摘要:

Different periacetabular and triple pelvic osteotomies are used to rotate a dysplastic acetabulum to a normal weightbearing position. If the acetabular fragment becomes too small or the acetabular artery is damaged, avascular necrosis (AVN) may result. On the other hand, if the osteotomies are situated too far from the acetabulum, free rotation in all directions may be impeded. In addition, all osteotomies should be clearly visible. Our modification considers these essentials. The osteotomy of the ischium, also leaves the sacral ligaments intact and avoids pseudarthroses by its length. We examined 216 joints of children aged >7 years and adults aged ≤55 years at follow-up of 5–16 years (average 7.7 years). Clinical results were good to very good in 85%. Radiologie results correlated with four degrees of decentration. Fairly centered joints and decentered joints with an elongated acetabulum had a high percentage of normal and slightly pathologic values. In false acetabuli and high dislocations, this rate was diminished. Results were also correlated with arthrosis and deformation of the femoral head and acetabulum. Sixteen percent had moderate and 5% had significant remission of pain. The four degrees of arthrosis were improved in 9.1% and unchanged in 73.2% and had deteriorated in 17.7%. Because of the high percentage of extremely deformed joints, we conclude that our technique provides very good potential for correction and long-lasting good results. Measurements of acetabular rotation that guarantee greatest pain relief have been evaluated for the future.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We report our experience with the Chiari pelvic osteotomy. The surgical technique is presented in detail, as is the mechanism of the displacement; results are analyzed with special reference to postoperative remodeling of the femoral head. Indications are discussed according to the etiology of the hip disease in three situations, including congenital problems, neurologic problems, and Perthes' disease.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

From November 1990 to March 1993, seven children with 10 congenitally hyperextended knees were investigated by ultrasound (US). Clinical, radiographic, and US examinations were started as early as the second day after birth. Sonographic controls were continued through the first year of life. Leveuf's classification of the deformity (19) could be confirmed. Three knees had true dislocation, five had subluxation, and two had simple hyperextension. US with a 7.5-MHz linear transducer with a ventral or lateral approach can replace radiographic or arthrographic documentation, avoiding the disadvantages of ionizing radiation. Success or failure of conservative treatment can be followed on repeated US images, allowing optimal timing for the change from conservative to surgical management of deformity.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We examined the results of medial approach open reduction without preliminary traction or attempt at closed reduction for congenital dislocation of the hip (CDH) in children aged <1 year prospectively. In all children, a trial of conservative treatment with Pavlik harness failed. Twenty-three hips in 19 children were treated. Follow-up ranged from 5 to 10 years (average 8 years). None of the hips redislocated. Osteonecrosis of the femoral head occurred in one patient with coxa magna. Two children subsequently underwent Salter innominate osteotomy for hip dysplasia. Early detection and treatment with Pavlik harness is our preferred approach to treatment of CDH. In children who have failed initial harness management, medial approach open reduction without preliminary traction affords a safe, effective, and relatively simple alternative to other methods of treatment.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We compared the effectiveness of different approaches to hip screening in newborns. Three groups were studied: children born in our hospital from 1980 through 1985 who were clinically examined by pediatricians (group A), children born in 1986 and 1987 who were examined by ultrasound (US) in addition to clinical examination (group B), and children born in three district hospitals where neonatal clinical screening had not been performed by pediatricians (group C). There were significant differences between the three groups in the incidence of late-diagnosed hip dysplasia (HD): 2.6 in 1,000, 0.7 in 1,000, and 5.3 in 1,000, respectively. We conclude that US screening of hips in newborns was more effective than clinical screening alone and that clinical screening by pediatricians was superior to screening by doctors with less experience in examining children. US appears to have the potential to eradicate late-diagnosed dislocations, but milder degrees of HD still occur. With regard to the US method, measurement of femoral head coverage appears to be more adequate than subjective evaluation only.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Fifty-four patients with 73 idiopathic clubfeet, primarily treated in our department, were reviewed with a mean follow-up time of 9 years 4 months. According to the Laaveg-Ponseti score, 56% of results were excellent or good, 37% were fair, and 7% were poor. According to the McKay score, only 25% of results were excellent or good, 45% were fair, 26% were poor, and 4% were failures. Patients were divided according to their treatment program. A one-stage reduction of all deformities with a posteromedial release showed the best results, superior to “chirurgie a la carte” or staged surgery. The best results were obtained with posteromedial release performed in the first year of life.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Twenty-nine patients with 39 tarsal coalitions were evaluated 1–10 years (average 3 years) after surgical treatment. Calcaneonavicular coalitions without secondary radiologic tarsal changes were scored as excellent or good results after excision and muscle interposition. Patients with secondary changes had slower rehabilitation, a higher recurrence rate, and a less favorable end result. Excision of talocalcaneal coalitions can provide good results, although, they are less predictable than calcaneonavicular coalitions. Most patients with a talocalcaneal coalition treated by excision and arthroeresis with a sinus tarsi spacer showed unsatisfactory early results because of severe tarsal pain. Long-term results after removal of the painful spacers were slightly better than those of patients not treated with spacers.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Twenty-two patients (26 synostoses) surgically treated at the Istituto Ortopedico Rizzoli were evaluated. These synostoses were divided into three radiographic types: “partial” or type 1, “complete” or type 2, and “extended” or type 3. After critical analysis of the results obtained by different treatments, we conclude that operative treatment is indicated only when synostosis is so severe that effective compensation by the shoulder and the wrist joints is impossible; this occurs only in radio-graphic type 2 and 3 in which pronation is >60°. Pronation <30°, which almost always corresponds to type 1, should not be surgically corrected because such patients have little or no functional limitation of the upper extremity. In intermediate cases (30°-60°), the indication for operation should be evaluated case by case based on the following parameters: bilaterality, involvement of the dominant side, psychological and cosmetic aspects and, in particular, the efficacy of compensatory mechanisms. In patients with <70° of pronation the Sever (5) and Green and Mital (4) methods are both appropriate. For more severe cases, transverse osteotomy at the synostosis level is indicated to avoid neurovascular lesions. Double osteotomy (proximal and distal) is indicated for very severe cases in which the desired correction cannot be obtained by either of the other methods.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We report a closed quadriceps tendon rupture in an 11-year-old girl. The lesion occurred when the girl jumped off a horizontal bar during a school gymnastic exercise; she sustained no direct trauma to the knee joint. At first, only hemarthrosis was diagnosed and the knee was immobilized in a cast. The patient continued to complain of knee pain and weakness of the knee extensors. The tendon rupture was not detected for 3 years. The quadriceps tendon was reinserted into the patella with restitution of knee function and only mild intermittent discomfort at follow-up 1 year later.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID