Children may develop a torticollis due to Rotatory Subluxation not only after minor trauma, infections of the upper respiratory tract, surgical procedures in the oropharynx but also spontaneously. Three cases with a delay in diagnosis are presented; the typical symptoms and other causes of torticollis are discussed. The suggested treatment is mobilisation under general anaesthesia, fixation with a Halo for a few days and consecutive immobilisation in a Minerva cast for 4-8 weeks. This regimen was successful in all three cases.

Atlanto-Axial Joint↗

PubMedDate not supplied

[In vivo measurement of 3-dimensional movement of the iliosacral joint].

The purpose of this study was to quantify in vivo the three-dimensional motion patterns of the sacroiliac joint during passive manipulations as the opinions about the extent of motion of this joint are varied. 12 sacroiliac joints of 6 patients with clinically and radiologically normal joints were investigated. All patients were treated with an external fixator for diagnostic purposes of low back pain unrelated of this study. The motion of the sacroiliac joint was measured continuously with a three-dimensional goniometric system, which was mounted at the end of Schanz screws implanted in S1 and the ilium. All measurements showed relatively small rotation angles around the three main axis to the body between the ilium and the sacrum (< 2 degrees) and very small translations between the screw entry points into the bones (< 1 mm). The maximum rotation angle in the sagittal plane was 1.3 degrees on the right joint and 1.6 degrees on the left joint for flexion plus extension. It is questionable whether this motion can be quantified during manual manipulation. Extension of the hip always produced the largest motion in the sacroiliac joint.

Adult↗

PubMedDate not supplied

Plate osteosynthesis of femoral shaft fractures in adults. A follow-up study.

In 67 diaphyseal femoral fractures in adults treated by plating, the average follow-up time was 5 years. Sixty per cent of the patients suffered multiple injuries; 69% of the fractures were comminuted. The goal of treatment was rigid internal fixation. However, bridging of the comminuted area with a plate was sometimes necessary to maintain length as well as to encourage reconstitution and revascularization of fragments. Almost all patients had satisfactory end results. Only 2 cases were rated poor. Patients with rigid interfragmentary fixation had few complications, while patients with obvious instability (14 cases) developed 2/3 of the complications. The infection rate was 3%. Some complications might have been avoided by early cancellous bone grafting. The study confirms the need for primary or early secondary bone grafting to ensure bony union if cortical defects, potentially unstable fixation, or devascularized fragments are present.

Adolescent↗