Innominate osteotomy and varus derotational osteotomy in the treatment of congenital dysplasia of the hip.

The long-term functional and radiographic outcome of congenital hip dysplasia in patients previously diagnosed and nonoperatively treated, who subsequently underwent operative treatment after walking age was retrospectively reviewed in 94 patients (87% return). Innominate osteotomy (75 hips, 15.2 years mean follow up) yielded satisfactory late radiographic results in 33% of the subluxated hips and 50% of the dislocated hips, despite more encouraging results at one year (56% and 63.6% respectively). Varus derotational femoral osteotomy (35 hips, 10.8 years mean follow up) yielded a satisfactory radiographic outcome in 55.6% of the subluxated hips and 38.5% of the dislocated hips, with little change from the results at one year. Late diagnosis, late operative treatment, and complications of treatment, particularly ischemic necrosis of the femoral head, were predictive of poor outcome. Combined procedures (10 hips, 12 years mean follow up) or secondary open procedures were ineffective. Although Severin radiographic grade varied with time, functional status remained virtually the same throughout individual follow up. Those patients followed beyond skeletal maturity who developed gross articular incongruity or osteoarthritis, showed a decline in functional status.

Intravenous lidocaine for anesthesia in the lower extremity. A prospective study.

We prospectively studied the clinical applicability of intravenous lidocaine for regional anesthesia in the lower extremity in fifty-eight consecutive patients. The effectiveness of the anesthesia that was obtained for a variety of procedures done at or distal to the knee was rated as excellent or good in 94 per cent of the patients. No significant cardiovascular or neural complications were encountered, and the levels of lidocaine in the blood were well below the toxic range. We attribute the success of this method to the use of a large volume of fluid, double pretested tourniquets, and judicious premedication to delay the onset of discomfort caused by the tourniquet.

Calmodulin activity in corticosteroid-induced osteopenia.

A reproducible high-pressure liquid chromatography assay of calmodulin, a multifunctional calcium-dependent modulating protein, was developed for cartilage and bone by using cyclic nucleotide phosphodiesterase activity as the basis for standard curve determination. Calmodulin activity was then measured in rabbits that were made osteopenic by prednisolone injection in an effort to characterize in vivo cellular events. A significant rise in bone calmodulin levels was noted when this data was correlated with osteocyte and osteoblast content by quantitative histomorphometry. This suggests that calmodulin mediates steroid effects on the collagen matrix as well as on calcium homeostasis. Diminished calmodulin levels in weight-bearing cartilage of steroid-treated animals has as yet unresolved significance. Further characterization of calmodulin activity appears warranted in the study of osteopenic states at the subcellular level.

Overuse syndromes in runners.

The increase in strenuous sports participation among adult Americans has led to a high incidence of overuse syndromes. Common running-related problems include iliotibial tract tendinitis, chondromalacia patellae, "shinsplints," stress fractures and various heel and foot syndromes. Most causes of overuse syndromes can be traced to training errors, anatomic factors, poor shoes and uneven running surfaces. These syndromes generally respond to modification of the exercise program, anti-inflammatory drugs and orthotic correction of lower extremity malalignment.

Multiple epiphyseal dysplasia: a longitudinal family study.

The natural history of multiple epiphyseal dysplasia in a 74-member kindred was monitored for 17 years. Genetic transmission was clearly autosomal dominant, with variable expressivity. Onset of symptoms, joint involvement, and severity of deformity in 24 definitely affected individuals were somewhat variable, though short stature and hip involvement were characteristic. In several cases patients displayed the clinical and radiographic course of such diverse diseases as Blount's, Perthes, and osteochondritis dissecans, suggesting a common developmental etiology. Longitudinal study suggests that non-weightbearing in the prepubertal patient may limit evolving hip deformity. Experience with surgical interventions is discussed.