Correction of tibial deformity in adults.

This report from five hospitals in Japan describes the results of correcting adult tibial deformities using external fixation. There were 49 patients with 59 lower limb deformities, with trauma being the most common cause of the deformity. Varus angulation was the most common deformity, and the most common magnitude was 11 degrees -30 degrees. Twenty-two patients had a leg-length discrepancy. The aim of the correction was to normalize both the mechanical axis and the inclination of the knee and ankle joints. In 63% of the patients corrections were performed gradually during bone lengthening or acutely after bone lengthening. Altogether, 71% of the patients were completely corrected, and no leg-length discrepancies remained after correction in 47%. Complications were encountered in 22 patients, about half of which were pin tract infections, 28% refractures, and the remainder delayed consolidation or fixator failure. There were no neurological or circulatory complications. The average fixation duration was 9 months. The average hospital charges were 3,740,000 yen in bilateral correction patients and 1,940,000 yen in unilateral correction patients. External fixation can correct not only the mechanical axis and joint inclination but also leg-length discrepancy simultaneously.

The treatment of femoral shaft fractures in children: a systematic overview and critical appraisal of the literature.

OBJECTIVE: Through a critical systematic overview of the literature on the treatment of pediatric femoral shaft fractures to determine if any method of treatment can be recommended over others. DATA SOURCES: A MEDLINE search was performed for all cohort and randomized clinical trials for the years 1966 to 1996. STUDY SELECTION: Of 1217 identified articles, 15 cohort studies (where 2 or more treatments were compared in the same study) reported the treatment of children with femoral fractures. DATA EXTRACTION: Information was abstracted and articles rated for quality blind to author, institution and journal. DATA SYNTHESIS: Children having early application of a hip spica cast had an average hospital stay of 11 days (range from 5 to 29 days), average charges of $5784 (range from $590 to $11,800), average rates of limb-length discrepancy (greater than 2 cm) of 3% (range from 0 to 25%), angulatory malunion rates (greater than 10 degrees) of 8% (range from 0 to 19%), and rotational malunion rates (greater than 10 degrees) of 13% (range from 0 to 5%). The costs and malunion rates of early application of a hip spica cast were lower than for traction. Internal fixation (including intramedullary nails) had low angulatory malunion rates compared with early application of a hip spica cast but higher over-lengthening rates (greater than 2 cm) of 25% (range from 5% to 100%) and mean rotational malunion rates (greater than 10 degrees) of 25% (range from 11% to 32%). CONCLUSION: Early application of a hip spica cast had lower costs and malunion rates than traction.

New rationale in management of tibial agenesis type II: a maturity review of its functional, psychological, and economic value.

It is now 3 years since we published a new surgical approach to type II tibial agenesis. All three patients have reached the end of growth, and we have been able to conduct a maturity review of the functional, psychological, and economic value of this method of treatment. All three patients were very satisfied with the treatment they had received, although it was long and often arduous. We have attempted to compare the costs of primary amputation without complication in the first year of life, followed by supply of at least 10 prostheses, until age 18 years, with that of the reconstructive technique, which is liable to require five operations and considerable periods of inpatients and outpatient care until age of 18 years.

Limb-length discrepancy measured with computerized axial tomographic equipment.

A simple, rapid, and accurate method for measuring limb-length discrepancies with computerized axial tomographic equipment is described. With this method less irradiation is delivered and some of the errors of computation are eliminated, compared with conventional methods. The costs of the technique are comparable with those of scanograms. The method is particularly applicable in the patient who has contracture of a joint.

[Leg length difference-, HWI- and lumbo syndrome one unit? Diagnostical and sociopolitical aspects. A research task? (author's transl)]. / Beinlängendifferenz-, HWI- und Lumbalsyndrom eine Einheit? Diagnostische und sozialpolitische Aspekte. Eine Forschungsaufgabe?

After taking into consideration the external causes of ailments of different leg length syndrome statistics will now be presented on 423 cases won from own practice and experiences. After a short description of result on proceeding of medical examination follows a tight statement about radiodiagnosis. Reflections are carried out about correlations between cases of illness named in title and an impulse is given to an urgently needed research in this special field. Moreover sociopolitical aspects are intimated and there are suggestions expressed for future medical examinations.