The author differentiates between prepubertal necrosis of the upper femoral epiphysis and Perthes' disease in children. A number of clinical and roentgenological factors are decisive in distinguishing between the two conditions. Prepubertal epiphysial necrosis is always quickly followed by severe hip deformity which, in contrast to Perthes' disease, cannot be corrected by any therapeutical means. Early osteoarthritis must be expected in all cases. The author discusses several therapeutic possibilities which have not yet been tested and which, in case which are diagnosed early, could have a positive effect.

Adolescent↗

PubMedDate not supplied

[Eccentric ossification of the femur head epiphysis in hip dislocation; consequences for diagnosis and therapy].

Ossification of the upper femoral epiphysis is dependent on biomechanical laws. In babies with normal hips, the osseous nucleus develops in the centre of the epiphysis. In babies with hip dislocation, however, the altered biomechanical factors result in a different location of the nucleus. Ossification begins in a more lateral and cranial position. After reduction of the dislocated hip, either a second nucleus forms and grows together with the first nucleus, or the eccentric nucleus extends in a caudal direction. Both of these alternatives are physiological processes and should not be confused with necrosis of the epiphysis. The eccentric development of the nucleus is hardly mentioned in the modern literature, but it is of the greatest importance for diagnosis and therapy. Ignorance of the phenomenon of eccentric ossification may lead to a false assessment of the position of the femoral head. This mistaken impression may be heightened by an inappropriate X-ray technique: only by using techniques which take into account that the middle rotation position in children is different from that in adults can mistaken diagnoses and unnecessary operations be avoided. Examples are presented.

Cartilage, Articular↗

PubMedDate not supplied

[Is synovectomy a sure treatment procedure for synovial osteochondromatosis?].

In recent literature synovectomy is recommended for treating osteochondromatosis. In the case of a 25-year-old woman with an affected knee joint, who was treated with synovectomy, the authors observed recurrence 5 years later. Ten years after the operation a severe osteoarthritis had developed. Our experience suggests that this method should not be overestimated. F. Kroh came in 1932 to the same conclusion.

Adult↗

PubMedDate not supplied

[Treatment of severe concave clubfoot in neural muscular atrophy].

The deformity with which this neurological condition first shows itself is the pes cavus. During the period of growth a severely instable cavovarus deformity develops. The author avoids operations on children because the results are usually poor; the basic problem cannot be resolved with surgical measures. He recommends that the affected feet be immobilized by plastic boots until puberty is reached, at which time only minor bone resections for correcting the form of the feet are necessary. In cases of severe cavovarus deformity in early adulthood the author does not use the usual treatment, triple arthrodesis, but operates according to a technique developed by himself: a wedge osteotomy of the Chopart joints is performed to the degree necessary to permit an exact correction of the deformity. In cases of pronounced deformities, the wedge must include the entire navicular bone. After the resection the heel automatically assumes a neutral position and subtalar stability is achieved. In a number of cases the Achilles tendon must be lengthened after wedge resection. To make possible dorsal extension of the operated foot it is necessary to translocate the tendon of tibialis anterior to the base of metatarsus V. If the tibialis anterior muscle is weak or paralysed, we translocate the tendon of tibialis posterior. Instead of running this tendon through the interosseous route, we lead it subcutaneously to the distal part of the forefoot. Preoperative toe deformities are much less pronounced following the operation, and only in rare cases is correction of the first toe necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Achilles Tendon↗

PubMedDate not supplied

[Remarks on the study: M.H. Hackenbroch and G. Torwesten: "Results with the Cologne treatment plan in epiphysiolysis of the juvenile femoral head" Z. Orthop. 128 (19910) 422-425].

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Child↗