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PubMedDate not supplied

[Correction of deformities with conventional and hexapod frames--comparison of methods].

AIM: Distraction osteogenesis for the correction of deformities with an external fixator is well established. The hexapod principle of robotic technique was invented for the Ilisarov apparatus (e. g. Taylor-Spatial-Frame/TSF). Treatment with conventional frames needs a patient-customised frame mounting. This demanding procedure is markedly reduced using this technology. The aim of this study was to analyse the value of the hexapod principle in external fixation. METHOD: The potential of a frame to correct deformities is limited by its work space. The geometry of a conventional frame is different from the geometry of a hexapod frame, which is the reason for their different work spaces. The work space of the hexapod frame is compared to the work space of a conventional frame. Important parameters for this analyses are minimal and maximal frame heights and the potential of correction. RESULTS: The minimal frame height of hexapod fixators is higher compared to conventional Ilisarov fixators. The standard hexapod frame (TSF 155 mm ring diameter) can correct 23 degrees of angulation, 36 mm of shortening, 71 mm of translation and 43 degrees of rotation without changing the telescope rods. The standard conventional frame (160 mm ring diameter) can correct 90 degrees of angulation, 100 mm of shortening, 25 mm of translation and 12.5 degrees of rotation without remounting of the frame. CONCLUSION: The different work spaces of the different frames result in consequences for their clinical application. The hexapod frame has more power to correct translation and rotational deformities than a conventional frame. Correction of extensive angulation and shortening deformities almost always needs an exchange of telescopic rods. Conventional frames are usually able to correct these deformities with the primary mounting. Because of its increased minimal frame height, the indication for hexapod constructs in child orthopaedics can be limited.

Adolescent↗
PubMedDate not supplied

[Specification of corresponding growth laws of Hueter-Volkmann and Pauwels (growth deformities) and their relation to deformities caused by loading].

Intermittent pressure within the limits of physiological stress and strain stimulates the growth plates of a healthy bone (Pauwels), whereas a constant pathological strong pressure does inhibit the enchondral longitudinal growth (Hueter-Volkmann). An active change of direction of growth is induced if the pressure is exerted excentrically: growth deformities. In the presence of a diseased weak bone asymmetrical pressure leads to passive bending of bone: weight bearing deformities. An attempt is made to support these distinctions by experimental and clinical observations.

Arthrogryposis↗
PubMedDate not supplied

[Bilateral habitual fibula head dislocation].

Dislocation of the fibular head is rare. In most of the cases a trauma caused by sports activity, sometimes associated with a tibia fracture, is described. Only a few publications exist about habitual dislocation of the fibular head without history of trauma. This article reports a case of bilateral habitual anterolateral dislocation of the fibular head in a 17-year-old female. There was no information about a neurological or other disease and no sign of generalized ligamentous laxity. Because of marked symptoms with severe pain after each sensation of dislocation which appeared several times a day, the patient was treated by using a part of the biceps tendon for fixation of the reduced fibular head.

Adolescent↗
PubMed1981

Use of computed axial tomography in pediatric orthopedics.

The use of the computed tomography has been rapidly expanding in the 7 years it has been clinically available, and there is no doubt that this modality will have an important role in the assessment of many pediatric orthopedic problems. Computed tomography now provides previously unavailable information in cases of tumors, infections, and fractures of the axial skeleton, pelvis, and hips. With the faster scan times, better density and two-point resolution of the newer generation scanners, computed tomography will be useful in other isolated cases and in more situations, but still may not gain wide applicability in pediatric orthopedics.

Adolescent↗
PubMed1983

Orthopedics in adolescence.

Many orthopedic problems occur during adolescence. This paper describes the various types of musculoskeletal deformities associated with this stage of development, and discusses methods of diagnosis and correction. It is argued that since such problems are managed most effectively if diagnosed early, the role of the primary-care physician is critical.

Acetabulum↗
PubMed1993

Patellofemoral joint: identification of abnormalities with active-movement, "unloaded" versus "loaded" kinematic MR imaging techniques.

A positioning device was used to apply a "load" to stress the patellofemoral joint during active-movement, kinematic magnetic resonance (MR) imaging. Twenty-three symptomatic patellofemoral joints were studied by using "unloaded" versus "loaded" techniques. With the unloaded technique, seven joints were normal, nine had lateral subluxation, three had lateral tilt, and four had medial subluxation. With the loaded technique, one was normal, 13 had lateral subluxation, four had lateral tilt, and five had medial subluxation. The active-movement, loaded kinematic MR imaging technique provides improved ability to identify patellofemoral joint abnormalities.

Adolescent↗
PubMedDate not supplied

Evaluation of the results of extensor mechanism reconstruction.

One hundred sixteen patients underwent extensor mechanism reconstruction. Ninety-four returned at followup (3 to 11 years after surgery). Twenty-two patients were lost to followup. Subjectively, 74% of the patients had either an excellent or good result and 26% either a fair or poor result. We found retrospectively, that the patients with either fair or poor results had a stable or only mildly unstable patella preoperatively.

Adolescent↗
PubMedDate not supplied

Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer.

This retrospective study determined that the outcome from anteromedialization of the tibial tubercle correlates well with the location of patellar articular lesions. Detailed descriptions of patellar articular cartilage lesions were obtained from the operative reports of 36 patients who had anteromedialization performed between February 1984 and March 1994. The patterns fell into four distinct groups. Ten patients with type I (distal) patellar lesions and 13 patients with type II (lateral facet) patellar lesions had 87% good to excellent subjective results, and 100% of these patients said they would have the procedure done again. Nine patients with type III (medial facet) lesions had 55% good to excellent results, and 5 patients with type IV (proximal or diffuse) lesions had only 20% good to excellent results. Patients with type I or II lesions were significantly more likely to have good or excellent results than those with type III or IV lesions. Central trochlear lesions were associated with medial patellar lesions and all patients with central trochlear lesions had poor results. There was no significant correlation between the Outerbridge grading of the patellar lesion and the overall results. Workers' compensation issues diminished the likelihood of a satisfactory outcome by 19%; however, this was not statistically significant. This is the first study to correlate the patellar articular cartilage lesion with outcome after tibial tubercle transfer.

Activities of Daily Living↗
PubMed1987

Grading the pivot shift. Objective tests with implications for treatment.

A logical, objective and reproducible grading system for the pivot shift test is proposed. The rationale is based on performing the examination in varying positions of rotation of the tibia, allowing the type and degree of the different laxities to be defined and quantified. The system has been assessed against a new "unblocked" test for anterior subluxation and against radiographic measurements, operative findings and results. This grading system can be valuable in pre-operative assessment and planning and its use in postoperative evaluation would enable results from different centres and different procedures to be compared more accurately.

Humans↗
PubMed1987

Recurrent dislocation of the patella. Histochemical and electromyographic evidence of primary muscle pathology.

The role of muscle function in the aetiology of recurrent dislocation of the patella has been examined. Eleven of the 12 patients we studied had joint hypermobility. Muscle biopsies from eight of nine patients treated by surgery had a predominance of abnormal Type 2C fibres, and three of six patients whose quadriceps muscles were studied by electromyography also had abnormal results. Our preliminary findings suggest that there may be a primary muscular defect in many cases of recurrent dislocation of the patella.

Adolescent↗
PubMed2001

Fracture of the proximal tibia six months after Fulkerson osteotomy. A report of two cases.

The Fulkerson osteotomy has proved to be a reliable treatment for subluxation of the patella due to malalignment. Aggressive rehabilitation in the early postoperative period is unwise since the proximal tibia is weakened by the oblique osteotomy. Early weight-bearing and unrestricted activity have caused fractures in a few patients. Even late in the postoperative period the osteotomy may adversely influence the biomechanical properties of the proximal tibia. We describe two athletes who sustained a fracture of the proximal tibia, during recreational activities, six months after a Fulkerson osteotomy. Both had been bearing full weight for about ten weeks without complaint. Bony healing of the osteotomy had been demonstrated on plain radiographs at ten and at 12 weeks. After a Fulkerson osteotomy, jogging and activities which impose considerable impact force should be discouraged for at least nine to 12 months.

Adult↗
PubMed1998

Medial subluxation of the patella without previous lateral retinacular release.

This case presented a 17-year-old patient with persistent complaints localized to the right patellofemoral joint. Clinical examination demonstrated increased medial translation of the patella on manual stress. In contrast to previous published reports on medial patellar subluxation, this patient had not undergone prior lateral retinacular release. Arthroscopic examination documented medial tracking of the patella as well as excess medial translation. Imbrication of the patient's lateral patellar retinaculum centralized patella tracking and diminished medial translation on stress testing as observed arthroscopically and clinically. This case illustrates that medial patellar subluxation is a subtle problem that may be overlooked in the patient presenting with patellofemoral complaints and should be included in the differential diagnosis.

Adolescent↗

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