Search

In this pilot cross-sectional study, the effectiveness of rigid spinal orthoses in the correction of spinal curvature of 14 patients with moderate adolescent idiopathic scoliosis (AIS) at different recumbent positions (supine, prone, right and left decubitus) was investigated. Using magnetic resonance (MR) imaging and multi-planar reconstruction technique, evaluation of the scoliotic spine in the coronal, sagittal and axial planes and the effect of spinal orthosis on AIS at different recumbent positions was studied. There was significant reduction of coronal Cobb's angle (p < 0.05) with bracing at all four recumbent positions and the maximal reduction was found in the prone position (18% reduction). The sagittal Cobb's angle was only significantly reduced at the supine position while the axial rotation did not change significantly in all positions.

A cross-sectional study was conducted to investigate the foot arch function of Chinese children. A total of 2715 children, 1246 girls, and 1369 boys, 4-18 years of age were recruited from kindergartens, primary, and secondary schools. The dynamic footprints of the children were collected using a portable pressure-sensing mat. The Contact Force Ratio (CFR, i.e. the ratio of the mid-foot loading to the total loading of the contacted foot, with the toes ignored) of each age group was calculated. In general, the CFR decreased from 4 to 10 years and plateaued at 10-12 years and then increased until 15-16 years. An abnormal low arch foot was defined as the foot that had a CFR value larger than the corresponding age mean plus one standard deviation. The cut-off CFR values of each age group were calculated. With the exception of the 17 years age group, which consisted of a relatively small number of subjects, the percentage of low arch subjects of all the other age groups ranged from 15 to 20%.

The treatment effectiveness of the CAD/CAM method and the manual method in managing adolescent idiopathic scoliosis (AIS) was compared. Forty subjects were recruited with twenty subjects for each method. The clinical parameters namely Cobb's angle and apical vertebral rotation were evaluated at the pre-brace and the immediate in-brace visits. The results demonstrated that orthotic treatments rendered by the CAD/CAM method and the conventional manual method were effective in providing initial control of Cobb's angle. Significant decreases (p < 0.05) were found between the pre-brace and immediate in-brace visits for both methods. The mean reductions of Cobb's angle were 12.8 degrees (41.9%) for the CAD/CAM method and 9.8 degrees (32.1%) for the manual method. An initial control of the apical vertebral rotation was not shown in this study. In the comparison between the CAD/CAM method and the manual method, no significant difference was found in the control of Cobb's angle and apical vertebral rotation. The current study demonstrated that the CAD/CAM method can provide similar result in the initial stage of treatment as compared with the manual method.

A study was conducted to compare the CAD/CAM method with the conventional manual method in fabrication of spinal orthoses for patients with adolescent idiopathic scoliosis. Ten subjects were recruited for this study. Efficiency analyses of the two methods were performed from cast filling/ digitization process to completion of cast/image rectification. The dimensional changes of the casts/ models rectified by the two cast rectification methods were also investigated. The results demonstrated that the CAD/CAM method was faster than the conventional manual method in the studied processes. The mean rectification time of the CAD/CAM method was shorter than that of the conventional manual method by 108.3 min (63.5%). This indicated that the CAD/CAM method took about 1/3 of the time of the conventional manual to finish cast rectification. In the comparison of cast/image dimensional differences between the conventional manual method and the CAD/CAM method, five major dimensions in each of the five rectified regions namely the axilla, thoracic, lumbar, abdominal and pelvic regions were involved. There were no significant dimensional differences (p < 0.05) in 19 out of the 25 studied dimensions. This study demonstrated that the CAD/CAM system could save the time in the rectification process and offer a relatively high resemblance in cast rectification as compared with the conventional manual method.

The traditional theory on subtalar joint neutral position and intrinsic foot deformities for the evaluation and treatment of foot and ankle disorders has been the basis for foot orthotics for many years. Although clinical evaluations have suggested a relationship between subtalar pronation and a variety of lower limb problems, such as shin splints and anterior knee pain, recent research has raised serious concerns about the reliability and validity of the assessment and intervention methods. Results of recent studies in foot biomechanics suggest that the orthosis design to control foot alignment should stabilise the medial apical bony structure of the arch to control the first ray mobility and transmit load through the lateral support structures of the foot, locking the calcaneocuboid joint and decreasing strain in the plantar aponeurosis. The concept of "posting" according to a measured foot deformity is de-emphasised. Reliable foot impression procedures are required to provide appropriate orthotic design and thus management. A prone lying position manipulated foot impression method using polycaprolactone based low temperature thermoplastic material was introduced. Ten (10) subjects were recruited to participate in the reliability tests, which were conducted by 2 orthotists specialized in foot orthotics. Results showed high intrarater and interrater reliability of the measured forefoot width and the navicular height. The reliability of the forefoot-rearfoot relationship was demonstrated by the small variance of the root mean square calculation. Subsequently orthotic intervention can be done in a more consistent manner.

Static footprint parameters have been used to quantify arch height with conflicting results. This could be caused by the inherent inaccuracy and variations of the methodology used. Since the foot is a dynamic structure that undergoes changes during a step, it is more desirable to capture and analyse the dynamic footprint at an instant during the gait cycle that can most closely reflect the weight-bearing foot function. Forty (40) volunteer subjects were recruited for the reliability test of a new parameter, the Contact Force Ratio (CFR), derived from dynamic footprint. This is a measure of midfoot loading during gait. The mid-gait dynamic footprints were collected using a pressure sensing mat. Results of ICC tests showed that the CFR had good intratester (0.918) and intertester (0.909) reliability. The validity of the method was examined by correlating the parameter to the functional change in arch height, i.e. the Navicular Drop between the non-weight-bearing and weight-bearing conditions.

Manual stretching frequently is used in the treatment of congenital muscular torticollis in infants. During manipulation, it is not uncommon for the sternocleidomastoid muscle to snap or suddenly give way. The main objective of this study was to evaluate the predisposing causes and clinical significance of such snapping. Four hundred fifty-five patients younger than 1 year of age with congenital muscular torticollis treated with a standardized gentle manual stretching program during a 13-year period were studied. Using prospective standardized assessment parameters, the pretreatment, treatment, and followup results of a group of 41 patients with snapping detected during treatment were compared with the results of a group of 404 patients without snapping during treatment. The group with snapping was associated with a more severe sternomastoid tumor, higher incidence of hip dysplasia, earlier clinical presentation, and shorter duration of treatment. With a mean followup of 3.5 years, the group with snapping was not different from the group that had no snapping in the final assessment score and percentage requiring surgery. From this study, unintentional snapping during the gentle manipulation treatment of congenital muscular torticollis has clinical and ultrasonographic evidence of partial or complete rupture of the sternocleidomastoid muscle. No long-term deleterious effect on the outcome was observed after the snapping.

Clinically, it is hard to achieve and reproduce prosthesis alignment at will during daily prosthesis fitting. A new alignment jig was designed and developed to facilitate quantification and prescription of prosthesis alignment for patellar-tendon-bearing (PTB) trans-tibial prostheses. The alignment jig provided instantaneous readings of the three-dimensional orientation and position of the socket relative to the prosthetic foot in standardised units. The inter- and intra-tester errors of the alignment jig in measuring prosthesis alignment were evaluated and demonstrated to have good reliability. The alignment jig was recommended to be used clinically after the conventional dynamic alignment procedure to document the prosthesis alignment. Further application of the alignment jig for systematic evaluation of the effects of prosthesis alignment on gait for trans-tibial amputees is suggested.

Eighty-four patients with congenital muscular torticollis were treated surgically in a 10-year period with a mean followup of 5 years (range, 2-13 years). All patients were classified into subgroups according to the type of congenital torticollis, the limitation of passive rotation of the neck, and other parameters, including head tilt and craniofacial asymmetry. Twenty-two (26.2%) patients underwent surgery before they were 1 year of age, 22.6% were between 1 and 3 years of age, 38.1% were between 3 and 10 years, and 13.1% were older than 10 years. Postoperative management included physiotherapy for 3 to 4 months and the application of a multiply adjustable torticollis brace for 10 weeks in children older than 2 years of age. Loss of the sternomastoid column was found in 82.6%, poor scar in 2.4%, lateral band in 47.2% and 1.2% required a second operation. The final overall score showed excellent results in 88.1%, good results in 8.3%, and fair to poor results in 3.6%. The most important factor affecting the overall result and outcome was found to be the age of the patient at the time of operation. However, this series also showed that for patients who were 10 years or older at the time of surgery, 63.6% had excellent results and 81.8% had good to excellent results, indicating the benefit of surgery even in the late cases.

A case of a young man with anterior tibial artery rupture and pseudoaneurysm formation that occurred during lengthening of a scarred limb is presented. Leg length discrepancy occurred because of previous distal femoral and proximal tibial fractures. Two corrective operations were performed 11 and 2 years earlier at another hospital. As limb deformity persisted, distal femoral and proximal tibial osteotomies combined with limb lengthening were performed. The aim was to achieve 120 mm (70 mm femoral, 50 mm tibial) lengthening. The operative and early postoperative course was uneventful. Twenty-six days after surgery (when femoral and tibial lengthening was 13.5 mm and 5.5 mm, respectively), blood began oozing from the operative scar during limb distraction. At 70 days after surgery (when femoral and tibia lengthening was 41.5 mm and 14 mm, respectively), a rupture and pseudoaneurysm of the anterior tibial artery became apparent. Documentation of a normal pulses in the foot after surgery, the late presentation of pseudoaneurysm, and the initiation of bleeding by limb distraction indicate that limb lengthening either aggravated an unrecognized arterial injury or precipitated de novo rupture of the anterior tibial artery scarred from previous trauma. The pseudoaneurysm was treated successfully by transarterial embolization.

Treatment options for degenerative joint disease of the ankle and subtalar joints are limited. When conservative management fails, the only effective procedure is arthrodesis. With the advent of the small arthroscope and the development of better instrumentation and distraction techniques, small joint arthroscopy has gained popularity as an important diagnostic and therapeutic tool in the treatment of ankle and subtalar disorders. Although the benefits of arthroscopic ankle arthrodesis are well established, and arthroscopic subtalar arthrodesis has been described recently, the role of arthroscopic debridement for degenerative joint disease of the ankle and subtalar joints remains controversial. Traditionally, operative arthroscopy for ankle arthritis has not met with great success; however, recent studies have shown that it can provide an interim alternative to arthrodesis in early arthritis with preserved range of motion. Lesions associated with arthritis, such as impinging osteophytes and loose bodies, can be treated effectively with arthroscopy.

The change of foot length and width with age has been reported in a few anthropometric studies in the literature. However, the relationship with body height rarely is reported, and the dynamic effect of weightbearing on foot size has not been documented. In this series, 2829 children 3 to 18 years of age of equal gender distribution were included in the study. The foot length and width on weightbearing and nonweightbearing were measured with a special precision electronic caliper. The foot length and width were found to increase linearly from the age of 3 years until 12 years in girls and 15 years in boys. This was followed by a phase during which the increase plateaued. The foot length and width increased significantly on weightbearing at all ages in both genders with a mean of 2.1 to 4.4 mm or 3.1% to 4.8%, respectively. The foot length and width also were found to correlate significantly with the body height in both genders, with a correlation coefficient of 0.96 to 0.98. No significant differences were found between the sizes of the dominant and nondominant foot in either gender.

Giant cell tumor of bone is a challenging clinicopathologic entity. Despite its benign designation, it has the capacity to recur locally and develop rare pulmonary metastases. Between 1945 and 1991, 104 patients with histologically benign giant cell tumors of bone, 5 of which metastasized to the lung, were treated at the authors' institution. In these cases, histologic materials from the lung were identical to those found in the primary bone lesion. The primary bone lesions were treated with local curettage (3), wide resection (1), and wide resection with prosthesis placement (1). The patients were observed for a mean of 12.6 years (range, 5-38 years). Four of the 5 patients experienced local recurrences (average time interval, 34 months), with 3 patients experiencing 2 or more recurrences. The average time to lung metastasis was 23 months; 1 patient presented initially with pulmonary findings. Four patients underwent surgical resection of pulmonary metastases. All 4 patients are alive with no disease progression, despite incomplete pulmonary resections in 2 patients. Locally aggressive disease and multiple recurrences appear to be risk factors for pulmonary metastases in benign giant cell tumor of bone. Pulmonary metastases occurred within the first few years after discovery of primary bone tumors. Radiographs and computed tomographs of the chest are recommended to rule out this complication in patients with local recurrences. Resection of pulmonary metastasis is recommended. Long term survival is not incompatible with persistent pulmonary lesions.

There are significant racial differences in body proportions. Such data are not readily available for Chinese children. This article reports a cross section study of body proportions of 2193 Hong Kong Chinese children, ages 4 to 16 years, with equal gender distribution. Standing height, sitting height, and arm span were measured with standard equipment and methodology. Lower segment height was calculated as the difference between standing height and sitting height. Statistical analysis of the results showed a high linear correlation of the standing height with arm span, sitting height, and lower segment height, with a correlation coefficient ranging from 0.965 to 0.983 for both genders. When expressed as the ratio of standing height to arm span, the value was relatively constant and changed only linearly from 1.03 to 1 in girls and 1.03 to 0.98 in boys ages 4 to 16 years. The ratio of sitting height to lower segment height varied from a mean of 1.4 to 1.14 in boys and 1.36 to 1.18 in girls ages 4 to 16 years. The Chinese children were found to have a proportional limb segmental length relative to the trunk that differed significantly from the proportionally longer limbs in whites and blacks.

Duplication at the metacarpophalangeal joint level (Wassel Type IV) is the most common type thumb duplication (polydactyly), accounting for 50%. It can be subdivided into 4 types: (A) hypoplastic (12%), (B) ulnar deviated (64%), (C) divergent (15%), and (D) convergent (complex) (9%). Type D has the most complex bone and soft tissue anomalies and is most likely to have residual deformities. A surgical protocol emphasizing early operation within 1 year of age, 1 stage osteotomy, meticulous collateral ligament repair, and abductor pollicis brevis tendon reattachment is presented. Twenty-one cases with an average followup of 5.25 years were reviewed. The cosmetic and functional results were satisfactory. Of a score system of 20 points, the mean score was 17.9. All except 1 patient had a stable metacarpophalangeal joint. Fifteen patients had a good range of movement, and 17 patients are satisfied with the outcome of surgery. Scar hypertrophy occurred in 2 patients.

Seven children (8 hips) with Choi's Type IV-B sequelae of septic arthritis of the hip underwent an unconventional reconstruction technique using a vascular-pedicled iliac crest graft to replace the destroyed femoral head and neck. The average age at surgery was 3.5 years, and the mean followup 7 years. Graft incorporation was observed in all patients; however, severe graft resorption was found in 1 hip, and mild resorption in 4 hips. The method of internal fixation of the iliac crest graft was not ideal and will require modification. Excellent femoral head-neck substitution with graft hypertrophy and remodeling was seen in 3 hips. In 7 hips (88%), vertical hip stability was achieved and a good range of hip motion was maintained. All children adapted very well to the operative procedures. At the final followup, the symptoms were those of limb-length discrepancy; pain was not a symptom.