Subcapital osteotomy of the femoral neck for patients with healed slipped capital femoral epiphysis.

We report the clinical and radiological outcome of subcapital osteotomy of the femoral neck in the management of symptomatic femoroacetabular impingement (FAI) resulting from a healed slipped capital femoral epiphysis (SCFE). We believe this is only the second such study in the literature. We studied eight patients (eight hips) with symptomatic FAI after a moderate to severe healed SCFE. There were six male and two female patients, with a mean age of 17.8 years (13 to 29). All patients underwent a subcapital intracapsular osteotomy of the femoral neck after surgical hip dislocation and creation of an extended retinacular soft-tissue flap. The mean follow-up was 41 months (20 to 84). Clinical assessment included measurement of range of movement, Harris Hip Score (HHS) and Western Ontario and McMaster Universities Osteoarthritis score (WOMAC). Radiological assessment included pre- and post-operative calculation of the anterior slip angle (ASA) and lateral slip angle (LSA), the anterior offset angle (AOA) and centre head-trochanteric distance (CTD). The mean HHS at final follow-up was 92.5 (85 to 100), and the mean WOMAC scores for pain, stiffness and function were 1.3 (0 to 4), 1.4 (0 to 6) and 3.6 (0 to 19) respectively. There was a statistically significant improvement in all the radiological measurements post-operatively. The mean ASA improved from 36.6° (29° to 44°) to 10.3° (5° to 17°) (p < 0.01). The mean LSA improved from 36.6° (31° to 43°) to 15.4° (8° to 21°) (p < 0.01). The mean AOA decreased from 64.4° (50° to 78°) 32.0° (25° to 39°) post-operatively (p < 0.01). The mean CTD improved from -8.2 mm (-13.8 to +3.1) to +2.8 mm (-7.6 to +11.0) (p < 0.01). Two patients underwent further surgery for nonunion. No patient suffered avascular necrosis of the femoral head. Subcapital osteotomy for patients with a healed SCFE is more challenging than subcapital re-orientation in those with an acute or sub-acute SCFE and an open physis. An effective correction of the deformity, however, can be achieved with relief of symptoms related to impingement.

Pemberton osteotomy for residual acetabular dysplasia in children who have congenital dislocation of the hip.

We reviewed the results for fifty-two hips in forty-two patients who had had a Pemberton pericapsular osteotomy between 1968 and 1984 as treatment for residual acetabular dysplasia of the hip. The average age of the patients at the time of the osteotomy was four years. The average duration of follow-up was ten years. At the time of the most recent follow-up, forty-two of the fifty-two hips had a rating of Severin class IA, an essentially normally developed hip. The results of the Pemberton osteotomy were unpredictable if there had been necrosis of the femoral head (without infection) preoperatively. We believe that the Pemberton osteotomy is a safe, effective procedure for the treatment of acetabular dysplasia in patients who have congenital dislocation of the hip.

Concentric and eccentric quadriceps torque in pre-adolescent males.

The purpose of this study was to evaluate the applicability of using the Kin Com (Chattecx Corp., Chattanooga, TN) isokinetic machine to measure concentric and eccentric quadriceps torque in a group of 12 healthy male volunteers aged 10-12 years. Each individual was tested by an experienced physiotherapist using a 60 degree per second velocity mode according to our standardized protocol. Average and peak torque values for concentric and eccentric contractions of the quadriceps were recorded; based upon the best of three maximum effort trials on each lower extremity. Retesting was performed on a randomly selected sub-group in an identical manner two weeks later. Our results showed no statistically significant difference between the original and retest values using the method error of repeated measurements and paired t-test analyses. Eccentric peak torque was greater on average than concentric. This was significant with p-values of 0.01 for the non-dominant quadriceps and 0.002 for the dominant side (paired t-test). There was no significant difference between the dominant and non-dominant sides. In conclusion, eccentric muscle testing has been reliably quantitated for the first time in children. This study has shown a practical and reproducible method of quantitative muscle strength assessment.

The effect of cryopreservation on the biomechanical behavior of bovine articular cartilage.

The short-term effect of cryopreservation on specific mechanical behaviors of bovine articular cartilage has been investigated. A flat-ended nonporous indentor was used in a nondestructive, repetitive, axisymmetric unconstrained testing system. Cyclical indentation from a fixed position to a fixed load was applied until a steady-state load-deformation relationship (limit cycle) was achieved. Indentation behaviors measured from the limit cycles of each articular cartilage specimen before and after treatment were compared. Testing was done in vitro using fresh, mature bovine radiocarpal joints. Twenty pairs of cartilage-subchondral bone cores from anatomically similar sites on contralateral joints were separated into three groups; thickness controls, dimethylsulfoxide (DMSO) controls, and cryopreserved experimental samples. Thickness controls and DMSO controls were used to examine the isolated effects of the thickness measurement and DMSO incubation techniques on articular cartilage indentation characteristics. Experimental samples were cryopreserved using DMSO, their thicknesses similarly measured and indentation behaviors examined. Following testing, histological and histochemical assessment of the specimens confirmed the nondestructive nature of the tests. Intra- and intergroup comparisons of controls and experimentals revealed no statistical differences in the mechanical behaviors measured from the limit cycle or in cartilage thickness. These results indicate that the cryopreservation protocol used did not have an effect that we could measure on these specific mechanical behaviors of articular cartilage.

Localized acquired hypertrichosis associated with fracture and cast application.

Three children who developed localized hypertrichosis following a fracture and cast application are described. We postulate that cutaneous hyperemia may be responsible for the hypertrichosis.

Internal fixation techniques for proximal humeral fractures.

Operative treatment of proximal humeral fractures is performed with a variety of fixation techniques. Selection of the optimum device for fixation is dependent on anatomic considerations, fracture characteristics, surgical exposure, and biomechanical features of fixation devices. Fixation objectives are evaluated in light of Neer's four segment classification. An extended deltopectoral approach with release of anterior deltoid distal insertion as well as the proximal pectoralis major raphe provides a wide exposure. The approach heals rapidly and allows rapid rehabilitation. The shoulder fracture fragments are adaptable to tension band wiring. With loss of bone stock, tension band wiring becomes increasingly important because compression or shearing forces can be expended in the tendinous insertion of the fragments. Fixation principles are applied according to specific fracture patterns. Whatever the choice of fixation method, a protracted and vigorous rehabilitation program is essential to achieve maximal functional recovery.