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PubMedDate not supplied

EndoButton-assisted repair of distal biceps tendon ruptures.

This report represents a multifactorial investigation of a new technique in which a titanium EndoButton was used for repair of distal biceps tendon ruptures. Cadaveric cases were used to demonstrate the anatomic efficacy and safety of the procedure. Biomechanical testing was done to compare the fixation strength of traditional techniques with the EndoButton repair. Finally, clinical results of the repair were evaluated. In 15 fresh-frozen cadavers the mean distance of the button from the posterior interosseous nerve was 9.3 mm. Instron testing showed a mean pullout strength of 253 N for the Mitek G4 Superanchor, 177 N for a conventional bone bridge, and 584 N for the titanium button. The button was 3 times stronger than the bone bridge (P =.0001) and 2 times stronger than the Mitek anchor (P =.0007). Fourteen patients who had their tendons repaired by this technique were evaluated at a mean of 20 months postoperatively. BTE (Baltimore Therapeutic Equipment, Baltimore, MD) testing revealed recovery of 97% of flexion strength and 82% of supination strength. Patients were able to participate in an aggressive rehabilitation program and were able to regain strength and function rapidly, with satisfactory return to preinjury activities and occupations. This technique is safe, simple, and stronger than any currently available anchoring techniques and gives the surgeon a choice in bone preparation. By using a single anterior elbow approach, the development of synostosis associated with two incision techniques can be minimized.

Biomechanical Phenomena↗
PubMedDate not supplied

Rupture of the distal biceps brachii tendon: isokinetic power analysis and complications after anatomic reinsertion compared with fixation to the brachialis muscle.

Anatomic reattachment of the distal biceps tendon is well established but bears the risk of complications including loss of motion and nerve damage. We questioned whether nonanatomic repair by tenodesis to the brachialis muscle is able to accomplish similar results with less risk. We compared the results of anatomic repair with suture anchors (n = 6) with the results of nonanatomic repair (n = 8). Anatomic reattachment of the biceps tendon can restore full power of flexion in most cases as determined by isokinetic muscle tests (mean, 96.8% compared with the contralateral side). Nonanatomic repair also restores flexion strength to a mean of 96%. Supination power averaged 91% after anatomic repair. Supination strength after nonanatomic repair did not improve in 4 of 8 patients (42%-56% of the uninjured arm). The other 4 patients were able to produce 80% to 150% of the strength of the contralateral side. Major complications such as radioulnar synostosis or motor nerve damage were not encountered in either group. Heterotopic ossification was seen in 4 cases after reinsertion to the tuberosity. One of these patients was not satisfied with the procedure because of anterior elbow pain, even at rest. After tenodesis to the brachialis, one patient was unsatisfied because of considerable weakness. We concluded that major complications after anatomic repair are rare but must not be ignored. Tenodesis of the distal biceps tendon is a safe alternative procedure. We inform our patients about the benefits and risks of anatomic and nonanatomic repair as well as those of nonoperative treatment. The decision concerning the type of therapy best suited for an individual patient should be made on an informed consent basis.

Adult↗
PubMed2003

Complications of open reduction and internal fixation of ankle fractures.

This article discusses the complications after open reduction and internal fixation of ankle fractures. Complications are classified as perioperative (malreduction, inadequate fixation, and intra-articular penetration of hardware), early postoperative (wound edge dehiscence, necrosis, infection and compartment syndrome), and late (stiffness, distal tibiofibular synostosis, degenerative osteoarthritis, and hardware related complications). Emphasis is placed on preventive measures to avoid such complications.

Age Factors↗
PubMed2002

Monteggia fractures in adults. Review of 54 cases.

INTRODUCTION: We present a review of Monteggia fractures treated in our hospital between 1992 and 1998. PATIENTS AND METHODS: Fifty four patients with a Monteggia fracture were treated in our hospital with an average follow-up of 24 months (12-48 months). The average age was 41 years (18-81 years). According to the classification of Bado, there were 24 type I, 20 type II, 6 type III and 4 type IV. The etiology was in 27 cases a motor-vehicle and motorcycle accident, five a pedestrian struck by a car, 21 by a causal fall and only one by a direct hit by an iron bar in an assault. In 56% of the patients, the lesions were associated with polytrauma. In all the cases, treatment consisted of open reduction and internal fixation of the ulnar fracture using different methods of osteosynthesis (3.5 mm DCP, 3.5 mm reconstruction plates, 6.5 mm cancellous screw, tension band technique with Kirschner wires, and one-third tubular plates). Initial treatment of the radial head dislocation was attempted by closed reduction and verification under fluoroscopy. Subsequent open reduction and osteosynthesis were performed in 10 cases, and resection of radial head was necessary in three cases as the initial treatment. There were six open fractures with one case developing chronic infection. RESULTS: Results were evaluated according to the criteria of Anderson (union fracture, elbow and wrist flexion/extension). The results were excellent in nine patients (17%), satisfactory in 33 (61%), unsatisfactory in nine (17%) and failure in three (5%). Complications could be attributed to the severity of injury, type of fixation and errors in technique (four non-union, three failure of one-third tubular plates, one distal radioulnar instability) and to some features peculiar to this lesion (five nerve injuries, three redislocations of the radial head and four radioulnar synostosis). We needed to perform 14 reoperations to resolve some of the above mentioned complications.

Adolescent↗
PubMed1999

Isolated congenital stapes suprastructure fixation.

Isolated congenital anomalies of the ossicles are rare. The majority of cases of congenital conductive hearing loss secondary to middle-ear anomalies have other associated defects, such as atresia, microtia and craniofacial deformities. We present a rare case of isolated congenital stapes suprastructure fixation, where a monocrural stapes with a mobile footplate was attached to the promontory by bony synostosis. There was no stapedius muscle nor pyramidal process. The incus and malleus were of normal configuration. Mobilization of the stapes from the promontory resulted in improvement in hearing. We believe this is the first reported case of such an abnormality. A review of the world literature of isolated stapes suprastructure ankylosis and the classifications of minor congenital anomalies are discussed.

Adult↗
PubMed2002

Cranial base changes following coronal suturectomy in craniosynostotic rabbits.

It has been suggested that surgical release of synostosed sutures may ameliorate various cranial base abnormalities in craniosynostotic patients. The present study was designed to test this hypothesis in a rabbit model with familial coronal suture synostosis (CSS). Data were collected from 56 New Zealand White rabbits: 32 unaffected controls, 11 with unoperated CSS, and 13 with CSS released by suturectomy performed at 25 days of age. Serial radiographs were taken at 25, 42 and 84 days. Linear, angular and triangular shape cranial base measurements were compared using ANOVA and tensor biometric analysis. Results revealed that at 84 days, both groups of CSS rabbits had significantly (p < 0.05) different anterior and total cranial base lengths, flatter cranial base angles, and dysmorphic anterior cranial base shapes when compared with normals. Significant (p < 0.05) differences were noted only for palatal and cranial base angles and posterior cranial base shape between CSS rabbits with and without suturectomy. However, significant (p < 0.05) changes were noted between pre- and postoperative measurements in posterior and total cranial base lengths and anterior and posterior cranial base shapes in CSS rabbits with suturectomy. Results revealed that surgical release of synostosed coronal sutures through suturectomy did not normalize cranial base growth patterns in CSS rabbits. These findings may be explained by the relatively late age of surgical release or suturectomy site resynostosis with continued dysmorphic cranial base growth. Alternatively, cranial base abnormalities seen in CSS rabbits may be early primary malformations, not secondary deformations amenable to surgical modification.

Analysis of Variance↗
PubMed1993

Achondroplasia and spinal cord lesion. Three case reports.

The most important complications encountered by achondroplastic dwarfs are neurological problems related to a narrowed spinal canal. Stenosis of the spinal canal is secondary to abnormalities of endochondral ossification with premature synostosis of the ossification centres of the vertebral body and the posterior arch, resulting in thickening of the lamina, shortening of the pedicles, and reduced height of the vertebral bodies. Additional factors such as prolapsed intervertebral discs, osteophytes and progressive thoracolumbar kyphosis contribute to the narrowing of the spinal canal. Three achondroplastic dwarfs having spinal stenosis and spinal cord lesion representing typical clinical courses are described.

Achondroplasia↗
PubMed2002

The fetal mandible: a 2D and 3D sonographic approach to the diagnosis of retrognathia and micrognathia.

OBJECTIVE: To define parameters that enable the objective diagnosis of anomalies of the position and/or size of the fetal mandible in utero. DESIGN: Fetuses at 18-28 gestational weeks were examined by two- and three-dimensional ultrasound. The study included normal fetuses and fetuses with syndromes associated with known mandible pathology: Pierre Robin sequence or complex (n = 8); hemifacial microsomia (Treacher-Collins syndrome, n = 3); postaxial acrofacial dysostosis (n = 1). Fetuses with Down syndrome (n = 8) and cleft lip and palate without Pierre Robin sequence or complex (n = 18) were also studied. Retrognathia was assessed through the measurement of the inferior facial angle, defined on a mid-sagittal view, by the crossing of: 1) the line orthogonal to the vertical part of the forehead at the level of the synostosis of the nasal bones (reference line); 2) the line joining the tip of the mentum and the anterior border of the more protruding lip (profile line). Micrognathia was assessed through the calculation of the mandible width/maxilla width ratio on axial views obtained at the alveolar level. Mandible and maxilla widths were measured 10 mm posteriorly to the anterior osteous border. RESULTS: In normal fetuses, the inferior facial angle was constant over the time span studied. The mean (standard deviation) value of the inferior facial angle was 65.5 (8.13) degree. Consequently, an inferior facial angle value below 49.2 degree (mean - 2 standard deviations) defined retrognathism. All the fetuses with syndromes associated with mandible pathology had inferior facial angle values below the cut-off value. Using 49.2 degree or the rounded-up value of 50 degree as a cut-off point, the inferior facial angle had a sensitivity of 1.0, a specificity of 0.989, a positive predictive value of 0.750 and a negative predictive value of 1.0 to predict retrognathia. In normal fetuses, the mandible width/maxilla width ratio was constant over the time interval studied. The mean (standard deviation) value was 1.017 (0.116). Consequently, a mandible width/maxilla width ratio < 0.785 defined micrognathism. Mandible width/maxilla width ratio values were below this cut-off point in eight and in the normal range in four fetuses with syndromes associated with mandible pathology. CONCLUSIONS: Retrognathia and micrognathia are conditions that can be separately assessed. The use of inferior facial angle and mandible width/maxilla width ratio should help sonographic recognition and characterization of fetal retrognathic and micrognathic mandibles in utero.

Cephalometry↗
PubMed1998

Antley-Bixler syndrome: a case report and discussion.

Antley-Bixler Syndrome (ABS) is an autosomal recessive trait disorder characterized by multiple bone and cartilaginous abnormalities. Primary features include significant craniosynostosis, midface hypoplasia with choanal stenosis or atresia, femoral bowing, radiohumeral synostosis, and multiple joint contractures. Cardiac, renal, and gastrointestinal malformations have also been described. This report describes the management of a four-month-old male who underwent cranial vault remodeling to relieve craniosynostosis and discusses the potential concerns of the anaesthetist during care of children with Antley-Bixler Syndrome.

Abnormalities, Multiple↗
PubMed2001

New Zealand Maori family with the pro250arg fibroblast growth factor receptor 3 mutation associated with craniosynostosis.

Background: A large New Zealand Maori family has non-syndromic coronal craniosynostosis, which is inherited as an autosomal dominant mutation with variable expression. The aim of the study is to determine whether the family has the pro250 arg mutation in the gene for fibroblast growth factor receptor 3 (FGFR3), a mutation found in patients with various types of craniosynostosis. Patients: Fourteen members of a New Zealand Maori family were evaluated, of whom five have coronal synostosis. A family pedigree tracing six generations was recorded. Methods: Blood samples were drawn for genomic DNA analysis from 14 family members. Polymerase chain reaction, restriction-enzyme digestion and DNA sequencing was performed to identify the pro250arg mutation in FGFR3. Results: Seven family members were heterozygous for the pro250arg mutation in FGFR3. The mutation showed autosomal dominance with reduced penetrance and variable expressivity. Conclusion: Our data and those of other investigators suggest that we should begin integrating molecular diagnosis with phenotypic diagnosis of craniosynostoses. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗
PubMed2002

Valgus deformity of the ankle following harvesting of a vascularized fibular graft in children.

Progressive valgus ankle deformity is a problematic postoperative donor-site morbidity of a vascularized fibular graft in children. To prevent this complication, tibiofibular metaphyseal synostosis (the Langenskiöld procedure) has been recommended. The authors objectively evaluated the preventive and therapeutic effects of this procedure on five children who had received free vascularized fibular grafts. Their average age at the time of operation was 3 years (range: 1 to 9 years). The Langenskiöld procedure was performed primarily in four patients, and not in one patient. The anteroposterior (A-P) mortise angle and the empirical axis of the donor-site ankle were measured radiographically. With regard to the A-P mortise angle, four of five patients showed valgus with a mild lateral wedging of the distal tibial epiphysis. The patient who did not receive the operation showed the largest A-P mortise angle and mild osteoarthritic changes. The empirical axis exceeded normal range in all of the five patients. These observations indicated that valgus deformity of the ankle in children after harvesting a vascularized fibular graft is inevitable, even if the Langenskiöld procedure is performed. The procedure can delay the ankle valgus. The authors recommend close follow-up of the children who receive the Langenskiöld procedure after harvesting a vascularized fibular graft.

Adolescent↗
PubMed2005

A complex brain malformation syndrome with rhombencephalosynapsis, preaxial hexadactyly plus facial and skull anomalies.

We report on a 15-year-old boy with epilepsy and mental retardation who had been repeatedly shunted since birth for hydrocephalus. This child showed at imaging an unusual, severe and complex brain malformation consisting of distorted gyral patterns with deeply infolded mantle in the parietal-lateral and posterior-temporal lobes, normal versus dysplastic cortex, unseparated thalami, thin white matter, collapsed ventricles, partial frontal corpus callosum agenesis, closely apposed superior and middle cerebral peduncles with narrow fourth ventricle, continuity of posterior cerebellum hemispheric foliar patterns across the midline, closely apposed cerebellar peduncles, asymmetrical hypogenesis of the vermis and herniation of the cerebellar hemispheric pattern up through the tentorial incisure. In addition, this boy had congenital skeletal and skin anomalies including pre-axial hexadactyly with thumb duplication, wide bone occipital lacunae (catlin mark) with partial occipital suture synostosis, cutis vertex rigirata and a tuft of hair in the outer region of the right eyebrow. Several of these cerebral and cerebellar abnormalities were suggestive of rhombencephalosynapsis. Nonetheless, many of these brain abnormalities are also recorded in Chiari type 2 malformation after operative shunting. To the best of our knowledge, however, this complex constellation of nervous system, skeletal and skin abnormalities has not been previously reported.

Adolescent↗
PubMedDate not supplied

[Tetra-X syndrome with epilepsy, mental retardation and multiple dysmorphias].

It is reported on a 21-year-old female with super-female syndrome in association with an early childhood brain damage exhibiting idiopathic epilepsy, severe oligophrenia, emotional instability, Little syndrome, areflexia of the legs, strabismus, telecanthus, broad nose, epicanthic fold, clinodactyly of little fingers, radio-ulnar-synostosis, retardation of ossification, aortic insufficiency, erythro-cyanosis, one-side clubfoot and nephrosclerosis, also menstrual cycle dysfunction.

Abnormalities, Multiple↗
PubMed1997

[Craniosynostosis operations in childhood].

Premature osteosynthesis of one or more cranial bones, either intrauterine or within the first postnatal months, is defined as craniosynostosis. The resulting limitation of intracranial space can cause retardation of cranial growth which, in turn, leads to craniostenosis with increasing intracerebral pressure. Complex forms of craniosynostosis with concomitant malformations (i.e. Apert-, Crouzon-, and Pfeiffer syndromes) must be principally distinguished from simple craniosynostosis. This complex cranio-facial dysostosis is a premature osteosynthesis of cranial and facial bones. In general, as far as Germany is concerned, the incidence of cranio-synostosis amounts to 1/1000 births. If they remain untreated, many of these children will suffer from cortex-associated retardation of intelligence. Surgical management, therefore, is initiated at a very early stage, and should be performed in specialised centres. Recommendations for operation vary from an age of 4 to 36 months. However, an age of 6 months or more is the most frequently preferred age for surgical intervention. Severe respiratory disorders, as well as impossibility of enteral intake of nourishment, are considered absolute indications for surgery, independent of the age; elimination of the stigmatisation regarding environmental contacts of the child is another mandatory indication for operation. The goal of early surgery is reconstruction of physiological, cranial, and facial bone structures ("fronto-orbital" or "fronto-facial advancement"). Correction of craniofacial malformation may be associated with--in part--severe complications for the child. From the anaesthesiologist's point of view, this disease demands highly qualified perioperative management, since a variety of idiosyncrasies and risks must be taken into account: These are, for example, venous air embolism, hypothermia, disorders of water and electrolyte equilibrium, and, extremely vital, difficult intubation and substantial blood loss.

Anesthesia, General↗
PubMed1981

[The development of eye symptoms in dysostosis craniofacialis Crouzon--a contribution to pathogenesis (author's transl)].

The eye symptoms in dysostosis craniofacialis Crouzon can be divided into obligate and facultative signs; the latter are nystagmus, megalocornea, coloboma of the iris, corectopia, ectopia of the lens and cataract. There is no causal relationship between these symptoms and the dysostosis craniofacialis. The common eye findings in this disease use proptosis, divergent strabism, hypertelorism with dystopia canthi lateralis as well as in about 80% an atrophy of the optic nerve. It is considered until now that the premature synostosis of cranial sutures is the leading and only pathogenetical factor in this disease. This theory can no longer be sustained because of its inability to explain the above mentionned eye findings. We want to stress on a malformation of the prosencephalic head organisator leading to a dyschondroplasia that mainly affects the base of the skull. This frontal dysplasia causes a characteristic displacement of the building materials and thereby produces the common eye findings in this disease.

Adult↗
PubMedDate not supplied

[Congenital round talus].

The collective consists of 11 patients with a "ball and socket"-anomaly of the talus with a mean age of 13.7 years. All patients demonstrated typical symptoms of the FFU-syndrome with a leg length discrepancy of 4.3 cm (2-20). In 6 patients a close follow-up was done in the early development of the talus form. In the metacarpal region also synostosis of some bones were seen at a mean age of 4.8 years (3.2-5.9). No clinical complaints but a slight reduction of hind foot mobility could been registered. Ball and socket deformity can not been seen as congenital, but as a subsequent deformity after congenital fusions in the metatarsal bones.

Adolescent↗
PubMed1996

[Sternocostoclavicular hyperostosis].

HISTORY AND CLINICAL FINDINGS: A 35-year-old previously healthy man developed a painful swelling in the area of the left sternoclavicular joint (SCJ), restricting movement. There had been no history of trauma. INVESTIGATIONS: A moderately increased erythrocyte sedimentation rate was the only abnormal finding among the usual laboratory tests. Radiologically there were marked hyperostotic changes in the area of the left upper thoracic cage with synostosis of the SCJ. Biopsy of the left clavicle showed non-specific chronic sclerosing osteomyelitis. TREATMENT AND COURSE: Over the next 6 years the SCJ became completely ankylosed and there were now extensive fibroses, some presternal and some in the upper mediastinum with thrombosis of the left subclavian, axillary and jugular veins causing inflow occlusion (Paget-von-Schroetter-syndrome). Lymph nodes in the region of the mandible, jugular veins bilaterally and mediastinum were noted for the first time, remaining unchanged in size over six months. CONCLUSION: Sternoclavicular hyperostosis is an important condition in the differential diagnosis of inflammatory or malignant processes of this joint.

Adult↗
PubMed1990

[Genetic aspects of esotropia in homozygous twins].

The present paper reports on 14 pairs of monozygotic twins with ocular motility disorders. Eight pairs were concordant and two partially concordant, while four pairs were discordant. Four pairs were born prematurely; two pairs were born by cesarean section, one of them also prematurely. Of the 24 patients with motility disorders, 10 had congenital squint syndrome, nine microtropia, one accommodative esotropia, two esophoria, and two orbital strabismus due to premature synostosis of the coronal suture. Genetic and exogenic factors and the forms of strabismus are discussed.

Adolescent↗