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PubMed1983

A literature review of congenital digiti quinti varus: clinical description and treatment.

Congenital digiti quinti varus is a deformity in which the fifth toe overlaps the base of the fourth; it consists of three main components: adduction, dorsiflexion, and external rotation. Treatment for this deformity may consist of conservative or surgical techniques, depending on the severity and/or age of the patient. The surgical techniques recommended by various authors may involve skin plasties, tenotomies and capsulotomies, tendon transfers and lengthenings, and bone resections.

Humans↗
PubMed1980

Protein turnover during skeletal muscle hypertrophy.

Skeletal muscle hypertrophy has been investigated in several models including denervation, increased work induced by tenotomy of a synergist, and the addition of weights to the wing of a chicken. The stimulus for growth probably involves passive stretch along with increased tension development induced by the stretch reflex in innervated muscles. In early studies of hypertrophy of rat soleus and plantaris muscles, turnover measurements were interpreted as indicating increased protein synthesis and decreased degradation as the mechanism for the hypertrophy. However, these conclusions are probably unjustified. In particular it has been shown that there is a marked increase in reutilization and isotope recycling in muscle during hypertrophy. Several studies indicate that both protein synthesis and degradation are increased during hypertrophy. This has been shown in the transient hypertrophy of the denervated hemidiaphragm. During hypertrophy of the innervated anterior latissimus dorsi of chickens, there are increases in protein synthesis and degradation to the extent that as much as two-thirds of the total increase in synthesis may be associated with increased turnover or "wastage" and only one-third with growth.

Animals↗
PubMedDate not supplied

Surgical correction of the splayfoot: the Giannestras procedure.

Clinically, the splayfoot is characterized by valgus of the great toe with bunion formation in association with a relative varus position of the first metatarsal. On the lateral side of the foot, there is varus of the fifth toe with a relative valgus position of the fifth metatarsal and resultant bunionette formation. Radiographically, splayfoot is characterized by an intermetatarsal angle between the first and second metatarsals of greater than 12 degrees, and an intermetatarsal angle between the fourth and fifth metatarsals of greater than 8 degrees. The Giannestras splayfoot procedure consists of excision of the bunion and bunionette, adductor tenotomy, opening-wedge osteotomy of the first and fifth metatarsal bases, and realignment of the first and fifth toes. One-hundred and sixteen splayfoot operations were performed in 72 patients, with an average follow-up of 5.2 years. Results were considered excellent in 33% (39 feet), good in 45% (52 feet), fair in 14% (16 feet), and poor in 8% (9 feet). The primary cause of a fair or poor result was collapse of the bone graft at the base of the first metatarsal, causing recurrent varus and symptomatic hallux valgus.

Adolescent↗
PubMed1982

Managing spasticity.

Spasticity, a common symptom of upper motor neuron lesions, may actually aid the patient and should be treated only if it interferes with function, comfort or nursing care. Stretching exercises and elimination of nociceptive stimuli are the first steps in management. If problems persist, medication should be considered. Tenotomies are useful. Motor-point blocks and peripheral nerve blocks are temporary aids, while neurectomies usually provide permanent relief. More drastic neurosurgical procedures are reserved for uncontrolled, incapacitating cases.

Adult↗
PubMed1982

Isolated paresis of the inferior oblique.

Four cases of isolated superior oblique paresis are presented. The usual course of events was that of a gradually increasing diplopia and head tilt. All patients fulfilled the three-step test criteria, with a hypertropia that increased on side gaze to the ipsilateral side and on head tilt to the side opposite that of the paretic muscle. All patients were treated with a superior rectus recession. Three patients had their hypertropia reduced to between zero and 2 diopters. One patient needed, in addition to his superior rectus recession, an inferior rectus resection to eliminate the hypertropia. Vertical rectus surgery presents an alternative to superior oblique muscle tenotomy in treating inferior oblique paresis.

Adult↗
PubMedDate not supplied

Total hip arthroplasty in congenital dislocated hips.

Experience with six typical cases demonstrates that total arthroplasty for congenital dislocated hips may be associated with malalignment of the ipsilateral knee, leg-length inequality, pelvic obliquity and structural changes in the lumbosacral spine. The preoperative planning may include computerized tomography scan to obtain accurate information about the optimal placement of the socket and the size and shape of the prosthetic components. Loosening of the stem or socket rather than polyethylene wear is the expected cause of late failure. The design of the femoral component should fit the canal and the shape of the proximal femur. Biological causes for failure, such as granulomatous reaction to wear, particles, and infection, are known but were not encountered in the present series of cases. The surgical technique is designed to obtain complete coverage of the socket in the available bone. A supplementary bone graft provides additional bone stock and is especially important for revision operations. Orientation of the components, stability of the joint, the need for tenotomy of contracted structures, and the improvement of abduction and flexion muscle power are also important considerations. Elderly patients with degenerated, painfully dislocated hips that are refractory to conservative treatment, may be candidates for arthroplasty.

Acetabulum↗
PubMed1978

Ultrastructural investigation of the human hand after tendon and motor nerve injury.

Specimens of the affected muscles obtained during reconstructive surgery 4 to 16 weeks after injury of the tendon or of the motor nerve of the human hand were studied. After tenotomy the most serious lesions were displayed by the contractile elements which were homogeneous brittle and atrophied, and disintegrated independently of the functional units. The number of mitochondria decreased, the sarcoplasmic reticulum accumulated and the red and white muscle fibres could not be distinguished. After motor nerve injury the motor end plates were completely destroyed and Wallerian degeneration appeared. The contractile elements atrophied and were brittle. The number of mitochondria and the sarcoplasmic reticulum decreased, the sarcoplasmic glycogen content was higher than normal, and often the cell nuclei occupied a central position.

Adult↗
PubMed1980

Repetitive mechanical stress and denervation in plantar ulcer pathogenesis in rats.

To test the hypotheses that physiologic limits of repetitive mechanical stress can stimulate the formation of ulcers on the plantar surface of the foot, and that denervation predisposes to such ulcer formation, 90 rats were subjected to neurectomy or tenotomy and the response of each animal's hind foot to 10,000 daily repetitions of mechanical stress in a walking simulator was determined. Plantar ulceration occurred in the neurectomized animals within 7 to 10 days of commencing the simulated walking procedures. Histologic examination of all the stimulated footpads showed traumatic damage in both neurectomized and tenotomized animals. It was concluded that normal levels of repetitive mechanical stress can cause plantar ulceration and that such ulceration occurs more readily in the denervated foot.

Animals↗
PubMed1980

[The Brown's syndrome: an anatomic variation (author's transl)].

In a young woman with an anomaly of the ocular motility evoking Brown's syndrome, an insertion anomaly of the superior oblique muscle, situated in the superior nasal quadrant 10 mm of the limbus, was found during operation. A stair-like tenotomy restored an almost normal motility.

Adolescent↗
PubMed1978

Extensor release.

An alternate procedure to lengthen the long extensor tendons has been examined. Thirty-six separate cases, of which 22 were bilateral, were performed during a 2-year period. The operations were performed both with percutaneous and traditional exposed approaches. The procedures consisted of lengthening by simple tenotomy, Z-plasty, or tendon-slide of the extensor digitorum longus and peroneus tertius at the ankle level. Most were done as an adjunct to biomechanical treatment or osseous operations with a few of the procedures utilized as the sole mode of therapy. Although it was found that the ease of technique and accessibility of tissues made the procedures desirable, the extended postoperative period and efficacy for other than minimal contractures seemed to out-weigh the advantages. The conclusion is drawn that the extensor release at the level of the ankle is of potential value in selected patients with mild to moderate dorsoposterior digital contractures in conjunction with traditional podiatric treatment.

Foot↗
PubMed1993

[Percutaneous method for achilles tendon lengthening in treatment of spastic equinus deformity with progressive muscular dystrophy].

Surgical technique of percutaneous lengthening of Achilles tendon has been presented. Thirty-seven feet in 26 children have been operated on. There was no intraoperative inadvertent tenotomy or excessive lengthening, no complications occurred in the postoperative course. An average follow-up was of 18 months. The procedure resulted in 7 degrees of dorsal flexion on an average. The authors recommend this method in the treatment of the spastic pes equinus.

Achilles Tendon↗
PubMed1995

Extensor tendon injuries at the distal interphalangeal joint.

The treatment options for the soft-tissue mallet finger, in both its acute and chronic forms, continue to generate some degree of controversy. Priority always should be given to nonoperative management of these injuries. This translates into a 6- to 8-week period of uninterrupted immobilization of the DIP joint with an external splint. Splinting has been shown to be highly effective, safe, and reproducible for both acute and chronic lesions. Even in the presence of an open injury, the value of splinting must be appreciated by the practitioner. The conversion of an acute closed soft-tissue injury to an open one is to be discouraged because of unacceptable complication rates. When surgery is contemplated, our first option would be the placement of a transarticular Kirschner wire at the DIP joint. If external splinting fails in an acute injury, an argument certainly can be made for a second trial of conservative management, and we offer this alternative to such patients. We find that some patients will not tolerate a second period of immobilization, and in most cases, we offer surgery in these failed cases. Surgical choice, again, would be a transarticular Kirschner wire. Another choice would be one of the salvage procedures, such as central slip tenotomy, with the expectation of a good result. In summary, mallet injuries are treated using closed, nonoperative techniques. The period of time after injury that this nonoperative treatment can be delayed and still be effective is being extended and the absolute outside time limit still is not known. When surgery is done, we prefer the simple placement of a transarticular Kirschner wire for 6 to 8 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Surgical possibilities in spastic paralysis of arm and hand].

OBJECTIVE: To determine the results of surgical correction of spastic paralysis of the hand due to cerebral palsy. DESIGN: Descriptive. SETTING: Academic Medical Centre, Amsterdam, the Netherlands, and rehabilitation centre De Trappenberg. METHOD: From 1-1-1990 until 1-6-1994 twenty patients with spastic upper limb in cerebral palsy were operated in our hospital. They were all seen preoperatively by our multidisciplinary team, and selected according to the Zancolli classification. Seventeen operations were aimed at improving hand function, the other three were performed for contractures or for cosmetic/hygienic reasons. Surgery was aimed at correcting the muscular imbalance, by weakening spastic muscles via tenotomy or lengthening and by reinforcing paralysed muscles via tendon transfer or rerouting. Often stabilisation of joints by tenodesis, capsulodesis or arthrodesis was necessary as well. RESULTS: Eighteen of the twenty patients were (very) happy with the results. In two patients there was no functional gain. Only once was a postoperative complication seen: pseudarthrosis of the first carpometacarpal joint. This was corrected successfully by rearthrodesis. We found we were able to predict the functional outcome fairly accurately. CONCLUSION: With accurate patient selection, surgical intervention in patients with cerebral palsy may restore hand function adequately and predictably.

Activities of Daily Living↗
PubMed1995

[Femoral lengthening by callotasis. A study of a series of 79 cases in children and adolescents].

PURPOSE OF THE STUDY: Results of femoral lengthening using callotasis method, with particular attention to the complications are presented. MATERIAL AND METHODS: 79 femoral lengthenings performed for limb length discrepancy in 75 children and adolescents were studied. Etiology of the femoral shortening was congenital in 23 cases, post-traumatic in 20, post-infection in 14, neurologic in 13, and miscellaneous in 9. Nine lengthenings were performed using the Judet lengthener and 70 using the Orthofix external fixator. We used gradual incremental distraction (callotasis). RESULTS: Average lengthening achieved was 52 mm (range: 35 to 85), which represented a 17.7 per cent increase in femoral length (range 7.6 per cent to 64 per cent). There were 87 complications, i.e. 110 per cent. Several complications were often encountered during one lengthening, thus, 23 lengthenings (30 per cent) were performed without any complication and 49 (62 per cent) without additional unpredicted operations or anesthesia. All these complications were studied according to the stage (intraoperative, elongation, consolidation and delayed) in which they occurred and to their severity. They were assessed to establish their relationship to etiology of shortening, amount of lengthening and age. Intraoperative complications were rare (2 cases). In the distraction period, joint complications are the most frequent (33 complications), involving the hip 22 times and the knee 11 times; 28 healed without any problems, 14 needed reoperation and 1 dislocation of the hip led to an avascular necrosis. DISCUSSION: The incidence of joint complications did not seem to be less than that encountered with previous methods of lengthening. The author believes that systematic tenotomies performed in order to avoid such complications in congenital short femurs are abusive and have to be discussed case-by-case. Bony consolidation was achieved without additional surgery in 90 per cent of cases. Eight patients had delayed consolidation but did not require surgery. Complicated consolidation was most commonly encountered in children less than 8 years old with congenitally short femurs. The author compared healing time according to the type of dynamization. A significant improvement was found when using a silastic collar (33.3 days/cm) in place of classical dynamization (46.6 days/cm). CONCLUSION: The author believes that good results can be obtained by incremental distraction using uniplanar fixation. Results could be improved by proper fixator application, aggressive physical therapy and well-thought dynamization of the fixator.

Adolescent↗
PubMed1995

Effect of antagonist weakening on developed tension in cat extraocular muscle.

PURPOSE: In a previous study, the authors found that recession of an extraocular muscle resulted in atrophy of both the recessed muscle and its antagonist. To determine if atrophy, caused by weakening of an extraocular muscle, results in changes in developed tension in the antagonist, the authors studied force development of the cat lateral rectus muscle after adductor weakening. METHODS: Tenotomy of the left inferior, medial, and superior rectus muscles was performed in 18 cats. At 3, 6, and 12 weeks after surgery, the right (control) and left lateral rectus muscles were exposed through a lateral orbitotomy and were attached to isometric force transducers. Length-tension curves were obtained by direct muscle stimulation using bipolar contact electrodes at 0.1 Hz and 50% suprathreshold stimulus intensity. In addition, peak tetanic tension was measured at the optimal resting tension using a 5-second stimulus train at 200 Hz. Pooled data from the operative and control muscles at each postoperative interval were compared. RESULTS: Three weeks after adductor weakening, a 28% decrease in maximal single-twitch tension was seen in the left lateral rectus muscle when compared with controls. This difference disappeared at 6 weeks. No statistically significant changes in peak tetanic tension occurred at any time interval after surgery. CONCLUSIONS: Adductor weakening results in a transient decrease in single-twitch tension in the antagonist lateral rectus muscle in the cat.

Animals↗
PubMed1995

Surgical correction of muscular torticollis in older children.

BACKGROUND: Children with muscular torticollis treated before the age of 1 year respond well to conservative treatment. Surgical correction is indicated only in resistant cases. Nevertheless, there is still controversy about the results and the type of operation in the management of neglected older children. METHODS: Seventeen patients, at a mean age of 9 years and 5 months, with muscular torticollis were surgically treated between 1986 to 1991. The average follow-up period was 3 years and 4 months. months. Combined approach with open tenotomy at mastoid and clavicular level was the choice of procedure. The outcome for these older children and young adults were evaluated with function and cosmesis. RESULTS: Our results showed that the best results can be expected in children before 12 years of age. Late releases give acceptable results, although facial asymmetry and some residual upper dorsal scoliosis remain. Adequate surgical release and intensive postoperative physical therapy are the keystones to a good result. CONCLUSIONS: Surgical correction of muscular torticollis in the older children is of benefit for functional and cosmetic recovery, but facial asymmetry is irreversible after 12 years of age.

Adolescent↗
PubMed1994

Use of lectins to evaluate the effects of GaAs softlaser on dog tendon.

1. Lectins labeled with colloidal gold particles were used for the ultrastructural evaluation of the biological effects of GaAs softlaser irradiation on the healing of dog tendon wounds. 2. Six dogs were submitted to tenotomy and tenorrhaphy on the right and left hind legs. All animals received laser irradiation (4 J/cm2) daily for ten days only on the left leg, and the right leg of the same animal was used as control. Biopsies were taken 11, 22 and 40 days after surgery. 3. Laser-irradiated and control tendon tissues were embedded in L.R. White resin and thin sections were incubated in the presence of gold-labeled Arachis hypogaea (PNA), Canavalia ensiformes (Con A) and Triticum vulgare (WGA). 4. In general, the control and laser-irradiated tissues presented homogeneous and similar labelling of heterochromatin, rough endoplasmic reticulum and extracellular matrix. 5. We conclude that GaAs softlaser irradiation does not produce significant changes in the glycosylation of healing tendons.

Animals↗
PubMed1994

Stroke and its manifestations in the foot. A case report.

CVA is a very common problem that can lead to lower extremity complications. Impairment in gait pattern occurs often due to spasticity and less frequently due to prolonged flaccidity. This problem is manifested by equinus, varus, equinovarus, and toe flexion deformities. Therefore, prevention or elimination of spasticity must be achieved. Various modalities have been used, both conservative and surgical. Nonsurgical interventions include range of motion and strengthening exercises, pharmacologic agents, local anesthetic and phenol motor point blocks, and the use of orthoses. Surgical intervention should be considered after conservative treatment has failed. The goal of treatment is to reduce the deforming force as a result of spasticity and to allow for almost normal function to be achieved. This includes tendon transfers, tendon lengthenings, tenotomies, and arthrodeses of small toe joints. Preoperatively, the extent and progression of spasticity must be determined because this may affect the rate of recurrence of the deformity following surgical correction. The combination of arthrodeses of the interphalangeal joints and flexor tendon release is the best option in the presence of a spastic deformity. Arthrodesis provides for stability at the joint, whereas a flexor release eliminates the deforming force. Failure to address the plantar-flexor force of the long flexors can lead to instability at the fusion site. This may in turn lead to nonunion and recurrence of flexion contracture as shown in the case report in this article.

Adult↗