Minne Heeg

• Consultant at wza

Dit hoofdstuk geeft een overzicht van de meest voorkomende fracturen en hun behandeling van de onderste extremiteit, het bekken en het acetabulum. Traumatische letsels van de onderste extremiteit komen zeer frequent voor. Veel eenvoudige letsels, zoals een enkeldistorsie, kunnen in de eerste lijn worden behandeld. Complexere letsels, inclusief die...

Context Percutaneous epiphysiodesis (PE) around the knee to reduce predicted excessive final height. Studies until now included small numbers of patients and short follow-up periods. Objective and design This Dutch multicentre, long-term, retrospective, follow-up study aimed to assess adult height (AH), complications, knee function and patient sat...

Wij zagen een 5-jarige jongen in verband met een pijnlijke, onbelastbare linkerknie een dag na een val op de trampoline.

Multiple osteochondroma, also known as hereditary multiple exostoses, is a relatively rare genetic disorder characterized by the presence of multiple osteochondromas. The disease is frequently painful, with restriction of the activities of daily living, problems with carrying out an occupation and performance at school. In addition, characteristic...

Een zeldzame complicatie van een fractuur van de distale onderarm op de kinderleeftijd is de vervroegde posttraumatische sluiting van de groeischijf. Door de veranderde groei die daardoor ontstaat, treden soms klachten op die een chirurgische interventie behoeven. Afhankelijk van de ernst van het letsel en de te verwachten groei zijn er verschillen...

Osteochondrosen vormen een groep idiopathische, ‘self-limiting’ aandoeningen die worden veroorzaakt door een stoornis van de enchondrale verbening. Zowel de normale chondrogenese als de osteogenese van het betreffende bot kan gestoord zijn in de apofyse, de groeischijf en de epifyse.

Multipele congenitale afwijkingen komen bij ongeveer 0,7% van de pasgeborenen voor. In sommige gevallen zijn de afwijkingen bij de geboorte al zichtbaar en kan een diagnose worden gesteld. Andere gegeneraliseerde congenitale afwijkingen openbaren zich na een aantal jaren. De grens tussen aangeboren afwijkingen en groeistoornissen is dan ook moeilij...

In dit hoofdstuk worden de traumatische letsels van de onderste extremiteit, inclusief het bekken en acetabulum, besproken. De frequentie van dergelijke letsels in de huisartsenpraktijk, in het verkeer, bij sport en op het werk is hoog, zodat iedere (para)medicus regelmatig met dergelijke letsels wordt geconfronteerd. Veel eenvoudige letsels, zoals...

Tijdens de adolescentie ontwikkelt ons steun- en bewegingsapparaat zich snel. Deze levensfase wordt dan ook gekenmerkt door een groot aantal groeistoornissen en overbelastingsklachten. Voor de huisarts zijn de meest voorkomende oorzaken van klachten van het bewegingsapparaat eenvoudig vast te stellen aan de hand van anamnese, gericht lichamelijk on...

Unlabelled: In this study, the results of percutaneous epiphysiodesis as a surgical method to decrease final height is described in 15 boys with a predicted final height of more than 205 cm. A total of 17 boys with a height prediction between 195 and 209 cm without treatment were included as controls. The study period was from 1995-2002 and patien...

Abductiebeperking van de heupen is de belangrijkste klinische aanwijzing voor heupafwijkingen bij zuigelingen en kinderen. Dit geldt in het bijzonder voor congenitale heupdysplasie/luxatie. Het heupgewricht van de pasgeborene en zuigeling is aanzienlijk minder stabiel dan van een volwassene. Dit wordt veroorzaakt door: mechanische factoren, zoals o...

In three male patients with hereditary multiple exostoses (HME), aged 50, 29 and 31 years, peripheral low-grade chondrosarcoma in the pelvic region led to swelling or pain. In the first patient, curative resection was not feasible because of the size and extension of the tumour. However, rapid tumour growth and unbearable pain necessitated a debulk...

A retrospective study of 29 acetabular fractures in children 2 to 16 years of age with an average followup of 14 years is presented. Nineteen patients had an additional dislocation of the femoral head and 14 patients had an associated neurologic injury. Surgical treatment was performed in 16 patients and consisted of open reduction and internal fix...

A case report.- To highlight the evaluation and treatment of neonatal infectious spondylitis of the cervical spine. Most authors advise intravenous antibiotics as first-choice treatment. The place of aspiration or operative drainage is debated, as is the position and duration of immobilization. A 3-week-old neonate was presented with intermittent q...

A case is presented in which two neuro-ectodermal tumors, an infra- and a supratentorial glioma, developed in a young man with multiple enchondromatosis of Ollier’s disease. This is the third such case of multifocal low-grade glioma in Ollier’s disease, suggesting a predisposition for non-mesodermal tumors in Ollier’s disease. The related condition...

Unlabelled: We evaluated the long-term results of three total hip and nine total knee arthroplasties in nine haemophilic patients with disabling pain and end-stage arthropathy. These patients have been followed over a period of 2-12 years (mean 6.9). One patient had a post-operative haematoma, which was evacuated; two patients required manipulatio...

Surgical management of osteosarcoma of the limb in childhood often involves extensive surgery. Intervention ranges from local resection to amputation depending on the level and the extent of the disease process. However, where the disease is extensive the level of amputation may preclude effective prosthetic use. In these circumstances resection of...

Nineteen patients with spina bifida and bilateral dislocation of the hips were studied with a minimal follow-up of 10 years. The average age at review was 21 years (range, 10-31). Ten patients had an upper neurologic level (thoracic to L3), and nine had a low lesion (L4 to sacrum). Three patients had no hip surgery. A closed or open reduction was p...

The treatment of fractures was originally conservative. Improvements in materials and surgical techniques and new insights into the biological aspects of fracture healing led to an increase of surgical treatment of fractures. The main breakthrough of osteosynthesis took place with the foundation of the Arbeitsgemeinschaft für Osteosynthesefragen (S...

We report the case of a patient with a haemophilic pseudotumour of the ilium who developed chronic fistulation, 6 months after en-bloc resection. During the initial resection, the large defect in the iliac wing was filled with bone cement, which may have contributed to fistula formation. A second surgical procedure consisted of excision of the fist...

We report the case of a patient with a haeophilic pseudotumour of the ilium who developed chronic fistulation, 6 months after en-bloc resection. During the initial resection, the large defect in the iliac wing was filled with bone cement, which may have contributed to fistula formation. A second surgical procedure consisted of excision of the fistu...

We report on 2 sisters with Karsch-Neugebauer syndrome comprising split foot and split hand anomalies in association with congenital nystagmus. These sisters share a nearly identical phenotype with the 8 previously reported instances of this disorder. Although genetic heterogeneity can not be formally excluded, most evidence suggests that Karsch-Ne...

There are not many quantitative data available about compliance in paediatric rehabilitation. This has possibly to do with the diversity in rehabilitation therapy which consists of not only medication but also paramedical therapies and management of orthotics and prosthetics. Besides, in many cases paediatric rehabilitation covers a long course of...

We reviewed 15 children with spina bifida or paraplegia who have used a reciprocating-gait orthosis between 1985 and 1995. All were nonfunctional ambulators. The level of the spinal lesions ranged from Th10 to L3. The mean age of fitting the orthosis was 5 years. 8 children have stopped using it at an average age of 10 years. The maximum ambulation...

Cystic hygroma is a rare congenital malformation of the lymphatic system. The lesion is characterized by the formation of a cystic mass of variable size. Most lesions are present in infancy or early childhood and are found predominantly in the region of the head and neck. This report describes a case with an unusual location of the lesion: A 12-yea...

We retrospectively evaluated the outcome of sacroiliac-joint disruption in 18 children, ranging in age from 2 to 16 years. Ten patients were treated with bedrest; eight were treated surgically. Follow-up was performed at an average of 14 years (range, 8-23); three patients had daily back pain, and six had occasional back pain. Six patients had limi...

A retrospective study is reported of the results of epiphysiodesis in 67 children. In 47 patients (70%) the final inequality was less than or equal to 1.0 cm. In 9 patients the final inequality was greater than or equal to 1.6 cm. The average leg length inequality could be reduced from 3.2 cm preoperatively to 1.2 cm at maturity. Technical errors w...

We retrospectively reviewed 20 patients at three to 19 years after displaced anterior fracture-dislocations of the hip. Eighteen of them were treated by traction, after ensuring that the femoral head was adequately reduced beneath the undisrupted part of the weight-bearing dome. Two required operation. Although none of the 18 conservatively treated...

We report a retrospective study of 54 acetabular fractures treated by open reduction and internal fixation, with an average follow-up of 9.6 years (3 to 17). Reduction leaving displacement of less than or equal to 2 mm was achieved in 36 hips (67%); good or excellent functional results were obtained in 33 patients (61%). Early complications requiri...

A retrospective study of 23 acetabular fractures in patients up to 17 years of age is presented, with an average follow-up of eight years. Good or excellent functional results were achieved in 21 patients; radiographic results were good or excellent in 16. Conservative treatment gave consistently good results in fractures with minimal initial displ...

Four patients with injuries of the acetabular triradiate cartilage are presented. In three of them premature fusion of the cartilage occurred; two of these developed acetabular deformity and subluxation of the hip. In all patients the sacroiliac joint also was injured; in two, the joint was completely disrupted, leading to fusion and growth disturb...

A retrospective study of 57 conservatively treated acetabular fractures with an average followup of 7.9 years is presented. The overall functional result was satisfactory in 75%. The least satisfactory results were seen in fractures crossing the weight-bearing dome of the acetabulum in which congruency could not be achieved (N = 11, nine patients h...

Accidents with power take-off mechanisms often cause very serious injuries. In this study the clinical data and circumstances of the accidents of 14 patients who suffered a power take-off accident were analysed. From a total of 38 fractures, three primary and three secondary amputations were necessary. Fifty per cent of the accidents were due to hu...