Faculty Bibliography

Congenital pseudoarthrosis of the tibia remains one of the most difficult conditions to treat in orthopedic surgery. Seven cases were treated in our hospital by different methods. Three out of seven patients were healed, two of these refractured. At follow-up, the success rate was 14% (one out of seven cases). It is our recommendation that early primary amputation with an appropriate prosthesis should be considered, and that the final evaluation should not be based on obtaining bone union, but on the level of function of the lower extremity

A subset of postoperative recurrent clubfeet was isolated in a group of patients 4 to 8 years old. Twenty-seven consecutive patients who underwent redo surgery consisting of complete soft tissue clubfoot release combined with a calcaneocuboid fusion were reviewed for this study. Twenty-six feet of 27 feet in 20 patients had a long-term good result, suggesting that this procedure is the one of choice for this age group

OBJECTIVE: To compare loads, load distributions, pressures, and areas of weight-bearing on the palm for forearm crutches with cylindrical and wide handles during ambulation to determine if one handle type produced greater loads on the carpal tunnel region. DESIGN: Single-group repeated measures of normal adults; descriptive study of patients who were long-term crutch users. Data were collected from six palmar regions using an F-Scan system. SETTING: Center for neuromuscular disorders in a hospital. PARTICIPANTS: Thirty normal volunteers and 6 patients. MAIN OUTCOME MEASURE: Differences in loads for the palmar regions between the two handles, particularly the carpal tunnel region. RESULTS: For the normal adults, significantly greater loads were found in two distal regions for the cylindrical handle and in one proximal region for the wide handle. Distribution of weight-bearing loads showed a similar pattern for both handles with the palm's proximal and distal radial sides having the greatest loads and the carpal tunnel region having the third highest load. The area of weight-bearing was significantly greater for the wide handle than for the cylindrical. CONCLUSIONS: Cylindrical and wide crutch handles have similar load distributions, making it impossible to recommend one type over the other to reduce the occurrence of carpal tunnel syndrome. The wide handle distributes the loads over a greater surface area, producing less focal pressure

A 16-year-old Hispanic boy born of consanguineous parents is described as having a history of cataracts, progressive lower-extremity spasticity and atrophy starting at 4 years of age, atretic ear canals with hearing dysfunction and diffuse patchy cutaneous hypopigmented areas. Clinical examination showed the typical signs of spastic paraplegia with increased tone, hyperreflexia, muscle atrophy and contractures. Sensation, autonomic and cerebellar functions were not disturbed. Neuroimaging studies were normal. Laboratory findings did not support a diagnosis of metabolic disturbance or infectious disease. This is considered a new form of complicated hereditary spastic paraplegia (HSP), transmitted presumably in an autosomal recessive pattern

Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result

Twenty-seven patients with cerebral palsy (CP) were recalled and studied in detail 2 to 9 years post tendo Achillis lengthening (TAL). The recurrence rate of equinus deformity was 22.2%. Multiple clinical characteristics and follow-up examination findings were analyzed to determine their relation to recurrence. The recurrence group had a significantly (P<0.05) smaller preoperative popliteal angle, a greater popliteal angle at follow-up, and a greater change in popliteal angle from preoperative to follow-up than the non-recurrence group. This indicated that increasing hamstring contracture was the major factor influencing recurrence. Spasticity of tibialis posterior and leg-length discrepancy may be related factors as well

Orthoses are used by patients with neuromuscular disorders to control their ankle and foot position. Heel contact inside an orthosis is difficult to determine. A simple, inexpensive device was constructed that could be positioned between the heel and the inside of the orthosis. It consists of a thin, single-cell pressure sensor connected to a low-cost, digital multimeter. The resistance reading was used to determine the presence or absence of heel contact during a controlled standing protocol. The device was evaluated in 23 patients. The majority of patients did not weightbear on their heels. The heel contact of five patients was reassessed by using a computerized F-scan system, which determines plantar weightbearing forces. A 100% agreement was found between the single-cell sensor and the F-scan system. This single-cell sensor is a simple, inexpensive, and easily used device to determine the presence or absence of heel contact within an orthosis

Two types of growth factors were used in an attempt to improve the quality of the regenerate bone in canine tibias after Ilizarov lengthening. Mechanical testing, biochemical analysis and histology did not demonstrate appreciable differences between the treated and the control limbs