The relationship between preoperative nutritional status and complications after an operation for scoliosis in patients who have cerebral palsy.

The records of forty-four patients who had cerebral palsy and spastic quadriplegia and in whom a spinal arthrodesis had been done for scoliosis were reviewed to determine if the preoperative nutritional status of the patients was associated with the rate of postoperative complications. The patients were divided into two groups: Group 1 consisted of twenty-four patients who had a preoperative level of serum albumin of at least thirty-five grams per liter (3.5 milligrams per cent) and a total blood-lymphocyte count of at least 1.5 grams per liter (1500 cells per cubic millimeter), and Group 2 consisted of twenty patients who had a preoperative level of serum albumin of less than thirty-five grams per liter (3.5 milligrams per cent) and a total blood-lymphocyte count of less than 1.5 grams per liter (1500 cells per cubic millimeter). The patients in Group 1 had a significantly lower rate of infection, a shorter period of endotracheal intubation after the operation, and a shorter period of hospitalization.

Digital nerves of the foot: anatomic variations and implications regarding the pathogenesis of interdigital neuroma.

Seventy-one cadaveric feet were dissected, with attention to communicating branches of the digital nerves, the diameters of the digital nerves, the distance between the metatarsal heads, and the presence or absence of interdigital neuromas. A communicating branch was absent in 52 feet (73.2%) and present in 19 specimens (26.8%). The communication was from the fourth to the third web space common digital nerve (i.e., from the lateral to the medial plantar nerve) in 11 specimens. A reverse communication, from the third to the fourth web space common digital nerve (i.e., from the medial to the lateral plantar nerve), was present in eight specimens. Neuromas were identified in the second web space in 26 specimens and in the third web space in 32 feet. The common digital nerve to the third web space was not thicker in feet with a contribution from the fourth to the third web space nerve. Additionally, the incidence of third web space neuroma in feet with this type of communication was not significantly greater than in those feet without an internervous communication. However, the intermetatarsal head distances and the ratios of the intermetatarsal head distance to the digital nerve diameter in web spaces 2 and 3 were significantly smaller in comparison to spaces 1 and 4 (P < .05). The morphometric data lend support to theories that explain the propensity for neuroma formation in both the second and third web spaces on a mechanical basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Knee kinematics and kinetics during locomotor activities of daily living in subjects with knee arthroplasty and in healthy control subjects.

BACKGROUND AND PURPOSE: Knee kinematics and kinetics have not been quantitatively studied during gait, stair negotiation, and rising from a chair in the same subjects, either among healthy control subjects or among subjects with knee joint impairments. Despite this paucity of data, rehabilitation goals often include achieving a specific peak knee torque at a specific, fixed angular velocity. SUBJECTS: We compared the kinematic and kinetic performance of the knees in 15 subjects (19 knees) who had undergone knee arthroplasty (KA group) and 11 healthy subjects (22 knees) who served as a control group. The KA group subjects ranged in age from 61 to 78 years, and the control group subjects ranged in age from 26 to 88 years. The KA group subjects had had knee osteoarthritis, were > or = 1 year postsurgery, and were considered fully rehabilitated. METHODS: All subjects were analyzed during barefoot paced walking, stair ascent and descent, and arising from a chair. RESULTS: Compared with the control subjects, the KA group subjects had significantly different knee sagittal range of motion, angular velocities, and maximum knee moments during loaded knee extension. Vertical ground reactions did not differ significantly between groups. Both groups' maximum extension angular velocity exceeded 350 degrees/s during the swing phase of gait, but the maximum loaded extension velocity averaged only 140 degrees/s (during rising from a chair). Maximum knee flexion moments were approximately 10 to 15 N.m/%BW (knee moments normalized to percentage of body weight in newtons). CONCLUSION AND DISCUSSION: We concluded that locomotor ADLs demand relatively slow loaded angular velocities and low knee torques, a factor that should be considered in knee postarthroplasty exercise prescription.