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Principles of deformity correction
- 1. Principles of Deformity Correction DrAnkit Madharia Junior Resident NKPSIMS & RC
- 2. Deformity • Definition: • It’sthe position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
- 3. Deformity • Described asabnormalities of • Length • Angulation • Rotation • Translation • The location, magnitude, and direction of the deformity complete the characterization of a bony deformity
- 4. Evaluation of Deformity •Clinical Examination • Radiological Examination • Xrays • CT Scans
- 5. Evaluation of Deformity: X Rays • Radiographs of the lower limbs: • Long films (51 Inches) • Frontal plane (AP view)(Patella Forward) Sagittal plane (Lateral view)
- 6. Evaluation of Deformity: X Rays • Radiographs of the lower limbs: • Long films (51 Inches) • Frontal plane (AP view)(Patella Forward) Sagittal plane (Lateral view)
- 7. Evaluation of Deformity: X Rays • Radiographs of the lower limbs: • Long films (51 Inches) • Frontal plane (AP view)(Patella Forward) Sagittal plane (Lateral view)
- 8. Evaluation of Deformity: X Rays • Radiographs of the lower limbs: • Long films (51 Inches) • Frontal plane (AP view)(Patella Forward) Sagittal plane (Lateral view) Square the Pelvis in case of Limb Length discrepancy
- 9. Evaluation of Deformity: CT Scan • CT Scanogram
- 10. AXIS • Each longbone has 2 axis :- Mechanical axis Anatomical axis.
- 11. MECHANICAL AXIS • Straightline connecting the joint center points of the proximal & distal joints. • Its always a straight line whether in frontal or sagittal plane.
- 12. ANATOMICAL AXIS • Ismid diaphyseal line. • In a normal bone, the anatomic axis is a single straight line. • In a malunited bone with angulation, each bony segment can be defined by its own anatomic axis
- 13. Limb Alignment • Itinvolves assessment of the frontal plane mechanical axis of the entire limb rather than single bones
- 14. Limb Alignment • Mechanicalaxis deviation (MAD) is measured as the distance from the knee joint center to the line connecting the joint centers of the hip and ankle. • Normally, 1 mm to 15 mm medial to the knee joint center.
- 15. Joint Orientation Lines •Line representing the orientation of a joint in a particular plane /projection. • ANKLE Frontal : along the flat subchondral line of tibial plafond. Sagittal : line from distal tip of posterior lip to tip of anterior lip.
- 16. Joint Orientation Lines •Knee: • FRONTAL : along the subchondral line of tibial plateau. • Line tangential to most distal point on the femoral condyle. • SAGITTAL : along flat subchondral line of plateau. Line connecting 2 points where the condyles meet the metaphysis.
- 17. Joint Orientation Lines •Hip: • FRONTAL : from tip of greater trochanter to center of femoral head. • Also from the centre of femoral head along the anatomical axis of the femoral neck
- 18. • The relationbetween anatomical or mechanical axes and the joint orientation lines can be referred to as joint orientation angles Joint Orientation Angles
- 19. Centre of Rotationof Angulation (CORA) • The intersection of the proximal axis and distal axis of a deformed bone is called the CORA , which is the point about which a deformity may be rotated to achieve correction. • Either Anatomical or Mechanical axis can be used to identify CORA.
- 20. Centre of Rotationof Angulation (CORA) • Correction of angulation by rotating the bone around a point on the line that bisects the angle of the CORA (the “bisector”) ensures realignment of the anatomic and mechanical axes without introducing an iatrogenic translational deformity. • All points that lie on the bisector can be considered to be CORAs because angulation about these points will result in realignment of the deformed bone
- 21. Evaluation of theVarious Deformity Types • Length • Clinically • Radiologically
- 22. Evaluation of theVarious Deformity Types • Angulation • Characterized by Magnitude and direction of apex • Identification of the CORA is key in characterizing angular deformities and planning their correction • Angulation can be in Frontal plane or in sagittal plane or in oblique plane
- 23. Evaluation of theVarious Deformity Types • Angulation
- 24. Evaluation of theVarious Deformity Types • Rotation • Clinically • Radiologically • Axial CT scans • Characterised by • Position • Magnitude
- 25. Evaluation of theVarious Deformity Types • Translation • Clinically • Radiologically • Axial CT scans • Characterised by • Plane • Direction • Magnitude • Level
- 26. Treatment • Following evaluation,the deformity is characterized by its • type (length, angulation, rotational, translational, or combined), • the direction of the apex (anterior, lateral, posterolateral, etc.), • the orientation plane, • It’s magnitude, • and the level of the CORA
- 27. Osteotomies • An osteotomyis used to separate the deformed bone segments to allow realignment of the anatomic and mechanical axes. • The ability of an osteotomy to restore alignment depends on • location of the CORA • Axis about which correction is performed (the correction axis), • Location of the osteotomy
- 28. Results when usingosteotomy A.The CORA, the correction axis, and the osteotomy all lie at the same location; the bone realigns through angulation alone, without translation. B.The CORA and the correction axis lie in the same location but the osteotomy is proximal or distal to that location; the bone realigns through both angulation and translation. C.The CORA lies at one location and the correction axis and the osteotomy lie in a different location; correction of angulation results in an iatrogenic translational deformity.
- 29. Wedge osteotomy • Thetype of wedge osteotomy is determined by the location of the osteotomy relative to the locations of the CORA and the correction axis
- 30. Wedge osteotomy A.Opening wedgeosteotomy. • The CORA and correction axis lie on the cortex on the convex side of the deformity. • The cortex on the concave side of the deformity is distracted to restore alignment, opening an empty wedge that traverses the diameter of the bone. • Opening wedge osteotomy increases final bone length.
- 31. Wedge osteotomy B. Neutralwedge osteotomy. • The CORA and correction axis lie in the middle of the bone. • The concave side cortex is distracted and the convex side cortex is compressed. • A bone wedge is removed from the convex side. • Neutral wedge osteotomy has no effect on final bone length.
- 32. Wedge osteotomies C. Closingwedge osteotomy. • The CORA and correction axis lie on the concave cortex of the deformity. • The cortex on the convex side of the deformity is compressed to restore alignment, requiring removal of a bone wedge across the entire bone diameter. • A closing wedge osteotomy decreases final bone length.
- 33. Dome Osteotomy • Ina dome osteotomy, the osteotomy site cannot pass through both the CORA and the correction axis. Thus, translation will always occur when using a dome osteotomy.
- 34. Dome Osteotomy Ideally, theCORA and correction axis are mutually located with the osteotomy proximal or distal to that location such that the angulation and obligatory translation that occurs at the osteotomy site results in realignment of the bone axis.
- 35. Dome Osteotomy When theCORA and correction axis are not mutually located, a dome osteotomy through the CORA location results in a translational deformity.
- 36. Dome osteotomy the CORAand correction axis are mutually located with the osteotomy distal to that location in all of these examples. A.Opening dome osteotomy. The CORA and correction axis lie on the cortex on the convex side of the deformity. Opening dome osteotomy increases final bone length.
- 37. Dome osteotomy B. Neutraldome osteotomy. The CORA and correction axis lie in the middle of the bone. Neutral dome osteotomy has no effect on final bone length..
- 38. Dome osteotomy C. Closingdome osteotomy. The CORA and correction axis lie on the concave cortex of the deformity. A closing dome osteotomy decreases final bone length It can result in significant overhang of bone that may require resection
- 39. Treatment By Deformitytype : Length • Acute distraction or compression methods obtain immediate correction of limb length by acute lengthening with bone grafting or acute shortening, respectively • Gradual correction techniques for length deformities typically use Ilizarov external fixation/ LRS
- 40. Treatment By Deformitytype : Angulation • Correction of angulation deformities involves making an osteotomy, obtaining realignment of the bone segments, and securing fixation during healing. • Alternatively, the correction may be made gradually using external fixation to both restore alignment and provide stabilization during healing
- 41. Treatment By Deformitytype : Rotation • Correction of a rotational deformity requires an osteotomy and rotational realignment followed by stabilization.
- 42. Treatment By Deformitytype : Translation • Translational deformities may be corrected in one of three ways.
- 43.
Editor's Notes
- #12 The hip joint center is located at the center of the femoral head. The knee joint center is half the distance from the nadir between the tibial spines to the apex of the intercondylar notch on the femur. The ankle joint center is the center of the tibial plafond.
- #15 MAD >15 mm medial to the knee midpoint varus malalignment MAD lateral to the knee midpoint valgus malalignment
- #26 Magnitude of translation is measured as the horizontal distance from the proximal segment's anatomic axis to the distal segment's anatomic axis at the level of the proximal end of the distal segment