Fractures of the hip in children and adolescents

Long-term results of 52 fractures of the hip in 51 children and adolescents are discussed. A distinction was made between fractures in children (aged 1 to 11 years) and those in adolescents (aged 12 to 18 years). Irrespective of the type of fracture it was found that immediate operative treatment leads to the best results. In children as well as in adolescents the risk of avascular necrosis, premature closure of the epiphysis and non-union is less following immediate operative treatment than following delayed operative treatment or conservative treatment. The prognosis of these fractures depends on the amount of damage to the vascularization. Treatment of children consisted of open reduction and fixation with K-wires followed by postoperative immobilization in a hip-spica for 6 weeks. Adolescents were treated with three-flanged nails usually without postoperative plaster immobilization. In both children and adolescents internal fixation may also be carried out with screws, in which case these must not cross an open epiphyseal plate. In both groups a non-weight-bearing period of 6 to 12 months is advisable. The results in adolescents were definitely poorer than in children. Seemingly completely destroyed hips can reintegrate even to a nearly "restitutio ad integrum" state after a period of years.     

Preparation of bonded porcelain inlays and onlays using a milling-coping system

The Celay-system offers an interesting alternative to existing systems for esthetic posterior restorations with ceramics. The basic idea of the concept is to prepare, either directly on the patient or indirectly on a plaster model, a pro-inlay using a light-curable precision material. The modelling also covers the occlusal surface. This pro-inlay is then used with the help of a milling center to machine a precise replica out of a ceramic block. The copying process is carried out via three-dimensional mechanical scanning and milling using eight axes of freedom. In this way additional corrections on the ceramic within the mouth can almost completely be avoided. The system is designed to be used as a direct chairside method by the dentist or as an indirect method by the dental technician. It is a promising but unproved restoration, more research and long-term clinical evaluation is recommended.     

Origin of sex for error repair. III. Selfish sex

Matching to sample is commonly used in research and practice to assess relational learning of persons with mental retardation. However, forced-choice matching tasks are not always appropriate. In this paper we have illustrated blank-comparison matching to sample, a selection-based "yes/no" method requiring no verbal skills. Participants select a comparison stimulus if it is judged to be related to the sample (analogous to "yes") but select a black square (blank) if it is not so judged ("no"). In the first experiment the method was used to explore bases for emergent symbolic "mapping" performances. In the second experiment we assessed similarity judgments between form stimuli. Both experiments confirmed the feasibility and utility of the method for making unambiguous inferences as to whether pairs of stimuli were or were not related.     

Shift of visual fixation dependent on background illumination

Visual fixation, the act of maintaining the eyes directed toward a location of interest, is a highly skilled behavior necessary for high-level vision in primates. In spite of its significance, visual fixation is not well understood; it is not even clear what attributes of the visual input are used to control fixation. Here we show, in four Macaca fascicularis monkeys, that the position the eyes assume during fixation depends on the luminance of the background. Dark background yields fixation positions that are shifted upward with respect to the fixation positions obtained with a dimly illuminated, featureless background. This phenomenon was observed previously in a nutshell by Snodderly; here first we rigorously establish its existence by testing proper controls. We then study the properties of this upshift of the fixation position. We show that, although the size of the upshift varies between monkeys, for all monkeys the upshift is larger than the radius of the fovea. Hence, if the background is dim, the eyes are positioned during fixation so that the target does not fall on the fovea. The size of the upshift remains almost unchanged while the eyes fixate at different orbital positions; thus the upshift is not caused by orbital mechanics. The upshift clearly is present even at the first days of training, but with additional training in fixation with dark background, the upshift increases in size. The upshift rotates with the head. The upshift increases gradually with decreasing levels of background luminosity. Luminosity, not visual contrast, is indeed the primary variable determining the size of the upshift. The contribution of a unit area of the retina to the upshift decreases as inverse square root of distance from the target; therefore, it is the perifoveal region of the retina that mostly contributes to the upshift, while the far periphery has little influence. The upshift can be induced or be canceled in the midst of a fixation by changing the background illumination; hence, the upshift is indeed an attribute of the fixation control system. Finally, the fixation-upshift studied here is different from a previously reported upshift of the endpoints of memory-guided saccades with respect to their target locations. These two types of upshift add up to each other. In discussing the function of the upshift, we note a possible morphological analogue with the retinal rod distribution. The upshift moves the line of gaze to a point intermediate between the fovea and the "dorsal rod peak." The upshift thus may improve visual acuity in scotopic conditions. The brain structure in which the upshift is generated must be involved in both ocular control and visual sensation. We consider several possibilities, of which we regard as the most likely the cerebellum and superior colliculus.     

Pet ownership and future health

It is difficult to treat the intra-articular fracture of distal tibia or Pilion's fracture. From 1987 to 1995, 43 cases of Pilon's fracture were admitted and treated with different methods. After treatment, they had been followed up for 1 to 8 years. According to Riiedi's Classification, there were type I 12 cases, type II 21 cases and type III 10 cases. The methods used on these patients included manual reduction and plaster of paris immobilization, calcaneous tubercle traction and plaster of paris immobilization, open reduction and internal fixation with Kirschner wires, and open reduction and internal fixation with AO plate. The outcome was evaluated according to Ovadia's criteria, for type I fracture, 8 cases were treated with conservative method with a satisfactory rate of 79.17% and 4 cases were treated with operation with a satisfactory rate of 91.67%; for type II, conservative method for 12 cases and the satisfactory rate was 33.33%, and operation for 9 cases with a satisfactory rate of 70.37%; for type III, conservative method for 2 cases, with poor result, and operation for 8 cases with satisfactory rate of 79.17%. The indication for conservative treatment was type I fracture. It showed that for Pilon's fracture, the outcome of open reduction and internal fixation was superior to that of the conservative treatment, especially in those having internal fixation with AO plate.     

Vertical transarticular pin fixation for unstable ankle fractures: impressions after 16 years of experience

The usage of vertical transarticular pin fixation combined with plaster immobilization for severe ankle injuries has been reviewed in 92 consecutive cases over a period of 16 years. Moderately simple in application and without a skin incision, the procedure has been found to provide efficient and reliable short-term stabilization of the ankle and subtalar joints with minimal complications. A new technique is described for accurate placement of the pin and the prevention of its migration. It is a reasonable alternative treatment for certain unstable distal tibial and ankle fractures when open reduction with conventional internal fixation cannot be done. In particular, the method is recommended in treating displaced fractures at the ankle and deltoid ligament ruptures in geriatric patients. It is often useful as a salvage or last-resort procedure in unusually severe ankle injuries with circulatory or neural deficits. In many instances additional trauma to the head, thorax or abdomen may have been sustained. Thus total patient care is essential and priorities must be recognized. The treatment of ankle trauma, furthermore, in a physiologically-aged diabetic patient is often not the same as that for similar injuries in a young healthy adult. The clinical judgement and experience of the operator is the basis for selection of the procedure. The simplest method is often the best. Pin fixation, however, is not for everyone. It should be done only by surgeons qualified to treat bone and joint trauma and even then only for those situations in which its usage is specifically indicated.     

Recurrent and repeated infectious endocarditis: causes and preconditions (lecture)

A way of reducing the cost price of hospital automation is proposed. It is not necessary for it to update the whole equipment, but only a small part--the workstations used by programmers for their work, which support the stability of hospital automation; the working places of operators should be kept without modifications, but to allot them properties to inherit a potency and modernity of the purchased equipment; for this purpose they should be equipped with virtual machines copying properties of workstations being arrange in accordance with the pyramidal structure. A UNIX which represents a multi-user, multitask operational operative system providing an access on several pseudoterminals is simultaneously installed on the PENTIUM 100/133 workstation. A graphic terminal of the AMR "UnTerminal" firm (USA) is proposed for use as working places. Their advantage is that they have a special adapter connected directly to the bus of PC extension. Each user is allotted a video adapter, a keyboard controller, sequential and parallel interfaces for connection of the printer and manipulator. Each working place supports multitasking and it can be equipped with a printer, a "mouse" or modem. The image is transmitted on work places with a very high velocity-77 mehabits/sec that supports not only a text mode, but also VGA or SVGA graphics. Certainly, graphic terminals are more expensive than text terminals, but their capacities are similar to those of the main computer, here, the workstation. They may be located from the main computer at a distance of up to 75 meters or more and do not require adjustment during their installation.     

Theophylline-induced convulsions

The author analyses indications and therapeutic possibilities of arthroscopic meniscopexy and presents his own results assembled at the First Orthopaedic Clinic of the Masaryk University in Brno. He describes the surgical technique used, i.e. OUTSIDE-IN, in treatment of recent paracapsular ruptures of the meniscus, postoperative fixation and the rehabilitation programme. The author discusses also the necessity of a rigid plaster fixation and advocates fixation of the knee joint by a bandage as proposed by R. Jones with elimination of burdening for a period of eight weeks.     

Functional analysis of linker insertions and point mutations in the alpha-Amy2/54 GA-regulated promoter

First metatarsal fractures are rare because of their thick size and shape. They are to be treated aggressively because of the prolonged disability associated with such fractures. Any injury to the first ray may drastically alter the pattern of normal gait and weight-bearing. Most of the literature regarding such fractures is anecdotal, and there is little in the way of scientific articles that investigate their management. The general consensus for treatment of closed, nondisplaced first metatarsal fractures is to use some form of plaster immobilization. Nevertheless, there is much variation in the literature concerning the length of time patients should be casted. Rigid internal fixation using AO techniques is preferred if open reduction is to be instituted. Long-term complications with first metatarsal fractures are attributed mostly to malunion in the sagittal plane, resulting in a nonplantigrade foot.     

Management of the anterior cruciate ligament rupture: indications, choice of procedure, timing, concomitant and after-care

The indication for operative or conservative treatment of the anterior cruciate ligament remains still difficult. Many years of intensive basic and clinical research and a better knowledge of biology, biomechanics and pathology have not been achieved standards of therapy. Therefore varying treatment options exist. In this paper we give an overview on the main indications and common treatments. Untreated ruptures of the ACL result in severe functional impairment. Therefore we find a wide indication for an operative reconstruction. Patient orientated factors (age, activity level, morphotype) and the range of instability are important for the decision-making between operative and conservative treatment. The time of intervention is determined by the chosen treatment. Multidirectional instabilities, ruptures of meniscus or damage of cartilage need an early, isolated injuries of the ACL an early or later (until 4 weeks) surgical therapy. An anatomical ligament reconstruction (so called "suture") is possible only for selected ruptures near the femoral insertion. Operative treatment needs a special suture technic and autologous or allogenous augmentation. In 15 until 25% of all ACL ruptures good results can be obtained in this way. In all other types of ruptures only a reconstruction using autologous material (lig. patellae, semitendinosous tendon) is recommended. Rehabilitation after ACL ruptures depends on the method of treatment (conservative procedure, reconstruction material, fixation technique, associated lesions) and has to be adapted to the biological healing process. Normally an immobilisation (cast, orthesis) has no benefit for ligament healing.     

The shoelace technique for wound closure in open fractures: report of early experience

A simple, reliable method of wound closure in open fractures is presented which has been used in this department. The necessity for split-skin grafting or flap cover, with the associated morbidity and cost implications, has been avoided by using this method. It has not been associated with any major complications in the patients studied, but it should be recognized that this method is not universally suitable in the treatment of all open injuries. We recommend this method as a simple way of achieving soft tissue cover in open injuries which are thoroughly debrided and cleaned, and in which there is no evidence of raised intracompartmental pressure.     

Linguistic considerations in the treatment of bilinguals.

Language is intimately connected with most aspects of human development. Because of this pervasive quality, language is incorporated as part of the individual's coping mechanisms, and at times it may even serve a definite defensive role. This investigation examines research and clinical data regarding the language independence phenomenon as it relates to the treatment of bilingual patients. Attempts are made to describe the way the bilingual individuals mobilize (shift) their languages under anxiety-producing conditions and how this shifting of languages can be utilized by these individuals as part of their coping mechanisms. There can be both positive and negative implications for treatment. In this regard, the article illustrates how the linguistic shifting may further reinforce defenses such as intellectualization, splitting, and isolation of affect. Linguistic shifting can also be technically introduced by monolingual clinicians to advance the therapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The management of war wounds involving bone

Over 200 high-velocity missile injuries treated in a low-technology environment were audited under the aegis of the International Committee of the Red Cross Hospitals in Afghanistan and Northern Kenya. Femoral fractures were treated either by traction or external fixation using a uniaxial frame. The results showed that patients treated by external fixation remained in hospital longer than those treated on traction. The positional outcome was identical in both groups. In tibial fractures the external fixator was only of extra benefit in those of the lower third when compared with simple plaster slabs unless more complex procedures such as flaps or vascular repair were to be performed. In complex humeral fractures, external fixation resulted in long stays in hospital and a large number of interventions when compared with simple treatment in a sling. We conclude therefore that in an environment where facilities are limited and surgeons have only general experience very careful initial wound excision is the most important factor determining outcome. The application of complex holding techniques was generally inappropriate.     

Spondylolisthesis in childhood and adolescence

Isthmic spondylolisthesis occurs in 4.4% of children. In general it is a benign condition. The majority of individuals with mild or moderate isthmic vertebral slip remain free of symptoms or get only mild symptoms. In children and adolescents with mild slip, primary treatment of pain symptoms is non-operative. Young children before the growth spurt need radiological follow-up for documentation of possible slip progression. If the slip exceeds 25% in a child, segmental fusion to prevent further progression should be considered. Uninstrumented posterolateral fusion is the method of choice for treatment of pain symptoms not responding to conservative measures in slips up to 50%. In severe slips (> 50%), anterior or combined fusion is necessary to prevent further progression of lumbosacral kyphosis. The clinical and subjective results of in situ fusion in this age group are satisfactory in 80-90% of cases. Slip reduction is possible. It requires internal fixation and is connected with a higher risk of complications. The results of slip reduction have not yet been shown to be superior to results after in situ fusion. It may be performed in cases of spondyloptosis with severe impairment of function and sagittal malalignment of the spine.     

Possibilities in the reconstruction of bone defects

The importance of the functional unit "bone-soft-tissue" for the treatment of bone defects is discussed. A division is made between non-vascular and vascular bone transport. The individual methods are explained and their clinical significance is illustrated partly using case material. In general, the best way to fill small defects in vital soft tissue is to use cancellous autografts. For bridging longer bone defects callus distraction is the method of first choice, but in individual cases vascularized bone transfer can be taken from the iliac crest or the fibula. Homo- or heterografts should only be used in cases where no autologic bone material is available or when there is not enough.     

Management of comminuted fractures of the distal radius in the adult. Conservative or surgical?

Displaced fractures of the distal radius are difficult to treat successfully by traditional nonoperative methods. The goal in the management of these fractures is to achieve extraarticular alignment and an articular step off of less than 2 mm. Cast immobilization has been supplemented with pins and plaster technique and external fixators. Percutaneous are limited open reduction techniques, combined with wrist arthroscopy, have been shown to be useful in the management of intraarticular distal radius fractures. Despite these advances, there are still a significant number of fractures in which the articular surface cannot be reconstructed without open reduction and internal fixation. The main objective is to restore articular integrity as perfectly as possible. Attention to meticulous surgical technique will facilitate good results. When articular restoration cannot be accomplished, early arthrodesis or arthroplasty should be indicated. In the absence of osteoarthritis, intraarticular osteotomy can be used for intraarticular malunions with a step off greater than 2 mm. Radius malalignment usually requires a dorsal opening wedge osteotomy, insertion of a corticocancellous graft, and a dorsal buttress plate. Early recognition and treatment of distal radioulnar joint injuries associated with fractures of the distal radius are paramount to reduce the incidence of painful sequelae and functional deficits.     

Minimally displaced distal radius fractures: do they need plaster treatment?

In a prospective, randomized trial, minimally displaced distal radius fractures were divided into two groups: those treated with plaster immobilization for 1 week compared with 3 weeks. Functional Cooney scores were determined at 6 weeks, 3 months, 6 months, and 1 year. No statistical differences could be found in functional outcome between the groups at any time during the evaluation. Although patients did not allow immediate functional treatment in the presence of a fracture, we could not find any differences between 1 week or 3 weeks of plaster treatment. No further dislocation occurred, and all patients experienced eventful healing with good and excellent results in 92% of the cases. We believe, therefore, that only minimal immobilization is required in these fractures and that they should be mobilized as soon as comfort allows.     

Dynamic psychiatric interpretation of a disease model of trichotillomania

Every patient's "communal existence" allows to interpret deviations of behavior such as trichotillomania as a disturbance of interaction. When the child begins to wangle out of the dual union between mother and child it needs ways to delimitate itself, If the mother does not concede this demarcation (f. i. because she does not want to release the child from the symbiosis and therefore is "overprotecting") the child often becomes a victim of despair and, later on, of perplexity. At last it uses the own body as "Vis-a-vis". The accumulated aggressiveness is then worked off motorically by means of trichotillomania. In this way despair and perplexity in the field of interaction are passed on so to speak "atmospherically" to the mother, who in turn, having arranged treatment, transfers them on to the doctor. It is discussed how the area of irritation can be dissolved.     

Characterizing dynamic brain responses with fMRI: a multivariate approach

In this paper we present a multivariate analysis of evoked hemodynamic responses and their spatiotemporal dynamics as measured with fast fMRI. This analysis uses standard multivariate statistics (MANCOVA) and the general linear model to make inferences about effects of interest and canonical variates analysis (CVA) to describe the important features of these effects. We have used these techniques to characterize the form of hemodynamic transients that are evoked during a cognitive or sensorimotor task. In particular we do not assume that the neural or hemodynamic response reaches some "steady state" but acknowledge that these physiological changes could show profound task-dependent adaptation and time-dependent changes during the task. To address this issue we have modeled hemodynamic responses using appropriate temporal basis functions and estimated their exact form within the general linear model using MANCOVA. We do not propose that this analysis is a particularly powerful way to make inferences about functional specialization (or more generally functional anatomy) because it only provides statistical inferences about the distributed (whole brain) responses evoked by different conditions. However, its application to characterizing the temporal aspects of evoked hemodynamic responses reveals some compelling and somewhat unexpected perspectives on transient but stereotyped responses to changes in cognitive or sensorimotor processing. The most remarkable observation is that these responses can be biphasic and show profound differences in their form depending on the extant task or condition. Furthermore these differences can be seen in the absence of changes in mean signal.     

A visual method for analysing bucco-lingual position of artificial posterior teeth. Part 1: use of the ridge crest

We have developed a visual analysis method to examine the spatial relationship between the edentulous ridges and the bucco-lingual position of the artificial posterior teeth in complete denture fabrication. In this system, a non-contact type shape measurement system is used. We applied this system to the plaster models and the wax dentures of an edentulous patient. Using the measurement data on the upper and lower plaster models, we reconstructed their shape three-dimensionally and determined the points regarded as the ridge crests and the inter-alveolar crest lines in the frontal sections. To generate the upper and lower ridge crest lines which consisted of the points of the ridge crests, interpolation by B-spline curves was applied. Furthermore, the loft surfaces that we regarded as the consecutive inter-alveolar crest lines, were generated between the upper and lower ridge crest lines. The surface models of the plaster models and artificial teeth were displayed on the cathode-ray tube display unit, and the ridge crest lines and the consecutive inter-alveolar crest lines were superimposed on the surface models. This method could be utilized to visualize and examine the bucco-lingual position of the artificial posterior teeth in reference to the inter-alveolar crest lines.