Cases reported "Contracture"

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11/19. femoral artery to prosthetic graft anastomotic dehiscence owing to infection: successful treatment with arterial reconstruction and limb salvage.

    A 66-year-old man had foot gangrene and a fixed contracture of the knee following two failed femoropopliteal bypasses, one with vein and one with polytetrafluoroethylene (PTFE). An external iliac to anterior tibial artery bypass and skeletal traction via the os calcis resulted in limb salvage and successful normal ambulation. After 3 months, he ruptured the infected femoral anastomosis of the failed PTFE femoropopliteal bypass with external bleeding. The use of arteriography and a balloon catheter to obtain proximal control allowed arterial repair, removal of the graft, and preservation of flow within a patent common and deep femoral artery. This flow preservation maintained the viability and function of the limb when the anterior tibial bypass closed 4 years later, and the limb continues to be fully functional 3 years later. Aggressive secondary attempts at limb salvage are worthwhile even in unfavorable circumstances.
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ranking = 1
keywords = tibia
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12/19. Failure of centralization of the fibula for congenital longitudinal deficiency of the tibia.

    Between 1962 and 1983, fourteen patients (twenty knees) had centralization of the fibula for congenital longitudinal deficiency: tibial, complete. Eleven of the twenty index procedures were performed on patients who were one year old or less. A progressive flexion deformity of the knee developed after all twenty index procedures. Twenty-six secondary procedures were needed, including disarticulation at the knee, posterior release, extension osteotomy, femorofibular arthrodesis, and biceps-to-quadriceps transfer, and one patient had a second attempt at centralization of the fibula. The duration of follow-up after the initial centralization of the fibula ranged from four years to twenty-two years and seven months (average, twelve years and four months). Seven patients (eight limbs) in whom the index procedure resulted in failure had a satisfactory result after disarticulation at the knee. The patients who did not have secondary disarticulation at the knee are also considered to have had a failed index procedure because they had a flexion deformity at the latest follow-up. Attempts to reconstruct the knee joint by centralization of the fibula are not warranted for patients who have congenital longitudinal deficiency: tibial, complete. Early disarticulation at the knee and fitting with a prosthesis, with close follow-up, is the treatment of choice.
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ranking = 3
keywords = tibia
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13/19. Compartment syndrome as a complication of the Hauser procedure.

    A compartment syndrome developed in eleven patients who had undergone the Hauser procedure. The residual disabilities ranged from mild weakness and contracture of the muscles in the anterior compartment of the leg to complete muscle necrosis necessitating above-the knee amputation in two patients. Dissections of ten cadaver limbs demonstrated that the anterior tibial recurrent vessels have numberous leash-like branches that terminate along the lateral border of the tibial tubercle. When these vessels are sectioned they retract laterally and distally under the fascia and within the muscles of the anterior compartment. It is postulated that continued postoperative bleeding from these vessels after the Hauser procedure may lead to an ischemic compartment syndrome in the leg.
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ranking = 1
keywords = tibia
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14/19. X linked muscular dystrophy with contractures.

    Another family with X linked muscular dystrophy affecting particularly the humeral and tibial muscles is described. Cardiomyopathy in the eldest male necessitated the insertion of a pacemaker.
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ranking = 0.5
keywords = tibia
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15/19. Congenital dislocation of the patella.

    This is a report of 2 rare, neglected congenital irreducible complete lateral dislocations of the patella. The patients were boys, 10 and 13 years old. The dislocations were designated irreducible because closed manipulative effects were invariably failures and the dislocations are permanent because they persist from birth until openly reduced. The deformity was neglected for years (one patient through childhood, the other into adolescence) during which time the anomalous defects were exacerbated by adverse growth changes. The propitious time (late infancy or early childhood) for open reduction and patellar stabilization with an excellent prognosis had long since passed by the time the patients were first seen by an orthopedic surgeon. Neglect had not only caused them to grow up as cripples, but had also rendered their patellae more difficult to reduce surgically. Neglect also increased the challenge to their surgeon to stabilize their patellae and to cope with their needless and preventable secondary deformities by multiple surgical interventions with decreased prospects of emerging free of residual problems and disabilities. In the growing child with active proximal tibial epiphyseal cartilage, interference with growth was avoided by patellar stabilization using the W. T. Green technique for quadricepsplasty. In the adolescent boy, who was closer to skeletal maturity, patellar stabilization was effectually accomplished by transplanting the tibial tuberosity medially and distally with relative impunity and reinforcing it with a Campbell sling. Angular and linear limb deformities were treated by epiphysiodeses. Prolonged dislocations result in loss of normal articular contours, and nonuse of articular cartilages has a morbid effect; both predispose the joint to early degenerative arthritis. early diagnosis and early referral for orthopedic care are imperative because delay vitiates the ultimate result.
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ranking = 1
keywords = tibia
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16/19. Periarticular fractures after manipulation for knee contractures in children.

    We report two cases, each of which sustained two separate periarticular fractures from overzealous manipulation for knee contracture. The four fractures reported in this study involve one normal child sustaining asynchronous ipsilateral distal femoral and proximal tibial fractures and a child with the diagnosis of amyoplasia sustaining bilateral proximal tibial fractures. The child with knee contracture must be treated carefully and not exposed to overzealous physiotherapy or manipulation. The child who has developed a joint contracture secondary to lengthy immobilization may be at increased risk for periarticular fracture secondary to disuse osteopenia. The knee joint is at particular risk because of the long lever arm of the leg. These concerns should be conveyed to anyone involved in the patient's care, including the parents, therapists, nurses, and physicians. Passive range of motion in the child should never be painful. Normal children often can obtain maximal range of motion if left alone and not restricted.
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ranking = 1
keywords = tibia
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17/19. Reconstruction of limb defects with the free posterior tibial artery fasciocutaneous flap.

    There are few reports on the use of free posterior tibial artery free flaps. We present four cases of reconstruction of a limb defect with a free posterior tibial artery fasciocutaneous flap.
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ranking = 3
keywords = tibia
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18/19. osteogenesis imperfecta with joint contractures: bruck syndrome.

    We describe an Egyptian boy with osteogenesis imperfecta who was born with thumb contractures and bilateral antecubital pterygia. He was seen at 16 months of age with femur and tibial fractures, thoracic vertebral compression fractures, scoliosis and Wormian bones. The findings are consistent with a diagnosis of Bruck syndrome.
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ranking = 0.5
keywords = tibia
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19/19. chondrodysplasia punctata--rhizomelic form. Pathologic and radiologic studies of three infants.

    Pathologic, ultrastructural and radiologic studies are described on 3 infants with the rhizomelic form of chondrodysplasia punctata. Radiologic criteria in the young infant include radiolucent coronal clefts dividing all or most of the thoracic and lumbar vertebral bodies, short humeri with flared metaphyses and punctate calcifications commonly present adjacent to the ossified ischial and pubic bones and less commonly in other locations. In late infancy and childhood the radiologic criteria include demineralization in all bones with slow maturation, flat vertebral bodies, short humeri and femora, metaphyseal flaring, especially in the distal humerus, proximal femur and proximal tibia, immature shape of pelvis, and disappearance of the punctate calcifications with advancing age. The histologic changes of the resting cartilage include areas of degenerating cartilage which had become partially calcified, cystic changes with severe disturbance of the maturation of the cartilage at the physial plate, and the formation of cancellous bone directly on resting cartilage. Ultrastructural changes are characterized by degeneration of chondrocytes, delicate collagenous fibrils without visible periodicity, and the presence of flocculent material within greatly distended endoplasmic reticulum.
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ranking = 0.5
keywords = tibia
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