Analysis of Lower Extremity Alignment in Achondroplasia

İnan, Muharrem; Jeong, Changhoon; Chan, Gilbert; Mackenzie, William G.; Glutting, Joe

doi:10.1097/01.bpo.0000187999.68966.58

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…In our study, five patients had a persistent pseudarthrosis of the fibula, but only three of these developed ankle valgus. These results are comparable to those of Inan [15] who noted seven cases of persistent fibular pseudarthrosis, with six ankle valgus, among 16 patients treated by intramedullary nailing, bone grafting and various subsequent procedures. Reestablishment of the integrity of the fibula decreases the load passing through the tibia and provides rotatory stress protection [2].…”

Section: Discussionsupporting

confidence: 88%

“…In our patient series, initial LLD was fully corrected in one patient, partially corrected in two and remained unchanged in one. No pseudarthrosis was observed at the lengthening site, as described by Inan [15].…”

Section: Discussionmentioning

confidence: 53%

“…Persistent pseudarthrosis of the fibula is known to cause ankle valgus deformity and functional impairment [9, 15]. This condition is due to a high position of the fibular distal epiphysis and because of an asymmetric growth of the distal tibial physis that grows more medially than laterally [2, 10].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, when multiple procedures fail to achieve union, amputation may be the consequence [6]. Treatment goals of achieving and maintaining union with joint alignment and symmetrical limb length may be compromised by refracture, residual deformity, limb length discrepancy or valgus deformity of the ankle [14, 15]. For the last three decades electromagnetic or low-intensity pulsed ultrasound stimulation of the non-union, vascularized bone grafts, intramedullary nails and Ilizarov's fixator have all been used with variable degrees of success [6].…”

Section: Introductionmentioning

confidence: 99%

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Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

Laurent¹,

Vialle²,

Thévenin-Lemoine³

et al. 2008

Journal of Children's Orthopaedics

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Purpose Many surgical techniques have been published on how to treat congenital pseudoarthrosis of the tibia (CPT). We combined Ilizarov's fixator with intramedullary nailing of the tibia and developed a procedure which combines the advantages of both methods: Ilizarov's high fusion rate with alignment control and the protection against refracture provided by the intramedullary nail. The results of this approach are presented and discussed. Material and methods Seven boys and three girls aged 3-14 years (mean age 8 years 2 months) were treated using our combined technique. In six cases, the CPT was associated with neurofibromatosis. Two strategies were adopted: in six cases, a compression was applied on the bone defect, and in four cases, segmental bone transportation was performed before the compression procedure. The final follow-up (1.2-6.6 years) included a clinical and radiological examination. Results Tibial union was achieved in nine cases without bone grafting. In one case, tibial union still remains uncertain, despite intertibiofibular bone grafting and additional compression procedures. Thirteen overall complications were noted, including three valgus deformity of the ankle. Bone transportation failed to achieve complete limb lengthening in three cases. One deep infection occurred 4 years after removal of the external fixator. The treatment for this included nail removal and antibiotic therapy for 3 months. Despite a permanent protection of orthosis, a refracture occurred 2 years after nail removal, reverting to the initial level of pseudarthrosis. Another surgical attempt using the same method was then performed with a satisfactory result. Conclusions The association of Ilizarov's technique and intramedullary nailing achieved and maintained tibial union in nine of ten patients at final follow-up. It also allowed correction of axial deformities and prevented refracture. Despite the short duration of the follow-up and a high rate of complications in our series, this method can be useful in many cases of CPT in which healing has failed to occur despite many previous surgeries.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

Laurent¹,

Vialle²,

Thévenin-Lemoine³

et al. 2008

Journal of Children's Orthopaedics

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Die kinderorthopädische Bedeutung der Achondroplasie und Hypochondroplasie

Correll¹

2007

Orthopäde

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Achondroplasia and hypochondroplasia are the most common forms of short stature. The leading sign is the diminished body height. Most cases of achondroplasia can be detected by clinical examination. Hypochondroplasia is more often not diagnosed until preschool age.In achondroplasia many different orthopaedic problems can arise, which influence the ADL. Mainly pathologic alterations of the occipitocervical region or a stenosis of the medullary cavity should be expected. In the limbs a bow-leg deformity and hyperlaxity of the ligaments often can be seen, which in some cases restrict walking capacity. Even if many people of short stature contemplate a lengthening procedure, the correction of deformities is much more important. The CORA method should be used in planning any osteotomy.

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How Reliable Are Standard Radiographic Measures of the Foot and Ankle in Children With Achondroplasia?

Park

Kang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Radiographic measurements are typically used in achondroplasia (ACH) during correction of lower limb alignment. However, reliabilities for the measurements on weightbearing radiographs of the foot and ankle in patients with ACH have not been described, and the differences between the ACH population and subjects without ACH likewise have not been well characterized; these issues limit the use of studies on this subject. Questions/purposes We proposed (1) to measure the inter-and intraobserver reliability of a number of radiographic measures of ankle and foot alignment in an achondroplastic cohort of patients; and (2) to compare our radiographic measurement values with age-matched literature-based normative values. Methods Ten radiographic measurements were applied to foot and ankle radiographs of 20 children (40 feet) with ACH (mean age, 10 years; range, 8-16 years). Interobserver and intraobserver reliabilities of these radiographic measurement methods were obtained and expressed by intraclass correlation coefficients (ICCs). The mean values were calculated and compared with the literature-based values. Results The interobserver reliability was excellent for eight measurements with ICCs ranging from 0.801 to 0.962, except for lateral talo-first metatarsal angle and mediolateral column ratio, which were much lower. The intraobserver reliability was excellent for all 10 radiographic measurements with ICCs ranging from 0.812 to 0.998. Compared with existing literature-based values, all 10 measurements had a significant difference (p \ 0.01). Conclusions We suggest tibiotalar angle, calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, metatarsal stacking angle, and AP talo-first metatarsal angle with excellent interobserver and intraobserver reliabilities should be considered preferentially in analysis of foot and ankle alignment in children with ACH.

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Analysis of Lower Extremity Alignment in Achondroplasia

Cited by 8 publications

References 11 publications

Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

Die kinderorthopädische Bedeutung der Achondroplasie und Hypochondroplasie

How Reliable Are Standard Radiographic Measures of the Foot and Ankle in Children With Achondroplasia?

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