Contractures of the triceps surae commonly are treated by surgical lengthening of the gastrocnemius aponeurosis or the Achilles tendon. Although these procedures generally relieve contractures, patients sometimes are left with dramatically decreased plantar flexion strength (i.e., decreased capacity to generate plantar flexion moment). The purpose of this study was to examine the trade-off between restoring range of motion and maintaining plantar flexion strength after surgical treatment for contracture of the triceps surae. A computer model representing the normal moment-generating characteristics of the triceps surae was altered to represent two conditions: isolated contracture of the gastrocnemius and contracture of both the gastrocnemius and the soleus. The effects of lengthening the gastrocnemius aponeurosis and the Achilles tendon were simulated for each condition. The simulations showed that nearly normal moment-generating characteristics could be restored when isolated gastrocnemius contracture was treated with lengthening of the gastrocnemius aponeurosis. However, when isolated gastrocnemius contracture was treated with lengthening of the Achilles tendon, the moment-generating capacity of the plantar flexors decreased greatly. This suggests that lengthening of the Achilles tendon should be avoided in persons with isolated gastrocnemius contracture. Our simulations also suggest that neither lengthening of the gastrocnemius aponeurosis nor lengthening of the Achilles tendon by itself is an effective treatment for combined contracture of the gastrocnemius and soleus. Lengthening the gastrocnemius aponeurosis did not decrease the excessive passive moment developed by the contracted soleus. Lengthening the Achilles tendon restored the normal passive range of motion but substantially decreased the active force-generating capacity of the muscles.(ABSTRACT TRUNCATED AT 250 WORDS)
A review was conducted of the records of fifty-five children who were admitted to the Hospital for Sick Children in Toronto between 1955 and 1975 with a diagnosis of Volkmann's contracture in fifty-eight limbs. Ten patients had been transferred to this hospital with established ischaemia after Bryant's traction for a fractured femur; all had a very poor outcome. Thirteen other cases of Volkmann's contracture affecting the superficial posterior compartment had been treated with a fixed Thomas' splint and a Bradford frame after fractures of the femoral shaft. Supracondylar fractures of the elbow resulting in Volkmann's contracture frequently had both an arterial injury and a compartment syndrome. Most of the fifty-five children reviewed here had not had early appropriate treatment. For the past twenty-one years the frequency of Volkmann's contracture has not declined in spite of many published reports on the compartment syndrome, and the hazards of supracondylar fractures and of Bryant's traction.
Les luxations de Ia rotule en dehors des luxations trauniatiques r#{233}centes. Revue d'Orthop#{233}die, 36, 181. MARZIANI, R. (1930): Sulla lussazione della rotula e sul suo trattamento operativo.
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