Briard Jl. How To Correct Extra Articular Deformity. Slide 41 56

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Briard Jl. How To Correct Extra Articular Deformity. Slide 41 56

  1. 1. Correct cuts PS But medial laxity
  2. 2. Revised with a TC3 + lateral release With still medial laxity
  3. 3. IA medial wedge (to regain IA stability) + Concomitant HTO (to regain alignment)
  4. 4. Correction Osteotomy <ul><li>where ? </li></ul><ul><li>when ? </li></ul>at the site of the malunion : &quot; ideal &quot; to correct all the components of the deformity
  5. 6. <ul><li>but : </li></ul><ul><li>-long to heal at this age! </li></ul><ul><li>-technique may be difficult (plane oblique) </li></ul><ul><li>-fixation: plate, locking IM rod </li></ul><ul><li>-often hypocorrection </li></ul><ul><li>impossible </li></ul><ul><li>- previous infection </li></ul><ul><li>- age </li></ul>
  6. 7. <ul><li>sometimes, easier to perform a metaphyseal osteotomy </li></ul><ul><li>closing or opening wedge </li></ul><ul><li>fixation if concomitant : </li></ul><ul><li>with the prosthetic stem </li></ul><ul><li>± staple, plate, tibial tubercle osteotomy </li></ul>
  7. 8. <ul><li>when you plan a concomitant osteotomy with TKA </li></ul><ul><li>for malunion </li></ul><ul><li>with good collateral ligts </li></ul>
  8. 9. <ul><li>Plan : </li></ul><ul><li>first intraarticular surgery </li></ul><ul><li>(prosthesis) </li></ul><ul><li>and then perform osteotomy </li></ul><ul><li>preoperative Xray planning with templates ++ (stems) </li></ul>
  9. 10. Post HTO Watch out !
  10. 11. LCL
  11. 12. <ul><li>FIRST </li></ul><ul><li>Forget the deformity </li></ul><ul><li>just think of IA surgery and implant the prosthesis with reference to the ligaments and the articular sufaces </li></ul><ul><li>Cuts // articular surfaces </li></ul><ul><li>flexion & extension gaps </li></ul><ul><li>knee mobile & stable </li></ul><ul><li>but malaligned </li></ul>
  12. 14. <ul><li>elevate the tibial tubercle </li></ul><ul><li>make a proximal tibial cut // tibial plateau </li></ul><ul><li>a distal tibial cut perpendicular to the mechanical axis with the tibial cutting guide </li></ul>//
  13. 15. And close the wedge
  14. 16. <ul><li>Until flush with the tibial cutting guide </li></ul><ul><li>long stem </li></ul><ul><li>tibial tubercle, 2 screws </li></ul><ul><li>± screws, plate, staple </li></ul>

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