Faculty Bibliography

In 50 patients (72 clubfeet), the posterior tibial tendon was excised during complete soft tissue clubfoot release. The end results after an average of 3 years were graded as follows: 55.5% excellent, 29.3% good, 8.3% fair, and 6.9% poor. Heel varus and forefoot adduction were the main causes for recurrence. Heel valgus occurred in one foot. Excision of the posterior tibial tendon is safe, does not lead to overcorrection, and may prevent further scarring created when the tendon is lengthened.

Postpoliomyelitis syndrome describes a inverted question marknew inverted question mark weakness, unrelated to any other neurological or medical disorder. It appears 10 to 15 years or more after recovery from the initial paralysis. This new weakness interferes with activities of daily living. The management of postpoliomyelitis syndrome may include orthotics, special exercises, a change in their lifestyle, or a combination of these regimens. This article is especially concerned with knee joint stabilization in various deformities that are weakened by the postpoliomyelitis syndrome.

Differences in the care of the pins used in association with the Ilizarov apparatus and technique are found in various countries and institutions. During a recent visit to the Ilizarov Institute in Russia, the methods of caring for the Ilizarov pins were extensively investigated and documented. The U.S. infection rate at pin sites has been reported to be nearly 10%. No specific infection rate has been reported from Russia. What constitutes an infection at the Ilizarov Center in Kurgan was investigated, as were methods of treatment. Our conclusion is that pin care in Russia is conducted under a more vigorous and stringent regimen, but less often, than in the United States. Soviet record keeping is different, and therefore the infection rates cannot be compared. In Kurgan, specific diligence is exercised in addressing the problems at each pin site. Treatment is directed toward alleviating these problems.

A transmetatarsal pin was used as part of an Ilizarov apparatus to correct equinovarus deformity of a foot in a 7-year-old patient. The pin created synostosis between the metatarsal bones. The synostosis led to persistent flattening of the transverse arch of the foot, producing a painful gait. To avoid this problem, we recommend that the metatarsal wire be placed only through the first and fifth metatarsals rather than through the neighboring metatarsals.

Clinical examination and plain roentgenograms have been the main methods of diagnosis and treatment of developmental dysplasia of the hip. Occasionally, concentric reduction cannot be achieved, or the reduction is questionable. A dynamic arthrogram can add more information but is usually performed under general anesthesia. "Mini" computed tomographic imaging demonstrates the femoral head-acetabulum relationship more accurately and produces minimal radiation. Three-dimensional computed tomography is useful in older children, in whom all sections are ossified. Magnetic resonance imaging, particularly 3-D magnetic resonance imaging, demonstrates the nonossified structures. It is the best method of visualization in developmental dysplasia of the hip. The disadvantages of this method include its cost and the lack of dynamic imaging. In the future, new software will overcome these shortcomings.

Excision of osteoid osteoma nidus utilizing a Kirschner wire for preoperative marking of the lesion and a CORB biopsy set for excision is described. The procedure is performed in a computed tomographic scan unit under local anesthesia and results in minimal postoperative discomfort.

Discitis is usually a benign, self-limiting disease that is frequently misdiagnosed. The disease usually leads to spontaneous disc-space narrowing and end-plate irregularity, which require no treatment and rarely cause morbidity.

To determine whether the Osgood-Schlatter lesion (OS) is produced by avulsion fracture or injury to the patellar tendon, all images obtained in 28 cases of OS in 20 patients (16 scintigrams, 34 computed tomographic [CT] scans, and 27 magnetic resonance [MR] images) were retrospectively analyzed. In 21 cases, imaging was performed before and after treatment; in 20 cases, relief from pain was complete at the time of repeat examination. In all patients (100%), abnormal size of the tendon, decreased attenuation, and increase in signal intensity were compatible with the CT and MR imaging appearance of tendinitis. Distended deep infrapatellar bursa was a frequent finding, particularly on MR studies. These abnormalities had partially disappeared at follow-up examination. An ossicle was seen in only nine of 28 cases (32%); in three of seven cases with follow-up, the ossicle remained nonunited to the tibial tuberosity on follow-up studies despite relief from symptoms. This implies that healing of fracture is not essential for relief from symptoms. These results strengthen the argument that in most cases of OS, insult to the tendon and associated soft tissues, rather than avulsion fracture, causes OS.