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At least 721 records · Page 40Linked to original sources
PubMed2005

Modified Turco procedure for treatment of idiopathic clubfoot.

UNLABELLED: Since 1980 we have used a modified Turco procedure for treating congenital clubfoot. The modifications include: (1) lateral position with the unaffected side on top; (2) Cincinnati-type transverse heel crease incision from the base of the first metatarsal around the ankle up to the lateral border of the tendoachilles; (3) complete excision of the abductor hallucis muscle; (4) complete tibialis posterior tendon tenotomy in the sheath; (5) no lengthening of long toe flexors; (6) no K wires for maintaining the correction; and (7) special splints instead of Denis Browne splints. Thirty-three feet in 18 patients were followed up prospectively at a mean of 13.8 years (range, 10-16 years). There were no wound complications. The mean Laaveg and Ponseti score was 87.2 (range, 49-98). Twenty-seven (82%) of 33 feet had good to excellent results. There were seven feet (21%) with recurrent deformities, which included two feet (6%) with recurrence of all deformities, two feet (6%) with forefoot adduction, one foot each (3%) with equinus and heel varus, and one (3%) with cavus. Ninety-four percent of patients were very satisfied or satisfied with the results. We think this modified approach has helped us to reduce the recurrence of forefoot adduction deformity and wound complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series-no, or historical control group). See Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

Treatment of the complex idiopathic clubfoot.

Treatment with the Ponseti method corrects congenital idiopathic clubfeet in the majority of patients. However, some feet do not respond to the standard treatment protocol. We describe the characteristics and treatment results of these complex idiopathic clubfeet. We identified 50 patients (75 clubfeet) from 762 consecutive patients treated at five institutions. Clinically, complex clubfeet were defined as having rigid equinus, severe plantar flexion of all metatarsals, a deep crease above the heel, a transverse crease in the sole of the foot, and a short and hyperextended first toe. The Achilles' tendon was exceptionally tight and fibrotic up to the middle of the calf. Correction was achieved in all patients by modifying the Ponseti manipulation and casting technique. Correction required an average of five casts (range, 1-10 casts). Two patients (4%) not initially recognized as having complex clubfeet had a posterior release with tendo Achillis lengthening. There were seven relapses that responded to casting. Three patients had a second tenotomy. Modifying the treatment protocol for complex clubfeet successfully corrected the deformity without the need for extensive corrective surgery.

Braces↗
PubMedDate not supplied

Results of an accelerated Ponseti protocol for clubfoot.

The Ponseti method has demonstrated excellent results when performed at weekly intervals, but it is not known whether correction can be accomplished in a shorter amount of time. This study evaluated the success in correction in relation to time between casts (5 or 7 days). The authors retrospectively reviewed 230 patients (319 clubfeet). One hundred sixty-five patients (72%) had undergone previous nonsurgical treatment elsewhere. Patients were assigned to 5 or 7 days based solely on geography. Ninety percent of patients required five or fewer casts for correction, and there was no difference between groups (P = 0.85). Average time from first cast to Achilles tenotomy was 16 days for the 5-day group and 24 days for the 7-day group (P = 0.001). Three patients (1.3%) required corrective surgery and there were 36 relapses (P = 0.4). In conclusion, the Ponseti method is very effective and the deformity can be corrected in a relatively short time.

Achilles Tendon↗
PubMedDate not supplied

Results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world?

This study looks at whether orthopaedic clinical officers, a cadre of clinicians who are not doctors, can effectively manipulate idiopathic clubfeet using the Ponseti technique. One hundred consecutive cases of uncomplicated idiopathic clubfeet in newborn babies were manipulated by orthopaedic clinical officers. Fifty-seven of these were fully corrected to a plantigrade position by Ponseti manipulation alone, and a further 41 were corrected by manipulation followed by a simple percutaneous tenotomy. Orthopaedic clinical officers therefore corrected 98 out of 100 feet; the remaining 2 feet were referred for surgical correction. This shows that the Ponseti method is suitable for use by nonmedical personnel in the developing world to achieve a plantigrade foot.

Achilles Tendon↗
PubMedDate not supplied

Long-term follow-up after one-stage reconstruction of dislocated hips in patients with cerebral palsy.

Twelve consecutive patients (average age 10.6 years) with 14 dislocated hips underwent one-stage hip reconstruction between 1973 and 1981. The procedure consisted of (1) adductor myotomy and anterior obturator neurectomy, (2) circumferential capsulotomy, iliopsoas and external rotator tenotomies, and ligamentum teres and pulvinar excision, (3) shortening femoral varus derotational osteotomy, (4) acetabuloplasty, and (5) spica immobilization for 4 weeks. All patients were followed clinically and radiographically at an average of 16.7 (range 12.4-19.5) years. No patients were lost to follow-up. Long-term results revealed complete stability in 13 of 14 hips, with no redislocations or subluxations. The one patient with "instability" had undergone bilateral proximal femoral resections for severe arthritis 12 years after left hip reconstruction; at the time of resection, the left hip was stable and reduced. Pain was absent in 13 of 14 hips. There were no problems with perineal care, decubitus formation, or sitting tolerance. Extension and abduction improved an average of 23 degrees and 10 degrees, respectively. Two patients' ambulatory status improved; none deteriorated. The mean center-edge angle was 35 degrees (range 22-50 degrees), and the mean migration percentage was 10.6% (range 0-31%). Complications included one case of degenerative arthritis, one case of painless coxa vara, and three episodes of supracondylar femur fractures. None of these patients developed radiographic evidence of avascular necrosis. In the authors' experience, one-stage hip reconstruction consisting of soft tissue lengthening, open reduction, femoral osteotomy, and pericapsular acetabuloplasty results in a painless, mobile, and stable hip at long-term follow-up that greatly improves the patient's quality of life.

Adolescent↗
PubMed2006

Anterior instrumentation of the cervicothoracic vertebrae: approach based on clinical and radiologic criteria.

STUDY DESIGN: Anterior instrumentation was performed in 42 cases of cervicothoracic tuberculosis operated using the modified anterior cervical approach. OBJECTIVES: To define the role of the modified anterior cervical approach in anterior reconstruction and instrumentation of the cervicothoracic vertebrae. To analyze the problems encountered during anterior stabilization in these patients. SUMMARY OF BACKGROUND DATA: In tuberculosis of cervicothoracic junction, direct anterior visualization is mandatory for optimal decompression of the spinal canal. Anterior reconstruction and stabilization has the advantage of providing immediate stability of vertebral column. The modified anterior cervical approach provides adequate exposure of the upper four thoracic vertebrae. However, radiologic and clinical criteria for anterior instrumentation of the cervicothoracic junction using the modified anterior cervical approach are unclear in literature. MATERIAL AND METHODS: A total of 42 patients with tuberculous kyphosis involving the cervicothoracic junction were operated. Based on the association of the sternal notch with the most distal normal vertebra, the patients were divided into 2 surgical groups. The long-neck patients were amenable to anterior instrumentation using the standard supraclavicular approach with a strap-muscle tenotomy. A manubriotomy was mandatory in short-neck patients for optimal visualization and proper placement of the implant. RESULTS AND CONCLUSION: Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable implant-bone construct anteriorly while preserving the posterior osseo-ligamentous tension band. Detailed preoperative assessment based on clinical and radiologic criteria helps in selection of patient for this procedure. Meticulous intraoperative technique helps to minimize the morbidity and complications associated with this procedure.

Adolescent↗
PubMed2003

A technique for cleft palate repair.

The author has developed a technique of palate repair that combines minimal hard palate dissection with radical retropositioning of the velar musculature and tensor tenotomy. The repair is performed under the operating microscope. Results are reported for 442 primary palate repairs performed between 1978 and 1992 inclusive, with follow-up of at least 10 years. In 80 percent of these palate repairs, repair was carried out through incisions at the margins of the cleft and without any mucoperiosteal flap elevation or lateral incisions. Secondary velopharyngeal rates have decreased from 10.2 to 4.9 to 4.6 percent in successive 5-year periods within this 15-year period. Evidence from independent assessment of speech results in palate re-repair and submucous cleft palate repair suggests that this more radical muscle dissection improves velar function.

Cleft Palate↗
PubMed2005

Athletic pubalgia: definition and surgical treatment.

INTRODUCTION: Athletic pubalgia, or "sports hernia," affects people actively engaged in sports. Previously described in high-performance athletes, it can occur in recreational athletes. It presents with inguinal pain exacerbated with physical activity. Examination reveals absence of a hernia with pubic point tenderness accentuated by resisted adduction of the hip. Diagnosis is by history and physical findings. Treatment with an internal oblique flap reinforced with mesh alleviates symptoms. METHODS: A retrospective review from December 1998 to November 2004 for patients with athletic pubalgia who underwent operative repair was performed. Descriptive variables included age, gender, laterality, sport, time to presentation, outcome, anatomy, and length of follow-up. RESULTS: Twelve patients, 1 female, with median age 25 years were evaluated. Activities included running (33%), basketball (25%), soccer (17%), football (17%), and baseball (8%). The majority were recreational athletes (50%). Median time to presentation was 9 months, with a median 4 months of follow-up. The most common intraoperative findings were nonspecific attenuation of the inguinal floor and cord lipomas. All underwent open inguinal repair, with 9 being reinforced with mesh. Four had adductor tenotomy. Results were 83.3% excellent and 16.7% satisfactory. All returned to sports. CONCLUSION: Diagnosis of athletic pubalgia can be elusive, but is established by history and physical examination. It can be found in recreational athletes. An open approach using mesh relieves the pain and restores activity.

Adolescent↗
PubMed2002

Evaluation of the risk factors of avascular necrosis of the femoral head in developmental dysplasia of the hip in infants younger than 18 months of age.

Sixty-seven dysplastic hips of 54 infants with an average age of 11.9 months were treated by the same surgical technique, including iliopsoas and adductor tenotomies via medial approach and arthrography for verification of the concentric reduction. The average follow-up period was 44.5 months. The rate of overall avascular necrosis (AVN) was 27% and that of severe AVN was 7%. With the numbers available in the study, a statistically significant relationship could not be found between the rate and severity of AVN and several preoperative and intraoperative components such as age, sex, side, dislocation grade, development of the ossific nucleus and qualitv of intraoperative reduction. Nevertheless, hips of infants treated between 13 months and 15 months of age, hips of male patients and left hips had slightly higher ratios of ischemic changes that were not statistically significant.

Arthrography↗
PubMed2005

Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method.

The purpose of this study was to sonographically compare the early anatomical outcome of a group of clubfeet treated with the Ponseti method (group A, nine clubfeet) with a group treated with an adjustable plexidur splint, the Copenhagen method (group B, 19 feet). The clinical severity was assessed using the Diméglio-Bensahel classification. The need for complementary surgery was clinically assessed at the age of about 2 months. Ultrasound investigation was made in the neonatal period, after 2-3 months of non-surgical treatment and 1-2 months post-surgically. After 2 months of non-surgical treatment the correction obtained at the talo-navicular joint, expressed as the distance between the medial malleolus and the navicular (MM-N distance), was significantly greater in group A. After surgery, tenotomy of the Achilles tendon for all group A feet, and posterior or posteriomedial release for 13 feet in group B, the correction at the talo-navicular and calcaneo-cuboid joints was similar for the two groups. Anatomical correction of the displacement in these joints can be achieved without extensive interventional procedures. Ultrasound may be a valuable tool to assess the effects of different treatment protocols quantitatively.

Achilles Tendon↗
PubMed1981

Efficacy of neonatal hip examination.

An examination of the ongoing neonatal hip screening program at the Vancouver General and Grace Hospitals in Vancouver, British Columbia, over a 9 1/2 year period revealed that of the 32,480 newborns examined, 321 (9.8 per 1,000 live births) had unstable hips. Treated immediately with abduction splintage, five of these children came to percutaneous adductor tenotomy and hip spica casts. There was one false-negative screening, and there were five children with unidentified acetabular dysplasia who presented within the first year of life. No child came to open reduction of the hip or innominate or femoral osteotomy. A standardized neonatal hip screening program would seem to significantly alter the natural history of the classic congenital dislocation of the hip but also seems unable to effectively screen out acetabular dysplasia.

British Columbia↗
PubMed1984

Radiographic comparison of adductor procedures in cerebral palsied hips.

Hip muscle imbalance in cerebral palsy may cause subluxation or dislocation. Pelvic radiographs were used to assess hip stability in 40 affected hips before and after open adductor surgery. Preoperative rates of hip migration were determined from radiographs using the center-edge angle and migration percentage. Either an open adductor tenotomy with partial obturator neurectomy or a posterior adductor transfer was performed. Follow-up averaged 5 years, with a reversal of preoperative lateral hip migration in 36 of 40 hips. There was no statistically significant difference in the radiographic outcome of the two procedures. Lateral hip migration can be arrested or reversed with properly timed hip adductor surgery.

Adolescent↗
PubMedDate not supplied

Surgical management of the severely multiply handicapped individual.

Thirty-four surgical procedures were performed over a 12-year period on a select population of severely multiply handicapped individuals. Heel cord lengthening, hamstring and adductor releases, as well as selected osteotomies, tenotomies, and arthrodeses (both wrist and foot) were performed. The objectives were improvement in sitting posture, care, and comfort. Independent evaluations of active function, passive function, cosmesis, self-esteem, limb posture, and ease of dressing and hygiene were assessed. Significant improvement was generally noted. No patient was made worse. Selected procedures in the severely multiply handicapped individual have a definite place in patient management.

Adolescent↗
PubMed1984

Superior oblique muscle surgery.

The anatomy and actions of the superior oblique muscle are discussed as a basis for logical surgical procedures. Weakening procedures are indicated for overaction or for a short superior oblique tendon. Tenectomy is performed nasal to the superior rectus while selective tenotomies for bilateral overaction are performed temporal to the superior rectus. Recession of the whole tendon on an adjustable suture is preferred for unilateral superior oblique overaction. Tendon tucking for unilateral superior oblique palsy is performed temporal to the superior rectus and inevitably causes a degree of pseudo-Brown's syndrome. Tucks may be used bilaterally in bilateral cases. Alternatively, anterior tendon advancement corrects tensional symptoms. It may be graded from a maximum advancement to the upper border of the lateral rectus to suit the degree of tension. Adjustable sutures may be used. Superior oblique tendon transfer for long-standing third nerve palsies may produce paradoxical eye movements in the long-term due to scarring.

Eye Movements↗
PubMed1987

Strapping of curly toes in children.

This is a retrospective review of 49 children with curly toes treated by strapping; 24 children (44 toes) presented for review. The strapping produced improvement in 68% of toes while strapping was maintained, but there was a statistically significant loss of correction once strapping was stopped. There was some sustained improvement in the shape of the toes compared with the natural history, but not sufficient to warrant its use for this minor congenital deformity. Treatment should be reserved for the more severely deformed toe, as this may cause symptoms in later life, and the author recommends open flexor tenotomy.

Adolescent↗
PubMed1981

Treatment of extension contracture of the hip in cerebral palsy.

Twenty patients with cerebral palsy had a total of 35 extension contractures of the hip, resulting from tightness of the gluteus maximus or hamstring muscles, with associated quadricepts muscle spasticity. Associated deformities included anteriorly dislocated hips, patella alta, lumbar lordosis, thoracic kyphosis and calcaneus feet. Active and passive exercises, surgical release of contractures and reduction of anteriorly dislocated hips improved function. Hip flexor or adductor tenotomies must be considered cautiously for patients with spastic hip extensor muscles, because severe extension constricture may develop after either procedure.

Adolescent↗
PubMed1986

Regulation of taurine transport in rat skeletal muscle.

Taurine concentration of soleus muscle (SL, slow-twitch) was initially about twofold higher than that of extensor digitorum longus muscle (EDL, fast-twitch). Taurine concentration in gastrocnemius muscle (GC) was intermediate between that of EDL and SL. Four days after sciatic nerve section, taurine concentration in the EDL but not in the SL was increased by 2.5-fold. The increase was not due to the muscle atrophy and was observed 28 days after denervation. Tenotomy did not increase the total taurine content of the EDL. The increase in taurine concentration of the denervated EDL was prevented by simultaneous ingestion of guanidinoethane sulfonate, a competitive inhibitor of taurine transport. The initial and the maximal rates of [3H]taurine uptake were significantly higher in SL than in EDL. Denervation dramatically accelerated the initial and the maximal rates of the transport in EDL, whereas it significantly reduced those in SL. In contrast, the electrical stimulation of sciatic nerve accelerated the uptake of taurine by EDL and SL of the control but not of the curare-treated rats. These results suggest that transport of taurine into rat skeletal muscles is regulated differently by neural information and by muscular activity, and that the regulation is dependent on the muscle phenotype.

Animals↗
PubMed1969

ACTH and decubitus ulceration: an experimental study.

1. Ulcers due to neurectomy with excision of the sciatic nerve are more severe than those due to tenotomy and can be inhibited by a single dose of ACTH.2. Timing and mode of administration of ACTH to prevent decubitus ulceration is critical and depends on its ability to prevent the separation of endothelial cells.

Adrenocorticotropic Hormone↗