Search PubMed⌕ Search

Biomedical subjects

P Dungl

Publications and source records attributed to P Dungl.

At least 37 records · Page 2Linked to original sources
PubMed1991

Lengthening for congenital short femur. Results of different methods.

We have reviewed the results in 37 patients with unilateral congenital short femur (Pappas classes III to IX), treated by different lengthening procedures. The increase in the length of the femur varied from 15.6% to 142%, excellent or good results being obtained in 32 patients (86%). There was an average of 1.9 complications per case, most being seen earlier in the series when the Wagner technique was used. With the Orthofix and the Ilizarov techniques, we used callus distraction in all cases. We found that the proximal diaphysis of the congenitally abnormal femur healed less well, and we now prefer to perform corticotomy and callus distraction of the distal metaphysis. The Ilizarov method gave the best results, offering the possibilities of the simultaneous use of a Hoffmann fixator across the hip and the treatment of knee dislocation and instability.

Adolescent↗
PubMed1990

[Surgical treatment of the sequelae of ischemic postdysplasia femur head necrosis in children. II. Surgical technique].

The author presents its concept concerning the possibilities of the surgical treatment of the sequelae of the postdysplastic necrosis of the femoral head originating from the treatment of congenital dislocation or subluxation of the hip joint. The classification is based on the division according to Bucholz and Ogden into 4 types. Indicated for the surgical treatment are hips with the injury of the type II and III. In Grade II type the joint congruence is not affected and the method of operation is the redirection pelvic osteotomy. In children up to the age of 10 the author applies Salter osteotomy and in elder children and adolescents he performs a triple osteotomy of pelvis. Grade III type is the most severe impairment because of the concurrent defect of the joint congruence, limb discrepancy and extensive anatomic changes of the proximal end of femur. Up to the age of 10 he recommends Salter innominate osteotomy with the simultaneous valgus osteotomy, in elder children he recommends successively a triple pelvic osteotomy and a double intertrochanteric valgus osteotomy. This facilitates a considerable improvement of most hip joints affected in this way and at the same time the compensation of the limb length.

Adolescent↗
PubMed1990

[Sprengel's deformity].

The authors deal with etiology, pathological anatomy and clinical finding in inborn high-riding scapula--the so-called Sprengel deformity. What is the best treatment tactics? Is the conservative treatment more suitable than the surgical one, or vice versa? By comparing their own experience with the data in the specialized literature the authors advocate a strictly individualized approach to each affected patient. After determining the diagnosis of Sprengel deformity it is necessary to evaluate the position of the scapula and the extent of the limitation of the range of motion of the respective shoulder-girdle. At the same time it is essential to consider the ability of the child and his parents to cooperate in the period of the postoperative rehabilitation. The rehabilitation carried out properly in the postoperative period is equally important as the perfect performance of the surgery. In more severe grades of affection combined with greater functional limitation of the ipsilateral shoulder the authors recommend the surgical treatment using the Green procedure with additional subperiosteal osteotomy of the ipsilateral clavicle (morcellation). The aim of the operation consists in the reduction of the scapula with simultaneous extraperiosteal release of most muscles inserted on the scapula. At the same time the os omovertebrale, if present, is always removed. The congruency of the anterior surface of the scapula and the thoracic wallis achieved by the resection of the supraspinatus part of the scapula. The proper position of the reduced scapula is ensured both by the reinsertion of muscle insertions to new, functionally more advantageous parts and by the fixation of the interior angle of the scapula in a newly created "pocket" in m. latissimus dorsi. Immediately after operation the proper position of the scapula is ensured by wire cerclage, distally anchored to the contralateral spica cast. The authors evaluate a group of 7 patients operated on at the Orthopaedic Clinic of the Institute for Further Education of Physicians, Teaching Hospital at Bulovka in Prague in the period of 1980-1987. Ensuing from the evaluation is the fact that in all deformities of III grade according to Cavendish the results achieved were satisfactory. On the other hand, the deformities of IV grade are difficult to treat even by operation. Only in one case the result was partially successful. In the conclusion the authors recommend a timely screening of the deformity, its timely operation (up to the age of 4 years) and indication carefulness in elder children.

Child↗
PubMed1990

[Extensive subtalar release in the treatment of congenital pes equinovarus].

The results of the surgical treatment by the method of extensive subtalar release after McKay is observed on the group of 35 feet operated on in 23 patients. In 17 feet it was the case of the recurrence after the operation, 18 feet were operated on primarily either after the conservative therapy or after no preceding therapy. Surgical technique is described in which major stress is put on the considerate approach and perfect correction of all abnormalities within one operation. A three-grade evaluation was used for the assessment of the results: good, fair, poor. Good results were achieved in 60 per cent of operated feet, 23 percent were evaluated as fair and 17 per cent as poor results. In the group of patients operated on beforehand the number of poor results is higher than in the group of patients operated on for the first time. As a supplementary procedure enucleation of os cuboideum is applied either during the basic operation or in the following period, in the second phase metatarsal osteotomy and transposition of the tendon of m. tibialis ant. into the base of Vth metatarsal are performed. This method of surgical treatment provides very satisfactory results. With the adequate performance of surgical treatment the number of complications is minimal. This type of operation is indicated for children between 1 and 4 years of age, exceptionally it can be performed also in older patients (the oldest boy in the group was 6 years old).

Child, Preschool↗
PubMed1989

[Calcaneonavicular coalition and its treatment].

The work deals with calcaneo-navicular coalition which occurs most frequently. The clinical picture is discussed of this congenital defect which is usually manifested by the peroneal spastic flatfoot in the period around 10th year of age and biomechanics of the foot with this anomalous coalition is dealt with. As for therapy the authors recommend surgical resection of the bony bridge between the calcaneum and the navicular with subsequent filling of the defect by a muscular flap of the short extensor of toes as recommended by Bentzon in 1928. Proceeding from their own material the authors evaluate the effect of this operation in 6 feet. In obsoleta symptomatic cases the authors recommend in case of arthrosis of the talo-navicular articulation desis of this joint, in case of arthrosis of the whole Chopart's joint the triple desis sub talo is the method chosen. With regard to the simplicity of the surgical operation conservative therapy is not recommended. However, it is essential to operate on in due time, and namely as early as at the age of about 11 years. The work points out the frequent wrong diagnosis of the painful flatfoot and the necessity is emphasized of performing an oblique dorsoplantar projection of the foot to reveal calcaneo-navicular coalition.

Adolescent↗
PubMed1986

Recurrent traumatic dislocation of the hip in a child: significance of early hip arthrography.

The authors describe a case of a recurrent posterior traumatic dislocation of the hip in a child in whom early arthrography demonstrated a large defect of the posterior capsule. The authors emphasize the necessity of prolonged immobilization and long-term follow-up. The operation of the patient was performed on the 7th day after the third recurrence of the dislocation. Revision and suture of the capsular defect from Gibson's approach were done.

Adolescent↗