Lateral shelf acetabuloplasty Legg-Calve-Perthes disease

Although head containment is extremely important for the development of the acetabulum and femoral head, there are debates about conservative and surgical treatment. Shelf acetabuloplasty is an effective means of treatment as regards the coverage of the femoral head within the acetabulum, which is the most important issue for the normal development of the hip joint. Nineteen hips of 18 patients were evaluated radiographically using the acetabulum-head index of Heyman and Herndon and the center-edge angle for containment. It was shown that postoperatively both indices improve to increase the containment, thus demonstrating the effectiveness of shelf acetabuloplasty. (c) 2004 Lippincott Williams & Wilkins

False profile radiography for the evaluation of Legg-Celvé-Perthes disease

False profile radiography (FPR), as proposed by Lequesne and de Sèze, depicts the pathology on the anterolateral acetabular wall and femoral head. A study was conducted to find out the differences between normal anteroposterior radiography and FPR. Twenty-seven patients with Legg-Calvé-Perthes disease who had not been operated on previously and 50 recruits without any pathology were studied for the acetabulum-head index of Heyman-Herndon (HHI) and center-edge angles (CEs) in anteroposterior radiographs and VCA angles in FPR. The VCA angle is most useful to detect anterolateral coverage of the femoral head in lateral pillar C hips. FPR is an easy, reliable and cheap technique to evaluate the anterolateral parts of the femoral head, and the acetabulum. © 2004 Lippincott Williams & Wilkins

Rib deformity in scoliosis.

Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level

Hamstring shortening in healthy adults

Hamstring shortening (HS) causes changes in the posture and walking ability in spastic children, however, there are no studies defining the abnormalities in patellar alignment in individuals with HS. Twenty-five patients with a primary complaint of anterior knee pain, having HS detected at physical examination, and 11 healthy individuals without any HS or knee discomfort as a control group are included in this study. Serial x-rays of the spine, pelvis and knee are taken and knee x-rays are evaluated for the position of the patella in both groups. In patients with Knee Extension Deficit (KED) ≥ 60°, the Blackburne-Peel ratio is lower and the Insall-Salvati ratio is higher than the other groups, denoting a cephalic location of the patella (p < 0.05). There are no changes in the congruency and sulcus angles between the HS and control groups. Vertebral and pelvic changes correlate well with the literature, confirming that significant alterations occur after 60° of KED in adults. The extensor mechanism of the knee is affected and patella is located higher than normal in patients with severe HS, which may be a cause for knee discomfort. In the light of these findings, a routine knee extension deficit examination can be suggested in the initial evaluation of knee discomfort

Short-term results of conservative treatment without reduction maneuver of the anterior sternoclavicular joint dislocation

BACKGROUND: To evaluate the results of the conservative treatment without a reduction maneuver in patients with anterior sternoclavicular joint (SCJ) dislocation. METHODS: Four cases with anterior dislocation of the SCJ were evaluated retrospectively. Three cases were unconscious and were followed in the intensive care unit. All of the cases were treated conservatively without any reduction maneuver, as they are either unconscious or refused the reduction in one case.Average follow-up period was 16 months (10-21 months). RESULTS: Good clinical results were achieved in three cases with only mild cosmetic problems, except one case with marked deformity. CONCLUSION: Good functional results may be achieved with conservative treatment of the anterior dislocation of the SCJ even without a reduction maneuver

The relation of joint laxity and trunk rotation

A study was designed to evaluate the joint laxity during scoliosis screening, and to show if there is a relation of joint laxity values to the trunk rotation. One thousand, two hundred and seventy-three children (598 females, 675 males) with an average age of 10.4 years were screened with a scoliometer and forward bending for trunk rotations. Scapular and shoulder elevations, flexible pes planus were recorded and joint laxity was evaluated with the Beighton score. There was high inter-observer and intra-observer reliability for both scoliometer and Beighton scores. In 41 children (3.2%) with Beighton score 7 or higher, trunk rotation measurements were higher than for the rest of the children. Trunk rotation measurements of 7° or higher were found in 30 children, who were more lax than the rest of the group and were invited for radiography, with a detection of curves between 11 and 18° in 10 of them. The Beighton score is a practical and reliable method for defining joint laxity. Although the number of patients with scoliosis was limited, there are findings supporting the relation between joint laxity and scoliosis. Moreover, there was increased laxity in children with increased trunk rotations. Ligamentous laxity may be one of the causes changing the contour of the back. © 2005 Lippincott Williams & Wilkins