ABSTRACT
A rare case of a complete fracture-separation of the proximal radial epiphysis is described in a pediatric patient. A further complicating factor is the delay in diagnosis that may worsen prognosis. An emphasis on early detection by physical examination and imaging studies, as well as consideration of treatment options, are presented.
Subject(s)
Elbow Injuries , Radius Fractures/diagnostic imaging , Bone Wires , Child, Preschool , Elbow Joint/diagnostic imaging , Humans , Male , Radiography , Radius Fractures/surgeryABSTRACT
A longitudinal study was performed in a series of 124 New Zealand White rabbits to determine the radiographic versus the histologic age of closure of the growth plates of the distal femur, proximal tibia, and proximal fibula. Periodic assessment was made by standard radiographs and histological studies. Histologically, growth plates in the distal femur closed at 19-24 weeks; growth plates in the proximal tibia, at 25-32 weeks; and growth plates in the proximal fibula, at 26-32 weeks. Radiographically, evidence of closure of growth plates in the distal femur occurred at 20-23 weeks; in the proximal tibia, at 22-27 weeks; and in the proximal fibula, at 23-31 weeks. A discrepancy in age between radiographic and histologic closure of the growth plate occurred in 3.6% of the femora, 10.9% of the tibias, and 16% of the fibulas.
Subject(s)
Femur/physiology , Fibula/physiology , Growth Plate/physiology , Tibia/physiology , Age Factors , Animals , Female , Femur/diagnostic imaging , Fibula/diagnostic imaging , Growth Plate/diagnostic imaging , Longitudinal Studies , Male , Rabbits , Radiography , Tibia/diagnostic imagingABSTRACT
The reoperated clubfeet of 29 children aged one to 12 years were reviewed. The surgical procedure most often used in revision surgery was recomplete soft-tissue release alone or combined with plantar release, calcaneocuboid fusion, and capsulotomies of the navicular-first cuneiform-first metatarsal joint. In 27 of 29 feet, acceptable results were achieved. Nineteen were excellent and good results. An algorithm that suggests surgical solutions to a variety of clubfoot deformities in different age groups has been developed, as well as an objective rating system, to evaluate the long-term results of revision surgery of clubfeet.
Subject(s)
Clubfoot/surgery , Child , Child, Preschool , Clubfoot/classification , Humans , Infant , Reoperation/methodsABSTRACT
Traditional conservative and surgical methods of treatment of melorheostosis, such as manipulations, plaster casts, soft-tissue releases, capsulotomies, and osteotomies cause a high recurrence rate. In a 12-year-old girl, flexion contracture of a knee with limb inequality caused by melorheostosis was corrected successfully with the Ilizarov distraction apparatus.
Subject(s)
Bone Lengthening/methods , Contracture/therapy , External Fixators , Knee Joint/diagnostic imaging , Melorheostosis/therapy , Bone Lengthening/instrumentation , Bone Wires , Child , Diagnostic Errors , Equipment Design , Female , Humans , Melorheostosis/diagnostic imaging , RadiographyABSTRACT
An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities.
Subject(s)
External Fixators , Hand Deformities, Congenital/surgery , Child , Child, Preschool , Hand Deformities, Congenital/diagnostic imaging , Humans , Male , Pseudarthrosis/congenital , Pseudarthrosis/surgery , Radiography , Syndactyly/surgeryABSTRACT
Massive scarring of the Z-lengthened flexor digitorum and flexor hallucis longus is a constant finding in clubfoot surgery. A method of fractional lengthening of the tendons is described. This method has been proven effective in preventing this complication.
Subject(s)
Clubfoot/surgery , Tendons/surgery , Child, Preschool , Female , Humans , Infant , Male , MethodsSubject(s)
Clubfoot/surgery , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , ReoperationABSTRACT
Fixation of the osteotomy site in the proximal femur is technically demanding. A new system, which includes cannulated chisels and a cannulated one-piece plate that can be inserted over a guide wire, is suggested. The new system simplifies the procedure and provides stable fixation.
Subject(s)
Bone Plates , Femur Neck/surgery , Osteotomy/instrumentation , Bone Screws , HumansABSTRACT
Primary skin closure after the surgical correction of severe club-foot may be difficult. We describe the use of a tissue expander to provide sufficient skin, and review some aspects of the use of the method.
Subject(s)
Clubfoot/surgery , Tissue Expansion/methods , Cicatrix , Humans , Infant , Male , Wound HealingABSTRACT
Skin problems are the cause of a high incidence of recurrent clubfoot problems. With respect to the demonstrated vascular territories (angiosomes) of the ankle and foot, the incisions which seem to be safest are vertical as opposed to transverse, and between angiosomes. The safest of all are the posteromedial incision with an additional vertical lateral incision if necessary, and the posterolateral with an additional medial incision.
