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1.
J Rehabil Res Dev ; 32(1): 25-31, 1995 Feb.
Article in English | MEDLINE | ID: mdl-7760264

ABSTRACT

Mechanical methods of quantifying gait are more sensitive to change than is direct clinical inspection. To assess gait parameters and patterns of patients with stroke, and the temporal changes of these parameters, a foot-switch gait analyzer was used to test 49 ambulatory patients with stroke and 24 controls. Patients walked significantly slower than controls, with decreased cadence, increased gait cycle, and increased time in double limb support. Patients' hemiplegic limbs spent more time in swing and stance when compared to controls; their unaffected limbs spent significantly more time in stance and single limb support compared to controls. Patients' hemiplegic side, when compared with the unaffected side, spent less time in stance and more time in swing. A flatfoot pattern was typically noted on the affected side. General gait parameters improved over time, with the largest changes occurring in the first 12 months. However, the percentage of time spent in double and single limb support, stance and swing, parameters which describe the asymmetrical pattern of gait, did not change over time. Abnormal gait was due to difficulty in moving the body over an unstable limb. Gait analysis can be of importance in documenting abnormalities and determining the effects of therapeutic modalities.


Subject(s)
Cerebrovascular Disorders/physiopathology , Gait , Adult , Aged , Aged, 80 and over , Case-Control Studies , Cerebrovascular Disorders/rehabilitation , Female , Hemiplegia/physiopathology , Humans , Male , Middle Aged
2.
Clin Orthop Relat Res ; (239): 12-8, 1989 Feb.
Article in English | MEDLINE | ID: mdl-2912611

ABSTRACT

The halo skeletal fixator, originally developed for use in patients with poliomyelitis, is now widely used with many types of cervical spine instabilities. Despite its demonstrated effectiveness, certain problem areas, including pin loosening and infection, have been identified. These problems have subsequently inspired detailed studies of skull osteology, biomechanics of pin fixation, and comparisons of techniques of application. Based on these studies, specific recommendations concerning the application and maintenance of the halo have developed. Anterior pin sites should be located in the safe zone approximately 1 cm superior to the orbital rim, cephalad to the lateral two-thirds of the orbit, and below the greatest circumference of the skull. The optimal posterior pin sites are located posterolaterally, diagonal to the corresponding contralateral anterior pins. Pins should be inserted perpendicular to the skull, tightened to eight inch/pounds (0.90 Newton-meter), and retightened once at 48 hours. A subsequent loose pin may be retightened once to eight inch/pounds if resistance is met; otherwise, it should be removed and a new one placed in a different location. Infected pins require antibiotic therapy, wound care, and possibly pin-site change and wound debridement.


Subject(s)
Orthopedic Fixation Devices , Bone Nails , Head , Humans
4.
J Bone Joint Surg Am ; 70(9): 1338-40, 1988 Oct.
Article in English | MEDLINE | ID: mdl-2903165

ABSTRACT

Osteomyelitis and intracranial abscess are among the most serious complications that have been reported in association with the use of the halo device. The cases of five patients who had formation of an intracranial abscess related to the use of a halo cervical immobilizer are described. All of the infections resolved after drainage of the abscess, débridement, and parenteral administration of antibiotics. Meticulous care of the pin sites is essential to avoid this serious complication. Additionally, since all of the infections were associated with prolonged halo-skeletal traction, this technique should be used with caution and with an awareness of the possible increased risks of pin-site infection and of formation of a subdural abscess.


Subject(s)
Bone Nails/adverse effects , Empyema, Subdural/etiology , Traction/adverse effects , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Child , Female , Humans , Male , Orthopedic Fixation Devices/adverse effects , Spinal Diseases/therapy , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiology
5.
Clin Orthop Relat Res ; (233): 7-18, 1988 Aug.
Article in English | MEDLINE | ID: mdl-3042237

ABSTRACT

Disruption of the upper motor neuron inhibitory pathways by stroke, brain trauma, or spinal cord injury leads to muscle spasticity. Spasticity is characterized by increased muscle tone, hyperactive reflexes, and possible clonus or rigidity. The increased muscle tone may result in loss of joint motion, leading to contractures. Treatment of established contractures is difficult. Prevention of contractures by joint mobilization is emphasized as a goal in the management of patients with spasticity.


Subject(s)
Contracture/physiopathology , Muscle Spasticity/physiopathology , Animals , Contracture/prevention & control , Contracture/therapy , Humans , Motor Neurons/physiology , Muscle Spasticity/prevention & control , Muscle Spasticity/therapy , Muscles/innervation , Neural Pathways/anatomy & histology , Neural Pathways/physiology , Neurons, Efferent/physiology
7.
J Bone Joint Surg Am ; 68(3): 320-5, 1986 Mar.
Article in English | MEDLINE | ID: mdl-3949826

ABSTRACT

The medical records of 179 patients were reviewed to identify complications related to the use of the halo external skeletal-fixation device. The complications that were identified included pin-loosening in 36 per cent of the patients, pin-site infection in 20 per cent, pressure sores under either a plastic vest or a plaster cast in 11 per cent, nerve injury in 2 per cent, dural penetration in 1 per cent, dysphagia in 2 per cent, cosmetically disfiguring scars in 9 per cent, and severe pin discomfort in 18 per cent. One hundred and eighty (25 per cent) of the 716 pins used had become loose at least once, and an infection had developed at sixty-seven pin sites (9 per cent). Two-thirds of the pins that were loose or associated with infection required change or removal. These complication rates, particularly of pin-loosening and infection, are exceedingly high. Attention to details in pin application, pin maintenance, and proper pin-site care may minimize the number of complications.


Subject(s)
Orthopedic Fixation Devices/adverse effects , Abscess/etiology , Adolescent , Adult , Aged , Bone Nails/adverse effects , Cervical Vertebrae/injuries , Child , Child, Preschool , Cicatrix/etiology , Female , Follow-Up Studies , Fractures, Bone/complications , Fractures, Bone/therapy , Humans , Joint Dislocations/complications , Joint Dislocations/therapy , Male , Middle Aged , Osteomyelitis/etiology , Skull/injuries
8.
Spine (Phila Pa 1976) ; 10(8): 696-8, 1985 Oct.
Article in English | MEDLINE | ID: mdl-4081875

ABSTRACT

Twenty-seven cadaver skulls and 20 CT scans of skulls were measured above the orbital rim and ear but below the greatest diameter to determine optimal placement of halo pin sites. At the antero- and posterolateral portions of the calvaria, the outer table averaged 2 mm, the diploe 3 mm, and the inner table 2 mm. At the temporal fossa, the outer cortex averaged 1.7 mm, the diploe 2.0 mm, and the inner table 1.6 mm. Average distance between the anterior edge of the temporal fossa and the frontal sinus approximated 3 cm. These data confirm previously recommended halo pin insertion sites, anterolaterally and posterolaterally, where the bone is thickest and the thinner frontal sinus and temporal fossae are avoided.


Subject(s)
Bone Nails , Skull/anatomy & histology , Adult , Aged , Female , Humans , Male , Middle Aged , Skull/diagnostic imaging , Tomography, X-Ray Computed
9.
J Orthop Res ; 3(1): 121-3, 1985.
Article in English | MEDLINE | ID: mdl-3981291

ABSTRACT

It has been recommended that halo torque screwdrivers be used only once. To determine if this advice is justified on biomechanical grounds, five commercially available torque screwdrivers were cycled 1,600 times each in an Instron testing machine over a 7-day period. The screwdrivers displayed an initial error from the dial reading at both 6 and 10 in-lb of only +/- 0.3 in-lb. After cyclic loading and retesting, the percent deviation from original calibration was 8% at both 6 and 10 in-lb. These data demonstrate the accuracy and dependability of the torque screwdrivers and imply that repeated use of these devices should be safe.


Subject(s)
Bone Nails , Fracture Fixation, Internal/instrumentation , Biomechanical Phenomena , Calibration , Cervical Vertebrae/injuries , Cervical Vertebrae/surgery , Equipment Failure , Evaluation Studies as Topic , Fractures, Bone/surgery , Humans , Rotation
10.
Spine (Phila Pa 1976) ; 7(6): 545-50, 1982.
Article in English | MEDLINE | ID: mdl-7167826

ABSTRACT

One hundred fifteen cervical fractures, 51 thoracic and lumbar major fractures, 214 compression fractures, and 34 transverse process fractures from Los Angeles County-University of Southern California Medical Center and Rancho Los Amigos Hospital were reviewed. Epidemiology, fracture type, and early results of treatment in terms of musculoskeletal and neurologic stability were studied. Flexion-rotation fractures of the cervical, thoracic, and lumbar spine showed significant loss of reduction when not treated with operative internal fixation. Operative intervention did not influence the neurologic outcome. Laminectomy resulted in progressive deformity and a significantly increased incidence of second operations. Epidemiology indicated changing patterns of fracture.


Subject(s)
Fractures, Bone/therapy , Spinal Injuries/therapy , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Fracture Fixation, Internal , Humans , Laminectomy , Male , Middle Aged , Reoperation
11.
Spine (Phila Pa 1976) ; 5(6): 502-6, 1980.
Article in English | MEDLINE | ID: mdl-7466458

ABSTRACT

A retrospective review of 152 cases of cervical spine injury suffered in water sport-related accidents is presented. Water sport accidents were the second most common cause of traumatic quadriplegia among patients treated on the Spinal Injury Service at Rancho Los Amigos Hospital. The mechanics of injury in 80% of the cases involved flexion and/or axial loading forces. A fracture of the body of C5 was seen in two thirds of the cases. The ratio of complete to incomplete cord lesions was approximately 1:1, with anterior cord syndrome being the most commonly observed. Various risk factors are identified.


Subject(s)
Athletic Injuries/etiology , Spinal Cord Injuries/etiology , Adolescent , Adult , Athletic Injuries/complications , Athletic Injuries/therapy , Diving , Female , Humans , Male , Paraplegia/etiology , Quadriplegia/etiology , Spinal Cord Injuries/complications , Spinal Cord Injuries/therapy
12.
J Bone Joint Surg Am ; 61(1): 2-6, 1979 Jan.
Article in English | MEDLINE | ID: mdl-759430

ABSTRACT

A study was made of thirty-nine traumatic posterior dislocations of the hip that had remained unreduced for from three days to nine years. The purpose of the review was to compare the results of closed and open reduction with those of primary reconstructive surgery. Three of the twenty hips that had closed or open reduction had good results as compared with ten of the thirteen hips that had primary reconstructive surgery. Six hips that were left dislocated had uniformly poor results.


Subject(s)
Arthrodesis/methods , Arthroplasty/methods , Hip Dislocation/surgery , Hip Fractures/surgery , Joint Prosthesis/methods , Acetabulum/injuries , Adolescent , Adult , Aged , Female , Follow-Up Studies , Fracture Fixation, Internal , Hip Dislocation/complications , Hip Fractures/complications , Humans , Male , Middle Aged , Osteotomy/methods , Time Factors
13.
J Bone Joint Surg Am ; 60(8): 1111-2, 1978 Dec.
Article in English | MEDLINE | ID: mdl-721863

ABSTRACT

Roentgenograms were made of two patients with acute dislocations of the cervical spine who were undergoing treatment on Stryker frames with cervical traction. Losses of reduction were evident when the patients were turned from the supine to the prone position. The pulmonary vital capacity of patients with complete traumatic quadriplegia consistently decreased when they were turned to the prone position. Prolonged supine positioning of patients on the Stryker frame also caused occipital decubitus ulcers.


Subject(s)
Joint Dislocations/therapy , Traction/adverse effects , Humans , Joint Dislocations/diagnostic imaging , Male , Posture , Pressure Ulcer/etiology , Quadriplegia/complications , Radiography , Traction/instrumentation , Vital Capacity
15.
J Bone Joint Surg Am ; 60(6): 769-75, 1978 Sep.
Article in English | MEDLINE | ID: mdl-100499

ABSTRACT

Twenty patients with spinal cord injury complicated by ossification around the hip were followed for eighteen months or more. The bone scan, roentgenogram, level of alkaline phosphatase, and range of hip motion of each patient were analyzed. The average follow-up was forty months. The heterotopic ossification usually did not mature until after one and one-half years. The roentgenograms were of no value in judging its maturity. The bone scan correlated well with the results of the alkaline phosphatase testing in judging maturity of the ossification. We concluded that before operative resection, a patient should have a normal level of alkaline phosphatase, decreasing activity on the bone scans, and a restriction of motion to less than 50 degrees of hip flexion.


Subject(s)
Ossification, Heterotopic/etiology , Pelvic Bones , Spinal Cord Injuries/complications , Adolescent , Adult , Alkaline Phosphatase/analysis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Ossification, Heterotopic/diagnostic imaging , Radiography , Radionuclide Imaging
16.
Spine (Phila Pa 1976) ; 3(2): 103-7, 1978 Jun.
Article in English | MEDLINE | ID: mdl-663758

ABSTRACT

Flexion-extension motion and compression-distraction forces across the cervical spine were evaluated in 6 patients in halo vests and in 1 patient in a halo cast. Motion in the vest was evaluated in supine and upright positions and averaged 31% of normal motion at the levels tested. Compression-distraction forces showed great individual variation and frequent compression. The average distraction force varied in different positions by nearly 20 pounds in the vest and over 30 pounds in the cast. Methods of improving cervical spine stability in halo orthoses are discussed.


Subject(s)
Cervical Vertebrae/physiopathology , Fractures, Bone/therapy , Motion , Orthotic Devices , Stress, Mechanical , Adult , Casts, Surgical , Cervical Vertebrae/injuries , Evaluation Studies as Topic , Humans , Middle Aged , Traction/instrumentation
18.
Prosthet Orthot Int ; 1(1): 47-51, 1977 Apr.
Article in English | MEDLINE | ID: mdl-615987

ABSTRACT

The Rancho Flotation Bed provides hydrostatic support with maximum pressures over bony prominences of 15 to 25 mm Hg (measured with a pneumatic pressure transducer). This is generally below the levels normally quoted as conducive to the development of ischaemia. Clinical experience has shown the bed to be a successful aid to nursing by eliminating the need to turn the patients for pressure reasons, allowing patients with pressure sores to remain in a position which is more comfortable and more suitable for other nursing care. It also makes it easier for nurses to handle patients in order to care for the pressure sores.


Subject(s)
Beds , Pressure Ulcer/prevention & control , Adolescent , Adult , Bentonite , Humans , Male , Paraplegia , Polyvinyl Chloride , Pressure Ulcer/therapy , Water
19.
J Bone Joint Surg Am ; 57(2): 206-15, 1975 Mar.
Article in English | MEDLINE | ID: mdl-1112847

ABSTRACT

Between 1954 and 1970, 351 patients with severe paralytic scoliosis were treated at Rancho Los Amigos Hospital. During this time the treatment evolved through five stages: body cast alone, halo cast, halo cast with buttons and traction wires, Harrington instrumentation, and finally preoperative halo-femoral traction and Harrington instrumentation. Coincident with this evolution, correction improved from 20 to 57 per cent, the incidence of curve progression dropped from 38 to 0 per cent, and curve extension decreased from 25 to 0 per cent, while postoperative recumbency was reduced from one year to about three weeks. In addition, complications changed, in general decreasing except for the rate of pseudarthrosis, which remained essentially the same. Clinically significant hyperlordosis involving the thoracic and lumbar spine was seen in sixteen patients who had long fusions from the fourth cervical vertebra and above to the fourth lumbar vertebra or the sacrum.


Subject(s)
Casts, Surgical , Paralysis/complications , Scoliosis/therapy , Spinal Fusion , Traction , Braces , Female , Follow-Up Studies , Humans , Lordosis/etiology , Male , Orthopedic Equipment , Postoperative Care , Preoperative Care , Pseudarthrosis/etiology , Quadriplegia/complications , Respiratory Paralysis/complications , Respiratory Paralysis/therapy , Scoliosis/surgery , Spinal Fusion/methods , Traction/instrumentation , Traction/methods
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