Biomedical subjects
Publications and source records attributed to I Bjerkreim.
Fluoroscopy for determination of femoral neck anteversion was evaluated in 24 patients (48 hips) aged 5 to 15 years. The measurements of the anteversion angle of the femoral neck obtained by the fluoroscopic method were compared with those determined by the biplanar method of Dunlap/Rippstein. It is concluded that fluoroscopy incorporates errors to such a degree that the method is not reliable for clinical work.
Anteversion of the acetabulum and of the femoral neck was determined by use of computed tomography in 47 adults with normal hips and in 39 patients with osteoarthritis. The normal anteversion of the acetabulum was found to be 17 +/- 6 degrees (mean +/- standard deviation) and of the femoral neck 13 +/- 7 degrees. In the patients with osteoarthritis the femoral anteversion was on the average 6 degrees larger than in the normals, whereas no difference was revealed in the figures of acetabular anteversion. The relationship between the degree of femoral and of acetabular anteversion was calculated. No correlation was found, neither in the normals, nor in the patients. Consequently, the relationship between the anteversion of the femoral neck and of the acetabulum was poor in the patients as compared to the controls, and it is concluded that this is a contributing factor to osteoarthritis due to poor adaptation of the femoral head to the acetabulum.
One hundred patients with idiopathic scoliosis treated conservatively were reviewed for a mean period of 10.6 years after the end of treatment. The majority of curves had increased; 70% between 16 and 20 years of age and 60% after age 20. The mean progression per year was 3 degrees and 2 degrees for single and double curves, respectively, in the first 4 years after the end of treatment and 1 degree and 0.5 degrees, respectively, in adulthood. Curves above 40 degrees increased significantly more than smaller curves. It is concluded that curves of more than 40 degrees, especially thoracic single curves, should be treated operatively in adolescence. Conservative treatment of smaller curves should be continued towards 20 years of age, and the patients should be followed up during early adult life.
Seventeen femoral lengthenings with an observation period of 1 year or more are reviewed. The mean leg length discrepancy was 6.9 cm, ranging from 3.8 to 14.8 cm. Mean lengthening was 5.8 cm, ranging from 3.6 to 10 cm. Osteosynthesis and bone grafting was done in all cases. Nonunion occurred in one lengthening, and five bones refractured. All failures, however, healed after reosteosynthesis. Transient peroneal paresis occurred in two cases, while in one case knee flexion was reduced to 55 degrees. In spite of minor pin-track drainage, no infections complicated the osteosynthesis. It is concluded that the Wagner procedure is an effective and fairly safe method for leg lengthening. Complications, however, are frequent and great caution is essential.
In an experimental study using rats it was found that intramedullary nailing through the distal femoral growth plate resulted in a significant retardation of longitudinal growth. Drilling only and pin removal after 7 weeks also gave significant inhibition of growth after 14 weeks, while drilling only with immediate removal of the pin gave no growth disturbance during the first 7 weeks. The investigation indicates that damage to the central portion of the epiphyseal growth plate in rats leads to inhibition of longitudinal growth.
The development of femoral neck angles in children with idiopathic increased anteversion was investigated. The anteversion (AV) angle in 16 non-operated patients (n = 32) decreased from a mean of 45 degrees at the age of 7.3 years (median) to 31 degrees at the age of 15.7 years. The neckshaft (CCD) angle remained unchanged. A subtrochanteric derotational osteotomy was performed in 24 patients (n = 48) aged 7.7 years (median). The AV angle was corrected from 47 to 3 degrees, and the CCD angle from 134 to 124 degrees. At follow-up at the age of 16.5 years the AV and the CCD angles had increased to 14 and 135 degrees respectively. The internal rotation of the hip was increased to the same extent in the two patient groups. The degree of external rotation as well as total rotation was significantly larger in the non-operated patients compared to the patients who needed an operation. At follow-up the rotational movements of the hip and the external torsion of the leg/foot were measured and compared with the corresponding measurements for a control group of 26 healthy subjects whose median age was 16.3 years. In the non-operated patients the internal rotation was reduced at a rate corresponding to the spontaneous reduction of the femoral anteversion, while the external rotation was unchanged. In the operated patients the rotational movements were normalized, as was the anteversion of the femoral neck. No differences in external torsion of the leg/foot were found in the three groups. Based on these results we conclude that cases of idiopathic increased anteversion of the femoral neck are not corrected spontaneously as the child grows up. With a subtrochanteric derotational osteotomy slight overcorrection may be indicated, but simultaneous varus correction of the femoral neck seems to be unnecessary. The degree of external rotation of the hip determines gait symptoms in patients with increased femoral anteversion. No regular compensatory external torsion of the leg/foot develops during growth.
Examination of the hip joint by computed tomography was evaluated in 34 children admitted to hospital with symptoms of idiopathic increased anteversion of the femoral neck and in 6 children with congenital dislocation of the hip. Anteversion of the femoral neck and the acetabulum was determined from tomographic cross-sections, and femoral anteversion was also determined by conventional radiography. A good correlation was found between these two methods. The relationship between anteversion of the femoral neck and that of the acetabulum was calculated in the 34 patients with idiopathic increased femoral anteversion. In creased anteversion of the femoral neck was not compensated for by a corresponding reduction in the ventral orientation of the acetabulum. In many cases the adjustment of the acetabulum to the femoral head was poor. In some of the patients the degree of external rotation of the hip was greater than would be expected from the relationship between the anteversion of the femoral neck and that of the acetabulum. In these patients the lower limb is forced outwards when walking, causing the femoral head to dislocate laterally and forwards. Based on the results of this study we conclude that calculation of the anteversion, both of the femoral neck and acetabulum, should play an important part in the evaluation of candidates for derotational osteotomy of the femur. Computed tomography yields valuable information in this respect.
Seventy patients more than 16 years of age with untreated idiopathic scoliosis were followed-up for a mean period of 8.5 years. The majority of curves increased; 3 degrees per year before 20 of age and 1 degree per year after 20 years. Curves below 40 degrees increased significantly less than bigger curves and curves from 60-80 degrees increased the most. Single curves increased significantly more than double curves; thoracic curves increased significantly more than lumbar curves. It is concluded that surgery should be recommended to adolescent patients with thoracic or thoraco-lumbar single curves larger than 40 degrees, and that patients not treated operatively should be followed-up through early adult life.
Eighty consecutive patients with idiopathic scoliosis were treated preoperatively with Cotrel traction. Distraction X-rays were taken 2 or 3 days after start of traction and 8-10 days later. In 47 patients equal distraction force was applied in both instances. The force, averaging 28 klb, was measured on the head sling. Cotrel traction reduced the spinal curve 37.5 per cent in the first and 38.9 per cent in the second measurement. The difference is not significant. Preoperative Cotrel traction did not improve the surgical curve correction. Postoperative loss of correction and complication rate was insignificantly reduced compared with the results in a previous study. Cotrel traction does, however, give some indication of the surgical correction achievable.
Five patients 10-21 years old were treated for severe angular kyphosis, ranging from 61 to 133 degrees, by a three-stage procedure: 1. distraction in a halo-pelvic apparatus, 2. anterior decompression and/or fusion and 3. posterior fusion with Harrington compression rods. An average correction of 68% and a good cosmetic result were obtained. A solid fusion was achieved in all patients. There were no neurological complications. A 12-year-old girl gained 20 cm in height and the spinal kyphosis was reduced from 133 to 27 degrees.
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The present investigation was performed to compare the healing of skin incisions following running subcuticular suture using the absorbable material polyglycolic acid (Dexon) (DSS), and our standard procedure using polyamid (Supramid) interrupted percutaneous suture (SPS). In unilateral incisions one half of the wound closure was performed with DSS and the other with SPS. In bilateral incisions one method of closure was used for each side. A total of 100 scars were compared, 50 of each method. Less inflammatory reaction, a broader scar but slightly better cosmetic result and no increase in hypertrophic scar formation was found following Dexon intracuticular suture. Thus we recommend subcuticular suture with absorbable material in children to avoid the inconvenience with the removal of skin sutures.
A method of grading Perthes' disease according to the involvement of the femoral capital epiphysis is presented. 99mTc-pyrophosphate bone scintigraphy was performed on patients in the initial stage of Perthes' disease. An estimate of the femoral head involvement was made based on the size of the area with decreased activity visible on the scintigraphic image. The estimate allowed classification into one of four grades of severity of involvement. A comparison was made between the involvement seen on the scintigraphic image and the involvement later seen on radiographs. The importance of early diagnosis and treatement could be demonstrated.
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A survey of 274 late detected cases of CDH born in the years 1970--74 is presented. The incidence of late cases in southeast Norway was calculated to 2.2 per 1 000 live births. The hips of all patients were examined at birth, the majority by trained pediatricians, without disclosing any hip affections. 86% were females. Only 6.9% were delivered in the breech position. One-half of the patients had luxation (20%) or subluxation (30%), the rest had dysplasia without dislocation. In 19% both hips were involved. The low incidence of breech presentations in late CDH-cases compared with the incidence among neonatal cases (15.7%) point to some etiological differences. It seems that we in Norway have two types of CDH, one caused by joint laxity and detectable at birth and another, not present at birth, with progressive dysplasia of the hip and dislocation developing during the first year of life.
A girl with the characteristic abnormalities of Larsen's syndrome is presented. A soft flabby consistence of the cartilaginous skeleton of the larynx and trachea was thought to be the cause of attacks of respiratory failure which suddenly caused her death at the age of 9 months. Microscopy revealed a considerably reduced number of elastic fibres in the larynx, trachea and bronchi. Closed reduction of the knee dislocation by skin traction seemed to be successful.
A survey of 37 young patients, 10 to 18 years of age, with lumbar intervertebral disc herniation is presented. Local physical findings and limitation in straight-leg raising are often more marked in the young than in adults, whereas pain may be slight or even absent. Neurological findings were normal in 40 per cent of the cases, and when deficits were found, they were usually of a minor nature. Herniated disc syndrome in children and adolescents is characteristic and should not be difficult to recognize. With surgical treatment good results were obtained in nearly all cases.