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Predicting translational deformity following opening-wedge osteotomy for lower limb realignment.

Barksfield RC, Monsell FP - Strategies Trauma Limb Reconstr (2015)

Bottom Line: A simulated model was developed using TraumaCad online digital software suite (Brainlab AG, Germany).Osteotomies were simulated in the distal femur, proximal tibia and distal tibia for nine sets of lower limb scanograms at incremental distances from the CORA and the resulting translational deformity recorded.There was excellent agreement between the predictive algorithm and simulated translational deformity for all nine simulations (correlation coefficient 0.93-0.99, p < 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK. rcbarksfield@hotmail.com.

ABSTRACT
An opening-wedge osteotomy is well recognised for the management of limb deformity and requires an understanding of the principles of geometry. Translation at the osteotomy is needed when the osteotomy is performed away from the centre of rotation of angulation (CORA), but the amount of translation varies with the distance from the CORA. This translation enables proximal and distal axes on either side of the proposed osteotomy to realign. We have developed two experimental models to establish whether the amount of translation required (based on the translation deformity created) can be predicted based upon simple trigonometry. A predictive algorithm was derived where translational deformity was predicted as 2(tan α × d), where α represents 50 % of the desired angular correction, and d is the distance of the desired osteotomy site from the CORA. A simulated model was developed using TraumaCad online digital software suite (Brainlab AG, Germany). Osteotomies were simulated in the distal femur, proximal tibia and distal tibia for nine sets of lower limb scanograms at incremental distances from the CORA and the resulting translational deformity recorded. There was strong correlation between the distance of the osteotomy from the CORA and simulated translation deformity for distal femoral deformities (correlation coefficient 0.99, p < 0.0001), proximal tibial deformities (correlation coefficient 0.93-0.99, p < 0.0001) and distal tibial deformities (correlation coefficient 0.99, p < 0.0001). There was excellent agreement between the predictive algorithm and simulated translational deformity for all nine simulations (correlation coefficient 0.93-0.99, p < 0.0001). Translational deformity following corrective osteotomy for lower limb deformity can be anticipated and predicted based upon the angular correction and the distance between the planned osteotomy site and the CORA.

No MeSH data available.


Related in: MedlinePlus

Demonstration of the use of the deformity templating software for a typical distal femoral deformity simulation. Note the translation that occurs where the osteotomy is performed proximal to the CORA
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Fig3: Demonstration of the use of the deformity templating software for a typical distal femoral deformity simulation. Note the translation that occurs where the osteotomy is performed proximal to the CORA

Mentions: Experimental data were simulated using the TraumaCad online digital software suite (Brainlab AG, Germany). Anonymised lower limb scanograms were uploaded and calibrated using the inbuilt “Deformity Correction model”. A lower limb deformity analysis was performed for each scanogram, and a CORA derived for correcting each deformity. A corrective osteotomy and limb realignment were then simulated at the level of the CORA; this was repeated at intervals of 5 mm proceeding proximally from the distal femoral and distal tibial metaphyses, and proceeding distally from the proximal tibial metaphysis (Fig. 3). For each simulation, a series of measurements was performed that included the angular correction, the distance to CORA, the measured translation and the percentage translation.Fig. 3


Predicting translational deformity following opening-wedge osteotomy for lower limb realignment.

Barksfield RC, Monsell FP - Strategies Trauma Limb Reconstr (2015)

Demonstration of the use of the deformity templating software for a typical distal femoral deformity simulation. Note the translation that occurs where the osteotomy is performed proximal to the CORA
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4666231&req=5

Fig3: Demonstration of the use of the deformity templating software for a typical distal femoral deformity simulation. Note the translation that occurs where the osteotomy is performed proximal to the CORA
Mentions: Experimental data were simulated using the TraumaCad online digital software suite (Brainlab AG, Germany). Anonymised lower limb scanograms were uploaded and calibrated using the inbuilt “Deformity Correction model”. A lower limb deformity analysis was performed for each scanogram, and a CORA derived for correcting each deformity. A corrective osteotomy and limb realignment were then simulated at the level of the CORA; this was repeated at intervals of 5 mm proceeding proximally from the distal femoral and distal tibial metaphyses, and proceeding distally from the proximal tibial metaphysis (Fig. 3). For each simulation, a series of measurements was performed that included the angular correction, the distance to CORA, the measured translation and the percentage translation.Fig. 3

Bottom Line: A simulated model was developed using TraumaCad online digital software suite (Brainlab AG, Germany).Osteotomies were simulated in the distal femur, proximal tibia and distal tibia for nine sets of lower limb scanograms at incremental distances from the CORA and the resulting translational deformity recorded.There was excellent agreement between the predictive algorithm and simulated translational deformity for all nine simulations (correlation coefficient 0.93-0.99, p < 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK. rcbarksfield@hotmail.com.

ABSTRACT
An opening-wedge osteotomy is well recognised for the management of limb deformity and requires an understanding of the principles of geometry. Translation at the osteotomy is needed when the osteotomy is performed away from the centre of rotation of angulation (CORA), but the amount of translation varies with the distance from the CORA. This translation enables proximal and distal axes on either side of the proposed osteotomy to realign. We have developed two experimental models to establish whether the amount of translation required (based on the translation deformity created) can be predicted based upon simple trigonometry. A predictive algorithm was derived where translational deformity was predicted as 2(tan α × d), where α represents 50 % of the desired angular correction, and d is the distance of the desired osteotomy site from the CORA. A simulated model was developed using TraumaCad online digital software suite (Brainlab AG, Germany). Osteotomies were simulated in the distal femur, proximal tibia and distal tibia for nine sets of lower limb scanograms at incremental distances from the CORA and the resulting translational deformity recorded. There was strong correlation between the distance of the osteotomy from the CORA and simulated translation deformity for distal femoral deformities (correlation coefficient 0.99, p < 0.0001), proximal tibial deformities (correlation coefficient 0.93-0.99, p < 0.0001) and distal tibial deformities (correlation coefficient 0.99, p < 0.0001). There was excellent agreement between the predictive algorithm and simulated translational deformity for all nine simulations (correlation coefficient 0.93-0.99, p < 0.0001). Translational deformity following corrective osteotomy for lower limb deformity can be anticipated and predicted based upon the angular correction and the distance between the planned osteotomy site and the CORA.

No MeSH data available.


Related in: MedlinePlus