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PubMed1990

[Indications for and the methods of surgical treatment of oblique strabismus].

The authors present a group of 3500 patients treated surgically in the years 1961-1986 for disturbances of function of the oblique muscles. Two forms of these disturbances are discussed. The first one--acquired paresis of the trochlearis muscle, most frequently a sequelae of injury, the second one--congenital disturbances of action of the superior oblique, with hyperfunction of the inferior oblique, determined as "strabismus sursoadductorius". When the healthy eye was the master eye one the authors performed operations weakening the inferior oblique which was in hyperfunction (recession, partial marginal tenotomy, myectomy, elongation) or they strengthened the superior oblique (plication) because of its paresis. In patients with the affected eye as the master one they weakened the opposite inferior rectus (recession) or strengthened the opposite superior rectus (resection). In cases of a coexistence of a horizontal deviation also this deviation was treated surgically. Five thousand seven hundred four operations had been performed. The vertical deviation was corrected in 75.5 p.c. and diminished in 24 p.c. Binocular single vision without compensatory positioning of the head was attained in 55.4 p.c. of patients, with a small compensatory positioning of the head--in 10.8 p.c.

Adolescent↗
PubMed1979

[Spasm of the adductor muscles, pre-dislocation and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part I: The effect of open myotenotomy of the gracilis muscle and of the long and short adductor muscles in connection with total extrapelvine resection of the obturator nerve, on the hip joints and static function (author's transl)].

Spasm and contraction of the adductor muscles involve, on the one hand, danger in respect of the development of a dislocation of the hip, and are a serious impediment to a walking ability on the other. Hence, surgery is often necessary. The article reports on the results of consequent weakening of the adductor muscles as a result of open myotenotomy in association with complete extrapelvine resection of the obturator nerve. 27 patients were subjected to surgery--in most cases bilaterally--at an age between 2 years and 5 months and 18 years, with a follow-up period of up to 15 years. The study does not include patients with spastic dislocation of the hip in whom this method was applied on the non-dislocated side and on the dislocated side in combination with iliopsoas tenotomy. This method makes it possible to achieve regression of existing defective positions of the hip joints. In a few cases, the valgus position of the neck of the femur was corrected to some extent. In two patients it was not possible to prevent the progress of a developing dislocation of the hip. These results show that, whereas the adductor muscles represent an essential factor for the occurrence of a spastic dislocation of the hip, other forces are most probably also involved. In the majority of cases, results were favourable in respect of the static function, although in some cases the success became evident after several years only, especially in mentally retarded patients and in apathetic individuals. Important for therapeutic success is the follow-up. The principles of its therapy are thoroughly discussed. Surgery is indicated only in special cases. Indications must be observed very strictly, since the risk of excessive weakening of the adductor muscles should not be underestimated.

Adolescent↗
PubMed1990

[The role of a shortening osteotomy of the first phalanges associated with soft-tissue release in the surgical treatment of hallux valgus].

The Authors report the results of 120 hallux valgus operated on 76 patients from January 1983 to June 1988. The operative procedure associated bunionectomy, tenotomy of the abductor hallucis which was resected from the base of the first phalanx and from the lateral sesamoid, shortening osteotomy of the proximal phalanx and finally adjustment of the sesamoids under the head of the first metatarsal. When there was an important metatarsus varus, a basilar osteotomy of the first metatarsal was associated (10 cases about 120). The results were appreciated functionally (pain, range of motion, easiness for putting on one's shoes) and anatomically (radiological correction of the deformity). The total result included anatomical and functional results. Anatomically, 110 feet had sesamoids perfectly adjusted (that is 92.5 per cent), 9 had an inadequate adjustment (first degree). The metatarsus varus was always improved except 3 cases; in these cases a basilar metatarsal osteotomy would have to be performed. The valgus of the big toe was corrected in 88 per cent of the cases (104 feet had a valgus lower than 15 degrees). A varus of the big toe was found in 6 cases (5 per cent). One was lower than 5 degrees; it was nevertheless included with the good results (very well endured). 5 were more than 10 degrees and were included with the poor results. Finally, we took notice of 4 degenerative changes of the first metatarso-phalangeal joint. The total results found 90 per cent of good and very good results, 6 per cent of fair results and 4 per cent of poor results.

Adolescent↗
PubMed1990

[Treatment of the dislocated hip in older children].

Between 1976 and 1987, 85 cases of CDH occurring after walking age were followed in the department. Eighteen children aged 5 years or older were reviewed. In 11 children the dislocation was unilateral and in 7 bilateral; out of these 25 hips, 20 were high luxations and 5 occurred at a lower level. Two children, 6 and 13 years old, had a bilateral dislocation. Except for 2 children of 5 years of age who were treated conservatively, surgical treatment was indicated in the other 18 cases usually after tenotomy and derotation. In 13 hips, a surgical repositioning was performed, associated with femoral osteotomies, either shortening osteotomies (7) or derotation osteotomies (3). Pelvic osteotomies were indicated either immediately or later in 15 hips. A triple osteotomy was usually performed (11); a Salter (2) or a Chiari (2) has been rarely used. After a follow-up of 5 years, evaluation according to clinical and radiological criteria showed 14 good and 7 bad results. The latter 7 cases had either a dislocation or an eccentration. Reviewing these series, the authors describe the problems in the treatment of the dislocated hip in the older child: the indications, the therapeutic strategy for those dislocations and the decision for treatment of the bilateral high dislocation in the older child.

Age Factors↗
PubMed1990

[Diagnosis and treatment of inferior oblique muscle paresis].

The authors report 12 cases of isolated inferior oblique muscle paresis which is very uncommon and mostly of congenital origin, though trauma is also cause. The clinical features, differential diagnosis and treatment of the disease are discussed. Inferior oblique palsy is differentiated from contralateral inferior rectus palsy by Park's 3-step test, and from Brown's syndrome by forced duction test and the overaction of the antagonist superior oblique during version. Surgical procedures include shortening and advancement of the inferior oblique muscle, recession of the contralateral superior rectus and shortening of the contralateral inferior rectus muscle, and tenotomy of the ipsilateral superior oblique.

Adolescent↗
PubMed1989

Glycogen-enzymes containing bodies in type 2 fibres of tenotomized muscles in the rat.

Inclusion bodies containing glycogen-enzymes were found in 30 to 60% of type 2 fibres of tenotomized calf muscles (m. gastrocnemius, m. soleus, m. plantaris) in rats, using histochemical reactions. The bodies appeared within 1 week after the tenotomy and were localized both in the central and the subsarcolemmal regions and rarely extruded into the extracellular space. These aggregates are 3 to 15 microns in length and 2 to 11 microns in diameter. In addition to glycogen, these bodies also contained various enzymes of the glycogen metabolism such as phosphorylase, a branching enzyme, and glucose-6-phosphatase, but showed no NADH-reductase, lactate dehydrogenase, or myofibrillar ATP-ase activity. The results indicate that glycogen-enzymes containing bodies are a degenerative phenomenon, which occurs only in type 2 fibres of the tenotomized muscles.

1,4-alpha-Glucan Branching Enzyme↗
PubMedDate not supplied

[Surgical treatment of sequelae of oculomotor paralysis of the 4th, 6th, and 3d cranial nerves].

The writers analyse the operative results of 43 cases of oculo-motor paralysis aftermaths of the 4th, 6th and 3rd cranial pairs treated since 1985. The applying of muscular puckering, associated with a controlled or kept tenotomy, of muscular transplant, of "Fadenoperation" and of oblique surgery, allowed to obtain good results with suppression of diplopia, at least in the facing and in the lower glance, attenuation of ocular torticollis, disappearing of the ocular deviation, and restitution of a fusion area in primary position, within a more or less extended zone of space.

Abducens Nerve↗
PubMed1989

Selective elimination of cross-compartmental innervation in rat lateral gastrocnemius muscle.

The calf muscles of the rat hindlimb are composed of smaller entities, called neuromuscular compartments, which are the territories of muscle innervated by a single, naturally occurring primary (first-order) muscle nerve branch. While it is quite clear that a precise connectivity exists very early in development between motoneuron pools and individual muscles, the mechanisms responsible for producing the adult pattern of compartmental innervation are unknown. This study uses intracellular recording techniques to demonstrate that neuromuscular compartments are essentially established at birth and that postnatal synapse elimination has little role in establishing neuromuscular compartments. Our results demonstrate the existence of a small number of cross-compartmental connections in neonates which are not present in adults. Examining the removal of these cross-compartmental connections in both normal muscles and in muscles that have had synapse elimination delayed by tenotomy reveals that the synapses responsible for this innervation are eliminated in a selective manner.

Animals↗
PubMedDate not supplied

Complications of the Grice-Green operation.

A case presentation involving complications resulting from errors in surgical technique with the Grice-Green procedure is discussed in this report. The patient was treated 18 years after bilateral tendo achillis lengthenings and Grice-Green extra-articular subtalar arthrodeses with autogenous tibial bone grafts. The complications encountered were severe adductovarus deformity of the feet with multiple painful plantar callosities, in-toed gait with weightbearing on the lateral aspect of the feet, inversion ankle instability, and tripping over the feet. Deformity and symptoms were worse on the right foot. The patient required further surgery, consisting of bilateral calcaneal osteotomy, metatarsal neck osteotomies, excision of callosities and ostectomies for painful plantar metatarsal base lesions, tenotomy of the abductor hallucis and digital fusions. The original surgery was performed for idiopathic flatfeet. Despite the many different causes of flatfoot for which the Grice-Green procedure has been employed, most authors believe it should not be used for idiopathic flatfeet, and restrict its use to the original indication, that of paralytic pes valgus secondary to poliomyelitis. The reader should also realize that there are very long-term consequences to surgery on the pediatric patient.

Adult↗
PubMedDate not supplied

CDH diagnosed at 2 to 12 months of age--treatment and results.

A treatment program for late-diagnosed CDH included skin traction, arthrography, tenotomy of adductor and psoas tendons, and immobilization of the hips in the "frog leg" position with a plaster cast for 8-12 weeks, followed by an abduction frame until the acetabular dysplasia normalized. Follow-up of 40 children with nonteratological CDH performed 2-12 years after diagnosis revealed 38 normal hips and 2 patients with coxa magna, one of whom had intermittent hip pain.

Casts, Surgical↗
PubMed1988

The effect of early functional activities on experimentally tenotomized Achilles tendons in rats.

Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, atrophy and ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. Because these complications may be minimized by limited immobilization and early functional activities, we studied the effects of early weight bearing on the maximum breaking strength of tenotomized tendons in 30 Wistar rats. After tenotomy, the right hind limb of the first group of 10 rats was immobilized for the first 5 days. Thereafter their casts were removed to permit weight bearing for the next 3 days. In a second group of 10 rats, casts were removed 2 days after surgery, the animals were allowed 3 days of unrestricted use of the limb, and then the limbs were re-casted for another 3 days. In a third group of 10 rats the right hind limbs were casted throughout the first 8 days of healing. At the end of this time, strain gauge measurements showed that tendons in the second group healed significantly stronger and without rerupture than those in either of the two groups. Although healing time in rats does not directly translate to humans, our findings suggest that function may return faster in humans, as, for example, following Achilles tendon rupture, if a better combination of immobilization and activity could be found than is currently employed.

Achilles Tendon↗
PubMed1988

[Extemporaneous lengthening of the femur in children and adolescents. Study of 25 cases].

Twenty-five one-stage lengthenings of the femur have been made using a specific technique: an oblique osteotomy in the frontal plane with a mean length of 12 cm, with routine tenotomies and fascial divisions. The average lengthening was 37 mm, that is 9.4 per cent of the femoral length. Complications were uncommon: one infection, three non-unions and one fracture, none of which resulted in any loss of length or deleterious late effects. One-stage lengthening is ideally indicated in adolescents at the end of growth for inequalities of limb length of 40 to 50 mm mainly affecting the femur, whatever the cause.

Adolescent↗
PubMed1988

[An experimental study on denervated muscle atrophy--effect of electrostimulation and comparison with immobilization muscle atrophy].

The efficacy of causing muscle atrophy was compared among denervation, arthrodesis and tenotomy in rat anterior tibial muscle. Reduction of wet weight was most pronounced in denervated muscle and least in arthrodesed muscle. Histochemical investigation by ATPase stain revealed that atrophy of Type 1 and Type 2 fiber was more severe in denervated muscle group than in the other two groups. Type 2 fiber atrophy was dominant in denervated muscle and in arthrodesed muscle. Type 1 fiber atrophy was dominant in tenotomized muscle. The effect of electrostimulation on denervated muscle was investigated. Electrostimulation significantly reduced the degree of denervation atrophy. Four weeks after severance of peroneal nerve, tibial nerve-crossing was done and electrostimulation was continued for eight weeks. Recovery of wet weight of re-innervated muscle with electrostimulation was significantly better than that without electrostimulation. Electrostimulation applied to denervated muscle reduced the progress of atrophy and improved the recovery after nerve repair.

Animals↗
PubMed1988

[Anatomic variants as a rare cause of distal ulnar nerve compression].

A case of anatomical variation of the course and branching of the ulnar nerve causing a nerve compression syndrome at the wrist joint is described. Decompression and transposition as well as tenotomy of the flexor carpi ulnaris were carried out, followed by improvement in neurological findings and complaints.

Adult↗
PubMed1988

Prosthetic replacement of the femoral head for fracture of the femoral neck in patients who have Parkinson disease.

A retrospective study was performed of forty-nine patients (fifty fractures of the femoral neck) who had Parkinson disease and who had had an endoprosthetic replacement of the femoral head. The average age of the patients was seventy-four years (range, forty-seven to ninety-two years). All of the fractures were Garden Stage III or IV. An anterolateral surgical approach was used in twenty-five hips; a posterior approach, in twenty hips; and a transtrochanteric approach, in five hips. An adductor tenotomy was required in five patients to release an adduction contracture. Ten patients died by the sixth postoperative month. The remaining thirty-nine patients were followed for a minimum of two years (average, 7.3 years). Common postoperative complications were infection of the urinary tract (20 per cent) and pneumonia (10 per cent). There was only one dislocation. At the time of writing, nineteen (80 per cent) of the surviving patients could walk.

Aged↗
PubMed1988

Monocular adaptation of the saccadic system and vestibulo-ocular reflex.

This study asks whether or not adaptation of saccades and the VOR is constrained to be conjugate by Hering's Law. Changes in saccades and the VOR produced by surgically weakening one of the horizontal recti by recession or tenotomy were examined in monkeys with the affected eye patched. After the restoration of vision a rapid monocular recalibration of both saccades and the VOR was observed in preparations with a small or moderate muscle weakening. Preparations with a severe weakening exhibited little monocular adaptation but when the normal eye was patched exhibited a strong conjugate adaptation. Thus the results indicate that saccades and the VOR have the capacity for monocular recalibration but that this capacity is more limited than that for conjugate changes.

Adaptation, Physiological↗
PubMed1987

Subluxation of the femoral head in coxa plana.

Twenty-two patients who had severe coxa plana had closed reduction for lateral subluxation of the femoral head, as determined radiographically. All had painful limitation of motion of the hip that prevented proper positioning of the femoral head using a brace. The average age when the patients were first seen was eight years and six months. General anesthesia was required in order to obtain the reduction, and percutaneous tenotomy of the adductor longus was done whenever necessary. After the reduction, a Petrie cast was worn for several months. The length of follow-up averaged three years and eight months (range, two years to six years and eight months). Radiographic evaluation at the time of the last follow-up showed nine hips to be spherically congruent, twelve to be spherically congruent, and one to be incongruent. Thus, in 95 per cent of the hips, a congruent joint was obtained using this method of treatment. These results strongly support the concept that all treatment should be directed at containing the femoral head within the acetabulum during the clinically active phase of coxa plana.

Casts, Surgical↗
PubMed1987

Low-intensity pulsed galvanic current and the healing of tenotomized rat achilles tendons: preliminary report using load-to-breaking measurements.

The possible beneficial effects of low-intensity, pulsed galvanic currents on the healing of tenotomized Achilles tendons was investigated in three groups (20 animals each) of male Sprague-Dawley rats. Treatments via implanted electrodes were given once daily for 15 minutes over a two-week period. Although a portable high-voltage galvanic stimulator was used, stimulus intensity was only 75 microA at a frequency of 10/sec. Tendons were tested after two weeks for the load required to rebreak them at the original tenotomy site. The group treated with anodal current withstood significantly greater loads (p less than 0.001) than did either the group which healed normally (ie, without stimulation) or the group treated with cathodal current.

Achilles Tendon↗