Woodward procedure improves shoulder function in Sprengel deformity.

BACKGROUND: Sprengel deformity is a congenital failure of descent of the scapula. Limited shoulder abduction and cosmetic appearance are the major concerns. Although the Woodward procedure reportedly affords satisfactory correction, the long-term functional outcome postoperatively has not been addressed. METHODS: Eight patients (9 shoulders) who underwent the Woodward procedure for Sprengel deformity were evaluated. The cosmetic appearance and functional results of the shoulders were evaluated using the Cavendish grading system and functional Constant scoring. Grading of the cosmetic appearance, range of motion of the shoulder, and radiographs were obtained for interpretation. RESULTS: After a mean follow-up of 113 ± 29 months, the cosmetic appearance had improved. The Cavendish cosmetic grade improved significantly (p = 0.000). The superior displacement ratio decreased from 0.5 ± 0.1 to 0.2 ± 0.1 (p = 0.004). The height-to-width ratio of the affected scapula increased from 1.3 ± 0.2 (range 1.1 to 1.7) to 1.6 ± 0.2 (range 1.4 to 2.0) (p = 0.001). The abduction of the shoulder improved from 122 ± 14 (range 100 to 140) degrees to 157 ± 20 (range 125 to 180) degrees (p = 0.008). The average abduction power of the involved shoulders was 21.8 ± 3.2 lbs, which was not significantly different from the uninvolved shoulders 23.1 ± 2.5 lb (p = 0.525). The average Constant score for the operated shoulders was 91.7 ± 4.2 (range 82 to 96) points. CONCLUSION: The Woodward procedure offers substantial improvement of shoulder function and cosmetic appearance for patients.

Extracorporeal shockwave shows regression of osteoarthritis of the knee in rats.

BACKGROUND: This study investigated the effects of extracorporeal shockwave technology (ESWT) in osteoarthritis of the knee in rats. MATERIALS AND METHODS: Thirty-six Sprague-Dawley rats were randomly divided into three groups with 12 rats in each group. Group I was the control group and received neither anterior cruciate ligament transection (ACLT) nor ESWT. In groups II and III, ACLT was performed in left knee and osteoarthritis (OA) was verified at 12 wk. Group II received no ESWT, and group III received ESWT at 12 wk after ACLT. Radiographs and bone mineral density (BMD) were obtained at 0, 12, and 24 wk. The animals were sacrificed at 24 wk. One half of the animals were subjected to bone strength test, and the other half for histomorphologic examination and immunohistochemical analysis. RESULTS: Radiographs of the left knee showed progressive OA changes at 12 and 24 wk in group II, whereas, very subtle OA changes were noted in group I and group III. BMD and bone strength were significantly lower in group II compared with groups I and III, but no difference was noted between group I and group III. The cartilage degradations were significantly higher in group II compared with groups I and III, but no difference was noted between group I and group III. The subchondral bone remodeling was significantly less pronounced in group II compared with groups I and III, but no difference was noted between group I and group III. CONCLUSIONS: Application of ESWT to the subchondral bone of the medial tibia condyle showed regression of osteoarthritis of the knees in rats.

Surgical results of concomitant treatment of deltoid contracture and rotator cuff tear.

BACKGROUND: Contracture of the deltoid muscle is an uncommon disorder. The symptoms usually are nonspecific and the diagnosis may be missed, especially when combined with other shoulder disorders, such as rotator cuff lesions. Few reports have described the surgical treatment of combined deltoid contracture and a torn rotator cuff. The purpose of this study was to share our experiences in the diagnosis and treatment of patients, who sustained deltoid contracture combined with rotator cuff tearing. MATERIALS AND METHODS: Between April 2001 and December 2006, 18 consecutive patients underwent concomitant treatment for distal release of deltoid contracture and repair of a torn rotator cuff. The mean age at operation was 55.1 years. There were eight female and ten male patients. The acromial type, winging angle of the scapula and thickest diameter of the deltoid fibrotic band were measured using preoperative magnetic resonance imaging studies. The abduction-contracture angle, extension-contracture angle, horizontal-adduction angle and Constant and Murley scores were measured preoperatively and at the latest follow-up. RESULTS: There were nine complete rotator cuff tears and nine partial tears. At an average of 5 years and 3 months' follow-up, the mean abduction-contracture angle significantly improved from 27° to 0° (p<0.001), the mean extension-contracture angle improved from 13° to 0° (p<0.001), and, the mean horizontal-adduction angle improved from 8° to 44° (p<0.001). The mean Constant score also improved from 69 points to 95 points (p<0.001). CONCLUSIONS: If a symptomatic torn rotator cuff and deltoid contracture co-exist, simultaneous operative treatment of both conditions is highly recommended.

Functional outcomes of bilateral hip necrosis: total hip arthroplasty versus extracorporeal shockwave.

INTRODUCTION: This study compared the functional outcomes of total hip (THA) in one and shockwave (ESWT) in the other in 17 patients with bilateral hip necrosis. METHOD: In THA side, only one type of prosthesis was used and all components were press fixed. In ESWT side, each hip received 6,000 impulses of shockwave at 28 kv. RESULTS: The evaluations included pain score and Harris hip score, radiographs and MR images. The magnitudes of improvement in pain and function favored the ESWT side. Thirteen patients rated ESWT better than THA; four patients reported comparable results between THA and ESWT, and none graded THA better than ESWT. Better functional outcomes were observed after ESWT for early hip necrosis than THA for late cases in patients with bilateral hip disease.

Functional outcomes of arthroscopic posterior cruciate ligament reconstruction: comparison of anteromedial and anterolateral trans-tibia approach.

INTRODUCTION: The hypothesis of this study is that anterolateral (A-L) trans-tibia approach is better than anteromedial (A-M) technique in posterior cruciate ligament (PCL) reconstruction. The purpose of this prospective clinical study was to compare the functional outcomes of A-M and A-L trans-tibia approach in arthroscopic PCL reconstruction. MATERIALS AND METHODS: Between 1999 and 2003, 55 patients (55 knees) with an average age of 30 +/- 11 years (range 16-60 years) underwent arthroscopic single-bundle reconstruction for symptomatic isolated PCL tear. Patients were randomly divided into two groups with 28 patients (28 knees) undergoing A-M trans-tibia approach on odd-numbered days, and 27 patients (27 knees) with A-L trans-tibia approach on even-numbered days. Hamstring auto grafts were used in all cases. All patients received the same rehabilitation program postoperatively. The evaluation parameters included clinical assessment, functional outcome, ligament laxity and radiographic changes of the affected knee. RESULTS: Significant improvements in pain and function of the knee were observed at an average follow-up of 48 +/- 15.9 months for A-M and 45.0 +/- 13.7 months for A-L approach. However, the difference between the two techniques was statistically not significant. In IKDC for symptom-activity level, normal or nearly normal knees were noted in 68% of A-M and 67% of A-L approach, respectively, but no difference was noted between the two groups. In ligament laxity, approximately two-thirds of the knees showed normal posterior laxity with no difference between the two groups. Radiographs of the knee showed no discernible difference in the overall alignment and degenerative changes as well as the sizes of bone tunnel between the two groups. CONCLUSION: A-M and A-L trans-tibia arthroscopic PCL reconstructions produced comparable clinical results in short-term follow-up. Contrary to our initial hypothesis, the theoretical disadvantages of A-M technique including graft failure were not observed during the follow-up period. Long-term results are needed to confirm the adverse effects of A-M trans-tibia approach in PCL reconstruction.

Conditions associated with hypertension in a high-risk premature infant.

Hypertension is an uncommon but significant problem in high-risk neonates and infants, and the spectrum of potential causes is broad. Here, we describe an extremely premature infant (birth weight, 728 g; gestational age, 27 weeks) with multiple complications and hypertension. During admission, umbilical artery catheters were used for a period of time, and he suffered from respiratory distress syndrome, intraventricular hemorrhage, pulmonary hemorrhage, patent ductus arteriosus, pericardial effusion, heart failure, repeated sepsis, anemia, thrombocytopenia, chronic lung disease, and progressive liver damage. He was treated with multiple medications, including erythropoietin, indomethacin, epinephrine, dopamine, aminophylline, multiple antibiotics, amphotericin B, and total parenteral nutrition. Hypertension was first noted when he was 41 days old, with spontaneous remission. It then recurred, reaching higher than 100 mmHg when he was almost 4 months old. After stopping erythropoietin, hypertension subsided for a short period of time and went up again. Multiple factor-related hypertension in this premature infant was considered. Related literature on hypertension in premature infants is reviewed. In conclusion, multiple factors can influence blood pressure and may induce hypertension in high-risk premature infants. Thus, blood pressure should be closely monitored in high-risk premature infants. Judicious use of all medications and interventions are crucial to decrease the incidence of hypertension in high-risk premature infants.