Speeded gradual lengthening and secondary angled blade plate stabilisation for proximal tibial shaft non-union with shortening.

Eighteen patients with proximal tibial shaft non-union and shortening were treated. In each patient, the non-union area was débrided, realigned and stabilised with an Ilizarov lengthening frame. The tibia was gradually lengthened by 1-1.5 mm per day. After achieving the desired length, external fixation was converted to an angled blade plate and packed with cancellous bone graft. Follow-up of 16 patients for a median of 2.4 (1.2-4.5) years revealed satisfactory outcomes in all. No wound infections were noted. The described technique has a high success rate, a short treatment course and reduces patient discomfort. This method may be considered preferential treatment for all patients with the specified indications.

Sonographic and color Doppler sonographic diagnosis of acute osteomyelitis: report of one case.

Acute osteomyelitis in childhood is uncommon. Early diagnosis is often difficult. We present a 7-year-old boy with clinical manifestation of fever and progressive left thigh swelling for one week. Sonography of the left thigh showed periosteal thickening with subperiosteal abscess around the metaphysis of the left distal femur. Tc-99m bone scintigraphy showed increased uptakes at the left distal femur. Osteomyelitis was suspected from the examination of ultrasound and bone scan examinations. His symptoms were not relieved following systemic antibiotic therapy and a follow-up color Doppler sonography showed vascular flows within and around the periosteum indicating active inflammation. He finally received surgical drainage and the operative findings confirmed the diagnosis of osteomyelitis. In conclusion, ultrasound may be a helpful and convenient tool for establishing the early diagnosis of pediatric osteomyelitis. Ultrasound and color Doppler sonography can be used as clinical parameters to evaluate the disease severity and the progression of osteomyelitis in children.

Localized femoral osteolysis in cementless ceramic total hip arthroplasty.

A retrospective review revealed localized femoral osteolysis occurred in 8 out of 134 cementless ceramic total hip arthroplasties (6.0%) performed during an average 9-year period. The average latent period was 8 years. The lesion was usually located in the deeper periprosthetic area. Localized osteolysis usually occurred after loosening of the femoral stem, suggesting the pathogenesis may be a foreign-body reaction to the ceramic debris.

Acute septic arthritis of the hip in children--clinical analyses of 31 cases.

This is a retrospective study of 31 cases of acute septic arthritis of the hip in children treated at Chang Gung Memorial Hospital from 1983 to 1989. The average follow-up period was 35 months. Among them, there were 18 males (58%) and 13 females (42%). None were involved bilaterally. Fifteen cases (48%) were below 5 years of age. All cases met the diagnostic criteria including bacteriological results, clinical and radiographic changes. Limited range of motion, fever, and tenderness were the most common symptoms and signs. More than half of the patients (52%) had a leukocyte count of over 15,000/cmm. The erythrocyte sedimentation rate was elevated in 30 cases (97%). Pathogens had been isolated from blood, arthrocentesis fluid, or surgical specimens in 26 cases (84%). Staphylococcus aureus was the most common causative organism (58%). Twenty-seven cases (87%) underwent emergency arthrotomy and debridement. Five (19%) of them received unsatisfactory results. A delay in definite treatment, very young infants, and the association with osteomyelitis of the adjacent bone were the important factors associated with poor prognosis. Four cases (13%) who received only medical treatment showed satisfactory results. Early diagnosis and significant response to antibiotics contributed to this favorable outcome.

A simpler surgical technique to treat aseptic nonunion-associated femoral length discrepancy.

In a prospective study from December 1986 to August 1989, 17 consecutive patients with femoral shortening due to aseptic nonunion of femoral shaft fractures were treated with limitedly open Gross-Kempf locking nailing with a lengthening procedure. Patients were followed up for at least 1 year (average 25 months). There was a 88.2% union rate with an average union period of 5.2 months. Average lengthening was 2.4 cm (1.0 approximately 3.0 cm), and average operation time 90 min (70 approximately 130 min). The blood loss was slight (average 200 ml). Complications (11.8%) were 5.9% implant failure and 5.9% nonunion which were not difficult to manage. No neurovascular complications were noted. We conclude that for 5 cm shortening or less in femoral aseptic nonunion, this treatment constitutes the simplest technique and can achieve a very satisfactory result.

Effect of long-term alcohol ingestion on the femoral head of rabbit.

Twenty New Zealand rabbits were chosen for this study (5 for controls and 15 for the alcohol group). In the alcohol group, each rabbit was fed with rice wine (2 g/kg/day alcohol) for 1 year. Bone marrow pressure of the femoral basal neck, erythrocyte sedimentation rate (ESR), liver functions, uric acid, triglyceride, cholesterol, amylase, and blood alcohol level were measured at 0 day, 6 months and 1 year. Finally, the rabbits were sacrificed at the end of the study. The livers and femoral heads were examined for pathology. The bone volume and fat cell size of the femoral head were measured with a computerized "Bone Scanner". The results (1 year comparison) were a significantly higher level of cholesterol in the alcohol group (72 +/- 40 mg% vs 26 +/- 8 mg%, p less than 0.05) and greater bone marrow pressure (27.71 +/- 8.97 mmHg vs 18.20 +/- 4.09 mmHg, p less than 0.05), and no significant difference in triglyceride, uric acid and liver function, ESR, etc., when using Student's 2-tailed t-test. Liver changes (fatty liver) occurred in 3 animals in the alcohol group. The effect of alcohol on the trabecular bone volume was not significant (51.5 +/- 4.6 vol.% vs 50.0 +/- 5.2 vol.%), but the average fat cell size of the femoral head was significantly larger than that for normal controls (2,745 +/- 605 mu2 vs 2,185 +/- 458 mu2, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Subtrochanteric fractures treated with interlocking nailing.

In a prospective study of 31 subtrochanteric fractures treated with Grosse-Kempf interlocking nails with a followup period of at least 1 year, there was a 87.1% (27/31) union rate, and a union period of 4.2 +/- 1.8 months. Knee range of motion in 28 acute traumatic cases was on average 127.5 +/- 23.0 degrees. The significant complications included: nail breakage, 3.2% (1/31); nonunion without nail breakage, 9.7% (3/31); neglected femoral fracture with malunion, 3.2% (1/31). The interlocking nailing has the advantages of: a) closed method, b) weight-sharing principle, c) shortening prevention, d) non-rigid fixation. From the theoretical and clinical comparison among the various implants, we conclude that closed interlocking nailing is one of the better instruments for subtrochanteric fracture treatment, and moreover, the most reasonable of all. However, for the higher level subtrochanteric fractures, reconstruction-style locking nails should be chosen.

Treatment of femoral shaft fractures with the Hoffmann external fixator in prepuberty.

Twenty-two children with femoral shaft fractures, between the age of 10 and 14 years, were treated with the Hoffmann external fixation apparatus from 1980 to 1985. This method of treatment is very simple. It requires less surgical exposure and allows earlier ambulation and easy nursing care. In addition, it makes patients comfortable in multiple trauma conditions. The average time to union and removal of fixators was 72 days (range, 44 to 80 days). There were no deep wound infections, nonunions, or rotationary deformities. On followup, all patients regained the range of motion of knee joints in 3 months without significant leg length discrepancy or radiographic evidence of growth disturbance. The device may serve as an alternative method for femoral shaft fractures in prepuberty, especially in areas of tropical climate.

Intraosseous hypertension in osteoarthritis of the hip and ischemic necrosis of the femoral head.

Intraosseous hypertension is noted both in osteoarthritis of the hip and ischemic necrosis of the femoral head. The mean intraosseous pressure in osteoarthritis cases was 30.0 +/- 4.2 mmHg. The incidence of abnormal intraosseous pressure and positive stress tests was 39% and 26.7%, respectively. In patients with ischemic necrosis of the femoral head, intraosseous pressure was 45.6 +/- 19.4 mmHg, 79% of patients had abnormal intraosseous pressure, and 56.1% had positive stress tests. Intraosseous pressure studies indicated a statistically significant difference between patients with osteoarthritis and those with ischemic necrosis of the femoral head.

Effects of stimulation of the satiety and feeding centers on gastric, cecal and rectal motility in the rat.

The effects of electrical stimulation of the satiety and feeding centers (SC, FC) on gastric, cecal and rectal motility were studied in rats anesthetized with urethane. Each center produced excitatory, inhibitory and biphasic responses in these organs. Cecal and rectal responses to stimulation of SC or FC were usually the opposite of the gastric response; for example, the gastric response was excitatory, whereas cecal and rectal responses were inhibitory. Gastric and cecal excitatory responses were abolished by vagotomy and the rectal response by severance of parasympathetic branches of the pudendal plexus (PSB). Gastric and ceca inhibitory responses were fairly depressed by vagotomy and abolished by successive splanchnicotomy, while the rectal inhibitory response was abolished by severance of inferior mesenteric nerves (IMN) and PSB. It was concluded that the satiety and feeding centers modulate not only gastric motility but also cecal and rectal motility, and that the excitatory response is conveyed through vagus nerves to the stomach and cecum and through PSB to the rectum. The inhibitory response is mediated mainly through vagus nerves, partially through splanchnic nerves to the stomach and cecum, and through IMN and PSB to the rectum. The characteristics of efferent terminal neurons eliciting excitatory and inhibitory responses were studied pharmacologically.

On the gastrocecal inhibitory reflex in the rat.

In rats anesthetized with urethane, the effects of distention of the stomach upon cecal motility and neural mechanisms which generate this effect were studied. Cecal motility was inhibited which generate this effect were studied. Cecal motility was inhibited when the pars glandularis of the stomach was distended by pressure ranging from 25 to 30 cm H2O. This inhibitory reflex was not affected by bilateral cervical vagotomy, but completely abolished following bilateral severance of the greater splanchnic nerves or after intravenous administration of guanethidine. After transection of the spinal cord at the level of the 5th thoracic segment the inhibitory reflex remained intact, but was abolished following pithing of the 6th thoracic segment and below. It may be concluded that the afferent and efferent path of the gastrocecal inhibitory reflex mainly pass through the greater splanchnic nerves and the reflex center is located in thoracic segments caudal to the 6th thoracic segment.