[The Grice-Green subtalar arthrodesis using a fibular bone graft--follow-up of 92 patients]. / Die extraartikuläre Arthrodese nach Grice und Green mit Implantation eines Fibulaspans--Nachuntersuchung von 92 Patienten.

BACKGROUND: The Grice-Green subtalar arthrodesis is considered to be a valid treatment option of severe pes planovalgus deformity especially in children with cerebral palsy. The purpose of this study was to evaluate long term results using Grice-Green procedure with a fibular bone graft. MATERIAL AND METHODS: Between 3/07 and 11/12 92 patients (36 girls, 56 boys) with 127 feet underwent surgery. The average age of patients was 12.3 years (5-21 years). 68 patients had infantile cerebral palsy, 17 patients suffered from other neuromuscular diseases and 7 had idiopathic pes planovalgus deformities. The preoperative and postoperative radiographs with full weight bearing in the frontal and lateral planes were analysed. The mean follow-up was 22.6 months (6-64 months). In addition to that, 23 of the 92 patients (13 girls, 10 boys) were reviewed preoperatively, in the first year after operation and after more than 24 months. RESULTS: The mean lateral talocalcanear angle was reduced from 49.52 to 31.49°. The calcaneal pitch angle changed from 2.95 to 7.55°. The mean lateral talo-first-metatarsal angle improved from -36.98 to -12.32°. The mean frontal talo-first-metatarsal-base-angle increased from -28.48 to -2.64° and the TMT index from -66.46 to -14.96°. All measured angles changed significantly (p < 0.0001). There was no significant change after 6-12 month and ≥ 24 month follow-up (p > 0.05). Eight feet were not corrected completely, three feet were overcorrected. In one case the fibular graft was reabsorbed. There were degenerative changes of the talus in three cases. 14 feet developed a dorsal bunion with extension deformity of the first metatarsal bone. CONCLUSIONS: The Grice-Green subtalar arthrodesis improves foot alignment and can achieve a significant correction also in long-term follow-up.

[Comparison of the diagnostic value of X-ray versus MRI in paediatric spine injuries]. / Stellenwert des konventionellen Röntgenbilds versus MRT in der Diagnostik kindlicher Wirbelsäulenverletzungen.

AIM: The evaluation of paediatric thoracic or lumbar compression fractures can be challenging. The anatomy of the growing spine often makes a correct diagnosis by plain radiography difficult. The aim of our study was to compare the diagnostic reliability of X-Ray and that of magnetic resonance imaging in the evaluation of acute compression fractures of the paediatric spine. METHOD: From January to December 2008 20 patients (12 boys, 8 girls) who were treated because of clinically suspected compression fractures of the vertebra were included in our study. The average age was 8.3 years. In all cases a radiograph in two planes and an MRI of the lumbar and thoracic spine were obtained. Two orthopaedic surgeons and one radiologist retrospectively assessed the radiographs. The results were compared with the MRI findings. RESULTS: In six cases the MRI was normal, in one case there was only a bone bruise without compression of the vertebra. 13 children had two or more than two minor compression fractures (29 fractures altogether). The 5th and 6th thoracic vertebra predominated. In only two cases there was a corresponding result of all three physicians and the MRI. In 4 cases the observers agreed on the localisation of the fracture. There was no agreement about the number of fractured vertebrae. CONCLUSION: An exact evaluation of minor compression fractures of the pediatric spine with plain X-ray was not satisfactory.

Minimal invasive surgery for coronoid fracture: technical note.

Operative treatment of coronoid fracture often requires a large dissection of soft tissue, resulting in elbow stiffness and functional limitation. The authors present a minimal invasive, safe technique, useful in the case of isolated coronoid fracture associated with elbow dislocation. This technique does not require soft tissue dissection and allows an early unlimited resumption of sports activities.

Quantification of intact quadriceps tendon, quadriceps tendon insertion, and suprapatellar fat pad: MR arthrography, anatomy, and cryosections in the sagittal plane.

OBJECTIVE: The purpose of this study was to quantify quadriceps tendon length, thickness, and insertion in relation to the suprapatellar fat pad. SUBJECTS AND METHODS: We used three methods to analyze the anatomy of intact quadriceps tendons and insertions into the patellar base: MR arthrography (53 knees with intact extensor mechanisms), gross anatomy (16 cadaveric knees), and cryosections (four cadaveric knees). With an electronic cursor, two observers independently quantified the extensor mechanism on midline sagittal T1-weighted spin-echo sequences acquired on a low-field-strength (0.23 T) scanner. RESULTS: On MR arthrograms, quadriceps tendon length, determined from the superior patellar pole to the most superior part of the suprapatellar recess, measured 49 +/- 7 mm in women and 50 +/- 9 mm in men. Thickness of quadriceps tendon at three sites (suprapatellar recess, center, and superior patellar pole) measured 7 +/- 1 mm in women and 8 +/- 1 mm in men. Thickness was significantly larger in men at all measurement locations. Quadriceps tendon insertion and the suprapatellar fat pad along the patellar base measured 16 +/- 2 and 6 +/- 2 mm, respectively, in women, and 18 +/- 3 and 7 +/- 2 mm, respectively, in men. CONCLUSION: On midline MR images, sagittal thickness of the quadriceps tendon and its insertion was significantly larger in men than in women. The prevalence of the suprapatellar fat pad was 100%.