Unchanged muscle function after bilateral femoral lengthening:A prospective study of 9 patients with a 2-year follow-up

We performed pre- and 2-3.5-year postoperative isokinetic knee-testing to assess thigh muscle function in 9 patients undergoing bilateral femoral lengthening by callotasis. The median femoral lengthening was 17 (12-18) percent. The angular testing velocities were 60°/sec (strength) and 180°/sec (endurance).

Only small changes in muscle strength were found postoperatively. Except for peak torque at 60°/sec on the last-operated side (median 2 years follow-up), there were no differences between the pre- and postoperative isokinetic measurements. There were 3 major complications, 2 fractures and 1 varus deformity. 2 patients had problems with patellar pain. All patients achieved normal range of motion. They judged the final result as very good and underlined the psychological effect and the practical advantages of being taller.     

Operative Treatment of Scoliosis with the Harrington Instrumentation Technique

Preliminary results of treatment of scoliosis with the Harrington instrumentation technique in 80 patients are presented. The curve correction at operation averaged 43.4 per cent with the best results being achieved in idiopathic single curves (49.3 per cent). Most of the patients had been treated conservatively for a long time prior to operation, and the curves were rather stiff. The initial loss of correction was 3.2°, and the overall loss at 2 years postoperatively averaged 6.5° in 28 patients. Complications occurred in 22.5 per cent of the patients, most often at the upper hook site. Serious complications were rare. It is concluded that the Harrington instrumentation technique is an effective means of treatment of scoliosis.     

Late diagnosed congenital dislocation of the hip

During the years 1975 to 1979, 82,574 children from five counties in southeast Norway were live-born, 197 of whom were treated for late detected CDH, for an incidence of 2.4 per 1,000 live births, i.e., 0.4 promille dislocation, 0.6 promille subluxation, and 1.4 promille dysplasia of the acetabulum without dislocation. All the hips had been found stable at birth. Eighty-six percent were girls, and the left hip was affected in 48 percent, the right hip in 31 perent, and both hips in 21 percent. Only 6.5 percent were delivered in the breech position. This and the stability found neonatally may indicate an etiologic difference between neonatally and late diagnosed CDH.     

Bilateral femoral shortening for unaccepted tallness.

We performed bilateral femoral shortening operations on 15 skeletally mature patients (11 women and four men). Their mean height pre-operatively was 193.5 cm and they were shortened by 5 to 9 cm. We used a subtrochanteric Z-osteotomy with an AO condylar plate in 11 patients, and mid-diaphyseal osteotomy with an intramedullary locking nail in four. After an average follow-up of 8.1 years, isokinetic muscle testing showed that muscle strength was reduced bilaterally in five patients. The strength ratio between hamstrings and quadriceps muscles was normal in all those treated by subtrochanteric shortening; in those shortened at the mid-shaft the quadriceps was relatively weaker. The result was rated as excellent by 11 patients, very good by three, and good by one.     

Progression in Idiopathic Scoliosis After Conservative Treatment

One hundred patients with idiopathic scoliosis treated conservatively were reviewed for a mean period of 10.6 years after the end of treatment. The majority of curves had increased; 70% between 16 and 20 years of age and 60% after age 20. The mean progression per year was 3° and 2° for single and double curves, respectively, in the first 4 years after the end of treatment and 1° and 0.5°, respectively, in adulthood. Curves above 40° increased significantly more than smaller curves. It is concluded that curves of more than 40°, especially thoracic single curves, should be treated operatively in adolescence. Conservative treatment of smaller curves should be continued towards 20 years of age, and the patients should be followed up during early adult life.     

Necrosis of the Femoral Capital Epiphysis Occurring During Human Growth Hormone Therapy

A girl with growth hormone deficiency developed a necrosis of the femoral capital epiphysis 6 months after the start of human growth hormone treatment. The compensatory growth spurt is believed to have caused an insufficient blood supply to the epiphysis, resulting in necrosis.     

Congenital dislocation of the hip joint in Norway V. Evaluation of genetic and environmental factors

The incidence of congenital dislocation of the hip joint (CDH) in Norway is high. Environmental factors and familial occurrence of CDH have been studied in 1147 probands with neonatal CDH and in 784 probands with late-diagnosis CDH. The proportion of affected sibs was 6 per cent in neonatal CDH and 8.5 per cent in late-diagnosis CDH. In 51 families, patients with neonatal CDH had sibs with late-diagnosis CDH, most of whom had been screened for CDH in the neonatal period. The distribution in families was computable with a polygenic mode of inheritance, and the heritability of CDH was calculated to be 74 per cent.
Breech presentation, the most important environmental factor, was observed in 15.7 per cent of the neonatal and in X.3 per cent of the late-diagnosis cases. A significant seasonal trend in month of birth was found in late-diagnosis CDH, with a maximum in early October. A higher percentage of birth rank one was found in CDH, but this was mostly due to an association between birth rank one and breech presentation. Probands with familial occurrence were significantly more often severely affected than those with no affected relatives. When several environmental factors were present in the history of a proband, the disorder tended to be more serious, and a familial occurrence of CDH was less likely. Concomitant anomalies were frequently found in CDH.