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Liang W, Zhou C, Bai J, Zhang H, Jiang B, Wang J, Fu L, Long H, Huang X, Zhao J, Zhu H. Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends. Front Bioeng Biotechnol 2024; 12:1328997. [PMID: 38405378 PMCID: PMC10884185 DOI: 10.3389/fbioe.2024.1328997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Recent advancements in orthopedic surgery have greatly improved the management of musculoskeletal disorders and injuries. This review discusses the latest therapeutic approaches that have emerged in orthopedics. We examine the use of regenerative medicine, including stem cell therapy and platelet-rich plasma (PRP) injections, to accelerate healing and promote tissue regeneration. Additionally, we explore the application of robotic-assisted surgery, which provides greater precision and accuracy during surgical procedures. We also delve into the emergence of personalized medicine, which tailors treatments to individual patients based on their unique genetic and environmental factors. Furthermore, we discuss telemedicine and remote patient monitoring as methods for improving patient outcomes and reducing healthcare costs. Finally, we examine the growing interest in using artificial intelligence and machine learning in orthopedics, particularly in diagnosis and treatment planning. Overall, these advancements in therapeutic approaches have significantly improved patient outcomes, reduced recovery times, and enhanced the overall quality of care in orthopedic surgery.
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Affiliation(s)
- Wenqing Liang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Chao Zhou
- Department of Orthopedics, Zhoushan Guanghua Hospital, Zhoushan, China
| | - Juqin Bai
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Hongwei Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Bo Jiang
- Rehabilitation Department, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jiangwei Wang
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Lifeng Fu
- Department of Orthopedics, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Hengguo Long
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Xiaogang Huang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jiayi Zhao
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Haibing Zhu
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
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Emara KM, Diab RA, Fathy A, Essa MN, Eisa M, Elshobaky MA, Emara AK, Rashid K, Gemeah M. Supplementary Fibular-guided Growth in Treatment of Late-onset Blount Disease. Tech Orthop 2023; 38:111-114. [DOI: 10.1097/bto.0000000000000630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Purpose:
Blount disease is due to an idiopathic defect in the posteromedial proximal tibial physis resulting in increasing bowing of the leg in addition to lateral knee thrust with lateral collateral ligament laxity. Our rationale is that Blount disease has a bony and ligamentous laxity element of the lateral collateral ligament that can be corrected simultaneously through hemiepiphysiodesis of the tibia and epiphysiodesis of proximal fibula physis by cannulated screws.
Patients and Methods:
This is a retrospective study conducted on 23 limbs with tibia vara treated between 2010 and 2017 followed up for 2 to 6 years. Ages ranged from 9 to 13 years with a late-onset type of Blount disease. We used a percutaneous transphyseal fully threaded screws traversing the proximal tibial lateral hemiepiphysis, and another screw inserted traversing the proximal fibular epiphysis.
Results:
There was a statistically significant improvement of the radiographic parameters, especially in the form of joint line congruence angle in both supine and standing positions. All patients were clinically and radiographically completely corrected without complications, except 1 patient with a surgical site superficial infection, treated medically.
Conclusion:
Fibular-guided growth surgery with lateral proximal tibia epiphysiodesis is a minimally invasive technique that improves the corrective power of hemiepyphysiodesis of the posterolateral compartment of the knee.
Level of Evidence:
Level IV, retrospective case series.
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Affiliation(s)
| | - Ramy Ahmed Diab
- Department of Orthopedic Surgery, Ain Shams University Hospitals
| | - Ayman Fathy
- Department of Orthopedic Surgery, Ain Shams University Hospitals
| | | | - Mohamed Eisa
- Department of Orthopedic Surgery, Ain Shams University Hospitals
| | | | - Ahmed K. Emara
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Kyrillos Rashid
- Department of Orthopedic Surgery, Ain Shams University Hospitals
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Kolbe N, Haydon F, Kolbe J, Dreher T. Single-Stage Tibial Osteotomy for Correction of Genu Varum Deformity in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020377. [PMID: 36832505 PMCID: PMC9955771 DOI: 10.3390/children10020377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
Conservative and operative treatments with gradual or acute correction of severe varus deformities of the leg have been described. We evaluated whether the corrective osteotomy used within the NGO Mercy Ships is an effective treatment for genu varum deformity of different etiologies in children and which patient specific factors have an influence on the radiographic outcome. In total, 208 tibial valgisation osteotomies were performed in 124 patients between 2013 and 2017. The patients' mean age at the time of surgery was 8.4 (2.9 to 16.9 (min/max)) years. Seven radiographically measured angles were used to assess the deformity. Clinical photographs taken pre- and postoperatively were assessed. The mean time between the surgery and the end of physiotherapeutic treatment was 13.5 (7.3 to 28) weeks. Complications were monitored and classified according to the modified Clavien-Dindo-classification system. The mean preoperative mechanical tibiofemoral angle was 42.1° varus (range: 85°-12° varus). The mean postoperative mechanical tibiofemoral angle was 4.3° varus (range: 30° varus-13° valgus). The factors predicting a residual varus deformity were higher age, greater preoperative varus deformity and the diagnosis of Blount disease. The tibiofemoral angle measured on routine clinical photographs correlated well with the radiographic measurements. The single-stage tibial osteotomy described is a simple, safe and cost-effective technique to correct three-dimensional deformities of the tibia. Our study shows very good mean postoperative results, but with a higher variability than in other studies published. Nevertheless, considering the severity of preoperative deformities and the limited opportunities for aftercare, this method is excellent for the correction of varus deformities.
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Affiliation(s)
- Nikolas Kolbe
- Department of Orthopedics and Traumatology, University Hospital Heidelberg, 69118 Heidelberg, Germany
| | - Frank Haydon
- Orthopedic Surgeon, NGO Mercy Ships, 1012 Lausanne, Switzerland
| | - Johannes Kolbe
- Orthopedic Surgeon, NGO Mercy Ships, 1012 Lausanne, Switzerland
| | - Thomas Dreher
- Head of Pediatric Orthopedic and Trauma Surgery, Children’s University Hospital Zürich, 8032 Zürich, Switzerland
- Head of Pediatric Orthopedics, Orthopedic University Hospital Balgrist, 8008 Zürich, Switzerland
- Correspondence: ; Tel.: +41-442667535
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Jardaly AH, Hicks JW, Doyle JS, Conklin MJ, Gilbert SR. Co-occurrence of Blount's disease and Legg-Calvé-Perthes disease: is obesity a factor? J Pediatr Orthop B 2022; 31:e180-e184. [PMID: 34139749 DOI: 10.1097/bpb.0000000000000888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Legg-Calvé-Perthes disease (LCPD) and Blount's disease share a similar presenting age in addition to similar symptoms such as limp or knee pain. A little overlap is mentioned about both diseases. We sought to present cases of children having both conditions to discuss the implications of this co-occurrence on diagnosis and management. After institutional review board approval, we retrospectively reviewed records of four children who developed both Blount's disease and LCPD. Patient details and outcomes were analyzed. Radiographs were evaluated for the lateral pillar classification, Stulberg classification, tibial metaphyseal-diaphyseal angle and tibiofemoral angle. Two of the cases were initially diagnosed with Blount's disease and subsequently developed Perthes, one case presented initially with both disorders and the final case had Perthes followed by Blount's. Three children were obese and one was overweight. The common symptom to all patients was an abnormal gait, which was painless in two children and painful in two. Blount's disease required surgery in three children. Radiographs showed Lateral Pillar B, B/C border and C hips, and the final Stulberg was stage II (n = 2) or stage IV (n = 2). Obesity is associated with Blount's disease and LCPD, so obese children can be at an increased risk of developing both disorders. Therefore, a child with Blount's disease who has persistent, recurrent or worsening symptoms such as gait disturbance or thigh or knee pain might benefit from a careful physical exam of the hips to prevent a delayed or even missed LCPD diagnosis.
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Affiliation(s)
- Achraf H Jardaly
- Lebanese American University, Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
- Department of Orthopedic Surgery, University of Alabama at Birmingham
| | - James W Hicks
- Department of Orthopedic Surgery, University of Alabama at Birmingham
| | - John S Doyle
- Department of Orthopedic Surgery, University of Alabama at Birmingham
- Department of Pediatric Orthopaedics, Children's Hospital of Alabama, Alabama, USA
| | - Michael J Conklin
- Department of Orthopedic Surgery, University of Alabama at Birmingham
- Department of Pediatric Orthopaedics, Children's Hospital of Alabama, Alabama, USA
| | - Shawn R Gilbert
- Department of Orthopedic Surgery, University of Alabama at Birmingham
- Department of Pediatric Orthopaedics, Children's Hospital of Alabama, Alabama, USA
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Cerqueira FDS, Motta GATA, Rocha de Faria JL, Pizzolatti IS, Motta DPD, Mandarino M, Kropf LAL, Cerqueira FDS. Controlled Double Gradual Opening Osteotomy for the Treatment of Severe Varus of the Knee-Blount's Disease. Arthrosc Tech 2021; 10:e2199-e2206. [PMID: 34504761 PMCID: PMC8417508 DOI: 10.1016/j.eats.2021.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023] Open
Abstract
Varus deformity of the knee can lead to early degeneration of the medial tibiofemoral joint. Pediatric patients can be pathologically affected with this deformity known as Blount disease. The cause of this pathology is still uncertain, but some risk factors are well established, such as obesity and family history. The diagnosis is made through clinical history, physical examination, and the radiographic analysis after the age of 2.5 years. The analysis of the metaphyseal-diaphyseal angle, described by Levine and Drennan, is also commonly used for prognosis. When this angle is greater than 16°, it is considered to be grossly abnormal. Possible options for correcting the generated angular deformity are epiphysiodesis, osteotomy (acute or gradual correction), and gradual correction by distraction of the physis. In this surgical technique, we performed a double tibial osteotomy with controlled gradual opening using monolateral external fixator (Orthofix, Verona, Italy). Our technique proved to be an effective way to correct the adolescent tibia vara and is practical and reproducible. Moreover, the use of gradual opening osteotomy allowed a more accurate outcome.
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Affiliation(s)
- Flavio dos Santos Cerqueira
- Dysmetria and Deformities Center of National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | | | - José Leonardo Rocha de Faria
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil,Address correspondence to José Leonardo Rocha de Faria, M.D., M.Sc., Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil. CEP: 20940-070.
| | | | - Diego Perez da Motta
- Dysmetria and Deformities Center of National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - Marcelo Mandarino
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | | | - Fernando dos Santos Cerqueira
- Dysmetria and Deformities Center of National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
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Taylor AJ, Carpenter W, Runner RP. Staged Bilateral Total Knee Arthroplasty for Neglected Blount Disease Using a Gap Balancing Technique. Arthroplast Today 2021; 11:25-31. [PMID: 34430686 PMCID: PMC8368345 DOI: 10.1016/j.artd.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/28/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
Blount disease is an acquired, asymmetrical disorder of proximal tibial growth that results in a complex three-dimensional proximal tibial deformity, with tibial varus being the dominating feature. Although the exact pathophysiology is unknown, Blount disease is separated into 2 clinical variants, infantile and adolescent, based on the onset of symptoms occurring before or after the age of 10 years. If recognized and treated early, affected patients generally have a favorable prognosis; however, if neglected, it can lead to progressive malalignment and premature osteoarthritis. We present a patient with bilateral neglected Blount disease who underwent successful bilateral total knee arthroplasty performed in a staged fashion using a gap balancing technique with constrained condylar knee implants.
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Affiliation(s)
- Adam J Taylor
- Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA.,Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - William Carpenter
- Joint Replacement Center, Tennessee Orthopedic Alliance, Nashville, TN
| | - Robert P Runner
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA
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Masquijo JJ, Artigas C, de Pablos J. Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use. EFORT Open Rev 2021; 6:658-668. [PMID: 34532073 PMCID: PMC8419796 DOI: 10.1302/2058-5241.6.200098] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Growth modulation (GM) with tension-band plates (TBPs) by tethering part of the growth plate is an established technique for the correction of angular deformities in children, and it has increasingly supplanted more invasive osteotomies.Growth modulation with TBPs is a safe and effective method to correct a variety of deformities in skeletally immature patients with idiopathic and pathological physes. The most common indication is a persistent deformity in the coronal plane of the knee exceeding 10°, with anterior and/or lateral joint pain, patellofemoral instability, gait disturbance, or cosmetic concerns. GM has also shown good results in patients with fixed flexion deformity of the knee and ankle valgus.This paper reviews the history of the procedure, current indications, and recent advances underlying physeal manipulation with TBPs. Cite this article: EFORT Open Rev 2021;6:658-668. DOI: 10.1302/2058-5241.6.200098.
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Affiliation(s)
- J Javier Masquijo
- Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina
| | - Cristian Artigas
- Hospital Roberto del Rio, Santiago, Chile
- Clínica Alemana, Santiago, Chile
| | - Julio de Pablos
- Advanced Bone Reconstruction Surgery, Hospital San Juan de Dios y Complejo Hospitalario de Navarra, Pamplona, Spain
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Robbins CA. Deformity Reconstruction Surgery for Blount's Disease. CHILDREN (BASEL, SWITZERLAND) 2021; 8:566. [PMID: 34209445 PMCID: PMC8303124 DOI: 10.3390/children8070566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
Blount's disease is an idiopathic developmental abnormality affecting the medial proximal tibia physis resulting in a multi-planar deformity with pronounced tibia varus. A single cause is unknown, and it is currently thought to result from a multifactorial combination of hereditary, mechanical, and developmental factors. Relationships with vitamin D deficiency, early walking, and obesity have been documented. Regardless of the etiology, the clinical and radiographic findings are consistent within the two main groups. Early-onset Blount's disease is often bilateral and affects children in the first few years of life. Late-onset Blount's disease is often unilateral and can be sub-categorized as juvenile tibia vara (ages 4-10), and adolescent tibia vara (ages 11 and older). Early-onset Blount's disease progresses to more severe deformities, including depression of the medial tibial plateau. Additional deformities in both groups include proximal tibial procurvatum, internal tibial torsion, and limb length discrepancy. Compensatory deformities in the distal femur and distal tibia may occur. When non-operative treatment fails the deformities progress through skeletal maturity and can result in pain, gait abnormalities, premature medial compartment knee arthritis, and limb length discrepancy. Surgical options depend on the patient's age, weight, extent of physeal involvement, severity, and number of deformities. They include growth modulation procedures such as guided growth for gradual correction with hemi-epiphysiodesis and physeal closure to prevent recurrence and equalize limb lengths, physeal bar resection, physeal distraction, osteotomies with acute correction and stabilization, gradual correction with multi-planar dynamic external fixation, and various combinations of all modalities. The goals of surgery are to restore normal joint and limb alignment, equalize limb lengths at skeletal maturity, and prevent recurrence. The purpose of this literature review is to delineate basic concepts and reconstructive surgical treatment strategies for patients with Blount's disease.
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Affiliation(s)
- Craig A Robbins
- Paley Orthopedic & Spine Institute, West Palm Beach, FL 33407, USA
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Assan BR, Simon AL, Adjadohoun S, Segbedji GGP, Souchet P, Metchioungbe CS, Fiogbe MA, Ilharreborde B, Gbenou AS. Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients. J Orthop 2021; 25:140-144. [PMID: 35068774 DOI: 10.1016/j.jor.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There are no comparative study between guided growth and tibial osteotomy in early stage of Blount disease (BD) to our knowledge. The aim of this work was to compare the results of patients treated by these two techniques. METHOD This was a retrospective, descriptive, and analytical study over a period of 5 years in including 17 children (24 Knees) with an early stage of infantile BD in two centers. Patient were classified in two groups: group 1(treated by guided growth), group 2 (treated by Tibial Osteotomy).Preoperative alignment analysis using the tibial femoral angle (HKA) and the proximal medial tibial mechanical angle (mMPTA) were compared with three measurements taken postoperatively in each of the groups. The mean variations of the angles were compared between the two groups. RESULTS Socio-demographic characteristics were similar for the two groups. Median age at surgery was 6.5 ± 2.5 [3-9 years] in group 1 and 6.8 ± 2.9 years [3-9 years]. At a follow-up of 24 ± 3.5 months, the limb alignment was significantly corrected (1,03°/month) in group 1 (median HKA 144°-171°; p = 0,001; median MMPTA 78°-87°, p = 0,018), and in group 2 we observed at a follow-up of 23 ± 15 months a progressive loss (0,52°/month) of the correction obtained immediately postoperatively (median HKA 160°-176°(immediate post operative) to 165,5°; p = 0,31; median MMPTA = 78°-86° (immediate post operative) to 80,5°; p = 0,37).There was a statistically significant difference between the mean variation in HKA between the two groups (group 1 = 22,5; group 2 = 4,5, p = 0.00), as well as for MMPTA; (group 1 = 7; group 2 = 2,5, p = 0,023).The rate of correction was 78% in group 1 with no rebound at a median follow-up after removal of the material of 10 ± 2.4 months. Within group 2, the rate of correction was 10% with a recurrence rate of 60%. CONCLUSION Guided growth appears to be the best treatment for early stage of BD in squelletically immature patients.
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Affiliation(s)
| | - Anne-Laure Simon
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
| | - Sonia Adjadohoun
- Department of Medical Imaging, National Teaching Hospital Center Hubert Koutoukou MAGA, Cotonou, Benin
| | | | - Philippe Souchet
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
| | - Codjo Serge Metchioungbe
- Department of Pediatric Surgery, National Teaching Hospital Hubert Koutoukou MAGA, Cotonou, Benin
| | - Michel Armand Fiogbe
- Department of Pediatric Surgery, National Teaching Hospital Hubert Koutoukou MAGA, Cotonou, Benin
| | - Brice Ilharreborde
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
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Blount's disease - an up-to-date insight with contemporary treatment guidelines deduced from critical analysis of a large 146 surgical case series. J Pediatr Orthop B 2021; 30:239-249. [PMID: 32694440 DOI: 10.1097/bpb.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To elucidate an up-to-date insight and derive clear treatment guidelines for Blount's disease deduced from critical analysis of 146 surgical case series. Cases were presented and analyzed separately under its two basic clinical groups and the author further derived four subcategories under each of these two groups; the first basic group was the early onset clinical variant; infantile tibia vara (ITV) included 56 cases. The second group was the late onset clinical variant; late onset tibia vara (LOTV) included 90 cases. Different operative procedures used for treatment of these cases were proximal tibial osteotomy (PTO), temporary eight-plate proximal lateral tibial hemiepiphyseodesis (PLTH), or medial plateau elevation either on a monomodal or multimodal line of treatment. After a mean follow-up period of ~5 (2-12) years, the results were critically analyzed using case series descriptive analysis. In ITV variant, both PTO and temporary eight-plate PLTH monomodal line of treatment gave satisfactory results for de-novo (stages I, II, and III) subcategory while multimodal line of treatment was needed for achieving satisfactory results for neglected (stages IV, V, and VI) and relapsed subcategories. For LOTV variant, PTO monomodal line of treatment gave satisfactory results when applied for treatment of its de-novo subcategory. The derived treatment guidelines for Blount's disease can be of value for recruiting the most suitable treatment modality for each case entity of the disease, leading to satisfactory outcome with prevention of recurrence.
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Jardaly A, McGwin G, Gilbert SR. Blount Disease and Obstructive Sleep Apnea: An Under-recognized Association? J Pediatr Orthop 2021; 40:604-607. [PMID: 32433261 DOI: 10.1097/bpo.0000000000001591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is strongly associated with both Blount disease and obstructive sleep apnea (OSA). Obesity increases risks for anesthetic and postoperative complications, and OSA can further exacerbate these risks. Since children with Blount disease might have both conditions, we sought to determine the perioperative complications and the prevalence of OSA among these children. METHODS Patients younger than 18 years undergoing corrective surgery for Blount disease were identified from 2 sources as follows: a retrospective review of records at a single institution and querying of the Kids' Inpatient Database, a nationally representative database. RESULTS At our institution, the prevalence of OSA among patients surgically treated for Blount disease was 23% (42/184). Blount patients were obese (100%), and predominately African American (89%), and male (68%). Patients were treated for OSA before surgery, and 2 patients (1%) had postoperative hypoxemia. In contrast, of 1059 cases of Blount disease from the Kids' Inpatient Database, 3% were diagnosed with OSA. In total, 4.4% of all the Blount children experienced complications, including hypoxemia, respiratory insufficiency, atelectasis, and arrhythmias. Complications were associated with 4.3 additional days of hospitalization (P<0.0001) and 39% additional hospital charges (P=0.002). CONCLUSIONS Data from the national database showed a low rate of OSA prevalence but high respiratory and OSA-associated complications, perhaps indicating that OSA may be underdiagnosed in children with Blount disease. Affected patients, especially ones with untreated OSA, sustain increased surgical morbidity. A high index of suspicion and preoperative planning helps alleviate the burden of OSA among these patients. LEVEL OF EVIDENCE Level III-case-control study.
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Affiliation(s)
- Achraf Jardaly
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.,Departments of Orthopedic Surgery
| | - Gerald McGwin
- Departments of Orthopedic Surgery.,Epidemiology, University of Alabama, Birmingham, AL
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Gómez-Palomo JM, Meschian-Coretti S, Esteban-Castillo JL, García-Vera JJ, Montañez-Heredia E. Double Level Osteotomy Assisted by 3D Printing Technology in a Patient with Blount Disease: A Case Report. JBJS Case Connect 2021; 10:e0477. [PMID: 32649128 DOI: 10.2106/jbjs.cc.19.00477] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe the case of a 26-year-old patient diagnosed with Blount disease. She underwent a medial oblique supracondylar biplanar closing-wedge osteotomy of the distal femur followed by a medial oblique biplanar opening-wedge osteotomy of the proximal tibia. 3D printed cutting guides were used for the procedures. At 18 months after surgery, the patient is pain-free and walks without aids. CONCLUSIONS Using 3D printed guides allowed for accurate correction of the deformity and reduced the risk of damaging critical structures. These guides could be an appropriate alternative for the surgical treatment of patients with Blount disease.
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Affiliation(s)
- Juan M Gómez-Palomo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Stephan Meschian-Coretti
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José L Esteban-Castillo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan J García-Vera
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Elvira Montañez-Heredia
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Altowigri A, Mirghani HO. Blount Disease, Vitamin D deficiency, and Associated Comorbidities: A review and Meta-analysis. WORLD JOURNAL OF ENVIRONMENTAL BIOSCIENCES 2021; 10:5-8. [DOI: 10.51847/j96vx6dhpc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
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Sakamoto Y, Ishijima M, Nakano S, Suzuki M, Liu L, Tokita A, Kim SG, Shimizu T, Kaneko K, Nozawa M. Physiologic Leg Bowing is not a Physiologic Condition but Instead is Associated with Vitamin D Disorders in Toddlers. Calcif Tissue Int 2020; 106:95-103. [PMID: 31595325 DOI: 10.1007/s00223-019-00619-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/21/2019] [Indexed: 11/27/2022]
Abstract
When children around 2-year-old show leg bowing without lower-limb radiographic abnormalities for rickets, the leg bowing is classified as "physiologic" genu varum without conducting a blood test. However, it has recently been suggested that toddlers who are diagnosed with physiologic genu varum may in fact have some form of bone metabolic disorder. In this 1:2 case-control study, blood samples were obtained from 33 toddlers with genu varum without radiographic abnormalities for rickets and 66 age- and gender-matched healthy children. Serum alkaline phosphatase (sALP), intact parathyroid hormone (siPTH), 25-hydroxy vitamin D [s25(OH)D], calcium (sCa), and inorganic phosphate (sP) were measured. s25(OH)D of the subjects with genu varum (24.8 ng/ml) were significantly lower than those of the control (33.6 ng/ml) (p < 0.001). The frequency of vitamin D insufficiency/deficiency (< 20 ng/ml) of the subjects with genu varum (39%) was significantly higher than that in the control (14%) (p = 0.004) (odds ratio by vitamin D insufficiency/deficiency: 4.1 [1.5-11.1, p = 0.004]). sCa in subjects with genu varum (10.2 ng/ml) were significantly higher than in control (9.8 ng/ml) (p < 0.001), as were sALP (1057 IU/l) and siPTH (28.4 pg/ml) (740 IU/l and 8.8 pg/ml in control, respectively; p < 0.001). siPTH levels were associated with s25(OH)D levels in subjects with genu varum (r = - 0.57, p < 0.001), while no association was observed in the control (r = 0.11, p = 0.36). Genu varum without radiographic abnormalities of rickets was associated with both vitamin D and bone-metabolic disorders in toddlers, indicating that physiologic genu varum is not a physiologic condition in toddlers.
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Affiliation(s)
- Yuko Sakamoto
- Department of Orthopaedics, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Satoshi Nakano
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsuyoshi Suzuki
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Lizu Liu
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Sung-Gon Kim
- Department of Orthopaedics, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masahiko Nozawa
- Department of Orthopaedics, Juntendo University Nerima Hospital, Tokyo, Japan
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