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Treatment of coxa vara in children by means of a modified osteotomy
380
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGEI~Y
of treatment by nail removal and the resultant instability and attempts by wiring to overcome this are described. Reduction of the fracture and of the dislocated nail base under the nail fold achieves the desired stability in all cases and a rapid return of function.--F. H. Robarts. CONGENITAL MACRODACTYLY. A CASE REPORT WITH THREE-YEAR FOLLOW-UP. M. Ben-Bassat,
J. Casper, I. Kaplan and Z. Laren. J. Bone and Joint Surg. 48B, 2:359-364 (May), 1966. The etiology of this condition is not clear. Neurofibromatosis is most frequently suggested as a causal factor. A case of a Yemenite male is reported with macrodactyly of the middle finger of the left hand from birth. This was of considerable and uniform enlargement and thickening of soft tissues with enlargement of bones and limitation of interphalangeal joint movements with a little ulnar deviation. Skeletal age in the finger appeared to be in advance of the others. Amputation, because of limiting function, was accomplished when three years old. Angiography pre-operatively showed no vascular anomaly. Parts examined showed soft tissue and bone hypertrophy, especially of the former and, microscopically, proliferation of adipose tissue with fibrosis of peripheral nerves was evident. No other abnormality was seen. An especial feature was a thick layer of osteoid tissue between the periosteum and the cortical bone.--F. H. Bobarts. SPINA BIFIDA CYSTICA: INCIDENCE OF SPI~A B l v m A O C C U L T A IN PARENTS A N D CONTROLS.
John Lorber and Keith Levick. Arch. Dis. Child. 42:171, 1967. In 83 normal women 3.7 per cent were found to have spina bifida occulta and in 117 normal men the incidence was 5.1 per cent, an overall incidence of 4.5 per cent. In the parents of children with spina bifida cystica 14.8 per cent in 188 mothers and 26.8 per cent in 179 fathers were found to have spina bifida occulta, an overall incidence of 21.4 per cent. Both groups were taken from the same geographic area. In spite of this large difference no genetic inference can be taken because spina bifida occulta was not commoner among parents with more than one affected child and in the majority of families neither parent had spina bifida occulta.--James Lister. TREATMENT OF Cox& VAllA IN CHILDREN BY MEANS OF A MODIFIED OSTEOTOMY. J. Borden,
G. E. Spencer, ]r. and C. H. Herndon. J. Bone and Joint Surg. 48A, 66:1106-1110 (Sept.), 1966. Congenital coxa vara is a condition in which the diminished femoral shaft angle is associated with faulty cartilage maturation and ossification of the femoral head and neck. The object of treatment is to correct the coxa rata, thereby changing the stress on the vertical fissure in the neck from shear to compression, to overcome shortening, and re-establish the proper length-tension relationships of the abductor muscles. Tha authors report a technique that consists of fixing the subtrochanteric osteotomy end-to-side with an infant-size bladeplate, thus providing excellent stability and adequate correction with minimum difficulty. Seven osteotomies were performed on five patients with no complications. The osteotomies healed rapidly and the medullary canal was re-established in all cases. Follow-up period ranged from six to seventeen months and therefore, no conclusions following long term results can be drawn.--Harvard Ellman. CORRECTION OF LEG LENGTH DISCREPANCY BY EPIPHYSEAL ARREST. M. B. Menelaws. J. Bone and Joint Snrg. 48B, 2:336-339 (May), 1966. Although it is known that there is variation in rates of growth and in age of cessation of growth, a practical assumption for a working hypothesis is made that the lower femoral epiphysis contributes three-eighths of an inch per annum and the upper tibial a quarter of an inch per annum, and that fusion of epiphyses occurs at the knee joint in boys at 16 years and in girls at 14. In practice the error of these assumptions is minimal for 96 children have since 1954 been operated upon in the Royal Children's Hospital, Melbourne, on these principles and 44 are now adult and in them 53 epiphyses were fused mainly for the sequelae of poliomyelitis. The Phemister technique of epiphyseodesis is described as used in these cases, and of these 53, 23 were within a quarter of an inch of the calculated discrepancy, 18 within three-quarters of an inch, and in 3 the error was greater. These results compare favorably with another series in which the calculations were based on other factors, especially familial characteristics. --F. H. Robarts. VOLKMANN'S ISCHAEMtA IN THE LowEn LIMB. H. I. Seddon. J. Bone and Joint Surg. 48B, 4:627636 (Nov.), 1966. Volkmann's original article of 1871 described a contracture of the muscles of the leg in spite of
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGEI~Y
of treatment by nail removal and the resultant instability and attempts by wiring to overcome this are described. Reduction of the fracture and of the dislocated nail base under the nail fold achieves the desired stability in all cases and a rapid return of function.--F. H. Robarts. CONGENITAL MACRODACTYLY. A CASE REPORT WITH THREE-YEAR FOLLOW-UP. M. Ben-Bassat,
J. Casper, I. Kaplan and Z. Laren. J. Bone and Joint Surg. 48B, 2:359-364 (May), 1966. The etiology of this condition is not clear. Neurofibromatosis is most frequently suggested as a causal factor. A case of a Yemenite male is reported with macrodactyly of the middle finger of the left hand from birth. This was of considerable and uniform enlargement and thickening of soft tissues with enlargement of bones and limitation of interphalangeal joint movements with a little ulnar deviation. Skeletal age in the finger appeared to be in advance of the others. Amputation, because of limiting function, was accomplished when three years old. Angiography pre-operatively showed no vascular anomaly. Parts examined showed soft tissue and bone hypertrophy, especially of the former and, microscopically, proliferation of adipose tissue with fibrosis of peripheral nerves was evident. No other abnormality was seen. An especial feature was a thick layer of osteoid tissue between the periosteum and the cortical bone.--F. H. Bobarts. SPINA BIFIDA CYSTICA: INCIDENCE OF SPI~A B l v m A O C C U L T A IN PARENTS A N D CONTROLS.
John Lorber and Keith Levick. Arch. Dis. Child. 42:171, 1967. In 83 normal women 3.7 per cent were found to have spina bifida occulta and in 117 normal men the incidence was 5.1 per cent, an overall incidence of 4.5 per cent. In the parents of children with spina bifida cystica 14.8 per cent in 188 mothers and 26.8 per cent in 179 fathers were found to have spina bifida occulta, an overall incidence of 21.4 per cent. Both groups were taken from the same geographic area. In spite of this large difference no genetic inference can be taken because spina bifida occulta was not commoner among parents with more than one affected child and in the majority of families neither parent had spina bifida occulta.--James Lister. TREATMENT OF Cox& VAllA IN CHILDREN BY MEANS OF A MODIFIED OSTEOTOMY. J. Borden,
G. E. Spencer, ]r. and C. H. Herndon. J. Bone and Joint Surg. 48A, 66:1106-1110 (Sept.), 1966. Congenital coxa vara is a condition in which the diminished femoral shaft angle is associated with faulty cartilage maturation and ossification of the femoral head and neck. The object of treatment is to correct the coxa rata, thereby changing the stress on the vertical fissure in the neck from shear to compression, to overcome shortening, and re-establish the proper length-tension relationships of the abductor muscles. Tha authors report a technique that consists of fixing the subtrochanteric osteotomy end-to-side with an infant-size bladeplate, thus providing excellent stability and adequate correction with minimum difficulty. Seven osteotomies were performed on five patients with no complications. The osteotomies healed rapidly and the medullary canal was re-established in all cases. Follow-up period ranged from six to seventeen months and therefore, no conclusions following long term results can be drawn.--Harvard Ellman. CORRECTION OF LEG LENGTH DISCREPANCY BY EPIPHYSEAL ARREST. M. B. Menelaws. J. Bone and Joint Snrg. 48B, 2:336-339 (May), 1966. Although it is known that there is variation in rates of growth and in age of cessation of growth, a practical assumption for a working hypothesis is made that the lower femoral epiphysis contributes three-eighths of an inch per annum and the upper tibial a quarter of an inch per annum, and that fusion of epiphyses occurs at the knee joint in boys at 16 years and in girls at 14. In practice the error of these assumptions is minimal for 96 children have since 1954 been operated upon in the Royal Children's Hospital, Melbourne, on these principles and 44 are now adult and in them 53 epiphyses were fused mainly for the sequelae of poliomyelitis. The Phemister technique of epiphyseodesis is described as used in these cases, and of these 53, 23 were within a quarter of an inch of the calculated discrepancy, 18 within three-quarters of an inch, and in 3 the error was greater. These results compare favorably with another series in which the calculations were based on other factors, especially familial characteristics. --F. H. Robarts. VOLKMANN'S ISCHAEMtA IN THE LowEn LIMB. H. I. Seddon. J. Bone and Joint Surg. 48B, 4:627636 (Nov.), 1966. Volkmann's original article of 1871 described a contracture of the muscles of the leg in spite of