19 research outputs found
Diagnosis and management of the osteonecrotic triad of the knee
Generalized osteonecrosis of the knee may include, in addition to
osteonecrosis of the medial femoral condyle that occurs most frequently,
osteonecrosis of the patella or the tibial plateau. Such involvement is
known as the osteonecrotic triad of the knee. Although the clinical
picture of idiopathic osteonecrosis of the medial femoral condyle seems
similar to several other disorders, certain distinct features, including
its typical location, clinical symptoms, and late onset of cartilaginous
erosion, facilitate differential diagnosis. Despite the progress made in
the diagnosis and treatment of idiopathic osteonecrosis of the medial
femoral condyle, the prognosis remains severe. More than 80% of the
patients deteriorate to the extent that surgical reconstruction is
necessary, whereas only about 20% of the patients demonstrate
spontaneous resolution or no additional deterioration of the
osteonecrotic lesion
Botulinum A toxin for treatment of lower limb spasticity in cerebral palsy - Gait analysis in 49 patients
Background: Injection of botulinum type A toxin is a new treatment for
spasticity.
Patients and methods: We evaluated the effect of botulinum A toxin
(BTX-A) in the lower limb muscles of patients having cerebral palsy. We
tested 49 patients before and, on average, 4 (2-9) months after giving
the toxin. The evaluation included 3-dimensional computerized gait
analysis, changes in mobility level, using the Gillette Functional
Assessment Questionnaire, and gastrocnemius muscle bulk, using
ultrasonographic measurements.
Results: The patients were divided into 3 groups, according to the site
of BTX-A administration (hamstrings, gastrocnemius and multilevel).
Those who were injected in the hamstrings showed a significant
improvement in only the maximum knee extension angle during the gait
cycle. Those with spastic equinus who were injected in the gastrocnemius
muscle responded better than the other groups. The ankle angle on the
initial contact, terminal stance and preswing, maximum dorsiflexion,
ankle range of motion, per cent of single support and gait velocity
improved significantly. Overall, the patients showed significant
improvements in motor skill performance and functional health.
Interpretation: Our findings indicate that botulinum type A toxin can be
given as an adjuvant to conservative treatment of patients with cerebral
palsy
Non-union of femoral neck fractures with osteonecrosis of the femoral head: treatment with combined free vascularized fibular grafting and subtrochanteric valgus osteotomy
Femoral neck fractures, frequently complicated by non-union and femoral
head osteonecrosis, present a difficult clinical situation, especially
when young patients are concerned. Existing treatment options are valgus
osteotomy to address the biomechanical factors or bone grafting to
address the biologic factor. The authors describe the operative
technique and results of combined subtrochanteric valgus osteotomy and
free vascularized fibular grafting in management of five young patients
with both non-union and avascular necrosis
The mangled extremity and attempt for limb salvage
<p>Abstract</p> <p>Background</p> <p>The decision, whether to amputate or reconstruct a mangled extremity remains the subject of extensive debate since multiple factors influence the decision.</p> <p>Methods</p> <p>Sixty three patients with high energy extremity trauma and attempts at limb salvage were retrospectively reviewed. We analyzed 10 cases of massive extremity trauma where there was made an attempt to salvage limbs, although there was a controversy between salvage and amputation.</p> <p>Results</p> <p>All of the patients except one had major vascular injury and ischemia requiring repair. Three patients died. All of the remaining patients were amputated within 15 days after the salvage procedure, mainly because of extremity sepsis. Seven patients required treatment at the intensive care unit. All patients had at least 2 reconstruction procedures and multiple surgical debridements.</p> <p>Conclusion</p> <p>The functional outcome should be considered realistically before a salvage decision making for extremities with indeterminate prognosis.</p