Cystic degeneration and calcification of muscle: late sequelae of compartment syndrome.

Cystic degeneration and calcification of the leg are uncommon late sequelae of compartment syndrome. Previously reported cases have all involved the anterior compartment of the leg. We present a 68-year-old man with a mass in the superficial posterior compartment of the leg who presented 37 years after the initial trauma and ischemic myonecrosis. MRI was useful in establishing the diagnosis and early surgical intervention. The mass was excised and closed primarily over a drain. Patient was followed up for 29 months, and there were no secondary infections, chronic sinus formation, or recurrences. Based on our experience and the available literature review, we recommend considering either excision and primary closure, or repeated needle aspiration of the mass. Packing the wound and delayed closure may lead to secondary infection, chronic sinus formation, and lower limb amputation as potential complications.

Removal of intramedullary rods after femoral shaft fracture.

We are reporting a retrospective review of the removal of 60 intramedullary rods in 58 patients. All fractures had healed at the time of rod extraction. The implant was removed from 34 asymptomatic patients (36 femurs). Twenty-four patients (24 femurs) had preoperative symptoms attributed to the femoral rod. Fourteen patients had symptoms about the greater trochanter preoperatively, five patients had symptoms referable to the knee, and five had infections about the femoral implant. Problems encountered included broken rods in five femurs, one of which was not apparent on preoperative radiographs. There were six patients (six femurs) who required further hospital care for postoperative hematomas. The development of a significant hematoma was not related to the location of the fracture, the presence of interlocking devices requiring removal, the length of time since injury, the performance of this procedure as an inpatient or outpatient, or the presence or absence of a functional drain. Of the 10 patients (10 femurs) who had proximal heterotopic ossification Brooker stage 2 or greater, wound hematomas developed in four patients (40%). There were no refractures. Although there may be an indication for rod removal, we do not recommend the procedure in asymptomatic patients.

Three traction knots for the orthopaedic surgeon.

This article reviews the technique of tying three knots that are used by orthopaedic surgeons when treating a patient in skeletal traction--the traction knot, the bowline, and the cow hitch. The advantages of the bowline and the cow hitch over the traction knot are also discussed.

Pyomyositis in children.

Bacterial infections of muscle, also known as pyomyositis or tropical pyomyositis, occur more commonly in tropical regions. This article reviews five cases of pyomyositis diagnosed in children over a 1-year period. Pyomyositis should be considered in the differential diagnosis of septic-appearing children as well as children complaining of joint pain or muscle aches. The diagnosis can be aided with either a computed tomography (CT) or magnetic resonance imaging (MRI) scan. The MRI is preferable because multiple processes can be evaluated, such as joint effusion suggesting septic arthritis. If the patient does not respond quickly to antibiotics and surgical intervention, either there is a recurrence of the previously debrided abscess, or there is an unrecognized secondary abscess. Multiple abscess sites should be entertained prior to initial debridement.

A newborn with bilateral hip flexion contractures and clubfeet.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

The relationship of lower extremity strength and gait parameters in patients with post-polio syndrome.

Relationships between lower extremity strength and stride characteristics were studied in 24 patients with post-polio syndrome. Maximum isometric torques were measured in the ankle plantar flexors, hip and knee extensors, and hip abductors. Gait velocity, stride length, and cadence were recorded during free and fast walking. Step-wise regression analysis was performed to determine which muscle groups best predicted ambulatory function. Plantar flexion torque was the best predictor of velocity (r = .55 free walking and r = .76 fast) and cadence (r = .46 free and r = .58 fast). The combination of plantar flexion and hip abduction torques was the best predictor of fast stride length (r = .78). These findings emphasize the important role of the plantar flexor muscles in gait. Knee extension torque was the poorest predictor for each of the gait parameters. Several patients demonstrated gait deviations that minimized the penalty of quadriceps weakness. Without a contracture or an orthosis, however, no adequate substitution exists for weak plantar flexion.

Lower spinal mobility and external immobilization in the normal and pathologic condition.

The study presented here used lateral flexion and extension roentgenograms to determine lumbosacral motion in healthy persons and in patients with spondylolisthesis. The lumbosacral corset, Jewett extension brace, and plastic thoracolumbosacral orthosis (TLSO) were then placed and repeat roentgenograms were done to see if effective immobilization could be obtained. Although individual variation existed, there appeared to be no significant difference in lower lumbar motion between the two groups studied, and the orthotics acted in a similar fashion on both the volunteers and the patients. The lumbosacral corset was unable to immobilize the L3-S1 levels. There was a statistically significant decrease in the average lateral disk space motion at L3-4 and L4-5 with the use of the Jewett brace and the TLSO (P less than .01); however, the motion was never completely eliminated. No brace could adequately immobilize the L5-S1 level, and some people demonstrated increased motion at this level while wearing the orthotics.

Femoral shaft fracture treatment in patients age 6 to 16 years.

Traction followed by spica casting, the one method used to treat femoral shaft fractures in children that was used in the past, has given way to a multiplicity of methods today. To evaluate the morbidity and costs of these various methods, 85 fractures in 81 patients age six to 16 years were evaluated. Early spica casting gave excellent results with low complications and low costs. All surgical treatments cost approximately the same: 3 times the cost of early spica casting and equivalent to traction followed by spica casting. Intramedullary flexible rods resulted in quicker healing and return to full weight bearing than did external fixation, which had the highest complication rate. One case of avascular necrosis in an 11-year-old girl treated with a reamed intramedullary rod suggests that this method is best reserved for children at or near skeletal maturity.