Interarticular dislocation of the patella.
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Chromosome abnormalities may result in a great number of osteo-articular anomalies. Little documentation concerning these anomalies is available. The main orthopedic problems encountered in 67 children with chromosomal abnormalities are reported here. Patients should be evaluated at regular intervals in order to detect osteoarticular involvement. Gradual deterioration results in disabling conditions which are difficult to manage. Orthopedic management should be mainly preventive. It's purpose is to delay or to avoid the onset of disabling complications.
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When assessing injuries to the lower extremity, they can best be discussed if divided into two groups: (1) vehicular or crushing injuries; and (2) nonvehicular, torsion, or overuse injuries. Vehicular injuries require speedy, accurate assessment as they are often complex and frequently involve other systems. The patient is initially stabilized, then assessment of orthopedic problems is begun. The nurse's role is an assistive one. If the patient is admitted to the hospital, orthopedic care involves prevention of complications, reduction of pain, and assisting the patient in daily activities. Nonvehicular injuries are more chronic in nature. The patient may have unsuccessfully ignored the problem, tried home remedies, or attempted to work with it. At this point, they are seen in the physician's office, hoping for a cure. After diagnosis, proper instruction for a rehabilitation program is begun. Treatment for a sprain, strain, or overuse syndrome can often be done at home. An active program should be encouraged and the patient should be taught why the problem occurred initially and how it can be prevented in the future.
Anteromedialization of the tibial tuberosity is a new and highly effective technique for transferring the tibial tuberosity when anteriorization is desired in addition to medial shift of the patellar tendon insertion. Prompt primary bone healing can be achieved, allowing rapid rehabilitation with substantially improved patellofemoral mechanics. No bone grafting is necessary to achieve anteriorization, although only slight to moderate anteriorization is possible in most cases. Realignment of the patellofemoral mechanism and relief of patellofemoral contact stress can be achieved in one procedure.
With few exceptions, patellofemoral problems should initially be treated with conservative measures. If results are unsatisfactory and no contraindications are present, surgery should be considered.
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