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Corrective tibial osteotomy in young adults using an intramedullary nail.

Kim KI, Thaller PH, Ramteke A, Lee SH, Lee SH - Knee Surg Relat Res (2014)

Bottom Line: There was no significant change in the proximal tibial anatomy and patellar height.Radiographic evaluation indicated that PTO using an intramedullary tibial nail leads to significant improvement in radiographic parameters without changes in posterior tibial slope or patellar height.We found that this technique could be a less invasive and effective alternative for correction of the varus knee in young adults.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.

ABSTRACT

Purpose: The purpose of this study was to document results of a less invasive technique of open wedge proximal tibial osteotomy (PTO) for the varus knee in young adults using an intramedullary tibial nail.

Materials and methods: We prospectively studied 24 knees in 16 young patients with varus knee deformity. The mean follow-up was 54 months (range, 36 to 107 months) and the mean age of patients at the time of operation was 25.8 years (range, 18 to 40 years). The open wedge PTO was performed below tibial tuberosity using a percutaneous multiple drill-hole technique. Conventional intramedullary tibial nail was used for fixation without bone graft. Radiographic evaluations were made using mechanical alignment (MA), posterior tibial slope angle, and Insall-Salvati ratio. Union time, loss of correction, implant failure, and associated complications were also investigated.

Results: The mean MA was significantly changed from -9.7° preoperatively to 1.1° at the final follow-up (p<0.001). There was no significant change in the proximal tibial anatomy and patellar height. All patients achieved radiographic bony union at an average of 3.1 months without loss of correction. The only complication was knee pain due to nail prominence in 3 patients.

Conclusions: Radiographic evaluation indicated that PTO using an intramedullary tibial nail leads to significant improvement in radiographic parameters without changes in posterior tibial slope or patellar height. We found that this technique could be a less invasive and effective alternative for correction of the varus knee in young adults.

No MeSH data available.


Related in: MedlinePlus

Osteotomy was completed with gentle manual force without displacement, and the fragments were still aligned to each other. Any changes in the alignment either varus or valgus direction was possible at this stage with minimum force.
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Figure 3: Osteotomy was completed with gentle manual force without displacement, and the fragments were still aligned to each other. Any changes in the alignment either varus or valgus direction was possible at this stage with minimum force.

Mentions: All surgeries were performed by the senior author. The level of osteotomy and direction of the nail were marked on the leg under fluoroscopic guidance according to the preoperative drawing. The entry point of the tibial intramedullary nail was made through a less than 3 cm skin incision medial to the patellar tendon. Only the proximal tibia above the planned osteotomy line was reamed under fluoroscopic guidance along the desired trajectory of the entry of nail in the proximal fragment. Then osteotomy was performed percutaneously22) through a small stab incision (<1 cm) on the antero-lateral surface of the tibia (Fig. 2A). Under fluoroscopic control, multiple transverse drill holes were made with a 3.2 mm drill bit with a low-speed to minimize heat generation (Fig. 2B). A 0.25 inch osteotome was then used to connect most of the drill holes and the osteotomy was completed using gentle manual force22) (Fig. 3). Then, a guide wire was passed through the medullary canal and reaming was performed in gradually increasing increments of 0.5 mm. We over-reamed the medullary canal by 0.5 mm before determining a nail of proper size.


Corrective tibial osteotomy in young adults using an intramedullary nail.

Kim KI, Thaller PH, Ramteke A, Lee SH, Lee SH - Knee Surg Relat Res (2014)

Osteotomy was completed with gentle manual force without displacement, and the fragments were still aligned to each other. Any changes in the alignment either varus or valgus direction was possible at this stage with minimum force.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061412&req=5

Figure 3: Osteotomy was completed with gentle manual force without displacement, and the fragments were still aligned to each other. Any changes in the alignment either varus or valgus direction was possible at this stage with minimum force.
Mentions: All surgeries were performed by the senior author. The level of osteotomy and direction of the nail were marked on the leg under fluoroscopic guidance according to the preoperative drawing. The entry point of the tibial intramedullary nail was made through a less than 3 cm skin incision medial to the patellar tendon. Only the proximal tibia above the planned osteotomy line was reamed under fluoroscopic guidance along the desired trajectory of the entry of nail in the proximal fragment. Then osteotomy was performed percutaneously22) through a small stab incision (<1 cm) on the antero-lateral surface of the tibia (Fig. 2A). Under fluoroscopic control, multiple transverse drill holes were made with a 3.2 mm drill bit with a low-speed to minimize heat generation (Fig. 2B). A 0.25 inch osteotome was then used to connect most of the drill holes and the osteotomy was completed using gentle manual force22) (Fig. 3). Then, a guide wire was passed through the medullary canal and reaming was performed in gradually increasing increments of 0.5 mm. We over-reamed the medullary canal by 0.5 mm before determining a nail of proper size.

Bottom Line: There was no significant change in the proximal tibial anatomy and patellar height.Radiographic evaluation indicated that PTO using an intramedullary tibial nail leads to significant improvement in radiographic parameters without changes in posterior tibial slope or patellar height.We found that this technique could be a less invasive and effective alternative for correction of the varus knee in young adults.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.

ABSTRACT

Purpose: The purpose of this study was to document results of a less invasive technique of open wedge proximal tibial osteotomy (PTO) for the varus knee in young adults using an intramedullary tibial nail.

Materials and methods: We prospectively studied 24 knees in 16 young patients with varus knee deformity. The mean follow-up was 54 months (range, 36 to 107 months) and the mean age of patients at the time of operation was 25.8 years (range, 18 to 40 years). The open wedge PTO was performed below tibial tuberosity using a percutaneous multiple drill-hole technique. Conventional intramedullary tibial nail was used for fixation without bone graft. Radiographic evaluations were made using mechanical alignment (MA), posterior tibial slope angle, and Insall-Salvati ratio. Union time, loss of correction, implant failure, and associated complications were also investigated.

Results: The mean MA was significantly changed from -9.7° preoperatively to 1.1° at the final follow-up (p<0.001). There was no significant change in the proximal tibial anatomy and patellar height. All patients achieved radiographic bony union at an average of 3.1 months without loss of correction. The only complication was knee pain due to nail prominence in 3 patients.

Conclusions: Radiographic evaluation indicated that PTO using an intramedullary tibial nail leads to significant improvement in radiographic parameters without changes in posterior tibial slope or patellar height. We found that this technique could be a less invasive and effective alternative for correction of the varus knee in young adults.

No MeSH data available.


Related in: MedlinePlus