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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

A valgus correction with medial opening was automatically created simultaneously with passing of the nail across the osteotomy site into the mid-diaphysis in the distal tibia.
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Figure 4: A valgus correction with medial opening was automatically created simultaneously with passing of the nail across the osteotomy site into the mid-diaphysis in the distal tibia.

Mentions: The nail was naturally inserted manually through the medially located entry point with free hand without the use of any blocking screws to guide the passage of the nail. When the nail engaged the medullary canal and isthmus distal to the osteotomy level, the distal fragment was automatically corrected into neutral alignment (Fig. 4). This correction was achieved by a medial opening at the osteotomy site, valgus tilting of the distal fragment, and lateral translation of the distal fragment23). No bone graft was performed in all cases. This nail was securely fixed with 2 or 3 proximal and distal interlocking screws. Concomitant osteotomy of the fibula can be performed before tibial osteotomy in case of severe varus, but we did not perform a fibular osteotomy (Fig. 5). On the first postoperative day, the patient was allowed bed-side leg dangling and wheel chair mobilization. Walking with partial weight bearing was started on postoperative day 2 with gradual weight bearing as tolerated.


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)

A valgus correction with medial opening was automatically created simultaneously with passing of the nail across the osteotomy site into the mid-diaphysis in the distal tibia.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: A valgus correction with medial opening was automatically created simultaneously with passing of the nail across the osteotomy site into the mid-diaphysis in the distal tibia.
Mentions: The nail was naturally inserted manually through the medially located entry point with free hand without the use of any blocking screws to guide the passage of the nail. When the nail engaged the medullary canal and isthmus distal to the osteotomy level, the distal fragment was automatically corrected into neutral alignment (Fig. 4). This correction was achieved by a medial opening at the osteotomy site, valgus tilting of the distal fragment, and lateral translation of the distal fragment23). No bone graft was performed in all cases. This nail was securely fixed with 2 or 3 proximal and distal interlocking screws. Concomitant osteotomy of the fibula can be performed before tibial osteotomy in case of severe varus, but we did not perform a fibular osteotomy (Fig. 5). On the first postoperative day, the patient was allowed bed-side leg dangling and wheel chair mobilization. Walking with partial weight bearing was started on postoperative day 2 with gradual weight bearing as tolerated.

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