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Long term results in treatment of femoral shaft fractures in young children by immediate spica immobilization
ABSTRACTS
625
Pavlik harness. There were 24 normal results clinically and roentgenographically. Two failures were felt to be because of inadequate flexion in the harness with a third failure of undetermined causes. No vascular abnormalities were seen in patients treated with the Pavlik harness alone.--/lnrhony H. Afrer
Limb discrepancies were essentially a problem only in transverse type fractures. The series documents that the children less than 5 yr of age tend to overgrow the injured limb whereas children over 10 yr of age had persistent shortening of the limb if the initial fracture reduction accepted overriding of greater than 2 cm.-Anthony H. Alter
Slipped Capital Femoral Epiphysis: A Study of 68 Cases in the Eastern Half
of Japan.
Ninomiya, Y. Nogasoko, and H. Togawa.
119:172-176
(September),
Clin
S.
Orth
The Clinical Manifestations and Pathomechanicr of Contracture of the Extensor Mechanism of the Knee. K. Bose and K. C. Chong. J Bone Joint
1976.
Surg Br 58:478-484 Sixty-seven hips in 56 Japanese patients were collected throughout the country. The disease entity is very rare. Twenty and seven tenths per cent of 58 patients developed acute chondrolysis unrelated to the type of treatment, which is much higher than seen in the rest of the world. The authors speculate that this may be caused by an unknown genetic factor.--dnthonp H. Alter Pathogenesis of
P&her’
M. A. R.
Freeman,
Mizuno.
Bone
J
B.
Disease. A.
Vernon-Robe&
Joint Surg
Br 58:453-461
Inque, and
5.
(No-
vember), 1976. In a study of the histology of femoral head biopsies in Perthes’ disease in children, together with evidence of experimental infarction inflicted twice in puffy femoral heads, the findings suggest that the observed pattern of deformity of the femoral head and the chronicity of Perthes’ disease in the human is due to repeated episodes of infarction rather than weight-bearing.--M. G. H. Smifh long Term Results in Treatment of Femoral Shaft Fractures in Young Children by Immediate Spica Immobilization. R. N. Iron;, 1. T. Nicholson, and S. M. K. Chung.
951 (October),
J Bone
Joint Surg Am 58:945-
1976.
Seventy-five children, ages up to 10 yr, were followed for at least 2 yr for the results of treatment of their variously fractured femurs. Treatment consisted of immediate reduction without anesthesia and the application of a I$ hip spica, with absence of a plantar sole plate. Children less than 5 yr of age had a double hip spica. Cast wedging was done as necessary to achieve adequate alignment. This series included open fractures. The cast was removed at 6-8 wk. depending upon the child’s age, with union confirmed by x-rays. Significantly shorter hospitalization periods were documented. No children lost motion in their lower extremities.
(November), 1976.
The findings in 38 children or adolescents of Asian origin with limited knee Rexion. genu recurvatum, or lateral dislocation of the patella are reviewed. In some the cause of the quadriceps fibrosis was clearly due to intramuscular injections in early life. Dislocation of the patella was due to contracture in the vastus lateralis portion and limited flexion and genu recurvatum to contracture of central parts of the quadriceps mass. Adequate early release of the contracture is advocated as being easier and avoiding the risk of secondary knee joint pathology.-M. G. H. Smith Triple Tenodesis of the Knee, a Soft Tissue Operation for the Correction of
Paralytic Genu
Recurvatum. J. Perry, J. P. O’Brien, Hodgson.
J
Bone
Joint
Svrg
Am
and A. R.
58:978-985
(October), 1976. Sixteen knees in I4 patients had a procedure described for the treatment of paralytic genu recurvatum. Average follow-up was 51 mo with average preoperative recurvatum of 42’ and at follow-up, 6”. The procedure consisted of a tenodesis of the capsule, transection and weaving of the medial hamstrings through bony tibia1 and femoral tunnels, and overweaving of the lateral hamstrings and ilio-tibia1 band. The patients were casted for 3 mo and prophylactically braced in 15” of flexion for I2 mo. Rehabilitation at that point consisted of a series of wedging casts to a few degrees of recurvatum. The authors feel that the protracted immobilization afforded adequate scarring to occur to avoid the overstretching commonly seen with soft tissue procedures used heretofore for this paralytic condition. The relationship to ankle and hip pathology is discussed. Twelve patients remained brace-free. Three limbs required bracing, but these were flail, which poses contraindication to this type of surgery. Four patients had delayed wound healing. One had a wound infection and one
625
Pavlik harness. There were 24 normal results clinically and roentgenographically. Two failures were felt to be because of inadequate flexion in the harness with a third failure of undetermined causes. No vascular abnormalities were seen in patients treated with the Pavlik harness alone.--/lnrhony H. Afrer
Limb discrepancies were essentially a problem only in transverse type fractures. The series documents that the children less than 5 yr of age tend to overgrow the injured limb whereas children over 10 yr of age had persistent shortening of the limb if the initial fracture reduction accepted overriding of greater than 2 cm.-Anthony H. Alter
Slipped Capital Femoral Epiphysis: A Study of 68 Cases in the Eastern Half
of Japan.
Ninomiya, Y. Nogasoko, and H. Togawa.
119:172-176
(September),
Clin
S.
Orth
The Clinical Manifestations and Pathomechanicr of Contracture of the Extensor Mechanism of the Knee. K. Bose and K. C. Chong. J Bone Joint
1976.
Surg Br 58:478-484 Sixty-seven hips in 56 Japanese patients were collected throughout the country. The disease entity is very rare. Twenty and seven tenths per cent of 58 patients developed acute chondrolysis unrelated to the type of treatment, which is much higher than seen in the rest of the world. The authors speculate that this may be caused by an unknown genetic factor.--dnthonp H. Alter Pathogenesis of
P&her’
M. A. R.
Freeman,
Mizuno.
Bone
J
B.
Disease. A.
Vernon-Robe&
Joint Surg
Br 58:453-461
Inque, and
5.
(No-
vember), 1976. In a study of the histology of femoral head biopsies in Perthes’ disease in children, together with evidence of experimental infarction inflicted twice in puffy femoral heads, the findings suggest that the observed pattern of deformity of the femoral head and the chronicity of Perthes’ disease in the human is due to repeated episodes of infarction rather than weight-bearing.--M. G. H. Smifh long Term Results in Treatment of Femoral Shaft Fractures in Young Children by Immediate Spica Immobilization. R. N. Iron;, 1. T. Nicholson, and S. M. K. Chung.
951 (October),
J Bone
Joint Surg Am 58:945-
1976.
Seventy-five children, ages up to 10 yr, were followed for at least 2 yr for the results of treatment of their variously fractured femurs. Treatment consisted of immediate reduction without anesthesia and the application of a I$ hip spica, with absence of a plantar sole plate. Children less than 5 yr of age had a double hip spica. Cast wedging was done as necessary to achieve adequate alignment. This series included open fractures. The cast was removed at 6-8 wk. depending upon the child’s age, with union confirmed by x-rays. Significantly shorter hospitalization periods were documented. No children lost motion in their lower extremities.
(November), 1976.
The findings in 38 children or adolescents of Asian origin with limited knee Rexion. genu recurvatum, or lateral dislocation of the patella are reviewed. In some the cause of the quadriceps fibrosis was clearly due to intramuscular injections in early life. Dislocation of the patella was due to contracture in the vastus lateralis portion and limited flexion and genu recurvatum to contracture of central parts of the quadriceps mass. Adequate early release of the contracture is advocated as being easier and avoiding the risk of secondary knee joint pathology.-M. G. H. Smith Triple Tenodesis of the Knee, a Soft Tissue Operation for the Correction of
Paralytic Genu
Recurvatum. J. Perry, J. P. O’Brien, Hodgson.
J
Bone
Joint
Svrg
Am
and A. R.
58:978-985
(October), 1976. Sixteen knees in I4 patients had a procedure described for the treatment of paralytic genu recurvatum. Average follow-up was 51 mo with average preoperative recurvatum of 42’ and at follow-up, 6”. The procedure consisted of a tenodesis of the capsule, transection and weaving of the medial hamstrings through bony tibia1 and femoral tunnels, and overweaving of the lateral hamstrings and ilio-tibia1 band. The patients were casted for 3 mo and prophylactically braced in 15” of flexion for I2 mo. Rehabilitation at that point consisted of a series of wedging casts to a few degrees of recurvatum. The authors feel that the protracted immobilization afforded adequate scarring to occur to avoid the overstretching commonly seen with soft tissue procedures used heretofore for this paralytic condition. The relationship to ankle and hip pathology is discussed. Twelve patients remained brace-free. Three limbs required bracing, but these were flail, which poses contraindication to this type of surgery. Four patients had delayed wound healing. One had a wound infection and one