Zvi Yosipovitch

Normal ranges of popliteal angle in children.

Measurement of the popliteal angle is used to assess hamstring contracture in children with cerebral palsy. The popliteal angle in 482 normal children, 1–10 years of age, was measured. Using a 360° goniometer, the popliteal angle was measured with the hip held at 9° flexion to indicate hamstring muscle tightness. Between the ages of 1 and 3 years, the mean angle was 6° (range, 0–15). At age 4, the angle rose to 17° in girls and 27° in boys (range, 5–45). At ≥5 years the mean angle was 26° with little change (range, 0–50). A popliteal angle of >50° in the above age groups indicates abnormal hamstring tightness.

Injuries in attempted suicide by jumping from a height

This study was undertaken to investigate the pattern of injuries and the management of 28 patients who attempted suicide by jumping from a height. Most of the patients had serious psychiatric disorders. All but two of the patients sustained multiple injuries. The most common injury patterns were fractures of the spine and lower extremities. It was concluded that, in addition to urgent orthopaedic and surgical care, early psychiatric assessment and therapy with transfer to a psychiatric department as soon as possible facilitates the recovery and rehabilitation of these patients.

Spinal involvement in children and adolescents with Gaucher disease.

Nineteen patients with type I Gaucher disease with spinal involvement first diagnosed during childhood, were followed for 2 to 24 years (average 9 years), and their clinical and radiologic history reviewed. Patients presented with three types of pain: mild pain that was defined as nonspecific, severe pain due to bone crisis, and pain associated with vertebral collapse. Collapse of vertebra occurred gradually anywhere along the thoraco-lumbar spine, and usually more than one vertebra was involved. In three patients, rectangular collapse was noted. Six patients suffered from central vertebra collapse, and two from anterior wedge compression. Further vertebral collapse with signs of root and cord compression developed in three patients as they grew. Awareness to the possibility of progressive vertebral collapse and periodic follow-up might prevent severe complications.

Gangrene of the upper extremity following intra-arterial injection of drugs: a case report and review of the literature

A case of inadvertent intra-arterial self-injection of crushed codeine tablets in an 37-year-old man, resulting in gangrene of an upper extremity, is presented. The problem studied was whether the gangrene was caused by the codeine or by one of the excipients found in the tablets. The cause of the gangrene was investigated in an experimental study. Each of the components of the tablet (codeine, lactose, gelatin, carboxymethyl cellulose, calcium stearate, talc, and microcrystalline cellulose) was injected into the femoral arteries of dogs. The results of the study clearly demonstrate that the unique component producing the gangrene was the micro-crystalline cellulose, while the injection of pure codeine was harmless. To date, the only reported deleterious effects of intravascular injection of micro-crystalline cellulose have been pulmonary embolism and granulomatosis. Some examples of drugs that include microcrystalline cellulose are methadone, methaqualone, oxcycodone, acetaminophen, aspirin with codeine, propoxyphene napsylate, meprobamate, and phenobarbital. Recently, the vulnerability of drug addicts who habitually inject drugs into veins to the accidental injection of an artery has been noted, and it seems likely that in the future the problem of intra-arterial injection will increase in severity. The literature of the last 40 years is reviewed, and a list of drugs known to have produced gangrene when injected intra-arterially is cited.

Humeral lengthening for septic neonatal growth arrest

A 9-year-old girl was treated by humeral lengthening for a 8.5 cm deficit caused by a septic arthritis 2 days after birth. A Wagner distraction apparatus was used after an osteotomy was done distal to the deltoid insertion. Six centimeters of length were gained. A second lengthening of about 7.5 cm is planned at the end of the patients growth. No complications were encountered; by dividing the lengthening into two procedures, none are anticipated. At 1-year follow-up, there was a full range of shoulder, elbow, and hand motion; the humeri were virtually the same length.

Adhesion characteristics of chondrocytes cultured separately and in co-cultures with synovial fibroblasts.

The present study was designed to investigate the adherence mechanism(s) and behaviour of cultured chondrocytes under various culturing conditions, co‐culturing with fibroblasts, or growth in the presence of conditioned medium either of fibroblasts or chondrocytes. The findings obtained indicate that chondrocyte time‐adhesion curves and the final percentiles of attached cells to a plastic substrate are much slower and lower respectively than those of anchorage dependent cell types. The poorest adhesion occurs employing chondrocytes originated from suspension cultures, as compared to chondrocytes grown in monolayers. No interference with chondrocyte adhesion was found by inhibiting the production of proteoglycan (PG). Puromycin and to a lesser degree actinomycin but not cytosine arabinoside interfered with chondrocyte adhesion, suggesting the importance of protein synthesis in this process.

Upper limb involvement in patients with Gaucher's disease

Seventeen of 55 children and adolescents with Gauchers disease presented with upper limb pain. Seven had nonspecific pain, 11 had bone crisis, and 2 had arthritis symptoms in the proximal interphalangeal joints. X-ray films of both hands showed osteopenia and thinning of the cortex in half of the patients.

Open reduction of acetabular fracture in pregnancy : a case report

A 24-year-old woman in her 20th week of pregnancy sustained a severely displaced acetabular fracture. Skeletal traction failed to achieve reduction. Open reduction and internal fixation were performed through an extended iliofemoral approach without affecting the pregnancy. At full term, she had a normal delivery. Four years after the injury, the patient had a pain-free hip with full range of motion and a healthy child. The potential benefit or danger of surgery to the patient and her pregnancy was thoroughly considered.

Primary bone tumor resectability: the value of serial MRI studies in the determination of the feasibility, timing, and extent of tumor resection.

: We report the prospective analysis of 119 magnetic resonance imaging (MRI) studies in 41 patients with primary bone tumors performed from January 1984 to December 1990 to evaluate the contribution of serial MRI studies in the determination of feasibility, timing, and extent of tumor resection. Long repetition time (TR)-long echo time (TE) T2-weighted (T2, second echo) imaging was the most useful in assessing soft-tissue involvement, and short TR-short TE T1-weighted (T1) imaging for documenting the bone marrow changes. The feasibility, timing, and extent of resection was determined with the help of MRI in 20 cases with only two local recurrences. One study falsely suggested active tumor. In four other cases, a treatment decision was made based on the MRI. The MRI added significantly to the evaluation by computed tomography, radiographs, and bone scans.

Early mobilization in septic arthritis. 14 children followed for 2 years.

Fourteen children with septic arthritis were treated by arthrotomy, intravenous antibiotics, and early mobilization of the joint.