Bulletin of the Hospital for Joint Diseases Orthopaedic Institute最新文献

The growth of tendon cell colonies on synthetic fiber materials used as soft tissue implants was compared to the growth of such cell colonies on flat plastic surfaces used as standard cell culture substrates. Fundamental differences in growth characteristics were observed, and a mathematical model was developed.

Twenty-nine reoperated clubfeet were reviewed. The age range of the patients at the time of the revision surgery was 1-12 years. The average follow-up period was 30 months (range 9-36 months). The surgical procedure used most often in the revision surgery was complete soft tissue release alone or combined with plantar release, calcaneocuboid fusion, and capsulotomies of the navicular first-cuneiform joint and the first-cuneiform first-metatarsal joint. In 27 of 29 feet the results were considered acceptable (19 of 29 were rated excellent or good). An algorithm that suggests surgical solutions to a variety of clubfoot deformities in different age groups has been developed, as well as an objective functional rating system to evaluate long-term results in revision clubfoot surgery.

MRI is the imaging modality of choice for evaluating ankle tendon derangements. CT may complement MRI when evaluating associated fractures or spurs, and can serve as a substitute when financial considerations and availability preclude the utilization of MRI.

A method for analyzing and correcting bone deformities with coronal, sagittal, and horizontal components is presented. It consists of the application of vector analysis in three-dimensional space to these clinical situations. The deformity correction is performed by determining the proper orientation in space of a treatment axis and rotating the limb segment about this axis so that all three deformity components correct simultaneously. This method has special application for the gradual correction of deformities by means of modular external fixators.

Fifteen deformed limbs in 10 patients with neuromuscular problems were treated by the Ilizarov technique. Five patients with cerebral palsy had, respectively, two deformities, two tight hamstrings and knee flexion contractures, and one bilateral external tibial torsion; two patients with spina bifida (L5-S1) had foot deformities; one arthrogrypotic patient had flexion contractures of both knees; one poliomyelitis patient had flexion contractures of both knees and equinovarus deformities of the feet; and one patient with Poland's syndrome had a 90 degree flexion contracture of the wrist. Complications were few, and none compromised full correction which was achieved in nine patients. The Ilizarov method is a new and efficient tool which can be successfully applied in the treatment of neuromuscular patients.

Dupuytren's disease is found only rarely among black and oriental populations. In a retrospective study, the authors report on 9 cases of Dupuytren's disease which they treated, and review an additional 10--the only other cases in Thailand reported in the literature.

A case of medial subtalar dislocation associated with a calcaneonavicular coalition is presented. The trauma of the dislocation resulted in fracture of the coalition.

Fifty patients (42 males and 8 females) with radial nerve paralysis were treated by tendon transfer. The age range was 20-50 years, and the follow-up period was 2-12 years. The right hand was affected in 39 cases; the left hand in 11. Forty-three of the 50 cases had high radial nerve palsy and 7 had low radial nerve palsy. Irreparable damage to the radial nerve associated with severe humeral shaft fracture was encountered in 38 cases; a penetrating stab wound was the cause in 7 cases; and 5 cases were found as a result of full recovery from brachial plexus palsy. The pronator teres was transferred to the extensor carpi radialis longus and brevis in 43 patients, the flexor carpi ulnaris to the extensor digitorum communis in 40 patients, and the flexor digitorum superficialis of the fourth finger to the extensor digitorum communis in 10 patients. The palmaris longus was transferred to the extensor pollicis longus in all 50 cases. The results of the surgery were excellent in 12 cases, good in 31, and fair in 7. Five cases had mild radial deviation of the hand without disturbance of hand function.