Journal of Clinical & Experimental Orthopaedics

Description

Corrections of a severe flexion deformity and slight hyperextension of the cervical spine was produced safely at the level between the seventh cervical vertebra and first thoracic vertebra in a woman, forty-four years old. The osteotomy was performed posteriorly under local anesthesia; the ossified annulus fibrosis was ruptured anteriorly by manipulation under nitrous oxide and oxygen anesthesia while the spinal canal was exposed and protected by the surgeon.

Dislocation or Subluxation

Full correction of the deformity was attempted only under controlled conditions after the patient was fully awake and after the spine was securely immobilized in a full spinal brace equipped with a jury-mast and a turnbuckle to raise the chin. The turnbuckle was unthreaded slowly and the cervical spine was extended in stages while the patient was closely observed and frequently examined to test her sensory perceptions, reflexes, and muscle power. The problem of instability of reduction of congenital dislocation and congenital subluxation of the hip has been studied. The basic cause of this instability is the abnormal direction in which the entire acetabulum faces. An operation, innominate osteotomy, has been designed to correct the abnormal direction of the entire acetabulum. The principle of innominate osteotomy is redirection of the acetabulum so that the reduced dislocation or subluxation, which was stable previously only in the position of abduction and flexion, is rendered stable in the functional position of weight-bearing. Most osteoarthritis of the hip results from chronic abnormal hip mechanics often associated with instability, impingement, or combinations of instability and impingement. The ethology of the mechanical problems in many hips is a surgically treatable anatomic abnormality, often a developmental deformity (dysplasia, Perthes disease, slipped epiphysis, femoral or acetabula retroversion, or reduced head-neck offset). The rationale of mechanically-based measures to prevent or treat osteoarthritis assumes the following correctable mechanical overload is a major etiologic factor in osteoarthritis and relief of the mechanical overload can prevent or improve osteoarthritis.The success of such mechanically-based joint-preserving measures depends largely on the completeness with which the joint-preserving treatment normalizes the mechanical environment of the hip. A limiting factor often is the amount of irreversible articular damage that is present at the time treatment is begun.

Avascular Necrosis

Fifty-one osteoarthritic knees treated by high tibial osteotomy were followed for at least five years. Deterioration after an initial good result was uncommon (five cases). Most of the good results were in knees (thirty of forty-five) with mild varus deformity and good ligament stability. It is, therefore, possible to select the knee suitable for osteotomy from measurement of the preoperative standing roentgenogram. We recommend that tibial osteotomy be done only when there is less than 10 degrees of varus deformity. In a knee with more than 15 degrees of varus deformity there will be subluxation on weight-bearing and tibial osteotomy is contraindicated. Different periacetabular and triple pelvic osteotomies are used to rotate a dysplastic acetabulum to a normal weight bearing position. If the acetabular fragment becomes too small or the acetabular artery is damaged, Avascular Necrosis (AVN) may result. On the other hand, if the osteotomies are situated too far from the acetabulum, free rotation in all directions may be impeded. In addition, all osteotomies should be clearly visible. Our modification considers these essentials. The osteotomy of the ischium also leaves the sacral ligaments intact and avoids pseudarthroses by its length. The osteotomy was performed posteriorly under local anesthesia; the ossified annulus fibrosis was ruptured anteriorly by manipulation under nitrous oxide and oxygen anesthesia while the spinal canal was exposed and protected by the surgeon. Full correction of the deformity was attempted only under controlled conditions after the patient was fully awake and after the spine was securely immobilized in a full spinal brace equipped with a jury-mast and a turnbuckle to raise the chin. The turnbuckle was unthreaded slowly and the cervical spine was extended in stages while the patient was closely observed and frequently examined to test her sensory perceptions, reflexes, and muscle power.