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T Terjesen

Publications and source records attributed to T Terjesen.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Idiopathic femur anteversion].

Intoeing is one of the most common reasons for referral of children to orthopaedic evaluation. The most frequent cause is increased femoral anteversion (AV). The AV-angles have traditionally been measured by radiographic methods. In recent years, ultrasonographic techniques for such measurements have been introduced. Relatively liberal indications for surgical correction of increased anteversion by derotational osteotomy have previously been practised in Norway. The indications are now much more restrictive, because several reports have documented spontaneous reduction of the AV-angles during growth. We think operative treatment should be considered if markedly increased AV-angles and serious complaints persist at age 10-12 years.

Child↗
PubMed1995

Femoral anteversion measured by ultrasound and CT: a comparative study.

Both computed tomography (CT) and ultrasonography have been used successfully to estimate the femoral anteversion (AV) angle. In this study, AV angles in 20 human adult femurs were determined by ultrasonography and CT and the measurements compared. On CT the real AV angle was measured as the angle between the head-neck centreline and the posterior condylar plane. In addition, the angle between the anterior head-trochanter (HT) tangent and the posterior condylar plane was determined. The latter angle was also measured by ultrasonography using the tilted transducer technique. The mean interobserver variation in the ultrasound measurements was 1.9 degrees. We found ultrasonography to correlate very well with CT, both when comparing with the HT angle (r = 0.95) and with the AV angle (r = 0.93). The HT angle was on average 4 degrees greater than the AV angle. In this study the accuracy of ultrasonography was +/- 5 degrees and the method is recommended for screening in patients with rotational disorders of the femur.

Adult↗
PubMed1995

Femoral shaft fractures treated by intramedullary nailing. A follow-up study focusing on problems related to the method.

One hundred and sixteen patients with 120 femoral fractures treated by reamed intramedullary nailing were reviewed. All fractures but one healed without additional procedures. One comminuted fracture had a bone transplant after 8 months to enhance bone remodelling in the lateral part of the fracture area. Three patients developed adult respiratory distress syndrome; all patients survived. Deep infection complicated one osteosynthesis. Thromboembolism was recorded in five cases. Twenty-three patients had a true torsional deformity (anteversion difference of 15 degrees or more), but only nine had complaints. Four of these patients needed a corrective osteotomy. Shortening of 10 mm or more was revealed in 11 patients; only one was above 20 mm. Prior to nail removal, hip and knee pain was present in 26 and 20 per cent, respectively. Few patients had such pain after nail removal. We conclude that reamed IM nailing of femoral fractures gives excellent fracture healing, rapid patient recovery and few complications. Some problems are, however, related to the method: torsional deformity occurs frequently, but will not always cause complaints. Shortening is a potential problem, but dramatic shortenings can be avoided when static locking is used. Hip and knee pain occurs frequently, but will usually disappear after nail removal.

Adolescent↗
PubMed1995

Ultrasound measurements in hips of children above 2 years of age. Normal variations in 232 hips.

In order to find the limits of normal variation of ultrasound measurements in children over 2 years of age, we examined 116 children and adolescents with normal hip joints. The children had been referred for various complaints from their lower extremities. Longitudinal ultrasound scanning from the lateral and anterior aspects was performed by the orthopedic surgeon as an integral part of the clinical examination. The most relevant parameters regarding hip dysplasia are those assessing the coverage of the femoral head: the lateral head distance (LHD, the distance from the lateral tangent of the bony epiphysis to the lateral bony acetabular rim) and the anterior head distance (AHD, measured as LHD, but from the anterior scan). The LHD increased with age; the upper normal limit (mean + 2 SD) increased from 4 mm at age 2-3 years to 7 mm at age 12-16 years. The AHD was larger in adolescents 12-16 years of age than in younger patients. The upper normal limit was 1 mm in the youngest and 2 mm in the oldest children. The mean (SD) differences (right minus left) in LHD and AHD were 0.3 (1.1) mm and 0.2 (1.0) mm, respectively. Radiographs were available in 15 of the patients and confirmed the ultrasound findings regarding femoral head coverage. Our findings should be of value in interpreting ultrasound measurements in older children.

Adolescent↗
PubMed1993

[Ultrasound screening of hip joints in newborn infants].

The aim of the present study was to assess the efficiency of ultrasonography in the screening of hip joints in newborn babies. In 1987, 2,531 newborns (92.4% of all liveborn babies) were examined clinically and with ultrasound. The coverage of the femoral head by the bony acetabular roof was measured on a longitudinal, coronal scan. The mean head coverage was 57% in boys and 55% in girls (p = 0.0001). Unstable hips, shown by both ultrasound and clinical examination, were found in 27 newborns (1.1%). The mean head coverage of unstable hips was 41%, significantly lower than for stable hips. No late hip dislocations were diagnosed in children with normal findings who were not included in the follow-up routines. In conclusion, the study indicated that ultrasonography measuring the femoral head coverage is an appropriate method of screening in newborns. It is useful for differentiating between a true and a false positive Ortolani sign. Moreover, ultrasound can show hip dysplasia that is not clinically demonstrable at birth.

Female↗
PubMed1993

Ultrasound examination for measurement of femoral anteversion in children.

Femoral anteversion (AV) angles were determined by ultrasound and biplanar radiography in 63 children aged 3-11 years. With the patient supine, knees flexed 90 degrees, and legs kept vertical, only one ultrasound scan of the proximal femur was needed. The anterior tangent of the femoral head and the greater trochanter was used as the reference line. The transducer was tilted until this tangent appeared horizontal on the monitor screen, and the angle of tilt, which represents the AV angle, was measured with an attached clinometer. There was a high correlation between ultrasound and radiographic results (r = 0.71). However, the AV angles appeared an average of 5.5 degrees larger by ultrasound. Thus, a correction factor of 5 degrees should be subtracted from the angle measured by ultrasound to obtain the actual AV angle in children. Because ultrasound does not require ionizing radiation, and because reliable results are obtained, our technique is recommended for screening of children with rotational disorders of the femur.

Adolescent↗
PubMed1993

Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients.

The torsion of both femora was evaluated in 110 patients who had been treated by intramedullary nailing for unilateral femoral shaft fractures. The anteversion (AV) angle was measured by ultrasound, using a tilted-transducer technique. True torsional deformity, defined as an AV difference of 15 degrees or more between sides was found in 21 patients, but only eight had complaints related to the deformity. Three patients had reoperations for troublesome external torsional deformities. Of 26 patients with AV differences of 10 degrees to 14 degrees, defined as possible torsional deformity, three had complaints, but none had serious problems. AV differences of up to 29 degrees were observed in symptom-free patients, and no patients with AV differences below 10 degrees had complaints. Static and dynamic nailing showed almost equal tendencies to lead to torsional deformity. We conclude that torsional deformities are usually established during the operation. Many patients tolerate abnormal torsion, but efforts should be made to reduce and stabilise the femoral shaft fracture with an AV difference of less than 15 degrees.

Adolescent↗
PubMed1993

Bone density and geometry after locked intramedullary nailing. Computed tomography of 8 femoral fractures.

8 patients with femoral shaft fracture treated with locked intramedullary (IM) nailing were examined by computed tomography (CT) a few days after nail removal. Cortical bone density, cortical thickness and geometrical shape of the fracture region were compared to those of the contralateral side. The cortical density was reduced by 23 percent at the mid-fracture level. However, at the same level the cortical thickness had increased by 47 percent, and the antero-posterior and medio-lateral diameters by 30 and 45 percent, respectively. We conclude that the fracture region of the femoral shaft had regained its mechanical properties at the time of nail removal.

Biomechanical Phenomena↗
PubMed1992

The effect on low back pain of shortening osteotomy for leg length inequality.

This study evaluates the effect on low back pain of shortening osteotomy in patients with leg length inequality (LLI). Twenty-two patients were followed up after an average of 5 years. The mean preoperative LLI was 32 mm and was 4.3 mm at follow up. The degree of low back pain was significantly reduced after the operation.

Adolescent↗
PubMed1992

Ultrasonography for diagnosis of slipped capital femoral epiphysis. Comparison with radiography in 9 cases.

In 7 of 8 patients with non-acute slipped capital femoral epiphysis, the slip was visualized by ultrasound. The mean epiphyseal displacement was 6.0 mm, measured on an anterior ultrasound scan. Grading of slip severity by ultrasound was consistent with the radiographic assessment. Two patients had a moderate hip joint effusion which did not affect the final outcome, whereas one patient with an acute slip had a pronounced effusion, and necrosis of the epiphysis occurred. The anteversion angles of the affected hips were reduced as compared to those of the normal hips. It was concluded that ultrasonography was reliable in detecting pronounced and mild degrees of epiphyseal slips, whereas minimal slips could be missed. The detection of hip effusion is important because a tamponade may cause vascular impairment of the epiphysis, unless aspirated.

Adolescent↗
PubMed1992

Bone loss after locked intramedullary nailing. Computed tomography of the femur and tibia in 10 cases.

10 patients with previous femoral shaft fracture treated with locked intramedullary nailing were examined by computed tomography (CT) a few days after nail removal. The bone density, cortical thickness and geometric shape of the fractured extremity were compared with those on the contralateral side. Only a small reduction in cortical density and thickness (4 and 7 percent, respectively) was revealed outside the fracture area in the diaphyseal part of the nailed bones. A distinct reduction in trabecular density was observed in the femoral condyles as well as in the ipsilateral tibial condyle (19 and 17 percent, respectively). Our results indicate that the stress-reducing effect of intramedullary nails on the femoral diaphysis is small.

Adolescent↗
PubMed1992

Femoral anteversion in normal adults. Ultrasound measurements in 50 men and 50 women.

The femoral anteversion (AV) angles were measured by ultrasound in a normal group of 100 adult subjects to find the normal range of anteversion, to determine the normal left/right difference, to assess the interobserver variation, and to find the correlation between AV angle and clinical hip rotation. All the ultrasound measurements were performed independently by 2 observers. The mean AV angle was 18 degrees in the women and 14 degrees in the men. The mean left/right difference in AV was 3.8 degrees, and the upper normal limit of side difference (mean +/- 2 SD) was 9.8 degrees. The mean (SD) interobserver variation was only 1.9 degrees (1.3 degrees). The correlations between AV angles and internal and external hip rotation were significant, but not very high (r = 0.49 and -0.49, respectively). We conclude that ultrasound is appropriate for measurement of femoral anteversion. Our results could be used as a basis when evaluating patients with clinically suspected rotational disorders of the femur.

Adolescent↗
PubMed1992

Closed reduction guided by dynamic ultrasound in late-diagnosed hip dislocation.

The potential for dynamic ultrasound in the primary treatment of late-diagnosed congenital hip dislocation was assessed in 21 patients. The study showed that dynamic ultrasound was a useful technique in guiding closed reduction and for assessing the effects of positioning on the stability of children less than 2 years of age. In older children, however, this assessment was less reliable. Although dynamic ultrasound evaluation can be done without sedation, general anesthesia provides optimal conditions for such evaluation. The benefits of ultrasound are that it does not involve exposure to radiation, that the need for elaborate radiographic methods like arthrography and computed tomography is reduced, and that closed reduction is more reliably achieved when guided by direct visualization. Because a thorough knowledge of the dynamics of hip dislocation is essential, the ultrasound evaluation should be performed by orthopedic surgeons.

Casts, Surgical↗
PubMed1991

[Ultrasonography in serous coxitis].

Ultrasonography is a rapid, reliable and painless technique for diagnosis of transient synovitis and other conditions with effusion of the hip joint. We therefore recommend ultrasonography as the primary imaging method in all patients with acute and subacute pain in the hip and thigh. The diagnostic criterion for intracapsular effusion is a side difference greater than or equal to 2.0 mm in the distance between the anterior joint capsule and the femoral neck. Ultrasonography is also useful in following the resorption of the effusion during the active stage of transient synovitis and in assessing the hip joint for possible development of coxa magna and Legg-Calvé-Perthes disease at later follow-up. Radiography and scintimetry may be omitted in uncomplicated cases but should be employed when Legg-Calvé-Perthes disease is suspected.

Diagnosis, Differential↗
PubMed1991

Computed tomography measurements of the acetabulum in adult dysplastic hips: which level is appropriate?

A study has been performed to evaluate whether one or several levels are needed with computed tomography (CT) study to provide sufficient information regarding anteversion and acetabular support to the femoral head. A total of 23 hips in 14 adults with uni- or bilateral congenital hip dysplasia (center-edge angle less than 20 degrees) were assessed by obtaining 5-mm contiguous CT slices and performing acetabular measurements at four levels. Both anterior and posterior acetabular supports as quantified by the anterior and posterior acetabular sector angles were significantly lower than normal at all levels. The sector angles increased in the proximal cuts, whereas the acetabular anteversion increased caudally. Because no important additional information was gained by measuring at different levels, we conclude that CT study at one level is sufficient for acetabular measurements and suggest that the slice through the center of the femoral head is the most appropriate one.

Acetabulum↗
PubMed1991

Leg-length discrepancy measured by ultrasonography.

Leg-length discrepancy was determined by real-time ultrasonography (ultrasound) in 45 patients, and the measurements were compared with those of erect-posture radiography. A special device for holding and moving the ultrasound transducer was constructed, and the leg length was measured as the highest level of the femoral head in the standing position. The correlation coefficient r between ultrasound and radiography was 0.94, the mean difference was -1.9 mm, and the limits of agreement (mean +/- 2 SD) were -9.1 to 5.3 mm. The mean difference between examiners 1 and 2 was 1.7 mm, and the 95 percent confidence interval was +/- 7 mm. We conclude that leg-length discrepancy can be reliably determined by ultrasound, although the accuracy is less than that obtained by radiographic methods. Because ultrasound is not limited by radiation hazards, our technique can be used for clinical screening.

Adolescent↗
PubMed1991

Ultrasound in the diagnosis of congenital dysplasia and dislocation of the hip joints in children older than two years.

To evaluate the use of ultrasound in the diagnosis to congenital dysplasia and dislocation of the hip (CDH) in children older than two years of age, 64 patients with normal hip joints and 47 patients with present or previous CDH were examined. Lateral and anterior ultrasound scanning was employed, and the coverage of the femoral head by the acetabular roof was assessed. The ultrasound measurements were compared with standard roentgenography, and a good accordance between the methods was found. A lateral projection of the femoral head in relation to the bony acetabular rim of more than 8 mm in children younger than ten years of age indicated subluxation and more than 15 mm at age two to four years indicated dislocation. Reliable images were obtained by ultrasound at any age between two and 18 years. Ultrasound is recommended as the primary imaging technique in the evaluation of hip joints, even in older children, and ultrasound should replace roentgenography in most of the follow-up examinations of children with previous CDH.

Adolescent↗