Multistaged surgical management of posttraumatic segmental tibial bone loss.

Fracture nonunions associated with segmental diaphyseal bone loss challenge present methods of sustaining bone length and securing bony union. In the tibia, single-stage grafting procedures to accomplish this reconstruction requires major tissue sacrifice from adjacent areas and often results in amputation. A series of nine patients with tibial segmental diaphyseal bone loss were treated with multistaged surgical reconstruction. All nine were patients with severe trauma, with soft-tissue loss and local sepsis, who were candidates for amputation. The follow-up period averaged 5.5 years. All of the patients achieved healed, stable legs. All but one were fully ambulatory without a brace eight to 15 months after the first stage of bone grafting. There were several minor complications, which were satisfactorily treated. Multistaged bone graft operations were relatively low-risk, with a high incidence of success for treatment of major tibial segmental bone loss.

Delayed wound healing, infection, and nonunion following open reduction and internal fixation of tibial plafond fractures.

The literature concerning tibial plafond fractures is briefly reviewed, and a series of 11 tibial plafond fractures of the compressive variety is presented. These fractures fall both prognostically and therapeutically into different categories based upon whether the primary mechanism of injury is rotational or compressive. The severity of the fracture, the degree of contamination, and the severity of concomitant soft-tissue injury in large part appear to determine the morbidity of surgical therapy in these patients. If rigid internal fixation can be performed in those patients with closed injuries that are primarily of the rotational type and performed with a minimum of soft-tissue trauma, this appears to be a reliable alternative in the hands of surgeons experienced with A-O technique and with this type of fracture specifically. In the presence of severe comminution and open wounds, however, the efficacy of rigid internal fixation performed by surgeons without great experience with these types of fracture is dubious.

Brachial neuritis.

Brachial neuritis is an unusual syndrome of unknown etiology that can be confused with other causes of pain or weakness, or both, of the shoulder and arm. It is important to distinguish this disorder because of its dramatic symptoms and relatively good prognosis. Sharp pain, usually in the elbow or shoulder, marks the onset of brachial neuritis, but is relatively short-lived. Weakness generally occurs as the pain is subsiding and most frequently involves the deltoid, spinati, serratus anterior, biceps, and triceps. Paresthesias, atrophy, and sensory loss are inconstant features. Electromyographic findings of fibrillation potentials and positive waves characteristically are found in a pattern indicating combined nerve-root and peripheral nerve involvement. Electromyography more frequently than clinical examination shows that the lesion is bilateral, and also is of both diagnostic and prognostic value. Other laboratory studies serve only to exclude other causes of shoulder pain. The clinical course is variable, but in 90 per cent of patients complete recovery occurs within three years. Recurrences are uncommon.

Postural impositions on the foot and ankle from trunk, pelvis, hip, and knee in cerebral palsy.

Postural impositions on the foot and ankle in cerebral palsied patients may be due to neurological or biomechanical causes. Neurological etiology is related to retained neonatal automatisms, mass reflexes, lack of phasic muscle activity, and lack of voluntary control. Biomechanical impositions on the foot and ankle of superincumbent deformities in the transverse, sagittal, and coronal planes are analyzed and specific examples are cited. It is important to be able to differentiate those problems of the foot and ankle which are primary from those imposed by superincumbent structures. Some iatrogenic problems may be prevented by careful analysis.