摘要:

Continuous passive slow motion (CPSM) was used to aid postoperative rehabilitation in seven difficult pediatric knee and elbow problems. Four patients had joint erosion secondary to hemophilic arthropathy and three patients had joint irregularities associated with long-standing limitation of joint movement. CPSM was started soon after surgery at the slow speed of 1 revolution every 12.5 min. The early, slow mobilization did not cause pain and established an arc of joint motion before intraarticular adhesions became a problem. Compared with a similar group not using CPSM, our hemophilia patients did not require postoperative manipulation, had decreased hospitalization time, and gained a greater range of motion. The group with long-standing limited joint mobility exhibited maintenance and in most cases improved motion after surgery. Thus CPSM after surgery enhances the rehabilitation process of difficult pediatric knee and elbow problems.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A trigonometric analysis of the effect of a proximal femoral osteotomy, either dome or cuneiform, on leg length was done to aid the preoperative planning for this surgery. Change in leg length may be determined for a dome osteotomy by multiplying the length of the head-neck segment by the difference between the cosines of the preoperative and postoperative neck-shaft angles as measured from the vertical. A series of determinations are tabulated for a variety of head-neck lengths and angulation changes. When a cuneiform osteotomy is being done, the effect of the wedge can be determined and should be considered. Also to be considered are a tendency for spontaneous correction and growth stimulation from the osteotomy.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Fourteen children with acute fractures, mostly open fractures, were treated with Hoffmann external fixation as a part of their fracture care. Thirteen fractures involved the tibia and one the femur. The average follow-up of these children was 17 months. The Hoffmann device was used for 6 to 20 weeks with an average of 11 weeks. One-half of the children had purulent drainage at some time during their treatment although no chronic infections resulted. Fracture union was present after 12 to 52 weeks with a median of 17 weeks. Three refractures occurred after apparent union. The only final angular deformity was in one patient with 6° of varus. Three patients had leg length discrepancies of 2 cm or more. Four patients had overgrowth of the injured limb of 1.0 to 3.0 cm. Range of motion was not permanently impaired by the Hoffmann device. Use of the Hoffmann device for external skeletal fixation is recommended in children with open fractures with skin loss or burns, in children with head injury with resultant increased motor tone, and in polytrauma patients to facilitate patient care and transport for diagnostic and therapeutic procedures.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Railyard or train-related accidents are a common cause of traumatic amputations in children. Four consecutive children with traumatic lower extremity amputations due to railyard amputation seen between 1975 and 1980 demonstrated: a common mechanism of injury—all were attempting to obtain rides on slow-moving trains near their homes or school; similar lower extremity amputation patterns—four right below knee and two left Syme's amputations; and distinctively abnormal psychosocial backgrounds. The psychosocial abnormalities have been demonstrated to be unique in children sustaining traumatic railyard amputations and are probably contributory. Awareness of these factors is important when considering surgical intervention and in planning for long-term rehabilitation.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To elucidate the cause of tibia vara, finite element analysis of the proximal tibia was used to investigate the stresses occurring in the physeal plate during one-legged stance in 2− and 5-year-old children. A modification of the method of Kettlekamp and Chao was used to assign forces to the medial and lateral plateaus and lateral ligament. Stresses were calculated in the physeal plate for the two age groups as a function of degree of varus and body weight. Our results show that increasing varus resulted in increasing compressive stress in the medial tibial physis to a level seven times normal at 30° of varus. Further, tensile stresses determined in the lateral tibial physis were increased above normal. Changes were more marked in the obese child and in the 5 year old. Using the data from Strobino et al. it appears that in the 2 year old 20° of varus resulted in forces sufficient to retard growth. In the 5 year old, however, 10° of varus resulted in borderline forces in a child of normal weight, but forces exceeding those necessary to retard physeal growth were calculated in the model of the obese child. Our data are consistent with the hypothesis that Blount's disease is primarily the result of the proximal tibial epiphysis responding to physical phenomena.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The radiographic changes in 57 patients with Legg-Perthes disease were studied to define the patterns of progression of one disease stage to the next. Femoral neck width, epiphyseal width and height, acetabular depth, “tear-drop” distance, and femoral head width and sphericity in the anteroposterior projection were measured on 529 X-ray films. Two distinct groups of hips were found. Group I (43) hips showed moderate changes in all parameters during fragmentation phase but improved in subsequent years, maintaining a concentric reduction and adequate sphericity in the femoral head. Group II (14) hips were initially identical to the hips in Group I. During mid-fragmentation phase, however, “tear-drop” distance increased suddenly and significant flattening and widening of the epiphysis rapidly followed. There was loss of the normal congruent relationship of acetabulum and femoral head with progressive increase in femoral head size and a marked loss of sphericity of the femoral head. Surgical reestablishment of an adequate femoral-acetabular relationship reversed the tendency toward further flattening in many cases.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

This study reports on the late results of septic arthritis of the hip in 29 children, after an average follow-up of 12 years 7 months. The purpose of the study is to show the severe destruction caused by infection in children's hips and to reemphasize the necessity for early diagnosis and treatment. The 29 patients were divided into two groups according to age (0–4 weeks and 1 month-3 years of age) because of the different prognoses. Functional and anatomical evaluations of the hips were performed. In some cases there was no correlation between the functional results and the anatomical situation of the joint. Our results showed that the prognosis is worse in young children and also in cases with associated osteomyelitis of the proximal femur. Eleven of the 16 neonates were premature. Late reconstructive surgery is difficult and does not always give the desired functional and anatomical improvement. The most important factor influencing the end result, however, is the time between beginning of symptoms and treatment; that is the only factor, also, we can change to improve the ultimate outcome of the disease.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A clinical sign of anteroposterior instability of the knee has been noted in patients with evidence of a congenital lower limb deficiency. This instability can be a reliable diagnostic sign during infancy when radiologic deficiency is barely evident. Furthermore this sign is evidence that apparent isolated deficiencies of femur, tibia, or fibula are actually deficiency in the development of the entire limb.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A retrospective study was performed to determine the incidence of spinal abnormalities in patients with skeletal defects of the upper extremities. The incidence of scoliosis in the patient population studied was 16%, and spinal abnormalities of all types were present in 18% of the population. Patients with bilateral amelia had a 100% incidence of scoliosis. Those patients with unilateral amelia had a 50% incidence of scoliosis. Patients with ulnar and radial hemimelias had an incidence of scoliosis of 20 and 13%, respectively. The transverse complete and partial hemimelias had an 18% incidence of scoliosis and the phocomelic group had an incidence of 11%. The patient population studied had an increased incidence of scoliosis compared with the general population. The patients with amelia had a particularly high incidence of scoliosis. There was no relationship between the side of the deficiency and the direction of the curve. The age of onset was not found to be related to the progression of the curve. The results of bracing were poor, due to patient rejection of the brace. All patients with upper limb deficiencies warrant close observation throughout growth for the development of scoliosis.

ISSN:0271-6798    

出版商:OVID    

年代:1983

数据来源: OVID