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Abstract
The primary result of this series is that each patient participated actively during his or her procedures. The concept of selective sensory block, therefore, which was the authors' overriding reason for using CEA in secondary tendon surgery, also may be beneficial to tetraplegic patients. Nystrom and Nystrom [2] also came to this conclusion. The use of CEA in tetraplegia is and must be used only in exceptional cases. If the usual surgical techniques seem to be inadequate for a given patient, and if the surgeon wishes to assess muscle tonicity and the effect of tenodesis in vivo, CEA may be used. The patients in the authors' series have been so satisfied with the technique that this dynamic approach to the tetraplegic upper leg may be as advantageous for the patient as it is for the surgeon.
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Danino A, Revol M, Cormerais A, Laffont I, Pedelucq JP, Dizien O, Servant JM. [Cup and cone arthrodesis of the thumb in palliative surgery for tetraplegia. Retrospective study of 57 cases]. CHIRURGIE DE LA MAIN 2002; 21:258-63. [PMID: 12357692 DOI: 10.1016/s1297-3203(02)00121-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The cup and cone technique, first described by Carrol and Hill is very simple. It affords excellent contact between bones, and allows all possible adjustments of the arthrodesis in three planes before its final fixation. MATERIAL AND METHODS Fifty seven cup and cone arthrodesis of the thumb were performed in 41 adult tetraplegic patients. Level of arthrodesis was i.p. in 28 cases, TM in 25 cases and MP in 4 cases. Distribution in Giens classification was 3 group 1, 14 group 2, 9 group 3, 23 group 5, 2 group 6, 1 group 7, 2 group 10. Mean follow-up was 51 months. Three criteria were retrospectively studied: the clinical strength of arthrodesis, its position, and the potential existence of complications. RESULTS Clinical fusion was obtained in 8 week in all cases, without any infection. No delayed union was observed. In only one case, a surgical revision was required, due to initial bad setting of TM arthrodesis and an intermetacarpal arthrodesis was performed with a bony graft. In all other cases, position of arthrodesis was correct. In a few cases, only minor or non specific drawbacks were observed: TM arthrodesis were sometimes painful during the first 6 months postoperatively; transient dystrophy of the thumb nail occurred two times in i.p. arthrodesis; the worst drawback was the shortening of the thumb, which impaired the key-grip in cases where the thumb was preoperatively short. DISCUSSION In tetraplegic patients, stabilization of the thumb can be obtained either by split distal FPL tenodesis or by an arthrodesis at TM, MP or i.p. level of the thumb. When the provided thumb length is adequate arthrodesis is preferred. The cup and cone technique is very simple and effective. It is fit particularly in tertraplegic patients, whatever the level of the thumb arthrodesis.
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Kozin SH, Schloth C. Bilateral biceps-to-triceps transfer to salvage failed bilateral deltoid-to-triceps transfer: a case report. J Hand Surg Am 2002; 27:666-9. [PMID: 12132093 DOI: 10.1053/jhsu.2002.34005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The treatment of failed deltoid-to-triceps tendon transfers for elbow extension in persons with tetraplegia is a difficult problem. This situation was managed in a 19-year-old man by bilateral biceps-to-triceps tendon transfers. Successful restoration of elbow extension resulted in an increase in the available workspace and enhanced ability to perform activities of daily living.
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129
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Greenwald D, Keith MW, Aguiar J, Singh S. Current surgical therapy for quadriplegia: functional electrical stimulation. Plast Reconstr Surg 2002; 109:1378-85. [PMID: 11964995 DOI: 10.1097/00006534-200204010-00027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mooney JF. Selective posterior rhizotomy and intrathecal baclofen for the treatment of spasticity. Pediatr Neurosurg 2002; 36:223. [PMID: 12006760 DOI: 10.1159/000056062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
STUDY DESIGN A case report is presented involving a subdural hematoma after cervical epidural steroid injection. OBJECTIVE To demonstrate a previously unreported complication of cervical epidural steroid injection. SUMMARY OF BACKGROUND DATA Cervical epidural steroid injection is a common procedure performed in the care of patients with spine-related complaints. Reports of complications are rare, and most of these are fairly benign. To the authors' knowledge, subdural hematoma has never been described as a complication of a cervical epidural steroid injection. METHODS A patient underwent an uncomplicated cervical epidural steroid injection by an experienced anesthesiologist. She developed acute onset of axial pain followed by progressive quadriparesis within a matter of 8 hours. She was transferred from a local emergency room after a CT scan suggested posterior cord displacement consistent with an anterior spinal hematoma from C3 to C5. She was taken to the operating room for urgent decompression. Exploration revealed an anterior subdural hematoma that was evacuated followed by dural closure with a patch. RESULTS After surgery the patient was initially quadriplegic but rapidly gained full function in the left upper and lower extremities. She was making steady progress with motor recovery on the right side when she developed acute meningitis about 8 days after surgery, and then she subsequently went into cardiopulmonary arrest. She was successfully resuscitated but remained critically ill with no evidence of encouraging neurologic function. Six days later she had a second cardiac arrest and could not be resuscitated. CONCLUSIONS It is important to acknowledge that spinal hematomas can occur after cervical epidural steroid injection, as prompt recognition and treatment could improve the prognosis for recovery. The sequelae of a cervical subdural hematoma after epidural steroid injection remain potentially devastating.
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Peckham PH, Kilgore KL, Keith MW, Bryden AM, Bhadra N, Montague FW. An advanced neuroprosthesis for restoration of hand and upper arm control using an implantable controller. J Hand Surg Am 2002; 27:265-76. [PMID: 11901386 DOI: 10.1053/jhsu.2002.30919] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An advanced neuroprosthesis that provides control of grasp-release, forearm pronation, and elbow extension to persons with cervical level spinal cord injury is described. The neuroprosthesis includes implanted and external components. The implanted components are a 10-channel stimulator-telemeter, leads and electrodes, and a joint angle transducer; the external components are a control unit and transmitter-receiver coil. The system has completed preclinical testing and has been implanted fully in 3 persons and partially in 1 person, all with tetraplegia caused by spinal cord injury at C5 and C6. The minimum follow-up time for any system component is 16 months. All subjects had improvements in grasp strength, range of motion, and ability to grasp objects and increased independence in activities of daily living. Each subject became a regular user of the neuroprosthesis and is satisfied with it. The implanted components have not caused any medical complications. The operation of the electrodes and sensors has been stable. The data show that this advanced neuroprosthetic system is safe and can provide grasping and reaching ability to individuals with cervical level spinal cord injury.
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Kron C, Revol M, Felten A, Marie O, Cormerais A, Laffont I, Servant JM. [Prevalance of nosocomial infections in tetraplegic upper extremity surgery. Prospective study of twenty patients]. ANN CHIR PLAST ESTH 2002; 47:12-6. [PMID: 11980347 DOI: 10.1016/s0294-1260(01)00081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Many risk factors of nosocomial infection may be met with tetraplegic patients. The objective of this work was to study the prevalence of colonization by 3 multiresistants bacteria (methicillin resistant staphylococcus aureus (MRSA), Klebsiella pneumoniae with widened spectrum beta lactamase or multi-resistant Acinetobacter baumannii) on this population. MATERIAL AND METHODS It was about a prospective study for which we included 20 consecutive patients coming from a rehabilitation of long stay center to have a surgical operation of palliative reanimation of the upper limb. For each patient, the first morning of his hospitalization, many sites cultures were carried out for bacteriological analysis whose results were returned in 48 h to the operator. No patient was excluded. RESULTS Five patients (25%) showed the presence of SARM. One patient (5%) showed the presence of Klebsiela pneumoniae. One of the patients carrying a SARM was also carrying Acinetobacter baumannii. Overall 6 patients were contaminated (30%) but no postoperative infection occurred, neither at the time of the hospitalization nor after the exit of the service. DISCUSSION The various risk factors of nosocomial infection appearance met in tetraplegic patient were analyzed. This study showed that the cares of tetraplegic patients limited to the maximum the risk of nosocomial infection appearance (no one in this series) in spite of an important contamination met in this type of population which presents long durations of hospitalization, main risk factor regularly met.
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Abstract
The management of the paralytic conditions in tetraplegia requires understanding neural pathophysiology. A comprehensive rehabilitative and surgical plan requires a multidisciplinary approach. Prior to redistributing the muscle forces across the elbow, a supple osseo-articular platform must be created. The authors recommend PDT and BTT transfers and a FES neuroprosthesis. Future work in this field will advance the application of neuromodulation and its deployment in different neurophysiologic states.
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Behari S, Banerji D, Trivedi P, Jain VK, Chhabra DK. Anterior retropharyngeal approach to the cervical spine. Neurol India 2001; 49:342-9. [PMID: 11799405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The anterior retropharyngeal approach (ARPA) accesses anteriorly situated lesions from the clivus to C3, in patients with a short neck, Klippel Feil anomaly or those in whom the C2-3 and C3-4 disc spaces are situated higher in relation to the hyoid bone and the angle of mandible where it is difficult to approach this region using the conventional anterior approach, due to the superomedial obliquity of the trajectory. The ARPA avoids the potentially contaminated oropharyngeal cavity providing for a simultaneous arthrodesis and instrumentation during the primary surgical procedure. Experience of five patients with high cervical extradural compression, who underwent surgery using this approach between 1994 and 1999, is presented. The surgical procedures included excision of ossified posterior longitudinal ligament (n=2); excision of prolapsed disc and osteophytes (n=2); and excision of a vertebral body neoplasm (n=1). Following the procedure, vertebral arthrodesis was achieved using an iliac graft in all the patients. Only one patient with vertebral body neoplasm required an additional anterior cervical plating procedure for stabilisation the construct. The complications included transient respiratory insufficiency and neurological deterioration in two patients; and, pharyngeal fistula and donor site infection in one patient.
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Rowley H, Lynch T, Keogh I, Russell J. Tardive dystonia of the larynx in a quadriplegic patient: an unusual cause of stridor. J Laryngol Otol 2001; 115:918-9. [PMID: 11779311 DOI: 10.1258/0022215011909350] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe a case of a quadriplegic brain-damaged man with severe upper airway obstruction. A diagnosis of tardive dystonia affecting the vocal folds was made and confirmed by flexible nasopharyngoscopy. Emergency tracheotomy was required. The tardive movement disorder resolved with discontinuation of thioridazine. This case serves to heighten awareness of potentially serious airway complications associated with the use of anti-psychotics and anti-emetics particularly in those with organic brain disease.
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137
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Abstract
In children with spastic quadriplegia, also described as 'whole body involvement', spasticity can interfere with motor function, contributes to the development of deformities and adversely impacts on care, positioning, and comfort. In this population, spasticity interventions address goals such as improving comfort, reducing pain, easing the burden of carers, slowing the progression of musculoskeletal deformities and perhaps improving function. Children with severe diplegia are distinguished from those with quadriplegia by their ability to ambulate, as well as by a greater emphasis being placed on functional motor goals even though similar treatment modalities are often employed to manage spasticity. The many treatment options currently available include, but are not limited to, botulinum toxin type A, phenol neurolysis, oral medications, intrathecal baclofen, selective dorsal rhizotomy, and orthopaedic surgery. The integration of these treatment modalities can help to optimize the overall care and function for a child with spastic quadriplegia or severe diplegia. However, the development of a management programme is complex and needs to take into account many factors, including age, weight and nutritional status, rate of progression of musculoskeletal deformities, developmental potential, comorbid conditions, current functional status and prognosis, and family and patient treatment goals. Children with marked spasticity are likely to benefit from a combination of interventions, rather than a single treatment modality. Because of these complexities, management should be planned and coordinated by a multidisciplinary team of medical and allied health professionals which recognizes the central role of the family in all decisions. Once the special characteristics of the child with spastic quadriplegia and the various treatment options are understood, outcomes can be maximized.
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Wild A, Jäger M, Fuss M, Werner A, Krauspe R. [Medical-insurance aspects of atlantoaxial instability in children]. ZEITSCHRIFT FUR ORTHOPADIE UND IHRE GRENZGEBIETE 2001; 139:481-4. [PMID: 11753766 DOI: 10.1055/s-2001-19227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION An os odontoideum is mostly diagnosed coincidentally on the basis of neurological symptoms or painful movement of the cervical spine. Diagnostic work-up and therapy are currently subjects of controversial discussion in the literature. CASE Our report is about an eleven-year-old boy with an unknown os odontoideum, who developed neurological symptoms with tetraparesis after a fall from 1.5 m height. Conventional X-ray examination resulted in the diagnosis of a suspected dens fracture, MRI showed atlanto-axial instability and an os odontoideum with significant dural sack compression but no signs of acute bony or ligamentous lesion. CONCLUSION Because of the importance concerning not only medical but also legal/insurance aspects, a possible coincidental finding of an os odontoideum versus a dens fracture must be included in the differential diagnosis. In the case of an os odontoideum without instability in children, conservative therapy is justified after due enlightenment regarding possible risks. In the event of neurological symptoms and/or persistent instability the authors advocate early surgical stabilization even in patients with little infirmity, particularly in view of the possible consequences.
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139
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Peckham PH, Keith MW, Kilgore KL, Grill JH, Wuolle KS, Thrope GB, Gorman P, Hobby J, Mulcahey MJ, Carroll S, Hentz VR, Wiegner A. Efficacy of an implanted neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study. Arch Phys Med Rehabil 2001; 82:1380-8. [PMID: 11588741 DOI: 10.1053/apmr.2001.25910] [Citation(s) in RCA: 227] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate an implanted neuroprosthesis that allows tetraplegic users to control grasp and release in 1 hand. DESIGN Multicenter cohort trial with at least 3 years of follow-up. Function for each participant was compared before and after implantation, and with and without the neuroprosthesis activated. SETTING Tertiary spinal cord injury (SCI) care centers, 8 in the United States, 1 in the United Kingdom, and 1 in Australia. PARTICIPANTS Fifty-one tetraplegic adults with C5 or C6 SCIs. INTERVENTION An implanted neuroprosthetic system, in which electric stimulation of the grasping muscles of 1 arm are controlled by using contralateral shoulder movements, and concurrent tendon transfer surgery. Assessed participants' ability to grasp, move, and release standardized objects; degree of assistance required to perform activities of daily living (ADLs), device usage; and user satisfaction. MAIN OUTCOME MEASURES Pinch force; grasp and release tests; ADL abilities test and ADL assessment test; and user satisfaction survey. RESULTS Pinch force was significantly greater with the neuroprosthesis in all available 50 participants, and grasp-release abilities were improved in 49. All tested participants (49/49) were more independent in performing ADLs with the neuroprosthesis than they were without it. Home use of the device for regular function and exercise was reported by over 90% of the participants, and satisfaction with the neuroprosthesis was high. CONCLUSIONS The grasping ability provided by the neuroprosthesis is substantial and lasting. The neuroprosthesis is safe, well accepted by users, and offers improved independence for a population without comparable alternatives.
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Pearl J, Ramirez AR, Petruzziello M, Perdue P. Small bowel perforation after a quad cough maneuver. THE JOURNAL OF TRAUMA 2001; 51:162-3. [PMID: 11468487 DOI: 10.1097/00005373-200107000-00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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141
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Razif M, Lim HH. Delayed decompression of chronic C1C2 subluxation in a pediatric patient with tetraplegia--is recovery possible? THE MEDICAL JOURNAL OF MALAYSIA 2001; 56 Suppl C:76-9. [PMID: 11814256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A 2 year-old Malay girl was admitted to our institution with a chesty cough and breathlessness but later found to have a chronic C1/C2 subluxation for one and half year with tetraplegia. Her cervical cord was decompressed and occipito-cervical fusion performed. Her neurological status improved significantly post-operatively and is able to care for her personal hygiene. The authors believe that the ability of the cervical cord to recover in the paediatric age group is remarkable that surgical option should be considered even when all seen lost. We believe that this is the first report in the literature to support this potential.
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142
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Kozin SH, Bednar M. In vivo determination of available brachioradialis excursion during tetraplegia reconstruction. J Hand Surg Am 2001; 26:510-4. [PMID: 11418916 DOI: 10.1053/jhsu.2001.24970] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The brachioradialis muscle is a common donor in tetraplegia reconstruction. The purpose of this study was to determine the available excursion of the brachioradialis during graduated release of its insertion sites. Fourteen extremities in 10 patients with cervical spine injuries underwent surgical reconstruction for restoration of hand function using the brachioradialis as a donor for one of the restored movements. At the time of surgery the brachioradialis was exposed along the forearm and a wire was inserted into the muscle followed by excitation with a biphasic, asymmetrical, charge-balanced waveform. A 12-Hz frequency and 20-mA current were used to stimulate the muscle while the pulse duration was varied between 0 and 200 milliseconds to achieve maximum contraction. Average brachioradialis excursion after incision of the radial styloid insertion site was 8 mm and 14 mm after mobilization to the musculotendinous junction. Further release of the fascial connections and mobilization of the muscle belly increased the excursion to an average of 61 mm. The increase in excursion after fascial release and muscle mobilization was significant and should be performed to obtain maximum available excursion.
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Borton DC, Walker K, Pirpiris M, Nattrass GR, Graham HK. Isolated calf lengthening in cerebral palsy. Outcome analysis of risk factors. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2001; 83:364-70. [PMID: 11341421 DOI: 10.1302/0301-620x.83b3.10827] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
We assessed the medium-term outcome of three methods of isolated calf lengthening in cerebral palsy by clinical examination, observational gait analysis and, where appropriate, instrumented gait analysis. The procedures used were percutaneous lengthening of tendo Achillis, open Z-lengthening of tendo Achillis and lengthening of the gastrosoleus aponeurosis (Baker's procedure). We reviewed 195 procedures in 134 children; 45 had hemiplegia, 65 diplegia and 24 quadriplegia. We established the incidence of calcaneus and recurrent equinus and identified 'at-risk' groups for each. At follow-up, 42% had satisfactory calf length, 22% had recurrent equinus and 36% calcaneus. The incidence of calcaneus in girls at follow-up was significantly higher (p = 0.002) while boys had an increased rate of recurrent equinus (p = 0.012). Children with diplegia who had surgery when aged eight years or younger had a 44% risk of calcaneus, while those over eight years had a 19% risk (p = 0.046). Percutaneous lengthening of tendo Achillis in diplegia was the least predictable, only 38% having a satisfactory outcome compared with 50% in the other procedures. The incidence of recurrent equinus in hemiplegic patients was 38%. Only 4% developed calcaneus. The type of surgery did not influence the outcome in patients with hemiplegia or quadriplegia. Severity of involvement, female gender, age at operation of less than eight years and percutaneous lengthening of tendo Achillis were 'risk factors' for calcaneus. Hemiplegia, male gender, and an aponeurosis muscle lengthening increased the risk of recurrent equinus.
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144
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Bellis YM, Linnau KF, Mann FA. A complex atlantoaxial fracture with craniocervical instability: a case with bilateral type 1 dens fractures. AJR Am J Roentgenol 2001; 176:978. [PMID: 11264093 DOI: 10.2214/ajr.176.4.1760978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
The results of 36 Chiari medial displacement osteotomies of the pelvis were studied to determine the efficacy of the operation in the treatment of subluxated and/or painful dysplastic hips. Fifteen of 16 osteotomies performed for congenital hip dysplasia provided satisfactory coverage, pain relief, and increased function. The results were less consistent in patients with myelodysplasia, spasticity, and Perthes disease. The Chiari osteotomy is a technically exacting procedure capable of providing adequate femoral head coverage. This coverage facilitates pain relief and increased function. This procedure is most suited for those individuals with a painful hip subluxation in whom a concentric reduction is not possible.
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Samilson RL, Carson JJ, James P, Raney FL. Results and complications of adductor tenotomy and obturator neurectomy in cerebral palsy. Clin Orthop Relat Res 2001; 54:61-73. [PMID: 5589608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
STUDY DESIGN A rare case of a laterally directed stab wound injury of the cervical spinal cord is reported. OBJECTIVE To describe the unusual mechanism of injury of this case and its clinical features. The surgical indications for penetrating injuries of the spinal cord are discussed. SUMMARY OF BACKGROUND DATA Spinal stab wound injuries are rare, and the literature on the subject is scant. There has been only one large clinical review from South Africa, published in 1977. The clinical features and the injury mechanism of a laterally directed stab wound to the cervical spine have not been previously described. METHODS An 18-year-old man was stabbed in the right side of the neck at C1-C2. The blade penetrated the spine laterally and went through the ligaments without affecting the bony structures. On admission the patient had tetraplegia and was in respiratory failure. Radiologic investigation showed the retained blade passing through the cord but showed no bony or vascular injuries. RESULTS Before extraction, the knife was followed to its tip with careful dissection. Because no cerebrospinal fluid leak was noted in the area, the dura was not exposed. After surgery, magnetic resonance images showed a complete transection of the spinal cord at C1-C2. The patient was neurologically unchanged in follow-up examinations. CONCLUSION Laterally directed horizontal stab wounds of the spine are particularly dangerous because the blade can pass between two vertebrae to transect the cord. The neurologic injury that results is irreversible. The more common stab wounds, inflicted from behind, usually produce incomplete cord damage.
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Lee JH, Chung CK, Kim HJ. Cerebral dissection from syringomyelia demonstrated using cine magnetic resonance imaging. Case report. J Neurosurg 2001; 94:318-21. [PMID: 11213972 DOI: 10.3171/jns.2001.94.2.0318] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 16-year-old boy presented at the authors' emergency department with a sudden deterioration of respiration. He had been paraparetic for 3 years and had become quadriplegic 2 days previously. Magnetic resonance images revealed a Chiari I malformation and a hydromyelic cavity extending from C-1 to T-11. Rostrally, a small cylindrically shaped lesion extended from the cervicomedullary junction to the left semioval center. The patient made a dramatic neurological recovery following suboccipital craniectomy and upper cervical laminectomies with augmentation duraplasties followed by placement of a syringoperitoneal shunt.
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van der Linde H, Snoek GJ, Geurts AC, Knoop HA, van Limbeek J, Mulder T. Kinematic assessment of manual skill following functional hand surgery in tetraplegia. J Hand Surg Am 2000; 25:1140-6. [PMID: 11119676 DOI: 10.1053/jhsu.2000.17870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To determine whether surgical key grip reinforcement actually leads to a better movement ability we developed a procedure for the kinematic analysis of manual skill following hand surgery in tetraplegia. The functional results of surgery in 5 cases were examined by the kinematic analysis of drawing movements using an electronic pen and a digitizer under 3 conditions: with eyes open, with eyes closed, and while performing a concurrent arithmetic task. Movement velocity and dysfluency (ie, the number of velocity changes per centimeter) were measured before and at several moments after surgery during subsequent rehabilitation. Both movement velocity and dysfluency showed good stability across repeated trials and were consistently affected by visual deprivation. Movement velocity showed a 39% increment between the first and last assessment. Although grip strength increased in all patients, it was not associated with the change of movement velocity. These results suggest that other factors (eg, deep sensibility, cognition, muscle coordination) play a critical role in the ability to use improved grip force for controlling drawing movements and emphasize the value of a kinematic assessment besides measuring isolated grip force in the evaluation of functional hand surgery.
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Bottero L, Revol M, Cormerais A, Servant JM. [Effect of brachial-radial and extensor carpi radialis longus tenodesis on elbow flexion-extension movements. Application to tendon transfers in tetraplegia]. ANN CHIR PLAST ESTH 2000; 45:511-5. [PMID: 11094828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The authors show that extension of the elbow produces a traction on brachioradialis (BR) and extensor carpi radialis longus (ECRL): if their tendon is distally freed, it is pulled in the proximal direction when the elbow extends. This phenomenon provides tenodesis effects, especially after tendon transfer in tetraplegia. It has been assessed on 31 upper limbs of patients and fresh cadavers. The mean tendon excursion, between 90 degrees flexion and full extension of the elbow, was 32 mm for BR and 19 mm for ECRL. These tenodesis effects related to the extension of the elbow leads the authors to recommend three practices in tetraplegic patients: active extension of the elbow should be restored before rehabilitation of the hand, and a 90 degrees flexion of the elbow is the position in which BR and ECRL transfers should be set intraoperatively, as well as immobilized postoperatively.
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