The orthopaedic aspects of multiple epiphyseal dysplasia.

Five cases of multiple epiphyseal dysplasia (MED) were treated from 1985-1996 at the Orthopaedics and Trauma Department of SSK Izmir Educational Hospital. Four patients were female and one was male. The pedigrees of the first two female patients had the same features of inter-related marriages. The patients have been followed up for 5.5-11 years (average of 7.5 years). Surgical operations were mostly required in the lower limbs. Problems in the hips required adductor myotomy, the Soutter procedure, total hip replacement, and pertrochanteric extension osteotomy. Management of the knees required supracondylar shortening and extension osteotomy of the femur, high tibial extension osteotomy, debridement of the knee joint with removal of osteophytes, ogleotomy of the patellar lengthening of the knee flexors and posterior capsulotomy. Interphalangeal arthrodesis for hammer toes, extension osteotomy of the head of the first metatarsals, and Kellers operation were carried out in the foot. In the upper limb decompression and anterior transposition of the ulnar nerve, debridement of the elbow joint, extension and valgus osteotomy of the distal radius, and extension osteotomy of the head of the first metacarpal were required.

Prevention of neurovascular complications in extension osteotomy of the tibia in poliomyelitis.

Extension osteotomy of the proximal tibia was carried out in patients with quadriceps weakness after poliomyelitis in order to obtain a stable knee during the stance phase. Blood flow in the anterior and posterior tibial arteries was measured by Doppler sonography before, during and after operation. It was found that there was a correlation between the degree of extension of the knee after operation and a diminished blood flow. This probably explains some of the neurovascular complications reported in the literature after this procedure. We recommend that blood flow is monitored sonographically in the postoperative phase and that optimum extension is obtained gradually over a period of time in a hinged plaster cast.

Knee arthroscopy with local anesthesia in ambulatory patients. Methods, results and patient compliance.

Knee arthroscopy in locally anesthetized ambulatory patients has been performed by filling the knee joint with 50 ml to 60 ml of 0.5% prilocaine, with adrenaline and with additional local infiltration at the sites of puncture. During the arthroscopic procedure the joint cavity is further distended with a mixture of the same local anesthetic diluted 1:10 with physiological saline or Ringer's acetate. During a normal arthroscopy of the knee joint about 500 mg of the local anesthetic is used. In 17 patients the blood concentrations of the local anesthetic used was measured 2.5 min to 135 min after instillation. The highest plasma levels found (after 60 min to 120 min) were still 10 to 15 times lower than an acceptable upper plasma level. These low blood levels probably depend on a slow absorption and that a considerable amount of the local anesthetic is washed out after the arthroscopy. A questionnaire was sent to 278 patients who during a two year period had undergone arthroscopy as an outpatient procedure. The degree of satisfaction for the anesthetic procedure was highest for general anesthesia where 97% were completely satisfied. Sixty-four percent were satisfied when given spinal anesthesia. However, 11% had to be put to sleep due to insufficient spinal block and 12% had headaches more than one day after outpatient spinal anesthesia. Seventy-seven percent were satisfied with local anesthesia. There was no statistical difference between the degree of satisfaction after local or spinal anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopy and arthroscopic surgery in a gas versus a fluid medium.

A comparison of arthroscopy in fluid and gas was performed in 50 consecutive knee arthroscopies and in 38 arthroscopies of other joints. Gas was found to give the same information as fluid in about two thirds of the knees and shoulders and to give better information than fluid in one third of patients. In elbows, hips, and ankles gas proved to be better than fluid in 52 percent of patients. The advantage of gas over fluid is that it allows a better study of the degeneration of the joint cartilage and that it presses the synovial folds down, allowing better inspection of small joints. Operative arthroscopy is fully possible in gas and may offer some advantages over operative arthroscopy in fluid.

A comparison between the transpatellar tendon and the lateral approach to the knee joint during arthroscopy. A cadaver study.

The cental transpatellar tendon arthroscopic approach and the standard lateral approach were compared in 200 unselected cadaver knees. A 5-mm arthroscopic dummy was used in the investigation. In 198 knees, using the transpatellar tendon approach, the dummy passed through the infrapatellar fat pad. In 7 cases with the transpatellar approach and in 22 cases with the lateral approach, we were unable to reach the medial posterior compartment of the knee joint. It was usually easier to insert the arthroscopic dummy into the posterior fossa if the knee joint was held at 35 to 40 degrees of flexion of the knee than at 90 degress of flexion. In 88 of 100 knees, the dummy could be passed from the transpatellar approach into the lateral posterior fossa and in 77 of 100 knees from the lateral approach. Patella baja was found in 16 knees (8%). Since the transpatellar tendon approach should not be used in these cases, it means that this technique cannot be used in all cases. From an anatomical point of view, the transpatellar tendon method thus does not offer any major advantages compared to the standard lateral one.