ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:The role of the Pavlik harness in the treatment of congenital dislocation of the hip in 122 patients over 3 months of age is presented. There were 21 patients with hip dislocation and 101 patients with hip dysplasia, with an average age of 5 months. In patients with dysplasia, concentric reduction in the harness was obtained initially, while it took 1 to 4 weeks to achieve reduction in the dislocated hips. The overall success rate was 97%, with no incidence of avascular necrosis. In three patients, the harness did not succeed in reducing the hips, and alternative methods were used with uneventful course. At follow‐up, which averaged 5 years, clinical and radiographic examinations were normal in every patient.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:We define the “bowstring” force of the iliopsoas, the force applied to the femoral head as the tendon angles across the hip joint, which we believe is an important cause of dislocation of the hip in patients with a midlumbar myelomeningocele. An operative procedure consisting of iliopsoas recession and suture of its tendon to the anterolateral hip joint capsule has been developed and used in 10 dislocated and 9 subluxated hips. The procedure was performed on patients with an average age of 6.6 months; the average follow‐up was 45 months. Arthrography demonstrated the subluxation pattern of Leveuf in 17 hips. Surgical observations included: (a) flattening of the femoral head beneath the iliopsoas, (b) “bowstringing” of the iliopsoas across the hip joint, (c) posterolateral displacement of the femoral head with hip extension, (d) apparent increase in leg length after release of the iliopsoas, and (e) decrease of hip flexion contracture after iliopsoas release. Following iliopsoas recession alone, 11 hips were stable; 7 had subluxation; 1 was dislocatable. Secondary varus derotation osteotomy for valgus and anteversion was performed on five hips with subluxation; each was stable at review. A combined varus derotation osteotomy and Chiari osteotomy was performed on the one dislocatable hip that remained dislocatable. Therefore, at review 16 of 19 hips were stable, two have subluxation, and one was dislocatable. Early surgical treatment to prevent secondary adaptive changes in the hip is recommended. Additional surgery to correct retained valgus and anteversion is frequently necessary to achieve stability.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:In a prospective study of ankle fractures in children, the growth rate was registered with a roentgen stereophotogrammetric method. The injuries were classified traumatologically according to Gerner‐Smidt and anatomically according to Salter and Harris. Twenty‐six ankle fractures were classified as supination‐eversion injuries. Of these, eight had intraarticular injuries, 16 had extraarticular injuries of the distal tibia, and two had a zigzag fracture through the growth plate of the distal fibula. Information about growth was obtained within 3 months after fracture, and the growth pattern was found stationary about 6 months after fracture. Five types of growth pattern were observed: Normal growth (1 case), initial growth stimulation of varying length (8), initial and temporary growth retardation (1), initial and permanent growth retardation (4), and initial and permanent growth arrest (7). The other 5 had very low growth rates bilaterally. Roentgen stereophotogrammetry was found useful in extraarticular supination‐eversion injuries in girls up to 12 years of age and in boys up to 13 years of age. Intraarticular supination‐eversion injuries always appear when there is low remaining growth; because of growth disturbance, no follow‐up is indicated. The traumatological classification was found of value in recognizing the different fracture types. Combined with an anatomical classification, high precision in predicting growth disturbance was obtained. However, factors such as trauma, displacement, skeletal maturity, and treatment must be considered. The roentgen stereophotogrammetric method permits early determination of the growth pattern with high accuracy. The growth disturbance can be registered months before this is evident from conventional radiographic examinations.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:We studied the theoretical stress distribution in the proximal femoral epiphysis by means of a three‐dimensional finite element model that allowed simulation of the central epiphyseal necrosis found in Legg‐Calve‐Perthes disease. The model was altered to study effects of age, extent of necrosis, portion of gait cycle, and effects of osteotomy on containment. It was found that small infarcts were less likely to exhibit collapse because of stress shielding, which decreased when the infarct was extensive or the area was not contained. There was little difference in stresses regardless of age or portion of the gait cycle. Femoral and pelvic osteotomies did little to modify mechanical stresses, and specifically failed to stimulate stress shielding in the case of extensive necrosis. This study suggests that basic mechanical behavior of the femoral epiphysis is similar in younger and older children, and good results in the former may be due to remodelling and low body weight. Although containment may have a place in less extensive lesions, there is no obvious mechanical support for the practice of performing osteotomies in the face of extensive epiphyseal necrosis.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:A technique of autogenous grafting for repair of large defects in long bones is presented. Quadrangular grafts, taken from the external table of the posterior ilium, are modeled by bending them into cylindrical form, which has higher mechanical resistance as compared to flat struts. Cancellous chips are added. The original shape of the bone is immediately restored, and heavy internal fixation is avoided. Combination of cortical and cancellous bone grafts provides both strength and rapid bone healing. There is no risk of fracture at the donor site. Of eight consecutive cases operated on, seven were successful. One failed because of relapsing infection. The procedure is suitable in children, adolescents, and young adults, for difficult cases of large defects in long bones left after resection of tumors and tumor‐like conditions, as well as after diaphyseal distraction for leg lengthening.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Two cases are presented, both males with severe total spondylolisthesis and both with Marfan's syndrome. One was treated by decompression and posterolateral fusion and the other by decompression, posterolateral fusion, reduction by halo‐femoral traction, and then anterior fusion. Both had excellent results in terms of pain relief and relief of severe hamstring tightness. One patient subsequently died of a dissecting aneurysm. A relationship between Marfan's syndrome and spondylolisthesis is strongly suggested.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Ten cases of septic bursitis in children during a 25 year period were reviewed. Infection occurred in five girls and five boys with a mean age of 9⅙ years. None had prior bursal disease. Direct trauma or local infection preceded the bursitis in seven children. The involved bursae were prepatellar (eight), olecranon (one), and subacromial (one). Presenting signs included fever with localized swelling, tenderness, and erythema; superficial fluctuance and painless joint motion were helpful diagnostic findings. Bursal fluid cultures yieldedStaphylococcus aureus(nine) andStreptococcus pyogenes(one). Surgical therapy included needle aspiration (three), incision and drainage (three), and both procedures (four). Antimicrobial therapy was given to nine children; four received only oral antimicrobials. Nine children including all who received oral antimicrobials recovered rapidly without apparent sequelae. One child's course was complicated by patellar osteomyelitis and septic arthritis. Septic bursitis is an uncommon infection in children and should be differentiated from cellulitis and septic arthritis. Rapid recovery is usually seen with appropriate therapy.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Bipartite primary ossification centers were found in 1 of 103 femurs. This variation of early endochondral ossification suggests a possible mechanism for some congenital deformities of the femur (such as proximal femoral focal deficiency), as well as normal variations such as multiple nutrient arteries.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Summary:Double layered patellae are a rare phenomenon found in association with multiple epiphyseal dysplasia. Lateral subluxation of the patella is commonly present. Of note is the discovery of a mobile synovial joint lined with hyaline articular cartilage between the two layers of the patella.

ISSN:0271-6798    

出版商:OVID    

年代:1982

数据来源: OVID