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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five cases are reported of children who presented with limitation of jaw movement and had some degree of deformity with shortening of the mandible on the affected side. X-ray examination demonstrated changes in the head and neck of the mandibular condyle. There were varying degress of sclerosis and new bone formation in the area extending from the neck of the condyle into the sigmoid notch. The left side was affected in each case. Parallels are drawn with Perthes' disease, and although the temporo-mandibular joint is not weight-bearing, in both conditions avascular necrosis is likely to be involved. Both have similar X-ray appearances. The fragmentation of the epiphysis in the later stages causes widening and collapse of the head of the femur and the mandibular condyle.
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PMID:Collapse of the condylar head of the mandible in children and subsequent ankylosis. 28 Mar 67

"Transtrochanteric anterior rotational osteotomy of the femoral head" is a new approach to the treatment of idiopathic avascular necrosis of the femoral head. The results of 41 hips with a follow-up suggest that the procedure prevents the progression of the collapse of the femoral head and preserves joint surfaces. Cases with extensive lesions and with bilateral involvement require long-term follow-up investigations in a large series of cases. This method does not preclude prosthetic replacement at a later date. The method is also applicable to the treatment of slipped capital femoral epiphysis, partial defects of the femoral head in weight-bearing area due to trauma and tumor and osteoarthritis of the hip with localized changes in weight-bearing area.
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PMID:Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. 63 89

Fracture-dislocation of the hip is an infrequent injury in adolescence. In combination with transepiphyseal separation of the capital femoral epiphysis, the injury is rare and catastrophic. A review of orthopaedic literature shows varied recommendations as to treatment approaches. The most recent articles have suggested that open reduction through a posterior approach and internal fixation is the best way to treat this problem initially. Later reconstructive measures are usually required because this injury often leads to avascular necrosis of the femoral head. The patient and family should be advised that the prognosis after such a fracture-dislocation is not good. Potential reconstructive measures after collapse of the femoral head include total hip arthroplasty and hip arthrodesis. Total hip arthroplasty is not a reliable means of providing a long-term painless joint in an active adolescent with one-joint disease. Hip arthrodesis has been shown to be a good alternative treatment for patients who develop avascular necrosis after this severe injury.
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PMID:Hip fracture-dislocation with transepiphyseal separation. Case report and literature review. 139 89

A 2-year-old 400-kg female American bison was admitted for evaluation and treatment of an open fracture of the right metacarpal bones 3 and 4. Radiography revealed osteolysis of the distal metaphysis and epiphysis, with extensive bony callus formation along the dorsoproximal and proximomedial aspects extending distally to the proximomedial aspect of the proximal phalanx. Evidence of periosteal or bony proliferation at the fracture site or along the distal segment of the third and fourth metacarpal bones was not visible, suggesting that the distal fracture fragment was becoming a sequestrum. Treatment consisted of soft tissue debridement and placement of the limb in a full-limb cast. The cast was changed every 4 weeks until the sequestrum was removed and the bone healed. It is rare for the distal half of a long bone to sequester following fracture. Additionally, it is remarkable that the sequestrum served as a buttress, which prevented collapse of the bone until the sequestrum was replaced by functional bony callus.
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PMID:Distal metacarpal sequestration in a bison. 163 11

A model was developed in the dog to allow both the metaphysis and epiphysis of the distal ulnar growth plate to be microsurgically revascularised from the pedicle of the anterior interosseous vessels. With both circulations revascularised, grafts retained their structural integrity and growth continued at rates only slightly less than normal (mean 85%). If either or both circulations were not revascularised, growth rates were lower and were associated with skeletal collapse in the ischaemic bone segment.
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PMID:Experimental microvascular growth plate transfers. Part I--Investigation of vascularity. 334 12

Radiologically, widening of the joint space in the hip affected with Perthes' disease is encountered in the very early stage of the disease when no changes are yet noted in the bone. This suggests that swelling of the articular cartilage may be taking place in the affected joint. Since the intra-articular volume of a ball-and-socket joint with a deep fossa, such as the hip joint, cannot be readily altered, this swelling is expected to exert a marked imbibitional pressure within the bone of the femoral head. We speculated that this biomechanical factor might play an important role in the development of Perthes' disease. A two-dimensional finite-element model with 853 elements was constructed to simulate the hip joint of a child. Stress distribution in epiphyseal bone of the femoral head was computed under the condition of swelling of articular cartilage, and biomechanical effects of the imbibitional pressure on the epiphysis were investigated. On the assumption that high stress concentrated in the bone caused collapse and necrosis, the process of development of Perthes' disease was simulated. The results of simulation using theoretical values were in close agreement with such clinical findings as destruction of the lateral portion of the epiphysis in the early stage, final fragmentation of the epiphyseal bone, and metaphyseal bone destruction.
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PMID:Biomechanical analysis of Perthes' disease using the finite element method: the role of swelling of articular cartilage. 361 2

Because the available preliminary data strongly indicate that MRI is accurate in diagnosing osteonecrosis, MRI of the hips is recommended in patients suspected of having osteonecrosis, especially if other diagnostic studies are equivocal. MRI also may be useful in following patients who have strong risk factors for osteonecrosis, such as corticosteroid therapy, femoral neck fracture, traumatic femoral head dislocation (Fig. 13), slipped capital femoral epiphysis (Fig. 14), and congenital hip dislocation. In diseases such as systemic lupus erythematosus, both hips eventually may become involved in 50 to 80 per cent of cases. Therefore, the unaffected hip of patients with systemic lupus erythematosus and unilateral nontraumatic osteonecrosis of the hip should be monitored regularly with MRI. The hope is that early diagnosis and treatment of femoral head osteonecrosis will prevent the relentless progression to subchondral collapse and disabling arthropathy. MRI also may be useful in staging patients known to have osteonecrosis. The ability of MRI to image directly in multiple planes facilitates the determination of the volume and location of infarcted segments of bone. This information is important in planning any of the surgical procedures used relatively early in the disease, such as core decompression, rotational osteotomy, or bone graft. Moreover, MRI may prove helpful in evaluating the effectiveness of any therapeutic intervention.
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PMID:Magnetic resonance imaging of osteonecrosis. 371 96

Opinions differ concerning the treatment of choice for severe slipped capital femoral epiphysis, probably due to the lack of long-term follow-up evaluations on the different methods of treatment. A series of 33 patients with severe slipped capital femoral epiphysis, treated per primam with wedge osteotomy of the femoral neck, were radiographically and clinically reexamined an average of 28 years (range, 16-32 years) after the operation. Segmental collapse and/or chondrolysis developed in ten patients. Nine of these patients were available for reexamination and all had severe arthrosis with poor function. Arthrosis developed in nine of the 19 patients without signs of segmental collapse or chondrolysis; these patients had a satisfactory joint function. This series was compared with another series (from the same orthopedic departments) of patients with severe slip without any primary treatment. The long-term results in these two groups were similar; consequently, the value of realignment by wedge osteotomy of the femoral neck is questionable.
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PMID:Slipped capital femoral epiphysis in southern Sweden. Long-term results after femoral neck osteotomy. 375 55

A case of unilateral spastic paresis in a Poll Hereford heifer is described. The heifer could not actively flex the right stifle or hock and the toe just contacted the ground. There was cranial distortion and collapse of the distal tibial epiphysis and remodelling of the articular surfaces within the stifle and hock. There was moderately severe muscle atrophy, but a primary peripheral or central neuropathological lesion could not be found.
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PMID:Spastic paresis in a Poll Hereford heifer. 382 72

Radiographs of 23 foals (35 forelimbs) with carpal region angular limb deformities, which later were corrected by hemicircumferential transection of the periosteum and periosteal stripping, were evaluated as to geometric and morphologic abnormalities. Geometric evaluation included deviation angle and deviation pivot point. Morphologic abnormalities were categorized as: asymmetric width of the distal radial physis; asymmetric width of the distal radial epiphysis; carpal bone collapse or fracture; carpal bone hypoplasia; carpal bone displacement; and metacarpal bone displacement. Fifty-seven percent of limbs had radiographic lesions in the carpal joints and 20% had lesions in the metacarpus. Of all the limbs, 48% had carpal or metacarpal bone hypoplasia, 26% had carpal or metacarpal bone displacement, and 12% had carpal bone collapse or fragmentation. On long-term followup (5 months to 2 years), 83% of the foals were sound and had straight limbs, regardless of the deviation angle, deviation pivot point, or morphologic carpal bone changes. Sixty percent of the foals were in performance training. About 50% of these foals in performance training had carpal bone hypoplasia before correction of the deviation. It was concluded that geometric and morphologic radiographic interpretation should be performed before surgical correction of carpal angular limb deformities with hemicircumferential transection of the periosteum and periosteal stripping, but that epiphyseal, carpal bone, or metacarpal bone changes, severe deviation angle (20 to 29 degrees) or distal location of the pivot point should not discourage attempted surgical correction.
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PMID:Periosteal transection and stripping for treatment of angular limb deformities in foals: radiographic observations. 403 Apr 49


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