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At least 685 records · Page 38Linked to original sources

PubMed2002

Effect of foot orthoses on 3-dimensional kinematics of flatfoot: a cadaveric study.

OBJECTIVE: To test in cadaveric feet the hypothesis that prefabricated foot orthoses will improve arch alignment in flatfoot deformity. DESIGN: Experimental, paired comparisons. SETTING: Biomechanics laboratory. CADAVERS: Nine cadaveric lower-extremity specimens with no abnormalities. INTERVENTIONS: To evaluate the performance of 2 orthoses specimens were tested in 4 combinations: intact, flatfoot, flatfoot with shoe and orthosis 1, and flatfoot with shoe and orthosis 2. To simulate the midstance phase of gait, loads were applied to 5 tendons and an axial load equivalent to two thirds of the standing load was applied to the foot's plantar surface. MAIN OUTCOME MEASURES: Arch height and tarsal bone positions before and after a flatfoot deformity created by ligament sectioning; tarsal bone positions determined with a magnetic tracking system. RESULTS: After ligament sectioning, the average decrease in arch height with a shoe applied was 4.6+/-1.6mm (8%); with orthosis 1, mean arch height increased 0.7+/-0.6mm (P=.008); with orthosis 2, it increased 0.3+/-0.5mm (P=.05). With both orthoses, arch height after sectioning was significantly less than that of the normal arch. Compared with the flatfoot condition, metatarsal-talar alignment improved in plantar flexion and inversion with both orthoses but did not approximate normal with either orthosis. Calcaneal-tibial position did not improve with either orthosis and was markedly different from that in the intact foot with either orthosis. No difference was found between the 2 orthoses except for metatarsal-talar motion in external rotation (P=.014) and eversion (P=.026). CONCLUSIONS: Arch alignment improved significantly but to a limited degree (<2%) in cadaveric feet with the use of orthoses. Hindfoot valgus malalignment did not consistently improve by the use of shoe inserts.

Aged↗

PubMed2002

Arthrodesis as salvage for calcaneal malunions.

Even with greater emphasis on anatomic reduction, outcomes after calcaneal fractures continue to be unsatisfactory in many patients. Lateral wall impingement, subtalar arthrosis with pain and stiffness, nerve compression syndromes, and hindfoot malalignment all can cause disabling symptoms. If conservative treatment fails to relieve symptoms, subtalar arthrodesis can provide a painless, stable hindfoot in most patients. For severe deformity with anterior ankle impingement and loss of the talar angle of declination, distraction bone block arthrodesis through a posterior approach is preferred.

Arthrodesis↗

PubMed2000

Hallux valgus correction by the method of Bösch: a new technique with a seven-to-ten-year follow-up.

Subcapital osteotomy of the first metatarsal is used as the treatment of choice for the correction of hallux valgus. The advantages are a short operation time, no soft tissue procedures, secure union, avoidance of metatarsal head (MTH) necrosis and a varus malalignment. An alternative temporary fixation of hallux valgus also having an arthrosis is performed with a specially developed angle plate (Synthes-Stratec, Austria) with the skin incision lengthened to 1-cm. Adequate displacement of the MTH over the sesamoid bones provides a permanent satisfying result even without an operation on the abductor or the adductor. This article reviews 98 feet of 64 patients who were examined in a follow-up study from the initial 114 cases that were operated. The mean follow-up time was 8 years and 9 months.

Adolescent↗

PubMed1997

[Closed intramedullary stabilization of femoral shaft fractures with Eder's nails].

Forty-one femoral shaft fractures were treated with flexible Ender nails which were introduced through the great trochanter without reaming of the medullary canal. There was one case of intraoperative femoral neck fracture. No wound infection or osteomyelitis occurred. Axial and rotational malalignment was always due to technical errors. All fractures united at an average of 12 weeks. Transverse fractures, short oblique and those with "unicortical" comminution proved to be stable after Ender nailing, while cases with "bicortical" comminution had tendency for bone shortening and often required additional procedures.

Adolescent↗

PubMed2006

Is there an alternative to the full-leg radiograph for determining knee joint alignment in osteoarthritis?

OBJECTIVE: To assess the concurrent validity of alternative measures of frontal plane knee alignment, namely the radiographic anatomic axis and 5 clinical measures, in medial compartment knee osteoarthritis (OA) as compared with the mechanical axis on radiograph. METHODS: Forty individuals (mean +/- SD age 64.7 +/- 9.4 years) with symptomatic medial knee OA participated. Knee alignment was measured according to the following methods: lower-limb mechanical axis on radiograph, lower-limb anatomic axis on radiograph, visual observation, distance between medial knee joint lines or medial malleoli using a caliper, distance between a plumb line and medial knee joint line or malleolus using a caliper, tibial alignment using a gravity inclinometer, and lower-limb alignment using a goniometer. Data were analyzed using Pearson's correlation coefficient or Spearman's rho correlation coefficient and simple linear regression. RESULTS: The anatomic axis best correlated with the mechanical axis (r = 0.88), followed closely by the inclinometer method (r = 0.80). Other clinical measures of alignment that were significantly associated with the mechanical axis were the caliper method, the plumb-line method, and visual observation (r = 0.76, 0.71, and -0.52, respectively). However, the goniometer method failed to correlate. CONCLUSION: The anatomic axis on radiograph and the inclinometer method appear to be valid alternatives to the mechanical axis on full-leg radiograph for determining frontal plane knee alignment in medial knee OA. These alternative methods of measuring knee alignment may increase the assessment of this parameter by clinicians and researchers alike, given that malalignment is an important indicator of disease progression and treatment outcome.

Cohort Studies↗

PubMed2006

Carpal collapse in patients with rheumatoid arthritis.

The inflammation of the wrist and carpal collapse play an important role in the deformity of the rheumatoid hand and leads to functional limitation. The aim of this study was to evaluate carpal collapse and related clinical variables in patients with rheumatoid arthritis (RA). Carpal height ratio (CHR) indicating the degree of carpal collapse was measured in 33 female RA patients with a mean age of 41.9+/-10.3 years and 30 female healthy control subjects with a mean age of 40.5+/-9.2 years. The normal range of the carpal collapse was defined in our study population and the incidence of carpal collapse was determined. The correlation between carpal collapse and clinical and laboratory variables including pain by visual analog scale, Ritchie articular index, erythrocyte sedimentation rate, C-reactive protein, health assessment questionnaire indicating functional status, and Larsen roentgenological evaluation were determined. Subgroup analyses were also performed in patients with and without carpal collapse. The mean disease duration of the patients was 12.4+/-5.5 years. The mean CHR index of the patients was significantly lower than in the control group (0.47+/-4.3 and 0.54+/-1.4 respectively). CHR <0.48 was defined as carpal collapse in our study group. Seventeen patients (51.5%) had carpal collapse in the patient group. None of the clinical or laboratory variables except levels of disease duration and Larsen score was correlated with carpal collapse as represented by CHR. The best related clinical variable with carpal collapse was found as duration of disease. The mean duration of disease and the Larsen score were significantly higher in patients with carpal collapse than those without collapse. Other clinical parameters and functional status were similar between patients with and without carpal collapse. In conclusion, although various clinical parameters and functional disability in patients with RA may not be correlated with radiological malalignment, the carpal collapse may be more common in RA than is generally recognized.

Adult↗

PubMed1975

Ambulatory treatment of femoral shaft fractures with cast-brace.

Our early results support use of the cast-brace, early ambulation treatment of both open and closed fractures of the femoral shaft in all adult age groups. We believe initial traction should be used to reduce the fracture and maintain reduction until the fracture is clinically "sticky" to avoid subsequent malalignment in the cast-brace. The method facilitates early rehabilitation of the fractured extremity and the patient with minimal residual disability such as non-union, malunion, chronic infection and joint stiffness, so often associated with other forms of long bone fracture treatment.

Adolescent↗

PubMedDate not supplied

Radial and tibial fracture repair with external skeletal fixation. Effects of fracture type, reduction, and complications on healing.

Twenty-eight consecutive fractures of the canine radius and tibia were treated with external skeletal fixation as the primary method of stabilization. The time of fixation removal (T1) and the time to unsupported weight-bearing (T2) were correlated with: (1) bone involved; (2) communication of the fracture with the external environment; (3) severity of the fracture; (4) proximity of the fracture to the nutrient artery; (5) method of reduction; (6) diaphyseal displacement after reduction; and (7) gap between cortical fragments after reduction. The Kruskal-Wallis one-way analysis of variance was used to test the correlation with p less than .05 set as the criterion for significance. The median T1 was 10 weeks and the median T2 was 11 weeks. None of the variables correlated significantly with either of the healing times; however, there was a strong trend toward longer healing times associated with open fractures and shorter healing times associated with closed reduction. Periosteal and endosteal callus uniting the fragments were observed radiographically in comminuted fractures, with primary bone union observed in six fractures in which anatomic reduction was achieved. Complications observed in the treatment of these fractures included: bone lysis around pins (27 fractures), pin track drainage (27 fractures), pin track hemorrhage (1 fracture), periosteal reaction around pins (27 fractures), radiographic signs consistent with osteomyelitis (12 fractures), degenerative joint disease (2 dogs), and nonunion (1 fracture). Valgus or rotational malalignment resulted in 16 malunions of fractures. One external fixation device was replaced and four loose pins were removed before the fractures healed. One dog was treated with antibiotics during the postoperative period because clinical signs of osteomyelitis appeared.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

PubMed2003

Corrective osteotomy for deformity in Paget disease.

BACKGROUND: Severe deformity resulting from Paget disease is not uncommon. Malalignment of the extremity may lead to intractable pain, mechanical overload of the neighboring joints, limitation of motion and function, and dysmorphic appearance. Although corrective osteotomy has been used to treat osseous deformities, the outcome of corrective osteotomy for long-bone deformities resulting from Paget disease remains largely unknown. METHODS: The results after twenty-five corrective osteotomies (twenty-two patients), performed between 1975 and 1995, in sixteen tibiae, eight femora, and one radius were evaluated. There were thirteen men and nine women with a mean age of sixty-seven years. The indication for osteotomy was pain in twenty limbs, recurrent stress fractures in three, and limitation of function in two. A variety of osteotomies and fixation methods were used. Two patients underwent simultaneous total hip arthroplasty and proximal femoral osteotomy. RESULTS: Twenty-three of twenty-five osteotomies healed with an average time to union of six months. Both nonunions were in patients who had been managed with intramedullary fixation. The time to union was significantly shorter in metaphyseal osteotomies fixed with plates than in diaphyseal osteotomies (p < 0.04). There was a substantial improvement in the deformities. Satisfaction was rated excellent or good by fourteen patients, fair by six, and poor by two. Complications included a pin-track infection in two patients, peroneal nerve palsy in one, and loss of fixation following external fixation in one. Disease activity, as measured by serum alkaline phosphatase level, and medical treatment with calcitonin and/or bisphosphonates did not have a significant impact on time to union. CONCLUSIONS: Corrective osteotomy for the treatment of severe deformity in Paget disease can be challenging and yet rewarding. A higher prevalence of complications was observed following intramedullary nailing and external fixation. Fracture-healing seems to be particularly protracted in diaphyseal osteotomies.

Adult↗

PubMed1996

MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients.

OBJECTIVE: We evaluated how well MR imaging revealed ligamentous and bony abnormalities in patients with injuries of Lisfranc's joint. SUBJECTS AND METHODS: We evaluated the studies of 11 patients with plantar hyperflexion injuries of the foot who underwent MR imaging in all three planes using spinecho T1-weighted, fast spin-echo T2-weighted, and short inversion time inversion recovery sequences. In four of the 11 patients, a three-dimensional spoiled gradient-recalled acquisition in the steady-state volume sequence was performed in the coronal plane. For five of the 11 patients, radiographs were available for evaluation. RESULTS: Radiographs revealed tarsometatarsal joint malalignment in all five patients for whom plain films were available, metatarsal fractures in four of these patients, and tarsal fractures in the same four patients. MR imaging showed joint malalignment in all 11 patients and disruption of the Lisfranc's ligament in eight of the 11 patients. In the remaining three patients, normal Lisfranc's ligaments were associated with avulsion fractures of the second metatarsal bases or the medial cuneiform bones. On MR imaging, fractures of the metatarsal bases were evident in 10 of 11 patients. Fractures of the tarsal bones were seen in the same 10 patients. CONCLUSION: MR imaging allows the detection of disruption of the Lisfranc's ligament as well as tarsal and metatarsal fractures and therefore may be a valuable technique in assessing patients after trauma to the tarsometatarsal joints when results of routine radiographs are not conclusive.

Adult↗

PubMed2001

Autologous osteochondral transplantation using the diamond bone-cutting system (DBCS): 6-12 years' follow-up of 35 patients with osteochondral defects at the knee joint.

Thirty-five patients with severe osteochondral defects were treated by autologous osteochondral transplantation between 1986 and 1992. The majority of patients (27) suffered from osteochondrosis dissecans, while 8 patients presented with posttraumatic osteochondral defects. The grafts were harvested with a diamond bone cutter from the posterior part of the medial or lateral femoral condyle. In 29 patients the lesion was located at the lateral part of the medial femoral condyle, in 3 it was at the lateral femoral condyle, and in 3 at the patella. Twenty-nine patients could be examined at the follow-up between 6 and 12 years later (mean follow up 8.1 years). Using the standard cartilage evaluation form, the transplanted knees of 12 patients were graded as normal (grade I), 14 knees were nearly normal (grade II), while 3 patients presented with an abnormal result (grade III). All 3 of them had a varus malalignment and refused a high tibial correction osteotomy against our advice. No patient was assessed as severely abnormal (grade IV). The majority of patients improved their activity level and the functional status of the joint. Twelve patients developed new radiological signs of osteoarthrosis with a decrease in the radiological score of Kellgren and Lawrence by about one stage. We conclude that autologous osteochondral transplantation with the diamond bone-cutting system is an effective method in the treatment of severe osteochondral defects.

Adult↗

PubMed2006

Carpal instability.

This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads ("dyskinetics") or suffers from abnormal motion of its bones during movement ("dyskinematics"). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being "occult" for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the hand surgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.

Biomechanical Phenomena↗

PubMed1984

Dental disease in hill sheep: an abattoir survey.

Heads from 478 aged sheep of a predominantly hill breed population were examined in detail for evidence of dental disease, using both soft and hard tissue measurements around incisor and cheek teeth. Almost 60 per cent of this population (all over 2 1/2 years of age and with a mean age between 7 and 8 years) had either loose or missing teeth. Malalignment of cheek teeth and/or incisors was also common. Pocketing was seen in 87 per cent of the population, and was significantly correlated with tooth looseness. There was also a significant relationship between incisor and specific cheek tooth pocket depths. Whilst local alveolar bone loss was found, it was not a reflection of more general skeletal deterioration. The survey confirms the high incidence of broken mouth in the national flock and shows that wherever incisor problems occur there is a likelihood that cheek tooth disease is also present, a relationship not readily appreciated clinically.

Animals↗

PubMed2002

A surgical guide for accurate mesiodistal paralleling of implants in the posterior edentulous mandible.

Malaligned implants often complicate the clinical and laboratory procedures employed for the fabrication of superstructures. Due to improper load distribution, an overall increase in stress concentrations on supporting implants may occur; in the long run, this may compromise the maintenance of the bone-implant interface. The utilization of surgical stents is imperative for optimum implant installation. This article describes a modified surgical stent that serves as a guide to proper mesiodistal paralleling of dental implants.

Bicuspid↗

PubMed1980

[Iso Kikuchi syndrome (C.O.I.F. syndrome). A report on 2 cases and a review of 44 cases in the literature (author's transl)].

Attention was drawn to congenital onychodysplasia of the index fingers (C.O.I.F.) by Iso, and later by Kikuchi who collected several cases. Micronychia, polyonychia, anonychia, hemionychrogryphosis and malalignment are the observed index finger defects. Five classical criteria were given to characterize the C.O.I.F. syndrome: 1 degree congenital, 2 degrees involvement of index fingers, 3 degrees variability in nail appearance, 4 degrees non-familial, non-hereditary, 5 degrees without bone and joint abnormalities. Alternative criteria are suggested for this syndrome. These are: 1 degree congenital, 2 degrees unilateral or bilateral index finger involvement, variability in nail appearance, 4 degrees possible hereditary involvement, 5 degrees frequent associated bone abnormalities.

Adult↗

PubMed1995

Proximal third tibial shaft fractures. Should they be nailed?

Thirty-two extraarticular fractures of the proximal third of the tibia were treated with locked intramedullary nails. There were 10 closed and 22 open injuries. Treatment consisted of a reamed nail in each of the 5 closed fractures, and an unreamed nail in the remaining 27 fractures. Thirty of the 32 fractures eventually healed; however, 9 (28%) underwent exchange nailing and 4 (13%) required bone grafting. At final followup, 27 of 32 fractures (84%) had angulation of 5 degrees or greater in the frontal or sagittal plane. Nineteen of the 32 fractures (59%) had 1 cm or more of displacement at the fracture site. In 8 fractures (25%), there was loss of fixation, most commonly associated with placement of a single proximal locking screw. Fractures of the proximal third of the tibial shaft do not appear to respond as favorably to intramedullary nailing as do fractures in the distal 2/3 of the tibia. Valgus, apex anterior angulation, and residual displacement at the fracture site are common after nailing. Surgical errors of a medialized nail entry point and a posteriorly and laterally directed nail insertion angle contributed to malalignment. Based on their findings, the authors have limited the use of intramedullary nailing for proximal third tibial shaft fracture and consider alternate forms of fixation (plate or external fixation).

Adolescent↗

PubMed1987

A method for fixation of femoral fractures below previous hip implants.

Previously applied plates and screws or endoprosthetic implants of the proximal femur create a recurrent problem in surgery for fractures below such implants. Of 13 elderly women (mean age, 81 years) six had had a hip arthroplasty, five a nail and plate, and two a nail or a plate only. The fresh fractures were stabilized from the condylar region by intramedullary nails connected to a coupling-piece with two transverse screws preventing extrusion or intrusion of the nails. All fractures healed uneventfully without rotatory and angulatory malalignment. The maximum shortening was 2 cm in two patients and was less in the others. Patients walking before surgery were mobilized the day after. The system is more stable than Rush pins or Ender nails only and does not require good quality of bone needed for plating.

Aged↗

PubMed1996

A comparison of early and late reconstruction of malunited fractures of the distal end of the radius.

We retrospectively evaluated the results for ten patients in whom a malaligned fracture of the distal end of the radius had been treated with early reconstruction (an average of eight weeks [range, six to fourteen weeks] after the injury) consisting of an osteotomy through the site of the fracture, autogenous cancellous iliac-crest bone-grafting, and internal fixation. The results for these patients were compared with those for ten patients in whom functional limitation after complete healing of a fracture of the distal end of the radius in a malreduced position had been treated with late reconstruction (an average of forty weeks [range, thirty to forty-eight weeks] after the injury) consisting of an osteotomy, corticocancellous bone-grafting, and internal fixation. The average duration of follow-up was forty-eight months (range, twenty to 120 months) after the early reconstructions and thirty-four months (range, twenty-four to forty-eight months) after the late reconstructions. After the early reconstructions, flexion of the wrist averaged 45 degrees; extension of the wrist, 52 degrees; pronation of the forearm, 79 degrees; and supination of the forearm,77 degrees, compared with 42, 45, 77, and 68 degrees, respectively, after the late reconstructions. Grip strength averaged forty-two kilograms after the early reconstructions, compared with twenty-five kilograms after the late ones. One patient from each cohort had mild pain in the radiocarpal joint. According to the scale of Fernandez, there were seven excellent and three good results after the early reconstructions, and one excellent, seven good, and two fair results after the late reconstructions. Complications included a rupture of the extensor pollicis longus tendon twelve weeks after one of the early reconstructions, persistent pain at the donor site of the iliac-crest bone graft after a late reconstruction, and a delayed union that necessitated a second procedure after another late reconstruction. We believe that the results of early and late reconstruction of malunited fractures of the distal end of the radius are comparable. For patients who have radiographic characteristics that are predictive of persistent functional limitation, early reconstruction is technically easier and reduces the over-all period of disability.

Adult↗