Blount's disease is a developmental condition characterized by a disturbance of orderly bone growth in the upper tibia. This results in a varus deformity of the knee. The disorder was first described by Blount in 1937. It most commonly affects children aged 2-8 years old and can be caused by factors like obesity, early walking, and hereditary influences. Radiographs show a widened and irregular growth plate medially with a beaked appearance of the metaphysis. Treatment depends on age and severity but may include bracing, corrective osteotomies, or hemiepiphysiodesis in more severe cases. Complications can include recurrence of deformity, nerve palsies, or loss of correction
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
Charla educativa sobre las epilepsias y cómo una persona debe manejar inicialmente una crisis.
Orientada a personas no relacionadas con el área de salud.
Congenital Pseudoarthrosis of Tibia and Blounte’s Disease.pptxKaushal Kafle
Congenital Pseudoarthrosis of Tibia and Blounte’s Disease, etiopathogenesis , cause of lowerlimb deformity and bowing in kids, treatment, prognosis and outcome, Tachdijans Padeiatric Orthopedics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. History
• Erlacher was the first to describe tibia vara and
internal tibial torsion- 1922.
• Blount- 1937- His Article prompted the diagnosis of
this disorder
• Langenskiold in 1952 came up with classification for
this disorder
3. Dr Blount Description
• “an osteocondrosis similar to Coxa Plana
and Madelung deformity but located at
the medial side of the proximal tibial
epiphysis”
4. Introduction
• It is a developmental condition
characterised by a disturbance of
orderly sequence of enchondral
ossification at the upper end of the
tibia, affecting the medial portion of
growth plate, mainly in its
posteromedial aspect and medial
portion of the epiphyseal ossification
centre.
• Resulting in abrupt varus
angulation at proximal portion oF
tibial metaphysis , while diaphysis
remains straight.
5. Etiology- What Causes It.
• Current concept – tibia vara is an acquired
disease of proximal tibial metaphysis of
unknown cause.
• Enchondral ossification is most likely altered.
6. Suggested causative factors
• Infection
• Trauma
• Osteonecrosis
• Latent form of rickets
ALTHOUGH NONE HAVE BEEN PROVED
Combination of developmental and hereditary
factors is most likely the cause
7. • The Relationship of early walking and obesity
with Blount disease has been clearly
documented.
• Rarely seen in non ambulatory children.
8. ETIOLOGY contd
• Familial occurance reported by several
authors…..but as noted by Langenskiold and
Riska, because radiographic features of infantile
tibia vara have never been seen in patients
younger than 1 year and rarely before 2
years..this condition should be consider
congenital one.
9. PATHOLOGY
Histologic evaluation of affected growth plates and
corresponding part of metaphysis shows :-
1. Islands of densely packed cartilage cells
displaying greater hypertrophy than expected
from their position in growth plate.
2. Island of nearly acellular cartilage.
3. exceptionally large clusters of capillary
vessels.
10. Pathophysiology
• The physeal cell collumns become irregular
and disordered in arrangement and normal
endochondral ossification is disrupted , both in
the medial aspect of metaphysis and in
corresponding part of physis.
• Varus deformity progresses as long as
ossification is defective and growth continues
laterally on lateral part of physis.
11. • In later stages , an actual bony bridge may
tether the medial growth , and the medial tibial
plateau may apear deficient posteromedialy.
• Ligamentous laxity on lateral side of knee
frequently develops in a neglected or recurrent
deformity .
12. Classification
• Blount distinguished it as :-
Infantile-
Less than 8 years of age
bilateral in 60 %
Adolescent :-
more than 8 years to skeletal fusion.
with a cause- black, obese.
13. Langenskoild classification (1952)
Depending on degree of
metaphysial epiphysial changes-
6 progressive stages with
increasing age
• Stage I- Irregular metaphyseal
ossification combined with
medial and distal protrusion of
the metaphysis.
• Stage II,III, IV - evolves from
mild depression of the medial
metaphysis to a step- off of the
medial metaphysis.
14. Langenskoild classification (1952)
Stage V- Increased slope of medial articular
surface and a cleft separating the medial and
lateral epicondyle.
• Stage VI- Bony Bridge across the physis.
15. • Bowleg deformity first
becomes apparent when
infant starts to stand and walk.
• Obese child.
• DEFORMITY
Sharp medial angulation of
tibia at metaphysis.
Deformity more evident in
weight bearing position
Internal tibial torsion
17. • To compensate for the tibial varus , the medial
femoral condyle hypertrophies.
• Over the medial aspect of epiphyseometaphyseal
junction , a bony , hard , non tender prominence is
palpable( reffered as BEAK on xrays )
• In long standing neglected cases –
slight flexion deformity is added to varus deformity.
collateral ligaments become lax- joint unstable.
medial tibial condyle becomes severely depressed
and OA develops within medial compartment of
knee.
18. Radiological examination
• Standing AP view from hip to ankle.
FEATURES :-
Varus angulation at the epiphyseal
metaphyseal junction.
Widened and irregular physeal line
medially.
Medially sloped and irregular ossified
epiphysis, sometimes triangular.
Prominent beaking of the medial
metaphysis with lucent cartilage
islands within the beak.
Lateral subluxaton of the proximal
end of tibia.
20. Tibia Femoral Angle
• Normally progresses from
pronounced varus before age
of 1 year to valgus between
the ages 1.5 to 3 years…
• any deviation from normal
tibiofemoral angle
development indicates Blounts
disease.
21. Metaphysio diaphyseal Angle
• Levin And Drennan
• If angle > 11 degree- mostly
blount lesions
• If angle < or = 11
degree….mostly resolves.
22. Further Work Up
• No specific blood markers.
• TESTS to rule out Rickets, ViTamin D deficiency
• Ct scan is indicated to detect physeal bar in
children above 5 years of age.
23. Diffrential Diagnosis
• Physiologic Genu Varum
• Skeletal dysplasias
• Metabolic diseases ( renal osteodystrophy, vit d
resistant rickets )
• post traumatic deformity
• Post infective sequelae
24. Developmental (physiological) bowing:
Developmental bowing Blount disease
Disappear after 2 years. Progressive.
Bilateral and symmetric. Unilateral or bilateral
asymmetric.
Metaphyseal diaphyseal
angle < 11
Metaphyseal diaphyseal
angle > 11
25. TREATMENT
• Treatment choices and prognosis greatly depends
upon on the age of the patient and radiographic
stage of the disease
27. KNEE ANKLE FOOT ORTHOSIS(KAFO)
• Rainley.et all Prefferred LOCKED
KAFO that produced valgus force
by 3 points pressure.
• Recommended 23 hrs /day.
• Full weight bearing.
RISKS of failure:-
Ligamentous laxity.
Patient weight above 90
percentile.
Late initiation of bracing.
28. ELASTIC BLOUNT BRACE
• 1987
• A medial upright design
that uses a wide elastic
band just distal to the knee
joint.
• Excusively used
ease of fabrication
Smaller profile
30. Rx – CORRECTIVE OSTEOTOMY
• In children older than 9 years with more severe
involvement , osteotomy alone , with bony bar
resection , or with epiphysiodesis of lateral tibial
and fibular physis is indicated.
• For older Children in whom bracing and tibial
osteotomy have failed to prevent progressive
deformity , Ingram , Siffert and others have
suggested an intraepiphyseal osteotomy to correct
severe joint instability and a valgus metaphyseal
osteotomy to correct the varus angulation
31. CORRECTIVE OSTEOTOMY Rx
• Schoenecker et al- elevation of medial tibial
plateau along with metaphyseaal wedge osteotomy
• Gregosiewics – Double elevating osteotomies;
intraepiphyseal and metaphyseal.
• Zeyer – hemicondylar tibial osteotomy through the
epiphysis into the tibial intercondylar notch.
• Bell, Coogan- Recommended illizarov technique.
32. Metaphyseal oblique osteotomy
• George .T.Rab
• Advantage-
• single plane oblique cut allows
simultaneous correction of varus and
internal rotation .
• permits postoperative cast wedging if
necessary to obtain appropriate position.
33.
34.
35. • Post-operatively
Cast is changed at 4 weeks
Weight bearing allowed if callus evident over
radiographs
Cast worn till 8 weeks/ till union is evident
radiologically
36. CHEVERON OSTEOTOMY
• GREENE
• MODIFICATION OF DOME OSTEOTOMY
• Advantages
Greater Stability
Mininmal changes in leg length.
40. INTRA EPIPHYSEAL OSTEOTOMY
• Stiffert , Johnson ET AL.
• Indication
severe joint instability
To correct intrarticular
components of Blount
disease
• in addition valgus osteotomy
to correct genu vara.
41. ILIZAROV TECHNIQUE
• Effective in correction of deformity and
lengthening if indicated in adolescent patient.
• Allows – adjustment of limb alignment
postoperatively.
• Fixation to tibia is achieved by 4 proximal and 4
distal wires that are affixed to rings and
tensioned.
43. Treatment in breif
AGE LANGENSKOILD
STAGE
TREATMENT
< 2 YEARS STAGE 1 AND 2 OBSERVATTION
2-3 YEARS STAGE 1 AND 2 MODIFIED LOCKED KAFO
3-8 YEARS STAGE 2 TO
STAGE 3
OBLIQUE / CHEVERON
OSTEOTOMY
9+ YEARS STAGE 4 AND
ABOVE
RESECTION OF BONY/ PHYSEAL
BAR + OSTEOTOMY + EPIPHYSEAL
ELEVATION +/- LATERAL
EPIPHYSEAL EPIPHYSEODESIS
Severel author have reported familail occurance of this disease, however acc to
Histologic evaulation has been reported by several authors.
By physeal cell collumns I mean all the layers of physis…..growth will cont on the lateral side of the physis ….but it wil be defective on the medial side…..soo the progression of varus deformity.
BONY BRIDGE FORMATION BETWEEN METAPHYSIS AND PHYSIS AND EPIPHYSIS….WICH WILL TETHER THE MEDIAL GROWTH
Ligamentous laxity is due to depression of med
Stage 2 – complete restoration possible
Stage 4 – restoration possible
Stage 2 – complete restoration possible
Stage 4 – restoration possible
This is a case of blounts disease…..showing an obeses childe……bilateral tibia vara……..foot is internaly rotated and hence internal tibial rotation is also present….
Metaphyseal beak….wich would be shown after few slides on xrays.
SLIGHT FLESION DEFORMITY …..AS POSTEROMEDIAL PART EPIPHYSIS BECOMES DEPRESSED.
LIGAMENT LAXITY CAUSED BY EXTREME DEPRESION MEDIAL CONDUYE
Angle formed by line joining the longitudinal axis of tibia and femur.- …..normally this angle is 7 degree
The angle formed by the line connecting most prominent medial portion of the proximal tibial metaphysis and the most prominent lateral point of metaphysis with a line drawn perpendicular to the long axis of tibial diaphysis……..in a study, blount disease developed in 29 out of 30 patients, whose angle was more than 11 degree…..and only out of 58 patients only 3 developed this condition whoes angulation was 11 degree or less.
From tachidian page 976
Mostly it is misdiagnosed with physiologic genu varum
Brace treatment not appropriate in children older than 3 years….because maximum trial of 1 year to correct the deformity with orthotic treatment is recommended…..if the correction is not achieved within this time frame the surgeon can stil perform definitive surgery till the time child is 4 years old….now if orthotic treatment begins after the child is 3 years old means that results wont be known till the time child is older than 4 years….this will delay the surgical osteotomy for 1 year…it may seem meldodramatic…but even few months delay in performing surgery after 4 years may lead to failure in achieving permanent reversal in inhibition of proximal medial physis.
Rainley and associates used kafo orthosis in 60 tibiae….out of wich 54 resiloved without surgery…out of 54 tibiae wich resolved 27 were treated with full time orthotic use…..23 by night time use only…..4 by day time use only....the 6 patients qwich required surgery …..3 patient ….full time orthotics……and 3 had only night time use of orthotics….according to this findings…..author recommended night time use only
KNEE ANLE FOOT BRACE….VALGUs CORRECTION SHOULD BE INCREASED BY BENDIONG THE MEDIAL UPRIGHT EVERY 2 months until standing radiographs shows that atleast a neutral mechanical axis is being correctedand the lesions should have nearly resolved by the time that the patient is no longer using orthotics.
In image note the medial upright that can be locked to increase the effectiveness of valgus pressure during weight bearing.
Principle of oblique osteotomy for tibia vara…..Rotation around the face of cut will produce valgus and external rotation. Which is done in case of tibia vara.
after preparing and draping patient….aaply and inflate tourniquet….
A- make a transverse incision over the lower pole of tibial tubercle.
b. The a y shaped incision over the periosteum ….
c…..steimen pin at an angle of 45 degree is placed just 1 cm distal to tibial tubercle and is advanced till the time ir passes just into posterior cortex…..this is done under image intensifier to make sure that the steimen pin is distal to the physis……
d…now this pin length is measured and the same length is markedd over or saw blades…….this will help to remind abt the saw depth
e….now the oblique cut is just made distal to the steimen pin….
F- now this osteotomy is rotated on its face by external rotaion and valgus rotationin blounts diseases…..and is fixed with corticalor cancellous lag screw …wich is kept loose….both limbs are checked for the correct alignment…..long knee ,bent knee cast is applied…..as the screw is kept loose …changes in the alignment can be made while applyind cast.
Patient is prepared in usual manner……sandbag is given under ipsilateral hip to improve exposure of fibula
Fibular osteotomy - middle third of fibula is exposed through the interval between lateral and posterior compartments…..1 cm segment of fibula is removed with saw……fibula is cut obliquely from superolateral to inferomedial …so that when leg is brought from varus to valgus position …the distal part of fibula can slide past the proximal fragment
Tibial osteotomy after hockey stick incision tibial tubercle and gerdy tubercle are exposed
…apex of osteotomy is just distal to tibial tubercle…..a whole is drilled anterior to posterior at this point to mininmise the riskof extending osteotomy beyond this location…..now the osteotomy is completed using a saw …..and lateral wdge is removed………after osteotomy distal tibia is swinged in desired position of valgus and external rotation…..lateral wedge is inserted medialy given a position which maintains correction….depending on age and degree of obesity of child osteotomy is fixed with single or 2 crossed threaded pins are given.
Postoperatively no weight bearing for 4 weeks after surgery ……cast removed after 4 weeks and f healing is satisfactory radiologically weight bearing is gegun after pins removal…….usually 8- 10 weeks of immobilisation is necessary.
IN THIS PROCEDURE ….OSTEOTOMY AND ELEVATION OF MEDIAL TIBIAL CONDYLE IS DONE…..
EPIPHYSIDESIS OF LATERAL TIBIAL PHYSIS AND FIBULA PHYSIS IS DONE IF INDICATED.
Procedure – in this procedure curved osteotomy through the medial aspect of the epiphysis is done….the osteotomised tibial condyle is elevated to place in congruity with femur condyle…and bone graft is placed in between…
Anterior tibial artery- at interossoeus membrane- streching of artery occurs on varus correction …..and occlusion with valgus correction