Modified Gruca procedure

Modified Gruca surgery for the surgical treatment of congenital tibial defects. Congenital tibial defect is also called paralateral tibia and extremity deformity. It is most common in congenital long bone defects. Its clinical manifestations depend on its type and associated malformations. Generally, there are limb lengths, which may be accompanied by horseshoe valgus, knee flexion contracture, femoral shortening, knee joint, ankle instability and hind foot stiffness, combined with lateral humerus and phalanx absent. Although the horseshoe valgus deformity is the most common, there are reports of horseshoe varus or overturned valgus. Clinical problems are unequal limb length and instability of the ankle and foot. Achterman Kalmchi divides these malformations into two major types. Type I is humeral hypoplasia, and type II is completely absent. Type I is further divided into Type I A and Type I B. Type I A is characterized by the proximal humerus epiphysis at the distal side of the proximal humerus and the distal epiphysis at the proximal side of the talus. Type I B is 30% to 50% of the length of the tibia, and loses its distal support for the ankle joint. Type II is a complete defect of the tibia, and the humerus is bent and shortened, as well as more severe foot and ankle deformities. Treatment of diseases: lack of congenital tibia Indication 2 to 7 years old type II congenital tibial defect with ankle instability. Contraindications 1. The general condition is poor and there are important organ diseases. 2. There are infected lesions in the skin near the surgical area. 3. The limb is shortened by more than 8cm. Preoperative preparation Prepare routinely before surgery. Surgical procedure Incision The S-shaped incision in front of the iliac crest is about 8 cm long. 2. Reveal the distal radius and ankle joint Cut the superficial and deep fascia, the tibialis anterior muscle, The long extensor muscle and the anterior tibial artery and vein are pulled to the medial side, and the long toe of the toe is pulled to the lateral side to expose the distal end of the humerus and the front of the ankle joint capsule. 3. Distal humerus osteotomy Incision of the ankle joint capsule, at the junction of the middle and outer 1/3 of the distal humerus articular surface, a slant osteotomy was made through the epiphysis to the proximal and medial sides. 4. Move the medial bone mass up and reconstruct the external malleolus The truncated bone pieces were displaced 1.5 cm proximally and medially. Fully release the talus and place it in a new acupoint. A cortical bone was implanted between the two bone blocks, and three bone pieces were fixed with two screws. When the talus and calcaneus axes move toward the midline, the valgus deformity is corrected. 5. Stitching Rinse the wound, completely stop bleeding, and suture the wound layer by layer. complication Modified Gruca surgery, such as exposure, osteotomy and internal fixation, can remove excess lateral and posterolateral periosteum, which can affect the blood supply of the reconstructed external hemorrhoids and the growth of the epiphysis. If the triangular ligament is severed during surgery, the stability of the ankle joint may be affected.

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