The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 1989
One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening.
We reviewed the results of primary operative treatment in twenty-five patients (thirty-three hips) who were two years or older and had congenital dislocation of the hip. None of the patients had had previous treatment for the dislocation. Preliminary traction was not used in any patient. ⋯ According to the rating system of Ferguson and Howorth, there were seventeen excellent, seven good, and three fair results; one hip had a poor result. It was concluded that children who are two years or older and who have a congenital dislocation of the hip can safely be treated with an extensive one-stage operation consisting of open reduction combined with femoral shortening and, often, pelvic osteotomy, without increasing the risk of avascular necrosis. The limb-length discrepancy that is produced by the shortening does not appear to cause a clinical problem.
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J Bone Joint Surg Am · Jun 1989
Measurement of pressure in the carpal canal before and after endoscopic management of carpal tunnel syndrome.
In forty-six patients who had carpal tunnel syndrome, a technique of continuous infusion, given under local anesthesia and without a pneumatic tourniquet, was used to measure pressures in the carpal canal before and after endoscopic release of the transverse carpal ligament (retinaculum flexorum manus). Pressures were similarly measured in sixteen subjects in a control group. ⋯ The mean pressures improved significantly postoperatively and were in the range of values that were found under each condition for the control group. Measurement of pressure in the carpal canal before and after operation may be useful in diagnosing carpal tunnel syndrome and in determining the effectiveness of endoscopic management.
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The cases of twenty-six patients who had a reconstructive surgical procedure for treatment of a malunion of a displaced fracture of the fibula were evaluated. In these patients, who had pain, swelling of the ankle, and stiffness at an average of six years after the injury, the malunions were classified radiographically as either occult (eighteen patients) or overt (eight patients). ⋯ All of the patients were treated by osteotomy of the lateral malleolus to correct the external rotation and shortening, to reduce the lateral subluxation of the anterior aspect of the tibiofibular joint, and to restore the stability of the talus. At an average follow-up of seven years (range, six months to eleven years), twenty of the twenty-six patients were able to resume the preinjury level of activity; three had improvement in the ability to walk and in the level of functional activity, although they still had intermittent pain; and three had not benefited from the procedure.
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J Bone Joint Surg Am · Apr 1989
Management of neuromuscular spinal deformities with Luque segmental instrumentation.
Forty-six patients who had a neuromuscular spinal deformity were treated with arthrodesis and Luque segmental spinal instrumentation and were followed for an average of three years. Twenty-two patients had cerebral palsy and twenty-four had another neuromuscular disease. In thirty-nine patients, the arthrodesis was extended to the sacrum. ⋯ Pseudarthrosis occurred in three patients (6.5 per cent). There were no major neurological deficits related to the correction or to the use of sublaminar wires. Three patients died, one in the immediate postoperative period and the other two at eighteen months and four years after the original procedure, due to causes unrelated to the operation.
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Twenty-one compartment syndromes of the thigh in seventeen patients were identified for retrospective review. Ten of the compartment syndromes were associated with an ipsilateral femoral fracture; five of these femoral fractures were open. In five patients, the syndrome followed femoral intramedullary stabilization. ⋯ Eight patients (47 per cent) died as a result of multiple injuries. Of the nine patients (ten compartment syndromes) who survived, infection developed at the site of the fasciotomy in six. Follow-up examination revealed marked morbidity, including sensory deficit and motor weakness of the lower extremity.(ABSTRACT TRUNCATED AT 250 WORDS)