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PubMed1983

Congenital clubfoot: results and therapeutic guidelines.

The authors report the results observed between 5 and 11 years after surgery in 100 cases of congenital clubfoot treated by posterior release and another 100 cases treated by combined posterior and medial release. On the basis of their experience, they believe that: 1. Grade 1 clubfoot can be successfully treated conservatively; 2. Grade 2 and grade 3 clubfoot must always be treated by complete posterior and medial release; 3. The best age for surgical intervention is around the age of 3 months; 4. In the first three months of life, manipulation and plaster casts should be used to try to correct the deformity.

Age Factors↗
PubMed1982

Morphological studies of the velopharyngeal orifice in cleft palate.

Silicone rubber impressions and plaster casts were made preoperatively to evaluate the velopharyngeal orifice areas in 91 children with cleft palate aged one year and two months to two years and five months. Cleft width was large in children with cleft lip and palate (CLP) than in children with cleft palate alone (CP). Velopharyngeal orifices were classified into four types based upon their area and shape. It was concluded that the classification might be useful in planning palatoplasty.

Child, Preschool↗
PubMed1980

[Primary repair of soft tissue injuries (author's transl)].

The primary treatment of an injured hand has great influence on later results, and also on secondary measures in reconstruction. In contrast to adults, children show a good healing of distal-pedicle flaps, after removal of fat and sparing the subdermal plexus. The choice of skin replacement must be made under careful consideration of site, function and the possibility of further measures for rehabilitation. Where several structures in the child's hand are injured, good results can be attained by combining an adaptation-osteosynthesis with Kirschner wires, and a plaster cast. Several cases are demonstrated, with examples.

Child↗
PubMed1981

Open fractures of the tibia.

The authors call attention to the work of Trueta on open fractures and to the fact that, even today, his principles are followed all over the world. Today, such fractures are immobilized with external skeletal fixation instead of plaster casts. The results are presented of 71 patients with severe open fractures of the tibia who were treated by external skeletal fixation. In three patients, in whom infection developed, the fractures united after cancellous bone grafting. Reference is made to some recent experiments on the fat of bone cells transplanted into infected cavities.

Accidents, Traffic↗
PubMed1982

Split-thickness autogenous skin transplantation in the horse.

Single or multiple split-thickness autogenous skin transplants were applied to 20 limb wounds of 17 horses. The surface area of the wounds ranged from 25 to 200 sq cm. Grafts 0.635-mm thick were collected by use of an electric dermatome and were expanded on a mesh dermatome. The expanded mesh grafts were applied to wounds on 3 horses 4 days after injury. For the other 14 horses, grafts were applied after a granulation tissue bed had formed. The grafts were secured to the recipient beds with sutures and a dressing composed of a foam pad and elastic adhesive tape or with the dressing alone. Further protection was provided by a plaster cast or bulky cotton bandage. Graft acceptance ranged from 50% to 100%, with an average of 88%. Epithelialization was complete within 14 to 21 days in most cases. Grafts with greater than 60% acceptance resulted in a healed wound that was considered cosmetically acceptable.

Animals↗
PubMed1982

Computed tomography in congenital hip dislocation. The role of acetabular anteversion.

Computed tomography usually can provide accurate documentation of the adequacy of a reduction in congenital dislocation of the hip. It should supplement other radiographic examinations when the status of a reduction is in question because the patient is wearing a plaster cast. The computed tomography scan provides a clear image of the reduction in the transverse plane, so that anterior or posterior subluxation of the femoral head can be easily detected. In addition it allows direct measurement of acetabular anteversion which previously had not been possible with non-invasive studies in the living patient. Radiation exposure is less than that for conventional tomography. We used computed tomography in five patients with congenital dislocation of the hip and our study provided new evidence concerning the role of acetabular anteversion in this condition. Acetabular anteversion was increased on the dislocated side in each patient, and returned to normal as treatment progressed.

Acetabulum↗
PubMed1982

Pulmonary function before and after surgical correction of scoliosis.

We compared the preoperative and postoperative pulmonary function of thirty-one scoliotic patients ranging in age from nine to twenty-five years. The mean postoperative follow-up period was three years and eight months. Twenty patients were treated by a posterior procedure with Harrington instrumentation. At more than two years postoperatively a significant improvement in the pulmonary function was noted, particularly in patients with a preoperative curve of less than 90 degrees (Cobb angle) and in those in whom the correction was greater than 30 per cent. The remaining eleven patients were treated by an anterior procedure, primarily a Dwyer operation, with or without posterior Harrington instrumentation. These patients manifested no remarkable improvement in pulmonary function more than two years after surgery; three patients showed deterioration. The results of tests performed less than two years postoperatively showed no improvement in pulmonary function, irrespective of the types of assessments used. We attribute our long-term improvements to a shortening of the postoperative period of plaster-cast immobilization and to the use of a plastic corset which allowed relatively free chest motion. We suggest that the Dwyer operation should be restricted to patients with a severe spinal deformity.

Adolescent↗
PubMedDate not supplied

Intervertebral discitis in children and adolescents.

In 29 children wih symptoms and signs as well as laboratory and radiographic findings consistent with intervertebral discitis, the syndrome appeared to be a manifestation of both infectious and noninfectious inflammatory processes. When systemic sepsis is present, antibiotic therapy is indicated. In the absence of fever and leukocytosis, plaster cast immobilization should suffice. Craig needle aspiration and/or open biopsy are not routinely required, but should be reserved for those patients who fail to respond to routine treatment in whom tuberculosis is suspected.

Adolescent↗
PubMed1982

Developmental orthopaedics. III: Toddlers.

The most common orthopaedic problems seen in toddlers are: (1) in-toeing due to femoral torsion, internal tibial torsion, talar torsion (persistent medial deviation of the neck of the talus), or metatarsus adductus; (2) genu valgus (bow-leg) and genu varus (knock-knee); and (3) pes valgus (flat-feet). In most cases these conditions will resolve spontaneously, as has been substantiated by a number of published studies. However, a small percentage of the disorders will persist if untreated. To prevent the deformity from becoming established and irreversible, treatment must begun while the patient is still young. Therefore the orthopaedist needs objective criteria to select those children in whom the deformity is likely to persist and who thus require prompt management. If femoral torsion persists, it becomes fixed by the time the child reaches eight years of age. Surgery is the only definitive treatment which can be offered, although gait training by augmented feedback methods may result in correcting by increasing the range of external rotation of the hip. Internal tibial torsion or talar torsion usually resolve spontaneously before the children reach seven years of age. However, in 8 per cent of cases in-toeing persists; it is cosmetically objectionable in the adult. I advise simple brace treatment in infants up to the age of 18 months if the medical deviation of the foot from the mid-sagittal plane is greater than 10 degrees. Because metatarsus adductus corrects spontaneously in many cases, some authors suggest that this condition should not be treated. However, I think it is prudent to use serial plaster-casts for infants under eight months of age in whom the deformity is moderate or severe. If treatment is withheld while the patient is observed, and if spontaneous correction does not occur, the deformity will become fixed and correctable only with surgery. Genu valgus and varus correct without treatment in the majority of patients. However, some cases of genu varus appear to develop into the progressive form of the disorder, Blount's disease. When the varus femoral-tibial angle exceeds the norm for age, early treatment with the Danish night-splint appears to prevent the development of this serious disease. 'Flat foot' (pes valgus) must be defined carefully by physical and radiographic examination. Treatment and radiographic examination. Treatment might be considered only for those feet classified as pes valgus with plantar flexed talus of 50 degrees or more. For children with this disorder between the ages of two and six years, a corrective moulded plastic shoe-insert may help to improve the abnormal anatomy while natural ligamentous tightening occurs.

Adolescent↗
PubMed1982

Mineral metabolism and immobilization osteopenia in ponies treated with 25-hydroxycholecalciferol.

The left thoracic limb was immobilized in a plaster cast in 6 grade weanling ponies for 6 weeks. Two ponies were injected intramuscularly each day with 2.4 micrograms of 25-hydroxycholecalciferol [25(OH)D3] per kg bodyweight, two with 1.2 micrograms and two received no injections. Immobilization of 25(OH)D3 treatment had no significant effect on mineral metabolism. Immobilization resulted in significantly decreased weight and specific gravity of metacarpus III (MCIII). Histologic examination and triple fluorochrome incorporation showed that the osteopenia was caused by atrophy of osteoblasts with failure of bone apposition. Immobilization caused retardation or cessation of proliferation of cartilage in the epiphyseal plate with thinning or premature closure. Treatment with 25(OH)D3 further reduced apposition and enhanced significantly the osteopenia as shown by quantitative morphometry of microradiographs of the MCIII metaphyses. There was parathyroid gland atrophy and fibrosis in proportion to the level of 25(OH)D3 treatment, which, in absence of hypercalcemia in all ponies, was interpreted to be a direct result of vitamin D treatment. It was concluded that immobilization osteopenia under the present design and duration is caused by failure of bone apposition and that treatment with 25(OH)D3 at dose levels applied is contraindicated.

Animals↗
PubMed1982

Surgical treatment of recurrent subluxation of the patella in athletes.

The authors describe the results obtained in fifteen athletes suffering from recurrent monolateral subluxation of the patella by a new technique which should represent a considerable improvement over existing methods, both in surgical and rehabilitation phases. The treatment consists of: a) a surgical stage comprising extensive lateral mobilisation by section of the lateral capsule and the external alar ligament, extensive manual detachment of the vastus lateralis muscle, and osteotomy performed obliquely to the frontal plane with antero-medial transposition of the tibial tuberosity to realign the extensor apparatus; b) a post-operative stage characterised by immediate mobilisation of the knee without the application of a plaster cast. The aim of this method is to eliminate above all the instability caused by recurrent subluxation of the patella, to cancel out any abnormal stress exerted on the femoral condyle by the patella, to normalize the extensor apparatus, to bring about the regression of any incipient chondromalacic lesions, and to prevent femoro-patellar arthrosis by restoring the anatomical and functional equilibrium of the femoro-patellar joint. The clinical and radiographic results determined by follow up examinations performed between one year and two and a half years after the operation were so satisfactory that the authors extended the method to recurrent subluxations in non-athletes.

Adolescent↗
PubMedDate not supplied

Reconstruction of severely injured forearm bones.

Twenty open and severe forearm fractures treated either immediately following crush injury or after primary treatment in other hospitals are reported. Soft tissue coverage required repeated debridement and skin grafting. Internal bone fixation was either delayed, primary or secondary, while tendon and nerve repair was always postponed. Two patients with avascular gangrene required amputation: six were initially placed in a plaster cast (in five there was non-union and in one, malunion); in five intramedullary nailing was used (in two there was non-union); in seven in whom compression plating was used for primary bone fixation and those in whom it was used for treatment of non-union after other methods of fixation, solid union was always obtained.

Adult↗
PubMed1982

Experimental studies on hypokinesis of skeletal muscle with different functions. VI.

In rabbits, the right hind limb was immobilized by means of plaster cast for 1, 2, 4 or 6 weeks and the activities of some metabolic enzymes: GOT, GPT, LDH, aldolase and acid phosphatase (in part of lysosomal origin), were examined in the slow m. soleus, and in the fast m. gastrocnemius. The former muscle is known to have mainly an oxidative, while the latter mainly a glycolytic type of metabolism. The activities of enzymes highly involved in the metabolism of the muscle diminished for a certain time during atrophy, then a relative rise occurred. Acid phosphatase activity likewise decreased after an initial relative increase. Reduction of enzymatic activities is explained by the activation of proteolytic enzymes, on the basis of measurements performed in these experiments and of results published by others. The decrease of enzymatic activity was more marked in the muscle which in normal state exhibits higher activity than in the other type of muscle studied. Thus, in the gastrocnemius a high rate of degradation of glycolytic enzymes was observed, while in the soleus degradation of oxidative enzymes prevailed. This phenomenon leads to the dedifferentiation of the muscle cell during immobilization.

Acid Phosphatase↗
PubMed1981

The effect of prolonged physical training on the properties of long bone: a study of Wolff's Law.

UNLABELLED: Five one-year-old immature swine were subjected to twelve months of exercise training. Four matched swine with no training served as controls. After they were killed, four-millimeter-wide strips of bone taken from the anterior, medial, posterior, and lateral quadrants of the central femoral diaphysis were subjected to four-point bending tests to failure. It was found that although exercise did not change the mechanical properties of the cortical bone, it resulted in significant increases in the averaged femoral cross-sectional properties: 17 per cent in cortical thickness, 23 per cent in cortical cross-sectional area, and 21 per cent and 27 per cent in maximum and minimum area moments of inertia, respectively. These changes were due primarily to reduction in the diameter of the medullary canal. The analyses of bone composition showed that the bone density and biochemical contents of the control and exercised animals were similar, but the total volume and the dry, ash, and calcium weights of the exercised bone were significantly higher. These combined results suggest that prolonged exercise has a significant effect on the quantity of the bone, but not on its quality. CLINICAL RELEVANCE: It has long been recognized that stress deprivation from immobilization in plaster casts results in profound bone atrophy, and it is generally accepted that a minimum level of activity is necessary for homeostasis of bone. These results show that exercise at a level comparable to that prescribed in running fitness programs for humans (65 to 80 per cent of maximum heart rate) can not only maintain homeostasis, but produce actual hypertrophy of bone. This work further suggests the importance of graduated, prolonged, supervised rehabilitation programs in overcoming osteoporotic states.

Animals↗
PubMed1981

Fractures of the patella. One hundred consecutive cases.

The series comprises 100 patella fractures treated during the period 1974-1977. Seventy-eight patients were treated operatively. The most common operative method was partial excision, which was performed in 36 patients. Twenty-four patients were treated with equatorially placed cerclage wires, while 10 patients were treated with tension band fixation only (AO). All the operated patellas were immobilized postoperatively in a plaster cast cylinder for a mean duration of 5.2 weeks. The average observation time was 18 weeks. At follow-up attention was paid to subjective symptoms and radiological findings, clinical status and duration of incapacity for work. The clinical results were considered excellent or good in 71 patients and the subjective assessments were excellent or good in 63. Superficial infections were recorded in three cases and in seven patients the osteosynthesis had deteriorated. The results suggest that tension band fixation and partial excision of the patella are methods of choice for patellar fractures requiring operative management.

Adolescent↗
PubMed1981

Experimental investigations on the hypokinesis of skeletal muscles with different functions, V.

The composition of myofibrillar proteins was studied in the soleus and gastrocnemius muscles of rabbit hind limbs immobilized by plaster cast in experiments lasting 1--4 weeks. The amounts of actin, M protein and C protein increased relative to the normal composition. The ratio of the light chain peptides of the fast muscle myosin changed from 1 : 2 : 1 to 1 : 2 : 0.5 as a result of 4 weeks of disuse. The LC-1 : LC-2 ratio of slow myosin did not change considerably while the amount of fast LC-3 peptide, hardly detectable in soleus muscle, increased more than tenfold. The amount of tropomyosin decreased significantly in both muscles. The submolecular composition of troponin changed, mostly in the slow muscle; TN--C and TN--I decreased significantly, whereas there was an increase in the TN--T values. It is concluded that the phenotype of the structural proteins of muscles with different functions is de-differentiated by disuse, while the genetic functions of the muscle cells is reprogrammed to the synthesis of contractile proteins (e.g. myosin) characteristic of the other type of muscle.

Actins↗
PubMed1981

Intramedullary nailing in segmental tibial fractures.

Thirty-eight consecutive segmental fractures of the tibia were treated by intramedullary nailing with the Küntscher-Herzog nail. Twenty-two fractures were closed and sixteen were open. Reaming of the medullary cavity was performed and adequate fixation was ensured by use of a plaster cast. Weight-bearing was allowed after thirty-days for closed fractures and sixty days for open fractures. All of the closed fractures healed without malunion or infection. Of the patients with open fractures, one had an infection; one, non-union; and one, malunion. In all cases but one, union was slower at the distal fracture.

Adult↗