Y. H. Li

Talectomy in patients with recurrent deformity in club foot: A long-term follow-up study

We reviewed 24 feet in 15 patients who had undergone talectomy for recurrent equinovarus deformity; 21 were associated with arthrogryposis multiplex congenita, two with myelomeningocele and one with idiopathic congenital talipes equinovarus. The mean follow-up was 20 years. Good results were achieved in eight feet (33%) in which further surgery was not needed and walking was painless; a fair result was obtained in ten feet (42%) in which further surgery for recurrence of a hindfoot deformity had been necessary but walking was painless; the remaining six feet (25%) were poor, with pain on walking. All patients wore normal shoes and could walk independently, except one who was wheelchair-bound because of other joint problems. Recurrent deformity, the development of tibiocalcaneal arthritis and spontaneous fusion of the tibia to the calcaneum were all seen in these patients.

Talectomy in patients with recurrent deformity in club foot

We reviewed 24 feet in 15 patients who had undergone talectomy for recurrent equinovarus deformity; 21 were associated with arthrogryposis multiplex congenita, two with myelomeningocele and one with idiopathic congenital talipes equinovarus. The mean follow-up was 20 years. Good results were achieved in eight feet (33%) in which further surgery was not needed and walking was painless; a fair result was obtained in ten feet (42%) in which further surgery for recurrence of a hindfoot deformity had been necessary but walking was painless; the remaining six feet (25%) were poor, with pain on walking. All patients wore normal shoes and could walk independently, except one who was wheelchair-bound because of other joint problems. Recurrent deformity, the development of tibiocalcaneal arthritis and spontaneous fusion of the tibia to the calcaneum were all seen in these patients.

Chiari Osteotomy and Shelf Augmentation in the Treatment of Hip Dysplasia

The clinical and radiographic results of Chiari osteotomy and shelf augmentation for acetabular dysplasia in 30 hips were reported. The average age at operation was 17 years for Chiari osteotomy and 13.8 years for shelf augmentation. The mean follow-up was 7.1 years for Chiari osteotomy and 4.1 years for shelf augmentation. Of the 14 Chiari osteotomies, 12 had good results by Tonnis clinical grading and 2 had poor results. There were significant improvements in the radiographic parameters measured (p < 0.01). They included center-edge angle of Wiberg, the acetabular angle of Sharp, the percentage of femoral head coverage, and the “c/b” ratio. For the 16 shelf augmentations, there were 8 good, 2 fair, and 6 poor results. The radiographic parameters measured were also all significantly improved (p < 0.01). The final Severin grading of the hips were improved by both Chiari osteotomy and shelf augmentation.

Twenty-year follow-up of hip problems in arthrogryposis multiplex congenita.

Nineteen patients with arthrogryposis (38 hips) with significant hip problems were reviewed (13 dislocations, 9 subluxations, 16 contractures). The average follow-up was 20 years, with 15 patients reaching skeletal maturity. All patients had minimal or no pain. Thirteen of the 19 patients were community walkers. The dislocation group in general had more stiffness of the hip joint than the subluxation and the contracture groups. However, the long-term functional results were comparable among these three groups. Closed treatment always failed in treating dislocation of hips in arthrogryposis. Open reduction was successful in stabilizing the hip, but the hips were usually stiffer. However, after 20 years of follow-up, the function of the openly reduced hips was comparable with others.

The c/b ratio in the radiological monitoring of the hip joint in congenital dislocation of the hip.

We report a method of monitoring hip joint development for congenital dislocation of the hip in children. The c/b ratio was measured on serial radiographs of 41 hips in 38 patients. The measurement was compared to c/b ratio obtained from normal hips. It was used to detect concentric reduction or its loss by migration of the femoral head during growth. The age at diagnosis ranged from 8 months to 10 years 6 months. The normal c/b ratio was found to change little with age. Deviation of the c/b ratio from normal in congenital dislocation of the hip resulted in a poor outcome and identified cases requiring further surgical intervention. This measurement of c/b ratio is simple and accurate, using easily determined points. The graphic display promotes critical analysis of situation and allows selection of cases at risk for treatment.

The Sofield-Millar operation in osteogenesis imperfecta

We have reviewed the results of the Sofield-Millar operation on 58 long bones in ten patients. If more than three osteotomies were undertaken the time to union of the bone was significantly prolonged (p < 0.001) with significant thinning of the bone (p < 0.02). We have used a modified technique in order to minimise surgical trauma and devascularisation of the bone. The rod is introduced under the control of an image-intensifier. Small surgical exposures are made only at the sites of corrective wedge osteotomies. The number of osteotomies is kept to the minimum.

Fractured lateral epicondyle associated with lateral elbow instability

A Jo-year-old housewife fell on her outstretched hand causing pain and swelling of the left elbow. Initial X-ray revealed no obvious fracture (Figure I). She was treated non-operatively. No manipulation was performed. Subsequently she noticed a varus deformity of the left elbow. It was 6 months later that she was seen by us. On examination, a varus deformity of the left elbow was noticed (FigmreZ). X-rays showed slight opening up of the radio-capitular space (Figure,?). On varus stress, there was marked lateral laxity with an avulsed fragment of the lateral epicondyle (Figure 4).