ABSTRACT
Operative intervention for juvenile flexible flatfoot is considered after a protracted course of orthotics and shoe modifications have failed to relieve associated symptoms. Surgical treatment options include hindfoot fusion, soft tissue procedures, calcaneal osteotomies, limited midtarsal arthrodeses, combination techniques, and subtalar arthroereisis. Long-term, high success rates have been documented with use of combination procedures and the anterior calcaneal osteotomy of Evans.
Subject(s)
Flatfoot/surgery , Adolescent , Child , Flatfoot/diagnosis , Flatfoot/diagnostic imaging , Flatfoot/physiopathology , Foot/diagnostic imaging , Foot Bones/surgery , Humans , Physical Examination , Prostheses and Implants , RadiographyABSTRACT
Eight patients (average age, 10 years) had a unilateral forearm lengthening procedure using the technique developed by Ilizarov. The procedure was performed in 4 patients with radial agenesis, in 2 with multiple hereditary exostosis, in 1 with ulnar agenesis, and in 1 with multiple enchondromatosis. Patients underwent distraction osteogenesis through either a unifocal or bifocal corticotomy. Forearm length increased on average 6.0 cm (range, 3.6-8.1 cm) or 54% (range, 21% to 94%) with a lengthening index of 1.3 months per centimeter (range, 0.6-1.9 months per centimeter). The length of follow-up averaged 4.5 years and involved office examinations with task evaluation and a questionnaire addressing function and appearance. Limb length discrepancy at follow-up measured 3.7 cm (range, 0.0-8.0 cm). Lengthening of the forearm was found to improve upper extremity function; it allowed the patient to reach distant body parts and to perform select activities requiring near-equal arm length. Forearm lengthening also improved the appearance of the arm if adequate soft tissue was preserved. Full restoration of arm length was not a requirement for a successful outcome and patient satisfaction with the results of the procedure was high.
Subject(s)
Forearm/abnormalities , Ilizarov Technique , Radius/surgery , Ulna/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Male , Postoperative Complications , Radiography , Radius/abnormalities , Radius/diagnostic imaging , Treatment Outcome , Ulna/abnormalitiesABSTRACT
Twenty-one cadaveric knees were dissected to analyze the functional anatomy of the vastus medialis complex (VMC), which is composed of the vastus medialis obliquus (VMO) and the vastus medialis longus (VML) muscles. The physiologic cross-sectional area of the VMO for 20 of the knees was 29% of the total physiologic cross-sectional area for the VMC. These values differed in one knee with a dysplastic VMO. The quantitative description of the VMO provided by this study will facilitate future efforts to accurately model the physiologic function of the VMO in cadaveric investigations on patellofemoral mechanics. The effect of simulated pathologies and surgical reconstructions then may be determined with more certainty to improve patient management.
