Biomedical subjects
T Lejman
Publications and source records attributed to T Lejman.
[Treatment of congenital clubfeet by the Goldner method].
The authors present an overview of Goldner's concept of clubfeet pathology and treatment. Goldner stresses the role of the talus in this foot deformity. According to this author full correction of the deformity can be achieved only by posterior, medial, plantar and lateral release.
Jansen type of spondylometaphyseal dysplasia.
Metaphyseal dysplasia, type Jansen (JMD), is a rare skeletal dysplasia with characteristic radiographic abnormalities. Of the various types of metaphyseal dysplasia, JMD shows the most severe alteration in metaphyseal architecture. All of the long tubular bones, including those of the hands and feet, show metaphyseal irregularity with a fragmented appearance and slight widening. The adjacent physes are abnormally widened, while the epiphyses tend to be slightly enlarged, rounded but otherwise normal. The spine in infancy and childhood usually appears normal. This report describes a young girl with metaphyseal changes typical of JMD except for the hands and feet, which appeared normal. She also showed very unusual abnormalities of the spine. This appears, therefore, to represent a unique osteochondrodysplasia for which we propose the term spondylometaphyseal dysplasia, type Jansen.
[Results of treatment of traumatic elbow dislocation in children].
Between 1987 and 1997 the authors treated 49 children with traumatic dislocation of the elbow joint. The study presents the results of treatment of 26 children, mean age of 10.7 years (ranging from 5.5 to 14.5 years) at the time of trauma. The mean follow-up time was 4.3 years (ranging from 1 to 10.5 years). In one case an anterior dislocation was observed, while in the remaining cases posterior dislocation was diagnosed. Twenty-five children were treated with closed reduction of the dislocation, followed by immobilization in a plaster cast. One case with a chronic dislocation was treated surgically. Concurrent injuries were observed in 18 (69.2) children. The most common concurrent trauma was a fracture of the medial epicondyle (44% of cases with additional trauma). The following additional fractures were also noted: fracture of the lateral epicondyle, fractures of the forearm, of the neck of the radius, of the olecranon, epiphyseolysis of the distal epiphysis of the radius with a concomitant fracture of the medial epicondyle. In 19 cases very good result was achieved. In 7 cases sequels of the dislocation were noted. These were: in 3 cases flexion contractures (5 degrees, 10 degrees, 15 degrees) of the elbow joint, in two cases periarticular ossification (in 1 case this entity was treated surgically with very good result), in 1 case an asymptomatic non-union of the medial epicondyle with a 30 degrees flexion contracture in the elbow joint, and in 1 case (treated surgically) a 90 degrees flexion contracture with a movement range up to 105 degrees with degenerative changes visible on X-ray in the joint was noted.
[Intraoperative sectional anatomy of congenital absence of tibia type I A].
Intraoperative, angiographic and preparation findings within lower leg and foot of a child with tibial hemimelia type IA according to Jones are presented. Disarticulation at the knee has been performed bilaterally. Dysplasia of the distal femur, absence of the patellae, extensor apparatuses and cruciates were found. Amputated preparation revealed fibrotic band attached via interosseus membrane to the fibula, presence of unidentified muscle attached to the tip of the lateral malleolus, doubled tibialis anterior muscle on one side and accessory extensor digiti II. Talocalcaneal synostosis was bilateral, abnormal cuboids and accessory bones were found. Popliteal artery division was found at the mid-length of the fibula. Unidentified thick nerve passed the lateral ankle and divided at the sole of the foot.
[Orthopedic problems in children with congenital insensitivity to pain].
Three children with congenital insensitivity to pain are described. Self-injuries of the tongue and fingers occurred during dentition. At infancy and early childhood fever of unknown origin and/or pneumoniae were observed in all children. All of them also suffered from osteomyelitis of various bones treated with antibiotics and surgery. The tibia and metatarsals were involved in one case, the tibia, metatarsals and the femur in second child and the jaw plus metatarsals in the third case. In one child the hip has been dislocated twice after minor trauma, lumbar arthropathy, distal femoral epiphyseal fusion causing shortening of the extremity by 4.5 cm, osteochondritis dissecans of the medial femoral condyle, elbow deformity after displaced fracture of the lateral humeral condyle and post-traumatic cataract were observed.
[Orthopedic management in children with fibrous dysplasia of bone].
The method and results of treatment in 9 children with fibrous dysplasia of bone and 3 children with Albright syndrome are presented. Curettage and filling of the defect with autologous and/or lyophilized grafts failed in all 5 attempted cases. Due to pathological fracture or deformity Rush nailing combined with multilevel osteotomies has been performed within 5 femoral bones and 4 tibial bones. Healing was undisturbed, neither fracture nor deformity recurred. Valgus osteotomy has been done in 2 children with pseudoarthrosis of the femoral neck. In one case osteotomy healed, in another bony union is not completed yet but the neck-shaft angle remained unchanged. In authors' opinion curettage and grafting proved ineffective; Rush nailing rendered good results in both fracture and deformity treatment.
[Transient osteopenia of the hip in children].
The course and results of treatment of 4 boys with transient osteopenia of the hip are presented. Mean age of patients at the onset of symptoms was 9 years 5 months (range 5 years 3 months-14 years 6 months). Pain at exertion and limp dominated in all cases. Quadriceps atrophy was a constant finding and hip rotation was restricted in 3 cases. Laboratory findings were normal except for the elevated ESR. Radiography and CT showed diffused osteopenia within femoral neck and head. Bone scan was abnormal in 3 cases. Weight bearing restriction and exercises introduction resulted in ceasing of the symptoms within 3 months.
[Percutaneous epiphyseodesis for treating limb length inequality in children --results after termination of growth].
Results of percutaneous epiphyseodesis for limb length egalization in 25 children (10 girls and 15 boys) after termination of growth are presented. Mean age at the surgery was 12.9 years (range 10.9-14.4 years), mean limb length discrepancy 4.3 cm (range 2-10 cm), mean follow-up was 50 months (range 14-86 months). In 17 cases distal femoral epiphyseodesis was done, in 7 cases distal femoral, proximal tibial and fbular and in 1 case only proximal tibial and fibular epiphyseodesis was performed. In 13 cases CT served to assess the area of removed physis. Among complications knee hemarthrosis was encountered twice and once subcutaneous hematoma of the lower leg occurred. At the final follow-up full range of motion in the knee and correct axial alignment was observed in all cases. Residual limb length discrepancy was 1.3 cm (range 0-4 cm). Between 20 and 60% of total area of the physis was destroyed. Yearly rate of femoral bone growth inhibition was the same in patients with 27% and 40% of physis removed.
[Chondrosarcoma arising in a solitary osteochondroma--case report and literature review].
Treatment of 13 years old boy with chondrosarcoma arising in solitary osteochondroma located within distal 1/3 of the femur is presented. Two local, nonradical excisions resulted in dissemination of the tumor within soft tissues making salvage procedure unfeasible. An above the knee amputation has been performed. At 1.5 years follow-up no recurrence of the neoplasm have been found.
[Surgical treatment of congenital cleft foot].
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.
[Congenital posterior and posteromedial bowing of the tibia and fibula].
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.
[Treatment for recurrent clubfoot with the Ilizarov technique].
Jlizarov technique was used to treat 34 recurrent clubfeet in 31 children between 1993 and 1996. No additional surgery was done; various configurations of the distractor were employed. The age at the operation ranged from 2.5 to 14 years (mean 6.7) and mean follow-up was 22 months (range 9-31 months). Twenty-six results were rated good, 4 fair and 4 poor. The authors claim ilizarov method is contraindicated in cerebral palsy and meningomyelocele. The ideal arrangement of the distractor is hinge connection between all rings and semi-rings allowing for simultaneous correction of all components of the deformity.
[Focal fibrocartilaginous dysplasia of the femur. A case report and review of the literature].
A case of focal fibrocartilaginous dysplasia of the femur is presented. Varus femoral malalignment progressed from 30 degrees in 5th month of life to 51 degrees in 27th month of life. CT revealed flattening of the bone in the frontal plane, sclerotic marrow cavity with focal change resembling nidus of osteoma osteoides. Longitudinal defect filled with compact fibrous tissue was found below it. Corrective osteotomy has been done at the age of 32 months with good cosmetic result.
[Treatment of benign chondroblastoma].
Six children have been operated on due to benign chondroblastoma at the mean age at first operation of 14.2 years (range 11-17 years). Mean follow-up was 4 years (2-7 years). Mean delay of the diagnosis was 12 months (6-24 months). One-stage surgery was successful in child with proximal fibula involvement, child with distal femoral epiphysis involvement (knee arthrodesis followed), two children with proximal tibia involvement. In 1 case of distal femoral epiphyseal involvement two revisions were necessary, 1 similar case is in the course of treatment. At the follow-up three children presented with the knee pain and restricted range of motion.
[Osteopetrosis: a case report and review of literature].
A case of type II autosomal dominant osteopetrosis is presented. The boy was admitted to the hospital at the age of 7 years and 6 months due to bilateral leg pain. Apart from radiography no pathology has been found.
[Modified Van Nes operation for treatment of congenital proximal femoral focal deficiency].
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.
[Orthopedic problems in children after surgical treatment for lipoma of the conus medullaris].
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.