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A personal revolution in the development of clubfoot correction.

This article presents the author's experience of having worked in London, England, under Denis Browne, whose method of treating equinovarus in the newborn involved manipulation of the baby feet until full correction had been achieved at the very first visit. The feet were then strapped to the sole plates of the Denis Browne splint, which ensured that the baby's normal kicking action maintained mobility at the subtalar joints and also a basic plantigrade posture. When he transferred to India, the author found a large population of children who had been born with talipes equinovarus, but who had never had treatment. He worked at obtaining correction without strong manipulation, using serial plaster casting followed by Denis Browne's splints. His personal reactions to the problems and the merits of the two methods forms the subject of this article.

Casts, Surgical↗

[Carpometacarpal dislocations of the long fingers. Apropos of 26 cases with review of 20 cases].

PURPOSE OF THE STUDY: A retrospective study reports the evolution of patients treated for dislocation of one or several of the four medial carpometacarpal joints. MATERIALS AND METHODS: In five of twenty-six patients, the dislocations were undiagnosed in emergency. Twenty-five dislocations were dorsal. A patient presented a divergent dislocation of the four medial metacarpals proximal ends. The mean age was 25-30 years. Twenty-six patients were treated: ten by closed reduction and sixteen by open reduction. Stabilization by oblique K-wire pining was used in twenty-four cases. Twenty patients were followed for an average of fourty-one months. Six patients were lost for follow-up. Two patients had an an ulnar nerve injury. In eighteen cases, dislocation was associated with avulsion fracture of the involved bone. Eleven fractures of the distal carpal row was reported. RESULTS: The results were assessed by the range of wrist and fingers motion, grip strength, pain and deformity. Three patients had a limited range of wrist motion, five patients had a limited range of fingers motion. Six patients had a loss of fourth and fifth carpometacarpal joint motion. Eight patients had an excellent grip strength. Four patients were pain free and fourteen had climatic pain, or after strenuous use of the hand. Eleven had no deformity or limited prominence and three a disabling deformity. Results were rated good in thirteen cases, fair in three and poor in four. DISCUSSION: Dislocation or fracture-dislocation of the carpometacarpal joints are uncommon injuries. The diagnosis can be easily missed. The authors recommend closed or open reduction but constant fixation by pins and immobilization in a plaster cast. In this study, the majority of results was good when no serious injuries were associated and when reductions were stabilized with k-wires. One out of four poor results had been treated by closed reduction without k-wires, the three others were due to associated injuries.

Adolescent↗

[Tenography in tenosynoviopathies of the posterior tibial tendon].

PURPOSE OF THE STUDY: The authors wanted to study diagnosis contribution and therapeutic importance of tenography in posterior tibial tendon tenosynoviopathies. MATERIAL: The series included 42 patients (26 females and 16 males) from 23 to 69 years old. The affection had a course for about two years. A trigger or promoter factor was founded in 32 cases. Clinical examination found only 12 standard feet. Biological exams were normal. METHODS: All patients had a tenography. When tenosynoviopathy was diagnosed, the surgeon injected cortivazol in the sheath by the catheter, within the extra-tendinous space. In case of treatment failure, a synovectomy was realized with possible tendinous suture, under the protection of a weight bearing plaster cast for 21 days. RESULTS: Pathological features: we have founded 26 major irregularities of the sheath, extensive with scalloped outlines of which 8 were supra-malleolar and 18 sub-malleolar, 15 irregularities located at the level of the sheath outline of which 4 were supra-malleolar and 11 sub-malleolar and with a tear of 1 cm length. Long term results: among 36 reviewed patients, pain disappeared in 29 cases, after only one injection (21 cases), or after a surgical treatment (8 cases). DISCUSSION: Tenography has for us great interest for the diagnosis of a tenosynoviopathy, allowing in the same time an extra-tendinous injection of corticoid in the sheath itself. But it doesn't always allow to make a diagnosis of a tendinous tear. A part of our failures can be secondary to these tears. According to our results it could be recommended to practice in a first time a tenotomodensitometry (teno TDM). In case of a tear, a surgical treatment by synovectomy with suture may be proposed first, for a tenosynoviopathy an injection must be realizes. CONCLUSION: Tenography allows a precise diagnosis and in the same time, a treatment by injection. The tendinous tears require a surgical suture but are better diagnosed on a teno TDM.

Adult↗

[Traumatic posterior dislocation of the elbow joint].

This paper presents the course and results of treatment in 10 patients with posterior luxation of the elbow joint. Patients underwent surgery under general anesthesia during which reposition was performed and the upper arm was immobilized in a plaster cast for 2 weeks. After a formal physical therapy program the achieved functional results were maximal.

Adolescent↗

[Fate of the calcium-dense proximal fragment in scaphoid fracture].

A cohort study with retrolective and prolective collection of data was carried out 49 of 99 patients with scaphoid fractures, initially treated by plaster cast immobilization and having developed a proximal fragment with increased bone density were studied. More than half of these patients had a good or excellent result according to the modified score of Green and O'Brien 29 of 49 proximal fragments with increased bone density returned to normal density: 45 of 49 showed bony union, and 35 of 49 showed no signs of posttraumatic arthrosis. The appearance of stripes with increased bone density in plain X-rays indicated a problem in the process of fracture healing; the clinical interpretation, however, was difficult. Four patients were treated by percutaneous canulated screw (Streli). These fractures showed bony union, the fragment with increased bone density returned to normal in three of four patients. All of these patients had some remaining clinical problems.

Adolescent↗

Comparative review of gnathometric characteristics in total dentures and eugnathic subjects.

The problem of determining the position and lining of the teeth in total dentures is presented by a comparative examination of gnathometric variables in eugnathic subjects and in those wearing total dentures. The material consisted of 51 plaster casts of eugnathic subjects and 49 subjects wearing total dentures. The following were examined: upper total number of incisors (T1), anterior width (AW), posterior width (PW), anterior length (AL) and posterior length (PL) of models. Analysis of the investigated variables was carried out by means of sliding calipers MECANIC Type 6901 (IVOCLAR, Lichtenstein) with a scale of 0-130 mm, and reading accuracy 97.5%. A three-dimensional pair of compasses according to Korhaus (Dentaurum, Germany) was used to measure the anterior and posterior lengths of models, with a scale 10-60 mm and reading accuracy 95%. No significant difference was observed between the eugnathic subjects and subjects wearing total dentures (p > 0.05). The results of this comparative gnathometric analysis of examined variables (Tl, AW, PW, AL and PL) are a contribution to the rules when lining anterior and posterior teeth in total dentures.

Dentition↗

Can algodystrophy be prevented after hand surgery?

Algodystrophy is characterized initially by an increase in arterial flow, an increase in blood pool, a decrease in microcirculatory velocity, and a loss of thermoregulatory control. These changes, producing the typical symptomatology, associated diffuse hand pain, diminished hand function, edema, and abnormal color and temperature, are believed now to correspond in most cases to an exaggeration of the normal post-traumatic inflammatory responses and are not the consequence of sympathetic damage. Algodystrophy may be prevented in most hand surgery patients by minimizing the normal postoperative inflammation, by increasing venous return (especially by avoiding plaster casts and constrictive dressings), by controlling post-traumatic pain, by promoting early active mobilization, and by reassuring the patient. If there is any sign of algodystrophy, three-phase bone scintigraphy should be obtained and treatment instituted immediately.

Arm↗

[Bone alloplasty: its place and role in the system of modern osteosynthesis methods].

The experience with alloplasty carried out upon 265 patients with fractures and pseudoarthrosis of long tubular bones is generalized in this work. In 87 cases the osteosynthesis with bone angular and T-bars was performed. The analysis of the results of surgical treatment of fractures and pseudoarthrosis has proved the advantages of the bone bar osteosynthesis over other surgical procedures, especially from the technical and biological points of view, which are the following: its simplicity and non-traumatic effect, good fracture stability, prevention from angular and rotational displacement of the fragments through the external plaster cast immobilization, shortening of the operation time, freedom from repeated operations for the removal of metallic constructions.

Adult↗

Compression neuropathy of the peroneal nerve caused by a ganglion.

Peroneal nerve injury usually results from fracture of the fibula neck or direct pressure from an ill-fitting plaster cast. Clinically, these patients present with "drop foot." Compression neuropathy caused by a ganglion is rarely encountered. This report concerns the clinical and radiologic evaluation of a 57-year-old man admitted to our clinic with left drop foot. A mass compressing the peroneal nerve at the level of the fibula neck was excised totally and diagnosed as a ganglion.

Bone Cysts↗

Gingival overgrowth in pediatric heart and heart-lung transplant recipients.

BACKGROUND: Gingival overgrowth is a recognized side effect of cyclosporine therapy with cosmetic and functional sequelae. This study examines the incidence and severity of gingival overgrowth in pediatric heart and heart-lung transplant recipients. METHODS: Thirty-one pediatric heart and heart-lung transplant recipients underwent a comprehensive dental evaluation. The severity of gingival overgrowth was scored by use of dental plaster casts. Parameters of dental hygiene in each patient included both a plaque index and a gingival inflammation index. The mean cyclosporine level and daily dose (mg/kg/day) at 3 and 12 months after transplantation and at latest follow-up were determined. RESULTS: The mean (+/- SD) patient age at transplantation was 10.5 (+/- 5.5) years, and the mean duration of posttransplantation follow-up was 3.2 (+/- 2.1) years. In all 30/31 (97%) of the cohort had some degree of overgrowth, with children aged less than 10 years at time of transplantation the most severely affected. By univariate analysis gingival overgrowth was inversely related to age at time of transplantation (r = -0.67, p < 0.001). With multiple regression analysis, only age at transplantation was significantly related to gingival overgrowth. CONCLUSIONS: Gingival overgrowth occurs in most pediatric heart and heart-lung transplant recipients treated with cyclosporine and is most severe in the younger patients. Attention to oral hygiene may improve gingival health parameters; however, the daily weight-adjusted dose of cyclosporine is not related to the severity of overgrowth.

Age Factors↗

[Surgical treatment of fractures of the radius neck in children using the Métaizeau technic].

Fractures of the radial neck in children must be reduced when the angular displacement is superior to 30 degrees. Given that orthopaedic reduction is difficult, internal fixation using closed intramedullary pinning, as described by Métaizeau in 1980, seems to be an elegant solution which preserves the vascularisation of the physis. The authors report their experience with this technique, which has been used to treat fifteen patients, with a mean age of nine years, between 1983 and 1996. A plaster cast was worn for three weeks after operation and sound union was observed at six weeks. Full functional recovery was observed in all patients at six weeks. No complication was encountered and the pins were removed at three months.

Adolescent↗

Congenital metacarpal synostosis treated by longitudinal osteotomy and placement of a silicone wedge.

Three cases of congenital metacarpal synostosis are reported. Two had congenital synostosis between the fourth and fifth metacarpal, and one between the third and fourth metacarpal. Both hands were involved in the former cases, while only one unilateral hand was involved in the latter case. An abnormal abduction position of the finger was noted in early infancy, and this gradually progressed as the patients grew. Operations were performed between the ages of three to eleven years. Fused metacarpal bases were longitudinally osteotomized with a chisel, and a silicone wedge was inserted between the metacarpal bases. After the operation, the hand was immobilized with a plaster cast for four weeks. The follow-up periods range from two to sixteen years. The postoperative function and appearance of the hand were remarkably improved.

Child↗

A CAD/CAM technique for fabricating facial prostheses: a preliminary report.

A computer-aided designing and manufacturing (CAD/CAM) technique for clinical fabrication of facial prostheses was developed. Laser surface scanning was applied to acquire three-dimensional imaging data of the patient's facial defect. The three-dimensional imaging data was then transferred to a CAD/CAM interactive program for image processing, which then mathematically designed and produced a model for fabrication of the facial prosthesis. This CAD/CAM technique has the potential to simplify the procedure and decrease the laboratory work required compared to that required for the conventional plaster-cast method. This new technique also provides a novel approach to the fabrication of prostheses for the reconstruction of facial defects. Two alternative three-dimensional modeling processes, laser lithographic modeling and numerically controlled milling modeling, were integrated in this study. The possibilities and current limitations of the techniques are also discussed.

Computer-Aided Design↗

[Inline skating, an old sport, newly discovered: harmless or a potential danger with socioeconomic effects?].

Over a period of one year, all accidents associated with in-line skating (ILS) were surveyed. Sport-specific data was recorded with a standardized questionnaire. The study comprised 66 patients with 75 injuries (48 upper limb, 16 skull, eight lower limb, three trunk). We were looking after 42 male and 24 female patients with an average age of 20 years (5-53 years). Twenty-seven patients (40%) had to be treated as inpatients. Overall, the most frequent injury (one third of all injuries) was forearm fracture close to the wrist (21 radius fractures, four radioulnar fractures). It had to be reset in 20 cases. Additional internal fixation was required in 10 cases (Kirschner wire osteosynthesis, intramedullary nailing or plate osteosynthesis). Only five patients could be treated with plaster cast fixation alone. Most patients with injuries in the vicinity of the wrist were not wearing a wrist protector at the time of the accident. The most frequent reasons given for not wearing protectors was forgetfulness or the high price of protectors. However, there were also two distal radius fractures and a disc injury in the wrist in patients who had been wearing wrist protectors. In most cases, ILS accidents lead to appreciable damage requiring a healing period of several weeks to months (average period of loss of work 41 days). The bfu (advisory center for accident prevention) reckons with 60,000 ILS cases annually in Switzerland. These injuries are thus of great socioeconomic importance. In the future, better risk behavior must be achieved by informing the population (wearing protectors, especially for the wrist and head, attendance of training courses).

Absenteeism↗

Fatigue fractures of tibial and femoral shaft in soldiers.

In 136 fatigue fractures in military recruits, 58 were in the femoral shaft and 43 were in the tibia. Fatigue fractures in the long bones of the lower limb can be classified on the extend of the periosteal reaction. Most were grade 1, showing periosteal reaction only on one or two cortices as seen on the anteroposterior and lateral projections of the roentgenograms. Physical activity was discontinued immediately when fatigue fracture of the femur or tibia was suspected on clinical grounds alone. Early clinical diagnosis the long bone fatigue fractures in all patients except one. The injured soldiers were ambulatory without plaster cast immobilization or crutches. The suggested classification was used to select patients with Grade 1 fatigue fracture for early resumption of active military training.

Adolescent↗

[Treatment and prognosis in vertebral fractures in children and adolescents].

Twenty-six children and adolescents with a total of 65 vertebral fractures are reported. Sixteen patients could be followed up an average of 3 1/4 years after the accident. The questions of growth disturbance after vertebral body fractures and adequate treatment are chiefly considered. -Most of the fractures occurred in the midthoracic spine. As a rule they were serial fractures. -Fractures of the vertebral body with sagittal wedge deformity alone have a better prognosis than those with concomitant sagittal and frontal wedge deformities. Whereas those in the first group correct themselves partially or completely during subsequent growth, improvement in the wedge deformity was only observed in about one-third of the patients in the second group. When the end-plates were fractured, there was no correction and there was a lack in vertebral growth. Severe destruction of the cartilagenous plates and intervertebral discs led to a fusion of the corresponding segment. Increase in wedge deformity was observed twice. -Slight axial deviations of the intervertebral discs following vertebral body fractures are compensated for during growth in most cases. In comminuted fractures, the axial deviation persists but can be compensated for by the adjacent segments of the spine. In instable fractures, it can increase in spite of treatment in a Milwaukee corset. -No difference was found between the children treated with a hyperextension plaster corset and those treated functionally. On the basis of the results, the fracture types which should be treated functionally and those for which a plaster cast is recommended are indicated.

Adolescent↗

Occlusal migration of the maxillary first primary molars subsequent to the loss of antagonists.

The purpose of this study was to observe the vertical changes in unopposed maxillary first primary molars longitudinally. The subjects of this study were 17 children whose lower first primary molars had to be extracted. Space closure were prevented by crown-loop space maintainers for all these children. Plaster casts were made every 4 months for 16 to 24 months after the extraction. These series of casts were standardized, and vertical changes of the maxillary first primary molars against the occlusal plane were measured using a micro-reader. The mean changes indicated that maxillary first primary molars without intercuspidation tend to drift toward the extraction space. On the control side with antagonists, the maxillary first molars seemed to move reversed to apical throughout the observation period. Accordingly, the results of this study showed new trends after the premature loss of primary molars. The vertical changes toward extraction space varied from -0.40 mm to 1.43 mm at the 16 months after extraction. Mean changes were small, but there were some individual differences in reaction, giving negative values. However, we should always be concerned about loss of arch length and also occlusal drift of unopposed teeth, because the vertical changes were greater than 1 mm at 16 months after extraction in some cases.

Child↗