Biomedical subjects
R Asirvatham
Publications and source records attributed to R Asirvatham.
Solitary infantile myofibromatosis of axis. A case report.
Lytic lesions of the cervical spine are rare and may be caused by infection or tumors. The authors report a rare case of solitary infantile myofibromatosis presenting as a lytic lesion of the second cervical vertebral body (C2) and odontoid, causing atlanto-axial instability.
Ossifying parosteal lipoma with exuberant cortical reaction. A case report.
Lipomas lying close to bone are called parosteal lipomas. They usually cause some bone reaction. We are reporting a dramatic example of this rare condition and have discussed the differential diagnosis and management.
Hypertension after surgical release for flexion contractures of the knee.
We reviewed retrospectively 94 patients who had undergone soft-tissue release to correct flexion contracture of the knee to determine the incidence of postoperative hypertension. The cause of contracture in most patients was cerebral palsy (45) or old poliomyelitis (39). Twenty patients developed persistent hypertension. Two of them were symptomatic, one developing hypertensive encephalopathy. Patients who had had poliomyelitis were at a higher risk than those with cerebral palsy; the risk increased with bilateral procedures. The amount of correction achieved had no influence on the incidence of hypertension.
Giant cell tumour of bone. A surgical approach to grade III tumours.
Thirty-one patients with giant cell tumours of bone (BGCT) were treated at our hospital by a conservative approach between 1975 and 1988. 94% of the tumours were grade III (Campanacci) and the follow up was from 2 to 13 years. In the 20 patients who had a modified intralesional excision (curettage) with bone grafting and cement, 5 recurrences occurred. There was one soft tissue recurrence in the 11 patients who had marginal or wide excisions. All recurrences were in grade III lesions. We conclude that grade III BGCT can be treated by modified intralesional excision provided the articular surfaces and part of the metaphysis are intact.
Primary resection total knee arthroplasty for complicated fracture of the distal femur with an arthritic knee joint.
Treatment of fractures of the distal end of the femur in an elderly patient is difficult. If the knee joint is arthritic, the problem is even greater. The reports of two patients with rheumatoid arthritis who sustained fractures of the distal end of the femur and underwent unconventional treatment with a resection total knee arthroplasty are presented.
Stabilization of the interphalangeal joint of the big toe: comparison of three methods.
Three methods of stabilizing the IP of the big toe were compared. In group A, 10 patients underwent tenodesis of the extensor hallucis longus to the extensor digitorum brevis tendon. All of them developed a toe-drop; two patients had significant symptoms that required IP fusion. In group B, 19 patients underwent IP fusion using smooth or threaded intramedullary Kirschner wire fixation. There were nine nonunions, three requiring refusion. In group C, 32 patients underwent IP fusion using intramedullary screw fixation. There was one nonunion with screw failure that required revision. Although none of our patients considered the toe-drop after extensor hallucis longus tenodesis cosmetically unacceptable, this may not be so in other cultures. All complications following IP fusion with screw fixation were technical and are avoidable. When stabilization of IP is required, we recommend fusion of IP with screw fixation.
Ollier's disease with secondary chondrosarcoma associated with ovarian tumour. A case report.
The association of an ovarian tumour with Ollier's disease or the Maffucci Syndrome is rare. We report what we believe to be the first patient with Ollier's disease associated with an ovarian tumour who later developed a secondary chondrosarcoma.
Rotation osteotomy of the tibia after poliomyelitis. A review of 51 patients.
After severe poliomyelitis, which is still relatively common in some developing countries, lateral rotation deformity of the tibia may occur. We have reviewed 51 patients treated by O'Donoghue's rotation osteotomy of the tibia. An average lateral rotation deformity of 57 degrees was fully corrected in all the patients, and in 38 of them the graft obtained during the osteotomy was used for a simultaneous Grice-Green subtalar arthrodesis in one or both feet. All the osteotomies united in an average of 11 weeks, some with relatively minor and unintentional posterior angulation. There was no posterior angulation when the length of the step cut osteotomy was 4.5 cm or more. O'Donoghue's osteotomy is a simple and safe operation, being particularly advantageous if a Grice-Green procedure is also required.
The reliability of sterilising Esmarch bandages.
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Extensor hallucis longus coaptation to tibialis anterior: a treatment for paralytic drop foot.
Between June 1982 and April 1983, a procedure to coapt the extensor hallucis longus (EHL) to the tibialis anterior was performed in eight post-polio patients to correct drop foot and to enable the EHL to be a more efficient dorsiflexor of ankle. Although at early follow-up, every patient was able to actively dorsiflex the ankle against gravity, at final review, (mean follow-up 7.8 years), only two patients could still do so. Three patients developed a cock-up toe deformity or dorsiflexion deformity of great toe. We have attributed the poor final results to stretching of the coaptation. Use of splints or orthosis for a longer period postoperatively and a more carefully designed physical therapy may have yielded better results. Alternatively, if the EHL is anchored to navicular bone better results may be obtained.
Proximal tibial extension medial rotation osteotomy to correct knee flexion contracture and lateral rotation deformity of tibia after polio.
A proximal tibial extension medial rotation osteotomy was performed on 17 tibias in postpoliomyelitis patients to correct knee flexion contractures simultaneously with the correction of lateral rotation deformity of the tibia through the same osteotomy. Gait improved in 10 patients. Five patients developed recurrence of knee flexion contractures; five more developed greater than 20 degrees genu recurvatum. One patient developed a common peroneal nerve palsy. Because of the high incidence of complications, we recommend that this procedure be abandoned.
Tendoachilles tenodesis to the fibula: a retrospective study.
Tendoachilles tenodesis to the fibula was performed in postpolio patients to improve their gait. The charts of 48 patients with 52 tenodeses were reviewed. The mean follow-up was 5.5 years. Gait improved in one-third. When the hindfoot was stabilized, gait improved in 40% of the patients, but when it was not stabilized, only 22% improved their gait. Excessive equinus developed in 18 patients, all of whom were less than age 12 years when operated. We conclude that it is reasonable to use this procedure to improve the gait of postpolio children with flail lower extremity, provided the hindfoot is stabilized.
Supracondylar femoral extension osteotomy: its complications.
Between 1979 and 1989, 105 supracondylar extension osteotomies of the femur were performed to correct knee flexion contractures. Disturbed by serious neurovascular complications, we reviewed our experience. Besides other complications, nine patients developed serious neurovascular complications; seven had permanent residua. There was no correlation between neurovascular complications and degree of preoperative contracture, patients' ages, or scarring from previous operation. We conclude that this osteotomy, although it appears to be technically simple, is potentially dangerous. We propose that the osteotomy be internally fixed and that the knee be flexed to relax the posterior neurovascular structures.
Idiopathic forefoot-adduction deformity: medial capsulotomy and abductor hallucis lengthening for resistant and severe deformities.
Between February 1981 and March 1993, 18 children (29 feet) with resistant forefoot adduction underwent medial capsulotomy and abductor hallucis lengthening for correction. There were 12 feet with metatarsus adductus (two simple, 10 complex) and 17 feet with skewfoot (15 simple and two complex). The mean age at the time of operation was 3.6 years (range, 9 months-5.5 years). When seen 3.6 years (range, 1-8) after surgical correction, all of them showed an improved talofirst metatarsal angle. Two children complained of pain in the foot, and one child had persistent difficulty with shoe fitting. We conclude that medial capsulotomy and abductor hallucis lengthening is a simple procedure that is effective in improving metatarsus adductus deformity.