Gait was analyzed in seven otherwise healthy males at least 11 mo after they had recovered from a traumatic unilateral transmetatarsal amputation incurred during the course of their usual occupation. All seven were fitted with a semirigid foot orthosis. Four were also fitted with a Chopart prosthesis. Gait was evaluated with forceplate measurements of ground reaction force during free walking, by clinical observation of such ambulation on videotape, and by the subjective impression of the men as obtained by a questionnaire. In all men, with unmodified footwear, with the orthosis, and with the prosthesis, the forceplate data showed an abnormal pattern characterized by reduced stance duration and deficient forward propulsion on the amputated side. The abnormality and asymmetry of ground-reaction forces were less with greater preserved stump length and for a given stump length were with the above-ankle concept (Chopart) prosthesis than with the below-ankle concept. These features were recognized during the clinical analysis of all footwear, but there was an extra irregularity of weight progression noted with the fixed ankle of the Chopart prosthesis. The questionnaire reported stump problems to be the principal difficulty, and the follow-up revealed persistent attempts at surgical management including consideration of amputation at a higher level. It was concluded that the patient and the surgeons are likely to choose preservation of limb length over considerations of function during acute care and that the prosthetic concept best suited to deal with the resulting stump should emphasize unloading the distal part of the stump and smoothing out the impulsive force peak on the stump in late stance to minimize pain and to enhance ambulation capacity.

Adult↗

PubMedDate not supplied

Anterior cruciate ligament injuries in skeletally immature patients.

Twenty-eight consecutive, skeletally immature patients (9.9-15.0 years of age at the time of injury) with total rupture of the anterior cruciate ligament (ACL) were followed up for 3-5 years. The aims of the study were to monitor the natural course of conservative treatment, to identify variables relevant to failure of conservative treatment, and to evaluate an over-the-top procedure for ACL reconstruction by using the semitendinosus tendon and avoiding the physes. The patients were interviewed according to Lysholm knee score and Tegner activity level. Knee laxity and muscle torque were measured. Five patients insisted on immediate reconstruction. Twenty-three patients were sent to a 3-month rehabilitation program. Sixty-eight percent of the patients, who made an attempt with conservative treatment, had been operated on at follow-up. The patients not operated on were younger at injury and had a lower activity level at follow-up. The surgical procedure improved objective and subjective knee function, but there was a correlation between high activity level and a low Lysholm score.

Adolescent↗

PubMedDate not supplied

Internal fixation with biodegradable rods in pediatric fractures: one-year follow-up of fifty patients.

Fifty children with transphyseal or osteochondral fractures were treated with biodegradable osteosynthesis material and followed for at least 1 year. All 50 fractures healed, and there were no major complications; 11 of them were fractures of the radial humeral condyle. In a prospective randomized study, they were compared with metal pin fixation of the same fracture (eight cases). No major differences were noted. After the study was completed, we observed two cases of nonunion of intraarticular fractures of the radial head, probably related to foreign body reaction to the resorbable implant material. Biodegradable osteosynthesis material is advantageous in treatment of children's fractures because it makes a removal operation unnecessary. It is ideal in cases of osteochondral fractures. Further experience with this material is necessary, however, before it can be safely recommended.

Adolescent↗

PubMedDate not supplied

Long-term follow-up of anterior tibial spine fractures in children.

In a long-term follow-up (mean 16 years) of 61 children with anterior tibial spine fractures, subjective knee function (Lysholm score) was excellent or good in 87% of the subjects and fair in 13%. Eleven percent of the children had a lower activity level (Tegner score) than desired. Muscle performance was affected in those subjects with the lowest Lysholm scores. Pathological knee laxity was found in 38% of the subjects, but was not reflected in poor subjective knee function. Age at injury did not influence the outcome. There was no indication that young children can eliminate slackness of the anterior cruciate ligament by further growth. Only in type III fractures was there a correlation between fracture displacement after healing and knee laxity, as well as between knee laxity and Lysholm score. Arthroscopy-guided or open reduction and internal fixation seems to be a worthwhile procedure only in dislocated type III fractures.

Adolescent↗

PubMedDate not supplied

Physician career management: organizational strategies for the 21st century.

Burnout is a state of physical, emotional, and mental exhaustion caused by long-term involvement in situations that are emotionally demanding. It is not stress, per se, that causes burnout, as many thrive in stressful, demanding careers. Rather, burnout results when stress continuously outweighs the sense of effectiveness, accomplishment, and reward. And, this fate is sealed when one feels helpless to effect significant change in the conditions that fuel the stress. Establishing an organizational environment that reduces the risk of physician burnout requires a new commitment of resources, one that can be challenging to justify to decision-makers with a strictly short-term, bottom line orientation. The key issues to consider in shaping a physician career management program include: (1) entry of new physician employees into the organization; (2) productivity measures; (3) responsiveness to safety concerns; (4) administrative and policy issues; and (5) variety and growth opportunities.

Burnout, Professional↗

PubMedDate not supplied

Considerations in the corticosteroid treatment of bone cysts.

To be effective in treating bone cysts, intracavital injections of corticosteroids must be able to run freely over their lining membrane. Free movement may be prevented by complete or partial osseous or fibrous septa or by the cyst contents. This report illustrates such situations. To solve the problem, the interior anatomy of the cyst should be evaluated by a contrast study and then, when necessary, several corticosteroid injections should be made in different cyst compartments. The volume of corticosteroid should be modified according to the size of the cyst.

Bone Cysts↗

PubMedDate not supplied

Radiologic evaluation of the liver in the alcoholic patient.

It has been well documented that long-term abuse of alcohol leads to dysfunction of multiple organ systems of the body. The liver, which is the primary organ responsible for alcohol metabolism, is also a major target for damage. Cirrhosis of the liver is the seventh leading cause of death in the United States. The radiologist plays an important role in the evaluation and possibly in the treatment of the conditions which result from alcohol abuse. The advantages and limitations of various radiologic diagnostic modalities in the evaluation of alcoholic liver disease are presented and discussed.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Osteochondral lesions in the radiocapitellar joint in the skeletally immature: radiographic, MRI, and arthroscopic findings in 13 consecutive cases.

Radiography, magnetic resonance imaging (MRI), and arthroscopy were performed in 13 consecutive cases of osteochondral lesions of the radiocapitellar joint in 12 patients aged 11-16 years. Nine patients had a high activity level, and two patients had a significant trauma before the onset of symptoms. Symptoms were limited range of motion, pain, and catchings or lockings. Clinical findings were decreased range of motion and lateral elbow tenderness. Radiography revealed loose body, flattening of the humeral capitellum, or subchondral cysts (or a combination of these) in all cases but three. There was a good correlation between MRI and arthroscopic examination. Nine lesions were located in the humeral capitellum, one lesion in the radial head, and in three cases, lesions were found in both sites. Loose-body removal, shaving, or subchondral drilling (or a combination of these) was performed in 11 cases. All surgically treated patients improved in the short run. Awareness of the typical clinical and radiologic picture will allow identification of the cases suitable for arthroscopy and surgical treatment. In these cases, MRI can be omitted.

Adolescent↗

PubMedDate not supplied

The influence of transphyseal drilling and tendon grafting on bone growth: an experimental study in the rabbit.

The undulating area of the distal femoral physis has been measured in New Zealand White rabbits, by using an image analyzer in histologic sections, and correlated to radiographic measurements. The relative size of a physeal drill injury necessary to cause growth disturbance has been found to be 7-9%. A transphyseally placed tendon, even as a free graft, prevented solid bone-bridge formation in the drill hole and growth disturbance. The results are of possible clinical significance.

Animals↗