Biomedical subjects
Publications and source records attributed to P Michno.
The authors present two cases (two boys, aged 11.5 and 13.5 years) with traumatic dislocation of the shoulder following traffic accidents. Proper diagnostic management and closed reduction gave good final results. A review of literature on this type of dislocation, rarely seen in children is presented.
The authors present a review of the literature and the diagnostic difficulties in a case of melorheostosis in a 6 year old boy. Melorheostosis is characterized by longitudinal foci of subcutaneous sclerosis, limitation of motion in the joints and swelling of the knee and ankle joints. Radiologically numerous foci of hyperostosis similar to wax flowing down a burning candle have been noted.
The paper presents the experience of the authors in employing reciprocal gait orthoses in a group of 23 patients age 3-25 years (mean age 7.8 years). The orthoses were indicated in patients with flaccid paresis (17 children with myelodysplasia and 3 patients with traumatic paraplegia) and with arthrogryposis (3 patients). The follow-up period was 6 months to 5 years (mean 2.4 years). The authors discuss the principles of construction and operation of reciprocal gait orthoses and types of patients in whom they are recommended. The principles of learning walking and using the orthosis are also presented.
Results of surgical treatment for congenital cleft foot in 3 patients (5 foot) are reported. Two foot were classified type IIIA, 1--IIIB and 2--IVB according to Blauth and Borisch. Mean age of the patients at the surgery was 97 months, mean follow-up was 39 months. Wedge resection of the metatarsals with screw fixation was followed by performing skin syndactyly in all patients. No complications occurred, all patients wear commercial shoes and are satisfied with the result of surgery.
Five children with congenital posteromedial bowing of the tibia and fibula and 1 child with posterior bowing of the tibia and fibula have been followed-up. At the final examination age of the patients ranged from 6 months of 16 years (mean 69 months). In most of the cases the angulation had a tendency to decrease, shortening of the tibia remained constant. Pseudoarthrosis appeared in one of the children in 4th month of life at distal tibial diaphysis/metaphysis junction but healed spontaneously in 13 months time.
The authors discuss the possibility of ambulation of children with myelodysplasia, employing different types of orthopedic devices. According to the personal experience of 23 myelodysplastic patients, the indications and results of using reciprocal gait orthoses have been described. The paper emphasizes the significance of interdisciplinary team in the treatment of this disease.
A case of a child with duplicated lumbar spine and concomitant multiple defects within alimentary tract, urogenital system, deformities and pareses of lower extremities is presented. After many operations, at the age of 5 he could walk unaided for 300 meters.
Van Nes rotation plasty was done in 5 children with congenital proximal femoral focal deficiency. Mean age at the operation was 8.7 years (range 38 months-16 years), mean follow-up was 16 months (6-30 months). In 3 children full rotation at the level of knee joint was done; in 2 cases additional rotation at the level of tibial shaft was necessary. No neural and vascular complications were observed. In all children the ankle is at the level of the knee of normal extremity. The range of flexion of the prostetic knee is between 70 degrees and 90 degrees. The review of the literature concerning the treatment of the most severe cogenital proximal femoral deficiencies is presented.
Deformities locomotor system in 24 children who have been operated on because of lipoma of conus medullaris are presented. At follow-up examination 6 patients were deformity free. The remaining group had feet deformities either present at birth or developed on average in 19th month of life. They mostly progressed and tended to recur after surgical correction. Trophic skin ulcer or chronic osteomyelitis of the foot was present in 30% of children; in 17% of cases they induced amputation. In 60% of cases scoliosis was found with mean angle of 10.2 degrees.
Forty-four bone scintigraphies were done in 37 children with diagnosis or suspicion of Perthes disease. In 5 children with transient coxitis 3 hips were normal and 2 presented slightly increased uptake. In 13 cases of epiphyseal dysplasia 12 hips were normal; one presented decreased uptake. Nineteen Perthes cases showed typical uptake deficits; 3 joints showed slight increase of uptake, 3 joints were normal. Scintigraphy was related to different stages of Perthes disease. The value of bone scintigraphy in Perthes differentiation and monitoring was discussed.
Results of treatment of 83 septic hip joints in 75 newborns and infants have been presented. Mean age at the onset of symptoms was 41 days (from 1 to 330 days), mean follow-up was 72 months (from 12 to 252). In 26 cases systemic antibiotics were administered. Single joint puncture was done in 7 cases, in 23 patients multiple puncture and intraarticular antibiotic therapy were employed, arthrotomy and drainage of the joint was performed in 27 joints. Radiographic results achieved, according to Hunk classification were as follows: Type I-26 joints, Type IIA-6 joints, Type IIB-18 joints, Type III-5 joints, Type IVA-7 joints, type IVB-8 joints, Type V13 joints. The authors conclude, that in majority of cases the treatment of choice should include arthrotomy from antero-lateral approach, suction drainage for 24-48 hours, systemic intravenous antibiotic therapy, abduction position of extremity in Frejka pillow and early physiotherapy.
Results of treatment of 55 acute hematogenous arthritis of the shoulder in newborns and infants are presented. There were 14 good results, 15 fair and 26 poor ones. The authors consider arthrotomy as the most efficient mode of treatment.
Double-contrast arthrography of the knee was performed on 16 knees in 14 children, who after septic arthritis of the knee in newborn and neonatal period, showed defects of the secondary ossification centers of the femur or tibia on plain radiographs. Cartilaginous epiphysis, normal in shape and volume, was present in 11 cases. In 3 cases cartilaginous epiphysis of the femur was present, but had diminished size.
Abduction contracture of the hip has been treated by two methods; the results of both have been compared. Modified Campbell's procedure has been performed in 5 children (6 hips). In 8 patients (9 hips) gluteal fascia and fibrotic scarring within the gluteal muscles has been transversely dissected. The mean follow-up was 26 months in either group. Dissection of the fascia and the scars resulted in doubled range of adduction and better cosmetic result compared to Campbell's method.
Septic arthritis in 99 newborns and 58 infants was analyzed epidemiologically. Multiple localization of septic process has been found in 37.4% of newborns and 16.0% of infants included in this study. The hip joint, knee and shoulder were affected most frequently in both groups. In 45.2% of newborns septic condition of the skin and in 37.1% otitis media was the source of infection. In infants septic arthritis was related to otitis media in 36.8%, septic condition of the skin in 23.3% and respiratory tract infection also in 23.3%. Staphylococcus aureus was the most frequent joint aspirate culture finding.
Chronic recurrent multifocal osteomyelitis is a rare entity with obscure etiology. A review of literature concerning clinical appearance, diagnostics and management of this condition is presented. Own material embraces a group of 7 children who have chronic recurrent multifocal osteomyelitis. Mean follow-up was 2.5 years. On the basis of results achieved the authors believe this condition is of good prognosis and should be differentiated with chronic osteomyelitis and neoplastic changes.
The long-term results of the lateral humeral condyle fracture treatment in 35 children are presented. The mean follow-up was 8.2 years. There were 31 good results and 4 poor. The most common errors and complication are discussed.
The method of closed reduction and percutaneous K-wire fixation has been used for treatment of 20 children with displaced supracondylar fracture of the humeral bone. No infection, vascular or neural complication has been observed. In all cases good clinical and radiological results have been achieved. The authors conclude the method presented above should be used as a treatment of choice for displaced supracondylar fracture of the humerus in children.