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When Simi begins to palpate Mary's joints, she finds her stride, spilling out technical terms as she goes: symmetrical deformity; ulnar deviation at the MCP joint; rheumatoid nodules, widespread over all joints; Z-thumb deformity; fixed flexion deformity on all fingers; swan neck deformity… The list seems endless, and Karan is impressed, needing to prompt Simi only once or twice.
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Stage III includes all of the signs of stage II; however, the hindfoot deformity becomes fixed.
A decision was taken to remove all metalwork and correct the proximal femoral deformity whilst fixing the fracture.
Correction of the skeletal deformity whilst fixing the fracture will help restore the mechanical axis and reduce the risk of a recurrent fracture.
Typical indications for UKA are a stable knee, functionally intact lateral and femoro-patellar compartments, correctable (intra-articular) varus deformity, less than 10° 15° of fixed flexion deformity, and flexion beyond 100°.
According to the specific hip deformity, we determined the prosthesis insertion angle and performed a trial reduction to check stability in all directions, correction of the fixed deformity and limb length.
Inclusion criteria were: primary osteoarthritis, indication for cruciate-retaining TKA, and fixed deformity of less than 10°.
The exclusion criteria were previous orthopedic surgery, severe asymmetrical fixed deformity or scoliosis (angle of vertebral lateral curvature >20°), and dislocation of the hip.
The knees were balanced in extension by an in-tube release on the concave side in case of fixed deformity before the distal femoral osteotomy.
The knees were balanced in extension by an in- tube release on the concave side in case of fixed deformity before the distal femoral cut.
The use of botulinum toxin A (BT-A) is recommended for the treatment of spasticity in ambulatory children with CP to improve motor function and slow down the development of fixed deformity with the need for surgical intervention [ 22].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com