Showing papers by "Nicola Maffulli published in 1996"

A review of 240 patients undergoing distraction osteogenesis for congenital post-traumatic or postinfective lower limb length discrepancy.

Abstract: Background We reviewed 281 lower limb lengthenings in 240 patients treated at three centers for congenital, post-traumatic, or postinfective limb length discrepancy (LLD) in the period 1984 to 1992. Study design A retrospective review was done of hospital charts and radiographs of patients who had completed lengthening at least 12 months prior to the beginning of the study. The variables studied included patients' age at operation, the bone segment lengthened, whether a corticotomy or an osteotomy had been done, the amount of lengthening planned and achieved, the level(s) of corticotomy or osteotomy, the external fixator used, and the difficulties encountered. Results Limb length discrepancy was reduced within 2 cm (1.6 percent or lower) of the normal contralateral leg in 249 (89 percent) lengthenings in 208 patients. The average time spent with the fixator in situ was 186.4 days (range, 94 to 617 days), with an average healing index of 35.3 days per cm (range, 26 to 43 days per cm). Femoral osteotomies or corticotomies healed faster than tibial osteotomies or corticotomies. The healing index in post-traumatic and postinfective LLD was significantly lower than in congenital conditions. The younger patients showed a significantly decreased time to bone healing and fewer complications. Conclusions A significantly greater number of difficulties were found in patients whose lengthening exceeded 18 percent of the original length of bone. Bifocal lengthenings healed significantly faster than single level ones. The three external fixators used were equally effective for lengthenings of less than 20 percent. The Ilizarov and the Monticelli-Spinelli circular fixators were associated with a significantly decreased number of complications when lengthenings above 20 percent were performed.

Principles and practice of isokinetics in sports medicine and rehabilitaion

Abstract: Principles and Practice of Isokinetics in Sports Medicine provides a comprehensive, critical review of isokinetic technology applied to sports training program testing and rehabilitation following injury and surgery. Featuring the work of renowned international contributors, the reference presents a step-by-step guide on practical isokinetic procedures and examines the significance and validity of variables commonly measured. The scientific value of isokinetics is highlighted both for sports medicine and sport sciences, enabling sports medicine practitioners to identify the merits of isokinetics and its relevant applications. The use of isokinetics in injury diagnosis and rehabilitation is outlined with specific illustrations from research data collected at the Chinese University of Hong Kong. Special attention is given to assessment of the most commonly injured sites: the knee, ankle, shoulder, and trunk. The reference offers guidelines for the interpretation of test results along with examples of how to apply the guidelines in designing appropriate rehabilitation programs. A special section is devoted to the use of isokinetics in the assessment of sport performance. Extensive photographs, charts, and illustrations throughout the reference highlight key points.

Paediatric sports injuries in Hong Kong: a seven year survey.

Abstract: OBJECTIVE: To ascertain the epidemiological characteristics of sports injuries in children in Hong Kong. METHODS: Retrospective review of all cases seen in the Sports Injury Clinic of the Prince of Wales Hospital, Shatin, Hong Kong, in the period May 1984 to December 1990. The variables studied were age at presentation, gender, side of the body injured, anatomical location of the injury, type and severity of injury, sport played, level (school, recreational, amateur and professional) and frequency of sports participation, length in years of sports practice, and initial management of the injury. RESULTS: Of the 2293 patients seen, 238 were youngsters (54% boys) 16 years old or younger. Ball games accounted for the greatest number of injuries, with 37 children taking part in basketball, 28 in soccer, 12 in volleyball, and 31 children taking part in a variety of other ball games. Of the remaining children, the single largest group was practising track and field, with sprinting and middle distance running accounting for 42 injuries, and 28 children were injured while cycling. Most of the injuries (85%) were classified as non-serious, but 15% of children presented with a total of 21 fractures, two joint dislocations, five concussions, and seven torn knee ligaments. CONCLUSIONS: Children sports participation in Hong Kong, although not at high level and not as widespread as in the West, accounts for significant morbidity. These injuries should be carefully monitored to ascertain whether they result in any detrimental long term effects.

Percutaneous longitudinal tenotomy in chronic Achilles tendonitis.

Abstract: In the period from August 1989 through December 1992, 42 track and field athletes with unilateralAchilles tendonitis and/ or peritendinitis were operated using multiple percutaneous longitudinal tenotomy under local anesthesia following failure of conservative treatment. Patients were reviewed in a special clinic over three consecutive days at an average of 19.2 (9.4) months from the operation. Of the 42 patients operated, 36 (86%) attended. On this occasion, only subjective assessment was carried out. Of the other six patients, four were interviewed by telephone using the same questionnaire; two were lost to follow-up. The results in 25 patients (59.5%) were rated as excellent, 11 (28.2%) as good, 4 (9.5%) as fair, and 2 (4.8%) as poor.

Antenatal sonographic diagnosis of clubfoot: A six-year experience

Abstract: In the period 1988 through 1993, 6351 pregnant women were referred to the Department of Obstetrics and Gynaecology, University "La Sapienza', Roma, for suspected fetal anomalies or maternofetal problems. All underwent serial transabdominal and/or transvaginal ultrasound scanning, which revealed a total of 235 fetuses with hydrocephalus, cardiac, or musculoskeletal malformations. Forty-one clubfeet were detected in 27 pregnancies in the early part of the second trimester of pregnancy. Of these, 14 feet in eight patients were isolated, and were classified as idiopathic. A clubfoot was associated with neural tube defects in six patients, with anomalies of the urinary and/or digestive system in a further six, with a cystic hygroma in two, and with other musculoskeletal abnormalities in the other six patients. Amniocentesis revealed an abnormal karyotype in six fetuses (22.2%). In only two cases was oligohydramnios present. In both these patients, a fetal urinary tract malformation was present. Polyhydramnios was found in 18 cases, and a normal amount of amniotic fluid was found in the remaining seven cases. Polyhydramnios was present in six of the eight idiopathic clubfoot fetuses. Clubfoot is associated with musculoskeletal and visceral anomalies in a high proportion of cases. The association of clubfoot with polyhydramnios in a high proportion of cases does not support the hypothesis of intrauterine moulding as an etiological factor in its development. Ultrasonographical prenatal detection of a clubfoot should prompt amniocentesis, as the condition is associated with an abnormal karyotype in a significant proportion of cases.

Iliopsoas haematoma in an adolescent Taekwondo player

Abstract: A 16-year-old male Taekwondo player was admitted with a 1-day history of right groin pain and a palpable mass in the right lower abdominal quadrant following a Taekwondo training session. No history of direct trauma was given, but the pain followed a high inward-tooutward kick. The patient was not on any medication, and tumour and infection were excluded. A high-resolution real-time ultrasound scan identified a well-defined, hyperechoic, heterogeneous mass in the substance of the right iliopsoas muscle, compatible with a collection of partially clotted blood, confirming the clinical diagnosis of iliopsoas haematoma. After conservative treatment the patient resumed training and is now fully asymptomatic.

Athletic knee injuries. Similarities and differences between Asian and Western experience.

Abstract: The pattern and prevalence of knee injuries among athletes are different in Asia, Europe, and North America because of factors such as the different sporting cultures of the regions and the type of favorite sports. Sampling and data bias and the variable levels of diffusion of sports in the different parts of the world also are responsible for the variation. In this review, the knee emerges as the most commonly injured part of the body; such injuries present significant problems of mechanical block or instability that may compromise athletic performance. Sports specific injuries are delineated, and specific groups, such as children and adolescents, female, and master athletes, are reviewed in light of the characteristic patterns of knee injuries. Differences in the patients' attitude, health care systems, and consultations of traditional medical practitioners produce major differences in management styles. However, it is encouraging to find a concerted effort on all continents in the search for a better understanding of knee injuries and a more satisfactory coordination between clinical and basic science research in this field.

Shoulder instability in athletes. The Asian perspective.

Abstract: Recently, there has been an upsurge of interest among the orthopaedic sports medicine community in Asia on the subject of athletic shoulder instability. This is particularly prominent in countries such as Japan, Korea, Taiwan, and Hong Kong, where sports requiring throwing and overhead use of the up

Fracture of the shaft of the humerus with a fracture-dislocation of the same shoulder. A case report.

Abstract: We report the case of a man aged 19 who sustained an anterior dislocation of the shoulder with a fracture of the greater tuberosity, and a fracture of the shaft of the same humerus. Open reduction and internal fixation of the shaft fracture was carried out followed by closed manipulation of the dislocation. He recovered full function of the shoulder and elbow.

Brachial plexus injury in association with fracture-dislocation of the shoulder.

Abstract: Anterior dislocation of the shoulder is generally not associated with neurological compromise. We report three patients in whom a brachial plexus injury was caused by an anterior dislocation of the shoulder. One patient was further complicated by vascular involvement. The forces producing the injury are usually small, and the neurological trauma is likely to be neuropraxia. Conservative management is usually successful, and, in our patients, recovery took place after an average of six months.

Management of forme fruste fibular hemimelia.

Abstract: Summary 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.

Callotasis lengthening : a review of some technical aspects

Abstract: Limb lengthening by gradual osteotomy distraction has been practiced since the beginning of the century. The results have not always been uniformly good because of the invasiveness and too sudden elongation applied. Using the callotasis technique, a low energy osteotomy is produced in a metaphyseal area. The periosteum is spared, and distraction, generally at a rate of 0.25 mm every six hours, is started 7 to 14 days after the osteotomy. Using the principle of tension-stress outlined by Ilizarov in the early 1950s, it is possible to produce consistent lengthening of a given bone segment. However, great attention to detail is necessary, as limb lengthening techniques show a steep learning curve, with a significant initial complication rate.

Athletic knee injuries : Similarities and differences between Asian and Western experience : How the east meets the west : Unique orthopaedic problems in Asia-pacific region

Abstract: The pattern and prevalence of knee injuries among athletes are different in Asia, Europe, and North America because of factors such as the different sporting cultures of the regions and the type of favorite sports. Sampling and data bias and the variable levels of diffusion of sports in the different parts of the world also are responsible for the variation. In this review, the knee emerges as the most commonly injured part of the body ; such injuries present significant problems of mechanical block or instability that may compromise athletic performance, Sports specific injuries are delineated, and specific groups, such as children and adolescents, female, and master athletes, are reviewed in light of the characteristic patterns of knee injuries. Differences in the patients' attitude, health care systems, and consultations of traditional medical practitioners produce major differences in management styles. However, it is encouraging to find a concerted effort on all continents in the search for a better understanding of knee injuries and a more satisfactory coordination between clinical and basic science research in this field.

Minimal trauma knee hemarthrosis.

Abstract: Four patients who suffered from minimal trauma knee hemarthrosis are presented. In all patients, the cause of the hemarthrosis was not the traumatic event in itself, but an underlying clotting or collagen disorder. The necessity of interaction between the orthopaedic surgeon and a coagulation unit is stressed.

Shoulder instability in athletes : The Asian perspective : How the east meets the west : Unique orthopaedic problems in Asia-pacific region

Abstract: Recently, there has been an upsurge of interest among the orthopaedic sports medicine community in Asia on the subject of athletic shoulder instability. This is particularly prominent in countries such as Japan, Korea, Taiwan, and Hong Kong, where sports requiring throwing and overhead use of the upper limb are popular. In this review, the classification of the condition is analyzed with a specific account of the rotator interval injury. A systematic plan of clinical assessment is presented highlighting the specific regional considerations in clinical practice and cost-effectiveness of the health care systems in Asia. The management of athletic shoulder instability depends on patient attitude and cultural background. In Asia, the popular choice of Bankart repair with capsular shift procedure is presented with special reference to the unique experience of multidirectional and habitual posterior instability. Arthroscopic surgery is becoming popular in Asia, and the indications and limitations of the technique in the management of shoulder instability are discussed.

A 6-year-old girl with neck pain.

Abstract: A 6-year-old girl presented to the accident and emergency department after a minor twisting injury to her neck. She complained of right sided neck pain. Physical examination showed a right sided torticollis with limitation of neck motion in all directions. Marked tenderness of the upper cervical spine was present, especially on the right side. No neck mass was detected by palpation, and there was no neurologic deficit. Physical examination was otherwise unremarkable. The patient was afebrile, with a normal hemoglobin (13.4 g/L) and white cell count (8.2 x 1 03/dl). The erythrocyte sedimentation rate was 80 mm per hour. Renal and liver function tests had normal results. Radiographs of the neck were obtained (Fig l), and the neck was immobilized in a hard collar. During the week after admission, a technetium 99 isotope bone scan showed no areas of abnormal uptake, a computed tomography (CT) scan (Fig 2) and a magnetic resonance (MR) imaging scan (Fig 3) were performed. Based on the history, physical examination, laboratory, and imaging studies, what is the differential diagnosis?