Types Of Contractures Research Articles

A Prospective Study of Reconstructive Procedures For Post Burn Hand Contractures

Objective: The hand is among the most frequent sites of burns contracture deformity. It represents a common problem and a difficult challenge for many reconstructive surgeons. It is important to restore length, function, and provide good quality skin cover. Our aim is to evaluate the different surgical procedures for resurfacing after release of post burn hand contractures in terms of functional recovery and aesthetic outcome. Methods: Totally 30 cases of post burn hand contractures were reconstructed between May 2018 and November 2019 according to site and type of contracture with individualization for each case. All cases were followed up with physiotherapy and splinting devices, functional and aesthetic outcome for each procedure. Results were analyzed as per successful reconstruction, type of procedure, complications, functional and aesthetic outcome. Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z- plasties with proper planning gives maximum length gain with no donor morbidity as other procedures and acceptable appearance. Conclusion: Postoperative physiotherapy and splinting are must for better outcome in all cases.

Post burn perineal contractures: case series and a classification system

Introduction: Perineal burn contractures remain under reported in our region. We have set out to study the pattern of presentation, describe the formation of these contractures and identify any recurring patterns that will form a basis for a classification that will be useful in planning their management. Methods: A retrospective study of the patients seen over a three year period (2009–2011) at the National Orthopaedic hospital Dala is presented. Information was retrieved from case notes in the medical records department. The bio-data, type of care received post injury associated percentage burns, formation of contractures, were all noted. Results: All the seven patients seen were children of which five were females. Flame burn was the main type of burn. All burns occurred at home. Four major types of contractures were identified as transverse bands, hooding, fusion and obliteration. An equal number of patients presented following home versus hospital care. Conclusion: The relative rarity of post burn perineal contractures leaves little experience for the young surgeon to take advantage of when in training. A classification system will help to make it easier to identify what structures are involved and make planning easier. In the absence of specialized care it is doubtful that there is any statistical difference in the likelihood of perineal contracture development of patients managed at home by traditional healers versus those presenting in peripheral centers lacking formal burn management protocols. Most childhood burns still occur at home. There is a need to continually educate the public on the need to make the home a safe place for children.

Surgical Management of Post Burn Hand Deformities.

Objective:To evaluate the efficacy of different surgical procedures on post burn contracture of hand.Methods:A quasi-experimental study design was conducted at the Department of Plastics and Reconstructive Surgery, Dow University of Health Science, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan from 1st June 2019 to 30th November 2019. Ninety-three participants of burned hand contracture of either gender, aged between 6- 60 years were included in the study. Resurfacing surgery with skin graft and loco-regional flaps were done according to type of contracture with individualization for each patient. All patients were kept under follow up for ninety days to assess efficacy of contracture release for each surgical procedure was noted. SPSS version 23 was used to analyse data.Results:Full thickness skin graft (FTSG) was performed in 60.2% cases, 17.2% with split thickness skin graft (STSG) and 12.9% with cross finger flaps. About 25% of recurrence was observed in cross finger flaps, whereas no recurrence was seen in Z-plasties and posterior interosseous flap. The significant association was between recurrence and surgical procedures (p<0.05).Conclusion:Z-plasty followed by FTSG was effective in the management of post burn contractures of hand.

Management of axillary burn contracture: A summary of 67 cases

The scapulo-humeral joint has the greatest range of motion of all joints. Axillary contractures, mostly sequela of trunk burn, are sometimes cause of important hindrances in daily activities. Once installed, their treatment are essentially surgical. The purpose of this study was to describe epidemiologic and clinical profile and to evaluate the therapeutic results. We carried out a review from January 2001 to December 2016. Sixty-seven patients with all post-burn axillary sequelae were included. The Kurtzman-Stern’s classification was used to describe the type of contracture. Surgical procedure consisted of releasing scar and covering the loss of substance by local plasty, skin grafting or loco-regional flap. The average age was 21 years [2–76 years] with a sex ratio (M/F) = 0.5. Post-burn contracture was following burn flame in 43 cases (64%) and hot fluid in 18 cases (27%). The mean duration of contracture was 3.3 years [1 month–20 years]. Type 1 and 2 were noted in 22 cases (33%), type 3 in 45 cases (67%). The deficit of abduction varied between 30° and 110°. Thirty-eight patients have been operated. Twenty-six patients underwent local plasty, 11 patients was treated by skin graft and one patient was treated by para-scapular flap. The complications were dominated by minor flap necrosis and skin graft loss in 9 cases (24%). After an average follow-up of 4 years, functional results were considered as satisfactory in more than 80% of cases.Management of post-burn axillary contracture flap and skin graft gives good results despite the minor complications related to peri axillary scar and difficulties of post operative immobilization of the shoulder. Early surgery and physiotherapy are important to achieve better results by avoiding ligament and capsular retractions.

Surgical Corrections in a Patient with Face &amp; Neck Burn Deformity

Introduction: Face and neck burn deformity is the most common deformity after deformity of hand. Flame burn and chemical burn are the common causes for the all types of burn contractures. Burn contractures involving the anterior neck represent a surgical problem for the Plastic surgeons. Objective: To evaluate the outcome of patients who underwent reconstructive surgery for face and neck burn deformity.Materials and method: The study was conducted in the department of surgery in plastic surgery unit, NGMC between February 2013 to June 2015. During this period 36 patients underwent reconstructive surgery.Result: In 36 patients, there were 12 males and 24 females. The age of patients ranging from 11 years to 56 years. The overall results were satisfactory in 34 cases and not satisfactory in 2 cases, The clinical satisfaction degree was 94.44% in overall evaluation. The average follow up period was from 3 months to 1 year.Conclusion: Among the different types of contractures, neck contractures are also very frequently treated. Common surgical procedure is release of contracture and application of skin graft, the other techniques are applied like expanded or without expansion island flaps, free flaps. Finally the main objective of the different surgical approaches is to obtain the better functional and aesthetical result.JNGMC Vol. 13 No. 2 December 2015, Page: 42-45

Abstract: 9.40 Analysis Of Functional Outcome On Post-Burn Upper Limb Contractures In Children In Two Different Countries

INTRODUCTION: To analyze the results of surgery and functional assessment in post-burn contractures in upper limbs in children. This evidence implies on how we think the impact of contracture on patients functions in two distant countries, with different cultures, skin colour and socio-economic life in Pristina - Kosovo and Bahawalpur - Pakistan. Study design: Descriptive case series study in two different countries. Place and duration of study: Clinic of Plastic and Reconstructive Surgery Center Prishtine-Kosova, Department of Plastic and Reconstructive Surgery-Bahawal. Victoria Hospital Bahawalpur and Department of Plastic and Reconstructive Surgery University from August 2009 to August 2014. MATERIALS AND METHODS: Patients from age 9 months to 17 years with post burn contractures in upper limbs with no metabolic derangement were included in the study. After proper assessment of the functional impairment, X-rays were done and then the surgical decision was made. Different procedures were used for release and coverage of contracture depending on the type of contracture. Patient was called for follow-up up to one year after discharge. RESULTS: 128 patients were included in study in both countries. 67 were male and 61 were female in B-Pk and 65 male and 63 female in Pr-Ks. Finger contractures are the most common. Best functional improvement was seen in the age group of 9 months to 5 years. CONCLUSIONS: Best results of study were obtained in young children. Joint stiffness plays an important role in functional improvement. Type of procedure has no relation with outcome of surgery, without any significant difference between two countries.

Study on Surgical Management of Post Burn Hand Deformities.

Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. It's a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases.

VOLKMANN’S ISCHEMIC CONTRACTURE;

Objective: To share our experience of post-circumferential Volkmann’s IschemicContracture (VIC) of the forearm seen in our setup. Design: A descriptive case series study.Setting: National Orthopedic Hospital, Bahawalpur, Pakistan. Period: January 2005 toDecember 2013. Methodology: A total of 42 patients were registered during the study period.Patients with VIC of the forearm resulting from direct circumferential compression were includedin the study. Patients who developed VIC of forearm indirectly secondary to arm pathology orother causes were excluded from the study. Assessment was made by detailed history, clinicalexamination and radiographs of the involved extremity. The age, sex, duration, side and type ofcontracture, length and width of forearm and resulting deformities were all documented on adetailed proforma. Patients were categorized into three types accordingly. Results: Forty twopatients comprising 29 males and 13 females were seen. Their ages ranged from 1 to 53 yearswith mean age of 14.47 years. Duration of established VIC of the forearm after insult ranged from 3months to 6 years with mean duration of 2 ½ years. Most frequent type of contracture wasmoderate variety seen in 19 patients (45.23%) with 14 cases on the right and 5 cases on left sidefollowed by severe varieties which were present in 13 patients (31%) with 10 cases on the rightand 3 cases on left side. Mild contractures were found in 10 patients (23.9%) with 6 cases on theright and 4 cases on left side. In 26 of 42 patients, a difference in forearm length that ranged from79% to 94% (mean, 80%) was observed. Majority of cases (37 cases) of VIC occurred after TBS forradius and ulna fractures while in the remaining 5 cases, contractures of forearm occurred due totight plaster of paris (POP) splint. Conclusions: Post-circumferential forearm contractures afterTraditional Bone Setters (TBS) are common in our society. Community awareness through healtheducation and conducting medical camps and seminars might play a role in decreasing theinfluence of TBS.

Treatment of postburn axillary contracture

Objectives The aim of the study was to evaluate different options for postburn axillary contracture treatment. Background Axillary postburn contractures remain a frequent problem after thermal burns involving the trunk and upper arm. Difficulties in rehabilitation of shoulder abduction during the initial period and the contractile evolution of the scar contribute to this problem. Patients and methods A prospective study of 25 patients with postburn axillary contracture was conducted. The contractures were classified according to the Kurtzaman classification and reconstructed using different methods including skin grafting, local flaps (Z-plasty and five flaps), and regional flaps (parascapular, scapular, and thoracodorsal artery flap). Postoperative follow-up continued for 6 months. Patients had to undergo a physiotherapy course as a routine part of each technique. Results The ages of the patients ranged from 7 to 46 years. Type of contracture was type 1A in 12 cases (48%), type 1B in four cases (16%), type 2 in four cases (16%), and type 3 in five cases (20%). The degree of abduction ranged between 50 and 130° with a mean of 100°. Split thickness graft was used in four cases (16%). Local flaps were used in 16 patients - Z-plasty in six patients (24%) and five flaps in 10 patients (40%) - and regional flaps were used in five patients (20%). The improvement in abduction seen postoperatively in the studied cases ranged from 25 to 80° with a mean of 55°. The overall functional and cosmetic results were satisfactory in most of the cases. Conclusion Z-plasty is suitable for short linear band contractures; the five-flap technique is indicated in longer ones. For type II and III contractures regional flaps are the treatment of choice whenever available. For severe cases release and split skin graft is indicated. Postoperative rehabilitation is very important to avoid recurrence and to maintain the result achieved.

Planning of surgical treatment of upper extremity in patients with cerebral palsy

The purpose - to devise the algorithm of patient examination with spastic hand to determine what the variant of surgical treatment is indicated. The variant of surgical treatment and it's results are depend on the cause of upper extremity deformation. Materials and methods. This study is based on a survey of children with cerebral palsy with lesions of the upper extremity. The main criterion for the selection of patients was the presence of the combined lesion of the upper extremity, where the cause of dysfunction hands are not only fixed contractures, but primary tonic. Was to survey 47 patients with spastic forms of cerebral palsy with the defeat of the upper limb, but the study group included only 26 of them in the ages of 7 to 18 years (average 12,1), as having the clinical picture both types of contractures. We have developed and applied a system of examinations, modeling expected outcome of selective neurotomy motor nerves of the upper limb, which allows to estimate the possible result of such treatment, and clearly differentiate tonic and fixed contracture. Results and conclusions. Based on the results of study we supposed that, using diagnostic blockade motor nerve at the period of planning surgical treatment help us to create temporary reversible model of selective neurotomy motor nerve branches and identify the type of contracture, degree of manifestation and functional perspective.

Serial splintage: Preoperative treatment of upper limb contracture

IntroductionThe present study aimed to study the efficacy of preoperative splints in treatment of upper limb contractures and to evaluate the response of contracture to splints depending on the etiology and the joint involved. MethodsNinety joints of 42 patients were studied. Patients age, gender, etiology, duration of contracture, contracture site and joint and type of contracture was noted. The range of motion of the involved joint was recorded. Serial static splints made of thermoplastic material were applied after customizing them for each patient. The range of motion and percentage movement was recorded at weekly interval and the splints were modified as per need. Time taken to reach a plateau stage was noted. To compare the statistical significance between two groups and more than two groups of continuous variable unpaired t-test and one way ANOVA respectively was applied. We considered differences to be statistically significant when the p value was below 0.05. The strength of relationship between the two continuous variables was analyzed by Pearson correlation analysis. ResultsEtiological factors were thermal burns (36.7%), electrical burns (13.3%), post traumatic (35.6%) and post cellulitis (14.4%). Age ranged from 2 to 70 years with a mean of 28.9±13.4 years. Sixty-two patients treated were males (68.9%) and 28 were female (31.1%). The mean range of motion present across all joints before starting the therapy was 54.7±23.6 degrees. The mean improvement in contracture angle obtained by serial splintage was 37.4±28.1 degrees. The mean time taken to achieve plateau was 23.6±3.2 days. Maximum improvement was seen in thermal burn contractures (41.2±30.3 degrees). Least improvement was seen in contractures due to cellulitis (6.5±16.2 degrees). This finding was statistically significant [F(3,86)=4.25, p=0.005]. Significant difference was seen in response to therapy based on the joint involved [F(3,86)=3.36, p=0.02]. Highest improvement in the range of motion was seen in the metacarpophalangeal joint (49.61±31.3 degrees). ConclusionsThe preoperative use of splints may lead to lesser surgical intervention and in selective cases obviate surgery. Thermal burns which are the most common cause of contractures of the upper limb, show the maximum response to preoperative serial splintage. Patient with minor contracture and supple tissues are fully corrected with splints without surgical intervention. In patients undergoing surgical correction, skin graft decreases due to decreased contracture angle.

Experience in 500 Total Knee Replacements

Experience of CITO joint replacement department in knee arthroplasty with implants from various manufacturers was analyzed. Implants of three modifications were used: basic, with posterior stabilizer and "semiconstrained" one. Tactics for a choice of optimum construction depending on a disease, gender, degree and type of contracture, degree and type of limb axis curvature was demonstrated and substantiated on the example of 500 operations performed to 426 patients with various knee joint pathology during the period from 2000 to 2010. By the data of clinical and roentgenologic analysis excellent result was achieved in 90 (21%), good inv 277 (65%), satisfactory in 51 (12%) and poor in 8 (2%) patients. This treatment tactics may be considered as an adequate one.

Post-burn microstomia: Anatomy and elimination with trapeze-flap plasty

Perioral contractures after burn (microstomia) is a common consequence of facial burns. A small oral opening creates a problem for oral hygiene, food intake and intubation. Therefore, contracture treatment is beneficial once severe limitation of function is realised. Traditionally, this type of contracture is released and the defect is closed with Y–V or Z-plasty. A commonly used technique consists of scar excision in the zone of the commissural apex down to the mucosal lining; the mobilised mucosal flaps are rotated up and down to cover the defect. Anatomical studies and surgical treatment experience for scar microstomia (345 patients) showed that a microstomia contracture could be described as an ‘edge’ contracture and is caused by a fold located at the oral angle. The lateral (exterior) sheet of the fold the scar causing the contracture; the medial sheet is the mucosa. The scar-surface deficit exists in the exterior sheet of the fold and the angle zone. Therefore, additional excision of scar deforms the oral angle. The contracture release, with a Y-shaped incision, and wound coverage (scar-surface-deficit compensation) with the single mucosal flap allows complete microstomia release and oral angle restoration. After the incisional contracture release, the wound, as a rule, accepts a trapezoid form. The defect (wound) is closed with a similar-shaped mucosal advancement flap. Good functional and cosmetic results were achieved in all cases. The commissural angle accepted a normal shape; the mucosal flap was invisible when the mouth was closed; the mouth had a normal appearance when the mouth orifice was open. After an adequate correction, no recurrence of contractures took place. Thus, scar dissection and wound coverage with the trapeze-flap plasty becomes a preferred reconstructive technique for microstomia release after burn.

Treatment of Recontracture with the Subcutaneous Pedicle Rhomboid Flap

Treatment of recontractures that were previously skin grafted or treated with Z-plasty is a challenge. Application of a subsequent Z-plasty is risky because of the possibility of tip necrosis of the triangular flaps, whereas donor-site morbidity is undesirable if subsequent skin grafting is planned. The subcutaneous pedicle rhomboid flap is an effective technique for the treatment of every type of contracture. This article presents the clinical results of the rhomboid flap used in treatment of recontractures as an alternate technique to Z-plasty and skin grafting. The authors operated on seven patients with recontractures (aged 4 to 45 years) using 19 rhomboid flaps. Flaps were applied in the upper extremity (seven flaps), lower extremity (five flaps), trunk (five flaps), neck (one flap), and axilla (one flap). Z-plasty scars were present in three locations, whereas skin grafting was previously applied in 16 locations. Preoperative rhomboid flap designs were made regardless of previous scars as single flaps in six locations and multiple flaps in 13 locations. Operations were performed under local and general anesthesia. Patients were followed up for at least 6 months. All flaps achieved adequate relaxation postoperatively and healed uneventfully. The subcutaneous pedicle of the flap provided a distinct advantage in terms of vascularity. Recurrence was not seen in any of the patients. The subcutaneous pedicle rhomboid flap is an effective and reliable technique for the treatment of recontractures. Preoperative planning is simple and independent of previous scars. Because the rhomboid flap resurfaces the emerged defects generated by relaxation incisions, one should consider that the flexibility of a single flap may not be adequate in some cases, and multiple flaps should be used.

Changes in muscles and tendons due to neural motor disorders: implications for therapeutic intervention.

Patients with an upper motor neurone syndrome (CP) suffer from many disabling primary symptoms: spasms, weakness, and loss of dexterity. These primary ‘neurogenic’ symptoms often lead to secondary disabilities, muscle contractures, and tertiary effects, bone deformations. A common symptom of CP is hypertonia, with. the consequence that the involved muscles remain in an excessively shortened length for most of the time. As a normal reaction of the muscle tissue, the number of sarcomeres is reduced and the muscle fibers shorten permanently: a contracture develops. A possible second type of contracture is that normal muscle lengthening along with bone growth is affected. Current treatments for the secondary effects include (1) reduction of muscle force, (2)lengthening of the muscle fibers by serial plaster casts, and (3)surgical lengthening of tendons or aponeurosis. The choice of treatment depends on the cause of the functional deficit. Bone tissue also adapts itself to abnormal forces, especially in the growth period. The hypertonias or contractures of CP so may give rise to bone malformations that interfere with function (e.g. femur endorotation) or may reduce the action of muscles by changing the lever arm (e.g. ankle varus). Although prevention should always be preferred, a timely surgical intervention cannot always be avoided. The differences in treatment for the various groups require and justify an extensive laboratory investigation, including EMG recordings in gait, measurement of passive elastic properties, and long-term observation of the hypertonia.

Limb deformations in oligohydramnios sequence: Effects of gestational age and duration of oligohydramnios

In order to study the pathogenesis of prenatal deformities, we reviewed maternal histories, delivery records, pathology reports, radiographs, and photographs of 90 fetuses with prenatally documented oligohydramnios at gestational ages from 14 weeks to term. The causes of oligohydramnios included premature rupture of membranes (44 cases), fetal renal insufficiency (25 cases), idiopathic (15 cases), and twin-twin transfusion (6 cases). The fetuses were grouped according to gestational age at delivery and duration of oligohydramnios. Sixty-three fetuses (70%) had documented contractures. As expected, contractures were more frequent with earlier onset and longer duration of oligohydramnios. During the 2nd trimester, the frequency of contractures in fetuses with oligohydramnios was 77% compared to 52% in the 3rd trimester (chi(2) = 5.33, 1 df, P =.02). Considering all gestational ages together, 57% of fetuses had contractures after less than 2 weeks of oligohydramnios compared to 81% of fetuses with a longer duration of oligohydramnios (chi2 = 6.23, 1 df, P <.02). The type of contracture varied with gestational age. Clubfoot was the most frequent at all ages, but hand contractures such as camptodactyly were common only in the 2nd trimester while the broad flat hand originally described in Potter sequence was found almost exclusively in the fetuses with oligohydramnios in the 3rd trimester. Of the 63 fetuses with oligohydramnios and contractures, 25 (40%) had either additional malformations or family history that could explain contractures independent of oligohydramnios.

Structural features of acute focal metabolic injuries to somatic muscle fibers caused by dimethylparaphenylenediamine

The pathological picture of an acute disorder of cell metabolism caused by dimethylparaphenylenediamine consists of typical focal reactions of striated muscles to injury: myofibril contractures and intracellular myocytolysis. Analysis of the pathological process demonstrates the time course of contracture injuries as a succession of overcontracture (first-third degree contractures) and necrobiotic phases (fourth degree contracture), followed by lump degradation and macrophagal resorption. Two polar types of contractures are clearly differentiated by the size, shape and structural and metabolic characteristics of target fibers: “ribbons“ and ”medallions”. Disappearance of Z strips, disaggregation, disorientation, and fragmentation of myofibrils are typical of intracellular myocytolysis. The observed changes form the morphological basis for acute disease of striated muscles.

Limb deformations in oligohydramnios sequence: effects of gestational age and duration of oligohydramnios

Oligohydramnios, regardless of cause, results in a sequence of anomalies including characteristic facies, contractures and lung hypoplasia, but the timing and duration of of oligohydramnios required to produce different features of the sequence, especially limb defects, are not well defined. Other causes of restricted fetal movement such as fetal neuromuscular disorders also result in limb contractures and lung hypoplasia. Because such neuromuscular disorders often cause polyhydramnios which in turn predisposes to premature rupture of membranes, such fetuses may present with ruptured membranes and oligohydramnios. Additional data regarding the type and incidence of limb contractures in fetuses with differing onset and duration of oligohydramnios is needed to provide accurate counseling regarding the underlying cause and recurrence risks.We have reviewed maternal histories, delivery records, pathology reports, radiographs and photographs of 90 fetuses with gestational ages from 14 weeks to term with >24 hrs documented oligohydramnios. The causes of oligohydramnios included premature rupture of membranes (44 cases), fetal renal insufficiency (25 cases), idiopathic (15 cases) and twin-twin transfusion (6 cases). The fetuses were grouped according to gestational age at delivery and duration of oligohydramnios. As expected, contractures were more frequent with earlier onset and longer duration of oligohydramnios. During the second trimester, the frequency of contractures in fetuses with oligohydramnios was 77% compared to 52% in the third trimester(p=.02). Considering all gestational ages together, 57% of fetuses had contractures after less than 2 weeks of oligohydramnios compared to 81% of fetuses with a longer duration of oligohydramnios (p<.02). The type of contracture varied with gestational age. Club foot was the most frequent at all ages, but hand contractures such as camptodactyly were common only in the second trimester while the broad flat hand originally described in Potter sequence was found almost exclusively in the third trimester. Of the 59 fetuses with oligohydramnios and contractures, 25 (42%) had either additional malformations or family history that could explain contractures independent of oligohydramnios.Oligohydramnios sequence is common in the second trimester, but presents differently compared to the third trimester and is more easily confused with other birth defects. Fetuses with oligohydramnios and contractures require a detailed examination and review of history before the contractures can be attributed to oligohydramnios sequence.

Some biomechanical aspects of contractures in coxarthrosis

On the basis of the clinical analysis (225 patients suffering from coxarthrosis with the affection of 295 joints and three-plane mathematical modelling of different types of contractures in hip joint, the genesis of contractures is described and biomechanical peculiarities of each type are given. The elimination of contractures in various surgical interventions is considered as a necessary component of the pathogenetic treatment of coxarthrosis, beneficially affecting the course of degenerative dystrophic process.

MR Study of Normal Joint Function Using a Low Field Strength System

A functional MR study was performed using a 0.064 T permanent magnet MR system. The shoulder joints, elbow joints, hip joints, and knee joints of three volunteers (mean height and weight, 176 cm and 71 kg, respectively) were examined at incremental joint angles in three to eight stages during flexion-extension, abduction-adduction, or pronation-supination movement. Each set of 16 images was obtained in 4 min, 49 s using three-dimensional Fourier transformation methods with gradient echo pulse sequences. The images were evaluated in static mode and sometimes in cine mode. The findings obtained about the physiology of these normal joints was generally compatible with findings previously accumulated in the field of kinesiology. The study suggests that this method can be useful for in vivo study of kinesiology and pathogenesis of diseases and that patients with most types of contracture or deformity can be examined by MR imaging.