Endoscopic-assisted epiphysiodesis: technique and 20-year experience JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B 2016; 25 (1): 24-30
The aim of the study was to describe the endoscopic-assisted epiphysiodesis technique and review our 20-year experience with it. A retrospective review of 44 patients who underwent proximal tibia and/or distal femur endoscopic-assisted epiphysiodesis was carried out. Only patients who had preoperative and postoperative scanograms with clinical follow-up of at least 6 months were included. The mean length of follow-up was 36.8 months. All patients had radiographic evidence of physeal fusion within 6-12 months from the index procedure. No patient required revision surgery. Endoscopic-assisted epiphysiodesis is safe, effective, and achieves predictable physeal fusion. Advantages over current techniques include reduced radiation exposure and lack of requirement for hardware placement.
View details for DOI 10.1097/BPB.0000000000000230
View details for Web of Science ID 000365714200005
Emergency surgical treatment of an ulcerative and hemorrhagic congenital/infantile fibrosarcoma of the lower leg: case report and literature review JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B 2013; 22 (3): 228-232
Fibrosarcomas are rare malignant soft-tissue tumors occurring mostly in infants younger than 1 year of age. Fibrosarcomas can ulcerate and cause various complications, which could threaten a fetus in utero or a child in the early neonatal period. We report a unique case of congenital infantile fibrosarcoma of the lower leg, its treatment and pathology. The large expansive and destructive lesion was not appreciated on routine prenatal ultrasound exams at 20 and 33 weeks gestation. The newborn required immediate emergency surgical intervention after delivery to prevent death by hemorrhagic shock. Initial debulking of the tumor was performed and hemostasis was attained on the day of birth. The child was resuscitated and definitive treatment of the leg was deferred until a pathologic diagnosis was obtained. Given the extent of the fibrosarcoma, the lower leg was not salvageable and the patient received a through-the-knee amputation in the neonatal period. The patient is free of disease at 2 years of age.
View details for DOI 10.1097/BPB.0b013e3283536908
View details for Web of Science ID 000316801200010
View details for PubMedID 22568962
Kyphectomy in the treatment of patients with myelomeningocele SPINE JOURNAL 2011; 11 (3): E5-E11
Myelomeningocele kyphosis is a complex disorder that usually requires surgical intervention. Many complications can occur as a result of this disorder and its treatment, but only surgical correction offers the possibility of restoring spinal alignment.The purpose of this retrospective study was to summarize the surgical results, complications, and short-term and midterm outcomes for surgical correction of severe kyphosis using a consistent surgical technique.This was a retrospective review of our database of pediatric patients with myelomeningocele and lumbar kyphosis who underwent kyphectomy with the use of the Warner and Fackler technique.Eleven pediatric kyphectomy cases performed by a single surgeon from 1984 to 2009 were reviewed.Outcome measures include imaging, kyphotic angle measurement, and physical examination.Patients underwent the Warner and Fackler technique of posterior-only kyphectomy and bayonet-shaped anterior sacral fixation.The mean extent of kyphosis was 115.6 (range, 77-176) preoperatively with a correction to 13.0 (range, 0-32) postoperatively, and a reduction with an average of 102.6 (range, 65-160), for an 88.7% correction. On an average, 2.0 (range, 1-6) vertebrae were resected. Immediately postoperatively and at follow-up, with an average of 67.2 months (range, 8-222 months), the average kyphosis angle was 13.0 (range, 0-32). All patients undergoing the procedure were unable to lie supine preoperatively. All patients postoperatively could lie in the supine position. The functional outcome in patients and caretakers was rated very favorably because all patients and caretakers who provided feedback (9 of 11) reported that they were satisfied with the procedure and would undergo the procedure again if given the choice.This technique has become the most effective surgical reconstruction in myelomeningocele kyphosis. Although significant complications can occur during and after the procedure, most patients had satisfactory postoperative outcomes and restoration of sagittal balance with high patient and parent satisfaction.
View details for DOI 10.1016/j.spinee.2011.01.020
View details for Web of Science ID 000288013200002
View details for PubMedID 21377598
Quantifying scoliosis: we are still not there SPINE JOURNAL 2010; 10 (9): 813-814
Long-term follow-up of the surgical management of neuropathic arthropathy of the spine. spine journal 2010; 10 (6): e6-e16
No studies have discussed the long-term surgical management and outcomes of Charcot arthropathy of the spine. This case series presents nine patients treated over 30 years. The study hypothesis was that surgery would reduce instability, pain, recurrence, and the need for revision surgery in the long-term, given previous study findings of successful fusion of Charcot spine in the short-term.To evaluate the long-term outcomes of surgery for Charcot spine.Retrospective case series. Cases took place at Stanford University Medical Center and Santa Clara Valley Medical Center.All patients had either complete paraplegia or dense paraparesis with both major motor and sensory deficits. Seven patients developed Charcot spine after spinal instrumentation for trauma, one after scoliosis repair for meningomyelocele, and one after spinal instrumentation for neuromuscular scoliosis caused by birth injury resulting in C6-C7 quadraplegia. Average time between initial instrumentation and development of Charcot spine was 7.6 years. Two patients underwent posterior fusion alone, six had anterior-posterior fusion, and one was managed with thoracolumbar orthosis.Average follow-up was 14.3 years. Revisions were necessary in 75% (6 of 8) of patients for complications including nonunion, new Charcot joints, recurrent hardware failure, and osteomyelitis. Achieving fusion often required multiple operations, and there were no deaths or neurologic complications.Long-term follow-up showed a high rate of revision surgery. Solid fusions often resulted in late breakdown or new junctional Charcot arthropathies. Patients initially fused to the lumbar spine instead of the sacrum or pelvis had a higher rate of developing another Charcot joint. Fusion was often difficult with persistent nonunions and functional deficits because of decreased mobility. We recommend that Charcot spine well tolerated without skin, seating problems, or dysreflexia should be cautiously observed with conservative management. For surgical care, we recommend three-column stabilization with either combined anterior-posterior or all posterior approaches with anterior support to obtain and secure greater long-term stability.
View details for DOI 10.1016/j.spinee.2010.03.030
View details for PubMedID 20494808
Dynamic skeletal traction spica casts for paediatric femoral fractures in a resource-limited setting INTERNATIONAL ORTHOPAEDICS 2009; 33 (3): 765-771
The objective of this study was to compare elastic intramedullary nailing (EIN) with dynamic skeletal traction spica casting (DSTSC) in terms of postoperative radiographic angulations, length of hospital stay, and cost in a resource-limited setting. We prospectively studied 51 children, five to twelve years of age, with femoral fractures treated with either EIN (n = 26) or DSTSC (n = 25). Children treated with EIN had significantly longer hospital stays (17 +/- 8.0 days) than those treated with DSTSC (6.0 +/- 2.5 days). Financial constraints in acquiring supplies caused a significant increase in time from admission to surgery (EIN 9.5 +/- 2.3 days; DSTSC 1.1 +/- 0.3 days), and cost was about 400% higher for EIN compared with DSTSC. At twelve weeks follow-up, all patients in both groups had acceptable radiographic angulations. In resource-limited healthcare settings, DSTSC is an effective alternative to EIN with comparable post-op radiographic angulations, decreased hospital stays, and lower cost.
View details for DOI 10.1007/s00264-008-0621-0
View details for Web of Science ID 000267041000029
View details for PubMedID 18654778
Magnetic resonance imaging-guided closed reduction treatment for developmental dysplasia of the hip SINGAPORE MEDICAL JOURNAL 2009; 50 (4): 407-411
This study aimed to describe the radiological aspects and procedural steps of magnetic resonance (MR) imaging-guided closed reduction for the treatment of developmental dysplasia of the hip (DDH).Infants were positioned on a custom-made hip spica table attached to a vertically open double doughnut-shaped MR imaging unit (GE Signa SP, 0.5T) affording access to one orthopaedic surgeon and one radiologist. Standard MR imaging sequences and rapid dynamic MR imaging sequences, including fast spin-echo, fast gradient-echo and a fluoroscopic echo-planar sequence, were available. Procedural steps were described and illustrated as a guide for the radiologist actively collaborating with the orthopaedic surgeon.Five separate procedural steps were defined, describing the imaging action and the radiologist's focus related to the clinical action. These procedural steps included patient positioning, static imaging to evaluate hip congruency and factors impeding reduction, dynamic stress testing and reducing the hip while using dynamic motion MR imaging sequences to visualise reduction or dislocation, cast application with intermittent imaging confirmation of the femoral head position, and postprocedural static imaging.The role of the radiologist was well-defined during each procedural step of the MR imaging-guided closed reduction focusing on the use of specific sequences and image interpretation. Knowledge of these procedural steps may be helpful for efficient collaboration with the orthopaedic surgeon and successful MR imaging-guided treatment of DDH.
View details for Web of Science ID 000267053500014
View details for PubMedID 19421687
Dynamic magnetic resonance guided treatment of developmental dysplasia of the hip JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B 2002; 11 (4): 279-283
This study demonstrates the feasibility and advantages of near real-time, multiplanar, dynamic magnetic resonance image-assisted treatment of patients with developmental dysplasia of the hip. Pathoanatomy and dynamic blocks to reduction are visualized with anatomic clarity not otherwise possible. Continuous imaging allows accurate assessment and maintenance of optimum positioning throughout the casting procedure. Patient charges for this new technique are less than standard methods of treatment, and the child receives no ionizing radiation.
View details for Web of Science ID 000178875700002
View details for PubMedID 12370576
Personal experiences with overseas volunteerism CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 2002: 89-97
Orthopaedic surgeons often are unaware of the many opportunities and rewards of practicing and teaching as an overseas volunteer in a developing country. Opportunities include participating as a member of an American team under the auspices of groups such as Operation Rainbow; or, one can go alone and practice just with host country personnel through organizations such as Orthopaedics Overseas. Typically, the group missions are short-term assignments of 1 to 2 weeks and are more oriented toward doing surgery. The solo visits typically are 1 month or more and aimed more at teaching. The visits are as rewarding and educational to the visiting volunteer as they are to the host country. The volunteer must be open minded and willing to adapt frequently; he or she will be impressed by the ingenuity and resourcefulness of the host orthopaedists who generally work hard with limited equipment and basic supplies. In general, patients are appreciative and rather stoic. Surgeons from the host country also are grateful and eager to learn and share knowledge.
View details for Web of Science ID 000174262700016
View details for PubMedID 11859229
Electromyographic test to differentiate mild diplegic cerebral palsy and idiopathic toe-walking JOURNAL OF PEDIATRIC ORTHOPAEDICS 2001; 21 (6): 784-789
The purpose of this study was to determine whether children with mild spastic diplegic cerebral palsy (CP) could be differentiated from those with idiopathic toe-walking (ITW) based on an obligatory coactivation during voluntary contraction of the quadriceps or gastrocnemius. Twenty-four subjects participated in this study, eight children with mild spastic diplegia CP, eight with ITW, and eight age-matched controls. Measurements included passive range of motion and surface electromyographic recordings of the lateral quadriceps and lateral gastrocnemius. Electromyographic recordings were obtained during resisted knee extension with knee flexed 30 degrees, isometric quadriceps contraction with knee extended (quad set), active plantarflexion, and during gait. The range-of-motion values were not different between the CP and ITW subjects, with the exception of the popliteal angle, which was greater in subjects with CP, with an overlap in values. Gait electromyography showed premature firing of gastrocnemius in swing in both groups of subjects compared with controls. During resisted knee extension and quad set, the mean duration of gastrocnemius coactivation in subjects with CP was high: 86% and 86% compared with 20% and 35% for the subjects with ITW and 0.4% and 3% for controls, respectively. Voluntary plantarflexion did not consistently elicit coactivation of the quadriceps. The results suggest that electromyographic testing of resisted knee extension and quad set to identify gastrocnemius coactivation can help differentiate patients with mild CP from those with ITW.
View details for Web of Science ID 000171936500016
View details for PubMedID 11675555
Electromyographic differentiation of diplegic cerebral palsy from idiopathic toe walking: Involuntary coactivation of the quadriceps and gastrocnemius JOURNAL OF PEDIATRIC ORTHOPAEDICS 1999; 19 (5): 677-682
Clinical differentiation of patients with mild diplegic cerebral palsy (CP) and idiopathic toe walking (ITW) can be difficult. However, an involuntary extensor pattern may be a distinguishing sign. The purpose of this study was to determine if selected gait parameters or patterns of electromyogram (EMG) timing of quadriceps, gastrocnemius, and tibialis anterior during knee extension while sitting can distinguish between these patients. The hypothesis was that EMG testing for selective control of the quadriceps and gastrocnemius could differentiate patients with diplegic CP from normal controls and from patients with ITW. We evaluated 10 control, eight CP, and eight ITW subjects. Measurements included walking speed, energy expenditure index (EEI), ankle position during stance, and EMG of the quadriceps, gastrocnemius, and tibialis anterior during gait and during knee extension while sitting. Dynamic EMG timing during gait showed significant differences in the mean onset of the gastrocnemius between subjects with CP and ITW, but there was considerable overlap. More consistent differences were found during active and active-resisted knee extension while sitting. Mean values for gastrocnemius EMG timing recorded as a percentage of duration of quadriceps EMG while sitting were 0 and 0.4% for controls, 0 and 3.9% for ITW subjects, and 84.3% and 93.4% for CP subjects. Patterns of EMG timing of the quadriceps and gastrocnemius during knee extension while sitting can help to differentiate patients with mild diplegic CP from those with ITW.
View details for Web of Science ID 000082295100025
View details for PubMedID 10488875
Analysis of radiographic measurements as prognostic indicators of treatment success in patients with developmental dysplasia of the hip JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B 1999; 8 (2): 118-121
Measurements were taken and statistically analyzed from the initial radiographs, the 1-year follow-up radiographs, and the most recent radiographs of 81 patients (103 hips) to determine which measurements could predict the success of treatment. The average follow-up was 49 months (range, 12-139 months), and the average age of the patients at the last follow-up was 65 months (range, 15-190 months). Analysis of the data showed that the measurement with statistically significant predictive value was the Tonnis grade of dislocation determined from the initial radiograph. A single unit increase in the Tonnis grade was associated with a doubling of the odds of failure in patients treated with a Pavlik harness (P < 0.04, odds ratio = 2.2) or a closed reduction (odds ratio = 2.0).
View details for Web of Science ID 000081887100011
View details for PubMedID 10218173
Untitled - Reply JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 1996; 78A (11): 1785-1785
Effectiveness of ice packs in reducing skin temperature under casts CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1996: 217-221
Skin temperature lowering effects were measured after application of crushed ice packs to the surface of synthetic and plaster casts. The skin temperature of legs in synthetic casts decreased an average of 10.4 degrees C (range, 8.3 degrees-12.6 degrees) to a minimum temperature of 19.7 degrees C (range, 16.2 degrees-21.8 degrees), and the temperature of legs in plaster casts decreased an average of 11 degrees C to a minimum of 18.7 degrees C (range, 13 degrees-22.8 degrees). It took an average of 56 minutes (range, 40-80 minutes) for the legs in synthetic casts and 63.8 minutes (range, 26-116 minutes) for the legs in plaster casts to reach the minimum temperature. Cryotherapy is used clinically with the intention of lowering skin temperature and presumably decreasing the pain and swelling of a patient's injured extremity. The presence of a synthetic or a plaster cast does not eliminate the lowering effects of skin temperature when crushed ice packs are applied to the surface of the casts.
View details for Web of Science ID A1996VG55100029
View details for PubMedID 8804296
Erroneous interpretation of magnetic resonance images of a fracture of the first rib with non-union. Two case reports. journal of bone and joint surgery. American volume 1995; 77 (12): 1883-1887
Erroneous interpretation of magnetic resonance images of a fracture of the first rib with non-union - Two case reports JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 1995; 77A (12): 1883-1887
GASTROINTESTINAL PROBLEMS IN PATIENTS WHO HAVE TYPE-III OSTEOGENESIS IMPERFECTA JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 1995; 77 (9): 1352-1356
We performed a study of forty-three patients who had type-III osteogenesis imperfecta. Our purpose was to determine the frequency and severity of abdominal problems and the relationship between these problems and pelvic deformity. Twelve patients had had recurrent episodes of abdominal pain. Eleven of them had a history of chronic constipation, and five had been treated for fecal impaction. Radiographs had been made for ten of these patients, and eight of them had radiographic evidence of pelvic deformity with severe acetabular protrusion. Chronic constipation and recurrent abdominal pain are more frequent in patients who have osteogenesis imperfecta and acetabular protrusion than in those who do not have protrusion. These patients may benefit from early attention to a bowel program and referral to a gastrointestinal specialist.
View details for Web of Science ID A1995RV56800010
View details for PubMedID 7673285
MUSCLE PATHOLOGY AND CLINICAL MEASURES OF DISABILITY IN CHILDREN WITH CEREBRAL-PALSY JOURNAL OF ORTHOPAEDIC RESEARCH 1994; 12 (6): 758-768
We performed a histologic and morphometric study of spastic muscle from 10 children with diplegic cerebral palsy, comparing muscle structure with the gait parameters of energy expenditure index and dynamic electromyography. Variations in fiber area within and between fiber types were increased significantly in children with cerebral palsy. In each of the control subjects, the combined coefficient of variation for type-1 and type-2 fiber area was less than 25% and the average was 17%; in the subjects with cerebral palsy, the combined coefficient of variation was more than 25% and the average was 36% (p < or = 0.004). The average difference between the mean area of type-1 and type-2 fibers was 26.7 +/- 18.9% for subjects with cerebral palsy and 4.2 +/- 2.4% for control subjects (p < or = 0.004). There was a 67% predominance of one fiber type in the subjects with cerebral palsy compared with a 55% predominance in the control subjects (p < or = 0.03). The difference between the total area of type-1 and type-2 fibers was 57% in the subjects with cerebral palsy and 17% in the control subjects (p < or = 0.002). There was a significant correlation between the combined coefficient of variation of fiber area and the energy expenditure index (r = 0.77, p < or = 0.03). The difference between the mean area of type-1 and type-2 fibers correlated with prolongation of electromyographic activity (r = 0.69, p < or = 0.05). No abnormalities in fiber ultrastructure were found in the subjects with cerebral palsy. Children with cerebral palsy had abnormal variation in the size of muscle fibers and altered distribution of fiber types. The values for variation in fiber area correlated with the energy expenditure index and with prolongation of electromyographic activity during walking.
View details for Web of Science ID A1994PW53900002
View details for PubMedID 7983551
USE OF APROTININ TO REDUCE INTRAOPERATIVE BLEEDING WESTERN JOURNAL OF MEDICINE 1993; 159 (2): 189-192
ADVANCES IN MANAGEMENT OF IDIOPATHIC SCOLIOSIS HOSPITAL PRACTICE 1992; 27 (4): 49-55
Management rests on two critical questions: whether the curve is likely to progress before cessation of growth, and whether further progression can be expected in the mature patient. With regard to both questions, we have learned a number of important lessons from mass screening and its follow-up. Along the way, a number of questionable technologies have been discarded.
View details for Web of Science ID A1992HN96700007
View details for PubMedID 1560077
LONG-TERM SCINTIGRAPHIC APPEARANCE OF EXTREMITIES FOLLOWING BONE-TUMOR RESECTION AND ALLOGRAFT RECONSTRUCTION CLINICAL NUCLEAR MEDICINE 1991; 16 (12): 907-909
The authors retrospectively reviewed the Tc-99m medronate scan findings in six patients who had no evidence of metastatic disease following en bloc resection of a primary osteosarcoma and subsequent limb reconstruction using allograft bone. Persistently increased radionuclide uptake was noted at the junction between the host bone and the graft, while the graft cortical bone showed persistently decreased activity. Radionuclide uptake at the periphery of the graft varied. Over time the youngest patient in the series had increasingly normal scan findings.
View details for Web of Science ID A1991KC60900005
View details for PubMedID 1663013
TRANSVERSE CERVICOPERTROCHANTERIC HIP FRACTURE JOURNAL OF PEDIATRIC ORTHOPAEDICS 1991; 11 (6): 779-782
A 3-year-old boy sustained a previously undescribed transverse hip fracture that involved the cervical, cervicotrochanteric, and intertrochanteric regions. The fracture was successfully treated with skeletal traction for 4 weeks using a Steinmann pin placed through the distal femoral metaphysis followed by spica cast immobilization. The 3-year follow-up examination demonstrated satisfactory growth and remodeling of the proximal femur with no evidence of osteonecrosis, premature physeal closure, or coxa vara.
View details for Web of Science ID A1991GM56700016
View details for PubMedID 1960206
SIMPLE METHOD OF DOCUMENTING METATARSUS ADDUCTUS JOURNAL OF PEDIATRIC ORTHOPAEDICS 1991; 11 (5): 679-680
A simple, accurate, and inexpensive method of documenting metatarsus adductus involves taking photocopies of the foot in the weightbearing position. Subsequently, treatment progress can be assessed objectively by reviewing serial photocopies. Some caution is urged because the strength of the glass copying surface of photocopying machines is unknown.
View details for Web of Science ID A1991GD03600023
View details for PubMedID 1918361
Arthropathy of the ankle in hemophilia. journal of bone and joint surgery. American volume 1991; 73 (7): 1008-1015
Seventy-five patients who had hemophilia were followed clinically and roentgenographically to assess the prevalence of hemarthrosis and the prevalence and severity of arthropathy of the ankle. The mean age of the patients at the time of follow-up was twenty-two years and seven months. The patients were divided into four age-groups: less than ten years (eleven patients), ten to nineteen years (twenty-one patients), twenty to thirty years (twenty-four patients), and more than thirty years (nineteen patients). Intra-articular bleeding occurred more frequently in the joints of the lower extremities than in the joints of the upper extremities. During the second decade of life, hemarthroses occurred more often in the ankle than in the knee. A history of recurrent bleeding into the ankle joint, chronic synovitis, and overgrowth of the medial portion of the distal tibial epiphysis was associated with an early onset of arthropathy. In older patients, compression arthrodesis of the ankle joint was helpful in eliminating pain, recurrent bleeding, and equinus deformity.
View details for PubMedID 1908466
ARTHROPATHY OF THE ANKLE IN HEMOPHILIA JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 1991; 73A (7): 1008-1015
SIMULTANEOUS CORRECTION OF PELVIC OBLIQUITY, FRONTAL PLANE, AND SAGITTAL PLANE DEFORMITIES IN NEUROMUSCULAR SCOLIOSIS USING A UNIT ROD WITH SEGMENTAL SUBLAMINAR WIRES - A PRELIMINARY-REPORT JOURNAL OF PEDIATRIC ORTHOPAEDICS 1990; 10 (6): 742-749
Ten patients with neuromuscular scoliosis and pelvic obliquity had segmental spinal instrumentation using a unit Luque rod with sublaminar wires and fixation into the pelvis. Nine of the 10 patients also had anterior spinal fusion without instrumentation before the posterior procedure. Average preoperative pelvic obliquity was 42 degrees which was corrected to 6 degrees (82% correction). Average preoperative scoliosis was 92 degrees, which was corrected to 16 degrees (81% correction). Complications included a wound hematoma in one patient and a superficial wound dehiscence in another. There have been no pseudarthroses or hardware failures to date. Excellent correction of the pelvic obliquity and the spinal curve in neuromuscular scoliosis can be obtained with use of a unit rod and without use of anterior instrumentation.
View details for Web of Science ID A1990EF61000007
View details for PubMedID 2250058
ESTABLISHED HIP DISLOCATIONS IN CHILDREN WITH CEREBRAL-PALSY CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1990: 90-99
Hip dislocation in children with cerebral palsy is caused by a combination of factors, including spastic muscle imbalance, persistent fetal femoral geometry, acetabular dysplasia, and flexion-adduction contracture. The incidence of dislocation correlates with the severity of the spasticity, and the prevalence is close to 50% in neurologically immature, spastic quadriplegic children. Successful hip reductions improve muscular balance, provide satisfactory reduction of the femoral head, and establish good pelvic coverage. In 31 occurrences of established hip dislocation in 24 patients, the most successful operations used a combined procedure consisting of soft-tissue release, open reduction, femoral varus derotation and shortening osteotomy, and pelvic osteotomy.
View details for Web of Science ID A1990CX27900012
View details for PubMedID 2180606
SURGERY OF SPINAL DEFORMITY IN CEREBRAL-PALSY - 12 YEARS IN THE EVOLUTION OF SCOLIOSIS MANAGEMENT CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1990: 100-109
In order to assess the lessons learned from 12 years of surgery on patients with cerebral palsy and spinal deformity, the cases may be divided into three groups classified according to type of posterior spinal fusion, instrumentation, and time period. Group I (1976-1980) included patients who had Harrington rods, usually with Dwyer instrumentation. Group II (1980-1985) consisted of patients with unlinked Luque or wired-in Harrington rods. Group III (1985-1988) comprised patients with a unit Luque rod extending to the pelvis. Most patients were retarded nonwalkers who had total body involvement, pelvic obliquity, and severe thoracolumbar curves (Group I average, 97 degrees; Group II average, 72 degrees; Group III average, 89 degrees). The frontal plane correction at follow-up study averaged 51% in Group I, 47% in Group II, and 76% in Group III. The correction of the pelvic obliquity averaged 71% in Group I, 58% in Group II, and 86% in Group III. The general trend was toward longer fusion, use of the unit 0.625-cm Luque rod, and first-stage anterior discectomy and fusion without anterior instrumentation. The second-stage posterior arthrodesis and fusion is now performed only one week after the first-stage anterior procedure. Skeletal traction has been abandoned. The Luque rod instrumentation without fusion has also been abandoned.
View details for Web of Science ID A1990CX27900013
View details for PubMedID 2317962
GAIT ELECTROMYOGRAMS AND SURGICAL DECISIONS FOR PARALYTIC DEFORMITIES OF THE FOOT DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY 1989; 31 (3): 287-292
Twenty-one patients who had 23 gait electromyographic (EMG) examinations for paralytic deformities of the foot had surgical procedures performed. Outcome of the surgery was analysed with respect to the value of the pre-operative gait studies in deciding on appropriate surgical procedures. When outcome at follow-up (mean 3.6 years) was satisfactory and surgery had been in accordance with the EMG findings, or when outcome was unsatisfactory when the EMG had been disregarded, the value was deemed positive. Conversely, if the EMG data had been disregarded but outcome was satisfactory, the value was negative. Using these criteria, 70 per cent of the EMGs of the four muscles tested (tibialis anterior and posterior, peroneal and gastrocnemius) were a positive contribution to the evaluation and decision for the particular surgical procedure.
View details for Web of Science ID A1989AC36100002
View details for PubMedID 2753236
Trapeziometacarpal abnormalities in Ehlers-Danlos syndrome. journal of hand surgery 1989; 14 (1): 89-94
We studied 24 patients with Ehlers-Danlos syndrome with particular attention to the thumb and the trapeziometacarpal joint. The 11 males and 13 females had a mean age of 15.9 years. Symptomatic complaints included pinch, grip and twisting weakness; measurements showed dominant hand strength deficits of 71% for tip pinch, 55% for palmar pinch, 46% for key pinch, and 70% for grip. All finger joint ranges of motion were increased. Sixty-six percent of all the patients had trapeziometacarpal subluxation; 29% had dislocation. Sixteen percent had radiographic evidence of arthritis. Early occupational therapy evaluation and education can help these patients better understand and adapt to their limitations.
View details for PubMedID 2786020
TRAPEZIOMETACARPAL ABNORMALITIES IN EHLERS-DANLOS SYNDROME JOURNAL OF HAND SURGERY-AMERICAN VOLUME 1989; 14A (1): 89-94
COMPLICATIONS OF INTRAMEDULLARY RODS IN OSTEOGENESIS IMPERFECTA - BAILEY-DUBOW RODS VERSUS NONELONGATING RODS JOURNAL OF PEDIATRIC ORTHOPAEDICS 1988; 8 (6): 645-649
Twenty-nine patients with osteogenesis imperfecta underwent 108 intramedullary roddings with 42 Bailey-Dubow rods and 66 nonelongating rods. The average age at insertion of the first rod was 5 years; average follow-up was 3.1 years (range 1-9 years). The overall complication rate was 60%-69% for Bailey-Dubow rods and 55% for nonelongating rods. Forty-seven percent of bones receiving rods required reoperation. Nonelongating rods had a 29% reoperation rate and a 24% replacement rate; Bailey-Dubow rods had a 19% reoperation rate and a 12% replacement rate.
View details for Web of Science ID A1988Q655600003
View details for PubMedID 3056970
Orthopaedic aspects of central core disease. journal of bone and joint surgery. American volume 1988; 70 (7): 1061-1066
We studied the cases of fifteen patients who had central core disease, a non-progressive congenital myopathy that is usually inherited as an autosomal dominant trait. As infants, the patients had poor muscle tone and developmental delay, and as adolescents and adults, they had varying degrees of proximal muscle weakness and tended to use the Gower maneuver. The most common musculoskeletal problems were dislocation or subluxation of the hip, pes planus, and hypermobility of the joints. The most serious orthopaedic problems were in the hips: ten patients had a total of nine dislocations and six subluxations, nine being present at birth and six developing later. Only nine hips were stable after the initial treatment, and there was a propensity for hip-joint contractures. Scoliosis and patellar instability were also seen. Although patients who have central core disease have been reported to be at increased risk for malignant hyperthermia, this did not occur in our patients.
View details for PubMedID 3403575
ORTHOPEDIC ASPECTS OF CENTRAL CORE DISEASE JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 1988; 70A (7): 1061-1066
KINGELLA-KINGAE INFECTION IN HEALTHY-CHILDREN JOURNAL OF PEDIATRIC ORTHOPAEDICS 1988; 8 (4): 445-449
Kingella kingae is a gram-negative occasional, but normal, inhabitant of the nasopharynx. We present two new cases of this infection that occurred in previously healthy children, and compare and contrast them to other cases reported in the literature. K. kingae osteomyelitis generally has an insidious, subacute onset, whereas septic arthritis has an acute presentation. To date, all strains of K. kingae have been sensitive to penicillin, and no residual damage has been reported following osteomyelitis or septic arthritis, except that residual disk space narrowing did occur after K. kingae discitis.
View details for Web of Science ID A1988N916200012
View details for PubMedID 3292580
Non-union of fractures in children who have osteogenesis imperfecta. journal of bone and joint surgery. American volume 1988; 70 (3): 439-443
Although a fracture rarely fails to unite in a healthy child, non-union is not a rare occurrence in a child who has osteogenesis imperfecta. We identified twelve non-unions in ten patients from a population of fifty-two patients who had osteogenesis imperfecta. The average age of these patients when the diagnosis of non-union was made nine years, and the average age at the time of treatment was 12.5 years. All of the patients had had a decrease in functional ability as a result of the non-union. There were five femoral, four humeral, one radial, one ulnar, and one pubic non-union. Five of the non-unions were hypertrophic, and seven were atrophic. Eight of the nine ununited fractures that were operated on healed after excision of the non-union, intramedullary nailing, and bone-grafting. Three of the non-unions (in two patients) were not operated on, and the one patient in whom surgery failed had an amputation. Non-union was frequently associated with repeated fractures at a progressively deforming site.
View details for PubMedID 3346270
NON-UNION OF FRACTURES IN CHILDREN WHO HAVE OSTEOGENESIS IMPERFECTA JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 1988; 70A (3): 439-443
ADOLESCENT IDIOPATHIC SCOLIOSIS WESTERN JOURNAL OF MEDICINE 1988; 148 (2): 182-191
Adolescent idiopathic scoliosis is the single most common form of spinal deformity seen in orthopedic practice. Our knowledge about the epidemiology, etiology, natural history, and treatment has recently increased dramatically. The incidence of small curves is rather high (2% of the population), whereas severe curves are much less common (<0.1%), but we cannot always predict which curve will progress. Abnormalities of the neuromuscular system and of calcium metabolism, and certain growth, genetic, and mechanical factors may all play roles in the pathogenesis of the disorder. The physiologic secondary effects of severe scoliosis relate to restrictive lung disease, but most patients do not have a deformity great enough to affect their cardiorespiratory function. The psychological and social effects of scoliosis are significant for patients but difficult to quantitate. For most patients with moderate scoliosis-that is, more than 25 to 30 degrees-treatment with an underarm brace or electrical stimulation is adequate to "control" progression of the curve. Surgical fusion allows actual correction of the curve but is indicated in only a small percentage of patients-usually those with more than 50 degrees of deformity.
View details for Web of Science ID A1988M118200005
View details for PubMedID 3279708
A NEW BENDING DEVICE FOR LUQUE RODS SPINE 1986; 11 (1): 52-54
CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS - A DISTINCT CLINICAL ENTITY JOURNAL OF PEDIATRIC ORTHOPAEDICS 1986; 6 (5): 579-584
We reviewed the cases of five children with the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) and compared and contrasted them to 11 cases of subacute osteomyelitis. Significant differences were found between these two groups in the number of cases with positive biopsy cultures, number of clinical episodes, and number of bones involved. In CRMO, cultures are negative, and recurrent clinical episodes involve different bones at different times. The data indicate that CRMO is a distinct clinical entity, different from subacute osteomyelitis; it is a benign, self-limiting inflammatory disease of bone, and no chronic problems have occurred as a result of CRMO. Restraint in antibiotic treatment and in performing repeated biopsies is indicated in CRMO.
View details for Web of Science ID A1986D802800010
View details for PubMedID 3760168
BALANCE REACTIONS AND EYE HAND COORDINATION IN IDIOPATHIC SCOLIOSIS JOURNAL OF ORTHOPAEDIC RESEARCH 1986; 4 (1): 102-107
We undertook this study to determine if subclinical postural control mechanisms were abnormal in idiopathic scoliosis. Ninety-one female patients and fifty-seven age-matched female controls were examined. We used a force plate ataxiometer to quantitate postural sway in the standing position and recorded the displacement and acceleration of the center of pressure during static stance and under perturbation with eyes opened and closed. A joystick-controlled video system was used to measure reaction time and eye-hand motor coordination. The scoliosis group demonstrated significantly less sway during two of the eight standing balance conditions and on the remaining balance tests there was a similar trend, albeit nonsignificant. The reaction time for the scoliosis group was also significantly slower, but the accuracy was not significantly worse. We noted no statistical differences between progressive and nonprogressive or between braced and unbraced patients. The subgroup of patients whose curves progressed despite bracing had a tendency to demonstrate greater stability on all standing tests. They also exhibited faster reaction times and less error in eye-hand coordination than other patient groups. No correlation existed between severity of curve and test performance. We found no indication of deficient balance in idiopathic scoliosis, and the tests could not predict curve progression.
View details for Web of Science ID A1986A508600013
View details for PubMedID 3950801
SEGMENTAL INSTRUMENTATION WITHOUT FUSION IN CHILDREN WITH PROGRESSIVE SCOLIOSIS JOURNAL OF PEDIATRIC ORTHOPAEDICS 1985; 5 (6): 687-690
Nine young children had segmental spinal stabilization without fusion for progressive scoliosis. External bracing was not used. There were no immediate complications, but at a mean follow-up of 28 months, the mean loss of correction was 32% and only four patients maintained the initial correction. The mean interval spinal growth was only 0.8 cm. Rods failed in three patients, requiring revision and fusion. Thus, the early results of this technique are discouraging.
View details for Web of Science ID A1985AVD8800011
View details for PubMedID 4066943
COXA MAGNA FOLLOWING SURGICAL-TREATMENT OF CONGENITAL HIP DISLOCATION JOURNAL OF PEDIATRIC ORTHOPAEDICS 1985; 5 (5): 528-533
We studied coxa magna after operative treatment of congenital dislocation of the hip, including incidence, relationship to treatment, and influence of coxa magna on the acetabulum. Coxa magna was defined as a femoral head with a horizontal diameter at least 15% greater than the symmetrical position on the opposite side. Coxa magna developed in 16 hips (33%). The mean increase was 20.9% (range 15-30%). Three factors correlated with coxa magna: femoral osteotomy (100%), open reduction (75%), and operation at a younger age (mean 15.6 vs. 35.8 months). Four of the 16 hips developed coxa magna following Type 1 avascular necrosis; no other growth deformities appeared. At follow-up, the acetabular indices and the center edge angles were not statistically different between the coxa magna and the control groups. One must avoid confusing coxa magna with hip subluxation or inadequate reduction, of which the latter requires appropriate treatment. Coxa magna gives a good hip if a concentric, congruous reduction is obtained, providing the acetabulum has enough growth potential for remodeling.
View details for Web of Science ID A1985APK9600004
View details for PubMedID 4044810
COMBINED OCCIPITOATLANTOAXIAL HYPERMOBILITY WITH ANTERIOR AND POSTERIOR ARCH DEFECTS OF THE ATLAS IN PIERRE-ROBIN SYNDROME JOURNAL OF PEDIATRIC ORTHOPAEDICS 1985; 5 (4): 475-478
Combined occipitoatlantoaxial instability of the cervical spine occurred in a 8-year-3-month old boy with Pierre-Robin syndrome. He also had failure of ossification of both the anterior and posterior arches of the atlas. An in situ fusion from the occiput to C2 restored cervical spine stability. This case is discussed in relation to other hypermobility and instability syndromes of the cervical spine.
View details for Web of Science ID A1985ALA9400018
View details for PubMedID 4019764
ACETABULAR OSTEOMYELITIS IN CHILDREN CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1984: 71-74
The clinical, laboratory, and roentgenographic features of acetabular osteomyelitis were present in a 20-month-old boy and a five-year-old girl. The clinical and laboratory parameters were similar in extracapsular acetabular osteomyelitis and septic arthritis of the hip. A secondary effusion was evident in roentgenograms in both conditions. Acetabular osteomyelitis responded to selected intravenous antibiotic therapy. Septic arthritis of the hip required immediate surgical drainage as well as appropriate antibiotic coverage.
View details for Web of Science ID A1984SW27700012
View details for PubMedID 6723163
THE CISTERNA CHYLI IN ORTHOPEDIC-SURGERY SPINE 1983; 8 (7): 787-792
The cisterna chyli is normally hidden in prevertebral tissue and rarely encountered by orthopaedic surgeons. However, hyperextension injury and anterior surgical approach to the spine can result in injury and the complication of chylothorax. Prevention of postoperative chylothorax is mainly through awareness of normal anatomic distribution. If a chylothorax occurs, conservative treatment should be instituted (ie, thoracentesis and/or intercostal tube drainage). If drainage persists, exploration may be required to ligate ducts. Intraoperative discovery of an injury can be treated with ligation or repair. Ten orthopaedic spine surgeons were surveyed (estimated 1000 anterior spinal approaches) disclosing observation of the structure 12 times and chylothorax on only three occasions. When using the anterior approach in both spinal trauma and deformity, one must be aware of the structure and the potential complication of injury.
View details for Web of Science ID A1983RY79100017
View details for PubMedID 6665581
MOIRE PHOTOTOPOGRAPHY IN THE EVALUATION OF ANTERIOR CHEST WALL DEFORMITIES JOURNAL OF PEDIATRIC SURGERY 1981; 16 (3): 353-357
One of the major remaining problems in the management of children with anterior chest wall deformities is the lack of a widely accepted objective method of evaluating the severity of the deformity. This deficiency has made it difficult to evaluate indications for operation or the results of operative repair. Moir phototopography is a new method of accurately measuring human body contours utilizing recent developments in applied optics and has been used successfully in scoliosis screening programs. This technique has been applied to the evaluation of anterior chest wall deformities and the initial results of this study are presented. Moir phototopography has proven to be a sensitive, reproducible, and easy to perform method of quantitating pectus deformities. While further evaluation is required, this early experience suggests this technique may provide a means of accurately and objectively measuring chest wall deformities so that their physiologic significance can be precisely investigated and the results of therapy critically reviewed.
View details for Web of Science ID A1981LS41400026
View details for PubMedID 7252740
PERSPECTIVES ON SURGERY FOR SCOLIOSIS IN MENTALLY-RETARDED PATIENTS ORTHOPEDIC CLINICS OF NORTH AMERICA 1981; 12 (1): 113-126
The goals of surgery in the retarded patient with spinal deformity are to maximize function (for example, free the hands, decrease the occurrence of pressure sores, and so forth). Concomitantly, the goal while treating the patient should be to minimize the interference with social, intellectual, and general development while counting on no operation by the patient. The new tools of internal fixation available to the surgeon have made spinal surgery possible in these patients despite their lack of cooperation and their other medical problems, seizures, and spasticity. Although combined Dwyer instrumentation with subsequent posterior Harrington instrumentation or posterior fusion and Harrington instrumentation alone have been used most commonly, recent favorable experience suggests a larger role for segmental stabilization of the spine because of the greater purchase on the spine and the lack of need for prolonged external mobilization.
View details for Web of Science ID A1981LB86800012
View details for PubMedID 7207981
INTRAOPERATIVE SKELETAL SCINTIGRAPHY FOR LOCALIZATION OF OSTEOID-OSTEOMA IN THE SPINE - CASE-REPORT JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 1980; 62 (1): 143-144
COCCIDIOIDOMYCOSIS OF THE SPINE - UNUSUAL ROENTGENOGRAPHIC PRESENTATION CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1979: 78-79
Vertebral osteomyelitis is a frequent consequence of disseminated coccidioidomycosis. In a 25-year-old man, the sequela was a single level unilateral osseous bridge between the second and third lumbar vertebra. A review of previous cases has disclosed one case with a similar roentgenographic picture. The occurrence of a single level unilateral reactive process should arouse suspicion of a localized chronic bone infection.
View details for Web of Science ID A1979HH34700016
View details for PubMedID 477088
DOES PERSISTENT FETAL FEMORAL ANTEVERSION CONTRIBUTE TO OSTEO-ARTHRITIS - A PRELIMINARY-REPORT CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1979: 213-216
Persistence of femoral anteversion into adulthood is a developmental abnormality which Somerville has postulated may predispose to the later development of osteoarthritis of the hip. To test this hypothesis, the femoral anteversion was measured in 20 adult patients with idiopathic osteoarthritis of the hip. The average anteversion in painful hips was found to be 24 degrees compared with 12.11 degrees in the uninvolved hip. None of the pain-free hips had an anteversion of greater than 22 degrees while 54% of those with pain had anteversion greater than this value. While these results are preliminary, they suggest that increased femoral anteversion may definitely contribute to the later development of osteoarthritis of hip.
View details for Web of Science ID A1979JM95400033
View details for PubMedID 535277
MASSIVE ANKYLOSIS FOLLOWING TOTAL HIP ARTHROPLASTY CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1978: 51-54
A total hip arthroplasty was undertaken in a 49-year-old man who had previously spontaneously ankylosed both hips. In addition, the patient possessed hyperostosis of the spine and calf, not characteristic of any previously described spondylitic or hyperostotic syndrome. Nine months postoperatively the patient reankylosed the total hip arthroplasty. This case provides further evidence that total hip arthroplasty must be undertaken with caution in patients with hyperostotic tendencies.
View details for Web of Science ID A1978GJ88000006
View details for PubMedID 743843
Selective arterial embolization for hemorrhage following hip arthroplasty. Clinical orthopaedics and related research 1977: 144-148
A case is presented in which selective embolization of gelfoam was used to control late postoperative bleeding, developing in a patient following hip arthroplasty. Although primarily used in gastrointestinal bleeding, diagnostic and therapeutic angiography, selective embolization is clearly applicable to postoperative bleeding encountered in orthopedics.
View details for PubMedID 598068
TC-99 BONE SCANNING IN EXPERIMENTAL OSTEOMYELITIS CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1977: 361-366
GENERAL ORTHOPEDICS - SELECTIVE ARTERIAL EMBOLIZATION FOR HEMORRHAGE FOLLOWING HIP ARTHROPLASTY CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 1977: 144-148
A cervical spinal cord injury following chiropractic manipulation. Paraplegia 1976; 13 (4): 223-227
A case is presented of a permanent C4 tetraplegia following chiropractic manipulation of a patient with ankylosing spondylitis. The pertinent literature is reviewed.
View details for PubMedID 1264476
FREEMAN-SHELDON (WHISTLING FACE) SYNDROME JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 1976; 58 (1): 148-150