Biomedical subjects
Publications and source records attributed to T Hallel.
Two cases of osteochondritis dissecans of the talar dome treated by closed percutaneous drilling are presented to illustrate a procedure for high-risk patients. The operation is performed with the aid of an image intensifier. The ostoechondral fragment is percutaneously drilled to avoid open operation and osteotomizing the medial malleolus.
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Premature fusion of the triradiate cartilage was obtained surgically in 10 three-week-old rabbits, and compared with isolated fusion of the ilio-ischial and of the ilio-pubic limbs of the triradiate cartilage in two further groups of 10 rabbits. Complete fusion caused acetabular dysplasia five weeks after operation in all animals and hip dislocation at nine weeks in half of them; ilio-ischial fusion had a comparable effect. Ilio-pubic fusion had only a minimal effect on acetabular development. The posterior position of the ilio-ischial limb in the acetabulum and its predominance in the formation of the triradiate cartilage in quadrupeds may have contributed to its decisive effect on acetabular development.
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A 73-year-old woman with fatigue fracture of the right pubic rami following total hip arthroplasty had a long delay to union. Discrepancy in leg lengths due to nonunion of an intertrochanteric osteotomy of the contralateral hip may have contributed to the fatigue fracture of the pubic rami. The postarthroplasty fatigue fractures in patients reported in the literature were of the compression type and healed within a few weeks. In the patient reported here, the fracture was of the distraction type and was characterized by failure of callus formation with slow healing requiring two years to union.
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Twenty-four hips in 21 patients suffering septic arthritis at infancy were followed 11-30 years (mean 17 years). Fourteen hips with none to moderate femoral head destruction proved to have a fairly good chance of becoming located following closed treatment. If it failed, open reduction was successful, provided the femoral head-neck was big enough to achieve a stable reduction. Out of the 10 hips with absent femoral head-neck and an iliac dislocation, 6 underwent trochanteric arthroplasty: 3 hips remained located though with limited motion, and one of the 3 became painful requiring arthrodesis. Two redislocated and one subluxated. Following infantile septic arthritis, the proximal femur may remain cartilaginous during the first years of life. Arthrography did not prove helpful in evaluating the hip damage, nor the remnant bone stock. During this stage, push-pull X-rays seemed the most reliable method to assess joint location. Only surgical exploration gave a definite evidence of the amount of hip destruction. If the hip persists unstable after the septic process is well under control, surgical exploration is indicated, at about one to 2 years of age. Open reduction should be performed if there is sufficient head-neck to achieve a stable reduction. Otherwise, a trochanteric arthroplasty seems the procedure of choice followed by a varus osteotomy if there is progressive subluxation. If successful, it will provide a stable joint, less length discrepancy and a limited motion which seems preferable than accepting a high iliac dislocation. It will also offer a better anatomical condition for joint replacement, if indicated at a later age.
Traumatic premature fusion of the triradiate cartilage is a rare complication of fractures of the pelvis in children. Only five cases were reported, leading eventually to subluxation of the hip. A case of premature closure of the triradiate cartilage where the injury occurred at the age of four years is reported. Severe hip subluxation with marked shallow acetabulum and widening of its medial wall was noted at the age of 15 years. Intrapelvic epiphysiodesis of the triradiate cartilage, without disturbing the hip joint, was performed in young rabbits, leading to thickening of the acetabular medial wall and subluxation of the hip. Fusion of the triradiate cartilage in young age leaves the growth plate inside the acetabulum intact, it continues to grow, displacing the acetabulum laterally. As the acetabulum becomes more shallow, the hip progresses to subluxation.
Osteochondritis dissecans of the femoral head occurs as a rare complication in the late onset of Legg-Perthes disease. The etiology of this complication is uncertain. Theories include: (a) persistence of an ununited fragment and (b) fragmentation of the femoral head weakened by revascularization accompanying healing. The area of osteochondritis dissecans may not be readily apparent on routine radiographs and a high index of suspicion is necessary for diagnosis. Four cases of osteochondritis dissecans of the hip presenting 6--18 years after the diagnosis of Legg-Perthes disease are described. Three patients were studied by arthrography, and the findings correlated well with symptomatology.
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In a retrospective study of 83,718 consecutive parachuting jumps effected in the Israeli Defence Forces, an injury rate of 6.26/1,000 jumps was observed. About two-thirds of the injuries were light. Injury rates were calculated according to type of jump (free jumps, basic course, refresher jumps, and maneuvers jumps) and time of jump (day or night). A significant difference was found between the injury rate by day (4.62/1,000) and night (11.25/1,000). The lowest injury rate was observed among free jumpers (2.96/1,000) and highest during maneuvers jumps at night (25.75/1,000). The injury rate during the basic parachuting course was 4.04/1,000, and 8.24/1,000 in refresher jumps. Clinical data collected on 723 parachuting injuries included the site and type of injury. More than 90% of the injuries were caused during the landing impact. The most vulnerable sites were the ankle (35.6% of all injuries) and the spinal vertebrae (14.5% of all injuries).
A medial discoid meniscus with cystic formation was found in a 9-year-old girl. The cyst was located in the anterolateral part of the meniscus, mechanically blocking knee extension. The presenting symptom was knee flexion contracture. Total meniscectomy was followed by full recovery.
The cruciate ligaments (and the intercondylar eminence of the tibia) should be removed when the knee is replaced. A mechanically unlinked prosthesis can be designed which will then be capable of restoring "cruciate" stability, i.e., anteroposterior stability of the tibia in the flexed knee. A knee replaced with such a prosthesis will only be stable if the prosthesis is inserted using the correct instruments and technique. Stability depends as much on precise surgical technique as it does on prosthetic design.
Bilateral epiphyseometaphyseal cupping of the distal femoral epiphysis occurred in a 9-year-old girl with a history of infantile scurvy. This rare condition is characterized by a cup-shaped depression of the metaphyseal end, growth disturbance at the distal femoral epiphysis and knee flexion contracture which develops slowly over many years of bone growth. Conservative treatment by corrective plasters and back slabs brought about recovery of the right knee flexion contracture and halted the growth disturbance. However, in the left knee, extension supracondylar femoral osteotomies had to be performed and severe growth disturbance of the distal femoral epiphysis led to premature epiphyseal fusion.
In 136 fatigue fractures in military recruits, 58 were in the femoral shaft and 43 were in the tibia. Fatigue fractures in the long bones of the lower limb can be classified on the extend of the periosteal reaction. Most were grade 1, showing periosteal reaction only on one or two cortices as seen on the anteroposterior and lateral projections of the roentgenograms. Physical activity was discontinued immediately when fatigue fracture of the femur or tibia was suspected on clinical grounds alone. Early clinical diagnosis the long bone fatigue fractures in all patients except one. The injured soldiers were ambulatory without plaster cast immobilization or crutches. The suggested classification was used to select patients with Grade 1 fatigue fracture for early resumption of active military training.