摘要:

In a retrospective study on the surgical management of clubfoot based on clinical and radiographic assessments, 171 feet in 137 patients were reviewed. The surgical procedure was selected according to the degree of the deformity. The more severe cases (group A, 75 feet) were surgically treated according to Turco's one-stage posteromedial release, whereas the milder degrees of deformity (group B, 96 feet) were corrected by elongation of the Achilles tendon with posterior capsulotomy. The mean age of the patients at surgery was 12.5 months in group A and 5.2 months in group B. The mean follow-up time for both groups was 12.2 years. At follow-up, 24 feet (41%) in group A and 52 feet (68%) in group B required repeat surgery. In group A the results were good in 51 feet (68%), fair in 15 (20%), and poor in 9 (12%). In group B, good results were obtained in 44 feet (45%), barely satisfactory results in 25 (27%), and poor results in 27 (28%). It is suggested that the accurate correction of talocalcaneonavicular and calcaneocuboid malposition is a prerequisite for successful surgical treatment of clubfoot. There was a tendency for a better result in group A when the patients were surgically treated between 6 and 12 months of age.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The purpose of this study was to develop a method of defining, in mathematical terms, the interpositional relationships of the bones of the hindfoot complex in the idiopathic clubfoot and the neurogenic clubfoot. The neurogenic clubfoot and contralateral normal-appearing foot of a stillborn infant with myelomeningocele, and the normal foot of a 10-year-old were sectioned with a cryomicrotome. Magnetic resonance images (MRIs) of the clubfoot and the normal foot of a 3-month-old boy were obtained. Using a computer program, three-dimensional foot models were generated from the digitized cryomicrotome sections and from the MRIs. The central principal axes were determined for the talus and calcaneus. The long central principal axes of the talus and calcaneus were neutrally rotated with reference to the bimalleolar axis in the idiopathic clubfoot while in the neurogenic clubfoot the long central principal axis of the talus was medially rotated 52° and that of the calcaneus 10°. The talocalcaneal angles defined by the long central principal axes in the superior and medial views were 0° and 10°, respectively, in the idiopathic clubfoot, and 42° and 56°, respectively, in the eurogenic clubfoot.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Forty-three tibia vara in 27 patients were analyzed retrospectively in two centers. The criteria for diagnosis of the child form are discussed. A simple classification is suggested to facilitate the choice of treatment. In stage 0 (possible Blount's disease), the patient is younger than2Viyears, and an observation period is indicated for gathering data. In stage 1 (confirmed Blount's disease and absence of medial metaphyseal bony bridge), known as physis+, a valgization osteotomy is proposed. In stage 2 (evidence of a medial metaphysoepiphy-seal bony bridge) known as physis-, valgization osteotomy with lateral epiphysiodesis and treatment of the lower limb discrepancy is proposed. For stages 1 and 2, there are two possibilities: normal medial tibial plateau or sloping of the medial tibial plateau, indicating a transphyseal elevation osteotomy. When one-step correction is proposed for stage 2 disorder, external fixators such as Orthofix or Ilizarov devices are useful.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Results are reported from an absence of physio-therapic, orthopaedic, or surgical treatment in 31 cases of osteochondritis dissecans in 24 children. The mean age at diagnosis was 11 years and 4 months, and all the children were suffering from pain for an average of 3 months. None of these children were treated, except for instructions to discontinue involvement in sports activities until their pain had disappeared. In all cases pain disappeared, and these children have all returned to their former activities. According to x-ray findings, 30 lesions disappeared totally, although there was one case of a loose body. As a result, absence of treatment is recommended for osteochondritis dissecans in children.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Several indices for patellar height measurement have been described to relate patellofemoral instability and maltracking. No known study has proved interobserver reliability of these indices when applied to growing knees. This study included comparisons of three of these indices: Caton-Deschamps, Blackburne-Peel, and Koshino. Three observers measured patellar height on 36 lateral radiographs of children's knees. The best interobserver agreement was achieved by the Caton-Deschamps method, a simple, reliable, and reproducible index that is not affected by skeletal maturation.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Fifteen patients with spastic diplegic cerebral palsy (CP) were monitored for a mean length of 9.5 years after they underwent staged operations and were evaluated by gait analysis, including joint motion in the sagittal plane and the ground reaction force (GRF) in three dimensions. Results showed an increased hip flexion (132%) at midstance, a reduction of peak knee flexion (PKF) during swing (45%) accompanied by an augmented time of PKF during swing (50%), and an increased dorsiflexion of the ankle during swing (293%) as well as its time during the gait cycle, in comparison with normal values. Moreover, significant decreases of the vertical GRF at the terminal stance and the forward and backward GRF were present. Additionally, it was found that a bilateral popliteal angle <20° is acceptable in spastic CP. Staged operations gave unpredictable results in the correction of contracture of the hamstrings, the Achilles tendon, and the iliopsoas. The authors are convinced that gait analysis is useful in evaluating these patients and enhances the results of operative treatment, and they have since changed their approach toward multilevel simultaneous corrections.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Tripartite patella is a form of double-layered patella in which the anterior layer is bipartite. It was first described by Biittner in 1925 (1). More recently, an association with multiple epiphyseal dysplasia has been described (2,3)- In this article, we describe a case of symptomatic tripartite patella in a 13-year-old child who was subsequently found to have features of multiple epiphyseal dysplasia. Her patellae had an abnormal excursion with a click and a visible jump in the longitudinal line of movement, but no lateral instability. We present a surgical solution not previously described by fusion of the two main components and report an excellent result.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This is the case report of a 15-year-old black male with spastic quadriplegia cerebral palsy who developed heterotopic ossification and spontaneous ankylosis of his contralateral nonoperative hip after unilateral adductor tenotomy. To the authors' knowledge, this is the only reported case of such an occurrence. The mechanism and possible risk factors are discussed as well as management of this complication.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This a well-documented case of a 13-year-old girl with unilateral pseudarthrosis of the left clavicle without the presence of cervical ribs or dextrocardia. Magnetic resonance imaging could not detect any abnormality that could be related to the left-sided pseudarthrosis.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 9-year-old boy had a spontaneous onset of enlargement of the medial end of the clavicle due to extensive sclerosis and periosteal reaction. There was no clinical or laboratory evidence of infection. Biopsy revealed an inflammatory exudate, and histochemical staining for Langerhans'-cell histiocytosis was negative. Hypertrophic sclerosis causing painful enlargement of the medial end of the clavicle in isolation should be distinguished from condensing osteitis and chronic recurrent multifocal osteomyelitis. An early biopsy to exclude neoplasia is recommended.

ISSN:0271-6798    

出版商:OVID    

年代:1999

数据来源: OVID