摘要:

In Sweden screening for congenital dislocation of the hip joint (CDH) on the maternity wards was commenced in the 1950s. Of the estimated number of cases with CDH approximately 50% are diagnosed on the maternity wards and 80% during the first 6 months of life. Of the children “missed” at the primary screening on the maternity wards a substantial number have been premature babies treated at the intensive care unit postpartum. X-ray examination at the age of 1.5–3 months has been a helpful tool to reveal failure of early abduction treatment, which has been difficult to detect by clinical examination. Children with neonatal hip instability and a family history of CDH seem to represent a subgroup with an increased risk of failure of primary treatment and may need prolonged abduction treatment. The von Rosen splint has proved to be a reliable brace if used properly. If abduction treatment is commenced already during the first few days of life the risk for avascular necrosis is very low—1%.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A possible mechanism for development of Legg-Calvé-Perthes syndrome following transient synovitis is the production of an effusion which acts as a tamponade of the intracapsular, subsynovial vessels to the femoral capital epiphysis. An intraarticular pressure of 150–200 mm Hg continuing for 10 to 12 h has been required to produce epiphyseal ischemia and subsequent osteonecrosis in animals. This study, on the hip of the immature pig, showed that an induced talcum synovitis did not increase intraarticular pressure. Autologous plasma was infused into synovitis-affected and normal hips to raise intraarticular pressures to 50, 100, and 200 mm Hg, respectively, in three groups of pigs. Decay of these joint pressures to 35 mm Hg occurred within a maximum of 132 min. This period is much less than the ischemia time required to cause osteocyte death. Decay of intraarticular pressure resulted from capsular stretching and efflux of the infusate from the joint. The data from this experiment do not support the theory that tamponade of the femoral capital epiphysis is the cause of osteonecrosis in Legg-Calvé-Perthes syndrome.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We reviewed 40 patients who had undergone 57 operations for tarsal coalition between 1965 and 1980. Ten patients were treated for talocal-caneal coalitions. Four had successful resections and the remainder had successful single or combination arthrodesis. Thirty patients had 39 calcaneona-vicular resections and five primary triple arthrodeses. In the entire series only two patients had a poor end result due to either technically poor surgery or failed calcaneonavicular resection because of advanced degeneration. Poly-tomography, computed tomography, or both were valuable in determining if talocalcaneal coalition resection was feasible. Care must be taken in evaluating the talonavicular joint for degenerative changes. The talar “beak” is not necessarily a degenerative spur, but rather a traction process occurring secondary to increased motion.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Functional ambulation occurred in 22 of 36 severely affected arthrogrypotic patients. Functional ambulation in these patients required hip motion to within 30° of full extension and knee motion to within 20° of full extension. Ambulation also required hip extensor strength of good (grade 4), quadriceps strength of fair (grade 3), or crutchable upper extremities and orthotic substitutes. Foot and spine deformities also interfered with ambulatory ability.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A radiographic survey of 25 patients with bilateral Perthes disease is compared with four inherited skeletal dysplasias also affecting the hip joints (45 patients with multiple epiphyseal dysplasia, 22 with spondyloepiphyseal dysplasia tarda, 18 with pseudoachondroplasia, and 17 with spondyloepiphyseal dysplasia congenita). The distinguishing features in relation to the pelvis and hip joint in the growing child are ascertained, in view of the importance of differentiating as early as possible the transient disorder of Perthes disease from the more serious progressive disorders.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

After intravenous injection of99mTc methyldiphosphonate, 190 hip bone scans were performed on 103 children. In 64 children with Perthes disease, 61 of 71 hips (86%) showed abnormal scintigraphy. There were no false positives. In other hip disorders, the scan was never considered to simulate Perthes disease. There were 36 children with acute synovitis and three with Meyer's dysplasia. The sensitivity was 97%, suggesting that this test should be used more frequently in the early assessment of hip pain in the young child, before the appearance of characteristic radiographic abnormalities. This test is also valuable for follow-up of the disease because of its prognostic value—the bone scan becomes normal far earlier than the radiograph. The progressive normalization of the scan may help determine when the child can begin weight-bearing.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A literature survey revealed 273 patients with congenital vertical talus. This condition does not seem to have any sex prevalence. One-half of the patients had bilateral involvement and one-half had additional defects. Treatment results seem better in those patients without any other abnormalities. Eleven additional cases are presented by the authors. Most patients were treated with the Coleman-Stelling procedure. The patients treated surgically fared better than those treated nonoperatively.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The clinical characteristics of clubfoot suggest a relative hypoplasia of the posterior and medial foot and leg. To test this hypothesis we compared quantitative cell and organelle characteristics between anterior and posterior tibial tendon sheaths from four clubfeet and two normal feet. Clubfoot posterior tibial tendon sheath had significantly less cell and cytoplasm volume than did clubfoot anterior sheath. Normal posterior tibial tendon sheath had significantly greater cell and cytoplasm volume than did normal anterior sheath. A similar tendency was found for nuclear volume and cell number, although not all samples reached statistical significance. No difference in organelle characteristics between anterior and posterior sheaths was found. We interpret this morphologic difference as suggesting a relative inactivity of clubfoot posterior tibial tendon sheath cells. This supports the hypothesis of a regional growth disturbance as the cause of clubfoot.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The importance of different factors in predicting post-traumatic growth was evaluated using multivariate statistical techniques. Forty-nine children with physeal fractures of the distal tibia or fibula or both were studied. The post-traumatic growth pattern was determined by roentgen stereophotogrammetry. The cases showed various types of growth patterns. The predictors used included sex, skeletal maturity, traumatological and anatomical classification, displacement, treatment, and associated tibial shaft fracture. Prediction of a specific growth pattern could be made only with low accuracy, whereas separation of the growth patterns into two groups—one group with symmetrical growth, initial and temporary growth retardation, and growth stimulation and the other with progressive growth retardation and growth arrest—resulted in a higher predictive accuracy. Comparing the predicted outcome with the actual resulted in two of three fractures being correctly classified. Considered individually, treatment, displacement and skeletal maturity were important, whereas the Salter-Harris classification system could not significantly predict the growth pattern. In summary, displaced physeal injuries treated by reduction showed the highest risk of developing deformity. These injuries were mainly combined fractures of the distal tibia and fibula with the physeal injury localized to one or both of the bones. The limited accuracy in predicting the post-traumatic growth pattern after ankle fractures in children indicates that in many cases there are grounds for radiographic follow-up to detect growth disturbance.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The authors report 136 fractures involving the proximal humerus in children (two-thirds with fractures of the proximal metaphysis, one-third with fractures of the epiphyseal growth plate). Functional and anatomical results are studied in 52 patients with a mean follow-up of 5 years (range 1–18 years). The results are compared with reports in the literature. Usually, treatment should not be operative. Surgical approach in older children with irreducible lesions is discussed.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID