Showing papers in "Journal of Pediatric Orthopaedics in 1984"
TL;DR: Since 1978, 3,500 infant hips by ultrasonography have been examined, finding that ultrasound provides no exposure to radiation and can differentiate soft tissue much better than radiography.
Abstract: Summary:Since 1978 we have examined 3,500 infant hips by ultrasonography. We classified these hips into four basic categories: (a) normal, according to age; (b) delayed ossification (dysplasia); (c) partial dislocation (subluxation); and (d) dislocation (total luxation). Ultrasound provides no expos
240 citations
TL;DR: Sixty-one cases of brachial plexus birth palsies were documented in 30,451 live births at Kaiser Foundation Hospital, San Francisco, between January 1972 and December 1982, for an incidence of 2.0/1,000 births.
Abstract: Sixty-one cases of brachial plexus birth palsies were documented in 30,451 live births at Kaiser Foundation Hospital, San Francisco, between January 1972 and December 1982, for an incidence of 2.0/1,000 births. Thirty-eight patients were evaluated in follow-up ranging from 1 year to 11 years 6 months. Associated birth traumas include facial palsy, clavicle fracture, arm ecchymosis, and cephalohematoma. The prognosis was excellent, with full recovery in 95.7% of cases. The presence of a palsy did not preclude the development of dominant use of the extremity. Right-handedness was noted in 73% of right-sided palsies. This study showed that the incidence of palsies has not declined in the past 10 years. Risk factors and associated birth injuries were similar to those in other reports. The severity of palsies has lessened, and early recovery is usual.
234 citations
TL;DR: The results of this study indicate that for the knee and elbow joints, goniometric measurements performed in a clinical setting can be highly reliable.
Abstract: Reliability of goniometric measurements has been examined only under standardized conditions and usually with healthy subjects. The purpose of this study was to assess goniometric reliability in a clinical setting. The reliability of goniometric measurements of passive elbow and knee positions was assessed using patients as subjects. The effect of using the means of repeated measurements and the interdevice reliability of three common goniometers were also examined. Results showed that intratester reliability for flexion and extension of the knee and the elbow joints was high (r = .91 to .99). Intertester reliability was also high (r = .88 to .97) for these measurements except for measurements of knee extension (r = .63 to .70). Although previous investigators have suggested that using the means of multiple measurements improves reliability, our data indicate that this procedure never improves the correlation coefficient more than .12. The reliability was similar for all three devices. The results of this study indicate that for the knee and elbow joints, goniometric measurements performed in a clinical setting can be highly reliable. The method described in this study provides a simple protocol that can be used clinically to investigate goniometric reliability.
179 citations
149 citations
TL;DR: The operative treatment of 37 patients with unicameral bone cysts and percutaneous steroid injection in 20 patients whose cysts were similarly predisposed with respect to mode of presentation, location, age, and sex exhibited a high rate of recurrence or persistence.
Abstract: The operative treatment of 37 patients with unicameral bone cysts was compared with the newer method of steroid injection in 20 patients whose cysts were similarly predisposed with respect to mode of presentation, location, age, and sex. In the surgical group the average operative time was 100 min, with a mean estimated blood loss of 300 ml. The recurrence rate was 40%, rising to 88% in patients under the age of 10 years with active cysts (less than 1 cm from the physis). Major complications occurred in 15% and included infection, refracture, coxa vara, extremity shortening, and physeal damage. A minimum follow-up of 2 years was necessary to rule out recurrence. In contrast, the steroid-injected group had a recurrence rate of 5%, although 50% required more than one injection for maximum obliteration. The average operative time was 30 min, with negligible blood loss and a minimum hospital stay and rehabilitation. The only complications were a mild steroid flush in one patient and extremity shortening due to preexisting fracture in another. The end point of healing was reconstitution of cortical thickness, rather than total obliteration at the cyst. No secondary fractures were encountered. Both operative treatment and percutaneous steroid injection exhibited a high rate of recurrence or persistence. The greater simplicity and lesser morbidity associated with the steroid technique favored it as the method of choice.
134 citations
TL;DR: It is recommended that the hip be closely monitored in infancy and that an aggressive treatment approach be undertaken if hip subluxation occurs, and the maintenance of hip stability will facilitate seating as well as minimize the effects of the windblown hip syndrome.
Abstract: Windblown hips in patients with cerebral palsy are difficult to treat and predispose to poor, unstable sitting. In an attempt to identify the temporal sequence between dislocation of the hip, scoliosis, and pelvic obliquity, an in-depth clinical and radiological review of 22 teenage children was undertaken. The most common temporal sequence was dislocation of the hip, followed by pelvic obliquity, and finally scoliosis. It is recommended that the hip be closely monitored in infancy and that an aggressive treatment approach be undertaken if hip subluxation occurs. This is greatly facilitated by a good orthotic, therapy, and seating program to maintain the hips in the correct position. The maintenance of hip stability will facilitate seating as well as minimize the effects of the windblown hip syndrome.
128 citations
TL;DR: In this retrospective study of 32 cases, residual symptoms and/or clinical instabilities were found in 16 instances and open surgery is suggested for displaced fractures in patients 10 years and older.
Abstract: Considerable differences of opinion exist concerning the best treatment of anterior tibial spine fractures in children. In this retrospective study of 32 cases, residual symptoms and/or clinical instabilities were found in 16 instances. Open surgery is suggested for displaced fractures in patients 10 years and older.
127 citations
TL;DR: Elective bunion surgery in adolescents should only be performed in the face of progressive, painful deformity where both the patient and the patient's parents fully understand the goals and risks of surgery.
Abstract: The results of bunion surgery on 50 feet in 31 adolescents are reviewed. Average follow-up was 3 years 2 months. The failure rate was 36%. Fifty-one percent of the children had hypermobile flatfeet, and 32% had a long first ray. The recurrence rate in these groups was 56 and 50%, respectively. There were 20 reoperations for either recurrence (12) or hardware removal (eight). Elective bunion surgery in adolescents should only be performed in the face of progressive, painful deformity where both the patient and the patient's parents fully understand the goals and risks of surgery.
107 citations
TL;DR: The benefits of using computerized gait analysis to plan and evaluate operations and examine the changes in estimated external work of walking, stride length, walking velocity, and joint rotations pre- and postoperatively were assessed.
Abstract: The benefits of using computerized gait analysis to plan and evaluate operations were assessed by studying the data from 20 children with spastic diplegia and examining the changes in estimated external work of walking, stride length, walking velocity, and joint rotations pre- and postoperatively. Of the 20 patients, 13 improved, 6 were unchanged, and 1 was worse. None of the patients walked in a crouch postoperatively. By clinical evaluation, 19 of the 20 patients were better. Thus objective gait analysis imposed much more stringent criteria for improvement. Computerized gait analysis has enabled us to be more objective in the evaluation and documentation of outcome.
103 citations
TL;DR: A series of 58 traumatic dislocations of the elbow observed over a 5-year period is reported, finding 21 excellent, 12 good, four fair, and two poor results.
Abstract: A series of 58 traumatic dislocations of the elbow observed over a 5-year period is reported. Average age of the children was 12 years old (range, 6 to 15 years). All dislocations were posterior. Neurovascular complications were few and transient in all cases. Associated fractures were present in 64% of the cases. In six cases (10%) closed reduction of the dislocation failed. Nineteen children (33%) were operated on, in most cases because of an associated fracture of the medial epicondyle. Results were the following: 21 excellent, 12 good, four fair, and two poor. Functional impairment was present only in the two cases with poor results. These occurred in patients in whom an associated fracture of the neck of the radius was present and were due to radioulnar synostosis.
91 citations
TL;DR: Fifteen children with fracture of the intercondylar eminence of the tibia were reviewed, and four had normal motion, four had atrophy, and all had some evidence of anterior cruciate ligament laxity.
Abstract: Fifteen children with fracture of the intercondylar eminence of the tibia were reviewed. Three with type I or type II fractures had closed treatment. Twelve with type III fractures had open reduction and internal fixation. Follow-up examination included history and examination of the knee; nine had follow-up radiographs. The mean follow-up period was 7 years. Seven patients were free of symptoms; eight had varying degrees of pain, of which four had to avoid some athletic activities; and two described subluxation episodes. All had normal motion, four had atrophy, and all had some evidence of anterior cruciate ligament laxity. The anterior cruciate ligament probably stretches before its tibial attachment fractures. Even though the fracture heals in its normal position, mild degrees of anterior cruciate ligament laxity often will result.
TL;DR: It is concluded that early identification of these patients and appropriate surgical management, including reduction of the subluxation and posterior cervical spine fusion, will in most instances result in a favorable outcome; however, patients with long-standing symptoms and marked neuronal damage show no or only little improvement postoperatively.
Abstract: In a prospective study 40 of 236 individuals with Down syndrome were found to have atlantoaxial instability. Whereas most of the 40 affected children were asymptomatic, seven patients exhibited various neuropathology. Historical data, neurologic findings, radiologic interpretations, and surgical management of these seven patients are described in detail. In addition, case reports of other individuals with Down syndrome and symptomatic atlantoaxial subluxation from the literature were analyzed. We conclude that early identification of these patients and appropriate surgical management, including reduction of the subluxation and posterior cervical spine fusion, will in most instances result in a favorable outcome; however, patients with long-standing symptoms and marked neuronal damage show no or only little improvement postoperatively.
TL;DR: The talar and Calcaneal axis-first metatarsal base angles (TAMBA and CAMBA) are introduced, which enable us to describe not only the obliquity of the talus and calcaneus but also the severity of the dislocation ofThe talonavicular joint and the contracture of the tendo Achilli.
Abstract: Sixty-nine cases of congenital vertical talus (CVT) were classified into five groups in association with (1) neural tube defects or spinal anomalies, (2) neuromuscular disorders, (3) malformation syndromes, (4) chromosomal aberrations, and (5) idiopathic CVT unassociated with any of the systemic conditions described above. Forty-four cases of idiopathic CVT were subclassified into four groups: (5A) intrauterine molded or deformed cases, (5B) cases of digitotalar dysmorphism associated with contractile finger abnormalities and genetic inheritance, (5C) patients whose close relatives had CVT or oblique talus (OT) deformity, and (5D) cases unassociated with any skeletal deformity or genetic inheritance. The talar and Calcaneal axis--first metatarsal base angles (TAMBA and CAMBA) are introduced, which enable us to describe not only the obliquity of the talus and calcaneus but also the severity of the dislocation of the talonavicular joint and the contracture of the tendo Achilli. The changing point from flexible OT to rigid CVT is TAMBA of about 60 degrees and CAMBA of 20 degrees, and there are many borderline cases of CVT that could be treated conservatively. For the typical CVT, open reduction should be carried out as promptly as possible if 3 months of corrective casting in extreme equinovarus fails to reduce the TAMBA to 50 degrees.
TL;DR: One hundred patients from the Gothenburg Scoliosis Data Base were studied as mentioned in this paper, and 95 of them were personally examined and functional assessment, including a questionnaire and pain drawing, full standing anterior-posterior (AP), and lateral roentgenograms of the spine.
Abstract: One hundred patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: (1) adolescent idiopathic scoliosis (2) completion of treatment before age 20, (3) a minimum follow-up of five years thereafter, (4) a minimum age of 22 years at final follow-up, and (5) operation performed by the senior author. Of these, 95 were personally examined. The surgical technique from 1968 to 1973 included a two-stage Harrington distraction, with fusion added at the second operation (52 patients). From 1973 to 1975, 48 patients were treated with a one-stage distraction and fusion after a week of preoperative Cotrel traction. Postoperatively, all patients were treated with a Milwaukee brace. A spinal examination and functional assessment, including a questionnaire and pain drawing, full standing anterior-posterior (AP), and lateral roentgenograms of the spine, was performed by independent observers. Eighty-five subjects without scoliosis served as a control group. The radiographic evaluation showed the usual nearly 50% permanent correction at the follow-up examination averaging nine years postoperatively. Lateral roentgenograms, however, demonstrated in 52% flattened or kyphotic cervical spines producing no significant complaints, non-significant flattening of the thoracic kyphosis, but significant lowering of the lumbar lordosis. Fifteen of the 24 patients with distal hook insertion and fusion including L4 or L5 demonstrated retrolisthesis. All had significant low-back pain. Degenerative facet joint changes and disc space narrowing was noted in 11 patients, again with a distal hook purchase in L4 or L5. Compared to the controls, the operated patients, as a group, revealed no lessened activity or back pain at any location.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: The Hilgen-reiner epiphyseal (HE) angle as measured on standard AP roentgenograms of the hip is introduced to aid in deciding candidacy for surgery, as well as a means of determining the amount of surgical correction necessary to prevent a recurrence of the deformity.
Abstract: Forty-two cases of coxa vara were retrospectively reviewed. All 42 cases were classified based on their history and roentgenographic appearance. Twenty-two cases of true congenital coxa vara were identified and are the primary focus of this review. In this study we have introduced the Hilgenreiner epiphyseal (HE) angle as measured on standard AP roentgenograms of the hip. Retrospectively, this angle was measured to aid in deciding candidacy for surgery, as well as a means of determining the amount of surgical correction necessary to prevent a recurrence of the deformity. The indication for surgery should be an HE angle of greater than 60 degrees. HE angles of less than 60 degrees and greater than 45 degrees represent a "gray zone" and should be observed. HE angles of less than 45 degrees will generally correct spontaneously without surgery.
TL;DR: Serial lumbar punctures should be used to treat this condition only when CSF flow is easy to establish and maintain and posthemorrhagic ventricular dilation often resolves spontaneously.
Abstract: Lumbar epidural abscess and vertebral osteomyelitis were diagnosed in a 3-month-old infant, born prematurely, who had had repeated lumbar punctures for the treatment of posthemorrhagic hydrocephalus. Staphylococcus aureus was the causative organism. Successful treatment was achieved with 6 weeks of intravenous antibiotics without surgical drainage. Infectious complications of lumbar punctures are rare, but may occur when multiple punctures are attempted in small premature infants whose subarachnoid space contains large amounts of blood. Infection can be introduced directly by a contaminated spinal needle, or trauma to the tissues with bleeding can create a favorable site for bacterial adherence and multiplication. Posthemorrhagic ventricular dilation often resolves spontaneously and serial lumbar punctures should be used to treat this condition only when CSF flow is easy to establish and maintain.
TL;DR: A review was carried out of arthroscopy of the knee in children, where, as in adults, hemarthrosis indicates significant injury to the knee, and meniscus lesions are rare.
Abstract: A review was carried out of arthroscopy of the knee in children. During a 34-month period, 2,378 arthroscopies were performed, 80 of these on children less than 16 years of age. Seventy-one cases were reviewed, which is approximately 2% of all children seen at the clinic. Thirty procedures were carried out in patients with hemarthrosis. Eleven patients required operative repair or reconstruction. There were 13 ruptures of the anterior cruciate ligament (43%), 4 ruptures of the posterior cruciate ligament, 14 ruptures of the medial collateral or posterior oblique ligament, and 5 ruptures of the lateral meniscus. Forty-one arthroscopies were done in patients without hemarthrosis or history of acute trauma. A clinical diagnosis of meniscus tear was correct in only 20%. Only one meniscectomy was performed and another meniscus tear was repaired. The most common diagnostic finding was abnormality of the patellofemoral articulation, which was diagnosed in 31 patients. Arthroscopic shaving of the patella was rarely indicated. As in adults, hemarthrosis indicates significant injury to the knee. Meniscus lesions are rare.
TL;DR: CRP behaved in a similar manner in both the medicated and the nonmedicated groups, its normalization suggests true extinction of the active inflammatory process, and may be of benefit in monitoring the duration of antibiotic therapy for SA.
Abstract: Body temperature, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured sequentially in nine children less than 11 years old during their recovery from culture-positive septic arthritis (SA). The measurements were compared with those of two other children who recovered without antibiotic therapy. A clinical investigation carried out several months after discharge suggested permanent recovery in all cases, including the spontaneously recovered patients. Defervescence and normalization of the primarily elevated CRP and ESR values occurred in a similar manner in both groups. On average, fever lasted 5 days, CRP level decreased below 20 mg/L in 7 days, and ESR reached a value of less than or equal to 20-25 mm/h in 22 days. The normalization time of ESR differed highly significantly (p less than 0.001) both from the duration of fever and from the normalization time of CRP level. Because CRP behaved in a similar manner in both the medicated and the nonmedicated groups, its normalization suggests true extinction of the active inflammatory process. If so, CRP level may be of benefit in monitoring the duration of antibiotic therapy for SA, but the hypothesis has to be confirmed in a larger clinical trial.
TL;DR: Clinical, radiographic, and histologic study clarifies the evolution of the distinct clinical and radiographic disorder known as adolescent tibia vara (Blount's disease) and suggests corrective osteotomy below the growth plate is recommended.
Abstract: Summary This clinical, radiographic, and histologic study clarifies the evolution of the distinct clinical and radiographic disorder known as adolescent tibia vara (Blount's disease). Although previous reports have suggested that the disorder occurs in a limb that has been normally aligned until adolescence, we have found that most children with adolescent tibia vara maintain a mild degree of infantile physiologic genu varum. Then, concurrent with the adolescent growth spurt, certain children with predisposing factors, such as obesity, extreme activity, or rapid growth, injure the posteromedial physis as a result of repetitive trauma due to normal use of a limb already in mild varus. The result is growth suppression, further varus, and a classic radiographic presentation. Histologic examination in two cases suggests injury to the growth plate as demonstrated by fissuring and clefts in the physis as well as fibrovascular and cartilaginous repair tissue at the physeal-metaphyseal junction. Transverse trabeculae, resembling growth arrest lines, were noted in the adjacent meta-physis; however, true bony bridging of the growth plate was not seen. Recommended treatment is corrective osteotomy below the growth plate.
TL;DR: Data support late-onset tibia vara as a distinct entity closely related to the infantile form and suggest three specific forms of tibiavara based on the age at clinical onset: infantile (0–3 years), juvenile (4–10 years), and true adolescent (11 years or older).
Abstract: We reviewed the clinical and radiographic characteristics and response to treatment of 11 children (16 knees) with idiopathic late-onset tibia vara (adolescent Blount's disease) followed for an average of 57 years (range, 3-10 years) The clinical characteristics were very consistent: black race; 2:1 male predominance; normal height; marked obesity; knee pain as the primary presenting complaint; and slowly progressive genu varum deformity that averaged 19 degrees (range, 10-45 degrees) Radiographically, the epiphyses were wedge shaped owing to medial flattening, the physes were irregular in thickness, and there was minimal, if any increased prominence of the proximal medial metaphysis Nineteen proximal tibial valgus and diaphyseal fibula osteotomies were performed on 15 knees There was a 50% rate of recurrent deformity in males with clinical onset at less than or equal to 10 years of age Females and older males had no recurrences Histopathologic studies of the physis performed on one case demonstrated abnormal cellular islands of hyaline cartilage, small foci of necrotic cartilage, prominent intertrabecular vascularity, and premature medial physeal closure These data support late-onset tibia vara as a distinct entity closely related to the infantile form They also suggest three specific forms of tibia vara based on the age at clinical onset: infantile (0-3 years), juvenile (4-10 years), and true adolescent (11 years or older) The juvenile group is characterized by a high rate of recurrence following surgical correction, whereas the others are not
Journal Article•
TL;DR: Segmental instrumentation and fusion of spinal deformity in patients with Duchenne muscular dystrophy yields good correction and provides firm internal stabilization that allows rapid mobilization of patients following surgery.
Abstract: Segmental instrumentation and fusion of spinal deformity in patients with Duchenne muscular dystrophy yields good correction and provides firm internal stabilization that allows rapid mobilization of patients following surgery. When surgery to stabilize spinal deformity is done in younger patients in whom pulmonary function is better and curves are milder, complication rate and length of hospital stay are diminished, correction and balance are improved, and patients rapidly return to their normal life-style. We no longer routinely attempt orthotic treatment of these curvatures, but advise stabilization of the collapsing spine surgically with segmental instrumentation and fusion when scoliosis reaches 30-40 degrees.
TL;DR: These equations (TW height prediction, Mark II) which replace the ones given in 1975 are based on larger numbers of normal children, and more importantly on a sample that includes, for the first time, numbers of very tall, very short, and very growth-delayed children.
Abstract: A new series of equations is presented for predicting the adult height of a child given present height and bone age. These equations (TW height prediction, Mark II) which replace the ones given in 1975 (TW height prediction, Mark I) are based on larger numbers of normal children, and more importantly on a sample that includes, for the first time, numbers of very tall, very short, and very growth-delayed children. In addition, equations are given for use when the increment of height or bone age, or both, over the previous year is known. These variates improve the prediction at most ages over 8 years in girls and 11 years in boys. The previously given parental allowance has been dropped. Typically 95% of the predictions lie within +/- 8 cm of the real value for boys aged 10 years, falling to +/- 6 cm for boys aged 15 years, or +/- 4 cm if their previous height increment is known. For premenarcheal girls the predictions lie within about +/- 6 cm at age 8 years; a figure which diminishes little till 13 years unless height and bone age increments are known, when it reaches +/- 4 cm at 13 years. For postmenarcheal girls the predictions are substantially more accurate.
TL;DR: Tension tests show the stress-relieving qualities of the implant improve pullout strength 47% over simple wire fixation of the spinous process, and tests on the scoliosis simulator show that the interspinous instrumented spine resists high compressive loads to failure, comparing favorably with other systems tested.
Abstract: A method for interspinous segmental spinal instrumentation (ISSI) is described and the laboratory testing and early clinical results are reported. The method utilizes a button-wire implant that is passed through the thickest and strongest part of the base of the spinous process. Tension tests show the stress-relieving qualities of the implant improve pullout strength 47% over simple wire fixation of the spinous process. Tests on the scoliosis simulator show that the interspinous instrumented spine resists high compressive loads to failure, comparing favorably with other systems tested. Early clinical experience with the implant for a wide variety of uses has been encouraging. The authors use ISSI as their procedure of choice in idiopathic and congenital scoliosis.
TL;DR: Transversely oriented lines within the metaphyses and proximate diaphyses were studied in multiple specimens from cadavers and amputation specimens from skeletally immature individuals and proved histologically to be thickened, transversely interconnected trabecular networks, with more typical, longitudinally oriented trABecular bone on either side.
Abstract: Transversely oriented lines within the metaphyses and proximate diaphyses were studied in multiple specimens from cadavers and amputation specimens from skeletally immature individuals. These lines, evident as transverse trabecular bands of increased radiodensity, proved histologically to be thickened, transversely interconnected trabecular networks, with more typical, longitudinally oriented trabecular bone on either side. They appeared following a temporary slowdown or cessation of rapid longitudinal bone formation in the primary spongiosa and were parallel to the contours of the contiguous physis. When growth rates were normal, longitudinally oriented trabeculae with interspersed marrow elements predominated at the zone of transformation of cartilage to bone. However, when growth rates slowed down or were temporarily arrested, the trabeculae thickened and fused with each other transversely. When the abnormal process (e.g., fracture or systemic illness) responsible for growth retardation subsided, more rapid rates of endochondral growth and transformation resumed, forming the more characteristic normal longitudinal trabecular orientation. As the bone elongated, these transverse lines were progressively displaced from the physis. As the metaphyseal bone was remodeled to diaphyseal bone, these trabecular lines were gradually remodeled and usually disappeared completely by the time skeletal maturity was reached.
TL;DR: Treatment is strictly surgical, but the procedure to be employed depends on the degree of displacement: Dunn's operation when the growth plate is still open, trochanteric osteotomy once it has closed.
Abstract: Summary
Guidelines are proposed for the treatment of slipped upper femoral epiphysis based on the analysis of 80 cases. Treatment is strictly surgical, but the procedure to be employed depends on the degree of displacement. Major operations are reserved for maximum tilting of the epiphysis: Dunn's operation when the growth plate is still open, trochanteric osteotomy once it has closed. Complications of treatment are epiphyseal necrosis and stiffness.
TL;DR: Patients with congenital posteromedial bowing of the tibia and fibula have soft tissue enlargement in the posterior aspect of the affected legs in early life and developed to a relative muscle atrophy in later years.
Abstract: Patterns of growth and development are presented for 33 patients with congenital posteromedial bowing of the tibia and fibula. The bowing is accompanied by shortening of the tibia and fibula, an initial calcaneovalgus deformity of the foot, and a decrease in ankle motion that does not improve with age. In general, the greater the initial bowing, the greater the ultimate extremity length discrepancy. The proportionate length differences between the normal and the bowed tibiae remained stable after the age of 12 months. This allowed a projection of anticipated extremity length discrepancy at maturity and a determination of the proper treatment. At birth the bowing varied from approximately 25 to 70 degrees, and at maturity the absolute tibial length discrepancies varied from 3.3 to 6.9 cm. Both the posterior and the medial components of the bow became markedly reduced with increasing age, but a mild residual medial portion of the bow remained. Soft tissue enlargement was observed in the posterior aspect of the affected legs in early life and developed to a relative muscle atrophy in later years.
TL;DR: An experimental model using immature bovine femora and tibiae was used to determine the varying patterns of failure in and around the physis when the direction of stress was varied, showing that the histologic failure pattern did vary with each type of applied load.
Abstract: An experimental model using immature bovine femora and tibiae was used to determine the varying patterns of failure in and around the physis when the direction of stress was varied. Compression, tension, shear, and torque were individually applied. The results showed that the histologic failure pattern did vary with each type of applied load. Compression resulted in failure in the zone of provisional calcification and the metaphysis rather than the previously hypothesized germinal zone. Tension loads caused failure in the upper zone of columnation. Failure in between the upper zone of columnation and lower zone of hypertrophy was caused by shear loads. Torque resulted in failure through all zones.
TL;DR: It is suggested that bone graft epiphysiodesis is at least as good as multiple pin fixation in the treatment of slipped capital femoral epiphysis and the extremely low incidence of overall complications.
Abstract: A retrospective review was carried out of all cases treated by bone graft epiphysiodesis for slipped capital femoral epiphysis at Children's Hospital Medical Center of Akron between the years 1950 and 1980. Only those cases followed for a minimum of 1 year following treatment were included in the review and evaluated as to their status of avascular necrosis, acute cartilage necrosis, or other complications attendant to the surgical approach. One hundred seventy-six patients representing 207 hips underwent bone graft epiphysiodesis over this 30-year period. One hundred fifty-nine patients representing 185 hips were followed a minimum of 1 year and were included in this study. There were 25 cases of acute slipping representing 26 hips and 134 patients representing 159 hips involved with the chronic slipping process. In the acute group of patients representing 26 hips, there were two cases of avascular necrosis and one case of acute cartilage necrosis. In the chronic group of 159 hips, there were four cases of reslipping, one due to graft resorption, one due to placement of the graft short the growth plate, and two that went on to acute slipping. All cases were salvaged with good results. There was one case of avascular necrosis in the chronic group; not a single case of acute cartilage necrosis was encountered. Owing to the rapid nature of growth plate closure following bone graft epiphysiodesis, the avoidance of hardware removal or pin penetration, and the extremely low incidence of overall complications, we suggest that bone graft epiphysiodesis is at least as good as multiple pin fixation in the treatment of slipped capital femoral epiphysis.
TL;DR: Subsequent fluoroscopic analysis revealed a verifiable correlation between the limited visualization of conventional X-ray analysis following the pinning of a slipped capital femoral epiphysis and unrecognized pin penetration.
Abstract: Over a 3-year follow-up period, 63 hips (in 49 patients) that were pinned as treatment for slipped capital femoral epiphysis were examined and evaluated. A 36.8% incidence of unsuspected pin penetration was discovered. Four types of experimental models representing different degrees of severity of slipped capital femoral epiphysis were designed and manufactured in the bioengineering laboratory. In situ pinning was performed on each model. An extensive series of controlled test films on the models indicated the difficulty of accurately determining the true position of the pins with conventional roentgenographic views. Subsequent fluoroscopic analysis revealed a verifiable correlation between the limited visualization of conventional X-ray analysis following the pinning of a slipped capital femoral epiphysis and unrecognized pin penetration.
TL;DR: Hereditary tendo Achillis contracture is an autosomal dominant condition with variable expression that is a relatively benign condition that is both a cosmetic and functional problem for the patient.
Abstract: Summary:A study was performed on eight patients with tendo Achillis contractures. Family histories were obtained and a short regimen of casting was performed. Hereditary tendo Achillis contracture is an autosomal dominant condition with variable expression. It is a relatively benign condition that i