1/7. Lengthening of replanted or revascularized lower limbs: is length discrepancy a contraindication for limb salvage?Some replantation cases require substantial bone shortening for primary closure. leg-length discrepancy can be restored by lengthening of the replanted or revascularized extremities. Between 1991 and 2000, four patients with four total and two subtotal below-knee amputations had replantation or revascularization for their severely damaged extremities. All of them had extensive debridement, vascular repair, bone shortening and nerve repair for sensibility of their soles. One of the replanted extremities failed and had to undergo below-knee amputation because of sepsis. No other infection or vascular complications were encountered following the replantations or revascularizations. After bony consolidation, four legs were lengthened; for elimination of length discrepancy in three cases, and for obtaining balanced body proportion in one case in which the other leg was also amputated. In all procedures, a unilateral dynamic axial external fixator was used. The lengthening was performed from the proximal tibial metaphysis, with a subperiosteal osteotomy. Evaluation of injury according to the Mangled Extremity Severity Score (MESS) would encourage the surgeon to avoid salvage surgery with a shortened extremity, because of the required debridement of soft tissue and bone. These authors think the amount of limb shortening is not a major criterion in evaluating a traumatic total or subtotal below-knee amputation for salvage replantation or revascularization. A knee that has stable joint motion and the possibility of preservation of sensibility of the sole broadens the scope of indications for limb salvage, even with deliberate shortening that can be restored by lengthening; length discrepancy is not a contraindication for limb salvage.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. Opening-wedge osteotomy, allografting with dual buttress plate fixation for severe genu recurvatum caused by partial growth arrest of the proximal tibial physis: a case report.Injuries to the proximal tibial physis are among the least common epiphyseal injuries. We present a case of severe genu recurvatum deformity (45 degrees) with leg length discrepancy (4 cm) following a neglected proximal tibial physeal injury incurred 6 years previously. The 16-year-old patient was successfully treated by open-wedge osteotomy, allograft reconstruction, and dual buttress plate fixation. At 3 years' follow-up, the patient was asymptomatic, fully active with a full range of motion (0 - 140 degrees) of the leg, and equal leg lengths. There were no signs of genu recurvatum clinically.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/7. One-stage surgical procedure for congenital dislocation of the hip in older children. Long-term results.The one-stage procedure described in this article, which has been used in children older than three years of age, is the method of choice in the treatment of late-diagnosed congenital dislocation of the hip. The present authors and their patients have been more than satisfied with the results of this procedure. With femoral shortening as the fundamental step, this method can be applied in high dislocations, as well as in cases of subluxation in which a pelvic osteotomy is indicated, to restore the depth of the acetabulum and to prevent undue pressure on the femoral head, which is the main cause of avascular necrosis, joint stiffness, and failures. Evaluation of the results is confusing but should rely on resistance of the hip in daily function, clinical appearance, range of hip motion, and the patient's opinion. Roentgenologic evaluation seems to be even more difficult, because numerous parameters need to be taken into consideration and correlated with the preoperative appearance of the hip. Certainly, it is reasonable to expect the majority of patients to develop osteoarthritic changes eventually, but nearly all patients can live a normal or satisfactory life for a number of years. The present authors are convinced that many patients will remain symptom-free for a long period.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/7. Genu recurvatum caused by partial growth arrest of the proximal tibial physis: simultaneous correction and lengthening with physeal distraction. A report of two cases.Two cases of genu recurvatum deformity and leg length discrepancy after partial growth arrest of the proximal tibial physis are described. The patients are both boys thirteen and fifteen years old respectively. The etiology of the deformity is considered to be local pressure on the tibial tuberosity, in the first case after treatment with plaster cast after correction of an angular deformity in a tibial fracture and in the second case after prolonged treatment with patellar tendon bearing brace. The boys were treated with physeal distraction which corrected both the leg length discrepancy and the angular deformity. The technique is recommended because the correction is done at the site of the deformity and knee motion is possible during the entire treatment period.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/7. A follow-up examination of the function of the lower extremity after pelvic tumour extirpation including the acetabular ring.gait, hip muscular function and clinical features were analysed in 5 patients with chondrosarcoma of the pelvis operated with removal of the tumour, including the acetabular ring. The lower extremity thus remained intact. The aim of this study was to compare the functional results with those obtained in a previous investigation two years earlier. The same tests were used, but more attention was focussed to the functional part and thus step length, gait velocity, and active range of motion were added. At both examinations none of the patients had pain. All performed surprisingly well as regards work and gait. Clinical and objective findings were, however, less impressive. There was a direct relationship between hip extension strength and weight bearing on the operated leg, gait velocity and maximal walking distance. Moreover, the extension strength was also related to the formation of a new acetabular roof and to the age the individual represented, with preference to the young. Compared with the previous examination, 2 patients had made remarkable progress, 2 were unchanged but still showed good results and one showed less good results.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/7. One stage femoral lengthening in the adult.One stage femoral lengthening procedures were performed in 9 adult patients. Eight patients had femoral shortening secondary to femoral fractures. The remaining patient had diffuse left hemiatrophy. The method of one stage lengthening has been modified from that described by Cauchoix. There were 7 males and 2 females with an average age of 23 years. The preoperative femoral shortening averaged 4.5 cm. The average lengthening at surgery measured 4.0 cm and 3.8 cm of this was maintained at follow-up. Complications included one case of serious sciatic and femoral nerve palsy, implant failure in 3 patients, a case of late femoral refracture following plate removal, and a case of acute femoral artery occlusion. There were no postoperative infections. Two cases required additional bone grafting of the osteotomy sites. There was no loss of preoperative hip or knee motion with this technique. One stage femoral lengthening by the method described is a major operative undertaking with several potential complications. The surgical technique is demanding and monitoring of the neurovascular status of the extremity during lengthening is mandatory. When properly executed, results are gratifying.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/7. Fractures of the distal femoral epiphyses. Factors influencing prognosis: a review of thirty-four cases.In a review of thirty-four fractures through the distal femoral epiphyseal plate followed for an average of four years, limb-length discrepancy of 2.0 centimeters or more (measured roentgenographically) occurred in 36% and varus or valgus deformity measured as a difference of 5 degrees or more between the involved and uninvolved extremities occurred in 33%. Reconstructive procedures (osteotomy, epiphyseodesis, or both) were required in 20%. Limitation of knee motion (eleven patients), ligament laxity (eight patients), and quadriceps atrophy (five patients) were also observed. Prognoses made on the basis of the Salter-Harris classification alone were not reliable. The development of deformity appears to be related to the degree of initial displacement of the fracture, the exactness of the reduction, and the type of fracture.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |