摘要:

Summary:Thirty‐five hips with muscle weakness, in ambulatory myelomeningocele patients, received muscle transfer surgery. In each hip, procedures were done either to augment the abductor side of the joint (Sharrard transfer or external oblique transfer) or to weaken adduction (adductor release or adductor transfer) or both. In addition, femoral osteotomy was performed in some patients. Surgery was evaluated by reviewing preoperative and follow‐up radiographs. If radiography demonstrated 5° of improvement in the CE angle or the acetabular index, the hip was considered improved. Best results occurred when abductor and adductor procedures were combined, which resulted in radiographic improvement in eight of nine cases. When abductor and adductor procedures were not combined, only 6 of 26 hips were improved radiographically. These procedures may be indicated in the ambulatory myelomeningocele child with unilateral hip subluxation (CE angle approximately 0°) but before complete dislocation has occurred. We support the trend away from major or frequent hip surgery in these patients. Our preferred procedure is to combine external oblique transfer with adductor transfer. All patients in this study continued to walk with a weak abductor gait following surgery.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Contractures of the knee joint can interfere with orthotic fitting and prevent the child from being upright and ambulatory. Two types of knee contractures are seen: flexion and extension. A flexion deformity is more common in the thoracolumbar level and, when beyond 20°, will require surgical treatment. The author reviewed his surgical experience with 23 knees undergoing a radical flexor release. With an average follow‐up of 38 months, 10 knees showed no contractures, 11 knees 5 to 10° of flexion deformity, and 1 knee a 15° deformity. Three knees had a simple tendon release with poor results. Fifteen knees with an extension contracture were treated surgically (VY quadriceps lengthening). With a follow‐up, of 43 months, eight knees had 120° of flexion, five 90°, and two only 45°. Three knees showed full recovery of quadriceps strength. It is concluded that a knee flexion deformity will respond well to the radical flexor release. Prolonged splinting is important in order to avoid recurrence. An extension contracture can be successfully treated by the VY quadriceps plasty with improvement in the child's gait and sitting.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Utilizing radioactive microspheres, blood flow to the femoral head of immature dogs was measured. Blood flow was measured with the leg in the control position, maximal abduction, submaximal abduction, and the human position of hip immobilization. Maximal abduction (to 90°) significantly decreased flow to the capital femoral epiphysis. Submaximal abduction and the human position did not reduce blood flow. Measurement of flow in the control position immediately after forced abduction demonstrated marked reactive hyperemia. These data indicate that ischemia occurs during 90° forced abduction of the hip. This finding supports the use of lesser degrees of abduction for hip immobilization in the treatment of congenital dislocation of the hip. The vascular anatomy of the head of the femur in puppies and children suggests that these data can be extrapolated to man.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Twenty‐five patients with congenital idiopathic clubfoot, aged 1 day to 22 months, were studied electromyographically. No myopathic or neurogenic changes were found in tibialis anterior, peroneus, gastrocnemius, extensor digitorum brevis, and abductor hallucis brevis muscles of the leg and foot. Maximum motor nerve conduction velocities for the peroneal and tibial nerves were normal. It is concluded that conventional electromyographic techniques were unable to demonstrate abnormalities suggesting neuropathic or myopathic changes in idiopathic clubfoot.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:A method for the measurement of the hip instability index and femoral and acetabular torsion using computerized tomography is presented. The influence of different positions of the hip was studied.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:In a retrospective investigation of 919 fractures of the lower leg or of the ankle in 903 children up to 18 years, 457 ankle fractures (453 cases) were classified traumatologically according to Gerner‐Smidt (juvenile fracture pattern) and Lauge‐Hansen (adult fracture pattern). Anatomically, the fractures were classified according to Salter and Harris in cases with open growth plates. A total of 176 (39%) ankle fractures were classified as supination‐eversion injuries. The number of boys was slightly higher than the number of girls (90/86). Most cases were more than 9 years of age. The mean age for girls (11.9) was lower than for boys (13.2) with open growth plates. The intraarticular fracture type occurred at a higher age than the extraarticular. The intraarticular fracture type of the distal tibia (55 fractures) showed a high degree of complexity, and the exact anatomical configuration could not always be determined from routine roentgenograms. The extraarticular fracture type of the distal tibia (71 fractures) always showed a posterior metaphyseal fragment in combination with a separation through the anterior part of the growth plate. The metaphyseal fragment could be situated dorsomedially, straight dorsally, or dorsolaterally. One fracture type not described earlier in the literature was difficult to classify according to Salter‐Harris. This fracture, starting medially in the medial malleolus and running upward to and through the growth plate, without entering the ankle joint but detaching a posterior metaphyseal fragment, was observed in two children. Three types of isolated fibular injuries (20 fractures) engaging the growth plate were identified. The first type had a posterior metaphyseal fragment, the second a posterior epiphyseal fragment, and the third type showing a zigzag pattern. The results of the study indicate that the traumatological and the anatomical classifications in combination are of value in recognizing different fracture types of the ankle in children and of importance for the treatment of these fractures.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Ankle injuries are common in adolescence, seldom initially seen by orthopaedists, and often treated primarily by emergency department personel. It is often not appreciated that the distal tibial growth plate fuses in a mediolateral direction, leaving it open and vulnerable to growth plate injuries for a longer period during adolescence. Fractures of the lateral plafond of the tibia are often not appreciated due to overlap of the fibula. A review of the injuries at the Winnipeg Children's Hospital has revealed these are not as uncommon as often supposed. A 3 year experience yielded 26 patients with so‐called “Tillaux fractures” of which 9 could be diagnosed only by the oblique view and 5 were initially missed. Knowledge of the anatomical behavior of the fusing tibial growth plate in the ankle‐injured adolescent plus mandatory oblique views of the ankle in this age group should enable the casualty officer in a busy emergency department of bring this fracture out of hiding and make the diagnosis in every instance.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Maple syrup urine disease (MSUD) is a rare heritable enzyme defect associated with mental retardation. A diet deficient in the branchedchain amino acids is essential for survival. Patients with MSUD are at risk of ketoacidotic metabolic crises brought on by catabolic states, including simple infection or fasting. Delayed diagnosis and therapy can predispose these patients to loss of the gag reflex, lethargy, seizures, and feeding problems. Ultimately, this may result in aspiration and respiratory arrest, which, in turn, can cause cerebral palsy. Of seven cases of MSUD reviewed at The Hospital for Sick Children, two developed spastic diplegic cerebral palsy because of these sequelae. These two patients are similar to other patients with cerebral palsy. Despite special diet, healing of surgical wounds and fractures in patients with MSUD is normal. Simple precautions allow uncomplicated surgery and recovery, even though catabolic states can easily trigger acute ketoacidotic metabolic crises in these patients. The patients with MSUD discussed did not have an increased risk of infection.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Examination of an aneurysmal bone cyst of the proximal fibula in a 10‐year‐old girl revealed herniation of the pathologic process through the growth plate into the secondary ossification center, leading to total replacement of the normal trabecular architecture and ischemic changes in the physeal cytoarchitecture.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:A method is presented for the release of severe contractures of the tendoachilles seen in burn patients, using an external fixation device and gradual lengthening of the tendon and adherent overlying tissues as one unit. The tendon is released from the deep, anterior side, with spreading of the skin over the distal gastrocnemius muscle as the lengthening is carried out. The method is described in detail, and a case report is included.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID