Lateral shelf acetabuloplasty in the treatment of Legg-Calvé -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

disease

False profile radiography (FPR), as proposed by Lequesne and de Seze, 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-Calve-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. (c) 2004 Lippincott Williams & Wilkins

A new technique for creating an abdominal window in a hip spica cast.

Opening an abdominal window in a hip spica type of cast can be a troubling maneuver for both orthopaedic surgeon and patient. We present a simple device to create an abdominal window more easily

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. ACT 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

False profile radiography for the evaluation of Legg-Calvé-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 antero-posterior 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

A new technique for creating an abdominal window in a hip spica cast

Opening an abdominal window in a hip spica type of cast can be a troubling maneuver for both orthopaedic surgeon and patient. We present a simple device to create an abdominal window more easily

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

Stress fracture of the fifth metatarsophalangeal sesamoid bone: a case report

There is a paucity of published literature on the injuries of the lesser toe sesamoids of the foot. A fifty-six-year-old male patient without a major trauma history was diagnosed as having a stress fracture of the fifth metatarsophalangeal joint medial sesamoid bone. Conservative treatment was employed and the patient was followed-up for 25 months without any complaints. The sesamoid bone injury of the fifth toe should be included in the differential diagnosis of lateral forefoot pain

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) greater than or equal to 60degrees, 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 60degrees 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