tibial derotational osteotomy recovery

In most cases, patients go home 1 to 2 days after an osteotomy. %%EOF Sorry, runners, you'll have to consult with your doctor depending on your recovery time. This spasticity involving the hip muscles, mostly in the groin, can cause the hips to gradually come out of their sockets. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Through the preservation of the knee anatomy, a successful osteotomy is capable of delaying the need to undergo joint replacement for a number of years. 1989; 71: 1040-1043. A tibial derotational osteotomy necessitates the surgeon to incise the bone, turn it appropriately to improve the alignment, and secure the bones in that position with metal hardware while they heal. Assuming an uneventful postoperative course, consolidation of the fracture can be expected within 4-6 weeks. Disclaimer. Distal femur osteotomy can also be performed percutaneously with a retrograde intramedullary nail for stabilization. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Postoperative management: Some causes of bunions include tight shoes that crowd the toes and "inherited faulty mechanical structure of the foot". The information on this website is for general informational purposes only. Your provider will talk to you about how to prepare for surgery. The doctors are amazing,always professional, compassionate and great listeners. Arhrodesis which requires screws or metal plates to correct the bunion and damaged joint. A thorough examination of the patient is performed by your doctor to check for any medical issues that need to be addressed prior to surgery. It is usually noticed at birth or early infancy. I am happy I found them and would refer them to friends and family. J Bone Joint Surg Br. Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up. Flex them in five second intervals and repeat them over and over again day by day. J Am Acad Orthop Surgeons 2011; 19(10): 590-599. Aside from that, a high tibial osteotomy is also considered as one of the best methods to improve the time before the knee replacement procedures become necessary, because the advantages one can experience typically last for 8-10 years. The aim is to take pressure off the . The office is very clean and I appreciated the reminders of my appointments via phone call and through text. You consent to these terms and conditions by using our website. 36, 45 The percutaneous osteotomy occurs roughly 8 cm proximal to the knee joint line. A follow-up appointment for X-rays and pin removal 4 weeks after surgery will be scheduled as well as to monitor your overall progress. Instructions on cast care and bathing will be provided. Oper Orthop Traumatol. Refrain from strenuous activities or lifting heavy objects for a month or two. It is a surgical procedure in which the upper part of shinbone (tibia) or lower part of thighbone (femur) is cut and realigned. Tibial derotational osteotomy is a surgical procedure employed to treat rotational deformities of the tibia, such as tibial torsion. Differences between Two Methods to Stabilize Supramalleolar Osteotomies in Children-A Retrospective Case Series. Physiotherapy after tibial derotation and osteotomy surgery is important to regain function in the lower limb. 27 0 obj <>/Filter/FlateDecode/ID[<853D954EE647498DB5D4F5938005C879><8A0528A33C7FA549B9CC69B8CC4D2B41>]/Index[10 34]/Info 9 0 R/Length 94/Prev 160785/Root 11 0 R/Size 44/Type/XRef/W[1 3 1]>>stream The bones are held together by protective tissues, ligaments, tendons, and muscles. It was the afternoon of Friday Sept. 24. Very friendly office and I'm glad to be a patient here. The site is secure. 2018 Aug;30(4):286-292. doi: 10.1007/s00064-018-0552-x. Diagnosis is made clinically with a thigh-foot angle > 10 degrees of internal rotation in a patient with an in-toeing gait. Most patients get rid of their crutches after a surgery. On the other hand, if the correction is still small enough, then the pelvic bone graft wont even be necessary at all. 2002 Aug;16(7):473-83 When I see him he makes sure to review my progress in detail. h{O8gW'qVHP`wUu Everything you need to know about bunion surgery! BC Children's Hospital. As a result, the knee can carry weight more evenly, easing pressure on the painful side. Likewise, a procedure known as the high tibial osteotomy can also be used to reconfigure the affected knee joint. Knee pain that is brought on mostly by activity, or by standing for a long period of time. They will review your medical history and discuss anesthesia choices with you. The .gov means its official. Osteotomy literally means "cutting of the bone." That said, an osteotomy procedure can also be performed together with other joint preservation treatments as a way to allow the cartilage to repair the tissue, encouraging it to grow without the need to deal with excessive pressure. A staff nurse will monitor blood oxygen levels and other vital signs as the patient recovers. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed. In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. Courtesy and kind would be an understatement. 2004 Nov;86(8):1170-5. doi: 10.1302/0301-620x.86b8.14479. Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Damage to adjacent soft tissue structures. 1973 Dec;55(8):1726-38 This will depend on what knee is affected. A 20-year-old patient with a bow-legged left knee. The slick cartilage is responsible for allowing the end parts of the bones to smoothly move against each other. What a great place! Toe Resistance - use a towel or t-shirt and pull your big toe towards you, gently. Arrange for someone to drive you home as you will not be able to drive yourself post surgery. This is done through a small stab wound at the level of the break. You won't want to put pressure or stress on your heeling foot so running is probably not going to happen soon after a bunionectomy. Increased age, smoking, impaired nutrition, impaired glucose control, and other things can also affect the duration of how long you should wear clutches. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Instructions on cast care and bathing will be provided. Rebecca K. - What a true burst of sunshine. and transmitted securely. Recovery from osteotomy is typically longer and more difficult because you may not be able to bear weight on your operated knee right away. The overall goals of the osteotomy and rehabilitation are to control joint pain, swelling, and hemarthrosis; regain normal knee flexion and extension; resume a normal gait pattern and neuromuscular stability for ambulation; regain lower extremity muscle strength, proprioception, balance, and coordination for desired activities; and achieve the Please enable it to take advantage of the complete set of features! It might take a year to fully recover, according to WebMD. I would highly recommend this office. product of hip rotation, tibial torsion and shape of foot. Dr Vaksha, is a great doctor very professional knows what he talking about. Tibial derotational osteotomy; Knee osteotomy is the most common form of realignment osteotomy. most common cause of in-toeing in toddlers, believed to be caused by intra-uterine positioning and molding, commonly noticed once child begins walking, parents report that the legs are "turning in", hip internal rotation to identify increased femoral anteversion, thigh foot angle to quantify tibial torsion, heel bisector to identify metatarsus adductus. Complete Orthopedics should be your choice! Bunions are no exception. A lot of patients have worn an unloader brace for a certain period of time after the procedure. Dr. Vaksha is excellent. Most of the time, the patients can be discharged from the hospital the following day, especially if the case isnt that serious at all. Weiner DS, Cook AJ, Hoyt WA, Oravec CE. The place is clean and organized.The staff is wonderful. After surgery, you will feel some pain, but your surgeon and nurses will make every effort to help you feel as comfortable as possible. The patient may have to stay in the cast for 4 to 6 weeks. This was my 1st time breaking something in my 27 years on this planet. [Torsion and torsional development of the lower extremities]. Rotational deformities at other levels, mainly the hip. Osteotomy material should be removed 1 year postoperatively. For most patients, osteotomy is successful in relieving pain and delaying the progression of arthritis in the knee. A written consent will be obtained after the surgical process has been explained in detail. After the surgery, you will be taken to the recovery room where you will be closely monitored as you recover from the anesthesia. I suffered with pain in both knees for years. Tweet us @womendotcom or follow us on Facebook and Instagram. The knee is made up of the femur (thighbone), the tibia (shinbone), and the patella (kneecap). I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731. A bone of the lower leg (fibula) forms a joint with the shinbone. nonsteroidal anti-inflammatory drugs (NSAIDs), To transfer weight from the arthritic part of the knee to a healthier area, To prolong the life span of the knee joint. Surgically cracking a bone is also known as an osteotomy. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Most osteotomies for knee arthritis are done on the tibia (shinbone) to correct a bowlegged alignment that is putting too much stress on the inner (medial) compartment of the knee. Schlemmer T, Brunner R, Speth B, Mayr J, Rutz E. Children (Basel). What happens during the surgery? A wedge of bone is removed from the outer (lateral) side of the tibia. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. Boston Sports & Shoulder Center, Shoulder Surgeon, Shoulder Surgery, Boston, Waltham, Dedham, MA, Boston Sports & Shoulder Center, Boston, Waltham, Dedham, MA, Rotational tibial deformities due to myelodysplasia and cerebral palsy, Tibialis spasticity (extreme stiffness or tightness of the muscles that interfere with normal movement). The lower end of the thighbone meets the upper end of the shinbone at the knee joint. Your surgeon will also see you before surgery and sign your knee with a marker to verify the surgical site. 2007 Mar;19(1):101-13. doi: 10.1007/s00064-007-1197-3. B5t|&>75=f&k^wM5lplvMh4DfA2eKESZ.v8xb/%'a9\@n BxlIa o'0 LN!R\Lq6.>P@?C1# $x,_gT!$x. Scheduling my appointment was quick and easy. Posttraumatic deformity due to malunion. Multiple drill holes are made in the femur through a small lateral . sharing sensitive information, make sure youre on a federal You'll need to take care of yourself after surgery on your bunion(s). This surgery can prevent or delay the need for partial or total knee replacement. Copyright An official website of the United States government. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. .elizabeth .thank you so much . If you had a more invasive surgery you could be looking at four to six months. His expertise gave me my life back. Your surgeon will line your knee cap up with your thigh and shin. HIGH TIBIAL OSTEOTOMY REHABILITATION PROTOCOL This protocol was developed for patients who have had a high tibial osteotomy. Great staff. This may relieve pain and improve movement of your leg. With this, youll be able to carry more weight without putting pressure on the affected side. << /Length 5 0 R /Filter /FlateDecode >> Recovery Time For Tibial Osteotomy. In general, the procedure involves the following steps: In general, postoperative care instructions and recovery for tibial derotational osteotomy involves the following: Tibial derotational osteotomy is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as: 840 Winter Street The information posted is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship or a doctor-patient relationship nor shall the information be used to form an legal or medical opinions. Some of the common indications for tibial derotational osteotomy include: Preoperative preparation for tibial derotational osteotomy will involve the following steps: The main objective of the procedure is to correct in-toeing or out-toeing while walking due to rotational deformities of the tibia. New look, new content: Kelty Mental Health Resource Centre launches revamped website! 1998 Jan-Feb;18(1):95-101. Osteotomy at supramalleolar level and fixation with 3.5 mm 90 locking plate. He is very compassionate. He had is team ready at the hospital and operated on me within 6 hours after my injury. Oper Orthop Traumatol. Plate and screws are used to hold the bone in the new position. Through this, the weight-bearing part of the joints shifted from the damaged tissue to a healthier tissue. osteotomy site Osteotomy means cutting the bone. -j[MjHiz4q?u2 Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo. Derotational osteotomies of the femur and the tibia were first introduced in children to treat torsional deformities leading to disability beyond the age of 8 years [ 1 ]. Perpendicular osteotomy at the intersection of midshaft to distal shaft. Your surgeon may also put your knee in a brace orcast for protection while the bone heals. After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . Bethesda, MD 20894, Web Policies Copyright 2023 Lineage Medical, Inc. All rights reserved. indications. In a tibial osteotomy, a wedge of bone is removed to straighten out the leg. Treating pain with medications can help you feel more comfortable, which will help your body heal faster and recover from surgery faster. There are no braces or treatments that can fix the problem. I was seen on time. J Pediatr Orthop. 51.1 Introduction. Distal tibial/fibular derotation osteotomy for correction of tibial torsion: review of technique and results in 63 cases. BSSC Research Foundation | Suzanne L. Miller, M.D. J Child Orthop. (Illustration by Gillette Children's Specialty Healthcare). Dr. Karkare is very knowledgeable, helpful, and caring. Your surgeon then turns or rotates the tibia bone accordingly to achieve a proper alignment. -. [Treatment of rotational malalignment of the lower leg]. Metal hardware, such as pins are placed in the bone just below the knee to hold the bones in position. There are three types of surgery to remove a bunion. I fought it for years, as I was just afraid. It is usually performed in arthritic conditions affecting only one side of your knee. In general, the procedure involves the following steps: In general, postoperative care instructions and recovery for tibial derotational osteotomy involves the following: Tibial derotational osteotomy is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as: Home Disclaimer Privacy Sitemap Feedback Tell a Friend Contact Us Accessibility Statement, Practice Policy Update regarding COVID-19, Ryan L. Dabbs, M.D., Board-certified Orthopaedic Surgeon, Knoxville, TN, Rotational tibial deformities due to myelodysplasia and cerebral palsy, Tibialis spasticity (extreme stiffness or tightness of the muscles that interfere with normal movement). Please note: Our Online Booking tool is currently down, please contact us on 0330 088 7800 to arrange your appointment and we will honour any online booking discount. endstream endobj 11 0 obj <>>> endobj 12 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 13 0 obj <>stream 2012; 6: 81-85. Excessive external tibial torsion has been associated with recurrent patellar subluxation and persistent anterior knee pain. measure the angle formed by an line from the lateral to the medial malleolus, and a second line from the lateral to the medial femoral condyles. The goals of this operation are to: wedge Improve knee alignment graft Shift weight from the arthritic part of the knee onto a healthier part of the knee stream Synovial fluid within the joint aids in smooth movement of the bones over one another. Because you might be in a cast, wheelchair, or other bandage walking on your foot is a bad idea. We have immediate appointments available today. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. I came back in for my follow up and had the same great experience. I was up walking mere hours after the surgery, and on the workout machines the next morning. Surgical management of persistent intoeing gait due to increased internal tibial torsion in children. Applying the 3.5 mm 90 LCP allows immediate postoperative full weight bearing. %PDF-1.5 % Depending on the patients medical history, social history, and age, routine blood work and imaging may be ordered for safely conducting surgery. Would highly recommend. Information regarding any allergies to medications, anesthesia, or latex is obtained. Thank You. Supramalleolar derotation osteotomy of the tibia, with T plate fixation. Several surgical techniques have been historically used to correct. Loafers, sneakers, and tevas are good options post-op. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. By preserving your own knee anatomy, a successful osteotomy may delay the need for a joint replacement for several years. I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . Treat patient with upmost respect. Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs. Patients who have underwent tibial osteotomy are usually kept in the hospital for 1-2 nights following an HTO. Very caring, profesional, and friendly!! Osteotomy literally means cutting the bone. That means, in the surgical procedure known as tibial osteotomy, the tibia is incised and its reshaped as a way to reduce the force on the knee joints. Proximal tibial derotation osteotomy for torsion of the tibia: a review of 43 cases. n/2geCYWbbMMrYrv+[kxWIW>oYyQY6oz;Y?TD5k. Dr. Vaksha was very thorough and kind. You will be able to return to your normal weight-bearing activities in 4 to 6 weeks, however, return to sports may take 3 to 6 months. endstream endobj startxref Federal government websites often end in .gov or .mil. Davids JR, Davis RB, Jameson LC, Westberry DE, Hardin JW. Patients with additional surgery will progress at different rates. Postoperative management: Following fixation of the osteotomy with the four hole 3.5 mm LCP, a lower leg cast is recommended for 4-5 weeks. The deformity is more obvious when standing. Doctor visit. In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on one compartment of the knee joint. Children under the age of 3 years due to the remodeling potential during growth. It looks like your browser does not have JavaScript enabled. 6MJ>8Ix Contact us to make an appointment. Tibial derotational osteotomy is a surgical procedure employed to treat rotational deformities of the tibia, such as tibial torsion. measure angle between foot position and imaginary straight line while walking, angle formed by a line bisecting the foot and line bisecting the thigh, infants- mean 5 internal (range, 30 to +20), age 8 years- mean 10 external (range, 5 to +30), transmalleolar axis > 15 degrees internal. Push against the towel and resist. The osteotomy needs time to heal, which takes approximately 6 weeks. Results: No patient was lost to follow-up. Osteotomy which requires cutting the big toe joint to realign it back to the normal position. Just like what has been mentioned earlier, its possible to do the activities you normally do, but keep in mind that there will be certain limits, because theres always the possibility of feeling pain and discomfort. The indication was formal in all patients with more than 30 of torsion. Patients and methods: Thirty-six derotation osteotomies of the proximal tibial metaphysis were performed between 1995 and 2006 in 29 patients (five men and 24 women, an average of 26.5 years old7.4 (18-44)) followed-up for a mean 4.7 years. Some of the common indications for tibial derotational osteotomy include: Preoperative preparation for tibial derotational osteotomy will involve the following steps: The main objective of the procedure is to correct in-toeing or out-toeing while walking due to rotational deformities of the tibia. HHS Vulnerability Disclosure, Help This is a condition characterized by twisting of the tibial bone of the lower leg, causing malalignment of the knee and ankle with an appearance of an inward or outward turning of the feet. After the wedge of bone is removed, the tibia may be held in place with a plate and screws. This procedure is employed at the early age of osteoarthritis, especially when one knee joint has already been damaged. Well, bunion surgery removes the bump in the foot! %PDF-1.3 Complete Orthopedics is a medical office and we are physicians . If it wasnt for Dr. Karkares expertise she never would have been able to work. Osteotomy which requires cutting the big toe joint to realign it back to the normal position. Tibial osteotomies are often performed for knee injuries such as total lateral compartment collapse following a motor vehicle accident. Try these exercises after consulting your surgeon or doctor: Toe Flexing - move the toes back and forth and side to side. Technique and results in patients with neuromuscular disease. Patients sometimes wonder "What is the recovery time for tibial osteotomy?". I have seen Dr. Kuo two times already and he's awesome along with his staff. This procedure can be performed in two different ways: When the surgeon opens the medial wedge or closes the lateral wedge, it straightens the leg. Dr. Karkare put my fears to rest . You may need x-rays or a CT scan. A metal plate is Recovery from osteotomy is typically longer and more difficult because you may not be able to bear weight on your operated knee right away. In most cases, knee osteotomy is a great way to eliminate arthritis pain and prevent the need of having a total knee replacement surgery for 10-15 years. The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . This information has been posted for informational and/or advertisement purposes only. It is similar to breaking a bone, except that it is done on purpose. Due to the fact that this procedure is usually done for severe knee instability, you ought to know that its not impossible to except for a fully normal knee after the procedure and once the recovery time is complete. &N<3Le8-&p&{9 [ x+L Weightbearing. I would refer this office to anyone who needs a great orthopedic doctor. However, if the OA seems quite severe during the time of operation, then it would be ideal to undergo knee replacement surgery 10 years after. Waltham, MA 02451, 40 Allied Drive A percutaneous incision is made anteromedial to the tibia approximately 2 cm proximal to the tibial plafond (Fig. The procedure was first performed in Europe during the 50s and was brought to the US in the 60s. from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. The . Toe marbles - pick up a marble with your big toe. Information is also obtained on any medications, vitamins, or supplements being taken by the individual. Great experience, the Doctor is nice but the staff is incredible. Reproduced from Rossi R, Bonasia D, Amendola A: The Role of High Tibial Osteotomy in the Varus Knee. This would result in a bow outward or inward. By shifting the weight off the battered side of the joint, its possible to lessen the pain and improve the overall function of the knees. An osteotomy is a surgical operation whereby a bone is cut to alter its length or change its alignment. Accessibility To put an end to the poor knee alignment. Gradual increase in activities over a period of time is recommended. The patient should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery. Saturday: 9am - 5pm Your surgeon will discuss each of the risks with you and will take specific measures to help avoid potential complications. Following fixation of the osteotomy with the four hole 3.5 mm LCP, a lower leg cast is recommended for 4-5 weeks. Bunions can be painful and impair your ability to walk correctly. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. The staff was super friendly and down to earth. Mon - Fri: 8am - 8pm Nothing on this site should be taken as legal advice for any individual case or situation. Internal tibial torsion (ITT) is the most common of the rotational deformities. This procedure is ideal for younger patients who are suffering from pain brought by misalignment and instability. A knee osteotomy operation typically lasts between 1 and 2 hours. Truth be told, there wouldnt be a need to do this. x\rHr}W`-'{f7ffw( rarely required. The surgery involves cutting the thighbone (femur) and re-positioning the ball of the femur in the hip socket. Your surgeon will insert a plate and screws to hold the bones in place until the osteotomy heals. JBJS. Your surgeon performs an osteotomy (surgical cut of the bone) of the tibia and fibula, normally above the ankle. Patients sometimeswonder What is the recovery time for tibial osteotomy? Generally you will wear a cast for 4 to 8 weeks, then you can put your weight on it to start physical therapy. They are an excellent practice. J Pediatr Orthop. Physio.co.uk have clinics located throughout the North West. 43 0 obj <>stream Selber P, Filho ER, Dallalana R, Pirpiris M, Nattrass GR, Graham HK. This was the right decision no pain and no limp. [High tibial osteotomy combined with lateral retinacular release for the treatment of knee varus osteoarthritis with lateral patellar compression syndrome] Most commonly, osteotomies about the knee are cuts in the top of the shin or "tibia" bone. Satisfactory short-term results after TDO have been reported but long-term results have not been studied. With an oscillating saw, your surgeon will cut along the guide wires, and then either place or remove a wedge of bone, depending on the technique used. You're in good company. Tibial derotation and osteotomy surgery is a surgical procedure to correct the alignment of the lower leg that is often required to treat tibial torsion (twisting of lower leg). Your surgeon performs an osteotomy (surgical cut of the bone) of the tibia and fibula, normally above the ankle. This can put additional stress on either part of the knee both either and outer. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. 1991 Jul;81(7):344-57 Are you thinking about bunion surgery? Pain management. lt=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s" title=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s">. After the follow-up, your surgeon will tell you when it is safe to put weight on your leg, and when you can start rehabilitation. Arrange for someone to drive you home as you will not be able to drive yourself post surgery. This causes the stiffness and severe pain on the knee. hb```f`` Surgical technique: Thank you Dr. Karkare.SincerelyVito Congro. 10). A tibial derotational osteotomy necessitates the surgeon to incise the bone, turn it appropriately to improve the alignment, and secure the bones in that position with metal hardware while they heal.

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