Subject(s)
Accidents, Traffic , Fracture Healing/physiology , Fractures, Open/surgery , Hip Fractures/complications , Nerve Compression Syndromes/complications , Sciatic Nerve/injuries , Child , Electromyography , Female , Follow-Up Studies , Fracture Fixation, Internal/methods , Fractures, Open/etiology , Hip Fractures/diagnostic imaging , Hip Fractures/surgery , Humans , Nerve Compression Syndromes/diagnostic imaging , Nerve Compression Syndromes/surgery , RadiographyABSTRACT
Seventeen patients with infantile Blount disease who were treated by surgical correction and followed up to skeletal maturity were reviewed by clinical and radiographic examination. Patients with symptomatic knees or significant ligament instability or both underwent further evaluation by magnetic resonance imaging (MRI) or arthroscopy or both. Average age at time of initial surgery was 5.5 years and at final follow-up was 20.5 years. Average length of follow-up was 15 years. Recurrence of the deformity requiring repeated osteotomy occurred more frequently in children who underwent initial osteotomy at > 4 years of age or at Langenskiöld stage > or = III or both. Patients who underwent a single osteotomy for correction of their deformity had significantly decreased pain in the affected knee at maturity. All patients who were symptomatic or had significant knee instability or both had abnormal ligamentous, meniscal, or bony changes (or more than one of these) on MRI, which were confirmed by arthroscopy. Early surgical intervention during initial stages of the disease process will result in a decreased incidence of recurrence of deformity and decreased symptoms and knee pathology at skeletal maturity.
Subject(s)
Bone Diseases, Developmental/surgery , Fibula/surgery , Osteotomy , Tibia/surgery , Arthroscopy , Bone Diseases, Developmental/diagnosis , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Menisci, Tibial/pathology , Retrospective Studies , Treatment OutcomeABSTRACT
We describe a modified technique using the gluteus maximum muscle as a splitting myocutaneous flap to close specifically low sacral and coccygeal pressure ulcers. Twenty-eight patients with sacral or coccygeal stage IV pressure ulcers (average size 4 x 4 cm) underwent a gluteus maximus muscle-splitting myocutaneous flap when conservative treatment failed to heal the ulcer. Twenty-seven of the 28 patients had complete healing of the pressure ulcer site at an average follow-up of 15 months (range 2 to 40 months). Complications occurred in 7 patients, requiring revision of the flap in 2 patients. The advantages of this technique include reduced blood loss, preservation of most of the gluteus maximus for future use, and retained function of the gluteus maximus for stair climbing and single-limb support in the ambulatory patient. We recommend the gluteus maximus muscle-splitting myocutaneous flap as the procedure of choice for closure of small low sacral or coccygeal ulcers in both the ambulatory and nonambulatory patient.
