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PubMed1984

Femoral head preservation following subcapital fracture of the femur.

Primary fixation of displaced subcapital fractures offers a low morbidity and low mortality approach to a very common problem. The vast majority of patients receiving this form of treatment will not require further surgery. When contrasted with the problems of primary arthroplasty which included a higher morbidity and higher mortality, a higher infection rate, and the possibility of prosthetic loosening, prosthetic dislocation, acetabular wear to subsequent pain, and protrusio, the choice seems very clear. We would reserve arthroplasty for the following: Patients with pathologic fractures of the femoral neck secondary to metastatic disease. Patients with displaced fractures of the femoral oral neck who have primary hip disease such as rheumatoid arthritis. Patients with coexistent serious illness with a grossly limited life expectancy. Enfeebled elderly patients with minimal demands (senile, demented, minimal ambulatory or not ambulatory before fracture. (We would not perform primary arthroplasty in patients with neurologic disorder leading to spasticity or contracture, since we found the dislocation rate in such patients to be unacceptably high). In patients under 60 years of age with displaced subcapital fractures of the femoral neck we would advocate the following: Anatomic reduction (open, if necessary); Sound secure fixation; Staged muscle pedicle graft to promote increased fixation and ideally femoral head vascularity; No weight bearing until the fracture unites. In patients greater than 60 years of age we would advocate the following: Anatomic or slight valgus reduction of the fracture; Sound secure fixation; Impaction of the fracture; Weight bearing as tolerated. If these principles are followed, the results of a policy of femoral head preservation in displaced subcapital fractures will be very acceptable for both the patient and surgeon alike. In our opinion, prosthetic replacement equals salvage surgery, and it should be delegated to that role.

Adult↗
PubMed1978

[One-stage osteosynthesis of 2 segments in multiple fractures of bones of the limbs].

From the experience with one-stage osteosynthesis of two segments in 71 patients with multiple fractures of the extremities and their sequelae the author considers that up-to-date achievements of anesthesiology favour such interventions. He believes that the patients tolerate well one-stage operation which has some advantages as compared to multi-stage operations: only one exposure to narcosis, psychic trauma and unpleasant sensations of the postoperative period; this type of intervention affords motility of the patients and makes it possible to start the functional treatment early and to prevent development of contractures and hypostatic complications. The period of the treatment shortens, which is of economic and social importance.

Adolescent↗
PubMed1995

Importance of lower limb surgery in Duchenne muscular dystrophy.

A total of 123 patients with Duchenne muscular dystrophy (DMD) was surgically treated during two different periods of their course by hip and knee release, aponeurectomy of the iliotibial band and z-shaped Achilles' tendon lengthening. In 57 patients (group I) this was carried out prophylactically as retractions of the lower limb joints were just beginning at the age of 6.4 +/- 1.43 years and in 66 patients (group II) as mild contractures of the joints at the end of walking ability were already manifest with an average age of 9.27 +/- 1.86 years. The average follow-up was 3.7 +/- 1.2 years in both groups. To be able to assess the interindividual course of both groups, we defined "joint and motor quotients", which allowed a complex assessment of joint function and motoric capacity. In addition, both groups were compared with a control group (natural history) consisting of 100 non-operated DMD patients. In both groups a significant release of the contractures could be obtained primarily. Patients in group I showed a much better long-term effect than those in group II. The motor quotient in group I was significantly better over the whole follow-up period (P < 0.001) than in group II or the control group. The prolongation of walking ability by about 2 years compared with the natural history is in our opinion not the central goal of this surgical treatment concept of lower limbs in DMD, but rather the additionally achieved prolongation of an assisted standing ability with the lower limbs free from contractures and deformities.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed2001

The concept of fillet flaps: classification, indications, and analysis of their clinical value.

Tissue of amputated or nonsalvageable limbs may be used for reconstruction of complex defects resulting from tumor and trauma. This is the "spare parts" concept. By definition, fillet flaps are axial-pattern flaps that can function as composite-tissue transfers. They can be used as pedicled or free flaps and are a beneficial reconstruction strategy for major defects, provided there is tissue available adjacent to these defects.From 1988 to 1999, 104 fillet flap procedures were performed on 94 patients (50 pedicled finger and toe fillets, 36 pedicled limb fillets, and 18 free microsurgical fillet flaps). Nineteen pedicled finger fillets were used for defects of the dorsum or volar aspect of the hand, and 14 digital defects and 11 defects of the forefoot were covered with pedicled fillets from adjacent toes and fingers. The average size of the defects was 23 cm2. Fourteen fingers were salvaged. Eleven ray amputations, two extended procedures for coverage of the hand, and nine forefoot amputations were prevented. In four cases, a partial or total necrosis of a fillet flap occurred (one patient with diabetic vascular disease, one with Dupuytren's contracture, and two with high-voltage electrical injuries).Thirty-six pedicled limb fillet flaps were used in 35 cases. In 12 cases, salvage of above-knee or below-knee amputated stumps was achieved with a plantar neurovascular island pedicled flap. In seven other cases, sacral, pelvic, groin, hip, abdominal wall, or lumbar defects were reconstructed with fillet-of-thigh or entire-limb fillet flaps. In five cases, defects of shoulder, head, neck, and thoracic wall were covered with upper-arm fillet flaps. In nine cases, defects of the forefoot were covered by adjacent dorsal or plantar fillet flaps. In two other cases, defects of the upper arm or the proximal forearm were reconstructed with a forearm fillet. The average size of these defects was 512 cm2. Thirteen major joints were salvaged, three stumps were lengthened, and nine foot or forefoot amputations were prevented. One partial flap necrosis occurred in a patient with a fillet-of-sole flap. In another case, wound infection required revision and above-knee amputation with removal of the flap.Nine free plantar fillet flaps were performed-five for coverage of amputation stumps and four for sacral pressure sores. Seven free forearm fillet flaps, one free flap of forearm and hand, and one forearm and distal upper-arm fillet flap were performed for defect coverage of the shoulder and neck area. The average size of these defects was 432 cm2. Four knee joints were salvaged and one above-knee stump was lengthened. No flap necrosis was observed. One patient died of acute respiratory distress syndrome 6 days after surgery. Major complications were predominantly encountered in small finger and toe fillet flaps. Overall complication rate, including wound dehiscence and secondary grafting, was 18 percent. This complication rate seems acceptable. Major complications such as flap loss, flap revision, or severe infection occurred in only 7.5 percent of cases. The majority of our cases resulted from severe trauma with infected and necrotic soft tissues, disseminated tumor disease, or ulcers in elderly, multimorbid patients. On the basis of these data, a classification was developed that facilitates multicenter comparison of procedures and their clinical success. Fillet flaps facilitate reconstruction in difficult and complex cases. The spare part concept should be integrated into each trauma algorithm to avoid additional donor-site morbidity and facilitate stump-length preservation or limb salvage.

Adolescent↗
PubMed1993

Familial hypertrophic synovitis.

We describe here a 14-year old male patient with a life-long history of deformities of hands and feet, swelling of both knees and both wrists and limited motion of hips and elbows. His paternal aunt has similar findings. A two-month-old brother developed flexion deformities of the hands similar to those of the patients.

Adolescent↗
PubMed1999

Diffuse metastatic infiltration of a carcinoma into skeletal muscle.

Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report a patient with rapidly progressive contractures due to metastatic infiltration of a carcinoma of unknown origin into the skeletal muscle. This 61-year-old man presented with a 1-month history of rapidly evolving, painful restriction of mobility of his right arm and his legs. Computed tomography showed diffuse metastatic nodules in all muscles, particularly in the hip abductors. Muscle biopsy revealed extensive infiltration of the muscle with carcinoma cells.

Biopsy↗
PubMed1993

The relationship of lower extremity strength and gait parameters in patients with post-polio syndrome.

Relationships between lower extremity strength and stride characteristics were studied in 24 patients with post-polio syndrome. Maximum isometric torques were measured in the ankle plantar flexors, hip and knee extensors, and hip abductors. Gait velocity, stride length, and cadence were recorded during free and fast walking. Step-wise regression analysis was performed to determine which muscle groups best predicted ambulatory function. Plantar flexion torque was the best predictor of velocity (r = .55 free walking and r = .76 fast) and cadence (r = .46 free and r = .58 fast). The combination of plantar flexion and hip abduction torques was the best predictor of fast stride length (r = .78). These findings emphasize the important role of the plantar flexor muscles in gait. Knee extension torque was the poorest predictor for each of the gait parameters. Several patients demonstrated gait deviations that minimized the penalty of quadriceps weakness. Without a contracture or an orthosis, however, no adequate substitution exists for weak plantar flexion.

Adult↗
PubMed1982

[Remarkable findings in the criminal dismemberment of a corpse].

The objects of examination were two legs and two arms that were recovered at different times from waters traveled on by motor ships. The right leg was exarticulated at the hip joint, as was the right arm at the shoulder joint. Identification was complicated since both thumbs were exarticulated at the basal joints; the fingers II to V, respectively, were partially amputated. Identity (57-year-old vocational school teacher) could be established nevertheless by a number of anatomic findings (such as Dupuytren's contracture, coxitis, hallux rigidus), the blood group "O" was tatooed on the inner side of the left upper arm. The results of the laboratory examinations were only of limited use due to advanced decomposition (beginning formation of adipocere). Special attention should be given to the fact that on the same part of the corpse there were signs of defensive corpse dismemberment and injuries from a ship's propeller as well. Under no circumstances can an examination of the bones, after thorough maceration, be dispensed with; X-ray examinations are also imperative in cases of this nature.

Amputation, Traumatic↗
PubMedDate not supplied

Ultrasonography of the unossified patella in young children.

Ultrasonography has become a useful technique to assess the cartilaginous hip of the newborn. We applied this technique and found that it gave useful information in helping to locate the unossified patella in two cases of congenital dislocation of the patella.

Contracture↗
PubMed1986

[Principles of joint protection in inflammatory joint disease with special reference to biomechanical status].

With respect to rehabilitation in inflammatory joint diseases, the activity of the disease, the influence of the disease on the physical ability and social and psychological situation of the patient should all be taken into consideration and treatment then planned accordingly. In the present article, special attention is paid to the biomechanical situation in the diseased joints of the upper and lower extremities, respectively. In the shoulder and elbow joints, the muscles working with long levers and the loading of joints create large intra-articular forces. In the hands the vulnerable joints are under high intra-articular stress because of loading in all situations in daily life. As the result of synovitis and destruction of cartilage, instability is often present. In the lower extremities, the hips and knees are under great strain when moving, rising from chairs, and walking on stairs. Much can be done to reduce loading on the joints. In the upper extremities splinting and the use of suitable technical aids are essential. In the lower extremities good quadriceps muscles and hip extensor muscles as well as correct loading techniques are essential. Whenever walking aids are used, they should be tried out with attention to grip function and the condition of the shoulder and elbow joints, as well as to the need of unloading the lower extremities. A walking aid should always be checked again later. A daily contracture prophylaxis program should help to prevent deformities. Strength training should be performed with attention to the intra-articular loading and stability of the joints.

Arthritis, Rheumatoid↗
PubMed1978

[Fibrosis of the rectus femoris muscle (author's transl)].

The author presents seven cases of isolated fibrosis of the rectus femoris muscle. The retraction of the rectus femoris muscle is characterized clinically by limping and the blocking of the knee flexion in the movement of the hip articulation in fixed in extension. The hip flexion immediately permits the knee flexion. The tenomiotomy of the proximal insertions of the muscle led in all cases to the disparition of the limping and to complete freedom of movement of the knee flexion.

Child↗
PubMed1988

Hand splint for rheumatoid arthritis patients during gait training after joint replacement in lower extremity.

Rheumatoid arthritis patients have multiple joint problems, often making it difficult to use gait aids after a joint replacement in the leg. To address this problem, we designed a hand splint with a hook on the palmar side for use with parallel bars. Patients put these splints on both hands and they can walk holding the bars with the hooks. Best suited for using this splint are rheumatoid arthritis patients who are unable to hold parallel bars without marked pain in the hands or fingers, contracture of the wrist joint, or dislocation of finger joints. Several patients have tried this splint, which worked safely and satisfactorily during exercise.

Arthritis, Rheumatoid↗
PubMed1999

Arthroplasty after war injuries to major joints.

From 1992 to 1995, replacement of the joint with an endoprosthesis after serious wounding and major destruction of joint elements was performed in 10 soldiers. Arthroplasty was performed on five knees, three hips, and two shoulders. The age range of the wounded soldiers was 22 to 55 years (mean, 37.7 years). Six soldiers suffered explosive injuries, and 4 were injured by gunfire. Time elapsed from the moment of wounding to the time of total joint replacement was 9 to 42 months. We decided on arthroplasty as the preferred treatment because of the presence of strong contractures and very painful movement. In 8 patients, the results of the treatment, based on a follow-up time of 36 to 48 months, were good. In 2 patients, early septic arthritis developed after arthroplasty of the knee with concomitant loosening of the endoprosthesis. Staphylococcus aureus was detected in both patients. In those 2 patients, therefore, arthrodesis of the knee with external fixation was performed.

Adult↗
PubMed2004

[Ilizarov technique for correcting flexion deformity of the knee of arthrogryposis multiplex congenita].

OBJECTIVE: To study the methods and effects of Ilizarov distraction technique in treating the flexion deformity of the knee of arthrogryposis multiplex congenita. METHODS: Between August 1998 and February 2003, 6 patients (10 knees) with the arthrogryposis multiplex congenita were treated, 4 patients in double knees, 5 males, 1 female, mean age 8 years and 2 months, ranged from 3 years and 7 months to 13 years. The preoperative flexion degree was averagely 51 degrees. The patients accompanied 13 other parts malformation of limbs. The modified Ilizarov distraction apparatus of the knee was used. While installing the apparatus in the operation, the knees should be kept in the of location of maximum extension, the center of joint hinges on the apparatus should be placed towards the rotatory center of the knee, two groups of 2 mm K-wires were passed through the femur and tibia around the knee, who were fixed on the proximal and distal rings. Distraction was started after the surgical procedure 5 days via rotating the threaded rods at the posterior of the knee, at an average of 2 to 3 mm per day, at the first week, after 2 weeks with the rate modified to 2 mm per day, up to the knee extended to 0 degrees. The accompanied deformities of the hip and/or the foot might be corrected at the same time or next time. The average duration of the distraction was 37 days (23-48 days). During the correction all limbs might undergo weight. After 2 weeks at the end of distraction the fixator was removed and the patients could walk by a long-leg brace. RESULTS: Ten knees with the flexion contracture were sufficiently corrected without severe complications. Nine knees of all were followed up at an average time of 1 years and 3 mouths, no recurrence of the deformity was seen in all patients, their function of walk was significantly improved. CONCLUSIONS: Ilizarov technique is a simply, safe and effective method for managing the flexion deformity of the knee of the arthrogryposis multiplex congentia. The procedure is conformable to the biological theories and microsurgical principles.

Adolescent↗
PubMed2006

[Surgical treatment of groin soft tissue defects].

BACKGROUND: Treatment of groin defects remains challenging due to their location and origin. Such defects commonly result from resection of tumours but can also occur after surgical or medical therapy. MATERIAL AND METHODS: From 2003 to 2005, 11 patients were treated with groin defects following radiation therapy and resection of lymph node metastasis, primary carcinoma, and sarcoma. Seven patients received wound closure with rectus femoris muscle flaps, and three had vertical rectus abdominis muscle flaps. One patient was amputated at the hip, and the defect was covered with dorsally pedicled muscle and skin flaps. RESULTS: All flaps healed primarily. There were no secondary infections or lymphorrhea. CONCLUSION: The flaps described here are well vascularised standard flaps which are easily harvested with no major donor site morbidity. They provide sufficient coverage for the groin, reduce long-term conservative treatment, hospitalisation, and problems such as scar contracture.

Carcinoma, Squamous Cell↗
PubMed2002

[Leg length changes after upper tibial osteotomy: analysis of different preoperative planning methods].

PURPOSE OF THE STUDY: The amount of change in the length of the lower limb resulting from upper tibial osteotomy depends on the type of osteotomy performed, the preoperative length of the limb, the degree of preoperative deformity and the amount of correction obtained. Wedge resection, for example, removes bone tissue and can lead to shortening. Inversely, a lengthening effect may result from correction of deformity. The purpose of this article was to present an analysis of the differences between different types of osteotomies and compare their effect on leg length. METHODS: Change in length of the lower limb was studied with a mathematical analysis in opening wedge osteotomy, closing wedge osteotomy, and dome osteotomy. Leg length was calculated for several preoperative deformity angles of the entire limb (hip-knee-ankle angle) and several values of planned correction. RESULTS: The theoretical mathematical model demonstrated that the greatest changes in leg length are obtained with opening wedge osteotomy, followed by dome, then closing wedge osteotomy. Tables were established showing calculated change in leg length. Tracings on radiographs or CT scans used to measure these changes are explained. Methods applicable in case of flexion contracture of the knee are presented. DISCUSSION AND CONCLUSION: Once the initial question regarding length changes is posed, many of the points become evident on image tracings. This work points out how quickly tables can be used to recognize significant differences in leg length changes produced by different osteotomies.

Anthropometry↗
PubMed1976

[Surgery in Diagnosis and therapy of infant rheumatoid arthritis (author's transl)].

In our hospital, diagnostic surgery is applied in as follows: confirmatory incisions of joints, excision of rheumatic nodulis, tissue excision of skin and muscles (dermatomyositis?), excision of mucosa of the rectum (amyloid?) and open biopsy of the kidney (amyloid?). Therapeutic measures are: total synovectomy of the knee joints or other joints, teno-synovectomy at the hands; treatment of contractions of the hip by myotenotomies and of the knee-joint by elongation of tendons and treatment of knock-knee by incision of the tractus ilio-tibialis and elongation of the tendon of the bicipital muscle.

Arthritis, Juvenile↗
PubMed2002

Perthes-like changes in geleophysic dysplasia.

Geleophysic dysplasia is a rare skeletal dysplasia characterised by 'happy natured' facies, short stature with short limbs, brachydactyly, and joint contractures. This report describes a case of a patient with unilateral Legg-Calvé-Perthes-like changes associated with dysplastic proximal capital femoral epiphysis, typical to geleophysic dysplasia.

Child↗