Treatment of adolescent Blount disease with the circular external fixation device and distraction osteogenesis.

The purpose of this study was to review both the anatomic and functional results of treatment of adolescent tibia vara with distraction osteogenesis by using the circular external-fixation device. Twelve tibias in eight patients were treated. Preoperative proximal tibial varus averaged 18 degrees (range, 7-26 degrees). Postoperatively the mean deviation from standard anatomic alignment of the proximal tibia was 2.5 degrees (range, 0-7 degrees). All patients were allowed to weight bear as tolerated throughout the 12 weeks of frame wear. Function was assessed by knee score and was improved in all patients at a mean follow-up of 23 months. There were no neurovascular complications or delayed unions. One patient required return to the operating room because of premature consolidation of his regenerate.

Hamstring muscle injuries among water skiers. Functional outcome and prevention.

Water skiing is associated with severe injuries to the proximal hamstring muscles. We wanted to define the mechanism of injury, describe the associated pathologic changes, determine the functional limitations of patients, and suggest measures to prevent injury. Twelve patients with water skiing-related hamstring injuries were included. Six patients were experienced skiers and six were novices. The mechanism of injury was identical in five of six novice skiers. Each sustained the injury while attempting to get up on one or two skis from a submerged position. In contrast, the expert skiers all sustained injury secondary to a fall while skiing. Physical examination documented evidence of complete or partial avulsion of the proximal hamstring muscle origins in all patients. In addition, six patients had magnetic resonance imaging or computed tomography scans that confirmed the location and extent of the tear. Convalescence ranged from 3 months to 1.5 years before the patient could return to vigorous activities. Seven patients (58%) returned to most of their preinjury sports, albeit at a lower level. Five patients (42%), all with complete disruptions, were unable to run or participate in sports requiring agility. Two of these patients required delayed surgical repairs because of persistent functional limitations.

Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips.

The results for 103 consecutive hips (eighty-nine patients) that had been treated with free vascularized fibular grafting because of symptomatic osteonecrosis of the femoral head were reviewed in a prospective study. The disease was associated with consumption of alcohol in 30 percent of the hips, use of steroids in 17 percent, trauma in 13 percent, and Perthes disease in 3 percent; in the remaining 38 percent, the condition was idiopathic. All patients, except for one who died of unrelated causes 4.5 years after the operation, were followed for at least five years. By the time of the most recent follow-up evaluation, a total arthroplasty had been performed in thirty-one hips: two of the nineteen that were in stage II, according to the criteria of Marcus et al., at the time of the operation; five (23 percent) of the twenty-two that were in stage III; seventeen (43 percent) of the forty that were in stage IV; and seven (32 percent) of the twenty-two that were in stage V. Kaplan-Meier survivorship analyses demonstrated that the probability of conversion to a total hip arthroplasty within five years after free vascularized fibular grafting was 11 percent for the stage-II hips, 23 percent for the stage-III hips, 29 percent for the stage-IV hips, and 27 percent for the stage-V hips. There was a trend toward a lower rate of conversion to a total hip arthroplasty in patients who were less than thirty years old, but this difference did not reach significance (p = 0.06). No association was found between a causative factor and the probability of conversion to a total hip arthroplasty. The average Harris hip scores had improved at the latest follow-up evaluation, compared with the preoperative values (p < 0.001). For the stage-II hips, the average score improved from 56 to 80 points; for the stage-III hips, from 52 to 85 points; for the stage-IV hips, from 41 to 76 points; and for the stage-V hips, from 36 to 75 points. An outcome questionnaire, completed for 73 percent of the hips, revealed that 59 per cent of the hips that had not been subsequently treated with an arthroplasty did not limit or only slightly limited the patient's ability to carry out daily activities, and 62 percent did not limit or only slightly limited the patient's ability to work.(ABSTRACT TRUNCATED AT 400 WORDS)