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PubMed1998

Lower limb trauma caused by power-driven cultivators: report of 23 cases.

OBJECTIVE: To determine the mechanism and the severity of injuries caused by power-driven cultivators. METHODS: This retrospective study analyzed the clinical records of 20 patients treated from 1984 to 1996 for a total of 23 lower limb injuries caused by power-driven cultivators (three patients had bilateral injuries) in the Nice University Hospital. RESULTS: A total of 90% of the accidents occurred when the machine was put into reverse and the limb was caught by the rotary blades; the cause of the remaining accidents was unknown. Of the 23 patients, 10 patients (43.5%) suffered posterior dislocation of the knee due to forced hyperextension. Injuries were classed in two groups as a function of their prognosis: group I consisted of osteomuscular lesions without vascular or nerve involvement (11 lower limbs, 11 patients). The mortality rate in this group was 9%, the rate of major amputation was 18%, and the prognosis was favorable in 82% of the cases. Group II corresponded to lower limb injuries with neurovascular involvement (12 lower limb injuries in 10 patients: one patient belonged to both group I and group II). Acute lower limb ischemia was constant in group II; the mortality rate was 20% (two of 10 patients), and the rate of major amputation was 41.6% (five of 12 patients; three emergency amputations and two secondary amputations). CONCLUSION: These agricultural machines can cause severe trauma, and the resulting wounds are contaminated by telluric germs in rural areas. Paradoxically, power-driven cultivators are not legally classified as "dangerous machines." Modification of existing legislation in this field would seem advisable.

Adult↗
PubMed1981

Perinatal fractures in arthrogryposis multiplex congenita.

Thirty-six patients with arthrogryposis have been followed at The James Lawrence Kernan Hospital of Baltimore since 1951. In this group, nine patients sustained 16 perinatal fractures. Femoral shaft fractures and epiphyseal separations were found more commonly in patients with fixed knee extension or dislocated hips and were related to relative stiffness and obstructed delivery. Femoral fractures were more common than humeral or tibial fractures. Arthrogrypotic infants displaying irritability and poor feeding are suspect of skeletal trauma. Thickening of limbs or joints may be the only clinical indication of fracture of epiphyseal injury. Plain radiographs of joints were inadequate for the diagnosis of epiphyseal separation when the epiphysis was not yet ossified. Arthrography is therefore recommended as a primary diagnostic tool.

Arthrogryposis↗
PubMed1983

Distal focal femoral deficiency.

Two children with a congenital limb deficiency, involving the distal end of the femur and the femorotibial joint, are described. Both had associated ipsilateral limb anomalies; one had absence of the shaft of the femur and agenesis of the fibula and the other had a malformed tibia and dislocation of the knee. The similarities between distal focal femoral deficiency and the more common proximal femoral defects are stressed.

Child, Preschool↗
PubMed1999

Zellweger syndrome in Saudi Arabia and its distinct features.

Clinical and laboratory findings of Zellweger syndrome (ZS) patients diagnosed at King Faisal Specialist Hospital and Research Center (KFSH & RC), Riyadh, Saudi Arabia over a period of 10 years are presented in this report. Eleven patients (nine females and two males) from 2 to 4 months old were referred to KFSH & RC for evaluation of hypotonia, seizures, and dysmorphic features. The common clinical findings included high forehead, large fontanelle, shallow orbit ridges, micrognathia, upslanting palebral fissures, epicanthal folds, severe hypotonia, hyporeflexia, pigmentary retinopathy, optic nerve atrophy, complete or partial agenesis of corpus callusum, and failure to thrive. We did not observe any Brushfield spots, any renal and brain cysts, or adrenal insufficiency. Some unique clinical findings were the presence of gallstones, club feet, or bilateral knee or hip dislocation in some patients. All patients had markedly elevated plasma levels of very long chain fatty acids (VLCFA). Electron microscopy performed on liver biopsies of two patients revealed absence of peroxisomes. Biochemical studies of dermal fibroblasts from three patients showed deficient beta-oxidation of lignoceric acid and dihydroxyacetone phosphate acyltransferase (DHAPATase) activity. The tribal living in Saudi Arabia and our observation that 10 of the 11 parents in this study were first-degree relatives and, except for families 1 and 3, each family had at least another baby who died of the same disease. This suggests that the incidence of ZS in Saudi Arabia may actually be higher than our experience at KFSH & RC.

Abnormalities, Multiple↗
PubMed1998

[Popliteal vascular trauma].

6 cases of popliteal vascular trauma are presented, 3 due to posterior dislocation of the knee and 3 due to crush injury. The patients were referred from another hospital and some had undergone unnecessary angiography when ischemia was present, leading to delay in surgery. All patients presented with distal ischemia and underwent reconstructive surgery; 2 subsequently underwent below-knee amputation because of irreversible ischemia and sepsis. Urgent operation for popliteal vascular trauma is necessary whenever there is ischemia and intraoperative angiography may be necessary. There should be reconstruction of the artery and vein when there is concomitant venous damage, and fasciotomy and debridement are important. The harmful potential of occult popliteal vascular injuries and their ostensible mild presentation present a challenge for the emergency room surgeon.

Adult↗
PubMed1992

Linkage studies of four fibrillar collagen genes in three pedigrees with Larsen-like syndrome.

We report seven children from three families who had a set of common clinical features suggestive of Larsen-like syndrome, including unusual facies, bilateral dislocations of the knees and elbows, club foot, and short stature. All of the patients originated from the island of La Réunion in the Indian Ocean. The occurrence of several affected sibs in these families and the large number of consanguineous marriages on this island are consistent with autosomal recessive inheritance of the disease. Based on this hypothesis, the pedigrees were used for linkage analysis in a candidate gene assay. Lod score calculations in a pairwise study with four different fibrillar collagen genes, COL1A1, COL1A2, COL3A1, and COL5A2, allowed us to exclude these genes as the mutant loci. Supporting this, electrophoretic analysis of collagens derived from fibroblast cultures failed to show defective molecules. We conclude that this syndrome is not a collagen disorder.

Abnormalities, Multiple↗
PubMed1987

Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index.

A retrospective review of 676 tibial-fibular fractures and 985 femoral fractures treated over a 71-month period yielded associated major vascular trauma in 12 (1.7%) tibial-fibular fractures and in five (0.5%) femoral fractures. Vascular trauma combined with orthopedic trauma was also identified in four other cases--two disruptions of the pubic symphysis and two dislocations of the knee without fracture. Nine (43%) of the 21 involved limbs were eventually amputated. Limb survival was not related to the temporal relationship of vessel repair to skeletal stabilization; the presence or absence of shock on admission; the presence of associated but repaired venous injury; or the presence of unrelated injuries. Limb survival was related to the interval from injury to arrival in the operating room; the level of arterial injury; and the quantitative degree of muscle, bone, and skin injury. By combining these variables a limb salvage index was established that identified lower extremities likely to require amputation after combined orthopedic and vascular trauma (sensitivity 78%, specificity 100%). Use of this predictive salvage index may prevent the trauma surgeon from attempting to salvage a doomed or useless lower extremity and may thus permit early prosthetic rehabilitation to follow definitive primary amputation.

Adolescent↗
PubMed1986

Nail-patella syndrome (hereditary osteo-onychodysplasia). A case report.

The present paper reports a case of osteo-onychodysplasia (nail-patella syndrome). There are very few descriptions of this syndrome in the orthopaedic literature, possibly because it is rare for the morphological changes in the knee and the associated abnormalities to require or be amenable to treatment. In the present case an accidental sprain of the right knee caused recurrent dislocation of the patella that necessitated surgical intervention.

Adult↗
PubMed1976

Clinical features and treatment of joint dislocations in Larsen's syndrome. Report of three cases in one family.

Of 3 cases of Larsen's syndrome in one family, one had bilateral dislocation of the hip and the knee joints. The knee joint was not reduced by manipulation and corrective cast, while both hip and knee joints were simultaneously reduced by skeletal traction of the tibia at the age of 4 months, and the course was satisfactory. Reduction of joint dislocations should be attempted by a conservative method such as skeletal traction as early as possible. Various radiographic skeletal abnormalities occurred in all 3 cases. Larsen's syndrome very likely has a genetic origin.

Abnormalities, Multiple↗
PubMed2005

Antero-medialisation of the tibial tubercle for patellar instability.

We reviewed 19 patients (24 knees) with patellofemoral instability treated surgically with antero-medialisation of the tibial tubercle and lateral retinacular release. Twenty-two knees had recurrent patellar dislocation and two patellar subluxation. Lateral retinacular release was performed arthroscopically in 15 knees. Average follow-up was 52 (16-86) months. There was one postoperative haemarthrosis and one failed fixation, which needed surgical revision. The average Lysholm score improved from 63.3 to 98 and only one knee had persistent patello-femoral pain postoperatively. The patellar tilt angle improved from 9.4 degrees to 5.5 degrees . There were no redislocations. We find that the surgical technique produces a consistent correction of patellar instability, but long-term studies are needed to confirm whether it can prevent arthritic degeneration.

Adolescent↗
PubMed1993

Pes anserinus transposition for patellar dislocations. Long-term follow-up results.

Transposition of part of the pes anserinus was used to treat 96 knees in 78 patients with recurrent, habitual or permanent dislocations of the patella. The knees with habitual (48) and permanent (27) dislocations also had extensive release of superolateral contracture. The patients were reviewed at an average follow-up of 9 years 8 months. The medial stability of the patella had been improved in all the cases. There were no recurrences in 21 knees with recurrent dislocations. There were four recurrences (5.3%) in knees with habitual and permanent dislocations due to inadequate release of the superolateral contracture and incorrect transfer of the whole of the pes anserinus. Correction of these technical errors prevented further recurrence in all four cases.

Adolescent↗
PubMedDate not supplied

The three-in-one proximal and distal soft tissue patellar realignment procedure. Results, and its place in the management of patellofemoral instability.

The three-in-one procedure for extensor mechanism realignment of the knee combines lateral release, vastus medialis obliquus muscle advancement, and transfer of the medial one-third of the patellar tendon to the tibial collateral ligament. We observed 37 patients (42 knees) receiving this treatment at a minimum 25-month follow-up (range, 25 to 85 months; mean, 44). Thirty-two of 42 knees (76%) with recurrent patellar dislocation had good or excellent results after surgery. Redislocation occurred in four knees (9.5%). Skeletal immaturity, chondral damage, and generalized ligament laxity did not seem to affect outcome. Thirty patients (37 knees) were studied 2 years earlier as well (mean follow-up, 29 months). When comparing the results 2 years later, there was a significant deterioration in outcome over time. These results are comparable with the published results for other techniques of patellar stabilization. We describe the place of the three-in-one operation in our surgical protocol for patellofemoral instability, which is based on the principle that a procedure should be selected to address the underlying pathologic features in an individual case rather than always using one operation for all cases.

Adolescent↗
PubMed2003

Chondral and osteochondral injuries associated with acute patellar dislocation.

PURPOSE: The purpose of this study was to evaluate the frequency and precise pathology of articular cartilage injuries after acute patellar dislocation. TYPE OF STUDY: Case series. METHODS: In 39 consecutive knees with initial lateral patellar dislocation, the articular cartilage injuries were examined using arthroscopy or macroscopic observation. RESULTS: Thirty-seven knees (95%) had articular cartilage injuries of the patellofemoral joint and 2 knees (5%) had no cartilage injury. In all 37 knees (95%), articular cartilage injuries were observed in the patella. The appearances were categorized into 3 groups: cracks alone (9 knees), cartilage defect caused by osteochondral or chondral fracture (7 knees), and cartilage defects caused by osteochondral or chondral fracture associated with cracks (21 knees). The main site of osteochondral fracture was the medial facet, and the main site of cracks was the central dome. Twelve knees (31%) had cartilage injury of the lateral femoral condyle. CONCLUSIONS: From this study, articular cartilage injuries, especially of the patella, seem to be common occurrences after acute patellar dislocation. Chondral and osteochondral injuries of the patella were classified into 3 groups.

Adolescent↗
PubMed2001

Congenital dislocation of the patella.

Congenital dislocation of the patella may occur as a persistent lateral dislocation of the patella that presents with a knee flexion contracture and the patella tethered lateral to the femoral condyles or as an intermittent dislocation of the patella. In the latter syndrome, the patella dislocates completely with each flexion and extension cycle of the knee and is best termed obligatory dislocation of the patella, because the patient has no control over the patella dislocating as he or she moves the knee. The first type of congenital dislocation, which is fixed, often is associated with syndromes such as arthrogryposis and should be corrected surgically by lateral release and realignment of the patella. Obligatory dislocation of the patella tends to be an isolated dysplastic anomaly and may be relatively well tolerated. Rebalancing of the patella usually is done at a later age because of less interference with function. The current author describes the natural history of patella femoral dysplasia, detailing the pathologic changes that are present, and recommends surgical techniques for correcting both types of congenital dislocation of the patella.

Child↗
PubMed2005

[Paralytic hip dislocation in cerebral palsy--soft tissue surgical procedures].

Results of a combination of soft tissue procedures performed for the first time in treating paralytic dislocation of the hip in cerebral palsy are presented. All hip flexors and adductors release, along with possible transposition or elongation of knee flexors on the side of the dislocation (if knee contracture exceeded 20) were peformed. 75 hips in 57 patients were operated on. 54 patients were analyzed. The average age of the patients was 6.6 years, the average follow-up was 7 years. Excellent result was achieved in 33patients (61%), good in 10 (18,6%), fair in 4 (7,4%) poor in 7 patients (13%). Poor results were registered in patients over 10 years of age and in patients with athetosis. Results were assessed according to clinical finding, radiological finding (migrational percentage) and the ability of patients to walk. When based on radiological findings only, excellent results were achieved in 63 hips (84%). This combination of soft-tissue procedures which includes all muscles that take part in the dislocation proved to be very successful in achieving reposition. It can be recommended to patients suffering from the spastic form of cerebral palsy up to 10 years of age.

Cerebral Palsy↗
PubMedDate not supplied

Patellar pain and quadriceps rehabilitation. An EMG study.

Eighteen patients (26 knees) giving a history of patellar dislocation and/or subluxation and continued patellar symptoms underwent evaluation to determine the efficacy of their rehabilitation programs. Four-channel cine-electromyography was utilized to assess the relative muscular effort of the vastus medialis, vastus lateralis, vastus medialis obliquus, and rectus femoris in a series of exercises. Ten degrees of flexion of the knee reduced effective muscle effort in the vasti group to an average of 1/4 of the muscle effort demonstrated in full extension of the knee. No consistent pattern was noted by altering the rotation of the hip from neutral to external or internal rotation. The addition of weight (5 lb) to the ankle did not enhance the muscle effort with the knee in full extension. Quadsets and straight leg-raising exercises in full knee extension offer the best quadriceps rehabilitation program in the patient with a patellar malalignment syndrome and persistent symptoms.

Adolescent↗
PubMed2002

Usefulness of the skyline view in the assessment of acute knee trauma in children.

We report a retrospective analysis of all cases of acute knee injuries in children presenting to the Winnipeg Children's Hospital, University of Manitoba, between Jan. 1, 1994, and Jan. 1, 1995. The mechanism of injury was recorded and all 3 radiographic views (i.e., anterioposterior, lateral and skyline) were available for 171 of 256 total cases. We found a significant association between mechanism of injury and visualization of damage on skyline view radiographs (p < 0.01). The skyline view showed damage in only 1 of the 158 cases involving direct or indirect injury not involving subluxation or dislocation. However, damage was visualized on skyline view radiographs in 7 (54%) of the 13 cases that included a history of subluxation or dislocation. We conclude that in acute knee trauma in children, a skyline view radiograph of the patella should be obtained only when the mechanism of injury includes subluxation or dislocation. When the mechanism does not suggest subluxation or dislocation, the skyline view is unlikely to reveal damage; it adds unnecessary radiation, cost and possible added discomfort for the child.

Acute Disease↗