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Re: Хондродисплазия
послал Myles Clough 16 Февраль 2006, 15:37
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I put your questions to Dr Yasseer Elbatrawy whose practice is confined to limb lengthening and deformity correction and who is organizing the 2007 ASAMI conference in Cairo. His response was as follows (edited slightly) - (This deformity) is simple and can be corrected acutely with dome osteotomy.
The x-ray is satisfactory for analysis. In The AP view, The knee and ankle should be exactly anterior and the patella should be facing forward, then we can measure the deformity in the AP. Another lateral view of the whole lower limb should be taken, so we can correct 6 dimensions (X, Y and Z axes and Alpha, Beta and Gamma rotation).
But it seemes to me that he has distal femoral valgus and may be also distal tibial. But anyway, we have to measure a good x-ray (lateral distal femoral angle, Medial proximal tibial angle and also the distal tibial angles).
Somtimes there are many deformities in the same lower limb. I do not like to make it sophistacted and correct everything, but just correcting the biggest deformity will make the alignment much better and the patient will be happy with the least risk and least duration of operation.
After Dr Elbatrawy saw the CT scans he added - the case has multible exostosis and the ulna also may need lengthening on both sides; he will need follow up, as one of the multible exostosis may transform to Chondrosarcoma on top of its cartilagenous cap. It is a common problem associated with this condition.
Myles Clough mylesclough(at)shaw.ca
Orthopaedic Surgeon, Kamloops, BC, Canada
Clinical Instructor, University of British Columbia
Editor, OWL (Orthopaedic Web Links) http://www.orthopaedicweblinks.com
Orthogate Workshop Pages http://www.orthogate.com/clough/index.htm
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