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PubMed1988

Scaphoid nonunion: role of anterior interpositional bone grafts.

Twenty-one cases of unstable fractures of the scaphoid were treated by open reduction, length restoration by interpositional anterior wedge grafting, and fixation with a Herbert screw to obtain union and restore carpal stability. There was primary union in 15 (71%) of 21 patients. Two failed cases were treated with a second anterior wedge graft and Herbert screw fixation; overall rate of union was 81%. Nonunions were related to improper screw placement, failure of compression at the nonunion, bone-graft resorption, or persistent avascular necrosis. In the united scaphoids, carpal instability was corrected, with improvement in the scapholunate angle (65 degrees to 54 degrees) and capitolunate angulations (35 degrees to 15 degrees). Scaphoid malalignment associated with nonunion was improved on biplanar tomographic measurement of the scaphoid angles.

Adolescent↗

PubMed1998

Digital replantation in children: a long-term follow-up study.

Twenty-six children aged from 14 months to 12 years had a total of 44 amputated digits replanted in our hospital between May 1979 and May 1985. The length of follow-up was from 9 to 15 years (average, 11 years). Among the 43 surviving digits, the mean total active motion of the thumb and fingers was 130 degrees and 151 degrees, respectively. Sensibility recovery was excellent, with normal 2-point discrimination in 88%. A mean of 19 of 20 preselected activities of daily living could be accomplished. Relative grip strength was 79% that of the normal side and the relative pinch strength was 88%. Cold intolerance was slight or moderate in 40% of patients, and slight atrophy was present in 12 digits. Angulatory deformity or malalignment were remodeled. The circulatory status of the replanted fingers was excellent in 88% of digits and good in 12%. Bone growth had a mean relative length of 93% of normal in digits without joint involvement and 88% in those with joint involvement. Assessed with Nakamura Tamai criteria, the results were excellent in 25 cases (96%) and good in 1. All patients and their parents were satisfied with the results of the digital replantation.

Amputation, Traumatic↗

PubMed1991

Osteitis pubis in athletes. Infection, inflammation or injury?

Medical records of 59 patients (9 females and 50 males), who presented to sports medicine clinics at the Australian Institute of Sport and the University of British Columbia between 1985 and 1990 and who were diagnosed as suffering osteitis pubis, were reviewed and comparison of data obtained was made with the literature. Women average 35.5 years of age (30 to 59 years) and men 30.3 years (13 to 61 years). Sports most frequently involved were running, soccer, ice hockey and tennis. Clinical presentations of osteitis pubis fell into 4 main groups. 'Mechanical' (sport-related) was the largest group (n = 48), followed by 'obstetric' (n = 5), 'inflammatory' (n = 4) and 'other' (n = 2). Period of follow-up averaged 10.3 months (1 to 20 months) in women and 17.5 months (2 to 96 months) in men. Full recovery, when documented, averaged 9.5 months in men and 7.0 months in women. Osteitis pubis recurred in 25% of these men and none of these women at follow-up. The most frequent symptoms were pubic pain and adductor pain. Men also presented with lower abdominal, hip and perineal or scrotal pain; women with hip pain. Most common signs were tenderness of the pubic symphysis and tenderness of adductor longus muscle origin. Men also revealed tenderness of one or both the superior pubic rami and evidence of decreased hip rotation (unilateral or bilateral). Evidence of pelvic malalignment and/or sacroiliac dysfunction was frequently seen in both men and women. There was poor correlation between radiographic and isotope bone scan findings and the site and duration of symptoms and signs. Femoral head ratios were estimated on 30 hips in the series and 2 were judged to be at the upper limit of normal, perhaps indicating a form of epiphysiolysis producing tilt deformity of the head of the femur. It is clear that osteitis pubis in athletes is not uncommon and that factors such as loss of rotation of hips and previous obstetric history are important in the aetiology and management of this condition. Pelvic infection, which was believed to be the primary factor of osteitis pubis in the literature up until the 1970s, plays a very small role in this condition in athletes.

Adolescent↗

PubMed1992

Free tissue transfer for type III tibial fractures. Microsurgery in 19 cases.

We report 19 tibial fractures Types III B and C treated by free flaps. The fracture healed in 16 cases after 12 (3-54) months. In 3 cases a secondary amputation was carried out. Tibial malalignment or substantial shortening ensued in 1 case each. We conclude that coverage with free flaps, radical removal of dead bone, stable external fixation and transfer of vascularized bone may salvage the majority of Type III B and C tibial fracture with function superior to that after amputation.

Adolescent↗

PubMed1999

[Treatment of distal metaphyseal fractures of the tibia with the interlocking flexible osteosynthesis system].

PURPOSE: Accurate anatomic identification of distal metaphyseal fractures of the tibia is necessary when comparing the fixation ability of internal fixation devices. First, we have set the dimensions of the metaphyseal area. The purpose of this study was to evaluate the Interlocking Flexible Osteosynthesis system in properly selected distal metaphyseal fractures, not to be confused with distal shaft fractures. PATIENTS: This study involves 28 fractures, including 10 diaphyseal-metaphyseal fractures, and 18 pure metaphyseal fractures, 9 of which were distal fractures involving the inferior half of the metaphysis. Five of them were segmental fractures. RESULTS: There were 5 severe complications: early loosening (1), nonunions (2), severe malalignments in 2. These resulted from a combination of insufficient distance between the tips of pins, with severe demineralization of bone tissue. The authors have emphasized the technical means available to avoid this. Twenty-five fractures united at a mean of 13.5 +/- 5 weeks (all types). CONCLUSION: Such a fixation is reliable as long as certain technical rules are respected, which requires a great deal of experience with the method.

Adult↗

PubMed1985

[Indications and results of corrective radius operations].

Posttraumatic malunion usually results from incorrect treatment of a Colles or Smith fracture. Chronic pain, limited motion and impaired power can be avoided and the cosmetic appearance of the hand improved, by restoration of the functional anatomy of the wrist. The malalignment is corrected by open wedge osteotomy of the distal end of the radius. A small iliac cortico-cancellous bone graft is inserted at the osteotomy site. By using this technique, it is usually possible to avoid additional resection of the distal ulna. The surgical approach dorsal or palmar is determined by the type of dislocation. The small T-plate offers a stable fixation. The results are illustrated by 41 cases.

Adolescent↗

PubMed1983

[Corrective radius operations. Indications and results].

Posttraumatic malunion usually results from incorrect treatment of Colles or Smith fracture. Chronic pains, limited motion and impaired power can be avoided and cosmetic appearance of the hand improved by restoration of the functional anatomy of the wrist. The malalignment is corrected by open wedge osteotomy of the distal end of the radius. A small iliae cortico-cancellus bone graft is inserted at the osteotomy site. By using this technique it is usually possible to avoid additional resection of the distal ulna. The surgical approach dorsal or volar is determined by the type of dislocation. The small T-plate offers stable fixation. The results are illustrated by 41 cases.

Adult↗

PubMed2002

Stress fractures of the ankle and forefoot in patients with inflammatory arthritides.

Twenty-four stress fractures occurring in the metatarsal bones and ankle region were examined in 17 patients with inflammatory arthritides. There were 16 metatarsal, four distal fibular, two distal tibial, and two calcaneus fractures. Radiographic analyses were performed to determine the presence of possible predisposing factors for stress fractures. Metatarsal and ankle region stress fractures were analyzed separately. Stress fractures occurred most frequently in the second and third metatarsals. In metatarsal fractures, there was a trend for varus alignment of the ankle to cause fractures of the lateral metatarsal bones and valgus alignment of the medial metatarsal bones. Valgus deformity of the ankle was present in patients with distal fibular fractures in the ankle region group. Calcaneus fractures showed neutral ankle alignment. Malalignment of the ankle and hindfoot is often present in distal tibial, fibular, and metatarsal stress fractures. Additionally, patients tend to have long disease histories with diverse medication, reconstructive surgery and osteoporosis. If such patients experience sudden pain, tenderness, or swelling in the ankle region, stress fractures should be suspected and necessary examinations performed.

Adult↗

PubMed1999

The mechanical effect of blocking screws ("Poller screws") in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails.

OBJECTIVES/HYPOTHESIS: To evaluate the mechanical effects of medial and lateral blocking screws in supplementing intramedullary nail fixation of high proximal and low distal tibial fractures treated with small-diameter intramedullary nails. STUDY DESIGN: Intact fresh human cadaveric tibiae were sectioned to provide ten distal segments measuring seventy millimeters and ten proximal segments measuring ninety millimeters. In the distal segments, stainless steel solid eight-millimeter tibial nails were advanced to eight millimeters from the ankle joint. Two transverse and one anterior-posterior (AP) locking screw were inserted using a custom-made jig. The same jig was used for the placement of a medial and a lateral blocking screw (BS) in the AP direction, nine millimeters above the superior most interlocking screw and eight millimeters distal to the lower end of the segment. In the proximal segments, two interlocking screws (both static and dynamic screws) were placed in a medial-lateral direction with the use of the insertion handle. A jig was used for placement of a medial and a lateral BS in the AP direction, nine millimeters below the lower transverse interlocking screw and sixteen millimeters proximal to the lower end of the segment. The bone-implant construct (BIC) was embedded and fixed in a materials testing machine. The BICs were loaded in the medial-lateral direction at a distance of 185 millimeters from the nail ends with loads from -150 newtons to + 150 newtons. Force-displacement curves were recorded before and after insertion of the BSs. RESULTS: In proximal BICs, the addition of BSs decreased the deformation of the BICs 25 percent, from 8.9 +/- 1.9 degrees [mean +/- standard deviation (SD)] in the control group to 6.8 +/-1.1 degrees in the BS group (mean +/- SD) (p < 0.0001). In distal BICs, the addition of BSs decreased the deformation of the BICs 57 percent, from 9.5 +/- 1.4 degrees (mean +/- SD) in the control group to 4.0 +/- 1.0 degrees in the BS group (mean +/- SD) (p < 0.0001). CONCLUSIONS: The study suggests that medial and lateral blocking screws can increase the primary stability of distal and proximal metaphyseal fractures after nailing and can be an effective tool for selected cases that exhibit malalignment and/or instability.

Aged↗

PubMed1991

Interlocking nails for femoral fractures: an initial experience.

We report the results of the first 50 femoral interlocking nails used in our city. The operations were performed by 20 different surgeons. The follow-up interval averaged 19 months. Five patients with pathological fractures died during this period and two could not be traced. Forty-three fractures were assessed clinically and radiologically by one of the authors. Malunion and/or shortening occurred in 22 patients. Six patients had varus (greater than 5 degrees), ten patients valgus (greater than 5 degrees) and ten patients had malrotation (greater than 10 degrees). Six patients were shortened (greater than 2 cm). Two cases progressed to non-union (greater than 26 weeks), and one had deep sepsis. We discuss the effect of insertion point, dynamic versus static fixation and the lateral table position on the final results. It is concluded that: 1. The nail should be inserted in line with the axis of the femoral shaft. This point is usually in the piriform fossa. 2. The static mode should be used for most fractures. 3. The lateral table position may result in rotational and valgus malalignment.

Adolescent↗

PubMed1999

Effect of nerve repair after unilateral partial facial paralysis on craniofacial growth and development.

The effect of partial transection, coaptation, and freezing of the left facial nerve on craniofacial growth and development was investigated. Twelve-day-old New Zealand White rabbits were randomly assigned to four groups: control group (n = 15), nerve ablation group (n = 15) with a surgically induced partial facial paralysis, nerve coaptation group (n = 15) with a surgically induced partial facial paralysis treated by immediate microsurgical nerve coaptation, and nerve freezing group (n = 13) with a freezing-induced partial facial paralysis. All animals were operated on at the age of 12 days; follow-up evaluations were performed at the ages of 2 months (end-point prepubertal growth) and 6 months (full grown). Computerized dorsoventral roentgencephalometric analysis and computer tomographic three-dimensional volumetric measurements were performed at both ages. Roentgencephalometric analysis revealed that the growth disturbances of the nerve ablation group and the nerve coaptation group were analogous. In contrast, in the nerve freezing group, hardly any growth disturbances as compared with the control group were seen. The CT volume measurements revealed a significant left-right difference in maxillary volume at the ages of 2 and 6 months in the nerve coaptation group as compared with the control group. Muscle histomorphometric analysis revealed a shift in muscle fiber composition in the nerve coaptation group and the nerve freezing group, with an increase of type I fibers at the cost of type IIA fibers. This shift was significantly less pronounced in the latter than in the former. Nerve histomorphometric analysis revealed a significant increase in the number of nerve fibers in the nerve coaptation group as compared with the control group. In the nerve freezing group, the increase in the number of nerve fibers was not significantly different as compared with the control group and the nerve coaptation group. Both the equivalent diameter and the myelin area were equally reduced in the nerve coaptation and nerve freezing groups. Thus, the nerve coaptation group and the nerve freezing group did not differ significantly in the extent of nerve recovery, although they differed in the extent of muscle recovery. The extent of muscle recovery, in turn, was related to the extent of abnormal craniofacial growth and development. Indeed, the growth and development were hardly abnormal in the nerve freezing group and as abnormal as after untreated paralysis in the nerve coaptation group. Therefore, factors related to nerve regeneration, other than those assessed by nerve histomorphology, were considered to be responsible for these differences between both groups. The duration of the denervation time was regarded to be considerably shorter in the nerve freezing group than in the nerve coaptation group, resulting in the observed improved muscle recovery. The difference in the degree of axonal malalignment between both groups was considered to be negligible, because of the tolerance toward axonal malalignment at neonatal age.

Animals↗

PubMed2004

Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications?

We evaluated the functional and radiologic outcomes after stabilization of distal femoral fractures using the distal femoral nail and a less invasive stabilization system to determine if the new implants are superior to other implants (especially the condylar blade plate) regarding the rates of axial deviation, nonunion, and infection and if one of these new implants (Less Invasive Stabilization System, or distal femoral nail) is superior to the other. Two groups, each with 16 patients, were documented prospectively and the results were compared. To record the findings objectively, the Lysholm-Gillquist score was used. A conversion procedure was done in two patients in the plate group and one patient of the nail group. At the 1-year followup mobility of the knee was on average 110 degrees in the plate group and 103 degrees in the nail group. The Lysholm-Gillquist score did not show any significant differences between the groups. There were clinically relevant varus or outer rotation deviations in three patients in the plate group and two patients in the nail group. The two minimally invasive implants used were good in terms of technique and outcome for treatment of distal femoral fractures and did not differ significantly for epidemiology, fracture type, conversion procedures, infection rate, malalignments, and subjective and objective findings at the 1-year followup. They were also superior to the condylar plate in terms of infection and axial malalignments.

Adolescent↗

PubMed1984

Overuse syndromes in runners.

The increase in strenuous sports participation among adult Americans has led to a high incidence of overuse syndromes. Common running-related problems include iliotibial tract tendinitis, chondromalacia patellae, "shinsplints," stress fractures and various heel and foot syndromes. Most causes of overuse syndromes can be traced to training errors, anatomic factors, poor shoes and uneven running surfaces. These syndromes generally respond to modification of the exercise program, anti-inflammatory drugs and orthotic correction of lower extremity malalignment.

Adult↗

PubMedDate not supplied

Acute correction and distraction osteogenesis for the malaligned and shortened lower extremity.

In limbs with combined shortening with angulation or malrotation, deformity may be quickly or slowly corrected before lengthening with external fixation. We examined a series of 35 patients with 40 limbs that underwent acute deformity correction and subsequent gradual lengthening. The average deformity corrected was 19 degrees, with subsequent average lengthening of 4.1 cm. Good radiographic callus formation was noted in 34 of the 40 segments studied. The magnitude of deformity correction had no effect on the quality of lengthened bone, incidence of complications, or the healing index. Skeletally mature segments had statistically significant decreased bone formation (p = 0.001), increased prevalence of callus complications (p = 0.001), and a higher healing index (p = 0.003). Based on this experience, it is our conclusion that immediate correction and lengthening is suitable in children and adolescents who have malaligned and shortened lower extremities. Because of poorer results in older patients, we believe that other techniques should be considered in adults.

Adolescent↗

PubMed2003

Ultrasonographic abnormalities detected in the sacroiliac area in twenty cases of upper hindlimb lameness.

REASONS FOR PERFORMING STUDY: The pelvis is covered with extensive musculature and often presents a challenge in diagnostic imaging. Ultrasonography provides diagnostic information about soft tissue, articular cartilage and bone surfaces, although little information exists about the normal ultrasonographic appearance of the equine sacroiliac region. OBJECTIVES: To determine the clinical applicability of ultrasonographic examination in horses with sacroiliac pain. METHODS: Horses presented to the University of Minnesota Veterinary Teaching Hospital for hindlimb lameness were evaluated and lower limb lameness was ruled out with examination and local anaesthesia. Twenty cases were diagnosed with sacroiliac pain, characterised by response to palpation over the tuber sacrale. Seven of the 20 had visible asymmetry of the tuber sacrale. Ultrasonography was performed percutaneously and per rectum. Structures imaged were measured and compared to normal reference measurements. Other methods used to confirm diagnoses included thermography, scintigraphy and radiology. RESULTS: All 20 cases with sacroiliac pain showed ultrasonographic abnormalities of the sacroiliac area. Abnormalities were detected in the dorsal sacroiliac ligaments. Ligament size was significantly different from the normal ranges (P < 0.01). Malalignment of the sacroiliac area and sacral fractures were also imaged. CONCLUSIONS: Ultrasonography of the sacroiliac region aided diagnosis of ligament damage and displacement of bone surfaces; and may aid in monitoring the progression of healing. POTENTIAL RELEVANCE: Diagnostic ultrasound is readily available to most practitioners. Therefore the findings of this study show that diagnosis of sacroiliac injuries is possible in the field.

Animals↗

PubMed2001

Skeletal manifestations of leprosy: analysis of 137 patients from different clinical settings in the pre- and post-modern treatment eras.

This study was conducted to further characterize the nature of leprosy-related bone alterations, to develop a hypothesis of their pathophysiology, and to define the impact of treatment on bone damage. Radiographs of 60 patients under care at the Carville, Louisiana leprosy hospital were compared with 50 from the early (before availability of effective treatment) part of this century and with 27 from the Toronto (Ontario, Canada) leprosy clinic. Two-thirds of lesions were so severe that distal digital tufts had been lost to whittling, resorption, or fragmentation. Fifty percent were felt to be pathognomonic for the changes of leprosy. Resorption, fragmentation, and malaligned fractures are highly suggestive of leprosy, while diaphyseal whittling appears specific when medullary sclerosis or wavy diaphyseal borders are present. Medicinal intervention appeared to be of limited benefit for bone damage; perhaps greater attention to joint/bone protection (as recommended in diabetes management) will prove helpful. Environmental adjustment to minimize injury risk and daily limb examination for injury are recommended.

Journal Article↗

PubMed1983

Chronic osteomyelitis. An unusual variant.

An unusual form of chronic osteomyelitis in children is described. Three children presented with clinical signs of acute infection and radiographs revealed a pre-existing destructive bone lesion. Exploration of the lesions did not release pus, and cultures for pathogens were negative. The lesions healed but the symptoms returned intermittently over many years with the development of sclerosis and disturbance of bone growth. The lesions did not respond to antibiotics or operative treatment. All the patients were fully investigated and although the erythrocyte sedimentation rate was increased the white blood count was seldom abnormal. There were no neurological abnormalities. Two of the three cases required an osteotomy to correct malalignment. A comparison is made between the findings in these three patients with similar cases reported recently and possible causes are discussed.

Adolescent↗

PubMed2001

Surgical management of delayed union and nonunion of distal radius fractures.

Ten patients with malaligned fractures of the distal radius that demonstrated either delayed healing or the development of an atrophic or synovial nonunion on standard radiographs were treated with surgical realignment, stable internal fixation, and autogenous iliac crest bone grafting. All 10 fractures healed with acceptable radiologic alignment within 3 months of the index procedure. After an average follow-up period of 3 years 6 months (range, 2 years to 8 years 6 months) patients had an average of 105 degrees wrist flexion and extension, 145 degrees forearm rotation, and 73% grip strength compared with the opposite limb. In the treatment of malaligned, ununited fractures of the distal radius, specific techniques and implants must be tailored to the deformity of the distal radius and the shape of the distal fragment. A stable, well-aligned wrist with preservation of at least 50 degrees mobility in flexion and extension was achieved in every patient, but the final result was compromised by associated problems in 3 patients.

Adult↗