Neurologic symptoms and signs in patients with sciatica were prospectively studied and compared with myelographic and operative findings in 403 cases with lumbar disc herniation as the cause of sciatica with special reference to accuracy of the clinical level diagnosis. Fifty-six percent of the herniations at L4-5. However, pain projection into the first sacral distribution was most common. Neurologic symptoms and signs of involvement of a single root were present in 239 cases and of two roots in 154 cases in L4-5 and L5S1 herniations. Pain projection into the fifth lumbar distribution was a very important symptom for identification of clinical findings of the fifth lumbar root involvement gave a level diagnostic accuracy comparable with myelography, while pain projection into the first sacral distribution was less reliable especially in cases with signs of two roots. The neurologic picture of high herniations was completely unreliable. Lumbar myelography or computer tomography is recommended as a routine preoperative study.

Adult↗

PubMedDate not supplied

Preoperative Russell traction in Legg-Calvé-Perthes disease.

Divergent opinions about the pathophysiology and the optimal time and methods for the treatment of Legg-Calvé-Perthes (LCP) disease exist. Synovitis causing restriction of hip motions may be hazardous to the circulation to the femoral head. We studied 23 children (24 hips) in the initial phase of LCP disease. Seven to 14 days of Russell traction decreased the intraosseous pressure significantly (p less than 0.001) and increased the hip motion a mean of 33.6 degrees. As assessed by osteovenography, the venous congestion decreased in almost every hip during Russell traction.

Child↗

PubMedDate not supplied

The hamstring syndrome. A new diagnosis of gluteal sciatic pain.

A series of 59 patients was treated and operated on for pain felt over the area of the ischial tuberosity and radiating down the back of the thigh. This condition was labeled as the "hamstring syndrome." Pain was typically incurred by assuming a sitting position, stretching the affected posterior thigh, and running fast. The patients usually had a history of recurrent hamstring "tears." Their symptoms were caused by the tight, tendinous structures of the lateral insertion area of the hamstring muscles to the ischial tuberosity. Upon division of these structures, complete relief was obtained in 52 of the 59 patients.

Adolescent↗

PubMedDate not supplied

Arthrography, clinical examination, and stress radiograph in the diagnosis of acute injury to the lateral ligaments of the ankle.

We examined 188 consecutive patients, each of whom had an acute ankle sprain, using clinical stability assessment, stress radiographs, and arthrography to compare the reliability of these methods used in diagnosing lateral ligament ruptures of the ankle. Sixty-six of the ankles were treated operatively. Arthrography accurately detected ligament damage in all of the patients with this injury and revealed the extent of the injury in about 85%, whereas clinical examination and stress radiographs detected only about half of the injuries. The injuries and the results of these two methods were often controversial, as our study will show.

Acute Disease↗

PubMedDate not supplied

Arthrography for the diagnosis of acute lateral ligament injuries of the ankle.

Arthrography was used for diagnosis of ruptures of lateral ligaments in 589 acutely injured ankles that were treated operatively. The accuracy of the method was tested comparing the findings of arthrography with those at operation. We found arthrography to be almost 100% reliable for diagnosing a fresh anterior talofibular ligament rupture. The best criterion for detecting calcaneofibular ligament rupture was filling of the peroneal tendon sheath with contrast medium. Leakage below and behind the lateral malleolus, when present with peroneal tendon sheath filling, confirms the diagnosis of calcaneofibular ligament rupture, but these findings without peroneal tendon sheath filling are too rare to base the diagnosis on them alone.

Adolescent↗

PubMedDate not supplied

Osteomedulloangiography: a method of estimating the consolidation prognosis of tibial shaft fractures.

Eighty-seven tibial shaft fractures were examined with osteomedulloangiography. The findings in a consecutive and unselected group of 19 fractures confirmed that intraosseous circulation develops within six weeks in normally healing fractures. For 68 tibial fractures which showed no sign of consolidation in conventional roentgenographic examination, osteomedulloangiography was usually performed at three months. Fractures showing positive osteomedulloangiographic results were further treated conservatively, and all consolidated at an average of 21 weeks after injury. On other hand, the 41 fractures with negative osteomedulloangiographic findings required bone-grafting, leading to solid union within three months. Osteomedulloangiography with phlebopression of the extraosseous soft-tissue veins is a reliable technique for early detection of fractures which heal without operation, especially ion cases where clinical and other roentgenographic criteria might prove inadequate. Thus, unnecessary operations for consolidation can be avoided.

Adult↗

PubMedDate not supplied

Evaluation of femoral osteotomy in the treatment of Legg-Calvé-Perthes disease.

The optimal time and type of the varus-innerrotation femoral osteotomy in the treatment of Legg-Calvé-Perthes disease (LCPD) was evaluated on the basis of 53 hips having early operations and 14 hips having late operations and also on the basis of the previous observations on the disturbed venous drainage in various stages of LCPD. The operation should be done as early as possible in the cases in which it is indicated. Both the operative results in the present series and the theoretical background based on the severe disturbances of venous circulation in the initial phases justify an early intervention. The anatomic results of the early operated-on hips (74% good, 17% fair, and 9% poor) were related to the degree of the varusation and to the postoperative uncovering of the head. In the good results, the attained varusation was greater and the positioning of the head within the acetabulum deeper than in the fair or poor results. Accordingly, in "risk" cases, the optimal angle of the neck immediately after the varusation should be 100--100 degrees. With such varusation, it is possible to obtain good containment and a remarkable relief of the load against the femoral head during walking and running.

Child↗