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PubMedDate not supplied

A simplified method for repair of distal biceps tendon ruptures.

Repair of distal biceps brachii tendon ruptures is recommended for active individuals desiring maximum return of elbow supination and flexion strength. A 2-incision method of repair has been most popular but carries a risk of radioulnar synostosis. In the past, repair through a single anterior incision required more dissection and risked injury to the posterior interosseous nerve. The authors present a simplified method for the repair of distal biceps tendon ruptures through a single anterior incision. The use of suture anchors provides secure fixation to the radius with minimal volar dissection. This method was used successfully in 16 patients, 8 acutely (<6 weeks) and 8 chronically, with excellent functional results. Patients who received acute repairs regained elbow strength and power; patients who received chronic repairs showed slight deficits of supination strength (16%) and flexion power (14%). Of 10 chronic ruptures treated, only 2 tendons could not be mobilized back to the radial tuberosity and had to be transferred to the brachialis. There were no failures and no complications of radioulnar synostosis or posterior interosseous nerve palsy. The single anterior incision approach in which suture anchors are used is recommended as an alternative to the traditional 2-incision method.

Adult↗
PubMed2001

The fourth dimension in simulation surgery for craniofacial surgical procedures.

The intracranial volume was measured in all 18 cases of craniosynostosis and craniofacial synostosis with 3DCT using a modification of Miyake's formula, with a 6 years' follow-up. 1: There were no cases where the intracranial volume was less than the modified Miyake's formula. 2: Total cranial reshaping, compared to the local forehead advancement, was effective in increasing the intracranial cavity and growth postoperatively. 3: In cases of craniofacial synostosis, there is a possibility that mental retardation will develop if the intracranial volume tends to increase rapidly and more than expected.

Child Development↗
PubMed2002

[The pathomorphology of congenital spinal defects in relation to future clinical development of the disease].

The authors categorised congenital malformations of the spine into five different pathomorphologic groups basing on a series of 61 cases (age ranging from 1 to 50 years): defects of the vertebra, of the vertebral body, intervertebral synostosis, rib synostosis, and defects of the vertebral arch. A total of over 30 different kinds of malformations were obtained in this classification. In the analysed series 34 patients had a predominant kind of malformation, while in 27 cases mixed malformations were noted. These malformations lead to spine deformities: 21 cases with arch scoliosis, 15 cases with kyphoscoliosis, 13 cases with angular scoliosis and 12 cases with kyphosis. Deformities had a tendency to progress with age. In 20 patients neurological deficits (increased spasticity, spastic paresis, spastic and flaccid paralysis) increased after reaching skeletal maturity. Prognosis as to deformity regression was made difficult be the large variety of different pathomorphologic types of deformity. Only general patterns were visible e.g. a tendency to progress in cases were hemivertebra were found. In cases were more than one type of deformity was noted, growth balance of the spine was not a rule. On the contrary, even small mixed deformities of ten progressed. This paper indicates that most congenital deformities of the spine should be treated operatively, either to correct the deformity or to attain spine growth balance.

Adolescent↗
PubMed2002

[Correction of deformities and length discrepancies of the forearm in children by distraction osteogenesis].

OBJECTIVES: To review the results of correction of deformities and length discrepancies of the forearm in children. METHODS: We evaluated the results of distraction osteogenesis in 10 forearms of nine patients with forearm shortening and/or deformity. The mean age at the time of surgery was 10.2 years (range 5 to 16 years). Etiologies included congenital radioulnar synostosis and preaxial longitudinal deficiency of the forearm (n=1), congenital radioulnar synostosis and shortening of the forearm (n=1), multiple hereditary osteochondromas (n=1), distal radial physeal arrest (n=1), Madelung's deformity (n=2), bilateral congenital forearm shortening due to postaxial acrofacial dysostosis syndrome (n=1), and defect nonunion of the radius alone (n=1) and with the ulna (n=1) with shortening. Ilizarov type circular external fixators and monoplanar Orthofix fixators were used in seven and three patients, respectively. The mean follow-up was four years and four months (range 1 to 9 years). RESULTS: The mean length gain was 36.7 mm (range 25 to 60 mm), which meant a mean increase by 31.5% (range 14% to 66%). A satisfactory functional and cosmetic improvement was achieved in all patients. Bone consolidation occurred in three to 13 months without a need for bone grafting. The most common complication was callus deformity seen after the removal of the fixator. CONCLUSION: Lengthening of the forearm results in improved upper extremity function, especially in activities requiring equal arm length as well as better cosmetic appearance if adequate soft tissue is preserved.

Adolescent↗
PubMed1992

[Vertical strabismus in plagiocephaly].

Plagiocephaly is cranial synostosis caused by premature closure of one half of the coronal suture. It is manifested by asymmetry of the face of a varying degree with vertical strabismus on the affected side and tilting of the head to the sound side. The vertical deviation imitates ocular torticollis, there are, however, no signs of paresis nor a positive Bielschowski test. Treatment involves early opening of the coronal synostosis or later at least treatment of vertical strabismus. The authors operated successfully a 14-year-old girl with medium grade plagiocephaly. They describe the preoperative and postoperative state. The authors recommend, in case of asymmetry of the face and vertical strabismus, to consider the possible diagnosis of this anomaly.

Adolescent↗
PubMed1989

[Metopic craniosynostosis. Surgical results in 35 surgically treated cases under 1 year of age].

The clinical features, the diagnostic findings and the surgical results obtained on 35 children, under 1 year of age, operated on because of an early synostosis of the metopic suture are presented. In 79% of cases, the diagnosis was obvious at birth. A M/F ratio of 2.0 was observed in this series. Associated malformations were recorded in eleven patients (30.5%). The surgical procedure consisted of bilateral frontal craniectomy, opening of the roof of the orbit, advancement of the superior orbital margin, and repositioning of the frontal flaps after 180 degrees rotation. The cosmetical correction was satisfactory even in the immediate postoperative period. No mortality was recorded. The surgical correction was followed by a normal psychomotor development in 33 cases; delayed milestones were recorded in 2 children in whom the metopic synostosis was part of a complex malformative syndrome. On the grounds of our results, the young age of the patients at the operation should not be regarded as an obstacle to the immediate surgical correction; in our advice, the early correction results also in better functional and cosmetic long-term outcomes.

Craniosynostoses↗
PubMed1978

Premature fusion of facial sutures with free periosteal grafts. An experimental study with special reference to bone formation with free periosteal grafts from the tibia, the scapula and the calvarium.

The present study was undertaken to obtain more information on the bone forming mechanisms with free periosteal grafts and to study premature synostosis of facial sutures achieved with free periosteal grafts. The results are based on a material of 196 rabbits operated on at the age of two weeks. It was found that the bone forming mechanism with free periosteal grafts from the tibia, the scapula and the calvarium is essentially the same. When implanted in the tibialis anterior muscle of the leg of the same animal they all produced bone. The mechanism of bone formation is reminiscent of the enchondral bone formation seen in fracture healing. There is no difference in the bone forming mechanism with the periosteum from an enchondrally ossifying bone when compared with the periosteum of an intramembranously ossifying bone. In all the three different periosteal grafts studied, there was a cartilage stage before bone formation. In the muscle, all these three periosteal grafts, in spite of their tubular or membranous bone origin, produced bones tubular in shape. When the transplants were overlying the membranaceous facial bones, membrane shaped bone developed via intramembraneceous type of ossification in the recipient area. It can be concluded from these experiments that the shape and type of bone developed with free periosteal grafts depends mainly on the environmental conditions in the recipient area. Fusion of the premaxillo-maxillary and fronto-nasal sutures was achieved with free periosteal grafts from the tibia. Free periosteal grafts from the scapula and the calvarium failed to develop premature fusion of the sutures. The fusion developed due to increased bone formation in the suture area. The fusion of the premaxillo-maxillary suture stopped the growth in this area and caused a severe growth disturbance of the whole snout. The fusion of the fronto-nasal suture by the bone bridge retarded the growth of the nasal bone on the fused side and led to deviation of the snout to the operated side. Compensatory changes developed in other sites of the cranio-facial skeleton in order to minimize the effects of the growth disturbance. The fused fronto-nasal suture was used as a model to study the treatment of premature synostosis of facial bones. Resection of the fused area led to correction of the developed growth disturbance and to subsequent normal growth of the snout.

Animals↗
PubMed1986

Cranial base changes following surgical treatment of craniosynostosis.

Three-dimensional osseous surface images from CT scans have been used to study the endo- and exocranial bases of 87 patients with a variety of craniosynostoses. Patients were studied prior to cranial surgery in infancy, perioperatively, and 1 year postoperatively. The dysmorphology of the endocranial base is diagnostically specific for synostosis of the metopic, sagittal, unicoronal, and bicoronal sutures. Cranio-orbital surgery in infancy for nonsyndromal solitary and bicoronal synostosis seems to induce normalization of endocranial symmetry in the first postoperative year. This normalization occurs to a lesser degree in patients with multiple synostoses. These findings suggest that the cranial base dysmorphology of craniosynostosis is a secondary manifestation of an undefined primary disorder. Furthermore, persistent postoperative dysmorphology may reflect abnormal neural rather than osseous growth.

Child↗
PubMed1982

[The fibula-pro-tibia operation in infected defect pseudarthroses of the lower leg].

Surgery to effect synostosis between fibula and tibia is to be considered if it is not possible to bridge a relatively large gap at the tibia directly at the site of the defect by autologous (cortico)-spongiosaplasty because of inflammatory complications. Various modifications of the procedure are possible--they are described in the article--but the authors are of the opinion that preference should be given to synostosis which leaves the fibula at its physiological site. Technical details are given and the pros and cons discussed. This article is based on the experience collected during the treatment of eight patients.

Bone Plates↗
PubMed1983

[Anterior joints of the thoracic cage].

The chondro-sternal, interchondral, costo-chondral joints and the upper and lower sternal joints were studied in the thorax of 60 children and human adults. Chondro-sternal joints occur as frequent symphyses in the 5th, 6th and 7th joints or ellipsoid joints which are mainly found in the 2nd, 3rd and 4th joints. Diarthrosis frequency increases with age in every joint. An articular space appears particularly in the lower part of the 2nd, 3rd and 4th joints; in fewer cases a space is found in the upper part of the 5th, 6th and 7th joints. These partial spaces disappear with age and are replaced by spaces occupying the whole articulation. The first joint is a synchondrosis which does not vary with age. Interchondral joints are diarthrodial or trochoid joints from earliest childhood and their frequency increases with age. No direct articular contact was observed between the 9th and 10th costal cartilages. Costo-chondral joints are synarthrosis. The upper sternal joint, which is a synchondrosis in the child, may develop into a non-synovial cavity with age, or even turn into synostosis. The lower sternal joint is a synchondrosis which develops partially towards synostosis.

Adult↗
PubMed1984

[Features of the structure of the metacarpal bones of athletes in different specialties].

Metacarpal bones have been examined in hand X-ray photos of 125 sportsmen at the age of 17-18 years who go in for swimming (dynamic loading on the hand) and competitive gymnastics (static loading on the hand). Under the effect of systematic trainings, which are connected with an increased loading on the hand, a number of morphological changes take place in the metacarpal bones. A prolonged loading of the dynamic character delays the synostosis process in the distal parts of the forearm bones and contributes to lengthening the I, III and IV and to widening the I-V metacarpal bones. As demonstrate decreasing indices of compactness in the swimmers, the widening diaphisis of the metacarpal bones occurs at the expense of dilatation of the medullary cavity. The static loadings result in a greater delay of the synostosis processes in the upper extremity parts mentioned, in a greater width of the I-III, V metacarpal bones in boy-gymnasts. The increased index of compactness demonstrates that the widening diaphysis of the metacarpal bones takes place at the expense of thickening of the compact substance and narrowing of the medullary cavity.

Adolescent↗
PubMed1978

Apert's syndrome.

This paper describes two cases of acrocephalosyndactylia (Apert's syndrome). Both very clearly showed the characteristic malformations. In addition, both patients showed synostosis between the calcaneus and the cuboid bone; this synostosis is not a typical feature of Apert's syndrome, but has been described in the literature once before.

Acrocephalosyndactylia↗
PubMed1981

[Mineral saturation of the hand bones of adolescent and young adult boxers of Khabarovsk].

By the method of standard linear roentgenodensitometry worked out by M. A. Kornev the effect of boxing on mineralization degree of the hand bones in young boxers has been studied, as well as dependence between dynamic of mineralization and ossification and synostosis processes in the bones mentioned. Boxing has been stated to result in certain adaptive-compensatory changes in the structure and development in the young boxer hand skeleton. They are revealed as an increased mineral component in the hand bones and as delayed ossification and synostosis processes in these bones.

Absorptiometry, Photon↗
PubMed1980

[Effect of participation in certain types of sports on the hand bones of adolescents and youth].

The effect of such sports training as boxing, basket-ball and football on the hand skeleton was studied. Roentgenograms of hands in 80 young sportsmen 15--17 years old were examined. Synostosis in the hand bones, in distal portion of the forearm and mineral saturation of the metacarpal bones were studied by the standard method of roentgenodensitometry. It was stated that specific loading on the hand bones as a result of sports training (boxing, basket-ball) produces certain adaptive-compensatory changes in the hand bones development and structure. These changes are manifested as: decreasing rate of synostosis in the distal epiphysis of the forearm and hand bones in young boxers; certain time changes in sinostosis of definite parts of basket-ballers' hand skeleton. Their structural changes are seen as increased mineral saturation in the hand bones (more in boxers and less in basket-ballers) that correspondingly results in their increasing resistivity.

Absorptiometry, Photon↗
PubMed1995

[Orthotopic tibiofibular fusion: indications--technique--results].

Between 1988 and 1992, 54 patients with complicated tibial non-union were treated by tibio-fibular fusion. In 6 cases of comminuted fracture the operation was performed within the first 2 months, especially in the case of distal fractures. Fifteen patients suffered from aseptic tibial pseudarthrosis, and further 6 from an additional defect. In 25 patients treatment for infected non-union was needed and in 3 cases tibio-fibular synostosis was induced after segmental transport and non-docking. Most of the patients had conspicuous soft tissue lesions, and 14 required transplantation of a regional or free flap. So far 46 patients have completed their treatment. In 44 cases full weight-bearing on the affected leg is possible. In 2 cases the treatment failed. None of our patients required limb amputation at the site of synostosis. In 13 cases the follow-up showed clearly that the axis was not right, in 11 cases a varus deformity. Most of these deviations have not been corrected because of poor quality of the soft tissue coverage. We suggest this method be used as part of a technique allowing the fibula to stay in its original position while providing tibio-fibular fusion by interposition of autologous cancellous bone grafting and transfixing screws. Additional stabilization might be achieved by using an external fixator, for preference. Partial weight-bearing is allowed after 2 weeks and full weight-bearing is attained on average after 3-4 months. Concerning the initial lesion, the primary aim of the treatment should be the recovery of full weight-bearing without an additional device and without chronic infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Triangular skull. Apropos of trigonocephaly].

The authors present 87 patients with trigonocephaly who were operated on. They take an interest in the consequence of the early synostosis of the metopic suture. The metopic suture combine with the sagittal sutural system, but his spot of manifestation is unambiguous. Its manage the dimension of the frontal bone which himself has repercussions on the set of the orbits. Thereby the fronto-orbito-facial dysmorphy has two component parts. One direct with little frontal bone and a thick sutural spot which extend more or less to the bregma and a second indirect with early deformation of the orbits and late deformation of the parietal bones. Three clinical patterns are described: micro-frontal shape, medio-frontal shape and orbito-frontal shape. In the pure shapes there is no direct impact on the encephalon but the venous stasis is high and probably liable for the encephalic damage when they exist. A single surgical proceeding does not meet the many varieties of deformations. Resection of fused metopic suture from a bifrontal flap; confection of orbito-fronto-nasal band which is opened by greenstick fracture on the metopic site; transposition of an hemicoronal suture between the two hemifrontal valves lateraly translated; foreward mobilisation and interventing temporal flaps. To finish the modeling it is necessary to open the periosteum sheet in order to translate temporal muscles then to overlay with interparietal pedicularly periosteum the anterior step. Metopic synostosis is ordinarily only an aesthetic deformity infrequently associated with intracranial pathology. The treatment must be required for pronounced deformities to prevent significant psychosocial consequences.

Abnormalities, Multiple↗
PubMed1993

Lambdoid craniosynostosis. A 3D-computerized tomographic approach.

From a series of eleven children aged from 4 months to eight years presenting with a parieto-occipital flattening that was unilateral in nine and bilateral in two, we attempted to determine a 3D-CT semeiology able to demonstrate the presence of a lambdoid suture synostosis, as well as the participation of coronal and lambdoid sutures in the genesis of complex cranial malformations. Pure isolated forms of lambdoid synostosis are rare and justify a surgical treatment for cosmetic purposes if the deformation is severe and progressive.

Child↗
PubMed1995

SAPHO syndrome: a followup study of 19 cases with special emphasis on enthesis involvement.

OBJECTIVE: To study the natural history, prognosis, and nosology of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. METHODS: We performed clinical, radiological, and biological reassessment of 19 cases of SAPHO syndrome (13 with pustulosis palmaris et plantaris, 3 with acne, 3 with no dermatological manifestations) after a mean disease course of 12.3 yrs (1-35). RESULTS: Similar involvement was noted in all patient groups. Despite persistent remittent attacks in 11/19 cases and new localizations in 10/19, the prognosis is promising and 18/19 patients considered that improvement has occurred. Enthesis involvement, occasionally associated with osteolysis, was in most cases the first event leading to hyperostosis, but tended to disappear in the spine and peripheral joints once synostosis was achieved. The behavior of osteochondral cartilage was similar to that of the enthesis, whereas the ribs below T6 were spared. We report the first descriptions of hyperostosis of the first costotransversal joint, interspinal ossification, erosion of wrist bones, followed by synostosis, and formation of bony bridges between ribs. CONCLUSION: SAPHO syndrome appears to be a relevant disease process with good prognosis. Although aseptic osteitis is regarded as the hallmark of this entity, our followup study strongly suggests that the initial disease targets are enthesis and related tissues. Forty-three percent of our patients met criteria of the European Spondyloarthropathy Study Group for spondyloarthropathy, but only one had the HLA-B27 phenotype. Thus, it may be considered that SAPHO syndrome is nosologically related to spondyloarthropathy, especially those types associated with psoriasis, but probably differs in pathogenesis.

Acne Vulgaris↗