Normal Lower Limb Alignment and Joint Orientation p. 1 Mechanical and Anatomic Bone Axes p. 1 Joint Center Points p. 5 Joint Orientation Lines p. 5 Ankle p. 5 Knee p. 5 Hip p. 8 Joint Orientation Angles and Nomenclature p. 8 Mechanical Axis and Mechanical Axis Deviation (MAD) p. 10 Hip Joint Orientation p. 12 Knee Joint Orientation p. 13 Ankle Joint Orientation p. 16 References p. 17 Malalignment and Malorientation in the Frontal Plane p. 19 Malalignment p. 19 MAT p. 23 Malorientation of the Ankle and Hip p. 28 Orientation of the Ankle and Hip in the Frontal Plane p. 28 MOT of the Ankle p. 28 MOT of the Hip p. 30 References p. 30 Radiographic Assessment of Lower Limb Deformities p. 31 Knee p. 31 Ankle and Hip p. 40 Radiographic Examination in the Sagittal Plane p. 46 Knee p. 46 Ankle p. 51 Hip p. 53 Radiographic Examination in One Plane When There Is a Deformity Component in the Other p. 57 Plane References p. 60 Frontal Plane Mechanical and Anatomic Axis Planning p. 61 Mechanical Axis Planning p. 61 Anatomic Axis Planning p. 63 Determining the CORA by Frontal Plane Mechanical and Anatomic Axis Planning: Step by p. 64 Step CORA Method, Tibial Deformities p. 64 Mechanical Axis Planning of Tibial Deformities p. 64 Anatomic Axis Planning of Tibial Deformities p. 74 CORA Method, Femoral Deformities p. 76 Mechanical Axis Planning of Femoral Deformities p. 76 Anatomic Axis Planning of Femoral Deformities p. 81
Multiapical Deformities p. 97 Osteotomy Concepts and Frontal Plane Realignment p. 99 Angulation Correction Axis (ACA) p. 99 Bisector Lines p. 101 Relationship of Osteotomy Type to Bisector Lines p. 101 Osteotomy Rules p. 102 Translation and Length Displacement at the Osteotomy Line p. 105 Opening Wedge Osteotomy p. 106 Closing Wedge Osteotomy p. 106 Focal Dome Osteotomy p. 112 Clinical Choice of Osteotomy Level and Type p. 114 Multiapical Osteotomy Solutions p. 140 Single Osteotomy Solutions p. 140 Multiple Osteotomy Solutions p. 142 References p. 154 Sagittal Plane Deformities p. 155 Sagittal Plane Alignment in the Lower Limb p. 155 Sagittal Plane MAT p. 157 Knee Joint Malorientation p. 157 Overall Sagittal Plane MOT p. 159 Knee Level Sagittal Plane MOT p. 163 Overall Sagittal Plane MOT of the Ankle p. 163 Ankle Level Sagittal Plane MOT of the Ankle p. 165 Sagittal Plane Anatomic Axis Planning of Tibial Deformity Correction p. 165 Sagittal Plane Anatomic Axis Planning of Femoral Deformity Correction p. 169 Osteotomies in the Sagittal Plane p. 169 References p. 174 Oblique Plane Deformities p. 175 Plane of Angulation p. 175 Graphic Method p. 179 Graphic Method Error p. 183 Base of Triangle Method p. 183 Axis of Correction of Angulatory Deformities p. 186 Definition of Angulation p. 193 References p. 193 Translation and Angulation-Translation Deformities p. 195 Translation Deformity p. 195 Two Angulations Equal One Translation p. 200 Translation Effects on MAD p. 200 Osteotomies for Correction of Translation Deformity p. 202 Combining Angulation and Translation p. 203
A-t Deformities and MAD p. 205 Graphic Analysis of a-t Deformities p. 205 Angulation and Translation in the Same Plane p. 205 Anatomic Plane Deformity p. 205 Oblique Plane Deformity p. 208 Angulation and Translation in Different Planes p. 209 Anatomic Plane Deformity with Angulation and Translation 90[degree] Apart p. 209 Oblique Plane Deformity with Angulation and Translation 90[degree] Apart p. 211 One Anatomic and One Oblique Plane Deformity with Angulation and Translation in Different Planes Less Than 90[degree] Apart p. 214 Oblique Plane Deformity with Angulation and Translation Less Than 90[degree] Apart p. 216 Osteotomy Correction of a-t Deformities p. 218 Osteotomy Correction of Angulation and Translation in the Same Plane p. 219 Correction of Angulation and Translation in Different Planes p. 222 Multilevel Fracture Deformities p. 231 References p. 234 Rotation and Angulation-Rotation Deformities p. 235 Clinical Assessment of Rotation Deformities p. 235 Level of Osteotomy for Rotation Deformities p. 243 Frontal Plane Preoperative Planning for Rotation Deformities p. 249 Factoring in Rotation for Mechanical Axis Planning of the Femur p. 250 Frontal Plane Anatomic Axis Planning for Rotation Deformities p. 252 Combined Angulation and Rotation Deformities p. 252 Locating the Inclined Axis p. 259 Locating the Inclined Osteotomy p. 261 Inclined Focal Dome Osteotomy p. 266 Clinical Examples p. 266 References p. 268 Length Considerations: Gradual Versus Acute Correction of Deformities p. 269 Length Considerations for Angular Corrections p. 276 Neurovascular Structures p. 278 Nerves p. 282 Vessels p. 287 Muscles, Tendons, and Fascia p. 287 Ligaments p. 287 Skin p. 288 References p. 289 Hardware and Osteotomy Considerations p. 291 Choice of Hardware p. 291 Patient Age p. 291 Osteotomy Types p. 291
Closing Wedge Osteotomy p. 291 Opening Wedge Osteotomy p. 297 Angulation-Translation Osteotomy p. 300 Dome Osteotomy p. 300 Hardware p. 300 Plate Fixation p. 300 Intramedullary Nails p. 307 External Fixation p. 346 Order of Correction p. 383 Lever Arm Principle p. 387 Method of Osteotomy p. 389 References p. 410 Six-Axis Deformity Analysis and Correction p. 411 The Taylor Spatial Frame Fixator p. 412 Introduction p. 412 Modes of Correction p. 416 Planning Methods p. 418 Fracture Method p. 418 CORAgin Method p. 420 CORAsponding Point Method p. 422 Virtual Hinge Method p. 424 Line of Closest Approach (LOCA) p. 426 Taylor Computer-assisted Design (CAD) Software p. 429 Reference Concepts p. 429 Rate of Correction and Structure at Risk (SAR) p. 430 Parallactic Homologues of Deformity: Proximal versus Distal Reference Perspective p. 433 References p. 436 Consequences of Malalignment p. 437 Static Considerations p. 438 Dynamic Considerations p. 440 Rotational Considerations p. 443 Animal Laboratory Models p. 444 Cadaver Laboratory Models p. 444 Clinical Longitudinal Studies p. 446 Summary p. 448 References p. 448 Malalignment Due to Ligamentous Laxity of the Knee p. 451 LCL Laxity p. 451 MCL Laxity p. 462 References p. 464 Knee Joint Line Deformity Sources of Malalignment p. 465
References p. 478 Realignment for Mono-compartment Osteoarthritis of the Knee p. 479 Deformities in Association with MCOA p. 479 Bone Deformities p. 479 Joint Deformities p. 479 Customized HTO p. 485 Malalignment Test form Mono-Compartment Osteoarthritis p. 485 Femoral versus Tibial Osteotomy p. 485 Level of Center of Rotation of Angulation p. 492 Magnitude of Correction p. 492 Type of Osteotomy and Fixation p. 494 Considerations p. 495 Medical Compartment Osteoarthritis Varus plus Medial Collateral Ligament Pseudolaxity Medial Compartment Osteoarthritis Varus plus Lateral Collateral Ligament Pseudolaxity p. 495 p. 497 Medial Compartment Osteoarthritis Varus plus Rotation Deformity p. 497 Medial Compartment Osteoarthritis Varus plus Hyperextension p. 499 Medial Compartment Osteoarthritis Varus plus Fixed Flexion Deformity p. 502 Medial Compartment Osteoarthritis Varus plus Lateral Subluxation p. 503 Medial Compartment Osteoarthritis Varus plus Medial Plateau Depression p. 503 Lateral Compartment Osteoarthritis (LCOA) p. 504 References p. 507 Sagittal Plane Knee Considerations p. 509 Frontal Plane Knee Considerations p. 509 FFD of the Knee p. 509 HE and Recurvatum Knee Deformity p. 538 Knee Extension Contracture p. 563 Patella Baja and Alta p. 568 References p. 569 Ankle and Foot Considerations p. 571 Frontal Plane Ankle Deformities p. 574 Supramalleolar Osteotomy for Varus and Valgus Deformities p. 579 Sagittal Plane Ankle Deformities p. 581 Supramalleolar Osteotomy for Recurvatum and Procurvatum Deformities p. 585 Compensatory Mechanisms and Deformities: Mobile, Fixed, and Absent p. 596 Specific Ankle Malalignment Deformities p. 611 Ankle Fusion Malunion p. 611 Flattop Talus Deformity p. 611 Ball and Socket Ankle Joint p. 619 Overcorrected Clubfoot and Other Lateral Translation Deformities of the Heel p. 623 Posterior Tibial Tendon Dysfunction p. 627
Completely Stiff Foot Treatment by Supramalleolar Osteotomy p. 627 Partial Growth Arrest p. 630 Malunion of Fibula p. 630 Ankle Contractures p. 630 References p. 645 Hip Joint Considerations p. 647 Limb in Neutral Alignment to Pelvis, No Intraor Periarticular Limitation of Range of Motion p. 647 Varus Deformity p. 647 Valgus Deformity p. 653 Limb in Neutral Alignment to Pelvis, Intra-articular Limitation of Range of Motion p. 653 Varus Deformity p. 653 Valgus Deformity p. 653 Lesser Trochanter Considerations p. 656 Greater Trochanter Considerations p. 660 Sagittal Plane Considerations p. 672 Deformities of the Head and Neck of the Femur p. 673 Pseudo-subluxation of the Hip p. 684 Deformities Due to Hip Ankylosis and Arthrodesis between the Femur and the Pelvis p. 686 Pelvic Support Osteotomy p. 689 References p. 694 Growth Plate Considerations p. 695 LLD p. 695 Predicting LLD p. 695 Multiplier Method p. 697 Additional Growth Databases p. 701 Relationship of Multipliers for Boys to Multipliers for Girls p. 701 Development of the Multiplier p. 702 Limb Length Discrepancy Prediction Formulae p. 702 Prediction of Limb Length Discrepancy at Skeletal Maturity Using the Multiplier Growth-Remaining Method for Cases of Postnatal Developmental Discrepancy p. 702 Percentage of Total Bone Growth from the Distal Femur and Proximal Tibia p. 703 Using the Multiplier Method to Calculate Timing for Epiphysiodesis p. 703 Growth Prediction Controversies p. 704 Growth Plate Considerations Relative to Deformity p. 705 Cause of Deformities p. 705 Developmental Angular Deformities p. 705 Angular Deformities: Gradual Correction by Hemi-epiphysiodesis p. 708 Planning for Hemi-epiphyseal Stapling for Angular Correction at the Knee in Children p. 708
Multiplier Method for Timing Hemi-epiphyseal Stapling for Correction of Angular Deformity Multiplier Method for Calculating When to Remove Hemi-epiphyseal Staples in Young Children p. 710 p. 710 References p. 715 Gait Considerations p. 717 Gait Considerations in Association with Lower Limb Deformities p. 717 Sacrifice of Joint Motion p. 717 Fixed Joint Position p. 718 Abnormal Loading of Joints p. 721 Compensatory Mechanisms p. 721 Frontal Plane Malalignment p. 722 Distal Tibia Varus or Valgus p. 722 Varus Deformity at the Knee p. 725 Valgus Deformity of the Knee p. 732 Varus or Valgus Deformity of the Proximal Femur p. 735 Sagittal Plane Deformity p. 738 Ankle Equinus Deformity p. 739 Excessive Ankle Dorsiflexion or Calcaneus Deformity p. 743 Ankle Arthrodesis Deformities p. 744 Anterior Translation of the Foot p. 746 Fixed Flexion Deformity of the Knee p. 749 Recurvatum of the Knee p. 751 Hip Flexion Deformity p. 751 Hip Fusion p. 752 Rotational Malalignment p. 753 Leg Length Considerations p. 755 References p. 758 Dynamic Deformities and Lever Arm Considerations p. 761 Levers p. 761 Mechanical Advantage p. 763 Moments and Motions p. 763 Redundancy p. 765 Normal Function p. 766 Introduction p. 766 Mechanics of the Ankle: First Rocker p. 766 Mechanics of the Ankle: Second Rocker p. 766 Mechanics of the Ankle: Third Rocker p. 767 Force Production and Compensation p. 768 Pathological Function p. 768 Short Lever Arm p. 768 Flexible Lever Arm p. 771
Malrotated Lever Arm p. 772 Unstable Fulcrum p. 773 Positional Abnormalities p. 773 References p. 775 TKR and Total Hip Replacement Associated with Malalignment p. 777 Normal Alignment Versus Malalignment in Association with Total Knee Arthroplasty p. 777 Management of Fixed Soft Tissue Deformities p. 780 Clinical Assessment p. 780 Radiographic Assessment p. 780 Intraoperative Placement of Components and Consequences of Malalignment p. 782 Varus Deformities p. 783 Valgus Deformities p. 783 Flexion Deformity and Contracture p. 783 Recurvatum Deformity p. 786 Peroneal Nerve Palsy and Operative Release p. 786 Trial Reduction after Ligamentous Balancing p. 786 Summary of Soft Tissue Balancing Principles p. 787 Extra-articular Bone Deformities p. 788 Total Knee Arthroplasty after Failed HTO p. 792 Preoperative Assessment p. 792 Proximal Tibial Osteotomy-Related Problems for TKR p. 793 Proximal Femoral Deformities and Total Hip Arthroplasty p. 794 Preoperative Planning p. 796 Soft Tissue Balancing p. 797 Bone Deformity Correction p. 797 Table of Contents provided by Blackwell's Book Services and R.R. Bowker. Used with permission.