Volume 12-3, Fall 2003

Although equinus deformity in children with cerebral palsy is often corrected with surgery, postsurgical recurrence of the deformity is not uncommon. In order to isolate factors that may be related to its recurrence, 31 studies were evaluated. Data from nine articles indicated that children younger than approximately 7 years of age at the time of surgery had a higher risk of recurrence than children who were older at the time of surgery. Recurrence rates may be understated in studies including less than a minimum of 4–5 years of patient follow-up. Lower recurrence rates are documented in diplegic patients compared with hemiplegic patients, and postoperative casting/splinting is stated, but not documented, to reduce recurrence. One study demonstrated that the use of chemodenervation delayed surgery and by inference theoretically would decrease recurrence after surgical release. (Journal of the Southern Orthopaedic Association 12(3):125–133, 2003) Key words: cerebral palsy, equinus, gait, spasticity

The purpose of this study was to evaluate the effectiveness of a newly designed brace in the treatment of adolescent Scheuermann thoracic kyphosis. Twenty-two children who met the roentgenographic criteria of Scheuermann kyphosis and were compliant with treatment were followed until skeletal maturity. Sixteen patients (73%) showed nonprogression of their kyphosis (nine patients demonstrated an improvement, seven patients remained unchanged), and had a mean improvement of 9° (64° to 55°
. Six patients (27%) demonstrated progression of the kyphosis and had a mean increase in their kyphosis of 9° (59° to 68°
. One patient underwent posterior spinal fusion for progressive thoracic kyphosis despite bracing. It was recommended that this brace be worn until skeletal maturity; in this study this time period was determined to be at least 16 months to induce improvement or halt progression of this disease. Flexible curves are a positive predictor of a successful outcome of bracing with the kyphosis brace. These results are comparable to previous reports in the literature describing the effectiveness of the modified Milwaukee brace in the treatment of Scheuermann thoracic kyphosis prior to skeletal maturity, and the kyphosis brace has the advantage of concealability under normal attire. (Journal of the Southern Orthopaedic Association 12(3):135–140, 2003) Key words: bracing, kyphosis brace, Scheuermann kyphosis, thoracic kyphosis, thoracolumbosacral
orthosis

Osteoid osteoma is infrequently localized to the hand. Initially the lesion may cause nonspecific symptoms. A 14-year-old boy presented with spontaneous onset swelling and pain wrist for 2 months. Initially he was suspected of having tuberculosis, but radiographs revealed a sclerotic lesion of the scaphoid and the sedimentation rate was not high. CT scan of the wrist showed a double-ring sign, indicating osteoid osteoma. Lesion was curetted and the nidus excised. This resulted in rapid resolution of the symptoms. (Journal of the Southern Orthopaedic Association 12(3):141–142, 2003) Key words: nidus, osteoid osteoma, scaphoid, tuberculosis, wrist pain

There is no consensus regarding surgical treatment for severely dislocated acromioclavicular joints. Although many treatments are suture-based, the suture materials and resulting suture-bone constructs have been subjected to limited systematic evaluation. This study identifies the strongest and least deforming suture construct among those commonly used for such repairs. Each suture-based repair was tested on a simulated clavicle and coracoid process with the skeletal components distracted until the suture failed to obtain tensile strength. Additional groups of sutures were subjected to cyclic loading to determine resistance to deformation. Panacryl braid had significantly greater tensile strength than all other constructs: Polydioxanone (PDS) braid, Mersilene tape, and Ethibond #5. Deformation after cyclic loading of Panacryl braid, PDS braid, and two strands of Mersilene tape was significantly less than that of the other constructs. A bioabsorbable suture loop, such as Panacryl, can act as a temporary internal splint, maintaining acromioclavicular joint reduction long enough for ligamentous healing during rehabilitation, and can avoid complications associated with permanent fixation materials. Panacryl braid deserves serious consideration for coracoclavicular fixation because of its strength, resistance to deformation, and bioabsorbable properties. (Journal of the Southern Orthopaedic Association 12(3):143–148, 2003) Key words: acromioclavicular, bioabsorbable suture, coracoclavicular fixation, Panacryl braid

The purpose of this study was to review knee kinematics following combined hamstring lengthening and rectus femoris transfer. Previous findings reported in the literature include kinematic changes in the magnitude of stance-phase maximum knee flexion, stance-phase minimum knee flexion (extension), and swing-phase maximum knee flexion; the timing of swing-phase maximum knee flexion and swingphase minimum knee flexion (extension); and total knee excursion. Twenty-three children underwent bilateral (22) or unilateral (1) hamstring lengthening and rectus femoris transfer (45 knees) at the Shriners Hospitals for Children in Lexington, KY between January 1996 and December 2001. Sagittal knee kinematic data were obtained as part of a complete gait study accomplished before surgery and at 1 year after surgery. Values were compared using a paired t test method set at a p < .05 level to determine statistical significance. Changes were seen in the magnitude of stance-phase maximum knee flexion, stance-phase minimum knee flexion (extension), swing-phase maximum knee flexion, and swing-phase minimum knee flexion (extension); in the timing of swing-phase maximum knee flexion; and in total knee excursion. (Journal of the Southern Orthopaedic Association 12(3):149–153, 2003) Key words: cerebral palsy, hamstring lengthening, gait analysis, rectus femoris, stiff-knee gait

From 1996 to 2000, 20 patients with a mean age of 53 underwent 20 arthrodeses with Herbert screws. There were 16 (80%) distal interphalangeal joint (DIP) and 4 (20%) thumb interphalangeal (IP) joint arthrodeses. Average follow-up was 25 months (range, 6–39 months). The diagnoses included rheumatoid arthritis in 10 patients, degenerative arthritis in 4, and post-traumatic arthritis in 6. Arthrodesis relieved pain and restored stability in all patients. Solid osseous union occurred in 19 patients (95%). The average interval to fusion was 8 weeks for DIP and 12 weeks for IP joint arthrodesis. Solid osseous union occurred in 19 patients (95%). The average interval to fusion was 8 weeks for distal interphalangeal joint arthrodesis and 12 weeks for interphalangeal joint of the thumb. There were three complications: one delayed union, one nonunion because of a short screw, and one dorsal skin necrosis with amputation. It was shown that distal interphalangeal joint arthrodesis with a Herbert screw is a technique with several advantages: good clinical results, high rates of fusion, early mobilization, and the screw does not need to be removed after the fusion heals. Potential complications may be avoided by using the Herbert mini-screw. (Journal of the Southern Orthopaedic Association 12(3):154–159, 2003) Key words: arthrodeses with Herbert screws, interphalangeal arthrodesis, small joint arthrodeses

Cannulated screws are utilized widely in the management of periarticular fractures and osteotomies. Reports of complications related to these screws have increased as use has become more commonplace. A novel mode of mechanical failure of 4.0-mm and 4.5-mm A-O cannulated screws is described in three patients, as well as hypotheses regarding possible causes of the failure. It may be prudent to predrill and tap dense cortical bone when such devices are used in teenagers and young adults patients in an attempt to avoid similar damage to the screw during insertion. (Journal of the Southern Orthopaedic Association 12(3):160–162, 2003) Key words: cannulated screws, complications

Lipoma arborescens (LA) (diffuse articular lipomatosis, synovial lipomatosis, Hoffa disease) is a rare intra-articular lesion of unknown etiology. This article presents three patients who had LA, which was diagnosed in the knee in two patients and in the wrist of the third patient. Details of the clinical and histomorphological examination and treatment, in addition to a review of the literature, are discussed. The article concludes that in patients with a slow increase in painless swelling of the joints, unresolving articular pain with or without limited motion, or intermittent effusions following a minor trauma, LA should be considered in the differential diagnosis. It should be remembered that LA occurs in joints other than the knee, such as the elbow, shoulder, and wrist. Although recommended surgery involves arthrotomy and synovectomy, arthroscopic synovectomy may be a useful treatment modality, particularly in the larger joints as the recurrence rate is low. (Journal of the Southern Orthopaedic Association 12(3):163–166, 2003) Key words: diffuse articular lipomatosis, Hoffa disease, synovial lipomatosis