Relationships between reference lines altered during leg shape correction as requested by the patient
https://doi.org/10.18019/1028-4427-2021-27-3-390-397
Abstract
Introduction. Patients who want their leg shape changed often identify the O- or X-shaped legs with varus or valgus deformity striving for ideally shaped legs as classified by A. A. Artemiev.
The purpose of the study was to compare changes in the relationship between reference lines as mechanical axis deviation (MAD), mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal tibial angle (mLDTA) and the associated duration of the correction (CP), fixation (FP) and frame-on periods (FoP) in patients who underwent correction to have the legs shape as requested and those who underwent tibial deformity correction.
Material and methods. There were 43 patients (84 segments operated on) in the cosmesis group and 15 participants (28 segments operated on) in orthopedic group. Preperative MAD, mMPTA, mLDTA measured 17.48 ± 1.14 mm medially, 84.90 ± 0.35° and 90.61 ± 0.39° in the cosmesis patients; 19.18 ± 2.86 mm medially, 84.04 ± 0.35°, 89.09 ± 0.37° in orthopaedic patients with no statistically significant differences observed between the groups.
Results. CP, FP and FoP lasted for 41.93 ± 3.96, 97.67 ± 7.78 and 139.60 ± 5.15 days in the cosmesis group, and 18.22 ± 3.05, 134.89 ± 9.42 and 153.00 ± 8.49 in controls. FP/CP, CP/FoP, FP/FoP measured 0.57 ≈ 1/2, 0.31 ≈ 1/3, 0.69 ≈ 2/3 in the cosmesis group and 0.15 ≈ 1/7; 0.12 ≈ 1/8; 0.88 ≈ 7/8 in controls. MAD, mMPTA, mLDTA measured 6.08 ± 0.87 mm laterally, 90.80 ± 0.31°, 88.62 ± 0.35° in the cosmesis participants, and 0.61 ± 0.82 mm laterally, 89.46 ± 0.54°, 87.68 ± 0. 63° in controls.
Discussion. There were no statistically significant differences in FoP with different duration of CP (≈ 1/3 FoP for the cosmesis group and ≈ 1/8 FoP for controls). The means of MAD, mMPTA of measured up to tibial valgus in cosmesis patients and were well within acceptable limits of normal in controls.Tibial valgus was caused by too much overcorrection (by ¼ on average).
About the Authors
P. N. Kulesh
City Hospital of St. George the Great Martyr
Russian Federation
Russian Federation
Pavel N. Kulesh, M.D., Ph.D.,
Saint Petersburg
L. N. Solomin
Vreden National Medical Research Center of Traumatology and Orthopedics;
Saint-Petersburg State University
Russian Federation
Russian Federation
Leonid N. Solomin, M.D., Ph.D., Professor,
Saint Petersburg
References
1. Limb Lengthening Forum. [Internet], 2020. Available at: https://www.limblengtheningforum.com/ (accessed 29.07.2020).
2. Korrektsiia nog [Correction of the Lower Limbs]. [Internet], 2020. Available at: https://legscorrection.ru/forum/index.php. (accessed 29.07.2020).
3. Khirurgiia Nizhnikh Konechnostei [Surgery of the Lower Limbs]. [Internet], 2020. Available at: http://varus-valgus.net/ (accessed 29.07.2020).
4. Federalnyi zakon “Ob osnovakh okhrany zdorovia grazhdan v Rossiiskoi Federatsii”: tekst s izmeneniiami i dopolneniiami na 2020 god [Federal Law “On the basics of protecting the health of citizens in the Russian Federation ": text with amendments and additions for 2020]. M., Eksmo, 2020, 96 p. (in Russian).
5. Artemev A.A., editor. Esteticheskaia i rekonstruktivnaia khirurgiia nizhnikh konechnostei [Lower limb aesthetic and reconstructive surgery]. Moscow, GEOTAR-Media, 2008, 248 p. (in Russian).
6. Marker N.A. Vybor taktiki i rezultata ortopedicheskoi korrektsii goleni pri kosmeticheskoi deformatsii. Avtoref. dis. ... kand. med. nauk [Choice of the tactics and result of orthopedic correction of the leg in case of cosmetic deformity. Cand. med. sci. diss. abstr.]. Novosibirsk, 2009, 35 p. (in Russian) Available at: http://medical-diss.com/docreader/288249/a?#?page=1 (accessed: 29.07.2020).
7. Kulesh P.N., Solomin L.N. Korrektsiia formy nog po esteticheskim pokazaniiam (obzor literatury) [Correction of lower limb shape according to aesthetic indications (review of literature)]. Genij Ortopedii, 2013, no. 2, pp. 117-123. (in Russian)
8. Whitaker A.T., Gesheff M.G., Jauregui J.J., Herzenberg J.E. Comparison of PACS and Bone Ninja mobile application for assessment of lower extremity limb length discrepancy and alignment. J. Child. Orthop., 2016, vol. 10, no. 5, pp. 439-443. DOI: 10.1007/s11832-016-0761-5
9. Paley D. Principles of deformity correction. Herzenberg J.E., editor. Springer Science & Business Media, 2002, 806 p.
10. Solomin L.N., editor. Osnovy chreskostnogo osteosinteza apparatom G.A. Ilizarova [Fundamentals of transosseous osteosynthesis with the Ilizarov fixator]. SPb., MORSAR AV, 2005, 544 p. (in Russian)
11. Solomin L.N. The Basic Principles of External Skeletal Fixation Using the Ilizarov and Other Devices. 2nd Edition. Solomin L.N., editor. Milan, Springer-Verlag, 2012, 1593 p. DOI: 10.1007/978-88-470-2619-3_18
12. Standart S.C., Herzenberg J.E., Conway J.D., Siddiqui N.A., McClure P.K. The Art of Limb Alignment. 9th ed. Baltimore, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore. 2020, 247 p.
13. Feldman D.S., Madan S.S., Koval K.J., van Bosse H.J., Bazzi J., Lehman W.B. Correction of tibia vara with six-axis deformity analysis and the Taylor Spatial Frame. J. Pediatr. Orthop., 2003, vol. 23, no. 3, pp. 387-391.
14. Programma modelirovaniia Legscorrection [Legscorrection Modelling Program]. Available at: https://legscorrection.ru/prog.php (accessed 29.07.2020).
15. Kaplunov O.A., Kaplunov A.G., Shevtsov V.I. Kosmeticheskaia korrektsiia formy i dliny nog [Cosmetic correction of the lower limb shape and length]. M., GEOTAR-Media, 2010, 160 p. (in Russian)
16. Coventry M.B. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J. Bone Joint Surg. Am., 1965, vol. 47, pp. 984-990.
17. Miniaci A., Ballmer F.T., Ballmer P.M., Jakob R.P. Proximal tibial osteotomy. A new fixation device. Clin. Orthop. Relat. Res., 1989, no. 246, pp. 250-259.
18. Lobenhoffer P., Agneskirchner J.D. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg. Sports Traumatol. Arthrosc., 2003, vol. 11, no. 3, pp. 132-138. DOI: 10.1007/s00167-002-0334-7
19. Segev E. Updates on preoperative planning, limb deformity analysis and surgical correction for the growing children: EPOS Meeting Marseille 2015 proceedings. J. Child. Orthop., 2016, vol. 10, no. 6, pp. 493-498. DOI: 10.1007/s11832-016-0795-8
20. Hambardzumyan V., Herzenberg J.E. Bone Ninja app as a body image simulation tool for shared decision-making. J. Limb Lengthen. Reconstr., 2019, vol. 5, no. 2, pp. 105-110. URL: https://www.jlimblengthrecon.org/text.asp?2019/5/2/105/274579.
21. Shevtsov V.I., Nemkov V.A., Skliar L.V. Apparat Ilizarova. Biomekhanika [The Ilizarov fixator. Biomechanics.]. Kurgan, Periodika, 1995, 165 p. (in Russian)
22. Caton J., Dumont P., Bérard J., Michel C.R. Etude des résultats à moyen terme d’une série de 33 allongements des membres inférieurs selon la technique de H. Wagner [Study of the medium-term results of a series of 33 lengthening of the lower limbs according to the technique of H. Wagner]. Rev. Chir. Orthop., 1985, vol. 71, pp. 44-48.
23. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin. Orthop. Relat. Res., 1990, no. 250, pp. 81-104.
24. Donnan L.T., Saleh M., Rigby A.S. Acute correction of lower limb deformity and simultaneous lengthening with a monolateral fixator. J. Bone Joint Surg. Br., 2003, vol. 85, no. 2, pp. 254-260. DOI: 10.1302/0301-620x.85b2.12645
25. Vilenskii V.A., Pozdeev A.A., Zubairov T.F., Zakharian E.A., Pozdeev A.P. Lechenie detei s deformatsiiami dlinnykh trubchatykh kostei nizhnikh konechnostei metodom chreskostnogo osteosinteza s ispolzovaniem apparata Orto-SUV: analiz 213 sluchaev [Treatment of children with deformities of the lower limb long tubular bones by transosseous osteosynthesis method using Ortho-SUV Frame: analysis of 213 cases]. Ortopediia, Travmatologiia i Vosstanovitelnaia Khirurgiia Detskogo Vozrasta, 2016, vol. 4, no. 4, pp. 21-32. (in Russian) DOI: 10.17816/PTORS4421-32
26. Jamali A.A., Meehan J.P., Moroski N.M., Anderson M.J., Lamba R., Parise C. Do small changes in rotation affect measurements of lower extremity limb alignment? J. Orthop. Surg. Res., 2017, vol. 12, no. 1, pp. 77. DOI: 10.1186/s13018-017-0571-6
27. Sabharwal S., Badarudeen S., McClemens E., Choung E. The effect of circular external fixation on limb alignment. J. Pediatr. Orthop., 2008, vol. 28, no. 3, pp. 314-319. DOI: 10.1097/BPO.0b013e3181653ba2.
28. Sokal R.R., Rolf F.J. Biometry: The Principles and Practices of Statistics in Biological Research. 3rd ed. New York, W.H. Freeman & Co, 1994, 880 p.
29. Chernchujit B., Tharakulphan S., Prasetia R., Chantarapanich N., Jirawison C., Sitthiseripratip K. Preoperative planning of medial opening wedge high tibial osteotomy using 3D computer-aided design weight-bearing simulated guidance: Technique and preliminary result. J. Orthop. Surg. (Hong Kong), 2019, vol. 27, no. 1, pp. 2309499019831455. DOI: 10.1177/2309499019831455.
30. Klimov O.V., Novikov K.I., Aranovich A.M. Modelirovanie formy nizhnikh konechnostei u patsientov s varusnoi deformatsiei golenei [Modeling the shape of the lower limbs in patients with varus deformity of the legs]. Genij Ortopedii, 2008, no. 2, pp. 50-53. (in Russian)
31. Barinov A.S., Vorobev A.A., Zaitsev S.S., Tsarkov P.S. Kosmeticheskie aspekty operativnoi korrektsii displasticheskikh varusnykh deformatsii nizhnikh konechnostei [Cosmetic aspects of the surgical correction of dysplastic varus deformities of the lower limbs]. Klinicheskaia Meditsina, 2010, no. 4, pp. 57-60. (in Russian)
32. Ashfaq K., Fragomen A.T., Nguyen J.T., Rozbruch S.R. Correction of proximal tibia varus with external fixation. J. Knee Surg., 2012, vol. 25, no. 5, pp. 375-384. DOI: 10.1055/s-0031-1299659
33. Park Y.E., Song S.H., Kwon H.N., Refai M.A., Park K.W., Song H.R. Gradual correction of idiopathic genu varum deformity using the Ilizarov technique. Knee Surg. Sports Traumatol. Arthrosc., 2013, vol. 21, no. 7, pp. 1523-1529. DOI: 10.1007/s00167-012-2074-7 3
34. Artemev A.A., Zagorodnii N.V., Ivashkin A.N., Bytdaev Z.M., Abakirov M.D. Sovremennoe sostoianie esteticheskoi ortopedii nizhnikh konechnostei: problemy i perspektivy [Modern status of aesthetic orthopaedics of the lower limbs: problems and prospects]. Klinicheskaia Praktika, 2015, no. 1, pp. 4-9. (in Russian)
35. Da Cunha R.J., Kraszewski A.P., Hillstrom H.J., Fragomen A.T., Rozbruch S.R. Biomechanical and functional improvements gained by proximal tibia osteotomy correction of genu varum in patients with knee pain. HSS J., 2020, vol. 16, no. 1, pp. 30-38. DOI: 10.1007/s11420-019-09670-6
36. Saragaglia D., Rubens-Duval B., Chaussard C. Doubles ostéotomies assistées par ordinateur dans les grands genu varum: résultats préliminaires à propos de 16 cas [Computer-assisted combined femoral and tibial osteotomy for severe genu varum: early results in 16 patients]. Rev. Chir. Orthop. Reparatrice Appar. Mot., 2007, vol. 93, no. 4, pp. 351-356. (in French) DOI: 10.1016/s0035-1040(07)90276-7
37. Özkul B., Çamurcu Y., Sokucu S., Yavuz U., Akman Y.E., Demir B. Simultaneous bilateral correction of genu varum with Smart Frame. J. Orthop. Surg. (Hong Kong), 2017, vol. 25, no. 2, pp. 2309499017713915. DOI: 10.1177/2309499017713915
38. Coventry M.B., Ilstrup D.M., Wallrichs S.L. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J. Bone Joint Surg. Am., 1993, vol. 75, no. 2, pp. 196-201. DOI: 10.2106/00004623-199302000-00006
39. Solomin L.N., Kulesh P.N. Analiz pokazatelei referentnykh linii i uglov pri izmenenii formy nog s ispolzovaniem chreskostnogo osteosinteza (predvaritelnoe soobshchenie) [Analysis of the values of reference lines and angles when changing the shape of the legs using transosseous osteosynthesis (a preliminary report)]. Travmatologiia i Ortopediia Rossii, 2011, no. 2, pp. 62-69. (in Russian)
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For citations:
Kulesh P.N., Solomin L.N. Relationships between reference lines altered during leg shape correction as requested by the patient. Genij Ortopedii. 2021;27(3):390-397. https://doi.org/10.18019/1028-4427-2021-27-3-390-397
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