Pharmacological management of aseptic osteonecrosis in children.

Aseptic osteonecrosis (AON) in children can progress during ossification of cartilage in periods of increased growth or excessive physical stain and may occur in various locations in the skeleton. Disturbance of blood supply to the bone has been suggested as the main pathological mechanism involved in AON, which is characterised by the death of bone marrow and trabecular bone. The extent and development of osteonecrosis and the duration of disease until restorative healing, depend on the formation of new blood vessels, the spreading of vessels in the affected bony areas, the absorption of osteonecrotic tissue and the structure of new bone.

Iloprost for the treatment of bone marrow edema in the hindfoot.

The parenteral application of the vasoactive drug, iloprost, might be a viable option for the treatment of BMES of different origins, especially ischemic ones. In edema that is secondary to osteoarthrosis or stress, the effect of therapy with iloprost depends on the grade of the basic disease. The natural course of the disease, as well as the normalization of the signal pattern of the MRI, seem to be accelerated.

Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery.

Background: Five different methods have been described to define the longitudinal axis of the first metatarsal for radiographic measurements of the first metatarsophalangeal angle. None of these methods has been validated for both preoperative and postoperative assessment of patients undergoing hallux valgus surgery. Previous studies have demonstrated conflicting results regarding the measurement accuracy of these methods.

Juvenile bone-marrow oedema of the acetabulum treated by iloprost.

The bone-marrow oedema syndrome is associated with local vascular disturbances and may be treated either conservatively or by core decompression after which recovery may take several weeks. We describe a 15-year-old girl with bone-marrow oedema of the left acetabulum which was confirmed by MRI. She presented with a four-week history of severe constant pain.

Intertrochanteric osteotomy for avascular necrosis of the head of the femur. Survival probability of two different methods.

We have compared different types of intertrochanteric osteotomy for avascular necrosis of the hip and evaluated their performance in the light of improving outcome after total hip arthroplasty (THA). During a period of 14 years we performed 63 flexion osteotomies (partly combined with varus or valgus displacement), 29 rotational osteotomies, 13 varus osteotomies, eight medialising osteotomies and two extension osteotomies. The mean period of follow-up for all 115 operations was 7.

Bone marrow edema of the forefoot after chevron osteotomy--a rare cause of metatarsalgia: a case report.

Treatment options of bone marrow edema syndrome, which is associated with vascular disturbances, are protracted nonoperative treatment or core decompression which still demands several weeks until complete recovery. We obtained excellent results by the use of the vasoactive drug iloprost, a stable prostacyclin analogue, leading to a complete relief of symptoms in cases of bone marrow edema which had initially suggested early avascular necrosis of the second metatarsal head. The bone marrow edema of the second metatarsal bone was thought to be due to altered biomechanics following a distal first metatarsal chevron osteotomy.

Keller procedure and chevron osteotomy in hallux valgus: five-year results of different surgical philosophies in comparable collectives.

We evaluated 97 Keller procedures and 64 chevron osteotomies, both combined with the "Cerclage fibreux" distal soft-tissue procedure, with a minimum follow-up period of five years to assess the limits of indications of these two different operations. We then formed two subgroups providing a statistical midrange of the metatarsophalangeal angle, intermetatarsal angle I-II and degree of arthrosis of the first metatarsophalangeal joint to obtain comparable collectives of 40 Keller and 36 chevron procedures. The postoperative AOFAS score averaged 85.

Interobserver and intraobserver reliability of Lenke's new scoliosis classification system.

Study Design: The assignment of idiopathic scoliosis curves to the curve types,1-6 to the lumbar spine modifier (A, B, or C), and to the sagittal thoracic modifier (-, N, +), as recently described by Lenke et al, was evaluated by five observers on two occasions.

Objective: To determine the intraobserver and interobserver reliabilities of Lenke's new system for classifying idiopathic scoliosis.

Summary Of Background Data: Lenke et al recently introduced a new system for classifying idiopathic scoliosis.

Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost. An MRI-controlled investigation of a new method.

Bone marrow oedema syndrome of the talus is a rare cause of pain in the foot, with limited options for treatment. We reviewed six patients who had been treated with five infusions of 50 microg of iloprost given over six hours on five consecutive days. Full weight-bearing was allowed as tolerated.

Haglund's syndrome: disappointing results following surgery -- a clinical and radiographic analysis.

Clinical and radiographic data were analyzed for 49 surgical interventions of painful heel syndrome with a mean follow-up of 4 years and 7 months. In all patients the surgical procedure consisted of a triangular shaped resection of the posterosuperior portion of the calcaneus. The clinical evaluation showed disappointing results with complete relief of complaints in only 34 procedures (69.

Metatarsophalangeal and intermetatarsal angle: different values and interpretation of postoperative results dependent on the technique of measurement.

For measurement of the first metatarsophalangeal angle and intermetatarsal angle I-II, five different methods for drawing the axis of the first metatarsal have been published. This study aimed to evaluate differences in the resulting angles that depend on the method of drawing this axis. Using pre- and postoperative radiographs of 20 patients who had surgery on the hallux (chevron procedure), highly significant differences were found: mean values for the preoperative metatarsophalangeal angle ranged from 27.

Antibiotic-associated colitis in orthopaedic patients.

Antibiotic-associated colitis was diagnosed in 23 orthopaedic patients: 17 had abdominal symptoms, 3 had a fever and the remaining 3 had no symptoms but increasing C-reactive protein values or white blood count. The antibiotic was clindamycin in 19, cephalosporins in 3 and a combination of vancomycin and fusidic acid intravenously in one. The antibiotics were stopped in 12, changed in 5 and continued in the remaining 5.