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Re: Деформация голеней
послал Tom Schaller 11 Сентябрь 2005, 03:03
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I prefer a medial opening wedge. Currently I prefer the tomofix system by synthes. Its instrumentation allows "dialing in" the correction nicely, and the fixed angle construct provides excellent stability. A few other companies have similar systems, Arthrex for example. Trying to hinge the correction on intact lateral cortex (1 cm.) is key to preserve stability.
The nonunion/hardware failure rate is substantially higher when the lateral cortex is breeched. Fibular osteotomy not required.
Attached is a screen capture from the AO foundation website which has an excellent training module on performing an opening wedge HTO. It shows from preop planning to intra-op techniques. It is helpful even if you don't use their product to perform the procedure. Certainly it is not mandatory to use any osteotomy system to obtain and secure a well done osteotomy - im not sure what instrumentation you have access to.
The question of what to fill the opening wedge with is an issue. Illiac crest is the gold standard, but has its own morbidity, and doesn't add to the overall cosmesis desired by this young lady. You may consider allograft or other substitutes, but research done at my center shows moderate increased likelihood of construct failure.
Good luck
Tom Schaller
MSU/KCMS Dept. of Orthopedics
Kalamazoo, Michigan
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