Complications of varus derotation osteotomy in the treatment of CHD during growth

Complications of varus derotation osteotomies in the treatment of congenital hip displacement (CHD) are reported. Only "true" complications were considered, that is, those related to errors in technique, while those related to errors in indications were excluded. An analysis of 150 cases with a mean follow-up of 4.2 years revealed that "true" complications are a rare occurrence. Among these the most frequent are dysmetria (20%), and infection (2.6%). There was only one case of osteochondrosis (0.6%). The dysmetria (usually under 2 cm) rarely required further surgical treatment involving temporary epiphysiodesis of the homolateral knee, while the infection responded satisfactorily to combined conservative and surgical treatment.     

Evaluation of treatment of hip subluxation in myelomeningocele by intertrochanteric varus derotation femoral osteotomy

A retrospective study of 27 subluxed hips was carried out in 18 patients with myelomeningocele treated by varus derotation intertrochanteric osteotomy. Twenty-three of the 27 hips were stable at follow-up review. The causes of failure were related to the presence of pelvic obliquity secondary to scoliosis or to a dysplastic acetabulum (acetabular index above 25 to 30 degrees). Transfer of the iliopsoas tendon was not found to be necessary in order to achieve stable reduction.     

Use of the spiral pin for fracture of the humeral neck

Our new method of intramedullary fixation of humeral neck fracture is described. Spiral pin is made of stainless steel. The top is coiled, and the end is threaded. It is inserted from a small incision over the posterior surface of the supracondyle. It is passed across the fracture site into the head of the humerus, where it locks the head. The fracture surface is pressed together by tigtening nuts. The fracture fixation allows early movement of the shoulder joint. The method was used in eight patients. The average age was one-year-old.     

Late treatment of brachial plexus palsy secondary to birth injuries: rotational osteotomy of the proximal part of the humerus

We retrospectively reviewed the results of rotational osteotomy that had been performed distal to the surgical neck of the humerus in twenty-two patients who had sustained an injury of the brachial plexus at birth. Eighteen patients had a lesion of the superior trunk of the brachial plexus (the fifth and sixth cervical nerve roots), and four had involvement of the entire brachial plexus. The patients ranged in age from four to seventeen years old (average age, ten years and three months old) at the time of the operation. The average duration of follow-up was fourteen years (range, two to thirty-one years). Preoperatively, the patients had been unable to perform self-care activities, such as grooming, feeding, and washing themselves, because of limited active external rotation or fixed internal rotation of the shoulder. All patients had decreased strength of the lateral rotator and abductor muscles and normal strength of the subscapularis and pectoralis major muscles. Radiographs showed some flattening of the humeral head, and four patients had posterior subluxation of the humeral head. A lateral rotational osteotomy of the proximal part of the humerus was performed between the insertions of the subscapularis and pectoralis major muscles. The site of the osteotomy was stabilized with catgut sutures in the periosteum in ten patients and with one or two staples in twelve. The extremity was immobilized in a plaster shoulder-spica cast for six weeks. At the latest follow-up evaluation, the average increase in active abduction was 27 degrees (range, 0 to 60 degrees) and the average increase in the arc of rotation was 25 degrees (range, 5 to 85 degrees). Supination of the forearm also had increased commensurate with the increase in external rotation. The appearance of the extremity had improved as well.     

Metatarsus varus corrected by open wedge osteotomy of the first cuneiform bone

The persistence of metatarsus adductus varus has been a problem in management. We have treated a series of selected patients with this problem and believe that our results have been better than with the procedure we have used in the past. Fowler has described a procedure which seems ideal for the patients in our series. Through personal communication the procedure and its application were discussed and the series was started eight years ago. Our series is small because our patients are responding to other forms of treatment at an earlier age. The few that do not respond are now considered for the operation described. The procedure is relatively simple to perform. Full correction should be obtained at the time of surgery. Casting is utilized to hold the correction and immobilize the extremity for healing. Our unsatisfactory results occurred because of errors in technique or poor selection of patients. We believe that this procedure should be considered in the older patient with metatarsus varus.     

Combined Sever''s release of the shoulder and osteotomy of the humerus for Erb''s palsy

We report a case of lumbar extradural abscess that presented 9 days after an elective Caesarean section performed under combined spinal-extradural anaesthesia. This was successfully treated conservatively with full recovery. The clinical course included development, and then resolution, of mild paraparesis. Conservative treatment of an extradural abscess in the obstetric population has not been described previously.     

手法整复治疗肱骨髁上骨折60例

目的:探讨肱髁上骨折的治疗方法与疗效.方法:回顾总结60例肱骨髁上骨折治疗的临床资料.结果:随访60例肱骨髁上骨折患者3月--1年;平均7个月所有病例均愈合,优良率90/95%.结论:手法整复,是治疗肱骨髁上骨折的重要手段.     

Primary management of comminuted humeral head fracture in the elderly patient with a humerus head prosthesis

The purpose of this prospective study was to determine the early subjective and functional result and outcome after primary implantation of humeral endoprosthesis in severely comminuted humeral head fractures in elderly patients. From 1993 to 1995, 27 humeral head fractures (27 patients) were treated by primary implantation of a Neer II modular shoulder prosthesis. Of these, 23 patients were women, 4 patients were men. The average age of patients was 76 (48-91) years. Postoperatively, one shoulder had to be mobilized under general anesthesia. Of the 27 patients 21 could be clinically examined after 16 (3-29) months postoperatively; 4 patients had died in the meantime, 2 did not come to the control examination because of a great distance and because they were happy. The average Constant Score was 48 (25-76) points; the difference to the other shoulder was 30 (18-69) points. Of the 21 patients 19 were satisfied by the result and 20 would reaccept the same procedure. These preliminary results suggest that primary shoulder prosthesis in humeral head fractures in the elderly patient is a valuable alternative option.     

Outcome of Perthes'' disease in unselected patients after femoral varus osteotomy and splintage

PURPOSE: To study the incidence, cause, recovery time, and prevention of diplopia following subcutaneous injection of botulinum A toxin for the treatment of facial spasms. METHODS: Patients who experienced diplopia after botulinum A toxin injections had their deviations examined in detail. When the muscle that caused diplopia was identifiable, the injection closest to that muscle was omitted in the next treatment in an attempt to prevent diplopia. RESULTS: Of 250 patients receiving about 1500 sets of injections, 25 (1.7%) incidents of diplopia occurred in 10 patients. Excluding two patients who declined further treatment after having diplopia on their first botulinum A toxin treatment, seven of the remaining eight patients had multiple incidents of diplopia. The most common pattern of diplopia was "uncertain diagnosis." The most common identifiable cause of diplopia was paresis of the inferior oblique muscle. Omission of the injection into the central portion of the lower eyelids in the next treatment prevented recurrence of diplopia in only one of the four patients. No significant correlation between botulinum A toxin doses injected and times to recovery was noted. CONCLUSIONS: Diplopia following botulinum A toxin treatment is uncommon. Seven patients (3% of patients studied) had 22 episodes of diplopia (88% of episodes). When diplopia occurs, it tends to recur on reinjection, sometimes with a prolonged recovery time. This response may not be dose dependent. The extraocular muscles of some patients may be more susceptible to chemodenervation than others, or botulinum A toxin may diffuse to extraocular muscles more easily in some patients than in others.     

A modified technique of the triple pelvic osteotomy: early results

A modification of the triple pelvic osteotomy for children over 8 years and the young adult is described. The results of the first 32 cases are reviewed. These show that the indications for the operation can be widened so that not only primary dysplasias but also subluxated or dislocated hips with secondary dysplasia can be operated on successfully. The operation is done in two stages. At first the patient is lying prone. The osteotomy of the ischial ramus is done dorsally by cutting the connection between the sciatic notch and obturator foramen immediately behind and below the acetabulum. In the second stage, with the patient lying supine, the pubic and the iliac osteotomy are performed rather circular and parallel to the hip joint. These modifications have several advantages: (a) the operator has a direct field of view at all times; (b) the osteotomy is performed close to the acetabulum, thus allowing a great amount of lateral rotation and medial displacement of the acetabulum, thereby providing good coverage of the femoral head by hyaline cartilage; and (c) the ischial ramus and its ligaments to the sacrum are left intact, leading to greater stability of the pelvis and spine.     

The effect of unilateral varus rotational osteotomy with or without pelvic osteotomy on the contralateral hip in patients with perinatal static encephalopathy

The hexane fractions from methanolic extracts of Anetheum graveolens L. (Umbelliferae) and Acorus gramineus Soland. (Araceae), revealed potent inhibitory activities against the resistance of multi-drug resistant Staphylococcus aureus SA2 when combined with ampicillin (Am) or chloramphenicol (Cm). As active principles, carvone and the liquid mixture containing carvone from Anetheum graveolens L. and a liquid mixture mainly consisting of benzoic acid phenylmethyl ester (benzyl benzoate) from Acorus gramineus Soland, were identified. They showed resistance inhibition at the level of 20-50 micrograms/ml when combined with 100 or 50 micrograms/ml of Am or Cm, respectively.     

Closed humeral shaft fractures: a prospective evaluation of surgical treatment

OBJECTIVE: We tried to define the roles of the rigid dynamic compression plate (DCP) and the semi-rigid Ender nail (EN) in the treatment of closed humeral shaft fractures. DESIGN: A prospective, randomized clinical study was performed with detailed comparison parameters. MATERIALS AND METHODS: Ninety-one closed humeral shaft fractures were treated. Randomly, 30 humeri were treated with open reduction and internal fixation with DCP and no bone grafting (BG), 29 were treated with the same procedure but with BG, and 32 were treated with closed reduction and internal fixation with Ender nails. The average follow-up period was 32 months (range, 13-54 months). MEASUREMENTS AND MAIN RESULTS: In the group with DCP without BG, the average blood loss was 270 mL, operation time was 92 minutes, hospital length of stay was 6.5 days, and union time was 12.5 weeks. In the group with DCP with BG, the average blood loss was 325 mL, operation time was 108 minutes, hospital length of stay was 6.9 days, and union time was 9.4 weeks. In the EN group, the average blood loss was 114 mL, operation time was 54 minutes, hospital length of stay was 5.6 days, and union time was 9.9 weeks. Analysis of variance and Fisher's exact test were used to evaluate the statistical significance. CONCLUSION: In our experience, for humeral shaft fractures fixed surgically, EN is better than DCP without BG. When DCP is chosen for the means of fixation, prophylactic BG is recommended, especially in cases with more comminution.     

Anterior cruciate ligament-plasty and high valgus tibial osteotomy as a combined procedure in anterior instability and varus deviation

Besides patients having an acute rupture of the ACL with a clear therapeutical strategy there are increasingly young patients with chronical anterior instability and degenerative arthritis of the medial compartment and varus malalignment. This constellation is taxing severely the operative procedure considering that there is not only the instability which has to be treated but that also an improvement of the arthritis symptomatology has to be achieved. In this paper we present a therapeutical concept of high tibial osteotomy combined with an arthroscopic assisted reconstruction of the ACL which is performed as a single procedure since the early 80-ies. The goal is to remove two severe arthrogenic factors correcting the instability and the pathological anatomical axis, to reduce the medial knee pain and to improve the use of the knee in life activities.     

Paresis of the brachial plexus: subcapital varus osteotomy, arthrodesis of shoulder joint and above-elbow amputation (author's transl)]

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.     

Valgus deformity of the femoral neck after nailing of infantile femoral shaft fractures (author's transl)

In 6 patients out of 29 who had suffered fractures of the femoral shaft at childs age and were treated mainly by open nailing, considerable growth disturbances of the major trochanter and valgus deformities of the neck of the femur had been observed in check-ups. The origin and prevention of these complications in nailing and nailremoval are discussed.