摘要:

It is now 3 years since we published a new surgical approach to type II tibial agenesis. All three patients have reached the end of growth, and we have been able to conduct a maturity review of the functional, psychological, and economic value of this method of treatment. All three patients were very satisfied with the treatment they had received, although it was long and often arduous. We have attempted to compare the costs of primary amputation without complication in the first year of life, followed by supply of at least 10 prostheses, until age 18 years, with that of the reconstructive technique, which is liable to require five operations and considerable periods of inpatient and outpatient care until age of 18 years.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We treated nine patients with congenital pseudarthrosis of the tibia consecutively by a modification of the Ilizarov (circular frame) technique. Seven patients had had several previous operations, and two patients had had none. After resecting of the pseudarthrosis and the surrounding pathologic periosteum, we performed acute shortening and compression at the level of resection, together with simultaneous lengthening of the proximal tibia. Union was achieved in all cases. With this technique, not only the mechanical but also the biologic problems are addressed. As compared with other methods, the circular frame technique also offers the possibility of correcting angulation and limb length discrepancy.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Children with fibular hypoplasia and three- or four-ray feet have a forme fruste of congenital short tibia with absent or dysplastic fibula. We outline the criteria For management of this condition. Although fibular deficiency can be considered benign, two thirds of our patients underwent operation. Leg length inequality may require epiphysiodesis, leg lengthening, or simply a shoe raise. Only very occasionally, when the foot is nonfunctional, is amputation through the ankle undertaken.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The introduction of Ilizarov leg lengthening techniques has allowed a change in philosophy in treatment of fibular hemimelia. Between January 1990 and October 1993, eight patients with 10 involved extremities underwent correction of severe grades of fibular hemimelia by the Ilizarov technique. Mean follow-up from operation was 26.7 months. Because the lengthening desired was achieved in all cases, this form of treatment is an attractive alternative to the more traditional Syme's amputation. However, complications are common. Frequency and severity of complications apparently is less in younger patients who require less extensive, staged lengthening.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Biodegradable PDS-rods have been used for the treatment of phalangeal neck fractures to oppose the disadvantages and complications of K-wire fixation. Reduction can be maintained during fracture healing, and the surrounding joints can be mobilized early. Because of the recessed position of the rods, there is no interference with motion.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We studied four indirect radiological measures of shoulder balance, their correlation with true shoulder balance, and measurement error of each method. Thirty-three consecutive patients with idiopathic scoliosis requiring surgical treatment were selected. Actual shoulder level was determined from a line in the top margin of the acromion clearly visualized in the wide chart. Indirect references used to assess shoulder balance were tilting of cephalic end-plate of T1, inclination of a line through superior border of both first ribs, the level of top margin of coracoid processes, and the level of two specific points where the clavicle intersects the rib cage. All radiographs were assessed by three independent observers. Correlation coefficients between each measurement and true shoulder level were 0.54 for T1 tilting (p = 0.001), 0.63 for first rib inclination (p < 0.001), 0.96 for coracoid process (p = 0.0001), and 0.93 for clavicle-rib cage intersection (p = 0.0001).

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We describe five cases of congenital hypoplasia of the fibula and the clinical appearance of the patients. The more relevant clinical manifestation is leg length discrepancy, which is usually <6 cm. The management of this problem has been approached with predictive tables and timing of the epiphyseodesis. Some cases have been treated with tibial lengthening to correct the associated valgus deformity simultaneously. The valgus deformity is secondary to the hypoplasia of the lateral femoral condyle, which can be treated with medial hemiepiphysiodesis of the distal femur. Anterior instability of the knee usually exists due to congenital absence of the anterior cruciate ligament and can complicate lengthening procedures. The hip joint is not involved, but mild shortening of the femur was observed in four cases. Ball and socket joint at the ankle and tarsal coalitions with absent lateral rays of the foot can occur. Management of the leg length discrepancy must be considered in light of all these possible associated defects.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Most herniated lumbar discs in children and adolescents respond to conservative treatment, but some young patients with persistent low back and neurological symptoms do not respond to noninvasive treatment and require operative treatment. Because the long-term results of disc surgery depend not only on the disc disease itself but also on the degree of surgical trauma, disc herniations in children and adolescents should be treated with minimally invasive procedures. We report our experience with four young patients aged 8–17 years with contained or small noncontained lumbar disc herniations who were treated by percutaneous endoscopic discectomy (PED). The clinical results were good to excellent in all four cases, with follow-up of 1 to 5 years. There were no complications, and the operation was tolerated well by the young patients. We recommend percutaneous endoscopic lumbar discectomy in patients with contained or small uncontained disc herniations who do not respond to conservative treatment.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We report a new arthrographic index to quantitate the loss of sphericity of the femoral head during early Perthes' disease. The technique has been applied to 272 arthrograms of 131 normal and 141 affected hips. It measures marginal or segmental collapse as well as central collapse of the epiphysis, thus providing a more accurate assessment of deformity in 57.4% of anteroposterior and 46.8% of lateral radiographs as compared with the previous standard measurement (caput index). The measurement principle applies equally to other recent radiological developments such as magnetic resonance imaging.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A review at maturity of 42 patients with Perthes' disease has allowed a correlation to be made between femoral head deformity during the initial phases of fragmentation and reparation, as quantified arthrographically, with the final shape and size of the femoral head measured on plain radiographs. Cases with loss of sphericity or coxa magna at maturity had significantly lower arthrographic indexes of deformity (p = 0.001 and p = 0.005 respectively), regardless of the age at presentation. All were treated uniformly by containment in recumbency and a daily exercise program.

ISSN:0271-6798    

出版商:OVID    

年代:1996

数据来源: OVID