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PubMed1987

Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases.

A retrospective review of 277 patients with congenital muscular torticollis seen between 1970 and 1982 was conducted. In 85 cases this was supplemented by questionnaires and recent photographs, permitting a two- to 13-year follow-up. The first visit for 81.6% of patients was before six months of age. All were enrolled in a specific physical therapy program at the time of the first visit, unless they presented with severe torticollis after 12 months of age. Torticollis was mild to moderately severe in 90.6% of cases. Sternomastoid fibrotic nodules were present in 38.6%, more frequently in the more severe cases. Hip dysplasia increased in direct relation to severity and occurred in 10.5% of cases. At 12 months the torticollis had been conservatively resolved in nearly 70% of patients regardless of severity and presence or absence of focal fibrosis. Tenotomies were indicated in only ten children, eight of whom had first been seen after 12 months of age. Long-term sequelae were mild and consisted of craniofacial asymmetry, intermittent head tilt, and mild scoliosis. Developmental asymmetry or high tone due to limited mobility in the cervical spine were noted in 25.3% of infants initially and tended to subside with appropriate therapy. However, 11.8% of patients with long-term follow-up showed persistent functional asymmetry of the involved body side despite mild or moderate severity, early diagnosis, and complete resolution of the torticollis. Long-term observations indicate that congenital torticollis rarely requires surgical treatment.

Female↗
PubMed1987

Effect of denervation, reinnervation and hypertrophy on the state of actin filaments in skeletal muscle fibres.

The conformational state of actin filaments was studied in the rat soleus muscle atrophying after denervation, recovering following reinnervation, hypertrophying following tenotomy of synergists and in intact muscle. Intrinsic (tryptophan residues of F-actin) and extrinsic (rhodamine-phalloidin or 1,5-IAEDANS attached to F-actin) polarized fluorescence was measured. In parallel, the influence of ATP or NEM on the state of F-actin was studied. The results show that the conformational state of F-actin is changed in all experimental muscles. These changes of the denervated muscle differ from those of the reinnervated and hypertrophying muscles. In the reinnervated muscle, beginning with the first days of recovery, the structure of F-actin seems to "recover" to the state in intact muscle. In the later stage of muscle recovery, the state of F-actin is similar to that in hypertrophying muscle. Differences between the mentioned muscles in the conformational state of actin monomers, in the orientation of monomers and in the flexibility of thin filaments are discussed.

Actin Cytoskeleton↗
PubMed1987

Surgical repair of a supraglenoid tubercle fracture in a horse.

A fractured right supraglenoid tubercle in a 15-month-old Thoroughbred gelding was repaired by partial biceps brachii tenotomy, interfragmentary compression, and tension band wiring. The horse is currently being ridden daily and has remained sound for 4 years.

Animals↗
PubMed1987

Unusual paraspinal muscle lesions in ankylosing spondylitis.

Minicore, multicore, core-targetoid and other ultrastructural lesions were found in the paraspinal muscles of patients with AS. The 10 patients studied, all men with AS, showed varying degrees of muscle fibre atrophy, Z band streaming, rod body formation, minicores, multicores and core-targetoid fibres. Central core disease, rod body myopathy, minicore and multicore diseases are recognized clinical entities within the congenital group of structural myopathies. Target fibres are believed to be a feature of reinnervation. It is also known that experimental tenotomy causes core-targetoid changes, rod bodies, minicores and multicores. Therefore, it seems possible that tension is a necessary stimulus for the correct programming of synthetic muscle enzymes, and without this disorganization occurs. It may also be assumed, but in this case for genetic reasons, that similar biochemical systems are disturbed in the group of congenital myopathies.

Adult↗
PubMed1987

[Surgical treatment of patients with rheumatoid diseases].

The selection of surgery methods in the treatment of rheumatism, and the success one can expect, depends on the stage of the disease and the location of the affected joint(s). A distinction is made between preventive methods (synovectomy, tenosynovectomy, tenotomy, relocation or lengthening of tendons, capsulotomy) and reconstructive/corrective operations (corrective osteotomy, arthrodesis, plastic arthrectomy, alloarthroplasty). The author also points to the limits of operative therapy, especially as regards social rehabilitation. The accent in rheumatism orthopedics should gradually shift toward early preventive operation.

Arthritis, Rheumatoid↗
PubMed1987

Treatment of congenital dislocation of the hip in older children.

The aims of treatment of a child with congenital dislocation of the hip (CDH) untreated until walking age should be to reestablish the mechanics of the hip joint and avoid complications, especially avascular necrosis, thus delaying the development of osteoarthritis. The pathology in the older child shows that both soft tissues and bony parts are distorted to some degree. The acetabular index and center-edge (CE) angle evaluations are helpful in the initial evaluation and in the follow-up examinations. A computed tomography (CT) scan may be helpful in determining a reduction and distinguishing between dysplasia and subluxation. A controversy still exists as to the relative value of closed and open reduction in the treatment of a child who has reached walking age. For most surgeons, in a child up to three years of age, a careful closed reduction following a period of traction is the most useful form of treatment. The home traction program has been successful in this age group. For gentle closed reduction all maneuvers must be done as gently as possible and carried out as "positioning" the leg rather than forcing a reduction. The indications for open reduction are (1) if the femoral head persistently lies above the triradiate cartilage on roentgenographic examination, (2) if the arc of reduction and redislocation is less than 25 degrees after an adductor tenotomy, (3) if the femoral head will not enter the acetabulum, (4) if the femoral head is still laterally placed in the acetabulum after four weeks of partial reduction, and (5) if a previous reduction has failed.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1987

Comparison of two caudolateral approaches to the scapulohumeral joint for treatment of osteochondritis dissecans in dogs.

Two caudolateral approaches to the canine scapulohumeral joint that do not require myotomy, tenotomy, or osteotomy were used to expose the humeral heads of both scapulohumeral joints in 10 clinically normal dogs. One approach (method 1) was used on the left shoulder of 5 dogs and on the right shoulder of the other 5 dogs. The other approach (method 2) was used on the opposite joints. The amount of humeral head articular cartilage that could be exposed with each approach was measured. The amount of articular cartilage exposed with method 1 was significantly greater than that exposed with method 2 (P less than 0.0001). Method 1 also provided for exposure of the caudomedial aspect of the scapulohumeral joint. Method 1 was used unilaterally in 20 dogs with osteochondritis dissecans. This approach provided excellent exposure of the humeral head and osteochondritis dissecans lesion. Of the 16 dogs that were available for follow-up evaluation, 1 developed a seroma after surgery. Other complications were not observed or reported.

Animals↗
PubMed1986

Hyaluronic acid and its effect on postoperative adhesions in the rabbit flexor tendon. A preliminary look.

The effect of hyaluronic acid in preventing adhesion formation in a surgically prepared rabbit flexor tendon model has been evaluated. Nineteen rabbits had partial tenotomy of the middle digit flexor profundus tendon, eight being treated with hyaluronic acid and eleven with saline. The quality of tendon repair and the quantity of adhesion tissue were graded. Though both the treated and control groups showed significant adhesions, the hyaluronic acid treated tendons showed less adhesion tissue and better sliding properties as compared to the controls. No significant difference was noted in the quality of tendon repair and no adverse effects of hyaluronic acid were seen. It is proposed that additional investigation into the development of a better model of postoperative tendon adhesions and an improved characterization of this model are needed. This preliminary study suggests that hyaluronic acid is effective in reducing the quantity of adhesions after tendon surgery but warrants further evaluation.

Animals↗
PubMed1986

Treatment of congenital dislocation of the hip in children between the ages of one and three years.

The results in fifty-one congenitally dislocated hips in forty-two children who were between one and three years old when treatment was begun have been reviewed. Thirty-eight hips (75 per cent) were treated by traction prior to reduction, gentle closed reduction under anesthesia, selective adductor tenotomy, and immobilization in a hip-spica cast. Thirteen hips (25 per cent) required an open reduction when stable closed reduction could not be achieved. Secondary femoral or acetabular procedures were performed after either form of treatment if subluxation became apparent after the child had resumed walking. At an average twelve-year follow-up (range, five to twenty-two years), thirty-six hips (71 per cent) were rated as Class I; six, as Class II; eight, as Class III; and one, as Class IV, according to the classification system of Severin. Significant avascular necrosis developed in three hips. We think that in this age group congenital dislocation of the hip is best treated by closed reduction, followed by femoral or acetabular procedures as needed. Open reduction should be done only in those hips that cannot be reduced by closed methods.

Bone Development↗
PubMed1986

The influence of exercise in the healing of the rabbit Achilles tendon.

Effect of exercise on tendon healing was studied in partially tenotomized rabbit achilles tendons by post-operatively applying a plaster splint to the right leg from the knee to the end of the toe, but no external fixation to the left leg. The animals were serially sacrificed, and new tendon tissues generated at the tenotomy site were examined. Collagen type analysis of the new tendon tissue showed a nearly constant ratio of type III to type I collagen of about 10% in the fixed side, but in the non-fixed side it showed an increase to 19% 2 weeks after the operation followed thereafter by a gradual decrease. Ultrastructural examination revealed an earlier increase in the diameter of collagen fibers suggesting their faster maturation in the non-fixed side.

Achilles Tendon↗
PubMed1986

[Progressive lengthening of the femur using Wagner's technic. Apropos of 48 cases].

Forty eight progressive femoral lengthenings using the Wagner technique have been performed on patients aged between 6 and 18 years (average 12 years). The main aetiology of the shortening was congenital deformity (25 cases). The mean lengthening obtained was 5.2 cm and the greatest was 11.2 cm. Lengthening obtained was more than 20 p. 100 in six cases with an extreme of 24 p. 100. The final discrepancy was always less than 25 mm. In 6 cases this was corrected by the addition of a contralateral epiphysiodesis or tibial lengthening. Weight bearing was resumed after an average of 5-6 months. Many complications occurred. Some were minor: sepsis in the pin tracks (14 cases) or varus derotation corrected at the end of lengthening (22 cases). Some were more severe: varus deformities of more than 5 degrees (8 cases), contractures at the knee or the hip corrected by tenotomies in the course of lengthening (2 cases), subluxation of the hip or knee (5 cases), fractures, delayed unions, non-unions without infection (7 cases). The major complications were 15 severe infections, 6 of them with fractures or non-unions and 5 neurological lesions.

Adolescent↗
PubMed1986

Infraspinatus muscle contracture associated with trauma in a dog.

Infraspinatus muscle contracture was diagnosed in a 4 1/2-year-old female Doberman Pinscher with lameness characterized by abduction and outward rotation of the right antebrachium and carpus. After infraspinatus tenotomy, the dog recovered. This case differs from previously reported cases of infraspinatus muscle contracture because of an associated history of blunt trauma.

Animals↗
PubMed1985

Depression in adduction syndrome.

Three cases of depression in adduction syndrome are described. All occurred unilaterally, in the left eye, in boys and were characterized by depression and retraction of the involved eye with attempted adduction. This was accompanied by an inability to elevate the eye in adduction and a markedly abnormal head posture. Surgery, consisting of superior oblique tenotomy and recession of the lateral rectus muscle, did not allow the ocular rotation to improve but did allow the anomalous head posture to be corrected. The homogeneity of the clinical appearance and the lack of response to surgery suggests that this is a distinct clinical entity.

Child↗
PubMed1985

The knee in arthrogryposis.

Of 104 patients with arthrogryposis multiplex congenita treated between 1952 and 1982, 74 had significant knee contractures, instability, or recurvatum. The minimum follow-up period was two years. Nonoperative treatment modalities included physical therapy, bracing, and serial casting in 43 patients (78 knees). Thirty-one other patients (46 knees) had 62 operative procedures, including hamstring and posterior capsular release, epiphysiodesis, distal femoral or proximal tibial osteotomy, arthrodesis, and knee disarticulation. Surgery was reserved for the more resistant causes and was recommended only as part of an overall treatment plan including the correction of foot and hip deformities. The average follow-up period for the surgically treated patients was 11 years, with a range of two to 20 years. Recurrence of deformity was frequent, with no one procedure being clearly favored. Physiotherapy alone rarely resulted in clinically significant improvement unless accompanied by prolonged casting and bracing. The most useful surgical procedure in the growing child was posterior capsular release performed in conjunction with hamstring tenotomy. Contractures treated by osteotomies before the completion of growth had a high rate of recurrence.

Arthrodesis↗
PubMedDate not supplied

Extirpation of the fibular sesamoid simplified.

This technique allows the surgeon to maintain a firm grasp on the fibular sesamoid during its dissection, thus minimizing surgical trauma to the surrounding tissue and decreasing the chance of an inadvertent tenotomy of the flexor hallucis longus tendon. The authors have used this technique in 30 sesamoidectomies and found it to lower the frustration level significantly. The only instances in which it does not work as well as expected is with severely osteoporotic sesamoids, and partite sesamoids with fragments too small to pierce with the Kirschner wire. This technique has proved to be relatively simplistic. The small diameter of the Kirschner wire permits both excellent vision of the operative field and easy access to dissection.

Bone Wires↗
PubMed1985

Correction of post-traumatic flexion contracture of the elbow by anterior capsulotomy.

Despite prolonged conservative therapy, including splinting, bracing, and supervised exercise programs, significant flexion contracture of the elbow after local trauma may remain both a functional and a cosmetic impairment. We studied the cases of fifteen patients who underwent a relatively limited surgical procedure consisting of anterior capsulotomy of the elbow without tenotomy of the biceps tendon or myotomy of the brachialis muscle. The mean preoperative flexion deformity of 48 degrees was reduced to a mean postoperative deformity of 19 degrees (a 61 per cent improvement). Two groups of patients were identified. Eleven patients who did not have significant preoperative evidence of intra-articular degenerative (post-traumatic) changes in the joint achieved a 65 per cent improvement in extension, with one patient having continued pain with vigorous activity. Four patients who had significant preoperative post-traumatic arthrosis achieved a 50 per cent improvement in extension; however, three of these four patients continued to have significant pain. Limited anterior capsulotomy is a safe and effective means of decreasing post-traumatic flexion contracture of the elbow in properly selected patients. Better overall results are obtained in elbows without significant post-traumatic arthrosis.

Adolescent↗
PubMed1985

[Congenital luxation of the hip in a newborn infant after tubal pregnancy (feto-salpynx). Plea for the postural theory of luxation].

The authors report a case of an infant born after a 37-week intra-tubal pregnancy (foeto-salpinx). There were several orthopaedic complications due to malposition: torticollis which will be treated by sternomastoid tenotomy at the age of three, pes valgus with metatarsus varus and congenital dislocation of the right hip. Conservative treatment proved inadequate and required treatment by pelvic osteotomy to correct a severe acetabular dysplasia. A review of the literature reveals that tubal pregnancies resulting in the birth of a mature and living new born are exceptional. From the mechanical point of view, the authors consider that, in this case, two factors combined to produce a congenital dislocation of the hip--excessive pressure exerted on the foetus by the tubal wall and an abnormal position of the foetus favouring the dislocation. The reasons for the ineffectiveness of conservative treatment to correct the severe acetabular dysplasia are discussed.

Female↗
PubMed1985

[Reinforcement of the tension of the knee extensor apparatus in triple-flexion gait in children with motor disorders].

Surgical reinforcement of the knee extensor mechanism produces improvement in gait in children with cerebral palsy who walk with a crouch gait with flexion of the hips and knees. In these patients, the defect is related to excessive length of the patellar tendon as shown by the presence of greater passive extension than active extension of the knee, and a high position of the patella on lateral radiographs of the knee. Surgical treatment combines shortening of the patellar tendon with lengthening of the hamstrings and tenotomy of the rectus femoris. In a series of eighteen patients, the authors obtained fifteen satisfactory results, the procedures being performed bilaterally. The average follow up was four years. These results are compared with those obtained by other methods.

Adolescent↗