Treatment of trochanteric bursitis: our experience.

[Purpose] Trochanteric bursitis is a disease for which there are no effective standardized therapy protocols. Very often pain persists in spite of applying all therapeutic treatments. The purpose of this study was to determine whether treatment of trochanteric bursitis with a local injection of bicomponent corticosteroid and 2% lidocaine would improve patients' conditions and relieve pain symptoms in the trochanteric area. [Subjects and Methods] A retrospective observational study was conducted of 2,217 patients in a 6 year follow-up period at the Special Hospital "Agens", Mataruska Banja, Serbia. [Results] Of 2,217 examined patients, 58 (2.6%) patients were found to suffer from trochanteritis associated with low back pain, and 157 (7%) were found to suffer from trochanteric pains without low back pains. Local corticosteroid therapy followed by physical therapy was effective in 77 (49%) of these patients, and only corticosteroid injection in 61 (39%) patients. A single injection was given to 47 (29.9%) of the patients. Two injections were given to 9 (5.7%) patients, and from 3 to 5 injections were given repeatedly every 4-6 weeks to 7 (4.5%) patients. [Conclusion] For most patients, local injections of corticosteroids with lidocaine alone or followed by physical therapy gave satisfactory results.

The results of surgical treatment for pronation deformities of the forearm in cerebral palsy after a mean follow-up of 17.5 years.

AIM: This study evaluates the effects of three surgical procedures in the treatment of pronation deformities of the forearm in cerebral palsy patients; namely the transposition of pronator teres to extensor carpi radialis brevis muscle; and rerouting of the pronator teres muscle with or without pronator quadratus muscle myotomy. METHODS: Sixty-one patients, 48 male/13 female, with a mean age of 17 years (5-41 years) were treated between 1971 and 2011. Pronator teres transposition was performed in 10, pronator rerouting in 35, and pronator rereouting with pronator quadratus myotomy in 16 patients. Ranges of motion, and assessments using the Quick Dash, Mayo Scoring, and Functional Classification system of upper extremity, were made before and after surgery. Mean follow-up was 17.5 years (3-41 years). RESULTS: All three procedures led to significantly improved ranges of motion and upper limb function, with good/excellent results in 80 % of patients. Mean active supination improved from 10 ° (0-60 °) to 85 ° (30-90 °) (p < 0.001). There were significant improvements in Functional Classification system for the upper extremity scores (p < 0.003), Mean Quick Dash Scores improved from 58.41 (38.63-79.54) to 44.59 (27.27-68.18), and mean MEPS improved from 68 (30-85) to 84 (60-100) following surgery. All three techniques had statistically improved MEPS following surgery (p < 0.001); only the pronator teres muscle rerouting with pronator quadratus myotomy showed an improved Functional Classification system for the upper extremity score (p < 0.05); and only the pronator teres rerouting procedure showed an improved Quick Dash score (p < 0.05). There were no statistically significant differences in outcomes between different ages groups, and no significant differences between isolated pronator teres muscle rerouting were compared with those undergoing simultaneous treatment of carpal flexion and thumb adduction deformities (p > 0.05). CONCLUSION: Surgery is very effective in the management of pronation deformities of the forearm in patients with cerebral palsy. Isolated pronator teres rerouting is probably the most effective and simple technique. Adjunctive pronator quadratus myotomy does not lead to an improvement in the results and requires an additional surgical approach. There should be no age restriction to surgery, as all age groups appear to benefit from similar improvements in range of motion and upper limb function.

A radiographic and clinical comparison of two soft-tissue procedures for paralytic subluxation of the hip in cerebral palsy.

This article summarises a comparative retrospective study (1983-2001) of 42 consecutive spastic-diplegic ambulatory patients (aged 2-10 years) by examining the radiographic and clinical results of two soft-tissue procedures for paralytic hip subluxation (PSH). Group A comprised 20 patients (26 PSHs) who were treated by iliopsoas tenotomy, and group B comprised 22 patients (31 PSHs) who were treated by rectus femoris and iliopsoas tenotomy with iliac crest resection (sartorius release). All patients had bilateral adductor tenotomies. At 8.8 years mean follow-up, group A migration percentages (MP) improved from 39.8% to 24.7% with 92.3% good/average results. At a mean follow-up period of 8.3 years, group B improved from 58.0% to 25.9% with 96.8% good/average results. Long-term hip reduction was achieved in 84.6% of group A and 80.6% of group B hips. Relative MP correction was superior in group B. No patient had MP progression in either the PSH or non-PSH hip. Walking ability improved in 55% of group A and 86% of group B patients (Functional Mobility Scale). In conclusion, we recommend release of all the principle hip flexors: rectus femoris, sartorius, and iliopsoas, coupled with adductor tenotomies, in this patient group.

Femoral derotation osteotomy in cerebral palsy: precise determination by tables.

Femoral derotation osteotomy is used to treat increased femoral neck anteversion and to correct medial hip rotation deformity in patients with cerebral palsy. We investigated if there were significant differences between planned and achieved corrections of increased femoral neck anteversion and whether our method influenced walking ability and number of complaints. We retrospectively evaluated 17 ambulatory patients (21 femurs) with cerebral palsy and medial rotation deformity of the hip. The new method of determining femoral derotation osteotomy precisely and simply using tables was applied. The average followup was 11 years (range, 3-20 years), and the average age of the patients was 20 years (range, 9-42 years). The average planned correction of femoral neck anteversion was 31.9 degrees (range, 20 degrees - 45 degrees), and the average achieved correction was 32.19 degrees (range, 15 degrees - 40 degrees). Of the 17 patients evaluated, 13 no longer had complaints. Deterioration of walking ability was not observed in any patients. The new method of determining femoral derotation osteotomy precisely and simply corrects femoral neck ante- version in patients with cerebral palsy and medial rotation deformity of the hip, leading to reduction in complaints and improved walking ability.

[Reconstruction of the infected war defects of the tibia: a fragment elongation according to the Ilizarov technique].

INTRODUCTION/AIM: The treatment of tibia defects complicated with chronic osteomyelitis is difficult, often requiring one or more surgical interventions with prolonged periods of functional incapacity. METHODS: We treated 20 patients with tibia defects, who had been wounded during the war operations in the former Yugoslavia, complicated with chronic osteomyelitis by applying the Ilizarov apparatus. In 10 patients with the average defect of 4.7 cm, interfragmentary diastasis of 1.5 cm, and 3.1 cm of shortening we applied the bilocal synchronous compressive - distractive method (BSCD). In the remaining 10 patients with average defect of 6.4 cm, interfragmentary diastasis of 5.5 cm, and 1.6 cm of shortening we applied bilocal alternating distractive - compressive osteosynthesis (BADC). RESULTS: The average followup was 93 months. In the group A, the average distraction index was 10.6, maturation index 39.8, and external fixation index 52.5. In the group B, the average distraction index was 11.7, maturation index 47.1, and external fixation index 60.1. The average time from the application to the apparatus removing was in the group A 6.5 months, and in the group B 11.9 months. There were 27 complications: 11 problems, 8 disturbs, and 8 true complications. Pin-track inflammation of the soft tissue was noted most frequently (6 patients). CONCLUSIONS: One stage of repairing inflamation and the restitution of defect in lower leg tissue was the advantage of this type of treatment. All of the patients recovered. There was not any bad result, either in osteal or in functional outcome.

[Medial rotation deformity of the hip in cerebral palsy: surgical treatment by transposition of gluteal muscles].

INTRODUCTION: Medial rotation deformity of the hip is a problem to patients who are handicapped by cerebral palsy but able to walk, because the knees point inward during gait ("kissing patellae") and cause falls and frequent injuries. Knees and ankles are subject to stress and, therefore, they assume compensating positions. Lower legs assume position of valgus and external rotation, whereas feet rotate either inwards or outwards. Secondary deformities make gait more difficult and cause rapid tear of footwear. AIM: The purpose of the paper was to retrospectively analyze the effects of transposition of the gluteus medius and minimus muscles, a procedure introduced for the first time in our country in order to correct the deformity. A new method of binding the muscles by wire was described. There had been no previous experience with this method. METHOD: This operation was indicated in patients with spastic form of cerebral palsy, who were able to walk, who had difficulties in gait and whose lateral rotation was less than 10 degrees along with the medial rotation of over 70 degrees of the hip on the side of the deformity. Additional prerequisite for the operation was the absence of flexion contracture of more than 15 degrees of either the hip or the knee on the side of deformity, as there is possibility of aggravation of the flexion hip deformity due to transposed gluteal muscles (now in front of the hip joint). Fifteen hips of 10 patients were operated on. Five patients were operated on bilaterally at one time. The average age was 8 (6-12) years. The majority of patients, 8 (80%) were aged between 6 and 8. The average follow-up was 5 years (3-8). The assessment of the results was based on the comparison of rotational abilities of both hips before and after the operation (in unilateral and bilateral deformities), as well as on individual complaints before and after the operation. In patients with unilateral deformity, their "healthy" hips were the control hips. The analysis of the femoral neck anteversion before and after operation was performed. RESULTS: Average values of medial and lateral rotation of the deformed hips before operation exhibited significant statistical difference when compared to control hips. The difference of average values of rotatory movements of control and operated hips was not statistically significant after operation. The difference of average preoperative values of the femoral neck anteversion in hips with deformity was statistically significant (49.40+/-4.63 degrees compared to 32.8+/-3.11 degrees ). Postoperative average values of anteversion in operated and control hips were not statistically significant. The difference between average preoperative (49.40+/-4.63 degrees ) and postoperative (35.80+/-7.66 degrees ) values of the femoral neck anteversion was statistically significant. Excellent results were achieved in 5 (50%) patients, i.e. 8 (53.3%) hips; good results were achieved in 3 (30%) patients, i.e. 5 (33.3%) hips; poor result in 2 (20%) patients, i.e. 2 (13.3%) hips. All 5 patients who had undergone surgery of both hips had symmetric outcome. Three patients had excellent results, while two had good results. Patients with excellent and good results (80% of patients, 86.6% of hips) showed neither weakening of the operated hip abduction nor pelvic instability (positive Trendelenburgh hip test). No complications were recorded postoperatively. CONCLUSION: Transposition of gluteal muscles can be recommended in patients under 10 years of age as there is still a chance for their femoral neck to change orientation, to decrease the anteversion and thus to achieve long-lasting effect. Fixation of transposed muscles by wire proved to be effective.