scholarly journals Management of Late Onset Perthes: Evaluation of Distraction by External Fixator—5-Year Follow-Up

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ajai Singh ◽  
Rajeshwar N. Srivastava ◽  
Prashant Shukla ◽  
Amit Pushkar ◽  
Sabir Ali
Keyword(s):  
External Fixator ◽  
Late Onset ◽  
Harmful Effect ◽  
Perthes Disease ◽  
Harris Hip Score ◽  
Older Children ◽  
Hip Distraction ◽  
One Year ◽  
Monolateral External Fixator

Background. Hip distraction in Perthes’ disease unloads the joint, which negates the harmful effect of the stresses on the articular surfaces, which may promote the sound healing of the area of necrosis. We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes’ disease.Methods and Materials. Twelve children with age more than 8 years with Perthes’ disease of less than one year were treated with hip distraction by a hinged monolateral external fixator.Observation and Results. Mean duration of distraction was 13.9 days. These children were evaluated by clinicoradiological parameters for a mean period of 32.4 months. There was a significant improvement in the range of movements and mean epiphyseal index, but the change in the percentage of uncovered head femur was insignificant. There was significant improvement in Harris Hip score.Conclusions. Hip distraction by hinged monolateral external fixator seems to be a valid treatment option in cases with Perthes’ disease in the selected group of patients, where poor results are expected from conventional treatment.

Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy

2017 ◽  
Vol 28 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Olivier Rosello ◽  
Federico Solla ◽  
Ioana Oborocianu ◽  
Edouard Chau ◽  
Tony ElHayek ◽  
...  
Keyword(s):  
Pelvic Osteotomy ◽  
Wilcoxon Test ◽  
Perthes Disease ◽  
Harris Hip Score ◽  
Salter Osteotomy ◽  
Stulberg Classification ◽  
And Performance ◽  
And Function ◽  
Chiari Osteotomy

Introduction: The goal of intervention in Legg-Calvé-Perthes disease (LCPD) is to prevent femoral head deformation by containing the head within the acetabulum. Currently, surgical containment methods are the mainstay of treatment, and pelvic osteotomies have been shown to be successful. They include triple pelvic osteotomy (TPO), Salter osteotomy, Chiari osteotomy and shelf procedure. The purpose of this study was to compare clinical and radiologic results for Chiari osteotomy and TPO in LCPD. Methods: 29 children treated between 1980 and 2010 for LCPD in 2 centres were reviewed. 19 underwent TPO, and 10, Chiari osteotomy. Two independent observers assessed sequential radiographs and medical data. Each hip was preoperatively classed by clinical data, Catteral, Herring and Salter-Thompson classification, centre-edge angle (CE), and acetabular index (AI). The 2 groups were first tested for their comparability. After surgery the hips were classified by Stulberg classification, CE, AI, Harris Hip Score (HHS) and performance of further surgery. Chiari osteotomy and TPO have been secondary compared on these data by Wilcoxon test. Results: Average follow-up was 4.2 years. The 2 groups were comparable before surgery. At first and last follow-up examination, statistically significantly superior results in patients with TPO regarding Stulberg classification (p = 0.01), AI (p = 0.002), pain (p = 0.02) and function (p = 0.01) in the HHS score were found. No differences were noticed concerning CE angle. Conclusions: In our series, TPO provided better radiologic and clinical outcomes compared to Chiari osteotomy, specially concerning the final Stulberg classification. We concluded that TPO should be preferred when indicated.

scholarly journals External Fixator in Elderly Patients with Hip Fractures

2013 ◽  
Vol 3 (1) ◽  
pp. 11-13
Author(s):  
Shilu Shrestha ◽  
Bibek Banskota ◽  
Tarun Rajbhandary ◽  
Babukaji Shrestha ◽  
Jwala Raj Pandey ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Local Anesthesia ◽  
Hip Fractures ◽  
External Fixator ◽  
Early Mobilization ◽  
Fragility Fractures ◽  
The Elderly ◽  
Harris Hip Score ◽  
Average Delay

Introduction: Fragility fractures around the hip are common in the elderly and are associated with significant morbidity and mortality. Early stabilization and mobilization reduces mortality associated with prolonged recumbence. In patients who are not fi t for general anesthesia, external fixation under local anesthesia will help early mobilization. Methods: A retrospective study of hip fractures treated between 2002 to 2009 was undertaken. Out of 242 hip fractures, 13 patients with inter-trochanteric fractures had undergone external fixator application under local anesthesia. There were 9 females and 4 males; five were on right side and 8 on left side. As per the system of American Society of Anesthesiologists (ASA), 10 were of grade III, 2 of grade IV and 1 of grade E. The age of the patient ranged from 60 to 92 years (average 80 years). The average delay in surgery was 8.2 days for cases presenting soon after the injury. Results: Follow up was done at 6 weeks, 3 months and 6 months with the average follow up of 4.7 months. All the fractures (n=13) united and the average time to radiological union was 3 months. Three patients had grade I pin tract infection which was easily controlled with local care. The average Harris hip score at final follow-up was 92. Conclusion: External fixator can be a valuable tool for the treatment of hip fractures in high risk elderly patients with concomitant medical co-morbidities. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9319   Nepal Orthopedic Association Journal 2013 Vol.3(1): 11-13

scholarly journals Does Juvenile Idiopathic Arthritis Affect the Course of Legg–Calvé–Perthes Disease? A Case-Control Study with a Mean Follow-Up of 8 Years

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1014
Author(s):  
Julien Roß ◽  
Ivan Foeldvari ◽  
Kara L. Krajewski ◽  
Sebastian Butscheidt ◽  
Frank Timo Beil ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Excellent Result ◽  
Retrospective Chart Review ◽  
Case Control ◽  
Perthes Disease ◽  
Harris Hip Score ◽  
Control Group ◽  
Modified Harris Hip Score ◽  
Control Study

Background: This study aimed to determine the clinical and radiological course in children who had Legg–Calvé–Perthes disease (LCPD) associated with juvenile idiopathic arthritis (JIA). Methods: In a retrospective chart review between 2007 and 2019, eight consecutive JIA patients diagnosed with concomitant LCPD were identified and compared with a case-control group of 10 children with LCPD only. Results: LCPD was diagnosed at a mean age of 8.1 years (3.0–14.7) in children with JIA as compared to 6.1 years (2.9–10.0) in controls. According to the modified Harris Hip Score (mHHS), four children with JIA and all controls had an excellent result. Regarding the fragmentation severity and the duration of each stage, we found no differences using the lateral pillar and modified Elizabethtown classification. Five hips were classified as Stulberg I/II, two hips as Stulberg III, and one hip as Stulberg V with no evidence of hip dysplasia or severe overcoverage in either group. Conclusions: The radiological outcome of LCPD did not differ between both groups, while the clinical outcome was slightly better in controls. Physicians should be aware that children with LCPD may have JIA too. In suspicious cases, further investigations are recommended, and patients should be referred to pediatric rheumatologists.

scholarly journals Acute correction of proximal tibial coronal plane deformity in small children using a small monolateral external fixator with or without cross-pinning

2021 ◽  
pp. 1-6
Author(s):  
Chaemoon Lim ◽  
Chang Ho Shin ◽  
Won Joon Yoo ◽  
Tae-Joon Cho
Keyword(s):  
External Fixator ◽  
Proximal Tibia ◽  
Weight Bearing ◽  
Coronal Plane ◽  
Time Interval ◽  
Angular Deformity ◽  
Small Children ◽  
Monolateral External Fixator ◽  
Tibia Osteotomy

PurposeSurgical correction of proximal tibia deformity in small children can be challenging. We present the surgical technique and outcome of proximal tibia osteotomy fixed with small monolateral external fixator in this patient group.MethodsA total of 17 cases in eight patients younger than nine years of age were study subjects. A proximal tibia osteotomy was fixed with a small monolateral external fixator with or without cross-pinning. Outcome was evaluated by changes of radiographic parameters such as medial proximal tibia angle (MPTA), metaphyseal diaphyseal angle (MDA) and clinical findings of complications, time interval until weight bearing and fixator removal time.ResultsMPTA improved from a preoperative mean of 73° (sd 4°; 66° to 78°) to an immediate postoperative mean of 90° (sd 3°; 85° to 96°) in varus tibiae, and from 104° (sd 1°; 103° to 105°) to 89° (sd 1°; 88° to 89°) in valgus tibiae. In all, 15 of the 17 cases (88.3 %) achieved postoperative MPTA within the normal range (85° to 90°). MDA improved from a preoperative mean of 19° (sd 5°; 11° to 24°) to an immediate postoperative mean of 0° (sd 4°; -6° to 7°) in varus tibiae, and from -25° (sd 2°; -22° to -24°) to 2° (SD 1°; 1° to 3°) in valgus tibiae. Full weight bearing was possible at mean 1.7 months (0.5 to 3.0). Mean follow-up period was 6.5 years (sd 5.4; 1.0 to 16.0). No complications developed during the follow-up.ConclusionProximal tibia osteotomy fixed with small monolateral external fixator provides accurate, safe and efficient correction in the management of coronal plane angular deformity in small children.Level of EvidenceLevel IV

scholarly journals Absence of dementia in late-onset schizophrenia: a one year follow-up of a Brazilian case series

2006 ◽  
Vol 64 (4) ◽  
pp. 946-949 ◽  
Author(s):  
Jerson Laks ◽  
Leonardo F. Fontenelle ◽  
Adriana Chalita ◽  
Mauro V. Mendlowicz
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Negative Symptoms ◽  
Late Onset ◽  
Case Series ◽  
Developed Countries ◽  
End Point ◽  
One Year ◽  
State Examination

BACKGROUND: Cognitive deficits of late-onset schizophrenia (LOS) patients have been reported as stable, although some prospective studies show that a sub-group develop a significant cognitive decline. Data on LOS from developing countries are scarce. OBJECTIVE: To evaluate the cognitive performance of Brazilian patients with LOS over the course of one year. METHOD: Thirteen LOS patients were evaluated at baseline and after one year with the Mini-Mental State Examination (MMSE), the CAMCOG, the Positive and Negative Symptoms Scale, the Pfeffer’s Activities of Daily Living (ADL), and the Neuropsychiatric Inventory (NPI). RESULTS: Cognition and activities of daily living remained stable over the course of one year [baseline MMSE= 21.31 (4.87) and CAMCOG=80.31 (16.68); end-point MMSE=20.77 (3.86) and CAMCOG=82.92 (14.42) (Z=-0.831; p=0.40); baseline ADL=4.31 (5.65); end-point ADL= 5.92 (3.86) (Z=-0.831; p=0.40)]; end-point NPI=10.54 (10.69) (Z=-0.737; p=0.46]. CONCLUSION: Like patients from developed countries, Brazilian patients with LOS do not seem develop dementia, at least over the course of one year.

scholarly journals Treatment of severe late-onset Perthes’ disease with soft tissue release and articulated hip distraction: revisited at skeletal maturity

2007 ◽  
Vol 1 (4) ◽  
pp. 229-235 ◽  
Author(s):  
Eitan Segev ◽  
Eli Ezra ◽  
Shlomo Wientroub ◽  
Moshe Yaniv ◽  
Shlomo Hayek ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Late Onset ◽  
Skeletal Maturity ◽  
Perthes Disease ◽  
Soft Tissue Release ◽  
Hip Distraction

scholarly journals Late-Onset Glaucoma-Filtrating Bleb Leak in a Penetrating Keratoplasty Patient: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Zuleyha Yalniz-Akkaya ◽  
Ayse Burcu ◽  
Firdevs Ornek
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Penetrating Keratoplasty ◽  
Late Onset ◽  
Corneal Graft ◽  
Case Presentation ◽  
Bleb Leak ◽  
One Year ◽  
Human Pericardium

Introduction. Late-onset bleb leaks occur more frequently after the use of adjunctive antimetabolites and require surgical management to seal and preserve filtrating bleb.Case Presentation. A 48-year-old female presented with decreased visual acuity for five days in her left eye. She had a left penetrating keratoplasty one year earlier and two trabeculectomies 7 years earlier. Visual acuity was hand motions, intraocular pressure was 3 mmHg, corneal graft was clear, mature cataract was present, and axial length was 30.48 mm. The conjunctiva covering the superotemporal sclerotomy was avascular, flat, and partially lost. After heavily painting the bleb with a fluorescein, late-onset point leak was revealed. Overlying conjunctiva was excised. The atrophic, irregular, and partially absent scleral flap was covered by a processed human pericardium graft and conjunctival advancement. Postoperatively, intraocular pressure stabilized around 16 mmHg. After four months, phacoemulsification and intraocular lens implantation were performed. Visual acuity did not exceed 0.1 (in decimal notation) due to degenerative myopia-related macular atrophy. Corneal graft remained clear at her 6-month followup period.Conclusion. Surgical bleb revision using a pericardium graft and conjunctival advancement seems to be an effective method for treating late bleb leaks. However, careful follow-up is required for detecting recurrent leaks and elevated intraocular pressure.

scholarly journals Patient-Specific Implants for Pelvic Tumor Resections

2021 ◽  
Vol 11 (8) ◽  
pp. 683
Author(s):  
Kevin Döring ◽  
Kevin Staats ◽  
Stephan Puchner ◽  
Reinhard Windhager
Keyword(s):  
Postoperative Complications ◽  
Median Number ◽  
Harris Hip Score ◽  
Patient Specific ◽  
Limb Salvage Surgery ◽  
Patient Specific Implants ◽  
Custom Made ◽  
Revision Reconstruction ◽  
One Year

Introduction Limb salvage surgery for periacetabular malignancies is technically demanding and associated with a considerable likelihood of postoperative complications and surgical revision. Reconstruction using custom-made implants represents the treatment of choice. This study was conducted to analyze treatment outcomes of custom-made implants in a single orthopaedic tumor center. Patients and Methods Twenty patients with a histologically verified periacetabular malignancy and a median follow up time of 5 (1–17) years were included. Results The median number of revision surgeries per patient was 1.5 (0–7). Complications were dislocations in 3 patients, aseptic loosening in 4 patients, deep infections in 9 patients, thromboembolic events in 5 patients and sciatic nerve lesions in 4 patients. Overall survival was 77% after one year, 69% after two years and 46% after five years. Median Harris Hip Score was 81 (37–92) points at last follow up. Conclusion Although internal hemipelvectomy and reconstruction using custom-made implants is linked with a high risk of postoperative complications, good functional outcomes can be regularly achieved. This information may help treating surgeons to find adequate indications, as eligible patients need to be critically selected and integrated into the decision-making process.

scholarly journals Clinico-radiological correlation during the course and healing of Legg-Calve-Perthes’ disease treated by a non-intensive conservative method

2020 ◽  
Vol 85 (5-6) ◽  
pp. 97-102
Author(s):  
Barik Sitanshu ◽  
◽  
Sethy Siddharth Sekhar ◽  
Paul Souvik ◽  
Arora Shobha ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Age At Onset ◽  
Limb Length Discrepancy ◽  
Final Outcome ◽  
Perthes Disease ◽  
Harris Hip Score ◽  
Conservative Method ◽  
Radiological Parameters ◽  
Acetabular Head Index

Introduction. The purpose of this study is to signify any clinical and radiological correlation, if present, in patients of Legg-Calve-Perthes’ disease (LCPD) who underwent an ambulatory conservative method of containment and their final outcome. Material and methods. Retrospective study over an 8-year period including patients of LCPD who were treated by an ambulatory conservative method showing signs of healing in the last radiological assessment was done. Clinically, gait, limb length discrepancy, range of motion of the hip, and Harris hip score were noted. The radiological parameters assessed in this study were epiphyseal index, epiphyseal quotient, acetabular head index, and epiphyseal extrusion index. Stulberg criteria was used to assess final outcome. Results. A total of 24 patients (17 males, 7 females) with a mean age of 7.9±3 years (5–9 years) who had a clinic-radiological diagnosis of LCPD were included in the study. There was a significant improvement of range of motion of the hip joint along with Harris hip score (t(18)= -16.77, p<0.001) but no significant changes in the radiological parameters during the course of the disease. There was no correlation between radiological parameters and Harris hip score. 79.1% (19/24) had a good outcome at final follow up. Conclusion. The function and clinical outcome during the course and healing of LCPD does not correlate with the radiographic changes and ambulatory conservative management leads to satisfactory improvement in functional activity. Age at onset and lateral pillar classification are important factors influencing final outcome in LCPD.

HEMOPHILUS INFLUENZAE MENINGITIS

PEDIATRICS ◽  
1949 ◽  
Vol 4 (5) ◽  
pp. 643-659
Author(s):  
WILLIAM G. CROOK ◽  
B. REED CLANTON ◽  
HORACE L. HODES
Keyword(s):  
Hospital Admission ◽  
Therapeutic Agent ◽  
Rabbit Antiserum ◽  
Complete Recovery ◽  
Specific Antiserum ◽  
Older Children ◽  
Number Of Patients ◽  
Continued Use ◽  
One Year

The results obtained in the treatment of 110 infants and children with H. influenzae meningitis are presented and the various agents used in the therapy of the disease are evaluated. Eighty-seven (79%) survived. Sixty-eight (62%) recovered completely. Eight of the 23 deaths occurred within the first 24 hours after hospital admission. Slightly over one half the children were less than one year of age. Only 69% of this group survived as compared with 90% in the group over one year of age; only 50% of the younger group recovered completely as compared with 75% of the older group. The plan of therapy underwent various modifications and additions during the eight year period covered in this study. Forty-four per cent of the patients were treated with specific H. influenzae rabbit antiserum and sulfadiazine; 48% were treated with these agents together with streptomycin (and in many instances penicillin). The remaining 8% were treated with streptomycin alone or in combination with sulfadiazine. The survival and complete recovery rates of those treated with serum, sulfadiazine and streptomycin were not significantly different from the rates of those treated with serum and sulfadiazine alone. The number of patients treated with streptomycin without serum was too few for analysis. Specific antiserum used early and in large doses seemed to be a valuable therapeutic agent in these studies. It is believed that this antiserum should be used in the treatment of all patients except perhaps older children and younger children who are only mildly ill. The high cost of this serum, however, remains a major problem. Streptomycin undoubtedly is a valuable therapeutic agent in the disease; in this study, however, there has been no striking improvement in the over-all results since its introduction. Sulfonamides and especially sulfadiazine appear to have been of limited but definite value in the treatment of this disease and their continued use in all patients is recommended. Penicillin when given in high dosages would also seem to be a helpful therapeutic adjunct when used along with other agents. Follow-up data on 64 of the 87 surviving patients are presented.

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