ROCK Form 5E: Surgery Form – Malalignment
1. Physical Exam
a. Appearance of standing alignment
i. Neutral
ii. Varus
iii. Valgus
b. Limb Length Discrepancy (block height to correct pelvic tilt): _____mm
2. Pre-Operative Radiographic Parameters
a. Mechanical Axis
i. Neutral
ii. Varus
iii. Valgus
b. Mechanical Axis Deviation
i. None/0 mm
ii. ______mm medial
iii. ______mm lateral
c. Mechanical lateral distal femoral angle (mLDFA): ______
d. Mechanical medial proximal tibial angle (mPMTA): ______
e. Limb Length Discrepancy: _______mm
i. Per Orthoroentogram
ii. Per Scanogram
iii. Per CT-Scanogram
3. Surgical Procedure
a. None
b. Guided Growth
i. Technique
1. Hemi-epiphysiodesis
a. Staple
b. 8-plate (orthofix)
c. Drilling/Curettage
d. Transphyseal Screw
2. Epiphysiodesis
a. Staple
b. 8-plate (orthofix)
c. Drilling/Curettage
d. Transphyseal Screw
ii. Location (select all that apply)
1. Femur
a. Medial Physis
b. Lateral Physis
2. Tibia
a. Medial Physis
b. Lateral Physis
c. Osteotomy
i. Technique
1. Closing wedge osteotomy
2. Opening wedge osteotomy
ii. Location (select all that apply)
1. Femur
a. Medial
b. Lateral
2. Tibia
a. Medial
b. Lateral
4. Post-Operative Radiographic Parameters (i.e. Assessment of Correction)
a. Mechanical Axis
i. Neutral
ii. Varus
iii. Valgus
b. Mechanical Axis Deviation
i. None/0 mm
ii. ______mm medial
iii. ______mm lateral
c. Mechanical lateral distal femoral angle (mLDFA): ______
d. Mechanical medial proximal tibial angle (mPMTA): ______
e. Limb Length Discrepancy: _______mm
i. Per Orthoroentogram
ii. Per Scanogram
iii. Per CT-Scanogram
5. Complications
a. Infection
i. Superficial
ii. Deep
b. Skin Necrosis
c. Arthrofibrosis
d. Non-union
e. Delayed Union
f. Painful Hardware requiring removal