Stanley M. K. Chung

Supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning.

During the period from 1973 to 1978, 38 children with displaced supracondylar fractures of the humerus were treated at The Childrens Hospital of Philadelphia by closed reduction and percutaneous pin fixation. The technical details of the procedure include (1) reduction under general anesthesia with adequate relaxation; (2) insertion of crossed pins from the medial and lateral side with the elbow in acute flexion; (3) and intraoperative clinical and roentgenographic examination of the pinned fracture with the elbow in extension to determine the adequacy of the reduction, with particular attention to the carrying angle. By Flynns criteria acceptable results were obtained in 19 of the 25 patients studied. Three results were unacceptable due to cubitus varus of 2 degrees, 5 degrees, and 10 degrees, respectively, and three to loss of flexion. Although rotational malalignment occurred in 19 patients, as manifested by a change in shoulder rotation, in no patient was it clinically significant, either cosmetically or functionally. There were no neurologic or vascular complications from the treatment. This is a safe and reliable technique for obtaining and maintaining an excellent reduction in this difficult fracture while preserving vascular function.

Management of osteonecrosis in sickle-cell anemia and its genetic variants.

Osteonecrosis secondary to sickling disorders differs from most other forms of osteonecrosis, because vaso-occlusive episodes generally involve many other organs. For this reason optimum management and care of these patients requires a team approach. The spectrum of clinical symptoms and bone involvement varies widely from one patient to another, even among patients with the same abnormal hemoglobin patterns. Although the efficacy of conservative therapeutic measures has not been definitely established, these may be all that can be offered because of the patients other problems. Before contemplating surgery, the surgical and anesthetic risks should be evaluated and measures taken to prevent complications. The varus osteotomy, Chiari pelvic osteotomy, prosthetic or total hip replacement, and the Neer shoulder prosthesis may benefit a limited number of carefully selected patients.

Congenital Generalized Fibromatosis with Complete Spontaneous Regression

A case of congenital generalized fibromatosis with multiple bone involvement is reported. The disease is often fatal, and often involves many systems with fibro-blastic lesions which are present at birth or shortly thereafter. Our case is the fourth reported case with extensive bone involvement. All of the lesions in our case have completely or almost completely disappeared during the first eighteen months of life.

Necrosis of the humeral head associated with sickle cell anemia and its genetic variants.

Hemoglobin A is the designation used for normal adult. hemoglobin, and the normal adult Pattern is AA. The first demonstration of all abnormal adult hemoglobin (de -ignated S) 111 sickle-cell anemia was made by Pauling and co-workers in 1949 , who used elect.rophoretic mobility. Homozygous or typical sickle-cell anemia has since been designated 55. After the original report by Pauling, other abnormal adult hemoglobins (hemoglobin C) 19 were reported, and reports of combinations of abnormal adult hemoglobins soon follow-ed (SC) 21#{149} Patients heterozygous for sickling aiid for one of the other inherited abnormalities of the red cells are

The colonna capsular arthroplasty. A long-term follow-up study of fifty-six patients.

1. A series of fifty-six patients with sixty-three dislocated hips treated by Colonna capsular arthroplasty are reviewed. The average follow-up is seventeen years. 2. The clinical results revealed excellent results in eight patients, good results in twenty-three patients, fair results in nineteen patients, and poor results in six patients. 3. The limitation of motion which occurred in many patients did not seen to affect the functional result except in patients with bilateral involvement. 4. Good results tended to occur in younger patients, in those who have had adequate preoperative traction, in patients with unilateral involvenient, and in those with no disease in other joints. 5. Poor results tended to occur in patients with bilateral involvement, in those in whom avascular necrosis developed, and in those who were operated on later in life. 6. The onset of degenerative changes in the hip associated with pain usually occurred in patients during the middle of the third decade following surgery. 7. The capsular arthroplasty can be a useful surgical operation if indications and technique are followed closely. One must realize the limitations and possible complications. 8. Centralization of the femoral head at the triradiate cartilage will facilitate subsequent reconstructive surgery.

The Histological Characteristics of Congenital Coxa Vara: A Case Report of a Five Year Old Boy

In a 51/2 year old boy with unilateral coxa vara who died of unrelated causes histological sections were made of the proximal femora and pelvic growth plates. The proximal femora were also perfused to study the pattern of arterial supply. Evidence of active endochondral ossification was not detectable in growth plates of the affected right femur, the clinically and roentgenographically normal left femur and the pelvis, including a Salter Type II fissure fracture. The endochondral ossification defect found in growth plates of the proximal right femur and pelvis was associated with a reduction in the number and caliber of intraosseous arteries supplying the metaphyseal sides of the growth plates in the proximal femur and those supplying the subchondral region and extraosseous medial ascending cervical arteries on the surface of the femoral neck. This deficiency in endochondral ossification resembles a form of dwarfism associated with a coxa vara and a generalized growth plate disorder.

Surgery of the Clavicle in Sprengle??s Deformity

Surgery for Sprengels deformity can produce less lowering of the scapula than desired and occasionally can result in an injury to the brachial plexus or brachial artery. The method used to produce better correction and to avoid complications was a softening of a clavicle by the morcellization technique of Robinson et al. We feel that the procedure is a simple one which helps to improve the degree of correction and to avoid neurovascular complications. The procedure should be combined with the Woodward correction for Sprengels deformity.