Prosthetic interposition arthroplasty for the palliative treatment of end-stage spastic hip disease in nonambulatory patients with cerebral palsy.

We reviewed our experience in using a prosthetic arthroplasty for the treatment of painful degenerative arthritis in 11 nonambulatory patients (14 hips) with cerebral palsy. Age of the patients ranged from 11 to 20 years. Three patients had previously undergone a salvage procedure. Radiographic follow-up averaged 16 months (range, 4 months to 5 years). Ten of the hips remained located on the latest radiographs, and four of the hips dislocated within 4 months of the procedure. No patient exhibited migration or failure of the implants, although one patient exhibited periprosthetic osteolysis, which remained unchanged over a 4-year period. Clinical follow-up averaged 5 years (range, 2-6 years). Ten patients (13 hips) had complete relief of hip pain. Caretaker satisfaction was high for these patients, with all 10 caretakers stating that they would recommend the procedure. One patient continued to have persistent pain in the hip, and the caretaker stated that she would not recommend the procedure.

Posttraumatic tibia valga in children. A long-term follow-up note.

BACKGROUND: We reevaluated seven patients who initially had been managed nonoperatively because of a progressive valgus deformity that had occurred within approximately twelve months after satisfactory healing of a proximal tibial metaphyseal fracture sustained at an average age of four years (range, eleven months to six years and four months). All seven patients were described in a previous report from our institution, published in 1986. In that report, spontaneous improvement of the angulation was documented after an average duration of follow-up of thirty-nine months and nonoperative treatment of the deformity was recommended. METHODS: The patients were followed radiographically for an average of fifteen years and three months (range, ten years and four months to nineteen years and eleven months) after the injury. The radiographs were reviewed to determine the metaphyseal-diaphyseal angle, the mechanical tibiofemoral angle, the proximal and distal tibial remodeling angles, the limb-length discrepancy, and the deviation of the mechanical axis of the limb from the center of the knee joint. Knee function was assessed with use of the rating system of the Cincinnati Sportsmedicine and Orthopaedic Center, and ankle function was assessed with use of the rating system of the American Orthopaedic Foot and Ankle Society. RESULTS: Every patient had spontaneous improvement of the metaphyseal-diaphyseal and mechanical tibiofemoral angles. Most of the correction occurred at the proximal part of the tibia. The mechanical axis of the limb remained lateral to the center of the knee joint in every patient, with an average deviation of fifteen millimeters (range, three to twenty-four millimeters). The affected tibia was longer than the contralateral tibia in every patient, with an average limb-length discrepancy of nine millimeters (range, three to eighteen millimeters). The knee score on the affected side was excellent for five patients and fair for two; one of the patients who had a fair score had had a tibial osteotomy at the age of sixteen years because of pain in the lateral aspect of the knee that was thought to be due to malalignment. The ankle score on the affected side was excellent for three patients and good for four. CONCLUSIONS: Spontaneous improvement of the deformity occurred in all patients and resulted in a clinically well aligned, asymptomatic limb in most. We believe that patients who have posttraumatic tibia valga should be followed through skeletal maturity and that operative intervention should be reserved for patients who have symptoms secondary to malalignment.

Isolated rupture of the soleus muscle: a case report.

Injuries to the musculature of the posterior compartment of the calf are a frequent cause of pain, particularly among athletes. The majority of ruptures and strains in this area occur in the gastrocnemius muscle and, to a much lesser extent, in the plantaris muscle. We present a case of an unusual cause of calf pain--an isolated rupture of the soleus muscle--that developed in a 15-year-old girl after participation in a volleyball match. The injury was confirmed by T1- and T2-weighted magnetic resonance imaging. In this case, magnetic resonance imaging was helpful; however, the cost effectiveness of its use for this injury has yet to be proved.

The limping child: a manifestation of acute leukemia.

Nine patients who presented to our institution with the chief complaint of a limp and no history of trauma were subsequently diagnosed with leukemia. A review of these patients identified clinical and laboratory findings that helped to establish the diagnosis. The presence of an antalgic gait with complaints of pain of variable intensity and duration, an irritable hip or knee, a mild to moderate elevation in body temperature, lymphadenopathy, hepatosplenomegaly, an increased erythrocyte sedimentation rate, thrombocytopenia, anemia, decreased neutrophils, increased lymphocytes, or blast cells on the peripheral blood smear should cause the physician to suspect leukemia in a limping child. Bone marrow biopsy confirms the diagnosis.

Epiphyseal-metaphyseal enchondromatosis. A new clinical entity.

We reviewed the cases of eight unrelated children who had an unusual form of enchondromatosis characterized by unilateral enchondromas arising within the epiphyseal and metaphyseal regions of the long tubular bones of the lower extremity. Unlike previously described enchondromas, the lesions developed extensively within the epiphysis before closure of the growth plate and there was direct extension across the epiphyseal growth plate into the metaphysis. The lesions resulted in severe limb-length discrepancy and angular deformity (which increased in every patient after the time of presentation), asymmetrical premature physeal arrest, and joint incongruity, all of which necessitated numerous operative procedures. Seven patients had limb-lengthening and one had a Boyd amputation without lengthening. Five patients had a second lengthening procedure. Twenty-seven osteotomies (range, one to five procedures per patient) were done; six patients had a repeat osteotomy. Four patients had an epiphyseodesis. We believe that these lesions represent a previously undescribed clinical entity, which we termed epiphyseal-metaphyseal enchondromatosis.