Orthopaedic Deformity Correction Methods

Scoliosis: A Complete Guide to Causes, Diagnosis & Treatment Options (Including Bracing, Physiotherapy Techniques & Surgical Interventions) 1. Definition  - Abnormal lateral curvature of the spine (≥10° Cobb angle) in the coronal plane, often with vertebral rotation.    - Diagnosed in childhood/adolescence; involves 3 planes: coronal, sagittal, axial.  2. Clinical Presentation   - Uneven shoulders/hips, rib prominence, asymmetrical waist.    - Possible back pain, reduced pulmonary function (severe cases).  3. Epidemiology    - Affects 2-3% of the population.    - Females 8x more likely to progress to severe curves.  4. Etiology    - Idiopathic (80% cases): Infantile, juvenile, adolescent subtypes.    - Congenital: Vertebral malformations.    - Neuromuscular: Secondary to conditions like cerebral palsy.  5. Diagnosis   - Physical exams: Adam’s Forward Bend Test.    - Imaging: X-ray (Cobb angle measurement), MRI/CT for complex cases.  6. Management   - Conservative:    - Bracing (e.g., Milwaukee brace) for curves 20-40°; worn 23 hours/day.     - Physiotherapy:   - Schroth Method: 3D postural correction, breathing exercises.   - SEAS Exercises: Active self-correction and stabilization.   - Core strengthening, flexibility training.   - Surgical: Spinal fusion for curves >45-50° or rapid progression.  7. Milwaukee Brace   - Components: Pelvic girdle, neck ring, thoracic pads, adjustable metal bars.    - Indication: Curves 20-40° in growing children/adolescents.    - Protocol: 23 hours/day wear; gradual weaning post-skeletal maturity.    - Physiotherapy:     - Exercises within brace (stretching, core stability).     - Posture training, psychological support.  8. Key Notes   - Cobb Angle: Determines severity; ≥10° for diagnosis.    - Bracing Efficacy: Reduces progression risk by 70-90% if compliant.    - Exercise Focus: 3D correction, muscle balance, pulmonary function.  Physiotherapy Highlights   - Schroth/SEAS: Customized exercises for derotation and alignment.   - Breathing Techniques: Improve lung capacity in thoracic curves.   - Holistic Approach: Addresses pain, posture, and psychological well-being.  Surgical Intervention - Reserved for severe/progressive cases; spinal fusion most common.   - Growing rods for young children to allow spinal growth.  Prognosis   - Early detection and conservative management improve outcomes.   - Regular monitoring essential during growth spurts.

Managing Double Varus Deformity with Increased Tibial Slope ⛷️ New research from Martin Luther Krankenhaus 📢 It’s a pleasure to share a recently published technical note in Arthroscopy Journals Techniques. This articles outlines a thoughtful approach to a challenging scenario we all encounter: double varus deformity combined with increased posterior tibial slope. In this tech note we describe a modified medial open-wedge high tibial osteotomy (HTO) technique that enables simultaneous correction of coronal malalignment and sagittal slope in a controlled and reproducible manner. Key surgical considerations highlighted: - Anterolateral hinge position Use of a hinge wire an cold osteotomy with a chisle! - Hinge position above the fibula head - Anterior wedge removal fascilitate rotation of the proximal fragment - Use of Schanz screws to optimize intraoperative correction This technical approach reinforces the importance of treating alignment in both planes, especially in complex varus knees. For those performing HTOs in active patients or ligament-compromised knees, her is the link to this open access article with video 📽️: https://lnkd.in/dPawtGMb Curious to hear: How are you currently managing slope control during open-wedge HTO? Thanks to my coauthors @YizzhouGe Martin Häner and @Amelie Klaumünzer #OrthopaedicSurgery #HTO #orthopedics #KneeSurgery #SportsMedicine #LowerLimbAlignment #knee #osteotomy

The MIS Zadek technique has garnered significant attention recently, with notable contributions from Oliver Schipper and Raquel Sugino DPM, MS, FACFAS. They have shared insightful videos demonstrating the creation of a bone wedge with two distinct cuts and the meticulous process of pulverizing or manually removing the wedge with precision, a task that may pose challenges for less experienced individuals. In my approach, I focus on creating a single osteotomy and methodically passing the bur through it to feather down the bone, enabling precise correction adjustments. With a 3mm diameter bur, approximately three passes are needed to achieve over 1cm of wedge correction. It is crucial to have an assistant dorsiflex the foot maximally to facilitate closing the osteotomy while maneuvering the bur. Continuous monitoring of a calcaneal axial is recommended to ensure the heel remains aligned correctly throughout the procedure. Utilizing two screws is advised, with the first aimed at compressing the osteotomy and the second serving to safeguard the plantar cortex. This technique offers a systematic and controlled approach to bone correction, emphasizing the importance of attention to detail and strategic execution for optimal results. #MISZadek #Orthopedics #SurgicalTechnique #MIS

Following Cristopher Martin and the new case-based discussion initiative from the Cervical Spine Research Society (CSRS) Communications Committee, I’m honored to contribute a case that challenged our traditional reconstructive algorithm. ⸻ Case Presentation A 60-year-old male go-kart driver presented to our clinic six months after undergoing a posterior cervical laminectomy at another institution. He is one of those patients you immediately think: “This is the nicest guy in the world.” Unfortunately, he developed a significant post-laminectomy cervical kyphotic deformity, clearly visible both clinically and radiographically. His initial surgery had been complicated by a MRSA infection, which made the prospect of further posterior surgery particularly concerning. He had been offered a C2–T2 posterior instrumentation and fusion as a salvage procedure. He was understandably terrified of undergoing another extensive posterior operation. ⸻ The Question Could we correct the deformity and stabilize the spine using an anterior-only approach, sparing him the much-dreaded posterior fusion? ⸻ Surgical Strategy We proceeded with: • Hyperlordotic stand-alone interbody implants with integrated screws • Multilevel anterior reconstruction • Anterior plating using a reconstruction plate from C4 to T1 The goal was to achieve: • Segmental lordosis restoration • Immediate internal fixation • Maintenance of correction without posterior supplementation ⸻ Outcome • Immediate postoperative radiographs demonstrated excellent deformity correction. • At 8 months follow-up, alignment has been maintained. • The patient has returned to his full gym routine and is doing remarkably well clinically. ⸻ Discussion Can this anterior-only strategy replace traditional combined anterior/posterior cervical reconstruction in selected cases of post-laminectomy kyphosis? While combined approaches remain the gold standard for many fixed deformities, this case raises important questions: • In carefully selected patients, can modern hyperlordotic implants with integrated fixation provide sufficient stability? • Can we avoid re-entering a previously infected posterior field? • Can patient-specific factors and preferences shift our decision-making paradigm? I currently have two patients treated with this strategy, both with encouraging early outcomes. ⸻ Invitation for Collaboration I am interested in exploring a multicenter study evaluating: • Radiographic correction and maintenance • Fusion rates • Complication profiles • Patient-reported outcomes • Comparison with traditional anterior/posterior constructs If you have treated similar cases or are interested in collaborating, I would welcome the conversation. Looking forward to your thoughts and experience. Cervical Spine Research Society Peter G. Passias, M.D. Pierce Nunley Kirkham B. Wood, MD Wood Christopher Bono

The Ilizarov technique, depicted in the video, is a revolutionary orthopedic method developed by Dr. Gavriil Ilizarov in the mid-20th century, primarily used for limb lengthening and deformity correction by promoting distraction osteogenesis, where new bone forms in the gap created by gradually separating bone segments. The procedure involves a circular external fixator, as shown, which stabilizes the bone segments while allowing controlled separation, a process that has been adapted over time with advancements like hexapod fixators and motorized intramedullary nails, enhancing precision and reducing complications. Despite its effectiveness, the technique carries risks such as infection (5% overall), hardware failure (3-4.5%), and nerve damage (3.5% for mandibular distraction), highlighting the importance of specialized medical facilities and careful patient management, as noted in recent systematic reviews and clinical studies.

Proximal tibia malunion with shortening and deformity. Would you fix this in one setting, staged, or with a frame? This 40 year old patient had a proximal tibia fracture that was fixed with a plate 5 years ago. The plate subsequently broke, and her fracture healed with a terrible malunion which left her with a significantly limb deformity and shortening. She was walking like this for 5 years! There’s many ways to approach this deformity: We corrected the deformity with a closing wedge osteotomy on the lateral side. An opening wedge osteotomy on the medial side is another option, but has a higher risk of nonunion. A gradual correction with a frame is another option if patient can tolerate a frame. 🦴 First step was to make sure patient understood the risks (including potential major vascular injury and loss of limb) and had no barriers to follow-up. Infection was also ruled out. 🦴 I use K-wires to mark the osteotomy angle at the apex of deformity (no software, just a goniometer) 🦴 A saw was used for tibial osteotomy 🦴 Fibula also needed an osteotomy 🦴 A plate was used to perform the provisional reduction and fixation 🦴 I felt this needed a strong fixation strategy, so once we had the reduction an IM nail was used. Blocking screws were needed proximally. 🦴 Some of the bone removed was used as bone graft 🦴 Patient was allowed immediate weightbearing 3 months post op she has significant improvement in the overall alignment and fracture is healing well. Used with patient permission #orthotrauma #orthopaedics #orthopedics #tibia #malunion

The Ilizarov method remains one of the most advanced and effective #orthopedic techniques for #bone lengthening and deformity correction. Originally developed by Dr. Gavriil Ilizarov, this circular external fixation system uses the principle of distraction osteogenesis—stimulating new bone growth through gradual, controlled tension. Whether treating congenital limb length discrepancies, post-traumatic deformities, or complex non-unions, the Ilizarov technique provides unmatched precision in bone regeneration and alignment. Its success lies in biomechanics, biology, and patient-specific customization—an intersection where orthopedic science meets surgical artistry. #medicaldevices #healthcareleaders

THE POWER of PATIENT-SPECIFIC ALIGNMENT and TECHNOLOGY or, how the more complex TKA cases become easy... A today's case, 79-year-old male with severe medial OA and a 20ish degrees varus deformity. A case that traditionally implied extensive releases, compromises in soft tissue balance, and potential use of constrained implants. Intervention 💥 robot-assisted TKA using #iKA strategy combined with #3gap balancing Execution 💥 1/ correction to the native 6° residual varus HKA tibia: 5° varus, distal femur: 1° varus #MCL back to it's native state, no medial soft tissue release 2/ post femur: 1.2° ER, #PCL balancing on point restoration of a #medialpivot mechanism peroperative kinematics, cfr. 2 videos in comments 3/extension deficit - corrected 15° to 5° Outcome 🔭 A well-balanced knee, low constraint, achieved through individualized bone cuts... and restoration of native joint #kinematics 💥💥 What else can we #hope for?

A great way to fix focal scoliosis: the Straight-Ahead TLIF technique where a TLIF cage is placed on the lateral annular ring in scoliotic segments. I’ve shown a few similar cases with long-term followup on LinkedIn previously. This case today reminded me why I love the technique: 1) Simple technique. No fancy lateral or oblique approaches, no fancy retractors, no Neuromonitoring needed. 2) No navigation needed. Not every hospital around the world has access to navigation or fancy robotics. Using simple, freehand or fluoroscopic technique allows for safe and rapid screw placement. 3) Low radiation exposure to patient and room. We did 7 total fluoro shots during the case. 4) Wolff’s Law at work: Bone adapts to stress, thus bone on the collapsed scoliosis side is sclerotic and very resistant to cage subsidence. Placing the cage directly on the hardened sclerotic bone resists collapse intraop and postop. 5) Laterally placed cage leaves a huge area for bone graft in the disc space for fusion. Miriam Hospital Brown Orthopedics University Orthopedics International Spine Study Group (ISSG) Bassel George Diebo, MD Eren O. Kuris MD Bryce Basques, MD Alan Job, MD Mohammad Daher Joseph Nassar Heather Schmutzler RN, BSN, ONC Ashley Knebel Andrew Xu Manjot Singh Chris McDonald, MD Sarah Criddle Krista Acciaioli Simbarashe Peresuh, MD Spinal Alignment Solutions (SAS) Medtronic Cranial and Spine Therapies Spineart

I find great joy in treating patients with adult spinal deformity via minimally invasive surgical techniques, when possible. This sextagenarian presented to me with refractory back pain and was treated with the “MIS special:” L5-S1 ALIF, L1-L5 MIS LLIF, and T10-S2AI MIS instrumentation with navigation, all in one day. Her back pain was gone at her first post-op visit and remains gone 2 years later. Spinopelvic parameters: SVA 11.8 cm --> 3.6 cm Cobb 37 --> 12 LL 26 --> 55 PI 53 Pretty cool this can be accomplished without stripping a single muscle fiber from the spine! Three things I consider important for these cases: 1.        PJK prevention. My preferred technique is vertebroplasty of the UIV and UIV+1 (and UIV-1 if there’s cement left). In the 8 years since adopting this technique I have had just 1 proximal failure (that I know of!). A variety of other techniques exist. 2.        Prevention of pelvic fixation failure. Did you know that 30% of pelvic fixation—whether pelvic bolts or S2AI screws—fails? I’m a big believer in the “bedrock” technique; having done 50+ bedrock cases I have seen just 1 case where those implants have loosened. 3.        Patient counseling. With 4 points of entry through the psoas, most patients will have some post-operative hip flexor weakness and sensory disturbances of the thigh. It’s best to let patients know this up front and reassure them that it will get better! Globus Medical NuVasive LifeNet Health Medtronic Spine & Biologics SI-BONE Brainlab Congress of Neurological Surgeons (CNS) AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Scoliosis Research Society International Spine Study Group (ISSG)