ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

We report eight additional cases of focal fibrocartilaginous dysplasia (FFCD) in the proximal tibia (five), distal ulna (one), and distal femur (two). Spontaneous, complete resolution of the lesion was observed in two tibiae and one ulna. Three tibial lesions with genu varum deformity were managed with osteotomy. Two femoral FFCDs caused persistent or progressive deformity: one genu valgum with patellar dislocation, and one genu varum. These patients underwent concomitant deformity correction and lengthening by the Ilizarov method. The final results were satisfactory in all patients except one, who underwent valgus tibial osteotomy and developed mild postoperative genu valgum. The analysis of a total of 46 cases in the literature and our experience suggests that (a) FFCD has a wide histopathologic spectrum, ranging from purely dense, fibrous tendon-like tissue to benign fibrocartilaginous tissue; (b) at least 45% of tibial FFCD demonstrates progressive, spontaneous resolution; (c) in contrast, femoral and humeral FFCDs appear to have a slim possibility of spontaneous regression of the deformity; and (d) corrective osteotomy is indicated when the deformity is increasing or persistent, or when the existing deformity is severe enough to jeopardize adjacent joint mechanics and alignment.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Fibular hemimelia is associated with an equinovalgus deformity of the foot and ankle and different degrees of wedging of the distal tibial epiphysis. This deformity is often a major problem during lengthening of the shortened tibia. To determine the significance of the wedge-shaped distal tibial epiphysis in the pathogenesis of the equinovalgus deformity of the foot and ankle during and after lengthening, we reviewed 20 patients who had undergone tibial lengthening by either the Wagner or the Ilizarov technique. The mean duration of follow-up after removal of the fixator was 5.2 years (range, 2.3–9.7 years). Three types of wedge-shaped distal tibial epiphyses were identified. A mildly wedged (type I) epiphysis was found in seven patients, a moderately wedged (type II) epiphysis was found in seven patients, and a severely wedged (type III) epiphysis, in six patients. Premature fusion of the lateral part of the distal tibial physis and growth retardation of the tibia were common after lengthening in patients with the type II or type III epiphysis. After lengthening, all patients with a type II or type III epiphysis had a recurrence or aggravation of foot deformities that existed before lengthening. This usually necessitated various secondary operative procedures to obtain a plantigrade foot. We believe that after lengthening, one should anticipate varying degrees of mild growth retardation and minimal foot deformity in patients with type I epiphysis, worsened asymmetric growth retardation and progressive foot deformity in patients with type II epiphysis, and severe growth retardation and severe foot deformity in patients with type III epiphysis.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Diastrophic dysplasia (DD), an autosomal recessive skeletal dysplasia, results in short-limbed short stature, generalized joint dysplasia, and spinal, hand, foot, and ear deformities. Children with DD experience both growth and motor developmental delays. To quantify the motor developmental delays, data on motor milestone attainment and other important characteristics were collected by retrospective questionnaire on 25 individuals with DD. Means and standard deviations were calculated for time to motor milestone attainment and are presented with minimum, maximum, 25th, 50th, 75th, and 90th percentile values. Percentages of individuals who could perform daily living and recreational tasks were tabulated. The mean times to milestone attainment for children with DD are all significantly longer than published means for nonaffected children. Notably, children with DD roll over at 5.2 ± 2.2 months, sit unsupported at 8.3 ± 2.3 months, pull up to a stand at 13.5 ± 5.8 months, and walk at 24.4 ± 9.2 months. The data presented here should be useful as preliminary reference standards for motor milestone attainment in children with DD.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Scleroderma is a connective tissue disease with a variety of clinical presentations. The purpose of our study was to review representative cases of scleroderma in childhood to determine the initial presentation, course of the disease, orthopaedic manifestations, and the necessity and success of surgical intervention. Records from the four medical centers were retrospectively reviewed to identify the patients who were diagnosed with scleroderma over the past 35 years. Data on disease presentation, course, treatment, and response were collected. Seventeen cases representing the variety of clinical presentations are presented. Scleroderma characteristically presents with asymmetric lesions involving the extremities and remains a diagnostic and therapeutic challenge. Treatment must be individualized to the patient and his or her specific limitations brought about by the disease. Early diagnosis, supportive care, and physical therapy combined with early orthopaedic surgical intervention to release joint contractures are among the most efficacious treatments.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The purpose of our review is to describe and report results of a surgical technique for the treatment of adolescent Blount's disease. We retrospectively reviewed the results of 15 inverted arcuate osteotomies combined with external fixation. The inverted arc provides a proximal and stable osteotomy that can correct deformity in three planes. External fixation provides stable fixation, access to surgical wounds, and postoperative adjustment. According to the criteria of Schoenecker, we had 80% good results. Two patients with poor results were the most overcorrected, suggesting that overcorrection may not be so desirable as once suggested. We conclude that the inverted arcuate osteotomy with external fixation is an effective, reliable, and simple technique for treating adolescent tibia vara.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Twenty-eight unselected hips affected by Legg–Calvé–Perthes disease (LCPD) in 24 patients from 1987 to 1994 had magnetic resonance imaging (MRI) performed. The patients were retrospectively reviewed at a mean follow-up of 5.4 years. An interobserver blind analysis was made to establish the reliability of four MRI parameters: extent of epiphyseal necrosis (EXT), lateral extrusion of the femoral head (LAT), physeal involvement (PHY), and metaphyseal changes (MET). The interobserver analysis resulted in a good reliability for all MRI parameters (concordance, >80%; K index, >0.45). A statistical correlation study (Spearman test) was then done between each MRI parameter and the condition of the hips at follow-up evaluated by Stulberg class and a personal scored system (total score) of clinical–radiographic condition. All MRI parameters appeared well correlated to the Stulberg class and to the total score (S > 0.66;p< 0.05). PHY resulted the strongest correlated parameter (S = 0.84 for Stulberg class; S = 0.91 for total score). Finally our statistical correlation study demonstrates physis involvement to have a high predictive value in LCPD; therefore it can be assumed as the main risk factor in formulating prognosis.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The most widely used system of grading Legg–Calvé–Perthes disease (LCPD) is still the radiographic grouping by Catterall, although it lacks interobserver reliability, especially in the early stages. The predictive value of Salter–Thompson classification and Herring's “lateral pillar” classification are still being studied. In Part 1, we demonstrated the good reliability and the predictive value of four magnetic resonance imaging (MRI) indices (extension of necrosis, lateral extrusion, physeal involvement, metaphyseal changes) through their correlation to clinical and radiographic conditions of the hips at follow-up. The same good results were obtained by submitting to statistical analysis a second group of 31 patients (French series). On the basis of these statistical studies, a new classification has been proposed. It takes into account the extent of necrosis and two MRI risk signs: lateral extrusion and physeal involvement. The extent of necrosis up to or more than 50% separates two main groups, A and B. The associated MRI risk factors distinguished six classes with different prognoses. Appropriated treatment also is suggested for each class. Our experience on MRI in LCPD led us to draw a pathomorphogenetic model called “packed capsule.” According to this biomechanical model, the femoral head is considered a segment of a sphere made of viscoelastic material and hermetically sealed. The deformation of the head depends on the behavior of the necrotic fluid collected inside the capsule under the weight-bearing forces. Finally, our suggestion in the treatment of Perthes disease is to relieve weight bearing up to the fragmentation stage, whether the diagnosis has been made by the use of MRI or without it. During the fragmentation stage, MRI is extremely useful in performing prognosis; at this time our classification can be applied, and the corresponding treatment can be followed.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

A group of 86 developmentally dislocated hips in children aged 6–48 months was treated by closed reduction before 1957 without preliminary traction, and another group of 176 hips was treated after 1957 with prereduction traction. The results in these two groups were compared to clarify the effect of prereduction traction. During the treatment of these cases, subcutaneous adductor tenotomy was performed when obviously indicated. Otherwise preliminary traction was the only variable between the two groups. To rule out tenotomy as a factor influencing the result, the hips of children aged 6–36 months who had prereduction traction as the single variable were taken out of the group and the results analyzed. It is concluded that prereduction traction decreases the incidence of avascular necrosis of the femoral head when developmentally dislocated hips of children aged 6–36 months are treated with closed reduction with traction as the single variable.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

One hundred thirty-nine children younger than 4 years were identified retrospectively from the period of 1993 through 1997 to have an isolated fracture of the shaft of one or both femurs. Abuse was classified as group A (definite, likely, or questionable abuse) or group B (unknown cause, questionable accident, likely accident, or definite accident). The average age of the children was 2.3 ± 1.1 years. Thirteen children, 9% of the total group, average age of 1.1 ± 1.0 years, were likely to have been abused (group A). A total of 126 children, 91% of the total, average age 2.3 ± 1.0 years, sustained their fracture most likely as a result of an accident (group B). Whether a child had not yet achieved walking age (toddler) was the strongest predictor of likely abuse. Ten (42%) of 24 of nonwalking children were in group A, whereas only three (2.6%) of 115 of walking children were in group A (p< 0.001). Child Protective Services may have been unnecessary in 42–63% of cases. Unless other evidence of abuse such as an inconsistent story, bruises, or other fractures are present, abuse is very unlikely to be involved in the walking-age child, analogous to the toddler fracture of the tibia.

ISSN:0271-6798    

出版商:OVID    

年代:2000

数据来源: OVID