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PubMed1988

Adhesive capsulitis of the wrist. Diagnosis and treatment.

Adhesive capsulitis occurs as a pathologic entity in the shoulder, hip, and ankle joints. Thickening and contracture of the wrist joint capsule were demonstrated on arthrograms performed on ten patients ranging in age from 20 to 82 years. The patients had pain and limited range of motion in the wrist. The findings included: (1) resistance to the injection of smaller than normal volumes of contrast material, (2) obliteration of recesses, and (3) extravasation of the contrast agent along the needle tract. Closed manipulation under general anesthesia of the wrist on four patients resulted in some improvement in range of motion. A distal ulna fracture in one older patient occurred as a complication of manipulation. Careful technique and judicious patient selection are of paramount importance.

Adult↗
PubMed1987

Central core disease. Clinical features in 13 patients.

Findings in 13 patients with central core disease are reported and compared with 62 patients from the literature. Patients with central core disease show wide variation in the clinical spectrum of muscle involvement. Some will have no symptoms and be completely normal on examination, many will show mild to moderate weakness, and a small number will be severely affected. Muscle atrophy is a frequent finding, but progression of muscle weakness is rare and occurs only slowly. Musculoskeletal deformities, including kyphoscoliosis, congenital hip dislocation, feet deformities, and joint contractures, are often seen but generally do not alter the natural history of the disease. Surgical treatment may be required for some of these abnormalities. No relationship appears to exist between the degree of muscle weakness and the presence or type of musculoskeletal deformities. Cardiac abnormalities have rarely been reported in association with central core disease. Mitral valve prolapse was noted in 3 of our patients and 2 others had cardiac arrhythmias. Central core disease and susceptibility to malignant hyperthermia was present in all 11 patients we studied (2 patients with central core disease did not have studies for malignant hyperthermia). These 11 patients came from 4 families. All patients with central core disease should be considered at risk for malignant hyperthermia unless in-vitro contracture tests show that the particular patient is free of the trait.

Adolescent↗
PubMed1986

[Progressive lengthening of the femur using Wagner's technic. Apropos of 48 cases].

Forty eight progressive femoral lengthenings using the Wagner technique have been performed on patients aged between 6 and 18 years (average 12 years). The main aetiology of the shortening was congenital deformity (25 cases). The mean lengthening obtained was 5.2 cm and the greatest was 11.2 cm. Lengthening obtained was more than 20 p. 100 in six cases with an extreme of 24 p. 100. The final discrepancy was always less than 25 mm. In 6 cases this was corrected by the addition of a contralateral epiphysiodesis or tibial lengthening. Weight bearing was resumed after an average of 5-6 months. Many complications occurred. Some were minor: sepsis in the pin tracks (14 cases) or varus derotation corrected at the end of lengthening (22 cases). Some were more severe: varus deformities of more than 5 degrees (8 cases), contractures at the knee or the hip corrected by tenotomies in the course of lengthening (2 cases), subluxation of the hip or knee (5 cases), fractures, delayed unions, non-unions without infection (7 cases). The major complications were 15 severe infections, 6 of them with fractures or non-unions and 5 neurological lesions.

Adolescent↗
PubMed2005

Amyoplasia congenita of the lower extremity: report in a premature baby.

Amyoplasia congenita is a diagnostic subgroup of children with arthrogryposis multiplex congenita (AMC). AMC is a relatively rare syndrome characterized by multiple joint contractures at birth. Amyoplasia congenita is the most common type of this syndrome with an occurrence rate of 1 in 10,000 live births, and mainly refers to the disorders with limb involvement. In this report, the author presents a premature baby with amyoplasia congenita, whose hips showed flexion, abduction, and external rotation contractures. The knees showed fixed extension contractures, so that his lower extremities were cylindrical with absent skin creases at birth.

Adult↗
PubMed2004

Open reduction of the dislocated hip in juvenile idiopathic arthritis: a case report.

An 8-year-old girl with systemic-onset juvenile idiopathic arthritis (JIA) required surgical reduction for a dislocated left hip joint following failure of skin traction for 1 week. Unaided walking was achieved by 3 months postoperatively. Incongruence and irregularity of the hip joint remained but may resolve with maturation. Joint laxity caused by synovitis, flexion/adduction contracture with pain, and acetabular dysplasia by growth disturbance apparently caused hip dislocation.

Journal Article↗
PubMed2003

Use of the AO femoral distractor in revision total hip arthroplasty.

Use of the femoral distractor in trauma settings is well documented in the orthopedic literature. Use of the device extends into adult reconstructive surgery; surgeons use this distractor as an aid in performing difficult revision total hip arthroplasties (THAs). Patients with associated soft-tissue contractures secondary to subacute or chronic dislocation of a THA may present a clinical picture that might make consideration of simple open reduction only a remote possibility. Patients with long-standing Girdlestone resection arthroplasty usually present with soft-tissue deficiencies that render the hip unstable (unless it is at maximal length), or these patients have severe contractures that make reduction difficult after all components are implanted. We present a distractor technique for reduction of prosthetic components in such clinical situations. The femoral distractor is easily applied, and, because of its mechanical effectiveness, it can assist in reducing the "irreducible" hip.

Arthroplasty, Replacement, Hip↗
PubMed1992

[Treatment concepts in knee malposition within the scope of primary neurologic diseases].

Disease and trauma to the central and peripheral nervous system can result in various disturbances to the stability and mobility of the knee joint. The aims of orthopaedic treatment in flaccid paralysis, spasticity, rigidity, athetosis and ataxia are discussed. The effect on the musculo-skeletal system is most severe when the damage occurs prenatally. The tendency to deformity in perinatal cerebral spastic disorders of movement can be considerably reduced by early systematic functional treatment. Active and passive exercise, corrective and reflex inhibiting casts and orthoses have proved their value in the prevention and treatment of muscle contractures in flaccid paralysis and spasticity. The dangers of treatment, such as subluxation of the knee and hip joint, osteoporotic fractures, and traction paralysis, must be taken into account. Muscle contractures often hinder function, both in spasticity and in flaccid paralysis, more than the underlying disease. The operative treatment of flexion contractures and impaired knee flexion in the swing phase of the step is discussed. Gait analysis facilitates the planning of treatment. The hip, knee and ankle joints must be treated as a single functional unit.

Cerebral Palsy↗
PubMed1998

A new test for estimating iliotibial band contracture.

Contracture of the iliotibial band leading to flexion and abduction deformity at the hip is common in residual paralysis after polio. Ober's test has been used to detect this, but it is unreliable and cannot determine the degree of contracture. We describe a new test which quantifies this contracture and can be used for comparative purposes.

Contracture↗
PubMed2002

Topical treatment of sclerodermoid chronic graft vs. host disease.

Sclerodermoid chronic graft vs. host disease is a severe adverse immunologic reaction following allogeneic bone marrow transplantation, with deposition of collagen in the skin and possibly other soft tissues, resulting in loss of range of motion and functional capabilities. We present a case of a 14-yr-old girl who received a matched, unrelated donor bone marrow transplant for myelodysplastic syndrome complicated by sclerodermoid chronic graft vs. host disease, causing severe contractures of the shoulders, elbows, wrists, fingers, hips and knees. This case report and review of the literature regarding chronic graft vs. host disease suggest that a controlled trial of a multimodality therapeutic approach, including topical treatment, is warranted to determine whether this approach improves function in these patients.

Administration, Topical↗
PubMed1987

Contractures. A major complication of craniocerebral trauma.

Contractures in craniocerebral trauma patients are a common problem noted during inpatient rehabilitation. Many factors influence this complication. Seventy-five consecutive cases of craniocerebral trauma observed during a one-year period were evaluated as to the duration of coma, degree of paralysis, treatment facility, and presence of fractures including their relation to contractures. Contractures measured by standard goniometric techniques were defined as loss of range of motion in a joint to a degree that impedes activities of daily living. The incidence of contractures was 84%. The most commonly affected joints were the hips (81%), shoulders (76%), ankles (76%), and elbows (44%). There was a statistically significant increase in the presence of contractures with prolonged duration of coma. Patients with contractures that developed independently of the facility where treated were examined for the presence of fractures. The emphasis after acute craniocerebral trauma is on life preservation. Limb positioning and maintenance of joint motion, which are imperative for the functional activity, have not received the attention necessary for the long-range welfare of the patient.

Brain Injuries↗
PubMedDate not supplied

The orthopaedic manifestations of Pelizaeus-Merzbacher disease in children.

Pelizaeus-Merzbacher disease (PMD) is a degenerative leukodystrophy of the central nervous system resulting in progressive spasticity and neurologic deterioration. Seitelberger (13) divided this rare disease into six types. Five patients with the type 1 and two patients with the type II form of PMD have been treated at the Children's Hospital of Eastern Ontario. Our study sought to identify the orthopaedic manifestations of PMD and to develop a common orthopaedic profile for these patients. All children with types I and II PMD developed spastic quadriparesis, truncal hypotonia, thoracolumbar scoliosis, soft-tissue contractures of the adductors and hamstrings, osteopenia, bilateral coxa valga, and associated hip dislocation.

Bone Diseases, Metabolic↗
PubMed1983

Salvage operations for failure of previous surgery in congenital dislocation of the hip.

Salvage operations for failure of previous surgery were performed on 27 children with 35 congenitally dislocated hips. In two children with rigid joints, surgery was limited to the correction of flexion contracture and of fixed pelvic obliquity. In all cases where the affected hip was mobile, concentric reduction and good coverage were obtained. In difficult cases, a combined operation including femoral shortening, open reduction, varization derotation, and a Chiari osteotomy gave satisfactory results.

Child, Preschool↗