摘要:

Major congenital limb deficiencies are rare and the experience of most orthopaedic surgeons of their management will be small. The suggestion of the establishment of special limb deficiency clinics seems a sensible way of collecting the necessary expertise together in one place in order to advise patient and parents on the long-term management, throughout life, of their problems. Advances in imaging have led to prenatal diagnosis, which produces very significant problems in counselling parents before their child is born. More sophisticated methods of imaging after birth such as magnetic resonance imaging allow more accurate assessment of the deficiency. Early classifications based on plain radiology in the first year of life are being superseded by classifications relevant to the modern methods of reconstruction particularly the circular (Ilizarov) fixator. Similarly the remarkable advances in molecular biology are increasing our understanding of the fundamental causes of these deficiencies and the ultimate aim of their prevention. The rapid advances in reconstruction particularly using circular fixators has made reconstruction rather than amputation and a prosthesis possible, particularly in the milder forms of deficiency. However, the surgeon must remember that these conditions represent a field defect so that reconstruction cannot produce a normal limb. One of the hardest things to explain to patients and parents is that however well reconstruction is performed the result is not a normal limb. In the more severe forms of deficiency frequently the best advice is still amputation and a modern prosthesis. For some patients and parents this is very difficult if not impossible to accept. However, life with a good amputation and modern prosthesis may be better than attempting a long and arduous reconstruction, which still results in an abnormal and imperfect limb.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Nail-patella syndrome is a rare dysplasia characterized by a typical tetrad: hypoplasic nails, hypoplasic or absent patella, radial head dislocation and iliac horns. We review eight patients, four men and four women, aged from 20 to 70 years. The main complaint at consultation was with their knees due to patellar instability and pain. Five of them required surgical treatment due to patellar dislocation and three patients were not treated. The Krogius–Lecène procedure was performed in four patients with a good result following the Insall classification of pain and instability and with an average follow-up of 24 years (range, 18–28 years). Patellectomy was performed in the eldest patient due to femoropatellar arthritis present at first consultation. No patients presented with elbow or nail disorders or with iliac horns.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The management of complex forearm deformities in patients with multiple cartilaginous exostoses is controversial. The objective of this study is to look into the outcome of treatment with the combined use of ulna lengthening, radial osteotomy, and excision of exostosis in our six patients, who all had Masada type 1 deformity of the forearm. Clinical assessment was performed using the pre- and postoperative range of motion of the wrist, forearm and elbow. The chief symptom each patient had was noted as well as the demographic data of all patients. Radiological assessment was performed by checking the degree of negative ulna variance, the radial articular angle, and the degree of carpal slip. The degree of satisfaction of the patients and their parents were noted. Good clinical and radiological results were obtained at a mean follow-up of 2.5 years. All patients and parents were satisfied and there was no recurrence of deformity in the latest follow-up. The authors believe in early and aggressive treatment of Masada type 1 deformity of the wrist and forearm for multiple cartilaginous exostoses with a combination of excision of exostosis, ulna lengthening and radial osteotomy.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Smith–Magenis syndrome is a rare condition, which occurs due to interstitial deletion of chromosome 17. In order to evaluate the various orthopaedic characteristics of this syndrome, we examined 22 patients in the UK. The orthopaedic characteristics included brachydactily, short stature, flat feet and scoliosis. We found that 30% of our patients had significant scoliosis and some of them required corrective surgery. The objective of this paper is to describe the general orthopaedic and spinal manifestations of the syndrome and provide an overview of the other medical characteristics that an orthopaedic surgeon might encounter. We highlight this condition as a rare cause of progressive scoliosis that is not reported in the orthopaedic or spinal literature. As a result of this study we recommend a screening programme for scoliosis in children with Smith–Magenis syndrome.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Fibular hemimelia is associated with a deformity of the distal tibial epiphysis resulting in a convexity with lateral and posterior slope of the distal joint surface. The deformity results into an equinovalgus position of the foot and ankle and frequently consecutive dislocation of the foot. A new procedure is presented, in with a metaphyseal ostotomy is performed towards the physis in order to bend the postero-lateral third of the distal tibial epiphysis forming a concave distal tibial joint surface. This procedure was done in four feet in three patients at ages between 7 and 20 months combined with soft tissue releases and rebalancing the tendons. At a follow-up between 6 and 42 months the position of the feet is well retained. 

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Femoral varus osteotomy in unilateral Legg–Calvé–Perthes disease was reviewed at a mean of 18 years (10–27 years) after surgery. Forty-four patients (mean age 24.5 years) received a clinical and radiographic evaluation. The range of motion index revealed good and very good results in 84.1% of the patients. The age at surgery was a significant predictor of joint congruence and mature trochanteric position. The Catterall classification correlated with the mature leg-length difference. The extent of osteotomy and age at surgery showed significant influence on the mature femoral head diameter. Femoral varus osteotomy proved to be an adequate treatment. Satisfied patients and hips without osteoarthritis and with good function for a long period of time can be expected.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Relative overgrowth of the greater trochanter is a problem related to proximal femoral growth cartilage damage. Eleven hips in 10 patients aged 4–13 years with acquired coxa vara were retrospectively reviewed. Distal and lateral transfer of the greater trochanter was performed in all patients. The average follow-up was 42.7 months. The causes of the overgrowth were Perthes disease, avascular necrosis after treatment of developmental dysplasia of the hip, septic arthritis and rheumatoid arthritis. Radiological assessment revealed an improvement of both the articulotrochanteric distance and the greater trochanter relative overgrowth. Values referred to the acetabulum or the neck-shaft angle remained unmodified. Clinical improvement was achieved. A fracture of the transferred greater trochanter was observed. We believe that this procedure is a simple technique, with good results and few complications.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Medial plica syndrome is usually a rare cause of anterior knee pain, but in adolescent athletes it is more common. A prospective investigation of clinical criteria for the diagnosis of medial plica syndrome was carried out. Investigating the stress test for the diagnosis of medial plica syndrome, we used active extension as a kick test and flexion to test blocking of swinging of the shank. The aim of this investigation was to examine these two new tests. The tests we used improved the accuracy of the clinical examination and allowed diagnosis of the symptomatic medial plica.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

From a cohort of 110 idiopathic clubfeet, 26 feet in 18 children requiring surgery for severe relapse have been studied. Surgery comprised a lateral column shortening procedure (Lichtblau) plus or minus a plantarmedial release. Surgery was staged to avoid wound complications. Preoperatively feet were prospectively categorized, according to a system reported by Dimeglio, into one of four grades. This grading system provides a clinical assessment. Children were reviewed on two subsequent occasions. At review feet were again graded and in addition appearance and functional outcome were analysed. This included an assessment of gait, activity and functional limitation. Three children were lost to follow-up leaving 22 feet in seven male and eight female patients available for review. The mean age at surgery was 43 months (23–82 months). The mean time from surgery to first and second reviews was 35 and 56 months respectively. There was a significant improvement in grading at first review compared with preoperative grading (Wilcoxon signed ranks test). Although there remained a significant improvement in grading at second review compared with the preoperative grading, there was a significant reduction in the number of feet in which grading had improved when compared with first review. There was no significant change in function between the two postoperative reviews, with the majority of children experiencing little functional limitation. There were no wound complications. We conclude that relapse surgery, involving a lateral column shortening procedure for severe clubfoot, results in a significant initial improvement when assessed using a grading system. This improvement in grading subsequently decreases over time. However, the functional outcome in such cases remains favourable.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Seventy-eight children (105 feet) operated on for congenital clubfoot with two different procedures – limited posteromedial-lateral release and complete subtalar release – were analysed. For all of them the age at operation ranged from 3 to 76 months (mean 17 months) and follow-up from 41 to 84 months (mean 58 months). The control group consisted of 42 opposite feet from the patients with a unilateral deformity. In all the feet operated on, a higher positioning of the fibula in relation to the talar dome was found. A correlation between the high positioning of the fibula and the strength of the plantar flexors was noted in children operated on by limited posteromedial-lateral release (the weaker the strength of the plantar flexors the higher the position of the fibula in the ankle). There was no correlation between the position of the fibula and the hindfoot valgus, the limited range of motion within the talo-calcaneo-navicular joint, and the talo-calcaneal angle in the anteroposterior view. In the same group, the difference in the distance between lateral malleolus and talar dome in the healthy and affected foot did not increase with age, but in the group operated on by complete subtalar release, there was a tendency for increasing shortening.

ISSN:0271-6798    

出版商:OVID    

年代:2003

数据来源: OVID