Download CORRECTION OF OUTWARDLY ROTATED LEG FROM

CORRECTION
OF
OUTWARDLY
THE
FROM
EMIL
The
outwardly
minimus
patient
drags
is oie
his stricken
position
further
Dissatisfied
a simple
leg
of the
and
effective
Model
Figure
as
an
ISRAEL
Labourer’s
after-effect
common
of
forward,
Sick Fund,
paralysis
complications
of
Haifa
the
gluteus
of poliomyelitis.
and
a statically
troubled
methods
of treatment
method
to show
2-Forward
HAIFA,
Department,
leg awkwardly
aggravates
with the
Communication
PAUKER,
the Orthopaedic
rotated
muscles
LEG
POLIOMYELITIS
Preliminary
From
ROTATED
the
femoral
medius
and
In consequence
head
the
in its unphysiological
gait in a progressive
fashion.
used hitherto
I have
attempted
to develop
of correction.
FIG. I
the mechanism
movement
FIG.
2
of the transplant.
Figure
1-Position
of limb at rest.
of limb. The graft under tension
pulls the femur into medial
rotation.
Rotation
arthrodesis
of
osteotomyof
the hip,
Transplantation
part
of
but
this
the
too
function
behind
70
under
femur
fails to align physiologically
the
useful
in some
respects,
is a rather
of the iliopsoas
greater
muscle
trochanter
is a rather
of the
Years
the
although
formidable
transplanted
ago
I tried
the
from
(Mustard
its insertion
L952),
may
operation,
and
at the lesser
provide
trochanter
a solution
in addition
whole
of the leg, and
crippling
operation.
to the
in a number
it severely
impairs
lateral
of
the
cases,
original
muscle.
to
attachment
dissect
of
a strip
the
vastus
of
the
lateralis,
iliotibial
in
tract
and
order
to
THE
JOURNAL
to
rotate
sling
the
OF
BONE
it forward
femur
AND
from
forward
JOINT
by
SURGERY
CORRECTION
action
weak
of the tensor
to move
the
longer
capable
OF
THE
OUTWARDLY
ROTATED
fasciae
latae.
This method
whole
leg.
The answer
was
leverage
with
of providing
the possible
such action.
avoidance
are
longitudinal
identified.
The
incision
POLIOMYELITIS
against
71
lever apparently
in a transplant
gravity.
The
being
too
providing
hamstrings
seemed
OPERATION
is made
semitendinosus
FROM
failed,
the short
therefore
sought
of action
THE
A medial
LEG
over the lower
muscle,
third of the femur.
if available,
The hamstrings
is considered
most
suitable
for
transplant
because
of its long tendon.
It is dissected
up to the lower medial
third of the femur,
and the tendon
is brought
under
the quadriceps
(vastus
and rectus)
to the antero-lateral
part
ofthe
femur about
a small hand’s
width above the kneejoint
and threaded
through
a horizontal
tunnel
drilled
from
the
lateral
bone, or to the tendon
itself
muscle,
or a combination
equally
suitable.
When
no medial
behind
the
femur
hamstring
and
fixed
3-Before
medial
aspect
of the
bone,
where
is available
to
the
the
medial
biceps
surface
may
of
the
be used,
bone
at
the
3
FIG.
Case 4. Figure
to the
its end
is fixed
to the
at the point of entrance
into the drill hole.
The semimembranosus
of more
than
one muscle
from
the medial
hamstring
group,
its tendon
same
FIG.
operation
: lateral
rotation
deformity.
Figure
4-Range
being
level.
is
passed
If only
one
4
of active
medial
rotation
after operation.
medial
hamstring
is available
but
the
biceps
patient
in whom
the semimembranosus-the
transplantation
the remaining
strong
biceps
of knock-knee.
Figures
1 and 2 show
needed
for medial
rotation.
the mechanism
The femur,
rotates
improves
muscles
good
a grading
of 3 with
to use
the
biceps.
In one
only acting
medial
hamstring-was
used
was thought
to be responsible
for the development
of the transplant,
and
moved
forward
by active
a swinging
movement,
automatically
Every
bit of active
muscle
power
with
I prefer
is powerful
indicate
muscle
how
power
little power
or simply
for
is
by
medially
by application
of the one-sided
brake.”
and reinforces
this movement.
I have transplanted
“
results.
RESULTS
The results
in seven cases are shown
in Table
in Figures
3 and 4. In assessing
the results
the
I, and
term
“
illustrative
excellent
“
photographs
was used
sway from the hip and with medial
rotation
of the leg possible
with
“Good”
meant
a swayless
or nearly
swayless
gait, the foot coming
while
walking
and medial
rotation
possible
with
the heel on the
allowance
VOL.
41 B,
for
NO.
some
1,
sway
FEBRUARY
from
1959
the
hip,
but
less
than
before
operation,
for
are reproduced
a gait without
the heel off the ground.
down
in good
position
ground.
“Fair”
gave
the
foot
coming
down
72
with
E. PAUKER
little
or
change
from
seven
patients
no
lateral
the
rotation,
condition
but
before
subjected
with
no
operation
to this
type
active
would
of transplant
number
(yers)
seventh
from
a poor
four
Transplant
used
Result
Semitendinosus
Good
-
14 months
Biceps
Fair
-
3
7
21 months
4
4
7 months
5
5
14 months
was
Semitendinosus
Good
Biceps
Semitendinosus
36 months
a woman
of the knee
re-education
Semimembranosus
of forty-seven
of age;
Complications
15 months
9 months
Six of the
years
CASrs)
(SEVEN
7
6
appreciable
I
RESULTS
5
47
of
result.
to seven
I
7
arthrodesis
very little
fOIIW-Up
AND
Lack
called
2
6
the
DETAILS
rotation.
been
ranged
TABLE
CLINICAL
medial
have
who
was
Moderate
knock
Excellent
-
Excellent
-
Good
-
Good
-
operated
upon
for the same condition.
It was remarkable
in the use of the transplanted
muscle.
with
that
knee
good
result
all the
patients
after
an
needed
SUMMARY
1.
A method
of one
of correcting
poliomyelitic
or more
of the
hamstring
results
in seven
cases
2.
The
3.
Though
it is emphasised
number
of patients
mechanically
and
so treated
physiologically
muscles
are
that
lateral
rotation
to the
femur
is described.
deformity
than
a preliminary
of the
thigh
by transplant
recorded.
this
is small,
sound.
is no
the
more
satisfactory
results
communication
suggest
that
the
and
the
procedure
is
REFERENCE
MUSTARD,
Surgery,
W. T. (1952):
647.
Iliopsoas
Transfer
for Weakness
of
the
Hip
Abductors.
Journal
of Bone and Joint
34-A,
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY