Biomedical subjects
Publications and source records attributed to P E Scranton.
Seven post-traumatic mucoid cysts of the patellar ligament occurred in six athletes. Non-operative treatment of two of the seven cysts was successful, as was operative resection of the remaining five cysts. The lesion, while uncommon, must be considered in the differential diagnosis for athletes who have persistent pain in the knee.
A 10-year prospective study was carried out on arthrodesis surgery of the major tarsal joints of the foot. The guiding principle of the study was that foot symmetry would be preserved, except where both feet were deformed. Correction in the frontal, coronal, and sagittal planes would be used to restore normal talocalcaneal relationships. In patients with normal relationships, triple, subtalar (talocalcaneal), and isolated tarsal arthrodesis would be carried out by iliac-crest-inlay grafting to preserve tarsal relationships. In 41 patients, 47 arthrodeses were carried out. There were 31 triple arthrodeses, 10 talocalcaneal fusions, four talonavicular fusions, and two naviculocuneiform fusions. In patients with deformity, significant improvement in the angles of anteroposterior talocalcaneal divergence and lateral talocalcaneal convergence was recorded. There were 27 good results, 15 fair results, and five poor results. Supplementary bone grafting and the use of internal fixation improved the rate of arthrodesis.
Arthrodesis of the ankle can result in a painless, normal walking gait. However, complications in ankle arthrodesis can be major, and can occur when anatomy, deformity, or bony deficiency is not properly addressed. Nonoperative treatment should always be considered first, and, if possible, an open or arthroscopic ankle debridement can provide significant pain relief. Arthrodesis should be considered after conservative treatment fails. Infections, deformity, sensory deficiencies, and bony defects require special consideration. The use of bone graft and internal or external compression will enhance the likelihood of a successful arthrodesis.
Fifty-eight professional and competitive amateur athletes had a combined reconstruction of the anterior cruciate ligament, with use of the semitendinosus tendon for the intra-articular portion of the reconstruction and a strip of iliotibial band for the extra-articular augmentation. Thirty patients (thirty-two knees) were evaluated two to seven years postoperatively to assess the results and the ability to return to athletics. Follow-up consisted of an interview, clinical and roentgenographic examinations, and testing with an arthrometer. Six patients (20 per cent) had a rating of excellent; twenty-two (73 per cent), good; and two (7 per cent), fair. There were no poor results. Of the thirty-two knees, twenty had an associated injury: twenty meniscal tears in eighteen knees, three tears of the medial collateral ligament, four osteochondral fractures of the lateral femoral condyle, and two loose bodies. Combined reconstruction of the anterior cruciate ligament resulted in improved stability of the knee in these patients whose goal of treatment was to be able to resume sports at a highly competitive level.
Any hemorrhage in a hemophilic patient must be regarded as a serious problem. A small percentage of hemophiliacs have an inhibitor that will destroy factor VIII or IX clotting activity, thus making control even more difficult. This occurrence predisposes these patients to joint contractures and deformities secondary to repeated, uncontrolled hemorrhages into muscle compartments and joints. Patients with an inhibitor must, therefore, be recognized, and any bleeding should be treated as an emergency. A combined treatment protocol has been developed by the hematology and orthopedic departments in a effort to achieve early hemorrhage control and prevent subsequent deformity.
Eighteen patients with primary osteosarcoma were studied for abnormal endocrinologic functions. Oral glucose tolerance tests revealed abnormal glucose, insulin, or growth hormone response curves in 78% of the study population. Elevated somatomedin values were noted in 72% of the patients tested. No significant deviations were observed in serum cortisol, estradiol, testosterone, follicle stimulating hormone, and luteinizing hormone levels. Likewise, lipid screening and 24 hour 17-hydroxy and 17-keto steroid excretion levels were normal. Statistically these derangements were unrelated, leading to the hypothesis that some additional factor or factors are present and responsible for the abnormalities noted. These deviations, found in association with primary osteosarcoma, constitute a new "paraneoplastic syndrome."
At a regional school for the blind, 157 children were examined for musculoskeletal abnormalities. The incidence of scoliosis was 9.5 per cent; of foot deformity, 53.5 percent; and of ligament laxity, 25 per cent. Thirty-six children (23 per cent) had evidence of spastic, flaccid, or athetoid cerebral palsy or other disorders of the central nervous system. The orthopaedist should evaluate blind children carefully and repeatedly for evidence of occult cerebral palsy and progressive deformity of the spine or foot.
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The histologic and clinical characteristics of 54 patients with osteosarcoma are reviewed. The association of rapid linear bone growth with the occurrence of this tumor is confirmed, and evidence for increased growth in these adolescent patients is presented. A significant increase in female survival is seen in this study, and the literature relevant to gender and survival is reviewed. A histologic characterization of six predominant tumor patterns is presented with correlation to survival. Increased survival is seen with two specific histologic patterns, but there is great variability in the histology and sampling of osteosarcomas, and the series is small.
Altered carbohydrate metabolism associated with fibrosarcomas and chondrosarcomas has been well-documented in past literature. This report describes abnormal carbohydrate metabolism in 2 osteosarcoma patients, and abnormalities in growth hormone and somatomedin serum levels. Experimental evidence is presented showing in vitro suppression of osteosarcoma tumor cell proliferation by 17 beta Estradiol. Estrogen inhibition of linear bone growth, cartilage proliferation, and somatomedin is discussed with reference to possible estrogen therapy in osteosarcoma.
Recent evidence suggests that endocrine factors play an important role in the natural history of osteosarcoma. The occurrence of this tumor in the metaphysis of rapidly growing adolescents, coupled with increased female survival led to the investigation of the effects of various hormones on cultured osteosarcoma cells. The in vitro effects of physiologic concentrations of human growth hormone, 17beta estradiol, and progesterone on cultured osteosarcoma cells and chondrocytes are presented. Growth hormone significantly enhances 3H-thymidine incorporation in osteosarcoma cells and chondrocytes, in the presence of human serum. The use of other sera, culture media, or heat inactivation of the human serum abolishes this effect. Estradiol and progesterone, alone, or in combination produce significant suppression of DNA synthesis in cultured tumor cells. Several sera contain a heat-labile factor which has the capacity to block the suppressive effect of estradiol. This factor could be overcome by increasing the concentration of hormone, or by heat-inactivation of the serum. The use of hormone therapy in the treatment of osteosarcoma has never been reported, despite its demonstrated value in certain other malignancies. In light of these observations and considering the poor prognosis in this disease it seems reasonable to initiate a study of adjunctive hormone therapy in osteosarcama.
A syndrome of ankle pain on weight-bearing while running due to post-traumatic ossification of the tibiofibular ligament is described. Pain is caused by failure of normal downward and lateral motion of the fibula. Treatment consists of complete excision of the synostosis, followed by cast immobilization for 3 weeks.
The association between osteosarcoma and growth, including altered carbohydrate metabolism has been investigated in 5 osteosarcoma patients. Serum from an adolescent osteosarcoma patient has been noted to consistently enhance 3-H-thymidine uptake in cultured chondrocytes and tumor cells. Females survive osteosarcoma more frequently than males. In vitro serum-enhanced proliferation of osteosarcoma cells is suppressed by estradiol.
It is felt that stress fractures are caused by excessive, repetitive muscle forces acting across the affected bone. These fractures should be suspected in participants of athletic endeavors who present with a history of persistent, focal, activity-related pain regardless of their stage of physical conditioning. Associated physical findings are localized tenderness and swelling without evidence of a generalized systemic response. Bone scans and serial roentgenograms including specialized views may be required for documentation. Limitation of the athletic activity is the hallmark of the treatment program.
We compared the difference in operative time, hospitalization and recovery time in two groups of patients who underwent open or arthroscopic resection of anterior, tibiotalar, impinging spurs. The operative time was approximately the same, but the average length of hospitalization and time to recovery were shorter in the arthroscopic group. A classification system is proposed that grades the degree of spur formation and assists in predicting the length of recovery time and whether the patient is a candidate for open or arthroscopic spur resection. In this series, grade I spur patients recovered and resumed full activity at 5.0 weeks, grade II at 5.6 weeks, grade III at 6.4 weeks, and grade IV at 10.0 weeks postoperatively. Grade IV patients are not suitable candidates for an arthroscopic debridement.
Fibular function has long been a point of controversy in the literature. Until recently the fibula's role during gait has been thought of as entirely static. A review of the literature reveals an important dynamic function for the fibula in maintaining ankle mortise stability during weight bearing. Roentgenographic and anatomical studies confirm the hypothesis of progressive distal fibular descent. A taut interosseous membrane and deepened mortise result when be flexors of the foot contract during stance phase. Congenital deformities of the ankle may stem from aberration in the dynamic role of the fibula. Stress fractures and problems resulting from impaired distal migration and synostosis formation are interpreted as disorders of the dynamic role of the fibula.