The present status of the problem of pes cavus

855

ABSTRACTS

Evolution of Treatment Ranch0 J. Perry, M.

Los Amigos. V.

Hot&r,

1.

of Paralytic

Nickel,

C. Stiles,

Scoliosis at

C. Bonnetf, 1. C. Brown, T.

and

Surg. (Am) 57A:206-215

W&sky,

1.

R. Brooks. (March),

Brooks,

J. Bone Joint

1975.

A 16-yr study of 351 patients with paralytic scoliosis was done. This study traversed the treatment span, beginning with body cast and progressing through halo treatment to the current approach to halofemoral traction and Harrington instrumentation. This review documents a change in curve correction from 209; improvement to 579, improvement as techniques improved. Current treatment programs have proved that rapid mobilization has not affected the result and, indeed, the complication rate was lower, although the pseudarthrosis rate remained the same. The main complication has been dorsolumbar hyperlordosis in long fusions from cervical through lumbar areas. This article addresses itself to the problem of respiratory function and management of the lumbosacral joint and does a thorough job of reviewing the management principle expected in 1975. based on objective data.--dnthon~ H. Alter Shelf

Operation

and Dislocation 1. S. Breivis. February),

for

Congenital

of the Hips.

Clin.

Orthop.

W.

Subluxation H.

106:27-34

Nickel

and

(Jonuary-

1975.

One-hundred congenitally dislocated hips with follow-up averaging 12.8 yr were studied. A superior acetabular shelf technique had been performed surgically on these patients with a failure in 31 patients. Twenty-four hips had been made worse, primarily if the shelf absorbed or was inadequate less than 15 yr following surgery. The operation was generally more successful if the procedure was performed in patients over the age of 10 yr.mmmAnthony H. Aiter Synovectomy

of the Hip in Juvenile 1. S. A/bright,

toid Arthritis. J. A. Ogden.

Clin.

Orthop.

Rheumo-

J. P. A/bright,

106:48-55

and

(Jonuary-

February), 1975. Five female children had nine hip synovectomies. Follow-up ranged from 2 to 8 yr, with an average of 5 yr. Indications were subluxation or progressive joint destruction with failure of conservative management for 2 yr. All patients were improved symptomatically and functionally. but no normal joint was achieved. Preoperative motion was maintained or improved

in five patients, although one subsequently deteriorated 4 yr postoperatively. Some mild deterioration appeared in several patients with time. Surgery of this type is indicated in progressive joint destruction to delay a downhill course until more appropriate surgery is needed. -Anthon.v H. Alter The Pathology Comparison

son. Clin. 1975.

of Legg-Perthes

Disease and

Its

With Aseptic Necrosis. A. 6. Fergu-

Orthop.

106:7-18

(January-February),

Forty-five patients with Legg-Perthes’ disease with over a 5-yr follow-up were reviewed radiologically with pathologic corroboration. The Legg-Perthes’ changes were compared to spontaneous osteonecrosis of the femoral head. First stage finds both lesions beginning in the femoral head. posterior to the fovea. As the lesion progresses more distally in the femoral head and outside of the weight-bearing dome, it is subjected more to the pressure changes of weight-bearing. The second stage includes new vessel ingrowth with associated fractures of bony trabecula. The third stage is described as separation of the nonvascular fragments, with an ultimate fourth stage of fibrous metaplasia and revascularization. The prognosis is directly related to the effect of weight-bearing involved segment Anthony H. Aitrr

and the containment of the within the acetabulum.-

The Present Status of the Problem of Per Cows. F. C. Dwyer. Clin. Orthop. February),

106:254-275

(Januory-

1975.

One-hundred

patients

with

pes cavus

were

studied. Fifty-seven had idiopathic etiology; 21, spina bifida; 27. poliomyelitis; and 13, other neurologic conditions. Surgical treatment consisted of a calcaneal valgus closing wedge osteotomy with excellent to good results in 109 out of 170 feet. Follow-up care usually included metatarsal padding or bars to allow progressive stretching out of the forefoot deformity. If the calcaneal osteotomy was not completely effective. additional procedures such as extensor tenotomies. metatarsophalangeal capsulotomy, interphalangeal arthrodesis, proximal transfer of the extensor hallucis longus, and plantar fascia release did afford some further improvement in some patients. This IS a thorough review of the clinical condition with a well worked-out treatment approach.-AnrhonJ, H. Alter