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PubMed2005

Melorheostosis--an unusual cause of amputation.

A 24-year-old female developed, in infancy, progressive right upper and lower limb muscle and soft tissue contractures and had a diagnosis of melorheostosis made on X-ray and pathological specimens. At the age of 11 years she began to have pain in the right hip and lower limb and this later became the dominant feature. She ultimately required amputation through the right hip joint and prosthetic fitting. She now has independent mobility with her prosthesis and has had no recurrence of pain. Her right arm remains flexed, shortened and contracted, but some hand function is retained. A review of the medical literature is discussed.

Adolescent↗
PubMed1980

Pelvic obliquity as a factor in dysplastic hip in infancy.

Screening of the newborn to detect hip dysplasia has led to the increasing recognition of fixed pelvic obliquity, in which one hip has restriction of abduction and the other, restriction of adduction. The hip with limited abduction is apparently short, so that the infant presents signs clinically indistinguishable from those of congenital dislocation. During the years 1974-78, 192 consecutive cases of unilateral dysplastic hips were treated by us; 44 (23%) were diagnosed as having pelvic obliquity. Nine were males and 35, females; 39 were firstborn. A characteristic postural pattern was found on examination. If untreated in the early stages, a morbid degree of subluxation developed and in six cases, complete dislocation occurred. In 33 cases, complete resolution of abduction contracture and subsequent pelvic obliquity occurred within the first year of life. In a number of cases, pelvic obliquity persisted for years and in a few, resulted in physical incapacity.

Biomechanical Phenomena↗
PubMedDate not supplied

MR study of normal joint function using a low field strength system.

A functional MR study was performed using a 0.064 T permanent magnet MR system. The shoulder joints, elbow joints, hip joints, and knee joints of three volunteers (mean height and weight, 176 cm and 71 kg, respectively) were examined at incremental joint angles in three to eight stages during flexion-extension, abduction-adduction, or pronation-supination movement. Each set of 16 images was obtained in 4 min, 49 s using three-dimensional Fourier transformation methods with gradient echo pulse sequences. The images were evaluated in static mode and sometimes in cine mode. The findings obtained about the physiology of these normal joints was generally compatible with findings previously accumulated in the field of kinesiology. The study suggests that this method can be useful for in vivo study of kinesiology and pathogenesis of diseases and that patients with most types of contracture or deformity can be examined by MR imaging.

Adult↗
PubMed2001

Intertrochanteric osteotomy for posttraumatic arthritis after acetabular fractures.

OBJECTIVE: To evaluate the long-term results of intertrochanteric osteotomies for posttraumatic arthritis after acetabular fractures. DESIGN: Retrospective study of eight patients who underwent a total of ten intertrochanteric osteotomies. Two patients underwent two osteotomies of the same hip. SETTING: Academic Level I trauma center. PARTICIPANTS: Patients who developed posttraumatic hip arthritis after nonoperatively or operatively treated acetabulum fractures. The average age of patients was twenty-nine years (range 16 to 47 years). INTERVENTION: Patients underwent an intertrochanteric osteotomy to decrease contact pressures on damaged cartilage and to lessen contractures. All intertrochanteric osteotomies at our institution were performed by the senior author (R.K.M.). MAIN OUTCOME MEASUREMENTS: The Merle d'Aubigné score and the Thompson and Epstein score were determined based on each patient's last follow-up. RESULTS: At an average long-term follow-up of 10.2 years (range 2.5 to 22 years), all eight patients had a significant improvement based on the Merle d'Aubigné score (average increase 5.3 points). Less improvement was observed according to the Thompson and Epstein score, which is consistent with the fact that radiographic appearance is weighted disproportionally in that score. CONCLUSIONS: Because most acetabular fracture patients are relatively young, the option of joint replacement for posttraumatic hip arthritis is less than ideal. However, we have observed significant improvement in hip function with a decrease in pain and disability when such patients are treated with an intertochanteric osteotomy.

Accidental Falls↗
PubMed2004

Two cases of joint disease in post-medieval church cemetery of St. Ilija.

Evidence of disease was analyzed from the skeletal remains of 11 individuals dating to the post-Medieval period from church cemetery of St. Ilija in Serbia. Two individuals showed pathological condition affecting joints. It was supposed that first individual had been suffering from Legg-Calvé-Perthes disease. It seems that this condition remained untreated, with extensive bone remodeling, and that the deformity of femoral head and acetabulum caused secondary degenerative joint disease at a relatively early age of this individual. Second case was related to the bony akylosis of the hand finger, probably caused by Dupuytren's disease. In addition, we discussed development of differential diagnosis in both pathological conditions.

Adult↗
PubMedDate not supplied

Biomechanics of walking, running, and sprinting.

A biomechanical study of 13 runners which consisted of 2 male sprinters, 5 experienced joggers, and 6 elite long-distance runners were studied. We obtained hip, knee, and ankle joints motions in the sagittal plane and electromyographic data from specific muscle groups. As the speed of gait increased, the length of stance phase progressively decreased from 62% for walking to 31% for running and to 22% for sprinting. The sagittal plane motion increased as the speed of gait increased. Generally speaking, the body lowers its center of gravity with the increased speed by increasing flexion of the hips and knees and magnifying dorsiflexion at the ankle joint. Electromyographic activity about the knee demonstrated increased activity in the quadricep muscle group and hamstring group with increased speed. Muscle function about the ankle joint demonstrated that the posterior calf musculature which normally functions during the midstance phase in walking became a late swing phase muscle and was active through the first 80% of stance phase, as compared to 15% in walking. Beside the changes in the electromyographic activity of the muscles, the anterior compartment muscles of the calf undergo a concentric contracture at the time of initial floor contact during running and sprinting but undergo an eccentric contraction during walking.

Ankle Joint↗
PubMed2004

Intraarticular osteoid osteoma: clinical features, imaging results, and comparison with extraarticular localization.

OBJECTIVE: Intraarticular osteoid osteoma is uncommon and presents diagnostic difficulties, which are important for both rheumatologists and orthopedic surgeons. Clinical symptoms, imaging procedures, differential diagnostic problems, and treatment results of intraarticular as compared with extraarticular osteoma are analyzed in this retrospective study. METHODS: Nineteen patients with intraarticular osteoid osteomas (Group A), with a mean followup period of 34 months, are compared with 15 others with extraarticular lesions (Group B). RESULTS: Nine intraarticular tumors were located in the hip, 3 in the elbow, 6 in the ankle, and one in the first metatarsal head. The nonspecific symptoms in Group A, such as chronic synovitis, decreased range of motion, joint effusion, contractures, and lack of the intense perifocal sclerotic margin on radiographs, led to significant delay in diagnosis (on average 26.6 mo in Group A, 8.5 mo in Group B). The extreme variety of previous diagnoses at referral reflect the problems of differential diagnosis. A detectable nidus is often absent on conventional radiograph. Bone scintigraphy is unspecific and often fails to visualize the nidus. Computed tomography scans were accurate in two-thirds of the intraarticular and in 90% of extraarticular cases. Magnetic resonance image findings, although sometimes controversial, provided essential additional information for the correct diagnosis and therapy. CONCLUSION: Clinical symptoms and imaging signs of intraarticular osteoid osteomas were significantly different from the classical hallmarks of extraarticular lesions. The 10% intraarticular occurrence of osteoid osteomas in this series is not as rare as some investigators suggest. The radiological and clinical findings are uncharacteristic and misleading, and the lesions are difficult to identify. Careful search for history data, such as nocturnal pain and positive salicylate test, in addition to extensive imaging procedures, led to the correct diagnosis prior to surgery in two-thirds of our patients with intraarticular osteoid osteomas.

Adolescent↗
PubMed2005

Muscle contracture emulating system for studying artificially induced pathological gait in intact individuals.

When studying pathological gait it is important to correctly identify primary gait anomalies originating from damage to the central nervous and musculoskeletal system and separate them from compensatory changes of gait pattern, which is often challenging due to the lack of knowledge related to biomechanics of pathological gait. A mechanical system consisting of specially designed trousers, special shoe arrangement, and elastic ropes attached to selected locations on the trousers and shoes is proposed to allow emulation of muscle contractures of soleus (SOL) and gastrocnemius (GAS) muscles and both SOL-GAS. The main objective of this study was to evaluate and compare gait variability as recorded in normal gait and when being constrained with the proposed system. Six neurologically and orthopedically intact volunteers walked along a 7-m walkway while gait kinematics and kinetics were recorded using VICON motion analysis system and two AMTI forceplates. Statistical analysis of coefficient of variation of kinematics and kinetics as recorded in normal walking and during the most constrained SOL-GAS condition showed comparable gait variability. Inspection of resulting group averaged gait patterns revealed considerable resemblance to a selected clinical example of spastic diplegia, indicating that the proposed mechanical system potentially represents a novel method for studying emulated pathological gait arising from artificially induced muscle contractures in neurologically intact individuals.

Adaptation, Physiological↗
PubMed2006

Prediction of gait outcome with the knee-ankle-foot orthosis with medial hip joint in patients with spinal cord injuries: a study using recursive partitioning analysis.

STUDY DESIGN: Retrospective study of the degree of gait independence achieved by persons with spinal cord injury (SCI) using knee-ankle-foot orthosis with a medial single hip joint (MSH-KAFO). OBJECTIVE: To examine the effects of the neurological level, degree of paresis, age, and inhibitory physical/other factors on the gait with a MSH-KAFO in patients with SCIs. SETTING: Three university hospitals and two rehabilitation hospitals in Japan. METHODS: The 45 patients (36 men, nine women) examined included 10 with injuries in the cervical cord between C6 and C8 (group C), 20 with injuries in the upper-middle thoracic cord between T4 and T10 (group UT), and 15 with injuries in the lower thoracic-lumbar cord between T12 and L1 (group TL). Mean age was 34.0 years (range 16-68 years). Of these patients, 13 used the Walkabout, four used the gear joint, and 28 used the Primewalk as the medial hip joint. Recursive partitioning, which predicted the final status of gait from the level, degree of paresis, age, and inhibitory factors, was performed, and a decision tree for gait was constructed. Inhibitory factors were spasticity, involuntary spasms or muscle contractions, pain, contracture, weakness of the upper extremities, and decreased motivation to perform gait exercise. The degree of gait independence was rated on the following five-point scale: outdoor independent gait (5 points), indoor independent gait (4 points), indoor supervised gait (3 points), indoor assisted gait (2 points), and gait within parallel bars (1 point). New branches were added to the decision tree for gait based on the clinical experience, thereby constructing a new decision tree. RESULTS: The coincident ratio between the value predicted on the basis of the decision tree of gait and the value actually observed was 53.3%. The coincident ratio between the value predicted on the basis of the modified decision tree of gait and the actually observed value was 68.9%. CONCLUSION: The results provide valuable information to medical teams that may assist prescription of gait orthoses.

Adolescent↗
PubMed2004

Valgus femoral osteotomy for hinge abduction in Perthes' disease. Decision-making and outcomes.

We studied, clinically and radiologically, the growth and remodelling of 21 hips after valgus femoral osteotomy with both rotational and sagittal correction for hinge abduction in 21 patients (mean age, 9.7 years) with Perthes' disease. The exact type of osteotomy performed was based on the pre-operative clinical and radiological assessment and the results of intra-operative dynamic arthrography. The mean IOWA hip score was 66 (34 to 76) before surgery and 92 (80 to 100) at a mean follow-up of 7.1 years (3.0 to 15.0). Radiological measurements revealed favourable remodelling of the femoral head and improved hip joint mechanics. Valgus osteotomy, with both rotational and sagittal correction, can improve symptoms, function and remodelling of the hip in patients with Perthes' disease.

Bone Remodeling↗
PubMedDate not supplied

Arthrogryposis and amyoplasia.

Arthrogryposis (multiple congenital joint contractures) is an uncommon problem. Because there are many causes, correct diagnosis is important to predict the natural history and determine appropriate treatment. Inconsistent terminology has caused confusion about both diagnosis and treatment. Amyoplasia, the most common type of arthrogryposis, is characterized by quadrimelic involvement and replacement of skeletal muscle by dense fibrous tissue and fat. Early physical therapy and splinting may improve contractures, but surgical intervention is often necessary. Aggressive soft-tissue releases in addition to casting may improve joint position. In more severe contractures, osseous surgery also may be needed. Deformity recurrence is common, particularly in skeletally immature patients.

Arthrogryposis↗
PubMed2005

Evaluation on the therapeutic effects of digital acupoint pressure for obstetric spastic cerebral palsy.

To probe the evaluation methods for effects of TCM treatment of cerebral palsy through clinical observation on the digital acupoint pressure in treating obstetric spastic cerebral palsy. From 1998-2003, 40 cases of spastic cerebral palsy were treated with digital acupoint pressure therapy. Ten indexes including intelligence, language, salivation, hand-grasping, thumb-adduction, turnover, sitting, standing, walking, and scissors-gait were divided into the 4 grades of normal, mild abnormal, moderate abnormal, and severe abnormal (dysfunction), respectively marked as 6, 4, 2, and 0 point, with 2 points increased for improving each grade of each item after the treatment. Meanwhile, the ranges were recorded and evaluated before and after the treatment on shoulder-abduction, elbow-extension, wrist-extension, forearm-backward-rotation, hip-abduction, straight-leg-lifting, knee-extension, and ankle-dorsiflexion. Those with the improvement of 10 degrees, 15 degrees, 20 degrees, 25 degrees, and 30 degrees in the range of movement of their contractured joints would obtain respectively 1, 2, 3, 4, and 5 points. There were significant differences before and after the treatment in the 18 items under observation except for intelligence, with obvious improvement shown after the treatment (P<0.01), the effective rate being 92.5%. The therapeutic criteria set in this research are well established in reflecting the functional improvements of the patient.

Acupressure↗
PubMed1988

Syndrome of deltoid and/or gluteal fibrotic contracture: an injection myopathy.

One hundred and fifteen cases of injection myopathy with deltoid and/or gluteal fibrotic contracture were studied, almost all of whom had definite histories of repeated intra-gluteal or intra-deltoid injections. One third had siblings affected by the same fibro-muscular disorders manifested by focal muscle atrophy and limitation of adduction and flexion of the shoulder or hip. Electromyography disclosed myopathic changes of the fibrotic muscles. Muscle biopsy showed marked perimysial and endomysial fibrosis with non-specific degeneration, regenerative changes and, in some cases, partial denervation signs. Under the electron microscope, endomysial and perimysial collagen fibrils lost their normal unimodal diameter distribution and showed a rather broad spectral distribution of diameters suggesting a defective control of collagen formation in this disease entity. Repeated injection injuries and myotoxicity resulting in multifocal myositis are the first trigger of this fibrotic syndrome, and abnormal control of collagen formation could be another important pathogenic factor.

Adolescent↗
PubMed2004

Serial changes in independent sitting in adults with severe cerebral palsy.

We investigated the natural course of independent sitting in 28 institutionalized patients with severe cerebral palsy (CP) and evaluated the factors associated with presence or absence of independent sitting during adulthood. Seventeen subjects (61%) who could not sit at the age of 10 years were never able to reach the milestone of independent sitting. Five (45%) of 11 subjects subsequently lost the ability to sit independently during the early stage of adult life. In adulthood, many of the dependent sitters had poor activities of daily living (ADL) scores and required medical care for respiration and eating/swallowing. Hip dislocation was not directly associated with the presence or absence of independent sitting. We conclude that it is important to prevent further deterioration of swallowing and respiratory functions, as well as the development of deformities or contractures from childhood and to maintain previously acquired motor function and ADL in adults with severe CP.

Activities of Daily Living↗
PubMed1981

Functional evaluation of Rolfing in cerebral palsy.

Rolfing is a technique which involves the use of pressure on areas of the body in which muscle tendons adhere to each other rather than sliding over one another in the normal way. In this study, a series of 10 patients with mild, moderate or severe cerebral palsy underwent Rolfing Treatment, and the results were evaluated. Mildly impaired patients made gains in velocity, stride length and cadence; the moderately impaired group made only minor gains in velocity; and the severely impaired did not improve by any of the criteria used in this study. Muscle strength and electromyography were not altered appreciably in any of the patients. While the effects of treatment on range of motion were highly variable, increased muscle tightness in the hip and knee flexors, hip internal rotators, hip adductors and plantar flexors was noted. These results indicate that Rolfing can lead to improved performance in mildly affected patients because they possess the neurological capacity to make use of increased tissue mobility, and thus avoid contractures. However, the increased muscle tightness which can occur probably outweighs any benefit which moderately or severely impaired patients may derive from the treatment.

Adolescent↗
PubMed2004

[Early results of total ankle arthroplasty].

UNLABELLED: Objective of the study was to evaluate total ankle arthroplasty as the treatment of choice for ankle arthritis; to analyze variables' influence upon early results after total ankle arthroplasty; and to determine early and late postoperative complications and the ways to avoid them. MATERIAL AND METHODS: We evaluated clinical results of 18 patients (out of 23 operated patients), for whom total ankle replacement was performed in 1998-2003. Uncemented Scandinavian Total Ankle Replacement (WLink, Germany) endoprosthesis was used in all cases. The patients were examined, questioned and evaluated according to modified rating system recommended by American Orthopedic Foot and Ankle Society. We observed early and late postoperative complications. RESULTS: Excellent and good results were observed in 9 cases (50%); fair results were in 6 cases (33%), poor in 2 cases (12%), and failure in 1 case (5%). Complications occurred in 11 cases (61%): 4 patients had neurological complaints in operated foot, delayed wound healing was observed in 2 cases, 3 patients had plantar flexion contracture, for 1 patient arthrodesis was done because of dislocation of meniscus component. CONCLUSIONS: Total ankle replacement is an alternative treatment to arthrodesis after posttraumatic ankle arthritis. Results after total ankle arthroplasty are worse than after total hip or knee replacement. Operative technique has great influence on total ankle replacement results. Accurately selected indications for surgery decrease complication rate.

Adult↗
PubMed1996

Wire mesh as a post-operative physiotherapy assistive device following peripheral nerve graft repair in the rat.

Traditional methods of assessing nerve recovery following injury, including histomorphometry and electrophysiology, do not necessarily correlate with return of motor and sensory function. Accordingly, many investigators have used walking track analysis as an assessment of global functional recovery following sciatic, peroneal or tibial nerve injury. However, walking track reliability may be compromised by the development of flexion contractures secondary to neurologic loss. To prevent this, regular manual physiotherapy is recommended which is a time-consuming and often frustrating process for both the animal and investigator. We report the use of a wire mesh as a simple post-operative assistive device to provide constant physiotherapy. Twelve Lewis rats were randomized to one of two experimental groups. Each rat received a 2 cm posterior tibial nerve autograft. Postoperatively, animals in group 1 received manual physiotherapy, consisting of repeated flexion and extension exercises of the ankle, knee and hip every two weeks. Group 2 rats were permitted to climb freely on a 30 x 18 cm piece of wire mesh placed at a 45 degree angle within their cage. Group 2 rats received no manual physiotherapy throughout the course of the study. Serial walking tracks were performed every four weeks until sacrifice at sixteen weeks. There was no development of flexion contractures in the injured hind limbs of either group. There was no morbidity such as blisters associated with the use of the wire mesh. There was no statistical difference in walking track recovery between groups at any time period. However, a trend towards better functional recovery was seen in the group receiving constant physiotherapy via the wire mesh. The use of a wire mesh as a post-operative assistive device is an inexpensive, simple and reliable method to provide continuous physiotherapy to animals following denervation.

Animals↗
PubMed1990

Intracapsular and atmospheric pressure in the dynamics and stability of the hip. A biomechanical study.

A cadaver study was undertaken to evaluate (a) the relations between the rotation around the axis of the neck of the femur, intracapsular effusion, and intracapsular pressure; and (b) the importance of the atmospheric pressure in stabilizing the hip joint. The following conclusions were reached: (1) There is no increase in intracapsular pressure within the normal range of rotation ("flexion") around the axis of the neck of the femur. (2) Intracapsular fluid (e.g., blood, pus, synovial edema and/or free synovial fluid) decreases this pressureless range of rotation, a likely cause of pain and subsequently flexion contractures. (3) Joint stability is primarily maintained by the atmospheric pressure within the normal range of rotation. The joint capsule is tightened only in extreme extension or flexion and contributes to stability only in these positions. (4) The traction force needed to overcome the stabilizing effect of the atmospheric pressure and thus subluxate the adult joint is approximately 200 N, in a child less, proportional to the square of the diameter of the femoral head. We also propose that intracapsular fluid makes the joint potentially unstable, a prerequisite for unfavorable mechanical cartilage load. These findings have clinical implications in synovitis, septic and juvenile arthritis, congenital dislocation of the hip, arthroplasty, and trauma.

Adult↗