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Biomedical subjects

G Fabry

Publications and source records attributed to G Fabry.

At least 19 recordsLinked to original sources

[The treatment of congenital tibial pseudarthrosis].

Congenital tibial pseudarthrosis (CTP) remains one of the most challenging problems in paediatric orthopaedic surgery. With the abandonment of older grafting techniques in favor of vascularized fibular transplants or the Ilizarov method the final outcome has improved and made the prognosis for patients less cumbersome. Using the latter technique in 10 patients, a success rate of 90 % could be reached. Nevertheless, although solid healing occurs in most of the patients nowadays, this is often at the cost of multiple operations before a definite well united, equalized and normally aligned limb can be obtained.

Child, Preschool↗

Three-dimensional imaging of acetabular dysplasia: diagnostic value and impact on surgical type classification.

OBJECTIVE: To investigate the diagnostic value and the impact on surgical type classification of three-dimensional (3D) images for pre-surgical evaluation of dysplastic hips. MATERIALS AND METHODS: Three children with a different surgical type of hip dysplasia were investigated with helical computed tomography. For each patient, two-dimensional (2D) images, 3D, and a stereolithographic model of the dysplastic hip were generated. In two separate sessions, 40 medical observers independently analyzed the 2D images (session 1), the 2D and 3D images (session 2), and tried to identify the corresponding stereolithographic hip model. The influence of both image presentation (2D versus 3D images) and observer (degree of experience, radiologist versus orthopedic surgeon) were statistically analyzed. The SL model choice reflected the impact on surgical type classification. RESULTS: Image presentation was a significant factor whereas the individual observer was not. Three-dimensional images scored significantly better than 2D images (P=0.0003). Three-dimensional imaging increased the correct surgical type classification by 35%. CONCLUSION: Three-dimensional images significantly improve the pre-surgical diagnostic assessment and surgical type classification of dysplastic hips.

Acetabulum↗

Bifocal pubic stress fracture after ipsilateral total knee arthroplasty in rheumatoid arthritis. A case report.

We present the case of a 78-year-old rheumatoid patient with a bifocal stress fracture of the pubic rami after ipsilateral total knee arthroplasty. Many risk factors that may cause insufficiency fractures are combined in rheumatoid arthritis. These patients are used to chronic pain, and therefore the diagnosis is often made late. When a patient suffering from rheumatoid arthritis presents with recent pain in the pelvic or hip region after hip or knee arthroplasty, a stress fracture should always be suspected. A standard pelvic radiograph and skeletal scintigraphy establish the diagnosis. CT-scan may be useful in the differential diagnosis with less benign pathology. Rest and analgesic drugs are sufficient to let the fracture heal. Nonunion has never been reported for these fractures.

Aged↗

A modified technique for tibial interference screw fixation of hamstring anterior cruciate ligament grafts.

This article describes a modified technique for tibial fixation of quadrupled hamstring grafts in anterior cruciate ligament reconstruction. Using this technique common problems with tibial interference screw fixation of hamstring grafts-such as loss of tension of the graft during screw introduction or twisting of the graft in the tunnel around the screw-are avoided.

Anterior Cruciate Ligament↗

Bilateral Legg-Calvé-Perthes disease: different from unilateral disease?

Twenty-five patients or 50 hips with bilateral Legg-Calvé-Perthes disease were reviewed at skeletal maturity in the orthopaedic departments of Leuven, Belgium, and Montpellier, France. The two groups were very similar as to age at onset of the disease, severity of involvement, and classification at skeletal maturity. The results seem to indicate that bilateral disease runs a more severe course as compared with unilateral Legg-Calvé-Perthes disease. Eighty percent presented with a Catterall group III and IV and Herring classification B and C. Forty-eight percent rated as Stulberg 4 and 5 at skeletal maturity.

Age Distribution↗

Severe heterotopic ossifications after total knee arthroplasty.

The authors report a case of severe heterotopic ossifications after a total knee arthroplasty in an 83-year-old woman. She showed a dramatic loss in range of motion between the third and sixth postoperative week, after she had obtained a satisfactory 0 degree to 90 degrees--range of motion at the 14th postoperative day. A treatment program of radiotherapy combined with indomethacin and nonaggressive antiinflammatory physiotherapy resulted in a slow but steady improvement with complete relief of symptoms 6 months postoperatively.

Aged↗

Volar dislocation of the proximal interphalangeal joint of the finger: an indication for urgent operative treatment.

Two patients are described with persistent acute volar dislocation of the middle phalanx of a finger. Closed reduction was impossible due to intra-articular interposition of the lateral slip of the extensor mechanism, combined with a tear of a collateral ligament. It is important to recognize these injuries at an early stage and an operative treatment is required.

Female↗

[Villonodular synovitis of the knee in a 5-year-old child. Apropos of a case].

PURPOSE OF THE STUDY: Case report of a five-year-old boy presenting with a painless swelling of the left knee with decreased range of motion. METHOD: Joint aspiration: fluid rich in red blood cells. X-ray--CT-scan--MRI: pigmented villonodular synovitis suspected. Arthroscopy with synovectomy and biopsy confirmed diagnosis. Because of remaining swelling one month after arthroscopy, intra-articular injection of triamcinolone hexacetonide gave a good result which has been maintained after 2 years. DISCUSSION: Hypothesis on etiology and pathophysiology, differential diagnosis and treatment of Pigmented villonodular synovitis are discussed based on a study of the literature. CONCLUSION: Pigmented villonodular synovitis is a rare condition in children. Association with other congenital disorders such as polyarticular localizations and family-history have been described. The diagnosis has to be proved by a biopsy. MRI seems to be the examination which gives the best information. Surgical treatment is indicated and consists of an arthroscopic synovectomy but which is often incomplete. A postoperative injection of triamcinolone hexacetonide may be the solution to avoid recurrence of Pigmented villonodular synovitis.

Administration, Topical↗

Gait pattern in patients with spastic diplegic cerebral palsy who underwent staged operations.

Fifteen patients with spastic diplegic cerebral palsy (CP) were monitored for a mean length of 9.5 years after they underwent staged operations and were evaluated by gait analysis, including joint motion in the sagittal plane and the ground reaction force (GRF) in three dimensions. Results showed an increased hip flexion (132%) at midstance, a reduction of peak knee flexion (PKF) during swing (45%) accompanied by an augmented time of PKF during swing (50%), and an increased dorsiflexion of the ankle during swing (293%) as well as its time during the gait cycle, in comparison with normal values. Moreover, significant decreases of the vertical GRF at the terminal stance and the forward and backward GRF were present. Additionally, it was found that a bilateral popliteal angle < 20 degrees is acceptable in spastic CP. Staged operations gave unpredictable results in the correction of contracture of the hamstrings, the Achilles tendon, and the iliopsoas. The authors are convinced that gait analysis is useful in evaluating these patients and enhances the results of operative treatment, and they have since changed their approach toward multilevel simultaneous corrections.

Adolescent↗

Osteofibrous dysplasia of the tibia: case report and review of the literature.

A case of osteofibrous dysplasia (OFD) of the tibia with 10 years of follow-up is presented. Spontaneous healing of this lesion occurred without any surgical intervention at the age of 10 years. The diagnosis was made retrospectively on the basis of clinical and radiographic appearance and evolution. The capricious nature and indolent course of this neoplasm has led to uncertainty regarding its etiology, evolution, and treatment. A review of the literature and the ongoing discussion about this matter is presented.

Casts, Surgical↗

Results of the Kudo elbow prosthesis in patients with rheumatoid arthritis: a preliminary report.

Sixteen elbows in 15 rheumatoid arthritis patients had a total elbow replacement with insertion of a non-constrained surface-replacement prosthesis. One patient died of an unrelated cause, but all the others were available for follow-up (mean follow-up period: 35.4 months). The results were graded according to a modified version of the Morrey elbow score. A good result was seen in 13 elbows and a fair result in two. One infection occurred, which was cured with intravenous antibiotics and maintenance of the prosthesis in place; however, recurrent dislocation persisted. Another patient had postoperative instability with recurrent subluxations. Eleven patients were very satisfied and one was satisfied. The total active range of motion increased significantly from 70.3 degrees (SD 29.6) to 97.0 degrees (SD 15.4), mainly by increased flexion. The modified Morrey score increased significantly from 32.7 (SD 13.1) to 89.3 (SD 10.3). Pain decreased from severe (n = 12) and moderate (n = 3) preoperatively to mild (n = 5) and absent (n = 10) postoperatively.

Adult↗