Biomedical subjects
Publications and source records attributed to M Napiontek.
The authors describe two children with spondylometaphyseal dysplasia, Sutcliffe type. This easily recognizable form of bone dysplasia is characterized by coxa vara, minimal metaphyseal changes, oval vertebral bodies and metaphyseal corner fractures later in life. It is probably the most common type of spondylometaphyseal dysplasia. Early diagnosis is important for proper management.
A new term called "femoral head anteposition" to describe the clinical appearance of a hip operated on because of CDH and suspected of anterior dislocation, has been introduced. CT scans of both the horizontal and sagittal planes of 22 hips suspected of iatrogenic anterior dislocation were made from 22 children. These had been operated on because of CDH by the open reduction method with derotation varus osteotomy of the femur and transiliac osteotomy by Dega. An evaluation of the CT scans combined with clinical examination allowed the differentiation of the homogeneous clinical appearance from the "anteposition". It was then possible to establish one or several coexisting reasons to the situation. These were: anterior dislocation of the hip, coxa magna after avascular necrosis, gluteal muscle fibrosis or periarticular ossifications.
CT examination of 9 patients with primary thoracic right sided scoliosis aged from 13 to 19 years (15 years and 4 months on an average) was carried out. The angle of curvature (Cobb method) ranged from 38 degrees to 99 degrees (68 degrees on an average). Rotation of the apical vertebra was measured and torsion evaluated. Rotation ranged from 5 degrees to 28 degrees (17 degrees on an average). No relation among rotation, angle of curvature and size of the hump was found. The directions of rotation and torsion were opposite. At the apex of curvature due to torsion the end of spinous process was deviated towards the hump but the vertebrae into opposite direction.
The technique of congenital clubfoot surgical treatment based on independently described method by Mc Kay and Simons is delineated. We have modified skin incision making it ca 2 cm above the calcanean tuber in order to facilitate an access for elongation of the calcaneal tendon. In some cases the procedure was supplemented with cuneonavicular and first tarsal-metatarsal capsulotomy and tibialis anterior muscle tendon transfer to the dorsum of the first metatarsal bone.
Six children with paralytic drop foot, which developed after intramuscular injections and who had co-existing gluteal fibrosis are presented in this study. Paralytic drop foot was diagnosed on an average of 5.5 months after intra-gluteal injections. This was the major therapeutic problem. The diagnosis of gluteal fibrosis was made on an average only 3 years and 7 months later. In 3 cases the external rotation and abduction contracture of the extremity in the hip joint, caused by gluteal fibrosis, with active plantar flexors and supinators of the foot could contribute to the recurrence of the equinovarus deformity of the surgically corrected foot.
Two cases of aseptic osteochondrosis ischiopubica in a 6-years-old girl and a 10-years-old boy have been presented. In the described cases the radiological and clinical picture was the reason of diagnostic difficulties suggesting diagnosis of tumor and hematogenic osteitis.
Fifty-five patients with primary thoracic dextral idiopathic scoliosis treated by the Harrington method were studied. Posterior spondylodesis involved 8-14 vertebrae. Immobilization by a plaster-of-Paris jacket after operation was employed for 7-11 months. The mean follow-up was 14 years and 8 months. The studies were based on the clinical, radiological, and photogramometric evaluation of patients before operation, at one year after operation, and at least 5 years after operation. Two groups of patients were considered: with spondylodesis involving 8-10 vertebrae (25 patients) and 11-13 vertebrae (29 patients). In the analyzed material, better compensated posture occurred in the patients with posterior spondylodesis of 8-10 vertebrae and in whom the lower distractor hook rested on the L1-L2 vertebral arches, and when biological maturity of the spine was medium or advanced, and the age at operation ranged from 14 to 18 years and 4 months.
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Thirty-one children with 49 feet after successful nonoperative treatment for congenital talipes equinovarus (CTEV) by redressements, hypoallergic adhesive bands, and plaster casts underwent follow-up. At the follow-up, the patients ranged in age from 4.2 years to 12.3 years (average, 8.3 years). The initial type of the deformity was as follows: type I (mild), 18 feet; type II (intermediate), 29 feet; type III (severe), two feet. Mild supination of the forefoot in five feet, isolated excavation in three, and adduction greater than physiological in two feet were the only persistent elements of the deformity. The lack or restriction of the dorsal flexion in the ankle were noted in 22 feet. In only three feet was the Beatson-Pearson index was < 40 degrees. In 17 feet, the radiographs revealed full talonavicular reduction in sagittal and horizontal planes. The average value of the talometatarsal first and tibiocalcaneal angles as in accordance with the standard. The most characteristic osseous disturbances concerned the tarsal navicular (22 feet) and consisted of the decrease of the ossification center, its flattening, fragmentation, cystic-like changes, and wedging.
Fourteen children (19 feet) ranging in age from 2.1 to 17.0 years (mean, 7.6 years) underwent tibial osteotomy for treatment of congenital talipes equinovarus (CTEV). The indications for tibial osteotomy were persistent or recurrent equinovarus deformity and internal rotation of the foot (medial malalignment syndrome), in most cases with severe distortion of the hindfoot joints resulting from previous operations. In 12 feet (9 children), bi- or triplanar supramalleolar osteotomy for the correction of all the elements of the deformity was performed. In the remaining cases, external rotation tibial osteotomy below the tuberosity in five feet (three children) and supramalleolar in two feet (two children) was performed. The follow-up ranged from 1 to 16 years (mean, 4.3 years). Partial or full improvement, concerning one or more elements of the equinovarus deformity, has been achieved in 11 feet (nine children). In eight feet (five children), tibial osteotomy did not improve the deformity. There are exceptionally rare indications for use of tibial osteotomy in the treatment of CTEV or medial malalignment syndrome after failed clubfoot surgery. They concern older children and adolescents with secondary osteoarthritis of the feet resulting from previous multiple operations.