Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2001
The long-term (8-12 years) results of valgus and lengthening osteotomy of the femoral neck.
Shortening of the femoral neck and proximal displacement of the greater trochanter are the principal complications following avascular necrosis of the capital epiphysis head in early childhood. We report here the long-term follow-up of a series of osteotomies performed to lengthen the femoral neck and thus to restore the normal anatomy and function of the hip joint. Out of a sample of 24 patients, 15 (62.5%) were reviewed at the end of a mean follow-up of 10 years and 2 months. ⋯ The average perpendicular distance from the center of the femoral head to a horizontal plane passing through the tip of the greater trochanter (the centro-trochanteric distance) was reduced from 33 mm to 7 mm. Apart from correcting the anatomical deformity, it is suggested that this operation may well provide lasting relief from pain and increase the power of the abductor muscles. It may also delay the onset of osteoarthritic change and in this way postpone the necessity for an endoprosthesis.
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Twenty-one affected elbows in 14 known hemophilic patients undergoing treatment at the Hemophilia Clinic of our institution between 1994 and 1997 were evaluated using the clinical evaluation score of the Orthopaedic Advisory Committee of the World Federation of Hemophilia and radiological examination using the Pettersson score. The mean age of patients was 16.2 years (range 10-25 years), and all patients except 1 had severe hemophilia with factor VIII levels less than 1% of normal. The mean duration of disease at the time of presentation was 12.8 years. ⋯ There was a positive correlation between the clinical and radiological scores (P < 0.0001). However, the clinical and radiological scores did not correlate with either duration of disease or joint bleeding score. Two new radiological signs of obliteration of the capitello-lateral epicondyle groove with rounding off of the lateral aspect of the distal humerus and lipping of the medial trochlear surface were also recognized in hemophilic arthropathy of the elbow.
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We amputated 35 limbs of 27 patients with diabetic foot from March 1988 to March 1998. The mean age of the patients at the time of operation was 67 years, and the mean follow-up period was 27 months. Thirteen patients died in the period from 1 day to 39 months after the operation. ⋯ Upper level reamputation was conducted on 15 limbs. Logistic regression analysis revealed that lower temperature of the amputation site, being female, and being elderly were significant risk factors in reamputation. Skin thermography was one of the effective determinants of amputation level, in order to avoid reamputation.
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Arch Orthop Trauma Surg · Jan 2001
The role of clinical examination and risk factors in the diagnosis of developmental dysplasia of the hip: a prospective study in 188 referred young infants.
In this prospective study, the role of clinical examination and risk factors in the diagnosis of developmental dysplasia of the hip (DDH) was analysed. For this purpose, 376 hips of 188 referred infants with an average age of 3.7 months (range 0-8 months) were clinically and ultrasonographically (Graf method) examined. Infants who had at least one risk factor for DDH had a three times higher occurence rate of DDH than those who didn't have any. ⋯ Limitation of abduction and asymmetry of the skin folds were the two most common clinical findings associated with DDH. Nearly two-thirds of the infants with at least one positive clinical finding and at least one risk factor had either an unilateral or bilateral dysplastic hip. It was concluded that a careful clinical examination was significantly more important than the coexisting risk factors in the detection of DDH.
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Arch Orthop Trauma Surg · Jan 2001
Effect of preoperative chemotherapy on the outcome of surgical treatment of vertebral tuberculosis: retrospective analysis of 434 cases.
A retrospective analysis of 434 patients with vertebral tuberculosis who were treated surgically was performed with special reference to the preoperative duration of chemotherapy. Of these, 376 underwent 4 weeks of a chemotherapy regimen with isoniazid, rifampin and ethamburol, and in 2 re-activation of the disease was observed. The remaining 58 underwent operation for neurological impairment with 6-18 h of the same chemotherapy regimen, and in no case did re-activation occur. These results suggest a shorter duration of chemotherapy may be utilised in all patients undergoing surgical treatment for vertebral tuberculosis, providing a thorough debridement is performed, leaving no necrotic or infected tissue behind.