摘要:

This final section on the new concept of and approach to treatment of clubfoot is the evaluation of 102 clubfeet treated over a 6-year period. Fifty-five unoperated feet received the surgical procedure described in Section II based on principles described in Section I. An attempt is made to evaluate the validity of correction of horizontal subtalar rotation, early ankle motion, recession of flexor tendon sheath on ankle motion and flexor hallucis longus function, early surgery, and release of the interosseous ligament. The results indicate that correction of horizontal subtalar rotation is beneficial and results in marked improvement in ankle motion by flexor tendon sheath recession and early motion. Longer follow-up is needed to determine the proper age for surgery. A rating system is developed and suggested for routine follow-up and comparison.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We studied I 17 in-toed children and found external tibial-fibular torsion and internal axial deviation of the foot from the mids;igittal plane. Based on studies of newborn infants, radiographs. and anatomical specimens. we concluded that ii major couse of in-toed gait in children wiis persistence of the fetid medial deviation of the talur neck and not internal tibial torsion. Spontaneous correction can be anticipated in children up to the age of 3 years if the internal axial rotation is less than 10%. If it is greater than 10%, prognosis for correction with urthoses is age related. In children over the age of 6 years, little correction seems possible.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Forty adults with a history of Legg-Calve-Perthes disease treated with spica casts were clinically and radiographically evaluated an average of 30 years post-treatment (range 14 to 40 years). Clinical results were 85% good, 5% fair, and 10% poor. Five percent showed significant degenerative joint disease on follow-up radiographs and 7% had undergone prosthetic replacement. Fifteen percent of the patients had a positive family history of Perthes disease. Factors associated with a better result included: diagnosis before age 9, shorter length of follow-up, minimal femoral head and neck involvement, and a congruous joint.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A retrospective study of 59 congenitally dislocated hips was undertaken to assess the relationship between the quality of a closed reduction and the eventual outcome. Good closed reductions were associated with rapid improvement of the acetabular angle and the center edge (CE) angle and a low incidence of avascular necrosis (AVN). Adequate reductions with up to 7 mm of widening of the joint on arthrogram had a good final outcome in 11 of 13 hips with a slower rate of improvement of the acetabular and CE angles and a low rate of AVN. Hips with poor or indeterminate reductions had an acceptable outcome in only five of 23 hips, did not benefit from prolonged closed treatment, and had a 57% incidence of AVN. Patients with marked ligamentous laxity often fared poorly, required prolonged treatment, and had a high incidence of AVN.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The presence, extent of abnormality, and measurement data in hips from six fetuses with congenital deformities and seven normal fetuses with 12 aberrant hips were compared with similar data from 140 normal fetuses. Six hips were abnormal on naked eye examination in fetuses with polycystic kidneys, multiple deformities, or cyclopia. Hips graded normal in two fetuses with cardiac defects were found to have dysplasia, greater on the left side, when measurement data were compared. Aberrant features observed resembled that reported in congenital hip disease. Although no joints were frankly dislocated, six hips were subluxated with marked deformity. Only two assessed abnormal hips did not have values outside normal limits for their comparison age group, and joints from six fetuses had some values that exceeded normal limits by 2 SD. In only two fetuses were the femoral angle values outside normal limits indicating that femoral angles alone may be poor criteria of hip dysplasia. Quantitative data for normal fetuses permit more precise evaluation of morphologically abnormal joints and enable detection of dysplasia not apparent on naked eye examination.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The ambulatory status of 50 patients, aged 15 years and older, with spina bifida is assessed and related to the level of the lesion, the stability and presence of deformity at the hip joints, and the presence of pelvic obliquity and of scoliosis. A retrospective study was made of these variables for the year the child began walking and, when applicable, the year the child stopped walking. More than two-thirds of the group were community ambulators at the time of review, and there were no household or nonfunctional ambulators. Lesion levels of the ambulators ranged from T11 to S2–S3, whereas lesion levels of the nonambulators ranged from T12 to L3–L4/L4. Most of the hips were not dislocated because the patients had undergone early surgery to restore muscle balance at the hip and, thus, to prevent dislocation. Some had undergone surgery to reduce hip dislocation, although it appears that such surgery is unnecessary for those with high lesions who use long calipers and whose hips require only flexion and extension ability in ambulation. Surgery resulted in significant limitation of flexion range at the hip in one instance only. Those ambulators with high lesions were compared with nonambulators, almost all of whom also had high lesions. The combination of hip flexion deformity, pelvic obliquity, and scoliosis is likely to preclude walking as is the presence of any one of these factors to a severe degree.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The authors have studied anatomical specimens and findings at time of surgery to determine the functional anatomy of clubfoot. The importance of the midtarsal joints (especially of the talonavicular joint) is emphasized as well as the importance of the tibialis posterior. The findings of the authors concerning the function of these elements have allowed them to develop a new approach to the treatment of clubfoot.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Growth arrest lines and zones have been reinvestigated. Sequential studies after dietary deprivation reveal transformations of the physis with diminution in formation of the zone of cell columns, resorption of previously formed bone, and cessation of new bone formation. At 6 weeks post diet restriction, the physis is prominently narrowed with transversely oriented, thin bone plaque sealing it from the subjacent marrow. Initially, restoration of stock diet thickens the bony plaque, creating a growth arrest line. Later the zone of osteogenesis adds new bone as a dense metaphyseal band.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The radiographs and records of 58 cases of lumbar disc prolapse in children and adolescents were reviewed, and 28 cases were followed up after an average of 6.8 years. Trauma was not a significant aetiological factor, but there was a high incidence of back pain in relatives of affected patients. The clinical picture is similar to that in the adult except for a relative paucity of neurological signs. This review of patients treated by surgical or conservative methods suggests that good results may be obtained in patients with a short history who are offered surgery early. Preoperative radiculography is considered to be essential because of the inaccuracy in localising the level of disc prolapse by clinical signs. The result of treatment in patients with long histories is usually disappointing.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A rabbit model modified from the one originally used by Osterman was used to test the effectiveness of interposition materials in the prevention of epiphyseal-metaphyseal bone bridge formation. Although fat was a moderately effective interposition material, cartilage was more effective in preventing growth retardation and angular deformity of the involved distal femur. None of the interposition materials, however, allowed for completely normal growth. It is theorized that the effectiveness of cartilage may be enhanced by the presence of a factor contained therein which inhibits bone formation.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID