographic outcomes can be partitioned into contributions from both sources. Because these models are formulated as matrices, they are amenable to a complete sensitivity analysis. As more detailed and longer longitudinal studies are developed, age × stage-classified demography will become more common and more important.

Dataset Information

New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach.

Publications

New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets