Showing papers in "Journal of Pediatric Orthopaedics in 1991"
TL;DR: A normal pediatric database for joint kinematics and kinetics which could then be used as a reference for clinical gait analysis is developed.
Abstract: Gait analysis is becoming a more integral part of the decision-making process in treatment of children with neuromuscular problems. A normal reference, however, must be available for comparison when one makes decisions. We wished to develop a normal pediatric database for joint kinematics and kinetics which could then be used as a reference for clinical gait analysis. Thirty-one normal children underwent a complete gait analysis including calculations of three-dimensional joint kinematics and kinetics. The pediatric data were similar to that of normal adults.
271 citations
TL;DR: A retrospective review of 143 supracondylar humerus fractures in children treated with K-wire fixation disclosed four neurologic complications after treatment, and all patients regained full neurologic function.
Abstract: A retrospective review of 143 supracondylar humerus fractures in children treated with K-wire fixation disclosed four neurologic complications after treatment. There were two late ulnar neuropraxias. One ulnar nerve injury and one radial nerve injury resulted from direct trauma during insertion of a K-wire. All patients regained full neurologic function.
154 citations
TL;DR: The syndrome of diminished femoral antetorsion, evaluated in 111 joints of 59 children and adults, is described, where internal rotation of the femur was significantly decreased, and external rotation was increased.
Abstract: The syndrome of diminished femoral antetorsion, evaluated in 111 joints of 59 children and adults, is described. Internal rotation of the femur was significantly decreased, and external rotation was increased. Femoral antetorsion was diminished in biplane radiographs to an 8.5 degrees mean value [1.0 degree in computed tomography (CT) scans]. Antetorsion values are higher in children, even in this syndrome. Pain was mainly experienced between the ages of 12 and 30 years. Ten patients had signs of beginning osteoarthritis. Rotational osteotomies performed to increase antetorsion were successful.
149 citations
TL;DR: MRI is recommended in patients undergoing spinal stabilization procedures and in all patients with Lumbosacral kyphosis and those with pain, neurologic findings, or cutaneous hairy patch.
Abstract: Forty-two patients with congenital spinal deformity were studied by magnetic resonance imaging (MRI). Sixteen patients had intraspinal abnormalities consisting of a tethered cord in 10, diastematomyelia in four, diplomyelia in three, syringomyelia in four, a low lying conus in three, and a teratoma of the sacrum in one patient. In seven patients, intraspinal anomalies were suspected based on routine spinal radiographs and physical findings. We recommend MRI in patients undergoing spinal stabilization procedures and in all patients with lumbosacral kyphosis and those with pain, neurologic findings, or cutaneous hairy patch.
142 citations
TL;DR: An energy expenditure index (EEI), the ratio of heart rate per meter walked, is calculated for 102 normal subjects, age 6-18 years, to evaluate and compare energy expenditure in a clinical setting.
Abstract: We used heart rate and walking speed to calculate an energy expenditure index (EEI), the ratio of heart rate per meter walked, for 102 normal subjects, age 6-18 years. Heart rate was measured at self-selected slow, comfortable, and fast walking speeds on the floor and on a motor-driven treadmill. At slow walking speeds (37 +/- 10 m/min) the EEI was elevated (0.71 +/- 0.32 beats/m), indicating poor economy. At comfortable speeds (70 +/- 11 m/min) the EEI values decreased to the maximum economy (0.47 +/- 0.13 beats/m). At fast speeds (101 +/- 13 m/min), the EEI increased (0.61 +/- 0.17 beats/m), indicating poor economy relative to comfortable speeds. A graph of the EEI versus walking speed provides a way to evaluate and compare energy expenditure in a clinical setting.
133 citations
TL;DR: It is shown that adolescent athletes may improve their flexibility after counseling and indicates a clear relationship between thigh muscle flexibility and anterior knee pain.
Abstract: To investigate the relationship between thigh muscle flexibility and anterior knee pain in adolescent athletes, we examined 46 skaters. We taught them flexibility exercises and later retested 28 of them. Three fourths of the skaters who improved their quadriceps flexibility eliminated their pain. Two of the three skaters who lost flexibility developed pain. Analysis of all examinations showed that skaters with pain had tighter quadriceps muscles than those without pain. Poor hamstring flexibility was correlated with patellofemoral pain. This study shows that adolescent athletes may improve their flexibility after counseling and indicates a clear relationship between thigh muscle flexibility and anterior knee pain.
108 citations
TL;DR: Thirty-three patients treated for displaced supracondylar fractures of the humerus, Type III, by means of closed reduction and percutaneous crossed-pin fixation were studied retrospectively.
Abstract: Forty-five consecutive patients treated for displaced supracondylar fractures of the humerus, Type III, by means of closed reduction and percutaneous crossed-pin fixation, were studied retrospectively. Thirty-three were available at an average of 33 months post-injury for clinical and radiographic follow-up of the affected and nonaffected extremities. Five additional patients returned radiographs for analysis. Baumann's angle and a lateral humeral capitellar angle were assessed and found to be useful clinical guides for assessing the adequacy of maintenance of fracture reduction. Based upon Flynn's criteria, 31 of 33 patients clinically assessed had a satisfactory result. Closed reduction with percutaneous pin fixation is believed to represent a safe, reliable, and efficient method of managing this difficult fracture.
103 citations
TL;DR: Achieving < 1 cm shortening at the time of cast application and close follow-up during the first 2 weeks after cast application are advised in order to achieve an acceptable final outcome.
Abstract: We retrospectively reviewed 51 patients aged 3-11 years with femoral shaft fractures selected for treatment with early spica cast immobilization. Shortening greater than 20 mm was the most common complication, occurring in 22 (43%) of the 51 patients. Factors associated with unacceptable shortening were shortening at the time of spica cast application greater than 10 mm, shortening greater than 20 mm at initial examination, and increasing age. Achieving less than 1 cm shortening at the time of cast application and close follow-up during the first 2 weeks after cast application are advised in order to achieve an acceptable final outcome.
98 citations
TL;DR: No prognostic factor for progression of slip or need for future operative treatment was found in 47 patients with symptomatic spondylolysis or low-grade isthmic spONDylolisthesis studied retrospectively.
Abstract: To evaluate the natural history of spondylolysis and spondylolisthesis, for clinical and radiological prognostic factors for progression of slip and the need for operative intervention, 47 patients with symptomatic spondylolysis or low-grade isthmic spondylolisthesis were studied retrospectively. The mean follow-up time was 7 years. Two patients (4%) had a progression of slip. Thirty percent of the patients required operation after a mean observation period of 3.7 years. At follow-up, 83% of the nonoperatively treated patients were rated excellent or good. No prognostic factor for progression of slip or need for future operative treatment was found.
86 citations
TL;DR: Angular and rotational profile of the lower limbs of 2,630 normal Chinese children from newborn to age 12 years were compiled using tibiofemoral angle, intercondylar, intermalleolar distance, medial and lateral rotation of the hip, and thigh-foot angle.
Abstract: Angular and rotational profile of the lower limbs of 2,630 normal Chinese children from newborn to age 12 years were compiled using tibiofemoral angle, intercondylar, intermalleolar distance, medial and lateral rotation of the hip, and thigh-foot angle. Children with clinical tibiofemoral angles, intercondylar or intermalleolar distances tended to be bowlegged at birth, maximally knock-kneed at age 3 and to have normal lower limbs by age 8. Medial hip rotation increased steadily from birth to a maximum of 56 degrees at age 9, and lateral hip rotation decreased from birth to a minimum of 30 degrees at age 9. Significant differences between Chinese children and children of other races were highlighted.
79 citations
TL;DR: The effectiveness of psoas and adductor tenotomies for the prevention of hip dislocation was investigated and successful results were obtained in 90% of patients under age 4 who had an MP less than 33%.
Abstract: The effectiveness of psoas and adductor tenotomies for the prevention of hip dislocation was investigated in 40 hips of 24 total-body-involved children. Age at operation ranged from 1.6 to 10 years. Results were evaluated by the Reimers migration percentage (MP). Average follow-up was 3 years. An overall good result was observed in 67% of cases. Results were correlated with age and MP at operation. Successful results were obtained in 90% of patients under age 4 who had an MP less than 33%. Preventive surgery should be performed at 2 or 3 years of age, before the onset of hip dysplasia.
TL;DR: Nail patella syndrome is a rare dysplasia with characteristic findings of finger nail abnormalities, hypoplastic patellas, radial head dislocations, and iliac horns, and the inheritance pattern is autosomal dominant.
Abstract: Nail patella syndrome is a rare dysplasia with characteristic findings of finger nail abnormalities, hypoplastic patellas, radial head dislocations, and iliac horns. We reviewed the problems and treatment of 44 patients with this syndrome from 13 Shriners Hospital units. The inheritance pattern is autosomal dominant, with foot abnormalities as the chief presenting complaint. All patients were ambulatory. Twenty of the patients underwent knee operations, and 24 underwent operations to correct foot and ankle deformities. Knee extensor realignments and foot posteromedial releases had overall good results. Knee flexion contractures required full posterior capsular releases. Elbow reconstructive procedures were rarely indicated.
TL;DR: Chinese children were far more lax throughout the age range, with 100% “laxity” at age 3, 67% laxity at age 6, and 28% laxITY at age 12, in contrast to 50, 5, and 1% laxness in the same age group respectively, in large series of Caucasian children.
Abstract: Joint laxity was measured clinically in 2,360 normal Chinese children aged 3-13 years with equal sex distribution using the Carter Wilkinson five tests and scoring system. Results showed minimal differences due to gender. The degree of joint laxity diminished with age. The knee extension and ankle extension tests were more sensitive than other tests. Chinese children were far more lax throughout the age range, with 100% "laxity" at age 3, 67% laxity at age 6, and 28% laxity at age 12, in contrast to 50, 5, and 1% laxity in the same age group respectively, in large series of Caucasian children.
TL;DR: The importance of continued follow-up until patients treated for congenital dislocation of the hip reach skeletal maturity is emphasized, as 17% of the hips demonstrated changes in the acetabulum.
Abstract: We present the long-term results of Pavlik harness treatment in 61 patients with 74 affected hips. At the beginning of treatment, the hips were either dislocated and reducible or dislocated and irreducible. The average age of patients at follow-up was 12 years (range, 10-16 years). At 3- and 5-year follow-up, all of the hips appeared radiographically normal. However, at latest follow-up, 17% of the hips demonstrated changes in the acetabulum (an upward tilt of the outer portion of the acetabular roof or sclerosis in this area). This study emphasizes the importance of continued follow-up until patients treated for congenital dislocation of the hip reach skeletal maturity.
TL;DR: A new three-dimensional osteotomy is proposed for the correction of cubitus varus deformity and among 12 patients who received this osteotomy, 11 had an excellent result and one had a good result.
Abstract: In the past, supracondylar osteotomy for the correction of cubitus varus deformity has been associated with a high failure rate and significant complications, even in simple lateral closing wedge osteotomy. This is because the supracondylar area is thin and fixation is difficult to maintain. In cubitus varus deformity, not only medial, but posterior, tilt and internal rotation of the distal fragment also frequently occurs. To correct all these deformities and to achieve a wide bony contact and more rigid fixation than simple lateral closing wedge osteotomy, we propose a new three-dimensional osteotomy. Among 12 patients who received this osteotomy, 11 had an excellent result and one had a good result.
TL;DR: A child with severe compartment syndromes of both lower extremities complicating the use of intraosseous fluid resuscitation is described.
Abstract: Intraosseous infusions are reserved for use in life-threatening hypovolemic or cardiogenic shock when intravenous (i.v.) access cannot be readily established. Although minor fluid extravasation is a common problem with this technique, a fully established compartment syndrome has never been reported. We describe a child with severe compartment syndromes of both lower extremities complicating the use of intraosseous fluid resuscitation.
TL;DR: Acetabular morphology in congenital and neuromuscular hip instability was evaluated with computed tomography (CT) and plain radiography and global deficiency was present in acetabuli of cerebral palsy and spina bifida patients with anterior, posterior, and superior deficiencies.
Abstract: Acetabular morphology in congenital and neuromuscular hip instability was evaluated with computed tomography (CT) and plain radiography. Thirty-three unstable hips in 27 children with congenital hip dysplasia, cerebral palsy, or spina bifida were studied. Fourteen normal hips in 14 children served as controls. Unstable hips in the children with congenital hip dysplasia demonstrated anterior and superior acetabular deficiency with increased acetabular anteversion. Global deficiency was present in acetabuli of cerebral palsy and spina bifida patients with anterior, posterior, and superior deficiencies. The acetabuli in cerebral palsy patients had significant posterior deficiency and were the shallowest of the groups evaluated.
TL;DR: Consideration should be given to prophylactic pinning of the contralateral hip and use of a smooth pin construct to prevent premature closure of the growth plate in children with significant growth remaining.
Abstract: Premature closure of the capital femoral physis after pin fixation of slipped capital femoral epiphysis (SCFE) in the juvenile population (at least 1 year less than the established mean) can lead to growth disturbances of the proximal femur. A retrospective review of 21 patients (33 hips) who had a pinning of a juvenile SCFE was performed. Growth disturbances including greater trochanteric overgrowth, coxa vara, and coxa breva were noted in 64% of the hips. An 80% incidence of bilateral involvement was noted in the juvenile group. Consideration should be given to prophylactic pinning of the contralateral hip and use of a smooth pin construct to prevent premature closure of the growth plate in children with significant growth remaining.
TL;DR: Gait capacity, operative intervention, and complications of operation were evaluated in 20 patients with osteogenesis imperfecta and the Sillence disease type was not a prognostic indicator of gait capacity.
Abstract: Gait capacity, operative intervention, and complications of operation were evaluated in 20 patients with osteogenesis imperfecta (OI). Thirty-two Bailey-Dubow (B-D) rods and 24 nonelongating rods were used. Postoperatively, gait capacity improved in eight patients, regressed in three, and remained unchanged in nine. No preoperative ambulator regressed to a nonambulatory status. The Sillence disease type was not a prognostic indicator of giat capacity. The complication rate was 72% for the B-D rod and 50% for the nonelongating rod, although the percentage requiring reoperation was similar for both types of nails. There was no difference in longevity between the two nails.
TL;DR: Rapid progression of hip subluxation was noted in the year after selective dorsal rhizotomy in seven hips, and hips with an intermediate degree of preoperative lateral extrusion had variable results.
Abstract: Rapid progression of hip subluxation was noted in the year after selective dorsal rhizotomy in seven hips (six patients). The hips that subluxed progressed from a lateral extrusion index averaging 25% preoperatively as compared with 50% after rhizotomy. Although preexistent hip dysplasia was a predisposing factor, hips with an intermediate degree of preoperative lateral extrusion (12-25%) had variable results. Ongoing and more frequent evaluation of hip stability is necessary after dorsal rhizotomy.
TL;DR: Opening wedge medial cuneiform and closing wedge cuboid osteotomies were done, resulting in good resolution of the prominent midfoot supination and forefoot adductus without significant soft tissue dissection and invasion of growing areas in the foot.
Abstract: Despite educated and conscientious treatment of clubfoot deformity, residual problems after surgical intervention are quite common. Certain clinical patterns can be manifestations of residua at the various sites that are involved in the original deformity, i.e., the leg, the ankle, the subtalar complex, and the forefoot. An internally rotated gait, because of uncorrected or recurring rotation at the talocalcaneal joint, is perhaps the problem most frequently addressed in the literature. Another common clinical pattern, the sagittally breached or “bean-shaped” foot, is the result of a combination of forefoot adductus, midfoot supination, and mild hindfoot varus, which produces an elongated lateral column of the foot with an internally rotated gait, but a plantar grade foot (Figure 13.21).
TL;DR: In the general visceral types, chemotherapy was effective in visceral sites and in extensions of the tumor outside the bone but did not alter the natural history of the bony lesion.
Abstract: Sixty-two patients with histiocytosis X were followed for an average of 5 years. The patients were classified into three groups: general visceral types (14 cases), multiple eosinophilic granulomas (nine cases), and solitary eosinophilic granulomas (39 cases). One hundred bony lesions were noted in 60 of the 62 patients. The bone lesions showed progressive improvement in single and multiple eosinophilic granulomas independent of treatment type. After biopsy, patients received no treatment unless there was a dangerous extension into the soft tissues because of its site, i.e., in the skull. In the general visceral types, chemotherapy was effective in visceral sites and in extensions of the tumor outside the bone but did not alter the natural history of the bony lesion.
TL;DR: In this article, the diagnostic criterion for intracapsular effusion was a side difference greater than or equal to 2.0 mm in the distance between the anterior joint capsule and femoral neck (anterior capsule distance, ACD).
Abstract: Of 59 patients (2-15 years of age) with acute synovitis of the hip, one patient developed Perthes disease (1.7%) and the others transient synovitis. The diagnostic criterion for intracapsular effusion was a side difference greater than or equal to 2.0 mm in the distance between the anterior joint capsule and the femoral neck (anterior capsule distance, ACD). At the time of admission, the mean ACD of the affected and unaffected hips was 8.2 and 4.2 mm, respectively. The effusion persisted for greater than 1 week in 58% of the patients. We recommend ultrasound as the main imaging technique in the diagnosis and follow-up of transient synovitis. Radiography may be omitted in uncomplicated cases, but should be employed when Perthes disease is suspected.
TL;DR: Green procedures and transfer of the flexor carpi ulnaris (FCU) in treatment of spastic forearm pronation, wrist volarflexion, and ulnar deviation deformities showed cosmetic improvement and functional improvement, and patients aged > 12 years showed less functional improvement.
Abstract: We retrospectively reviewed Green procedures and transfer of the flexor carpi ulnaris (FCU) in treatment of spastic forearm pronation, wrist volarflexion, and ulnar deviation deformities. Patient's ages ranged from 3 years 5 months to 16 years 5 months. Surgically, a single volar incision was made and the extensor carpi radialis brevis and/or longus (ECRB, ECRL) were used for insertion. The FCU was tensioned at neutral against gravity and immobilized in 5 degrees of dorsiflexion and 45 degrees of supination. Arc of flexion (47 degrees) did not change but was centered about neutral. Supination improved markedly when operation included a pronator procedure. Quadraplegia athetosis and intellectual impairment did not affect the operative result adversely. Patients aged greater than 12 years showed less functional improvement. Eighty-eight percent had cosmetic improvement, and 79% improved functionally. None had a decreased functional rating.
TL;DR: Early resection of fibrous pseudarthrosis probably does not require the extensive grafting and internal fixation that has been recommended for older children, and all children were solidly healed by 14 weeks after surgery.
Abstract: Eight children were treated operatively with resection of fibrous pseudarthrosis and sclerotic bone ends, careful dissection and preservation of the periosteal sleeve to maintain continuity, and approximation of bone ends. None had additional bone grafts or internal fixation. All had bridging ossification 6-8 weeks postoperatively, and all were solidly healed by 14 weeks after surgery. Follow-up has ranged from 2 to 14 years, with no evidence of recurrence. Remodeling of the prominence occurred slowly in 2-5 years, with the distal clavicle variably underdeveloped in all patients. Early resection of fibrous pseudarthrosis probably does not require the extensive grafting and internal fixation that has been recommended for older children.
TL;DR: Independent of the type of lesion, the median nerve showed the best ability to regain complete motor and sensory function and those affecting the radial nerve had a worse prognosis regarding motor function recovery.
Abstract: In a 15-year retrospective study, the results of 37 surgically treated nerve lesions of the upper extremity in 33 children were reviewed after a mean follow-up of 2 years. Children ranged in age from 4 to 15 years. There were 19 ulnar, 12 median, and 6 radial nerve injuries. Discontinuity of the nerve trunk was found in 23 patients operated by interfascicular grafting (18 patients) or epineural suture (5 patients). The other 14 lesions were treated by decompressive external neurolysis. Useful sensory function (S4-S3) assessed at the autonomous zone was restored in 31 patients (84%). Satisfactory motor recovery was achieved in 25 patients (67%). Independent of the type of lesion, the median nerve showed the best ability to regain complete motor and sensory function. In lesions with continuity of the nerve trunk, those affecting the radial nerve had a worse prognosis regarding motor function recovery. Unfavorable prognosis was mainly related to a time interval of more than 1 year between nerve damage and surgery.
TL;DR: It is suggested that children with symptomatic nonunion and malunion of lateral condylar fractures of the humerus can benefit from late surgical treatment at the time of diagnosis.
Abstract: Summary
We describe four cases of successful late surgical treatment of lateral condylar fractures of the humerus performed 8 weeks and 2, 5, and 14 years after injury and review the literature on the subject. We suggest that children with symptomatic nonunion and malunion of these fractures can benefit from late surgical treatment at the time of diagnosis. We describe the technique of functional reduction and the regions in which anatomic reduction is precluded by remodeling or gross displacement of the fragment.
TL;DR: This case documents the natural progression of the formation of os odontoideum and correlates it with a traumatic event, the first case reported in the literature.
Abstract: Os odontoideum has recently been considered an acquired lesion of the second cervical vertebrae. This case documents the natural progression of the formation of os odontoideum and correlates it with a traumatic event. This is the first case reported in the literature.
TL;DR: The high percentage of other indications for metal removal and the low incidence of major complications support the practice of routine metal removal in this population of patients with internal skeletal fixation.
Abstract: Thirty-eight percent of patients with internal skeletal fixation had indications for removal other than uncomplicated healing. Plates were removed (p = 0.023) routinely, however, because intramedullary rods and staples were likely to be subcutaneous and painful (p = 0.02). Complications included incomplete removal of the device (7%) and two postoperative fractures. Most complications had no known significant adverse effects on the patients. Operative time and blood loss were significantly increased when a tourniquet could not be used. We believe that the high percentage of other indications for metal removal and the low incidence of major complications support the practice of routine metal removal in this population.