Alfred D. Grant

The Ilizarov technique in correction of complex foot deformities.

The Ilizarov technique allows new histogenesis of soft tissue as well as bone. This process, extended to the foot, has allowed correction of complex three-dimensional deformities. The method is described and demonstrated to illustrate the action and limitations as well as the complications of the method.

Idiopathic toe-walking: a review

Debra A Sala* MS PT, Research Physical Therapist, Center for Neuromuscular and Developmental Disorders, Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003; Lisa H Shulman MD, Assistant Clinical Professor of Pediatrics, Director of Infant/Toddler Services, Children’s Evaluation and Rehabilitation Center, Rose F Kennedy, Center University Affiliated Programs, Albert Einstein College of Medicine, Bronx; Alfred D Grant MD, Clinical Professor, New York University Department of Orthopedics; Mary Lynn Y Chu MD, Associate Director, Center for Neuromuscular and Developmental Disorders, Hospital for Joint Diseases, New York, NY 10003, USA.

Congenital pseudoarthrosis of the tibia.

&NA; Congenital pseudoarthrosis of the tibia remains one of the most difficult conditions to treat in orthopedic surgery. Seven cases were treated in our hospital by different methods. Three out of seven patients were healed, two of these refractured. At follow‐up, the success rate was 14% (one out of seven cases). It is our recommendation that early primary amputation with an appropriate prosthesis should be considered, and that the final evaluation should not be based on obtaining bone union, but on the level of function of the lower extremity.

The problem of evaluating in situ pinning of slipped capital femoral epiphysis: an experimental model and a review of 63 consecutive cases

Over a 3-year follow-up period, 63 hips (in 49 patients) that were pinned as treatment for slipped capital femoral epiphysis were examined and evaluated. A 36.8% incidence of unsuspected pin penetration was discovered. Four types of experimental models representing different degrees of severity of slipped capital femoral epiphysis were designed and manufactured in the bioengineering laboratory. In situ pinning was performed on each model. An extensive series of controlled test films on the models indicated the difficulty of accurately determining the true position of the pins with conventional roentgenographic views. Subsequent fluoroscopic analysis revealed a verifiable correlation between the limited visualization of conventional X-ray analysis following the pinning of a slipped capital femoral epiphysis and unrecognized pin penetration.

Equinus deformity in cerebral palsy: recurrence after tendo Achillis lengthening.

Twenty‐seven patients with cerebral palsy (CP) were recalled and studied in detail 2 to 9 years post tendo Achillis lengthening (TAL). The recurrence rate of eauinus deformity was 22.2%. Multiple clinical characteristics and follow‐up examination findings were analyzed to determine their relation to recurrence. The recurrence group had a significantly (P<0.05) smaller preoperative popliteal angle, a greater popliteal angle at follow‐up, and a greater change in popliteal angle from preoperative to follow‐up than the non‐recurrence group. This indicated that increasing hamstring contracture was the major factor influencing recurrence. Spasticity of tibialis posterior and leg‐length discrepancy may be related factors as well.

Revision surgery in clubfeet.

The reoperated clubfeet of 29 children aged one to 12 years were reviewed. The surgical procedure most often used in revision surgery was recomplete soft-tissue release alone or combined with plantar release, calcaneocuboid fusion, and capsulotomies of the navicular-first cuneiform-first metatarsal joint. In 27 of 29 feet, acceptable results were achieved. Nineteen were excellent and good results. An algorithm that suggests surgical solutions to a variety of clubfoot deformities in different age groups has been developed, as well as an objective rating system, to evaluate the long-term results of revision surgery of clubfeet.

Treatment of complex limb deformities in children with the Ilizarov technique.

Twenty-nine children underwent 36 Ilizarov procedures for a variety of limb deformities. We present the results in 11 patients, six with leg length discrepancies and five with achondroplasia, who underwent lengthening procedures using the Ilizarov method. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus length 11 cm (40%). Eleven complications occurred. The most common were pin tract infections (4), joint contractures (2), transient nerve injury (4), premature consolidation (5), and three fractures of the regenerated bone. The complication rate was as high as in other methods, but with the Ilizarov apparatus longer segments of bone were lengthened and more complex deformities were treated. The number of complications were lessened as experience was gained.

Crutch handle design: Effect on palmar loads during ambulation☆☆☆

OBJECTIVE To compare loads, load distributions, pressures, and areas of weight-bearing on the palm for forearm crutches with cylindrical and wide handles during ambulation to determine if one handle type produced greater loads on the carpal tunnel region. DESIGN Single-group repeated measures of normal adults; descriptive study of patients who were long-term crutch users. Data were collected from six palmar regions using an F-Scan system. SETTING Center for neuromuscular disorders in a hospital. PARTICIPANTS Thirty normal volunteers and 6 patients. MAIN OUTCOME MEASURE Differences in loads for the palmar regions between the two handles, particularly the carpal tunnel region. RESULTS For the normal adults, significantly greater loads were found in two distal regions for the cylindrical handle and in one proximal region for the wide handle. Distribution of weight-bearing loads showed a similar pattern for both handles with the palms proximal and distal radial sides having the greatest loads and the carpal tunnel region having the third highest load. The area of weight-bearing was significantly greater for the wide handle than for the cylindrical. CONCLUSIONS Cylindrical and wide crutch handles have similar load distributions, making it impossible to recommend one type over the other to reduce the occurrence of carpal tunnel syndrome. The wide handle distributes the loads over a greater surface area, producing less focal pressure.

Ilizarov Technique in Correction of Foot Deformities: A Preliminary Report

Four deformed feet in three patients were corrected completely using the new limited intervention technique of Ilizarov. One foot in the younger patient was corrected by soft tissue distraction only. In three feet in the older patients V osteotomies were needed to initiate the distraction. Two complications occurred: herpes simplex infected two of the osteotomy sites, which were treated successfully with local treatment. The detailed method and indications are outlined.

Equinus Deformity in Cerebral Palsy: A Retrospective Analysis of Treatment and Function in 39 Cases

Equinus deformity, due to a contracture of the triceps surae, is a frequent problem in cerebral palsy. The authors present a retrospective analysis of the functional status of 27 patients (39 feet) of equinus deformity seen in a 10-year follow-up study. When either a Hoke or White tendo Achillis surgical lengthening procedure was combined with a postoperative management program of night-bracing, the recurrence of equinus deformity was significantly reduced.