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Limbdeformity 210906185601
Limbdeformity 210906185601
DEFORMITY AND
PLANNING
Abdul
LEARNING O B J E C T I V E S
• Definition of deformity
• Definition:
• It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical
position.
D E F O RMITY
• Described as abnormalities of
• Length
• Angulation
• Rotation
• Translation
•The location, magnitude, and direction of the deformity complete the characterization of a bony
deformity
D E F O RMITY
• Evaluation of Deformity :
• Clinical Examination
• Radiological Examination
• X-rays
• CT Scans
EVALUATION OF DEFORMITY : X RAYS
• AXIS
• Each long bone has 2 axis :-
Mechanical axis
Anatomical axis.
MECHANICAL
AXIS
• Straight line connecting the joint center points of the proximal & distal joints.
distance from the knee joint center to the line connecting the
joint centers of the hip and ankle.
• ANKLE
Frontal : along the flat subchondral line of tibial plafond.
Sagittal : line from distal tip of posterior lip to tip of anterior lip.
JOINT ORIENTATION LINES
Knee
metaphysis.
JOINT ORIENTATION LINES
• Hip:
femoral neck
JOINT ORIENTATION ANGLES:
identify CORA.
CENTRE OF ROTATION OF ANGULATION (CORA)
•Correction of angulation by rotating the bone around a point on the line that bisects the angle of the
CORA (the “bisector”) ensures realignment of the anatomic and mechanical axes without introducing an
iatrogenic translational deformity.
• All points that lie on the bisector can be considered to be CORAs because angulation about these
points will result in realignment of the deformed bone.
EVALUATION OF THE VARIOUS DEFORMITY TYPES
• Length
Clinically
Radiologically
EVALUATION OF THE VARIOUS DEFORMITY TYPES
• Angulation
•Identification of the CORA is key in characterizing angular deformities and planning their
correction.
• Angulation
EVALUATION OF THE VARIOUS DEFORMITY TYPES
• Rotation
Clinically
Radiologically
• Axial CT scans
• Characterized by
• Position
• Magnitude
EVALUATION OF THE VARIOUS DEFORMITY TYPES
• Translation :
• Clinically
• Radiologically
• Axial CT scans
• Characterized by
• Plane
• Direction
• Magnitude
• Level
TREATMENT
• It’s magnitude,
•An osteotomy is used to separate the deformed bone segments to allow realignment of the anatomic
and mechanical axes.
A. The CORA, the correction axis, and the osteotomy all lie
at the same location; the bone realigns through angulation alone,
without translation.
B. The CORA and the correction axis lie in the same location but
the osteotomy is proximal or distal to that location; the bone realigns
through both angulation and translation.
C. The CORA lies at one location and the correction axis and the osteotomy
lie in a different location; correction of angulation results in an iatrogenic
translational deformity.
WEDGE OSTEOTOMY
•The type of wedge osteotomy is determined by the location of the osteotomy relative to the
locations of the CORA and the correction axis.
WEDGE OSTEOTOMY
•The CORA and correction axis lie on the cortex on the convex side
of the deformity.
• The CORA and correction axis lie in the middle of the bone.
cortex is compressed.
• The CORA and correction axis lie on the concave cortex of the deformity.
both the CORA and the correction axis. Thus, translation will
always occur when using a dome osteotomy.
DOME OSTEOTOMY
Ideally, the CORA and correction axis are mutually located with
the osteotomy proximal or distal to that location such that the
angulation and obligatory translation that occurs at the
osteotomy site results in realignment of the bone axis.
DOME OSTEOTOMY
When the CORA and correction axis are not mutually located,
a dome osteotomy through the CORA location results in a
translational deformity.
DOME OSTEOTOMY
The CORA and correction axis are mutually located with the osteotomy
distal to that location in all of these examples.
The CORA and correction axis lie on the cortex on the convex side of
the deformity.
The CORA and correction axis lie in the middle of the bone.
• The CORA and correction axis lie on the concave cortex of the deformity.
•Correction of angulation deformities involves making an osteotomy, obtaining realignment of the bone
segments, and securing fixation during healing.
• Alternatively, the correction may be made gradually using external fixation to both restore
alignment and provide stabilization during healing
D E F O RMITY
ways.
THANK YOU