Cases reported "Osteochondritis"

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11/31. Double L-rod instrumentation in the treatment of severe kyphosis secondary to Scheuermann's disease.

    patients with untreated kyphosis secondary to Scheuermann's disease occasionally develop significant deformities associated with pain in adult life. When these painful deformities do not respond to conservative measures, surgery may be indicated. This report describes a two-stage surgical technique for correction of the deformity. First, an anterior spinal release and fusion is performed and is followed 7-10 days later by a posterior spinal fusion with double L-rod instrumentation. L-rod instrumentation has the advantage that no postoperative immobilization is necessary, which allows the patient to return to a relatively normal life-style in the immediate postoperative period. Excellent maintenance of correction of the deformity in these patients has occurred with no serious complication to date in 24 patients followed from 19 months to 4 years although "transient hyperesthesia" occurred in 16% of patients. A longer follow-up will be necessary to evaluate fully possible late pseudarthrosis and instrumentation failure in this group of patients.
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12/31. Long-term results of Kienbock's disease treated by excisional arthroplasty with a silicone implant or coiled palmaris longus tendon.

    Of 32 patients with Kienbock's disease, 19 had lunate silicone implant replacements, and 13 had coiled palmaris longus tendon replacement. The carpal height was measured and osteoarthritic changes were noted in plain x-ray films before and after the operation. Follow-up periods ranged from 3 to 11 years, with an average of 6 years 4 months. In patients in the mild stages of the preoperative carpal collapse, both excisional arthroplasties had good clinical results. The x-ray films showed that a silicone implant played a more important role in preventing further carpal collapse than a palmaris longus tendon replacement in patients in the early carpal collapse stage. However, the clinical results of the silicone implant replacement were unsatisfactory because of the postoperative progression of osteoarthritic changes or subluxation of the prosthesis in the advanced stages of carpal collapse. The palmaris longus tendon replacement gave satisfactory results in four of seven patients with advanced carpal collapse. These results suggest that silicone implant replacement is indicated primarily in patients with the early stages of carpal collapse, and replacement of the palmaris longus tendon is rarely recommended in either the early or late stages of carpal collapse.
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13/31. Transchondral fractures of the dome of the talus.

    osteochondritis dissecans of the talus is a well documented entity, defined as a transchondral fracture of the dome of the talus. As a fracture, it should heal with immobilization; however, this lesion often causes severe disability and, more often than not, the fragment will not unite with conservative treatment. There is much debate concerning operative versus nonoperative treatment, and the purpose of this paper is to discuss the salient points of the controversy, review literature on the subject, and present a case with a follow-up of 4.5 years.
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keywords = operative
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14/31. The surgical treatment of osteochondritis of the capitellum.

    This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and elbow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was increased an average of 18 degrees. Eighty-six percent (12 out of 14) patients returned to organized, competitive athletic activity without restrictions. The Little League background of those patients with apparent repetitive microtrauma to the elbow is examined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis. We conclude that after a failure of conservative therapy, surgical treatment, including removal of the intraarticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.
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15/31. Joint occurrence of aseptic necrosis of the head of the third metacarpal and Freiberg's disease.

    Freiberg's disease of the second metatarsal was found together with the aseptic necrosis of the head of the third metacarpal in a 54-year-old female patient. No similar case was found in the available literature. The deformity of the second metatarsophalangeal joint was corrected with an operation, the alteration of the third metacarpal did not need operative correction.
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16/31. Degenerative lumbar scoliosis.

    Recent work on degenerative lumbar curves has focused on stable deformities with entrapment syndrome secondary to spondylotic compression. A review of our local experience with degenerative lumbar curves shows that approximately half of the 14 cases have had a less typical radiographic presentation of short reciprocating lumbar curves thought to be on the basis of asymmetric intervertebral osteochondrosis. In these latter cases, marked spondylotic ridging and intervertebral buttressing were absent; therefore, major decompressive surgery on the residual posterior elements may increase instability and hasten further collapse. Although most patients have had good relief of radicular leg complaints with decompressive procedures, several patients had persistent low-back pain that appeared to have a mechanical basis. In those instances of potentially increased postoperative instability or persistent mechanical back complaints, consideration should be given to augmenting decompressive procedures with Harrington instrumentation and fusion for these painful collapsing lumbar spines.
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keywords = operative
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17/31. Operative arthroscopy.

    In a period of 20 months, over 200 patients (age ranged from high school students to middle-aged persons) with knee injuries were treated by operative arthroscopy. The majority of the injuries were incurred while the patients had been participating in athletic events, either competitive or recreational. Operative arthroscopy offers the advantage of shortened hospital stay, rapid rehabilitation, lack of disfiguring scar, and reduced costs. patients are followed yearly after the first postoperative year. Improved long-term results from diagnostic and operative arthroscopy, as compared to conventional surgical procedures, are expected. The proof of those expectations will be determined in the next several years as this group of patients requiring partial meniscectomies or procedures for pathologic and degenerative conditions is reevaluated.
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ranking = 1.5
keywords = operative
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18/31. Aspergillus osteochondritis after median sternotomy. Combined operative treatment and drug therapy with amphotericin b.

    A case of aspergillus fumigatus osteochondritis after median sternotomy for open heart surgery is presented. To the best of our knowledge, it is the second well documented case that has been reported in the literature. Successful healing was obtained with combined operative treatment (consisting of a large resection of the 8th, 9th and 10th right costal cartilages and surrounding soft tissues), and systemic drug therapy with amphotericin b. Repeated serologic studies and bone scans were used for both the diagnosis and monitoring of the evolution of the infection; these 2 tools are recommended in cases of mycotic infections in that area.
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ranking = 2.5
keywords = operative
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19/31. Cervical osteochondrosis and disc herniation. Eighteen years' use of interbody fusion by Cloward's technique in 755 cases.

    Seven hundred and forty patients (mean age 51 years) underwent anterior cervical interbody fusion by the method of Cloward in an 18-year period because of cervical osteochondrosis/disc herniation. Fifty-nine needed re-spondylodesis (same or different level or levels in the period. Ninety-six percent presented with radicular symptoms or signs, or both, while seven percent presented with "long tract" symptoms and signs. myelography was done in all cases except three. Kiel-surgibone was used in 83% of 560 one-level, 177 two-level, and 3 three-level fusions. Eighty-one percent reported total or partial relief of preoperative (predominantly redicular) symptoms and signs postoperatively, but ultimately (observation time 1-13 years) only 71% benefited with regard to neck pain, radicular brachialgia, and neuropathy, and only 42% of those with symptoms and signs of spinal cord compression benefited. Operative complication rate was 4%, and Kiel-surgibone graft problems occurred in 2% of 958 interbody fusions. Beneficial results could be related to short period of symptoms, free intraspinal disc fragments, and a cautious attitude to multi-level fusions. Cloward's interbody fusion is found to be reliable, but delineated attitude to the different types of alternative operations (disc resection, facetectomy or laminectomy) is emphasized.
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ranking = 1
keywords = operative
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20/31. Surgical treatment of Osgood-Schlatter's disease.

    This report reflects the evolution of the operative treatment of Osgood-Schlatter's disease as practiced in Our Lady's Hospital for Sick Children. In the earlier portion of the series patients were treated by drilling of the tibial tubercle with or without removal of the prominence (Group A--22 operations). In the latter portion of the series loose pieces of cartilage or bone were excised without removal of the prominent tubercle or drilling (Group B--22 operations). The results showed a much higher incidence of excellent or good results in Group B. These patients had a short simple operation followed by rapid mobilization and return to full activity. We would, therefore, recommend this procedure for those who have significant symptoms from osteochondritis of the tibial tubercle.
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keywords = operative
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