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  • , Principles of Multiplanar Deformity Analysis and Correction in Long Bone

    2022-02-17Principles of Multiplanar Deformity Analysis and Correction in Long Bone

  • , Tips for Timely Diagnosis of Charcot Foot and Ankle

    2022-01-17Tips for Timely Diagnosis of Charcot Foot and Ankle

  • , Acute or Gradual Correction of a Deformity?

    2022-01-17Acute or Gradual Correction of a Deformity?

  • , Magnetic Resonance for Charcot Foot and Ankle Diagnosis

    2021-12-21Magnetic Resonance for Charcot Foot and Ankle Diagnosis

, Calculation of the True Plane of the Deformity
  • Tags complex_foot_deformity, correction_of_deformity, correction_of_deformity_following_lengthening, correction_of_deformity_with_lengthening, fusion_with_concomitant_femoral_lengthening, lengthening
Calculation of the True Plane of the Deformity
2022-02-17

The initial assessment of any lower extremity deformity is fundamental to plan a successful surgical program of correction, as well as an effective post-operative management of the healing process. The assessment should include the X-rays of full length weight bearing of both legs, with a complete axis evaluation to fix the position of the deformities, which is “the true plane of the deformity”.

Bone deformity is usually a combination of angulation and rotation. Coronal planes angular deformity (varus and valgus) is seen on AP radiographs, and sagittal plane angular deformity is seen on lateral radiographs.(1) This understanding of angular deformities is central to the correct use of an external device.

The graphical method of calculating the true plane of the deformity is a low-tech one: the only tools required are a pencil, a ruler, a goniometer and a graph paper. X and Y axis are marked with the center of the bone at the intersection with the abscissa – then anterior, posterior, medial and lateral positions are indicated. The grade of deformity is plotted on each axis to the same scale. For instance, a deformity that measures 21° degrees valgus on the AP rays is marked along the X-axis in a medial direction. S. Nayagam, an expert orthopedic surgeon from the University of Liverpool (UK), suggests a simple way to remember this: try to think of a valgus deformity as one with the apex pointing medially, and mark the size on the graph paper in the medial direction. Likewise, a recurvatum deformity that, for instance, measures 38° on the lateral X-rays is plotted in a posterior direction (recurvatum, apex posterior).(2) Orthogonal lines are drawn from these points so they intersect each other, and then a line is drawn from this intersection to the zero position. And this is the true plane of the deformity. The deviation of this plane from the sagittal and coronal planes can be established directly off the graph paper: if a millimeter-square graph paper is utilized, and the scale adopted for plotting is 1 mm to 1 degree, then the length on the line (AD) in millimeters, connecting the abscissa to the two orthogonal lines’ intersection, is the size of the deformity in degrees, and the angle that it subtends with both coronal and sagittal planes measures the true plane of deformity.

There is also a mathematical method for calculating the plane of deformity. In this case, the parameters can be measured trigonometrically from the known angles of the deformity in the AP view and lateral planes, as following: X is the AP (procurvatum/antecurvatum) angulation; Y is the varus/valgus angulation. The deviation of the deformity from the sagittal plan is X/Y° tan–1. The true plane of angular deformity is the plane in which the hinge of the fixator clamp should be placed. Other similar methods of estimation of the true angular deformity may be used, such as the rectangular rule.(3)

References

  1. Youngman J, Raptis D et al. 2015. An accurate method of determining a single-plane osteotomy to correct a combined rotational and angular deformity. Strategies Trauma Limb Reconstr; 10(1): 35-9.
  2. Patterson M (reviewed by) 2006. Apley’s Concise System of Orthopaedics and Fractures (3rd edn) by Solomon L, Warwick D, Nayagam S. Ann R Coll Surg Engl; 88(4):425-426.
  3. Jansen Paccola CA. 2011. A simplified way of determining the direction of a single-cut osteotomy to correct combined rotational and angular deformities of long bones. Rev Bras Ortop; 46(3):329-34.

< Tips for Timely Diagnosis of Charcot Foot and Ankle > Principles of Multiplanar Deformity Analysis and Correction in Long Bone

MORE POSTS

, Principles of Multiplanar Deformity Analysis and Correction in Long Bone

Principles of Multiplanar Deformity Analysis and Correction in Long Bone2022-02-17

A multiplanar deformity analysis can be both simple and complex: a correct determination of angular and metric deformity apex and plane is a fundamental task. This is true in both the preoperative surgery planning and the postoperative management phases, in order to obtain the most accurate correction and promote the quickest recovery for the patient’s well-being.

, Acute or Gradual Correction of a Deformity?

Acute or Gradual Correction of a Deformity?2022-01-17

Although several studies have reported good results of the treatment of the lower extremity deformity combined with shortening – a condition that often means disabling impairment in the daily life activities – to date there are still very few studies that review the evidence by comparing the outcomes of acute versus gradual correction.

, CORA (Center Of Rotation of Angulation)

CORA (Center Of Rotation of Angulation)2021-12-17

The term CORA (Center of Rotation of Angulation) means a method of mechanical and anatomical axis planning based on joint orientation, which has gained international recognition and acceptance. Many surgeons from all over the world apply this method to limb lengthening and deformity correction, and the CORA principles and concepts have clearly shaped both design and functionality of the last generation of external devices.

, Basic Considerations of Deformity Correction: Anatomical and Mechanical Axis

Basic Considerations of Deformity Correction: Anatomical and Mechanical Axis2021-05-15

Bone deformity is a three-dimensional issue, considering the three-dimensional shape of bones and joints. All basic considerations of deformity correction by using an external device should include the fundamental concepts of Anatomical and Mechanical Axis. These concepts allow a better understanding of the effects of adjustments or modifications in one plane when managing a three-dimensional problem such as bone deformity.

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