Posterior Angulation Research Articles

Posterior Angulation in Trochanteric Fractures Detected with Roentgen Stereophotogrammetry

Roentgen stereophotogrammetric analysis has been carried out in 8 patients with trochanteric fracture after fixation with a sliding screw-plate. In 6 of the 8 cases the proximal fragment angulated posteriorly after the operation. Posterior angulation may be an important mode of failure of trochanteric fractures.

Ultrasonographic display of complex vascular rings

Ultrasonographic display of vascular ring anatomy has been limited to single-plane views. This does not readily allow for a three-dimensional interpretation of structural relations. A method that included a sweep consisting of multiple contiguous frontal planes was used in 12 patients with a vascular ring before repair for the evaluation of the arch sidedness and number, brachiocephalic vessel pattern, upper descending thoracic aorta sidedness, ductus arteriosus site or sites and proximal pulmonary arteries; 7 patients had Doppler color flow imaging.Complete imaging of the luminal vascular components was possible in all but one patient. Its four other patients, atretic segments of the vascular ring could not be displayed. The addition of Doppler color flow imaging especially aided in the tracing of multiple vascular structures in complex cases and in assessing ductus arteriosus and arch patency. The use of a suprasternal frontal sweep with posterior angulation could display encirclement of the air-filled trachea. Vascular ring segments without (lumens could not be displayed.

Rotation osteotomy of the tibia after poliomyelitis. A review of 51 patients

After severe poliomyelitis, which is still relatively common in some developing countries, lateral rotation deformity of the tibia may occur. We have reviewed 51 patients treated by O'Donoghue's rotation osteotomy of the tibia. An average lateral rotation deformity of 57 degrees was fully corrected in all the patients, and in 38 of them the graft obtained during the osteotomy was used for a simultaneous Grice-Green subtalar arthrodesis in one or both feet. All the osteotomies united in an average of 11 weeks, some with relatively minor and unintentional posterior angulation. There was no posterior angulation when the length of the step cut osteotomy was 4.5 cm or more. O'Donoghue's osteotomy is a simple and safe operation, being particularly advantageous if a Grice-Green procedure is also required.

The Value of Oblique Angle Reorientation in SPECT Bone Scintigraphy of the Hips

SPECT bone scintigraphy has been shown useful for detecting avascular necrosis (AVN) of the femoral heads. Because the femoral necks project in a 15-20 degree posterior angulation from the coronal plane, the femoral head is partially superimposed upon the acetabulum in standard coronal SPECT images. To avoid this problem, the authors now perform oblique angle reorientation of all hip SPECT studies. This new technique, which allows display of the hip in a more anatomic fashion and better definition of hip abnormalities, is described. No new data acquisition is needed, and only a small amount of extra time is required for reconstruction.

Tibial shaft fractures treated with functional braces. Experience with 780 fractures.

We have reviewed our recent results with functional bracing of tibial shaft fractures in adults in order to define its role in management. We also analysed several parameters of these fractures to discover those which influence healing. A total of 780 tibial fractures treated in prefabricated functional braces were followed to union; shortening of less than 10 mm and angulation of less than 5 degrees in any plane were our parameters for successful treatment. The average time before applying a brace was 3.8 weeks for closed fractures and 5.2 weeks for open ones. Closed fractures healed in an average of 17.4 weeks and open fractures in an average of 21.7 weeks, 90% of them with 10 mm of shortening or less. Varus angulation and posterior angulation were the most common deformities encountered at union. There were 20 nonunions (2.5%) and 46 braces were discontinued during treatment. We found no association between fracture healing and the patient's age, the mechanism of injury or the fracture location. The degree of soft tissue injury appeared to have most influence on the speed of fracture healing. Fracture comminution and initial displacement, the condition of the fibula and the time from injury to bracing also appeared to affect the speed of union.

Posterior capsular opacification and intraocular lens decentration Part II: Experimental findings on a prototype circular intraocular lens design

In a prospective randomized study, 25 New Zealand white rabbit eyes were implanted with four intraocular lens (IOL) designs These included a one-piece modified J-loop IOL, a three-piece modified J-loop IOL, a rigid disc IOL, and an experimental compressible disc (CD) IOL. The CD IOL revealed the lowest mean posterior capsular opacification (PCO) of all IOLs tested (P <.01). With all lenses tested, a positive correlation between PCO and decentration was found (R = 0.55, P <.05). These results suggest that because of its design features (i.e., one-piece construction, biconvex optic, posterior angulation of the fixation element), the CD lens produces a mechanical barrier against lens epithelial cell migration and reduces the incidence of PCO.

Femoral Shaft Fractures in Children

Sixty-five children between 3.5 and 12 years of age with femoral shaft fractures were treated with fixed traction using supracondylar Kirschner wires incorporated in a one-and-a-half spica cast. Medial angulation up to 15 degrees, lateral angulation up to 5 degrees, and overriding up to 2 cm have been accepted. Posterior and anterior angulations have been rejected. After an average 4-year follow-up, neither joint stiffness nor skeletal deformity developed. At follow-up, maximal shortening was 0.8 cm, and overgrowth was 0.5 cm. Except for complicated cases, the use of this method is justified.

Tibial fractures in children: follow-up study.

One hundred seventeen children with tibial shaft fractures were treated by above knee cast with or without traction depending on stability. All fractures united in an average period of 37 days. Reevaluation after 3-10 years showed that initial shortening, fracture type, fracture location, and age of the patient affected growth acceleration, whereas the initial angular magnitude, direction, and planes, as well as the type of the fracture, the age of the patient, and length of follow-up period, affected correction of angulation. We concluded that: shortening can be compensated by growth acceleration; varus deformities can undergo spontaneous correlation whereas valgus deformity and posterior angulation partially persist and rotational deformities persist.

Surgical correction of chondromanubrial deformity (Currarino silverman syndrome)

Chondromanubrial (arcuate) pectus carinatum is the rarest protrusion deformity of the chest. Its surgical correction was first described by Ravitch in 1952. We have recently encountered five patients with this deformity who have provided additional insight into the anatomy and optimal repair of this condition. It is notable for a short nonsegmented sternum with marked posterior angulation at the site of the normal chondromanubrial junction. It is optimally corrected by subperichondrial resection of the second to the seventh costal cartilages with a broad wedge-shaped osteotomy through the anterior cortex of the sternum at the point of maximal angulation. Anterior displacement of the sternum is achieved by closing the osteotomy with heavy silk sutures while the costal cartilages are regenerating.

VALPROIC ACID EMBRYOPATHY

We describe three children born to an epileptic woman who received carbamazepine (CBZ) and methosuximide (MT) during one pregnancy and valproic acid (VPA) and CBZ during the other two pregnancies. The children exposed to VPA and CBZ showed craniofacial abnormalities including prominent forehead, epicanthal folds, hypoplastic zygomatic arches, shallow philtrum, depressed nasal bridge, posterior angulation of the ears and infraorbital creases while the child exposed to only CBZ and MT did not. In addition to the previously described features, both patients exposed to CBZ and VPA had lateral displacement of the medial origin of the eyebrows and a carrying angle of zero degrees. One of them also had hypoplastic nails and teeth. This unique family enabled us to compare sibs with the same parents who were exposed to a different combination of antiepileptic drugs and evaluate potential teratogenic effect. The findings in this family would support the previous observation that valproic acid may be associated with a pattern of dysmorphic features in addition to the 1-2% risk for neural tube defect it is known to have when taken during the early part of pregnancy.

Surgical correction of pectus carinatum

Pectus carinatum is an infrequent but eminently correctable chest wall deformity. It is encountered much less frequently than pectus excavatum. In 12 years, from 1973 to 1985, 152 pectus carinatum (16.7%) and 758 pectus excavatum deformities (83.3%) were corrected. It occurs more frequently in boys (119 patients) than girls (33 patients). The majority, 89 cases, were symmetric, while 49 were asymmetric, and 14 were mixed deformities (ipsilateral carinatum, contralateral excavatum). In almost half the patients the deformity was not identified until after the 11th birthday. A family history of chest wall deformities was present in 26%, and of scoliosis in 12%. Associated musculoskeletal abnormalities were identified in 34 patients (scoliosis 23, Poland's syndrome 4, neurofibromatosis 2, Morquio's disease 2, vertebral anomalies 1, hyperlordosis 1, and kyphosis 1). Surgical correction required bilateral resection of the third through seventh costal cartilages in 143 patients, and unilateral resection in nine patients with an isolated abnormality. A single osteotomy was used in 88 patients and a double osteotomy in 53 patients. In 11 cases no osteotomy was required. Mixed deformity with posterior angulation of the sternum was managed by osteotomy and anterior displacement. The remaining cases had sternal osteotomy and fracture of the posterior cortex to correct anterior angulation. The operation was completed with a low complication rate 3.9% (pneumothorax 4, wound infection 1, atelectasis 1, and local tissue necrosis 1). Three patients required revision with additional unilateral lower cartilage resection for persistent malformation of the costal arch. All patients ultimately had a satisfactory result.

Costovertebral anomalies in osteogenesis imperfecta.

Study of 16 patients with Type III osteogenesis imperfecta showed marked elongation of the pedicles of the vertebrae in all cases, a deformity which was not seen in other types of the disease. Posterior rib angulation was also noted in Type III disease. These features have proved useful in suggesting the diagnosis of osteogenesis imperfecta even before long bones have fractured and in categorizing patients with osteogenesis imperfecta into the correct type for prognostic purposes.

An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease: Robinson JA, Burch BH Surg Gynecol Obstet 159:149–152 Aug 1984

An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease: Robinson JA, Burch BH Surg Gynecol Obstet 159:149–152 Aug 1984

Long-term results in the treatment of femoral-shaft fractures in young children by immediate spica immobilization

Manual traction reduction without anesthesia and immediate immobilization in a spica cast were used to treat eighty-five children ranging in age from birth to ten years old who had closed femoral-shaft fractures and no associated injuries. Up to two centimeters of overriding, 30 degrees of anterior angulation, and 15 degrees of medial angulation were accepted. Any angulation in excess of these amounts, or lateral or posterior angulation, was corrected by wedging the cast at the fracture site. Further telescoping of the fracture fragments in the case was attributed to the child pressing the foot against the bottom of the cast and was prevented by removing the sole of the cast. Of the seventy-five children examined two to eighteen years after fracture, none had any residual skeletal deformity or joint stiffness. The length discrepancies of the fractured limbs ranged from 1.7 centimeters of shortening to 0.9 centimeter of overgrowth.

Congenital posterior angulation of tibia and fibula.

Congenital posterior angulation of the tibia occurs less frequently than congenital anterior bowing. Concomitant deformities of the foot and contractures of the soft tissue usually exist. A review of the literature indicates that nonoperative treatment is usually successful in correcting the deformity. Tibial growth is frequently less than normal and epiphysiodesis of the opposite extermity may be necessary. Three patients are presented who have been followed up for 17 years, two years, and over one year. Improvement is occurring with nonoperative treatment.

A helpful addition to the Marshall-Marchetti-Krantz operation

A large modified Babcock clamp to stabilize and elevate the proximal urethra and bladder neck has greatly simplified placement of the periurethral sutures in the Marshall-Marchetti-Krantz vesicourethral suspension operation. This is especially true in obese women and/or women with posterior angulation of the pubic bone.

Congenital Posterior Angulation of the Tibia

Fellow in Orthopedic Surgery, Alton Ochsner Medical Foundation, New Orleans, La. Chief, Orthopedic Service, E. A. Conway Memorial Hospital, Monroe, La.

Congenital Recurvatum of the Fibula

A case of isolated posterior recurvatum of one fibula without associated deformities is reported which has progressed to spontaneous resolution during growth. A similarity to posterior angulation of the tibia is implied.

Congenital Posterior Angulation of the Tibia with Talipes Calcaneus

Congenital Posterior Angulation of the Tibia with Talipes Calcaneus

Injuries to the thigh, knee, and leg.

Fractures of the proximal one-third of the femoral shaft usually show abduction and flexion of the proximal fragment, due to the pull of the gluteal and iliopsoas muscles. In the middle one-third there is no constant deformity; however, overriding is usually present. In the distal one-third, or supracondylar type of fracture, the gastroenemius and soleus muscles cause posterior angulation of the distal fragment. In the emergency treatment of these fractures, as with all fractures, splints should be applied before moving the patient to prevent more soft-tissue damage, increased bleeding, and vascular and nerve injury. Emergency splinting cannot be overemphasized. A Thomas splint is the most satisfactory means of immobilization but is rarely available at the time of injury. A board from the groin to the toes or binding of the leg to the normal leg is an available and satisfactory method for emergency splinting. Most fractures of the femur can