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At least 667 records · Page 37Linked to original sources
PubMed2000

Type and outcome of reconstructive surgery for different patterns of psoriatic arthritis.

OBJECTIVE: To describe our experience of musculoskeletal surgery in patients with different patterns of psoriatic arthritis (PsA). METHODS: From 1986 to 1996, 71 operations in 43 patients with established PsA were performed at our institution. The patterns of PsA recognized in this patient group were: distal PsA, oligoarticular PsA, and polyarticular PsA, with or without associated spondylitis. Surgical findings and procedure, intra- and postoperative complications were recorded. Nineteen patients were available for clinical evaluation, both by conventional surgeon generated and by patient generated self-administered questionnaires. RESULTS: The majority of patients had polyarticular PsA. All operations in patients with distal PsA were distal interphalangeal (DIP) and proximal interphalangeal (PIP) joint fusions. All operations in patients with oligoarticular PsA involved the hip or knee. Polyarticular patients underwent a range of procedures. Soft tissue contractures and bone loss required specific attention in 14 procedures. In the 19 patients who were reviewed clinically, conventional scoring of individual procedures showed good to excellent results. Patient oriented outcomes had low scores compared to a disease-free general population. CONCLUSION: The 3 principal patterns of PsA are associated with different types of surgery. Although traditional surgeon generated scores evaluating individual procedures indicated results comparable to patients who have osteoarthritis, patient generated outcome measures of global health and function scored substantially lower than a general, arthritis-free population, reflecting the burden of polyarticular involvement.

Adult↗
PubMed1975

[Observations on the Prune-Belly syndrome].

5 Male children exhibiting the typical features of the Prune-Belly syndrome (malformations of the urogenital tract, aplasia of abdominal muscles) are described. Two of these are deaf. This syndrome has also been observed in a few females. Final interpretation of the cause and pathogenesis cannot yet be given. In two siblings with defects of the abdominal muscles an contractures of the joints, but without renal anomalies, a new and hitherto undescribed hereditary syndrome seems to be present.

Abdominal Muscles↗
PubMed1987

Orthopaedic management of the lower extremities in spina bifida.

Myelodysplasia is a multisystem disease that requires a multidisciplinary approach. The orthopaedist is often the first to identify a changing neurologic picture or deformity and must work closely with neurosurgical colleagues to identify correctable neurologic lesions. The role of the orthopaedist begins at the birth of the child with spina bifida. At this time, the level of neurologic involvement can be determined. Education of the parents can then begin by outlining the expected ambulatory potential of the child, and predicting deformities or complications that might be anticipated depending on the level of neurologic involvement. The orthopaedist must also emphasize the extreme importance of neurosurgical care in preventing deterioration of neurologic function, so that goals for ambulation and musculoskeletal function can be achieved. As the child gets older, motor milestones paralleling those of a normal child should be sought with use of a corner chair or sitting device, followed by the use of a standing frame if needed. If appropriate, the child will then progress to full-control braces, with weaning as determined by neurologic level of involvement . Long-term mobility may be achieved by bracing or by the use of a wheelchair. A realistic approach must be taken in goal-setting, so that a child is not pressured to achieve unrealistic goals yet is enabled to achieve full functional capacity.

Braces↗
PubMed1984

Functional treatment of congenital dislocation of the hip.

A prerequisite for the development of congenital dislocation of the hip is ligamentous laxity of the hip-joint, which is demonstrable shortly after birth when the hip can be easily dislocated and reduced. This situation is described as dislocatable hip. Ligamentous laxity naturally tends to disappear, and 90% of all dislocatable hips in fact stabilize spontaneously. No dislocation develops unless an exogenous factor is involved. In infants born in breech presentation the hyperextension of the knees with the resulting increased tension in the hamstrings plays a role. During or shortly after birth, the deflexion of the hip-joint causes an increased tension in the relatively shortened iliopsoas muscle, as a result of which the hip can be dislocated in postero-superior direction. By the time the infant is two months old secondary changes (more specifically restricted abduction) become more pronounced. It may therefore be stated that contracture of the iliopsoas muscle is one of the causes, and restricted abduction a consequence of congenital dislocation of the hip. The degree of dislocation is determined by a balance between the degree of ligamentous laxity and the influence of exogenous factors. When the infant starts to stand and walk, its body weight also begins to function as a deforming exogenous factor. When dislocatable hips are not treated immediately after birth, the frequency of congenital dislocation of the hip at the age of three months amounts to 1-2 per 1000 neonates. The male:female ratio is 1:4. The secondary changes in the osseous structures of the hip-joint should always be studied three-dimensionally. Apart from conventional antero-posterior pelvic roentgenograms, CT-scans can enhance spatial insight. The secondary changes manifest themselves in an enlarged neck-shaft angle, increased femoral anteversion, an increased inclination of the acetabulum and possibly also in diminished acetabular anteversion. In view of the high radiation load involved, examination by CT-scan is not yet a routine procedure in congenital hip dislocation. Radiological examination is usually confined to an antero-posterior pelvic roentgenogram on which the acetabular angle, the neck-shaft angle and the CE-angle can be measured. These are all values projected in a frontal plane. To determine the real values the degree of acetabular and femoral torsion has to be known. With the aid of the CT-scan the torsion of the acetabulum and of the femoral neck as well as their summation - the instability index - can be measured without difficulty.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1995

[Neuro-orthopedic and muscle tonus disorders in patients with spinal cord injuries].

Heterotropic ossifications and contractures are frequent during evolution of spinal cord injury. Heterotopic ossifications occur in the first months following the acute state. Hip is the most common localisation. No preventive or curative treatment is available. At an early stage, clinical or instrumental (sonographic) diagnosis may prevent functional consequences. Muscular disbalance, incomplete physiotherapy, tonus disorders lead to contractures of limbs or trunk. They may have severe consequences on activities of dairy living. Surgical procedures may be necessary. Tonus disorders may resist to usual drugs. In this cases, intrathecal infusion of baclofen, injection of botulinus toxin, neurosurgery of orthopedic surgery may be useful.

Contracture↗
PubMedDate not supplied

Equinus contracture following Bryant's traction.

A case of a 14-year-old girl with both foot and hip sequelae secondary to the use of Bryant's traction at the age of 2 years, 8 months, is presented. It serves as a reminder of the dangers of Bryant's traction, which should be used with discretion, if at all.

Adolescent↗
PubMed2004

Secondary gait compensations in individuals without neuromuscular involvement following a unilateral imposed equinus constraint.

Ankle equinus is the most commonly identified impairment of individuals with spastic hemiplegia (SH). However, it is not clear how equinus at the ankle may contribute to gait deviations at other joints. The purpose of this study was to determine what compensatory gait deviations may occur as a result of an imposed, unilateral equinus constraint. Gait data were collected on 12 adult subjects with and without one ankle constrained in equinus using a unique taping method. Knee extension at initial contact, knee extension in mid stance, and hip extension at terminal stance were all found to be significantly reduced on the ipsilateral side as a result of the ankle constraint. On the unconstrained or contralateral side, subjects tended to adopt a foot-flat or toe-first initial contact pattern. This study suggests that stance phase limitations in both hip and knee extension in the gait of persons with hemiplegia are not necessarily caused by limited length of the involved side hamstrings and/or hip flexors, but rather that they can occur as the result of an ankle plantarflexor contracture alone. Deviations in the contralateral foot contact pattern can also occur secondary to unilateral equinus and should not be assumed to represent bilateral involvement.

Adult↗
PubMed1991

Total hip arthroplasty in ankylosing spondylitis.

Total hip arthroplasty was performed on 29 hips in 19 patients diagnosed with ankylosing spondylitis over a 13-year period. The results were analyzed retrospectively with an average follow-up period of more than four years. Complete pain relief was achieved in 97%, and significant gains were made in ambulatory capacity. The limited gains in total range of motion (average improvement 75 degrees) were felt to be primarily due to the high incidence of Brooker Class III and IV myositis ossificans (23%) and long-standing soft tissue contractures.

Adult↗
PubMedDate not supplied

Orthopedic aspects of Rett syndrome: a multicenter review.

Twenty-three of 36 patients (64%) with Rett syndrome showed orthopedic problems at an average age of 8 years 7 months. Sixteen patients had spinal deformities (45%), six had scoliosis, one had sagittal deformity, and nine had scoliosis with sagittal deformity. Eight patients with scoliosis have shown progression, with two patients requiring surgery. Thirteen patients (36%) exhibited joint contractures; three of them have required surgery. Ten fractures occurred in five patients (14%). Coxa valga was present in all 14 hips. Skeletal ages in four preadolescent patients were normal.

Adolescent↗
PubMed1988

Joint surgery in severe ankylosing spondylitis.

Twenty-three patients with ankylosing spondylitis with severe deformities of hips, knees, and ankles were treated by a variety of surgical procedures followed by a comprehensive rehabilitation program. The surgery included 35 total hip replacements, six knee arthroplasties, and seven femoral osteotomies. Elongation of the Achilles tendon (eight procedures) was done on 6 patients. Shortening of the femur was performed in patients with long-standing flexion contractures when straightening of the limb during the operation caused traction on the vessels and the nerves. When there was both hip and knee involvement, hip arthroplasty was performed first. Preoperative planning aimed at obtaining plantigrade position of the feet and lower limb-length equality. Availability of custom-made and miniaturized components was essential. Positioning of patients on the operating table necessitated special supports. Six patients were completely bedridden before surgery and 17 were severely disabled or deformed. All the patients but 2 improved markedly, became mobile, independent, and self-supporting. Revision arthroplasty was performed in 4 patients; 3 others deteriorated functionally, but refused further treatment. Heterotopic bone formation was observed after operation in 6 patients. Surgery for severe ankylosing spondyloarthritis requires highly specialized and well-equipped centers.

Activities of Daily Living↗
PubMedDate not supplied

Arthrogryposis multiplex congenita: report of a case of amyoplasia.

Arthrogryposis multiplex congenita is a congenital syndrome characterized by multiple congenital joint contractures; and refers to a large heterogeneous group of disorders. We present a 40 days old male baby who has had multiple fixed contractures of joints since birth. Midline capillary hemangioma, internal rotation of bilateral shoulders, extension contracture of elbows, flexed wrists with pronation deformity, flexion and internal rotation of hips, equinovarus of feet were noted. A series of examinations for differential diagnosis including brain sonogram, echocardiogram, muscle echogram, muscle biopsy, chromosome study were performed and all showed normal findings. Amyoplasia was impressed. Early rehabilitation was arranged. Normal intelligence and a normal life span are expected.

Arthrogryposis↗
PubMed2004

Joint range of motion limitations in children and young adults with spinal muscular atrophy.

OBJECTIVES: To elicit descriptive data about limited joint range of motion (ROM) in subjects with type II or III spinal muscular atrophy (SMA) and to examine the relation between the number of motions with limited range and both age and functional ability. DESIGN: Descriptive cross-sectional study. SETTING: Neurologic pediatric outpatient clinic at a hospital in Taiwan. PARTICIPANTS: Twenty-seven subjects with SMA type II (mean age, 9.8+/-6.5y) and 17 with SMA type III (mean age, 12.2+/-8.7y). Intervention Measurement with transparent goniometers of joint ROM bilaterally of the shoulder, elbow, wrist, hip, knee, and ankle. MAIN OUTCOME MEASURES: The proportion of participants with each ROM limitation compared with all participants with the same SMA type, age distribution of the participants with each ROM limitation, mean range loss of each motion limitation, and the contracture index (risk index of joint contracture). RESULTS: Eighty-nine percent of the participants with SMA type II experienced knee extension limitation. Approximately 50% of the participants with both types of SMA had ankle dorsiflexion limitation. The motions of knee and hip extension and ankle dorsiflexion also had a relatively high contracture index. The number of motions with limited range positively correlated ( P <.001) with age and upper-extremity functional grade (the higher the functional grade, the poorer the functional ability) for SMA type II. CONCLUSIONS: We found varying degrees of joint ROM limitation. Certain motions were noted to be high risks for the development of contractures. This risk was higher mostly in younger children.

Adolescent↗
PubMedDate not supplied

[Orthotic treatment and walking ability of patients with myelomeningocele--analysis of influencing factors].

In 106 patients with myelomeningocele, which were fitted with orthotic devices, we analyzed the influence of level of neurologic deficit, scoliosis and contractures of the lower extremities on different walking parameters, e.g. orthotic wearing time, duration of walking and velocity, step length and mobility status. The most important factor is the level of neurologic deficit. From a functional point of view a bilateral hip dislocation can be neglected. Whereas impairment of walking ability is strongly correlated with scoliosis of more than 50 degrees and unilateral hip dislocation; therefore both conditions should be treated operatively.

Adult↗
PubMed1990

Total hip and knee arthroplasty in juvenile rheumatoid arthritis.

Total hip or knee arthroplasty is indicated in patients with juvenile rheumatoid arthritis when there is marked functional impairment and/or severe disabling pain from advanced structural hip or knee joint involvement. Relief of pain and dramatic improvement in function can be achieved in most patients. When both the hip and knee are involved, hip arthroplasty should probably be done first. Regional anesthesia is preferable. Careful preoperative planning is essential because custom prostheses are often required. Small bone size, osteoporosis, and soft-tissue contractures make the surgery technically demanding. Skeletal immaturity is not an absolute contraindication to surgery. Component loosening is the most frequent late complication in hip arthroplasty. It is less common in condylar metal-to-plastic knee arthroplasty in which patellar complications predominate. Cementless arthroplasty has an evolving role in the patient with juvenile rheumatoid arthritis and, to date, is more often used in the hip than in the knee.

Arthritis, Juvenile↗