Showing papers in "Journal of Pediatric Orthopaedics in 1982"
149 citations
TL;DR: Failure to recognize this initial or subsequent medial tilt during early treatment of the fracture was the major factor in the development of cubitus varus deformity, thus explaining the average delay in diagnosis of 6 to 10 weeks postfracture.
Abstract: A retrospective study of 63 patients with cubitus varus deformity following supracondylar fracture of the humerus was carried out in order to identify the causes of cubitus varus, to define the best method for prevention, and to evaluate the indications for and results of treatment of the established deformity. There was no evidence of growth disturbance in any of our patients after a mean follow-up of 5 years postfracture. Cubitus varus was found to be secondary to medial tilting of the distal fragment. Failure to recognize this initial or subsequent medial tilt during early treatment of the fracture was the major factor in the development of cubitus varus deformity, thus explaining the average delay in diagnosis of 6 to 10 weeks postfracture. Since all patients regained essentially normal use of the upper extremity after the fracture, cosmesis was the primary indication for corrective surgery. Fifteen supracondylar osteotomies are reported with 33% unsatisfactory results. Prevention of this deformity by careful clinical and radiological evaluation during initial treatment of the supracondylar fracture is emphasized.
140 citations
TL;DR: The author believes that internal rotation and failure of correction are due to unrecognized rotation in subtalor complex.
Abstract: SummaryThe first section of three on the new concept and approach to treatment of clubfoot gives a detailed description of morbid anatomy. The author believes that internal rotation and failure of correction are due to unrecognized rotation in subtalor complex. A detailed explanation of the horizont
135 citations
TL;DR: Clinical and anatomic studies suggest that in some cases a bipartite patella may be a trau-matically induced, chondroosseous disruption of the superolateral pole of the incompletely ossified patellA, analogous to Sinding-Larsen-Johansson disease at the inferior patellar pole or Osgood-Schlatter disease in the tibial tuberosity.
Abstract: Two skeletally immature patients with bipartite patella, a lesion normally classified as a developmental variation, proved to have a symptomatic lesion with a traumatic etiology In both patients, appropriate treatment resulted in complete subsidence of symptoms; one patient was treated with cast immobilization, while the other eventually required surgical resection In addition, normal and bipartite patellar specimens from skeletally immature cadavers were histologically and morphologically assessed These clinical and anatomic studies suggest that in some cases a bipartite patella may be a traumatically induced, chondroosseous disruption of the superolateral pole of the incompletely ossified patella, analogous to Sinding-Larsen-Johansson disease at the inferior patellar pole or Osgood-Schlatter disease in the tibial tuberosity The possibility of bipartite patella being such a chronic stress fracture in a symptomatic patient should be considered in order to render appropriate treatment
110 citations
TL;DR: It is found that 18 children with hematogenous osteomyelitis had a subacute course marked by mild pain, few systemic or laboratory signs, and little functional impairment, and the correct diagnosis was delayed an average of 3 months.
Abstract: Summary We studied 55 consecutive children with hematogenous osteomyelitis and found that 18 (33%) had a subacute course marked by mild pain, few systemic or laboratory signs, and little functional impairment. Radiographic findings frequently suggested a tumor (50%), and the correct diagnosis was delayed an average of 3 months. We therefore suggest a radiographic classification that will help provide more accurate diagnosis of this disorder.
107 citations
TL;DR: There appears to be no justification for a surgical approach in the child with congenital muscular torticollis under 1 year of age, and satisfactory results were seen for the primarily cosmetic deformity when surgically approached using an open distal myectomy.
Abstract: Of the 232 patients with a diagnosis of congenital muscular torticollis, more than one-half were initially revealed before 3 weeks of age. The most common presentation at the initial clinical evaluation was head tilt. A surprisingly high incidence of associated conditions including hip dysplasia and lower extremity changes was seen. As a consequence all patients with a diagnosis of congenital muscular torticollis underwent a careful clinical review and roentgenographic examination of the entire spine and hips. Good or excellent results were achieved in all children diagnosed and treated under 1 year of age utilizing conservative measures. In the older child satisfactory results were seen for the primarily cosmetic deformity when surgically approached using an open distal myectomy. There appears to be no justification for a surgical approach in the child with congenital muscular torticollis under 1 year of age.
85 citations
TL;DR: Both isthmic and dysplastic defects occurred in most families, regardless of the classification of the index patient, and spina bifida occulta was most common among the siblings and children of index patients and in the first-degree relatives.
Abstract: Seventy index patients and 222 first-degree relatives with spondylolysis or spondylolisthesis have been studied by means of interview and clinical and radiological examinations. The index patients had an average age of 18 years, and included 43 females and 27 males. Following Wiltse's classification, 18 patients had dysplastic lesions and 52 had isthmic defects. The first-degree relatives included 99 parents and 125 siblings and children of the index patients. Both isthmic and dysplastic defects occurred in most families, regardless of the classification of the index patient. Isthmic defects were consistently more frequent than dysplastic defects. Spina bifida occulta occurred at the lumbosacral area in 61% of the index patients; in the first-degree relatives, spina bifida occulta was most common among the siblings and children of index patients, and occurred more often in relatives of index patients with dysplastic lesions than in those with isthmic lesions.
84 citations
TL;DR: It is concluded that oral therapy can be successful for the majority of patients but that it is hazardous and not indicated if careful laboratory monitoring of compliance and serum bactericidal activity cannot be performed.
Abstract: Seventy-five infants and children with suppurative skeletal infections were managed with a sequential parenteral-oral regimen of cephalosporin antibiotic therapy Initially, parenteral antibiotics (cefamandole for 48 patients and cefuroxime for 27 patients) were given for a median of 5 days Oral therapy was with large doses of cefaclor (150 mg/kg/day) or cephalexin (100 mg/kg/day) Eight patients (11%) had inadequate serum bactericidal activity with cefaclor Six of them were successfully managed with alternative oral antibiotics, and parenteral therapy resumed in one patient Chronic disease developed in a child who was continued on oral cloxacillin therapy in spite of absent serum bactericidal activity It is concluded that oral therapy can be successful for the majority of patients but that it is hazardous and not indicated if careful laboratory monitoring of compliance and serum bactericidal activity cannot be performed
84 citations
78 citations
TL;DR: Difficulty in reproducibly choosing the end vertebrae prior to making the angle measurment appeared to be the major source of measurement error.
Abstract: SummaryThe variability in measurement of the angle of curvature in scoliotic spines was estimated by having 50 anteroposterior roentgenograms read in random order twice by five orthopedic surgeons. The average error was ±9 (±2 SD) on duplicate readings, with a range of ±5° to ±15.1° for individual o
72 citations
TL;DR: Singh index determinations in normal children, children with mild scoliosis, and Scheuermann's kyphosis indicate that the femoral trabecular index is applicable to children as well as adults and thatChildren with mild, untreated scoliotic have relative osteoporosis when compared to normal children.
Abstract: Singh index determinations in normal children, children with mild scoliosis, and Scheuermann's kyphosis indicate that the femoral trabecular index is applicable to children as well as adults and that children with mild, untreated scoliosis and untreated Scheuermann's kyphosis have relative osteoporosis when compared to normal children. The relationship of osteoporosis and acquired back deformities is discussed.
TL;DR: The role of the Pavlik harness in the treatment of congenital dislocation of the hip in 122 patients over 3 months of age is presented and the overall success rate was 97%, with no incidence of avascular necrosis.
Abstract: Summary: The role of the Pavlik harness in the treatment of congenital dislocation of the hip in 122 patients over 3 months of age is presented. There were 21 patients with hip dislocation and 101 patients with hip dysplasia, with an average age of 5 months. In patients with dysplasia, concentric reduction in the harness was obtained initially, while it took 1 to 4 weeks to achieve reduction in the dislocated hips. The overall success rate was 97%, with no incidence of avascular necrosis. In three patients, the harness did not succeed in reducing the hips, and alternative methods were used with uneventful course. At follow-up, which averaged 5 years, clinical and radiographic examinations were normal in every patient.
TL;DR: Preliminary tibial tendon transfer is generally not indicated in congenital clubfoot with six unsatisfactory results in 10 procedures, and the procedure should only be done in Charcot-Marie-Tooth disease as part of staged treatment that includes a possible future hindfoot stabilization.
Abstract: At Rancho Los Amigos Hospital on the Children's Orthopedic Service, 43 patients underwent anterior transfer of the posterior tibial tendon through the interosseous membrane between 1969 and 1979. This included 74 procedures for the following diagnoses: Duchenne muscular dystrophy, club-foot, cerebrospastic disease (cerebral palsy and head injury), Charcot-Marie-Tooth disease, scapuloperoneal dystrophy, and peroneal palsy. The purpose of this paper is to present the 54 of these transfers that have a minimum 2 year follow-up were performed with a uniform surgical technique, and had uniform postoperative management. This series is analyzed and compared with a review of the literature in order to set down guidelines for the use of the procedure. The analysis reveals that the patient with Duchenne muscular dystrophy who has decreasing gait function or brace fitting problems is the ideal candidate for the procedure with 26 of 28 satisfactory results. Gait electromyography was critical to the selection of the cerebrospastic patient for the transfer with those patients demonstrating swing-phase function of the posterior tibialis muscle yielding the best results. Finally, posterior tibial tendon transfer is generally not indicated in congenital clubfoot with six unsatisfactory results in 10 procedures, and the procedure should not be done in Charcot-Marie-Tooth disease as part of staged treatment that includes a possible future hindfoot stabilization.
TL;DR: Partial avulsion of the patellar ligament associated with avulsion fracture of the tibial tubercle is reported and the need for surgical treatment is stressed.
Abstract: SummaryComplete avulsion of the patellar ligament associated with avulsion fracture of the tibial tubercle has not been previously reported. The mechanism of injury is reviewed, and the need for surgical treatment is stressed.
TL;DR: Nine patients with triradiate physeal-cartilage injury were classified according to the degree of displacement and the probable type of growth-plate disruption, and the prognosis is dependent on the age of the patient at the time of injury and on the extent of chondro-osseous disruption.
Abstract: Traumatic disruption of the acetabular triradiate physeal cartilage is an infrequent injury. When it occurs during adolescence, subsequent growth changes in acetabular morphology and congruency of the hip joint are unlikely. However, in younger children, especially those who are less than ten years old, acetabular growth abnormality is a frequent complication of this injury and may result in a shallow acetabulum similar to that seen in patients with congenital disease of the hip. By the time of skeletal maturity, disparate growth increases the incongruency of the hip joint and may lead to progressively more severe subluxation of the hip. Acetabular reconstruction may be necessary to correct the gradual subluxation of the femoral head. Variable irregularities of growth at the proximal end of the femur also may occur. In this series, nine patients with triradiate physeal-cartilage injury were classified according to the degree of displacement and the probable type of growth-plate disruption. Two main patterns of injury occurred. The first was a shearing type-1 or 2 growth-mechanism injury, with central displacement of the distal portion of the acetabulum. This injury pattern seems to have a favorable prognosis for continued normal acetabular growth, although premature closure of the triradiate physes may occur. The other pattern appeared to be a crushing type-5 growth-mechanism injury. This type has a poor prognosis, with premature closure of the triradiate physes occurring secondary to the formation of a medial osseous bridge. In either pattern, the prognosis is dependent on the age of the patient at the time of injury and on the extent of chondro-osseous disruption.
TL;DR: It is hoped that this new, more detailed scheme will further the understanding of growth mechanism injuries, will aid in roentgenographic recognition and treatment, and will allow better estimation of prognosis for normal or abnormal growth.
Abstract: SummaryA revised classification of injuries to the epiphyseal, physeal, metaphyseal, and diaphyseal growth mechanisms is proposed. While based on preexistent schemes, it adds subclassifications that relate specific injury patterns to the risk of growth disturbance, as well as other growth mechanism
TL;DR: Avascular necrosis was highest after simple open reduction and was responsible for most of the fair and poor results, with late development of poor femoral head coverage after an initial concentric reduction with good coverage.
Abstract: Summary Between 1940 and 1970. 107 patients more than 1 year of age with 134 congenitally dislocated hips were treated at the Alfred I. duPont Institute. It was found that after initial reduction 66% of hips reduced closed and approximately 30% of hips reduced open required further surgery. Good acetabular development was seen in 19% of hips reduced between 2 and 3 years, but only in 7% reduced after 3 years of age. The best results in the correction of residual dysplasia or subluxation were seen if correction was done before 6 years of age. Avascular necrosis was highest after simple open reduction and was responsible for most of the fair and poor results, with late development of poor femoral head coverage after an initial concentric reduction with good coverage.
TL;DR: The experience of 74 cases confirms the good results already reported by several authors; however, four instance of moderate avascular necrosis of the femoral head occurred.
Abstract: The Pavlik harness has made an important contribution to the treatment of congenital dislocation of the hip before walking age. Our experience of 74 cases confirms the good results already reported by several authors; however, four instances of moderate avascular necrosis of the femoral head occurred. The precise indications for the harness and the rules governing its use must be clearly understood. It may be used from the neonatal period up to 6 to 8 months of age for dislocation or subluxation with limitation of hip abduction. Selection of suitable candidates is made more accurate by taking into account the child's general tone and that of the adductor muscles, as well as the data from X-ray films taken in the harness position.
TL;DR: It is found that, in the absence of neurological deficit, herniated lumbar discs in children and adolescents can be safely treated conservatively.
Abstract: Of the hundreds of papers written on intervertebral lumbar disc herniation, very few have reported protruding lumbar intervertebral discs in children. Although surgical treatment of this problem in children has been well documented, we found no report of conservative treatment. This study concerns 23 patients under the age of 19 years who were treated for herniated lumbar intervertebral discs at the Alfred I. duPont Institute between 1963 and 1978. Thirteen patients were treated surgically and 10 were treated conservatively. The most common complaint in our patients was low back pain. We have found that, in the absence of neurological deficit, herniated lumbar discs in children and adolescents can be safely treated conservatively.
TL;DR: The salient features of the syndrome include intermittent pain in the posterolateral region, accentuated by knee extension and localized tenderness when the fabella is compressed against the femoral condyle.
Abstract: Sixteen adolescents presented with symptoms referable to the posterior lateral compartment of the knee, specifically the region of the fabella. The salient features of the syndrome include intermittent pain in the posterolateral region, accentuated by knee extension and localized tenderness when the fabella is compressed against the femoral condyle. The condition appears to be unique to late adolescence (15-17 years of age). Five patients responded to conservative measures. Eleven patients required surgery, all of whom obtained immediate relief of symptoms with removal of the ossified fabella, cartilaginous fabella, or thickened gastrocnemius fibers.
TL;DR: A retrospective review of 67 distal femoral and proximal tibial epiphysiodeses performed over a 14 year period for correction of leg length inequality revealed only 22 patients with a final discrepancy of less than 1 cm.
Abstract: A retrospective review of 67 distal femoral and proximal tibial epiphysiodeses, performed over a 14 year period for correction of leg length inequality, revealed only 22 patients with a final discrepancy of less than 1 cm. Ten of the 45 failures were secondary to inadequate surgical epiphysiodesis. The remaining 35 failures were secondary to errors in timing surgery due to incorrect use of Green and Anderson growth prediction tables. The primary causes of failure would have been decreased by more careful follow-up and the use of the Moseley Graph.
Journal Article•
TL;DR: It is felt that L-rod instrumentation is a more effective adjunct in the surgical management of cerebral palsy scoliosis than combined Harrington-Dwyer instrumentations.
Abstract: From April 1977 through September 1980 at the University of Texas Medical Branch, 10 cerebral palsied individuals with total body involvement were surgically treated for their scoliosis. Each underwent L-rod instrumentation either as a definitive procedure or as the second surgery in a two-staged correction and arthrodesis. The average age of the group was 15.6 years and the average curve severity 70.8 degrees. An average correction of 59.9% or 41.5 degrees was obtained; two-stage procedures averaged 7.2 degrees correction per segment as contrasted with 5.4 degrees for single stage surgery. Most patients had regained their preoperative level of function within 2 weeks after L-rod instrumentation. At an average follow-up interval of 2.73 years, all have a solid spinal arthrodesis. On the basis of this experience, we feel that L-rod instrumentation is a more effective adjunct in the surgical management of cerebral palsy scoliosis than combined Harrington-Dwyer instrumentations.
TL;DR: The nature of acetabular deficiency in both congenital and paralytic hip instability was investigated by computed tomography and showed anterior deficiency in cerebral palsy and congenital hip instability.
Abstract: The nature of acetabular deficiency in both congenital and paralytic hip instability was investigated by computed tomography (CT). Sixty-six hips in 35 children with paralytic or congenital hip instability underwent transpelvic CT. Two angles were defined: angle 1 is a function of anterior and angle 2 a function of posterior coverage. The sum of the two angles represented acetabular depth. Results showed anterior deficiency in cerebral palsy and congenital hip instability. An absolute acetabular deficiency as opposed to a torsional disorder was present.
TL;DR: It was concluded that the functional assessment of the brain center of the postural regulation system can be used in predicting the outcome of idiopathic early curves detected in the school screening program.
Abstract: In an attempt to elucidate whether assessment of the brainstem function helps to predict the outcome of early idiopathic scoliosis, a series of neurophysiological studies in children with idiopathic scoliosis was made cooperatively in Japan and the United States. The eye movement in 86 cases with idiopathic scoliosis in the rapidly growing ages was tested and compared with 66 normal control children. About one-half of the patients with idiopathic scoliosis demonstrated dysfunction in the brainstem test. The natural histories of the curves were available in 48 of the 86 cases in a follow-up study ranging from 6 months to 2 1/2 years. Statistically, there was a positive correlation between the brainstem dysfunction and the curve progression. It was concluded that the functional assessment of the brain center of the postural regulation system can be used in predicting the outcome of idiopathic early curves detected in the school screening program.
TL;DR: In a 3-year period, 101 children were admitted to hospital with supracondylar fractures of the humerus and 39 cases were treated with percutaneous K-wire pinning and plaster as mentioned in this paper.
Abstract: In a 3-year period, 101 children were admitted to hospital with supracondylar fractures of the humerus. Eight-six were examined an average of 3.7 years after the injury. Forty-seven cases were treated with closed reduction and plaster bandage. After an unsuccessful attempt at closed reduction, 39 cases were treated with percutaneous K-wire pinning and plaster. The cases treated with percutaneous pinning thus include the most severe fractures. Nevertheless, the results at follow-up in these cases easily equalled those obtained by closed reduction for the less displaced fractures. They were also comparable with reported results of extension treatment and, in contrast, required only a few days of hospitalisation.
TL;DR: The Pavlik harness allowed for treatment of the congenital knee dislocation and hip dysplasia simultaneously as mentioned in this paper, which was used for the treatment of both the hip and the knee.
Abstract: Congenital knee dislocation presents with a fixed hyperextension deformity and anterior displacement of the tibia on the femur Seventeen patients with a dislocation of 27 knees and no other neuromuscular syndrome have been reviewed for treatment outcome Almost one-half of the patients had associated congenital hip dysplasia Early closed treatment obtained a successful reduction and satisfactory knee motion Open reduction was required for failure of closed reduction The Pavlik harness allowed for treatment of the congenital knee dislocation and hip dysplasia simultaneously
TL;DR: The vascular anatomy of the head of the femur in puppies and children suggests that these data can be extrapolated to man and support the use of lesser degrees of abduction for hip immobilization in the treatment of congenital dislocation of the hip.
Abstract: Utilizing radioactive microspheres, blood flow to the femoral head of immature dogs was measured. Blood flow was measured with the leg in the control position, maximal abduction, submaximal abduction, and the human position of hip immobilization. Maximal abduction (to 90 degrees) significantly decreased flow to the capital femoral epiphysis. Submaximal abduction and the human position did not reduce blood flow. Measurement of flow in the control position immediately after forced abduction demonstrated marked reactive hyperemia. These data indicate that ischemia occurs during 90 degrees forced abduction of the hip. This finding supports the use of lesser degrees of abduction for hip immobilization in the treatment of congenital dislocation of the hip. The vascular anatomy of the head of the femur in puppies and children suggests that these data can be extrapolated to man.
TL;DR: A Dictionary of Medical Ethics is neither pharasaical nor permissive in its moral judgments, and is an excellent book of reference.
Abstract: Dictionary of medical ethics , Dictionary of medical ethics , کتابخانه مرکزی دانشگاه علوم پزشکی تهران