ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:One widely held theory on the pathogenesis of adolescent late-onset tibia vara is that obesity coupled with mild preexisting varus alignment produces forces sufficient to retard growth in the medial portion of the proximal tibial physis and initiates the development of the condition. Two cases are presented in which neutral mechanical alignment was clearly documented in an extremity that subsequently developed adolescent late-onset tibia vara within 19 months. We conclude that in at least some cases, preexisting varus alignment is not a prerequisite for the development of adolescent late-onset tibia vara.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:In evaluation of bowlegs, the tibiofemoral axis (TFA) and the proximal tibial metaphyseal-diaphyseal angle (MDA) are commonly measured, but both are subject to measurement error. In this study, we determined the intraobserver errors for the MDA and TFA, comparing several different measurement techniques. We also determined the variability of these angles caused by 15° and 30° of external rotation of the knee. We noted that limb malrotation may affect the measurement variability of these angles significantly, especially the TFA. To minimize radiographic measurement error, the clinician must ensure neutral limb rotation and uniform measurement technique.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Six pediatric orthopaedic specialists and six senior orthopaedic residents independently classified 60 radiographs of infantile tibia vara according to the six-stage Langenskiöld classification. Correlation coefficients and percentage agreement were similar in both groups. Interobserver agreement was good for early and late stages, but was poor for intermediate stages. We caution clinicians that small but frequent discrepancies in radiographic staging impart a dubious prognostic value to the Langenskiöld classification.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:We performed five transfers of the ipsilateral fibula in the treatment of congenital pseudarthrosis of the tibia. In all cases, conventional treatment by intramedullary- rod and autogenous-iliac bone grafting had failed at least once. We hoped to avoid the use of contralateral-fibular grafting or other methods that have not yet been proven effective. The ipsilateral fibula was transferred, and its vascular pedicle left intact and secured to both fragments of the tibial pseudarthrosis by cerclage wires. All five transfers have united and hypertrophied with growth. We believe this salvage method is superior to others not only because of the successful results, but also because the intact limb is left undisturbed.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Nine patients were evaluated following nerve grafting of segmental injuries to the peroneal or sciatic nerve. Using a device that quantitated ankle dorsiflexion strength, the average return in strength was 11% recovery of the contralateral leg (correlating to motor grade M2). Four patients had a functional degree of motor recovery (grade M3 or M4), which corresponded to an average ankle dorsiflexion strength of 21% of the contralateral leg. The return of protective sensation occurred in all patients. Even though nerve grafts were required, repair of the peroneal and sciatic nerves provided enough motor function to decrease the need for full-time bracing in four of the nine patients, and provided protective sensation in all the patients.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:A retrospective study of 255 consecutive tibial osteotomies performed for correction of frontal, sagittal, and rotational deformities in children is presented. Eleven (4.3%) peroneal neurapraxias were identified; seven were motor and sensory (2.7%), and four were sensory only (1.6%). In all cases, traction on the peroneal nerve, either by intraoperative retraction, or by anatomic displacement of the osteotomy fragments, was felt to produce the neurapraxia. There were no vascular injuries or compartment syndromes. Increased patient age, estimated blood loss and tourniquet time, difficulty in exposure, and male sex were associated with an increased risk of peroneal neurapraxia. Rotational osteotomies were of little risk for peroneal nerve injury; whereas angulatory osteotomies, particularly proximal procedures, were more prone to complication. Prophylactic anterior compartment release and fibular osteotomy are recommended to avoid anterior compartment syndrome after tibial osteotomy. In cases of persistent peroneal nerve palsy due to suspected anatomic traction and displacement, exploration of the peroneal nerve is warranted.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Displaced distal physeal fractures of the radius are at risk for development of median neuropathy. The mechanism of injury includes compression of the nerve by the displaced fracture, contusion of the nerve at the time of fracture or reduction, or the development of a compartment syndrome. Patients with significant soft-tissue swelling and symptoms or signs of median nerve dysfunction are especially at risk for worsening neuropathy after closed reduction and closely applied cast immobilization or after open reduction. Closed reduction and percutaneous pin fixation may be the optimal treatment for these patients.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Thirty-one femoral-shaft fractures in 30 patients were treated with interlocking intramedullary nails. The 19 boys and 11 girls ranged in age from 10 to 15 years (average age 12 + 3 years) at the time of injury. All fractures united, and the average leg-length discrepancy (comparing the injured to the uninjured extremity) was 0.51 cm. Two patients had overgrowth of >2.5 cm; none had angular or rotational malunions. One patient developed asymptomatic segmental avascular necrosis of the femoral head, which was not seen on radiographs until 15 months after injury. All nails were removed at an average of 14 months after injury; no refracture or femoral neck fracture has since occurred. Intramedullary nailing is a reasonable alternative for the treatment of isolated femoral-shaft fractures in older adolescents and in younger adolescents with multiple trauma.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:This retrospective study reviews our results with intramedullary nail fixation of 37 fractures of the femur in 35 skeletally immature patients. Five of these fractures were open. Twenty-two patients (average age 12 + 9 years) were treated with reamed intramedullary nails. Fifteen patients (average age 9 + 6 years) were treated with nonreamed nails. All fractures united in 6−12 weeks. There were no infections, delayed or nonunions, nor were there any incidences of avascular necrosis. There were very few significant complications. One patient required excision of heterotopic bone to restore hip motion. When surgical treatment of pediatric femur fractures is indicated, we prefer intramedullary nail fixation (either reamed or nonreamed) depending on age, fracture pattern (level, degree of comminution), and size of femoral canal. Experience and careful surgical judgment are required to appropriately individualize treatment for these patients.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID