Simple method of documenting metatarsus adductus.

A simple, accurate, and inexpensive method of documenting metatarsus adductus involves taking photocopies of the foot in the weightbearing position. Subsequently, treatment progress can be assessed objectively by reviewing serial photocopies. Some caution is urged because the strength of the glass copying surface of photocopying machines is unknown.

Early complications in the operative treatment of ankle fractures. Influence of delay before operation.

We have reviewed the early complications of 121 surgically treated closed ankle fractures; the complication rate was 30%, with 14 major and 22 minor complications. Fractures with skin blisters or abrasions had more than double the overall complication rate. Fracture-dislocations had three times as many major complications as simple fractures, and those not fixed within 24 hours had a 44% major complication rate compared to 5.3% in those operated upon as emergencies. Patients transferred from another medical facility had high complication rates, especially if they had fracture-dislocations. We conclude that operative treatment of ankle fractures must be delivered in a timely fashion, especially in severe fractures. We would caution against the practice of transferring patients with serious ankle fractures before completion of definitive care.

Biomechanical analysis of the Chiari pelvic osteotomy. Preserving hip abductor strength.

Although the Chiari osteotomy is usually effective in reducing pain, many patients are left with a long-term limp. The postoperative limp can at times be caused by hip abductors that have strength insufficient to counteract the torque from body weight during single-leg stance. To study how the surgical technique affects the hip abductor muscles, a biomechanical model was developed that computes the postsurgery pelvic geometry and the resulting hip abductor torque given three surgical parameters: angulation of the osteotomy, distance of medical displacement, and angle of internal rotation. The computer simulations of the Chiari osteotomy showed that some sets of surgical parameters conserve abductor torque while others greatly reduce it. Simulated surgeries with high angulation and large medial displacement reduce gluteus medius abductor torque by up to 65%. Therefore, this combination of surgical parameters may account for some instances of the postoperative limp. In the model, high angulation reduces the length of the gluteus medius and is the primary cause of reduced abductor strength. Simulated horizontal osteotomies (0 degrees to 10 degrees) were found to best conserve both muscle length and abductor torque.

Established hip dislocations in children with cerebral palsy.

Hip dislocation in children with cerebral palsy is caused by a combination of factors, including spastic muscle imbalance, persistent fetal femoral geometry, acetabular dysplasia, and flexion-adduction contracture. The incidence of dislocation correlates with the severity of the spasticity, and the prevalence is close to 50% in neurologically immature, spastic quadriplegic children. Successful hip reductions improve muscular balance, provide satisfactory reduction of the femoral head, and establish good pelvic coverage. In 31 occurrences of established hip dislocation in 24 patients, the most successful operations used a combined procedure consisting of soft-tissue release, open reduction, femoral varus derotation and shortening osteotomy, and pelvic osteotomy.

Gait electromyograms and surgical decisions for paralytic deformities of the foot.

Twenty-one patients who had 23 gait electromyographic (EMG) examinations for paralytic deformities of the foot had surgical procedures performed. Outcome of the surgery was analysed with respect to the value of the pre-operative gait studies in deciding on appropriate surgical procedures. When outcome at follow-up (mean 3.6 years) was satisfactory and surgery had been in accordance with the EMG findings, or when outcome was unsatisfactory when the EMG had been disregarded, the value was deemed positive. Conversely, if the EMG data had been disregarded but outcome was satisfactory, the value was negative. Using these criteria, 70 per cent of the EMGs of the four muscles tested (tibialis anterior and posterior, peroneal and gastrocnemius) were a positive contribution to the evaluation and decision for the particular surgical procedure.

Comparison of stereognosis and two-point discrimination testing of the hands of children with cerebral palsy.

The authors compared tests of stereognosis using shape recognition and two-point discrimination with a paper-clip in evaluating sensation in the fingers of 51 patients with cerebral palsy between the ages of six and 20 years, and of 170 controls in the same age-range. The two-point discrimination test had significantly higher sensitivity in detecting tactile sensation than shape recognition, with slightly less specificity. Testing hand sensation should be part of the assessment of patients when considering reconstructive surgery, therapy, or the teaching of specific hand-skills. The two-point discrimination test with a paper-clip is a simple and reliable method of doing so.

Complications of intramedullary rods in osteogenesis imperfecta: Bailey-Dubow rods versus nonelongating rods.

Twenty-nine patients with osteogenesis imperfecta underwent 108 intramedullary roddings with 42 Bailey-Dubow rods and 66 nonelongating rods. The average age at insertion of the first rod was 5 years; average follow-up was 3.1 years (range 1-9 years). The overall complication rate was 60%-69% for Bailey-Dubow rods and 55% for nonelongating rods. Forty-seven percent of bones receiving rods required reoperation. Nonelongating rods had a 29% reoperation rate and a 24% replacement rate; Bailey-Dubow rods had a 19% reoperation rate and a 12% replacement rate.

Role of radionuclide imaging in the diagnosis of acute osteomyelitis.

Over the last decade, the role of nuclear medicine studies in the diagnosis of acute osteomyelitis has been discussed in depth in the literature. Yet, the respective roles played in this setting by each of the commonly used radionuclide studies often are confusing. In an attempt to develop a cogent diagnostic strategy, we reviewed the literature published within the last 12 years pertaining to the use of radiophosphate bone scintigraphy as well as gallium and indium WBC imaging in the diagnosis of this condition. Based on our findings, we propose an alternative approach to the evaluation of a patient with suspected acute osteomyelitis.