The obstacles of prolonged healing time and technically demanding osteotomy and plate fixation in the performance of ulnar shortening osteotomies have been overcome by a precision system that includes a 45 degrees osteotomy and 2.7 mm interfragmentary lag screw. In 23 transverse osteotomies healing time averaged 21 weeks with one nonunion. In 17 precision oblique osteotomies healing time averaged a substantially shorter 11 weeks. Biomechanical data obtained from cadaveric testing comparing these two constructs demonstrated a structural stiffness that was clearly greater in torsion testing for the oblique osteotomy. No biomechanical difference was identified in the anteroposterior and lateral bending tests. The system permits the reliable performance of two parallel osteotomy cuts, allowing the removal of a precise amount of bone. The compression device and specialized plate permit easy coaptation of the osteotomy surfaces, which are locked into position by a precise 22 degrees interfragmentary lag screw. The surgical procedure is more quickly completed, and the frustration of this previously challenging procedure is now completely removed.

No abstract

Twenty-three cases of Little Leaguer's shoulder were reviewed including the history and physical examination findings, as well as bilateral internal and external rotation anteroposterior comparison radiographs of the proximal humerus. The average follow-up was 9.6 months (range, 1.5 to 54), and all patients were observed until they had either returned to baseball or their symptoms had resolved. The average age of the patients in this series was 14 years. The chief complaint in all patients was pain localizing to the proximal humerus during the act of throwing. The average duration of symptoms was 7.7 months. Nineteen patients (83%) were pitchers. Physical examination revealed tenderness to palpation over the proximal humerus in 20 patients (87%), with 16 (70%) demonstrating specific tenderness over the lateral aspect of the proximal humerus. Swelling, weakness, atrophy, and loss of motion were uncommon findings. All 23 patients demonstrated radiographic widening of the proximal humeral physis of the throwing arm on internal and external rotation comparison anteroposterior radiographs of the shoulder. All patients were treated with rest from baseball throwing for an average of 3 months. Twenty-one of the 23 patients (91%) returned to playing baseball and were asymptomatic. The classic radiographic finding of widening of the proximal humeral physis can easily be seen on bilateral anteroposterior internal and external rotation radiographs of the proximal humerus. Rest from throwing for at least 3 months is recommended, followed by a gradual return to throwing in an asymptomatic shoulder.

Twenty-two skeletally immature patients with 39 accessory tarsal navicular bones were seen over a 4-yr period. Twenty-five of the feet with accessory naviculars were symptomatic and, after failure of conservative treatment, were treated by excision of the accessory bone, the synchondrosis, and the prominent portion of the main navicular ossification process. No attempt was made to reroute the posterior tibial tendon. All 25 operative feet were completely relieved of the preoperative pain. The external oblique view was found to be the best radiographic view to demonstrate the accessory navicular. Histological findings in the surgical specimens included areas of micro-fracture through the cartilaginous synchondrosis, acute and chronic inflammation, and cellular proliferation indicative of attempted repair. These changes are consistent with the theory that chronic chondro-osseous tensile failure can occur in this condition and is responsible for the clinical findings.