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Pes cavovarus: Review of surgical approach to using selective soft tissue procedures
ABSTRACTS affect the neck-shaft angle whereas damage of the total head and neck leads to a deformed femoral head with varus angulation, femoral shortening and secondary acetabular dysplasia.--,dnthony H. Alter Transient Arthritis of the Hip in Childhood and Perthes Disease. O. Barta and fd. Bellyei. Magy Traumatol Orthop
23:98-103, 1980. The possibilities of a relationship between transient arthritis of the hip and Perthes disease have been analysed. They pointed out that intraarticular pressure is increased by overproduction of the synovial fluid as a result of inflammation, and a constantly high pressure can lead to necrosis of the femoral capital epiphysis. Experiences are reported here, when an intertrochanteric osteotomy at the early stage of Perthes disease was performed with simultaneous fenestration of the joint capsule for decompression, and a great amount of synovial fluid was discharged under high pressure. They conclude therefore that transient synovitis can not be regarded only as a harmless condition, but it can be a precursor of Perthes disease. --,dndrew Pint~r Measurement of Intraarticular Pressure in the Hip of Young Rabbits. O. Barta, J. Szepesi, Gy. Mike, and T. Simor.
Magy Traumatol Orthop 23:204-208, 1980. The changes of intraarticular pressure in young rabbits have been examined, using a model developed earlier by the authors. The amount of pressure necessary for expansion of the capsule and lateral displacement of the femoral head has been established. Arteriographic studies have been added to these examinations and the pressure limits influencing the intraarticular blood supply have been measured. They showed that changes in the position of the hip significantly influence the amount of intraarticular pressure. Some modifications in the management of Perthes disease and transient arthritis of the hip are recommended on the basis of their experiments.--Andrew Pintkr Diffuse Aggressive Fibromatosis of the Right Calf-Treatment with Intratumorous Injection of DexamethasonePreliminary Report. C. Janneck and F. Kaiser. Z Kinderchir
31:40-45, 1980. Aggressive fibromatosis is a rare, histologically benign tumor in childhood which is, however, clinically progressive. Diffuse aggressive fibromatosis of the right calf is reported in a 9.5-yr-old boy who was treated by the injection of dexamethasone into the tumor at a dose of 4 mg per day for 17 days. The tumor responded completely to this therapy so far. This method of treatment is recommended if radical surgery must be avoided.--Thomas ,4. ,dngerpointner Results of Soft Tissue Operations in the Management of
Congenital Club Foot. J. Kri~nicz, O. Barta, and A. Bellyei. Magy Traumatol Orthop 23:191-200, 1980.
A review is given of the experience with 152 patients operated on for club foot. Exact x-ray assessment is thought to be very important, because even after excellent morphological and functional end results, residual x-ray changes were observed, which, potentially, may lead to the redevelopment of abnormalities. Clinical and radiologic assessment
425
can only be informative of the result of management. Analysis of the authors' "own" and "referred" patients showed better clinical and radiologic results in the first group, which is attributed to early operation, regular follow-up and care.--,dndrew Pintbr Pes Cavovarus: Review of Surgical Approach to Using Selective Soft Tissue Procedures. L. Palucs and S. S.
Coleman. JBJS:62A:942-953, (September), 1980. Twenty-seven patients with 39 cavovarus or equinocavus foot deformities were studied. The article includes a review of surgical and conservative measures, proper physical diagnosis, and x-ray diagnosis. A minimum 2-yr follow-up was required. Surgical treatment was based upon the degree of flexibility of the deformity with procedures ranging from radical plantar and/or medial releases; osteotomies of the forefoot; and/or combination with tendon transfers. Twentysix of the twenty-seven patients felt that the foot was better than pre-operatively. Four patients still had persistent varus hindfeet, but all were operated at over 9 yr of age. Complications included partial or full-thickness skin sloughs, not affecting the ultimate results and thought to be a function of over-correction. The over-corrected feet had no subjective complaints associated with them. Eleven of the 13 tendon transfers were functional with maintenance of correction. The authors conclude that, at least on the relatively shortterm basis, the cavovarus foot can be helped with appropriately selected procedures, based upon the pre-operative physical examination. Anthony H. Alter NERVOUS SYSTEM Premature Craniosynostosis with Special Reference to the Indication for Operative or Expectative Procedure. J. Spier,
F. H~pner, and G. Oberlinner. Z Kinderchir 31:103-110, 1980. Premature craniosynostosis may result in cerebral damage due to raised intracranial pressure. Thirty-four children with craniostenosis who underwent linear, bilateral craniectomy are presented. Twenty-three of them could be re-examined. Fifteen children developed normally, 4 were moderately and 4 severely retarded. Most children showed bony repair of the craniotomy within 2 yr following surgery. As the authors became rather reluctant in the indication for operation during the last years, they compared the children who underwent surgery with 15 children whose craniosynostosis had only been followed. The fundus of the eye was normal in all 15 children, 12 of them developed normally. Indication for craniectomy is given (1) if the intracranial pressure is elevated and (2) if all skull sutures are closed. Cosmetic indication is not accepted. If necessary, a craniectomy should be performed as early as possible because the maximum growth of the brain takes place during the second and third year of life.--Thomas A. ,dngerpointner Subgaleal Hematoma, A Complication of Instrumental Delivery. W. C. Plauche. J A M A 244:1597-1598, (October),
1980. One hundred twenty-three cases of subgaleal hematoma are summarized in the literature. This is a potentially fatal lesion and is to be differentiated from the relatively benign
23:98-103, 1980. The possibilities of a relationship between transient arthritis of the hip and Perthes disease have been analysed. They pointed out that intraarticular pressure is increased by overproduction of the synovial fluid as a result of inflammation, and a constantly high pressure can lead to necrosis of the femoral capital epiphysis. Experiences are reported here, when an intertrochanteric osteotomy at the early stage of Perthes disease was performed with simultaneous fenestration of the joint capsule for decompression, and a great amount of synovial fluid was discharged under high pressure. They conclude therefore that transient synovitis can not be regarded only as a harmless condition, but it can be a precursor of Perthes disease. --,dndrew Pint~r Measurement of Intraarticular Pressure in the Hip of Young Rabbits. O. Barta, J. Szepesi, Gy. Mike, and T. Simor.
Magy Traumatol Orthop 23:204-208, 1980. The changes of intraarticular pressure in young rabbits have been examined, using a model developed earlier by the authors. The amount of pressure necessary for expansion of the capsule and lateral displacement of the femoral head has been established. Arteriographic studies have been added to these examinations and the pressure limits influencing the intraarticular blood supply have been measured. They showed that changes in the position of the hip significantly influence the amount of intraarticular pressure. Some modifications in the management of Perthes disease and transient arthritis of the hip are recommended on the basis of their experiments.--Andrew Pintkr Diffuse Aggressive Fibromatosis of the Right Calf-Treatment with Intratumorous Injection of DexamethasonePreliminary Report. C. Janneck and F. Kaiser. Z Kinderchir
31:40-45, 1980. Aggressive fibromatosis is a rare, histologically benign tumor in childhood which is, however, clinically progressive. Diffuse aggressive fibromatosis of the right calf is reported in a 9.5-yr-old boy who was treated by the injection of dexamethasone into the tumor at a dose of 4 mg per day for 17 days. The tumor responded completely to this therapy so far. This method of treatment is recommended if radical surgery must be avoided.--Thomas ,4. ,dngerpointner Results of Soft Tissue Operations in the Management of
Congenital Club Foot. J. Kri~nicz, O. Barta, and A. Bellyei. Magy Traumatol Orthop 23:191-200, 1980.
A review is given of the experience with 152 patients operated on for club foot. Exact x-ray assessment is thought to be very important, because even after excellent morphological and functional end results, residual x-ray changes were observed, which, potentially, may lead to the redevelopment of abnormalities. Clinical and radiologic assessment
425
can only be informative of the result of management. Analysis of the authors' "own" and "referred" patients showed better clinical and radiologic results in the first group, which is attributed to early operation, regular follow-up and care.--,dndrew Pintbr Pes Cavovarus: Review of Surgical Approach to Using Selective Soft Tissue Procedures. L. Palucs and S. S.
Coleman. JBJS:62A:942-953, (September), 1980. Twenty-seven patients with 39 cavovarus or equinocavus foot deformities were studied. The article includes a review of surgical and conservative measures, proper physical diagnosis, and x-ray diagnosis. A minimum 2-yr follow-up was required. Surgical treatment was based upon the degree of flexibility of the deformity with procedures ranging from radical plantar and/or medial releases; osteotomies of the forefoot; and/or combination with tendon transfers. Twentysix of the twenty-seven patients felt that the foot was better than pre-operatively. Four patients still had persistent varus hindfeet, but all were operated at over 9 yr of age. Complications included partial or full-thickness skin sloughs, not affecting the ultimate results and thought to be a function of over-correction. The over-corrected feet had no subjective complaints associated with them. Eleven of the 13 tendon transfers were functional with maintenance of correction. The authors conclude that, at least on the relatively shortterm basis, the cavovarus foot can be helped with appropriately selected procedures, based upon the pre-operative physical examination. Anthony H. Alter NERVOUS SYSTEM Premature Craniosynostosis with Special Reference to the Indication for Operative or Expectative Procedure. J. Spier,
F. H~pner, and G. Oberlinner. Z Kinderchir 31:103-110, 1980. Premature craniosynostosis may result in cerebral damage due to raised intracranial pressure. Thirty-four children with craniostenosis who underwent linear, bilateral craniectomy are presented. Twenty-three of them could be re-examined. Fifteen children developed normally, 4 were moderately and 4 severely retarded. Most children showed bony repair of the craniotomy within 2 yr following surgery. As the authors became rather reluctant in the indication for operation during the last years, they compared the children who underwent surgery with 15 children whose craniosynostosis had only been followed. The fundus of the eye was normal in all 15 children, 12 of them developed normally. Indication for craniectomy is given (1) if the intracranial pressure is elevated and (2) if all skull sutures are closed. Cosmetic indication is not accepted. If necessary, a craniectomy should be performed as early as possible because the maximum growth of the brain takes place during the second and third year of life.--Thomas A. ,dngerpointner Subgaleal Hematoma, A Complication of Instrumental Delivery. W. C. Plauche. J A M A 244:1597-1598, (October),
1980. One hundred twenty-three cases of subgaleal hematoma are summarized in the literature. This is a potentially fatal lesion and is to be differentiated from the relatively benign