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The surgical correction of congenital elevation of the scapula: A review of seventy-seven cases
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treatment seemed to have little affect on the ultimate course.--Anthony H. Alter Wrist Arthrodesis in Paralyzed Arms of Children. M. Makin. J Bone Joint Surg 59A:312-316 (April), 1977.
The author operated upon 34 children with poliomyelitis residuals with a technique he describes for wrist arthrodesis; fusing the radius to the carpal bones. This procedure does close the epipbysis, and hence, should be delayed until after the youngster is 6 yr of age. Other contraindications consist of a fixed deformity of the wrist or an anesthetic hand. Review of cases reveals 32 of the 34 cases fused without damage to the distal radioulnar joint. There was one infection in a failure and the other failure was because of technical reasons. All forearms shortened, depending upon the age of the youngster.--Anthony H. Alter Early Arthrodesis for Flail Shoulder in Young Children. M. Makin. J Bone Joint Surg 59A: 317-321 (April), 1977.
Seven children had an arthrodesis of the shoulder performed for flail shoulder. The procedure is done with the shoulder at 80 ~ abduction, protecting the epiphyseal plate and transfixing it with Steinman pins, later removed. This technique preserves the plate and, by holding it in the abducted position, minimizes the likelihood of bone crossing the plate from the glenoid. In addition, no bone grafts are necessary. The author prefers to do a corrective adduction osteotomy in adulthood if the resulting abduction deformity poses problems, in an effort to preserve this epiphyseal plate. All shoulders fused within 12 wk. Shortening was from 2 to 4 cm, with the youngest patient being operated at the age of 5 yr. The important feature of this procedure is that it does protect the epiphysis in those rare cases where shoulder arthrodesis is necessary in childhood.-- Anthony H. Alter The Surgical Correction of Congenital Elevation of the Scapula: A Review of Seventy-seven Cases. D. IV. Ross and R, L. Cruess: Clin Orthop 125:17-23 (June), 1977.
Seventy-seven cases of Sprengle's congenital elevation of the scapula were reported. A review of these cases reveals all procedures increased scapular abduction approximately 30 ~ and were associated with a correction of shoulder symmetry to 1.8 inches. Thirty-three of all procedures were associated with some loss of proximal correction. Complications included wound hematoma, infection, and one cardiac a r r e s t . T h e r e w e r e five t r a n s i e n t n e u r o v a s c u l a r compressions, clearing in four, with one ultimately clearing on release of the repair. Three patients having the Woodward type repair had scapular winging. The authors conclude that the procedure is worth doing, from a functional and cosmetic point of view.--Anthony H. Alter Effectiveness of Pre-operative Carrel Traction for Correction of Idiopathic Seoliosis.A. Nachemson andA. Nordwall, J Bone Joint Surg 59A:504-508 (June), 1977.
Two-hundred six idiopathic scoliotic patients, less than 20-yr-old, required Harrington instrumentation for their scolioses. Ninety patients were treated preoperatively with Cotrel traction and one hundred sixteen had no immediate
ABSTRACTS
preoperative traction, both having comparable results. The operative technique was the same for both groups of patients. Chin irritation from the traction was a common problem. The authors conclude that, for idiopathic curves less than 90 ~ in children under 20 yr of age, no traction is necessary preoperatively as the results are the same, with or without the traction. In the more severe curves of older patients, halopelvic or halofemoral traction is the method of choice.--Anthony H. Alter Harrington Rod Distraction Instrumentation: Its Effect on Vertebral Rotation and Thoracic Compensation. E, R. Benson, R. L. DeWald, and A. B. Schultz. Clin Orthop 125:40-44 (June), 1977.
Seventy-three patients were studied. The authors have devised an objective m e a s u r e m e n t of determining the degree of thoracic vertebral rotation and compensation, using x-rays. Using this criterion, the patients treated with Harrington rod instrumentation were reviewed. The authors conclude that the Harrington instrumentation does correct for decompensation, but does little in altering thoracic rotation.--Anthony H. Alter Development of Present Knowledge of Congenital Displacement of the Hip. B. Howorth. Clin Orthop 125:68-87 (June), 1977.
This is a thorough article reviewing all the major literature on the subject of congenital dislocation of the hip. It should be a basic reference for all who deal with this problem.--Anthony H. Alter An Assessment of the Value of Examination of the Hip in the New Born. D. Jones. J Bone Joint Surg 59B:318-322 (August), 1977.
Over a 5-yr period, in a population of 400,000 an assessment of the value of neonatal examination for congenital dislocation of the hip (CDH) was carried out. The diagnosis was missed during neonatal examination rather more in home deliveries than in hospital. Although it was observed that abnormal deliveries were associated with a higher incidence of CDH, it was more frequently after normal delivery that the neonatal diagnosis was missed. Factors involved in the missing of the neonatal diagnosis are discussed and the fate of the splinted unstable hips reviewed. It is apparent from these that neonatal examination and treatment alone will not eliminate the problems of C D H . - - M . G. H. Smith Damage to the Capital Femoral Epiphysis Due to Frejka Pillow Treatment. F. W. Ilfe/dandM. Makin, J Bone Joint Surg 59A:654-658 (July), 1977.
Seven patients are presented who have damage to the capital femoral epiphysis associated with their congenital hip pathology, be it dysplasia, subluxation, or dislocation. The only common denominator is that the youngsters were treated with a Frejka pillow splint, although their subjective andobjective changes do not appear until 2-5 yr posttreatment. The authors make the association with the splint without proof, but suggest that the pillow splint should be applied loosely, and gradually tightened as the hip abductors stretch out, to avoid excessive abduction tension on the hip.
treatment seemed to have little affect on the ultimate course.--Anthony H. Alter Wrist Arthrodesis in Paralyzed Arms of Children. M. Makin. J Bone Joint Surg 59A:312-316 (April), 1977.
The author operated upon 34 children with poliomyelitis residuals with a technique he describes for wrist arthrodesis; fusing the radius to the carpal bones. This procedure does close the epipbysis, and hence, should be delayed until after the youngster is 6 yr of age. Other contraindications consist of a fixed deformity of the wrist or an anesthetic hand. Review of cases reveals 32 of the 34 cases fused without damage to the distal radioulnar joint. There was one infection in a failure and the other failure was because of technical reasons. All forearms shortened, depending upon the age of the youngster.--Anthony H. Alter Early Arthrodesis for Flail Shoulder in Young Children. M. Makin. J Bone Joint Surg 59A: 317-321 (April), 1977.
Seven children had an arthrodesis of the shoulder performed for flail shoulder. The procedure is done with the shoulder at 80 ~ abduction, protecting the epiphyseal plate and transfixing it with Steinman pins, later removed. This technique preserves the plate and, by holding it in the abducted position, minimizes the likelihood of bone crossing the plate from the glenoid. In addition, no bone grafts are necessary. The author prefers to do a corrective adduction osteotomy in adulthood if the resulting abduction deformity poses problems, in an effort to preserve this epiphyseal plate. All shoulders fused within 12 wk. Shortening was from 2 to 4 cm, with the youngest patient being operated at the age of 5 yr. The important feature of this procedure is that it does protect the epiphysis in those rare cases where shoulder arthrodesis is necessary in childhood.-- Anthony H. Alter The Surgical Correction of Congenital Elevation of the Scapula: A Review of Seventy-seven Cases. D. IV. Ross and R, L. Cruess: Clin Orthop 125:17-23 (June), 1977.
Seventy-seven cases of Sprengle's congenital elevation of the scapula were reported. A review of these cases reveals all procedures increased scapular abduction approximately 30 ~ and were associated with a correction of shoulder symmetry to 1.8 inches. Thirty-three of all procedures were associated with some loss of proximal correction. Complications included wound hematoma, infection, and one cardiac a r r e s t . T h e r e w e r e five t r a n s i e n t n e u r o v a s c u l a r compressions, clearing in four, with one ultimately clearing on release of the repair. Three patients having the Woodward type repair had scapular winging. The authors conclude that the procedure is worth doing, from a functional and cosmetic point of view.--Anthony H. Alter Effectiveness of Pre-operative Carrel Traction for Correction of Idiopathic Seoliosis.A. Nachemson andA. Nordwall, J Bone Joint Surg 59A:504-508 (June), 1977.
Two-hundred six idiopathic scoliotic patients, less than 20-yr-old, required Harrington instrumentation for their scolioses. Ninety patients were treated preoperatively with Cotrel traction and one hundred sixteen had no immediate
ABSTRACTS
preoperative traction, both having comparable results. The operative technique was the same for both groups of patients. Chin irritation from the traction was a common problem. The authors conclude that, for idiopathic curves less than 90 ~ in children under 20 yr of age, no traction is necessary preoperatively as the results are the same, with or without the traction. In the more severe curves of older patients, halopelvic or halofemoral traction is the method of choice.--Anthony H. Alter Harrington Rod Distraction Instrumentation: Its Effect on Vertebral Rotation and Thoracic Compensation. E, R. Benson, R. L. DeWald, and A. B. Schultz. Clin Orthop 125:40-44 (June), 1977.
Seventy-three patients were studied. The authors have devised an objective m e a s u r e m e n t of determining the degree of thoracic vertebral rotation and compensation, using x-rays. Using this criterion, the patients treated with Harrington rod instrumentation were reviewed. The authors conclude that the Harrington instrumentation does correct for decompensation, but does little in altering thoracic rotation.--Anthony H. Alter Development of Present Knowledge of Congenital Displacement of the Hip. B. Howorth. Clin Orthop 125:68-87 (June), 1977.
This is a thorough article reviewing all the major literature on the subject of congenital dislocation of the hip. It should be a basic reference for all who deal with this problem.--Anthony H. Alter An Assessment of the Value of Examination of the Hip in the New Born. D. Jones. J Bone Joint Surg 59B:318-322 (August), 1977.
Over a 5-yr period, in a population of 400,000 an assessment of the value of neonatal examination for congenital dislocation of the hip (CDH) was carried out. The diagnosis was missed during neonatal examination rather more in home deliveries than in hospital. Although it was observed that abnormal deliveries were associated with a higher incidence of CDH, it was more frequently after normal delivery that the neonatal diagnosis was missed. Factors involved in the missing of the neonatal diagnosis are discussed and the fate of the splinted unstable hips reviewed. It is apparent from these that neonatal examination and treatment alone will not eliminate the problems of C D H . - - M . G. H. Smith Damage to the Capital Femoral Epiphysis Due to Frejka Pillow Treatment. F. W. Ilfe/dandM. Makin, J Bone Joint Surg 59A:654-658 (July), 1977.
Seven patients are presented who have damage to the capital femoral epiphysis associated with their congenital hip pathology, be it dysplasia, subluxation, or dislocation. The only common denominator is that the youngsters were treated with a Frejka pillow splint, although their subjective andobjective changes do not appear until 2-5 yr posttreatment. The authors make the association with the splint without proof, but suggest that the pillow splint should be applied loosely, and gradually tightened as the hip abductors stretch out, to avoid excessive abduction tension on the hip.