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In cases of hallux valgus tendon transfer combined with wedge osteotomy of metatarsus I yields good results. Considering the experience of 36 operated feet in 25 patients the operation can be recommended especially for young patients. An exact technique helps to avoid complications such as hallux varus and delayed ossification of the osteotomy.
Congenital metatarsus varus may be regarded as a deformity caused by a dislocation and in that respect is similar to congenital clubfoot and vertical talus but not to calcaneovalgus. The dislocation causes adaptive bone changes as well as secondary contracture of the soft tissues. That the dislocation in the forepart of the foot may occur in a maximally dorsiflexed foot also may explain the valgus position of the hindfoot. The secondary changes in bone and soft tissue may explain the lack of spontaneous recovery and the difficulties in effecting correction in severe cases. It is still not possible to explain why the dislocation arises.
Calcaneal varus or calcaneal cavus alone can be readily corrected, and the surgical procedure is not technically difficult. The author states that if the four basic points he describes are followed, good results will be obtained, and the osteotomy will heal in the desired position without incident. If other osseous deformities of the foot are involved, the deformities must be considered separately and in relation to each other, and other procedures may be necessary.
Varus derotational osteotomy of the femur is designed to correct coxa valga and femoral anteversion which contribute to progressive hip subluxation and dislocation in certain cases of cerebral palsy. By the application of a careful preoperative evaluation, vigorous postoperative rehabilitation and treatment of complications, satisfactory results were obtained in 17 of 20 patients followed for one to 17 years after osteotomy. No hip subsequently dislocated and dysplastic acetabulae were predictably remodeled in those patients less than 8 years of age.
The results of 254 Lance-acetabuloplasties in a modified technique combined withe detorsion-varus-osteotomy have been analysed. The children were operated upon in the years 1970-1974. Regarding the acetabulum the results were as follow: 1. In children between 1 and 6 years a normal acetabular index (as compared with the Normal Values of Tönnis and Brunken) was achieved in 78.3%, a slightly dysplastic index in 14.8%. In 6.6% a severe dysplasia remained. 2. In children between 6 and 10 years a normal acetabular index was found in 59.4%, a slightly dysplastic index in 24.3% and an index as classifies severe dysplasia in 16.2%. 3. In children older than 10 years and adults in 38.3% a normal Hip Value (Busse et al., Brückl et al.) was achieved, in 19.4% the value classifies a slight dysplasia, in 41.6% a severe dysplasia. These results show, that acetabuloplasty in the technique used here is a very effective method, especially in the first 6 years of life. But even in the older age groups significant improvement has been achieved. There for the indication of different operative techniques should be discussed again.
In brachial plexus paresis with partial sensory sparing in the upper arm and complete motor paralysis we amputate through the humerus at the distal limit of sensation. The remaining proximal humerus is fixed by an arthrodesis of the shoulder joint, combined with a varus-osteotomy below the head. This increases with axillary space, facilitates the fitting of a prosthesis and improves care of the skin in this critical area. It also improves the outline of the shoulder the muscles of which shrink.
The results of operation performed within the first six months of life upon seventy-seven resistant club feet are presented. The indications for and the rationale of early operation are discussed. Particular attention has been paid to the relationship between the age at operation and the outcome more than four years later; the results were greatly superior when operation was undertaken early. Two surgical techniques are compared, the postero-medial release proving better than a simple posterior release. The relationship between clinical and radiological assessment is discussed, and also the influence of the results reported upon future practice.
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Serologic investigations carried out in 254 children admitted to a Clinic for Children for respiratory diseases, established a diagnosis of infection with parainfluenza virus in 19.2% of cases. The predominant age-group affected was 7--12 months and 0--6 months; the causative agent in most cases was parainfluenza type 3, followed by type 2 and then type 1. The role of parainfluenza viruses in the aetiology of laryngotracheobronchiectasis was confirmed, as well as their participation in the aetiology of pneumonia in infants. The results also showed the wide circulation of parainfluenza viruses in children and their outstanding contribution to respiratory diseases among hospitalized children within a period of four years.
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