osteotomy

Aetiology

Trauma

RA

Rickets / osteomalacia

Issues

Horizontal joint line important

- < 10° tilt acceptable

> 10^o joint line tilt / due to femoral valgus

- continues to overload lateral compartment

Management Summary

Stage 0

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

Stage 1 / Normal X-ray, abnormal MRI

Forage: 80% G/E

Bisphosphonates

Stage 2 / Abnormal X-ray with cysts and sclerosis

A:  As for Stage I

Chondrolysis

Definition

- loss of 50% joint space or < 3mm joint space

Epidemiology

- female 2:1

- 10-20% of SUFE 

Causes

1.  Head penetration

- use only 1 screw

2.  Immunologically mediated global loss of articular cartilage

- can occur in no treatment of SUFE

Clinical

Causes of Deformity

Metabolic Bone Disease

Paget's

Fracture Malunion

Previous Osteotomy

Options

1.  Intra-articular correction

2.  Simultaneous osteotomy and TKR

3.  Staged correction and TKR

1.  Intra-articular correction 

Indications

Femur

- draw line of mechanical axis of femur

Definition

Progressive varus deformity of knees

- secondary to abnormality of medial upper tibial physis

- localised varus & internal rotation deformity

Infantile form 

- onset 1-3 years / bilateral

Adolescent form 

Definition

Inflammation of achilles tendon; insertional or noninsertional

Spectrum

Tendonitis / Tendonosis / Rupture

Anatomy

Triceps surae

- medial and lateral gastrocnemius

- soleus

- surrounded by paratenon which allows gliding and supplies nutrition

Inserts middle 1/3 calcaneal tuberosity

- 2 x 2 cm area

- 90^o rotation distally

Retrocalcaneal bursa (x2)