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1.
J Pediatr Orthop ; 21(2): 162-4, 2001.
Article in English | MEDLINE | ID: mdl-11242242

ABSTRACT

This study evaluated the accuracy of plain radiographs and computerized tomography (CT) in assessing juvenile Tillaux fractures of the distal tibia. A simulated Tillaux fracture was made in four cadaver specimens and displaced 0, 1, 2, 3, and 5 mm. Plain radiographs and CT were performed on each specimen at each amount of displacement, and the results were compared with the actual amount of displacement present. Plain radiographs and CT were accurate within 1 mm in depicting the actual fracture displacement about 50% of the time. CT was more sensitive than plain radiographs in detecting fractures with >2 mm of displacement. Fracture displacement of >2 mm is generally considered an indication for fracture reduction. Because of its sensitivity in detecting fractures displaced >2 mm, CT is the preferred imaging modality in the assessment of juvenile Tillaux fractures.


Subject(s)
Tibial Fractures/diagnostic imaging , Tomography, X-Ray Computed , Cadaver , Child , Humans , In Vitro Techniques
2.
J Am Acad Orthop Surg ; 8(4): 232-42, 2000.
Article in English | MEDLINE | ID: mdl-10951112

ABSTRACT

The term "developmental dysplasia or dislocation of the hip" (DDH) refers to the complete spectrum of abnormalities involving the growing hip, with varied expression from dysplasia to subluxation to dislocation of the hip joint. Unlike the term "congenital dysplasia or dislocation of the hip," DDH is not restricted to congenital problems but also includes developmental problems of the hip. It is important to diagnose these conditions early to improve the results of treat- ment, decrease the risk of complications, and favorably alter the natural history. Careful history taking and physical examination in conjunction with advances in imaging techniques, such as ultrasonography, have increased the ability to diagnose and manage DDH. Use of the Pavlik harness has become the mainstay of initial treatment for the infant who has not yet begun to stand. If stable reduction cannot be obtained after 2 weeks of treatment with the Pavlik harness, alternative treatment, such as examination of the hip under general anesthesia with possible closed reduction, is indicated. If concentric reduction of the hip cannot be obtained, surgical reduction of the dislocated hip is the next step. Toward the end of the first year of life, the toddlerTs ability to stand and bear weight on the lower extremities, as well as the progressive adaptations and soft- tissue contractures associated with the dislocated hip, preclude use of the Pavlik harness.


Subject(s)
Hip Dislocation, Congenital/diagnosis , Hip Dislocation, Congenital/etiology , Hip Dislocation, Congenital/therapy , Algorithms , Anthropometry , Casts, Surgical , Decision Trees , Humans , Infant , Infant, Newborn , Manipulation, Orthopedic , Medical History Taking , Neonatal Screening , Physical Examination , Risk Factors , Splints , Terminology as Topic , Treatment Outcome , Walking , Weight-Bearing
3.
Orthop Clin North Am ; 30(3): 457-66, ix, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10393767

ABSTRACT

Care of children with disorders of the cervical spine requires an understanding of the anatomic and biologic features particular to the developing pediatric spine. Congenital and developmental alterations further complicate evaluation and treatment of children. Basic knowledge of pediatric cervical spine disorders in Down syndrome, Klippel-Feil syndrome, osteochondrodysplasias, mucopolysaccharidoses, and post-traumatic instability is essential for all orthopedic surgeons. Thorough patient evaluation and appropriate early management may prevent potentially serious neurologic injury and other complications related to cervical spine pathology.


Subject(s)
Cervical Vertebrae/abnormalities , Cervical Vertebrae/surgery , Child , Down Syndrome/complications , Humans , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Mucopolysaccharidoses/complications , Mucopolysaccharidoses/diagnosis , Osteochondrodysplasias/complications , Osteochondrodysplasias/diagnosis
4.
J Pediatr Orthop ; 16(5): 597-601, 1996.
Article in English | MEDLINE | ID: mdl-8865044

ABSTRACT

Cubitus varus may occur after supracondylar humerus fractures. Poor fixation, however, complicates operative treatment of cubitus varus. We discuss the use of external fixation in the treatment of cubitus varus. Five patients had humeral osteotomies with external fixation. The preoperative humeroulnar angle (HUA) averaged -24.2 degrees. The immediate postoperative HUA averaged 12 degrees, and the final angle averaged 13 degrees. Duration of external fixation averaged 8.9 weeks. Complications were one transient radial neurapraxia, one superficial pin infection, and one keloid. No loss of correction or motion occurred with external fixation; we recommend external fixation as safe and effective.


Subject(s)
Fractures, Malunited/surgery , Osteotomy/methods , Postoperative Complications/physiopathology , Shoulder Fractures/surgery , Adolescent , Child , Evaluation Studies as Topic , External Fixators , Female , Fractures, Malunited/complications , Fractures, Malunited/diagnostic imaging , Humans , Male , Radiography , Retrospective Studies , Shoulder Fractures/complications , Shoulder Fractures/diagnostic imaging , Treatment Outcome
5.
Radiology ; 193(2): 447-52, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7972761

ABSTRACT

PURPOSE: To compare computed tomography (CT) and magnetic resonance (MR) imaging in the detection, localization, and characterization of tarsal coalitions. MATERIALS AND METHODS: Preoperative CT and MR images were obtained for 10 feet in nine patients (eight male and one female patients), aged 11-18 years who were unresponsive to conservative therapy. Results from two blinded readers were compared with results from surgery. RESULTS: Five calcaneonavicular and four medial subtalar coalitions were found at surgery. One patient had synovitis. CT depicted six coalitions and four were characterized correctly, but the fibrous coalitions were not characterized correctly. MR depicted all coalitions and seven were characterized correctly, including the fibrous coalitions. At MR imaging, proliferative synovitis was incorrectly characterized as a fibrous coalition. CONCLUSION: These results suggest that MR imaging depicts all coalitions but may not be able to help differentiate synovitis from fibrous coalitions and that CT has limitations in the depiction of fibrous coalitions.


Subject(s)
Magnetic Resonance Imaging , Tarsal Bones/abnormalities , Tomography, X-Ray Computed , Adolescent , Ankle Joint/diagnostic imaging , Ankle Joint/pathology , Child , Congenital Abnormalities/diagnosis , Congenital Abnormalities/diagnostic imaging , Diagnosis, Differential , Female , Humans , Male , Prospective Studies , Synovitis/diagnosis , Synovitis/diagnostic imaging , Tarsal Bones/diagnostic imaging , Tarsal Bones/pathology
6.
Spine (Phila Pa 1976) ; 19(18): 2110-6, 1994 Sep 15.
Article in English | MEDLINE | ID: mdl-7825054

ABSTRACT

STUDY DESIGN: This study kinematically evaluated radiographs of the cervical spine of patients with the Klippel-Feil syndrome in flexion and in extension to determine alterations from normal motion and potential risk. OBJECTIVES: The results in the study group were compared with those of a control group and with published standards for expected motion of the cervical spine. SUMMARY OF BACKGROUND DATA: The body of orthopedic and neurologic literature suggests a significant problem with neurologic deficit in patients with Klippel-Feil syndrome. No previous study has evaluated the kinematics of the cervical spine with a control group of normal individuals and published standards. METHOD: Lateral flexion-extension radiographs of the cervical spine of 111 patients with Klippel-Feil syndrome were kinematically evaluated to determine the motion of each open interspace and to compare motion with that of a control group and published standards. RESULTS: A statistically significant difference of increased motion per open interspaces in the upper cervical segment was noted in individuals with Klippel-Feil syndrome when compared with the control population. Conversely, total motion of the lower cervical segment was significantly decreased in the Klippel-Feil population when compared with normal controls. Lower segment motion per open interspace was not significantly different when the two groups were compared. CONCLUSION: The results of this study suggest that individuals with Klippel-Feil syndrome with hypermobility of the upper cervical segment are at risk for neurologic sequelae, whereas those with alteration in motion of the lower cervical segment are predisposed to degenerative disease.


Subject(s)
Cervical Vertebrae/physiopathology , Klippel-Feil Syndrome/epidemiology , Range of Motion, Articular/physiology , Adolescent , Adult , Cervical Vertebrae/diagnostic imaging , Child , Female , Humans , Klippel-Feil Syndrome/diagnostic imaging , Klippel-Feil Syndrome/physiopathology , Male , Middle Aged , Nervous System Diseases/epidemiology , Radiography , Risk Factors
9.
Instr Course Lect ; 42: 463-72, 1993.
Article in English | MEDLINE | ID: mdl-8463696

ABSTRACT

The young athlete involved in modern sports activity may be subject to considerable problems involving the spine. An appreciation of the differences in spinal anatomy, development, and kinematics facilitates the evaluation of each individual. While a variety of factors are operant that could contribute to difficulty in evaluation and treatment, an organized approach with an emphasis on naturally-occurring variations of the immature spine will allow for appropriate recommendations. While concern exists regarding the individual with congenital, developmental, or hereditary conditions, it is important to respect the individuality of these young athletes and to assess each problem in a comprehensive manner before recommending full or restricted activity. Current research should yield important information that will serve as more absolute guidelines in formulating recommendations for involved adolescent athletes and will establish the natural history of conditions that today remain obscure.


Subject(s)
Athletic Injuries/diagnosis , Spinal Injuries/diagnosis , Adolescent , Athletic Injuries/complications , Down Syndrome/diagnosis , Humans , Joint Instability/diagnosis , Quadriplegia/etiology , Radiculopathy/etiology , Spinal Injuries/complications
10.
J Bone Joint Surg Am ; 72(8): 1150-65, 1990 Sep.
Article in English | MEDLINE | ID: mdl-2398085

ABSTRACT

We evaluated the residual deformity and late treatment of thirty-four hips of thirty-one children who had had septic arthritis when they were less than one year old. The hips were classified into four groups on the basis of radiographic changes. Type-I deformity (five hips) involved transient ischemia of the epiphysis, with or without mild coxa magna, and these hips did not need reconstruction. Type-II deformity (eleven hips) included deformity of the epiphysis, physis, and metaphysis, and these hips needed an operation to prevent subluxation; the goals of the operation included improvement in acetabular coverage, improvement in abductor efficiency by epiphyseodesis or transfer of the greater trochanter, and equalization of limb-length discrepancy by epiphyseodesis of the contralateral limb. Type-III deformity (five hips) involved malalignment of the femoral neck, with extreme anteversion or retroversion or with a pseudarthrosis of the femoral neck that necessitated a realignment osteotomy of the proximal part of the femur or bone-grafting of the pseudarthrosis. Type-IV deformity (thirteen hips) included destruction of the femoral head and neck, with persistence of only a remnant of the medial base of the femoral neck. In the hips that had a Type-IV deformity, the complex clinical problems, which included severe limb-length discrepancy and incompetent articulation of the hip, necessitated operations such as Pemberton osteotomy, trochanteric arthroplasty, arthrodesis, epiphyseodesis of the contralateral limb, and lengthening of the ipsilateral tibia. The functional result was satisfactory in all five hips that had a Type-I deformity, in seven of eleven that had a Type-II deformity, in three of four that had a Type-III deformity, and in only four of thirteen that had a Type-IV deformity.


Subject(s)
Arthritis, Infectious/complications , Hip Joint/pathology , Arthrodesis , Arthroplasty , Bone Lengthening , Epiphyses, Slipped/etiology , Female , Femur Head Necrosis/etiology , Follow-Up Studies , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Infant , Joint Diseases/diagnostic imaging , Joint Diseases/etiology , Male , Osteotomy , Pseudarthrosis/etiology , Radiography
11.
J Pediatr Orthop ; 9(5): 538-40, 1989.
Article in English | MEDLINE | ID: mdl-2529267

ABSTRACT

Eighty-two adolescent patients with symptomatic spondylolysis or spondylolisthesis were treated by nonoperative modalities. Patients' ages ranged from 6.5 to 21 years, and follow-up ranged from 1 to 14.3 years. Thirty-one patients became asymptomatic, 17 had significant but incomplete relief of pain, nine had no relief, and 25 required surgical treatment for pain. Of 12 patients with grade 3 or 4 slip, only one had significant relief of pain, whereas 48 of 70 patients with lesser degrees of slip had significant relief of pain. Nonoperative treatment of degrees of spondylolisthesis of less than or equal to grade 2 can reliably relieve pain in two-thirds of patients.


Subject(s)
Back Pain/therapy , Spondylolisthesis/therapy , Spondylolysis/therapy , Adolescent , Braces , Casts, Surgical , Child , Exercise Therapy , Female , Follow-Up Studies , Humans , Male , Prognosis , Retrospective Studies , Traction
12.
J Pediatr Orthop ; 9(1): 76-8, 1989.
Article in English | MEDLINE | ID: mdl-2492542

ABSTRACT

We report a 15-year-old boy with mucopolysaccharidosis (MPS) Type VII (Sly disease) who was found to have atlantoaxial instability with quadriparesis. Subluxation of C1 on C2 has also been documented in patients with Type I and Type IV MPS. Routine screening of the cervical spine is recommended in patients with "MPS Type VII" so that delayed diagnosis of instability, which may lead to neurologic compromise, is avoided.


Subject(s)
Atlanto-Axial Joint , Joint Instability/etiology , Mucopolysaccharidoses/complications , Quadriplegia/etiology , Adolescent , Atlanto-Axial Joint/diagnostic imaging , Atlanto-Axial Joint/surgery , Humans , Male , Radiography , Spinal Fusion
13.
Clin Nucl Med ; 12(5): 349-53, 1987 May.
Article in English | MEDLINE | ID: mdl-3581619

ABSTRACT

Fourteen patients with slipped capital femoral epiphysis (SCFE) who had high-resolution and magnification bone scintigraphy during treatment were studied. By demonstrating the vascular status of the femoral head and physiologic condition of the growth plate, scintigraphy was found to assist the clinician in the management of patients with this disorder.


Subject(s)
Epiphyses, Slipped/diagnostic imaging , Femur Head/diagnostic imaging , Acute Disease , Adolescent , Child , Chronic Disease , Epiphyses, Slipped/therapy , Female , Humans , Male , Pain Management , Radionuclide Imaging
14.
J Bone Joint Surg Am ; 69(3): 429-36, 1987 Mar.
Article in English | MEDLINE | ID: mdl-3818705

ABSTRACT

We are reporting the cases of five patients who had occipito-atlantal instability, a rare condition that may be due to either trauma or congenital abnormalities. In three of the patients the instability was secondary to trauma. The clinical and neurological manifestations were varied and included cardiorespiratory arrest, motor weakness, quadriplegia, torticollis, pain in the neck, vertigo, and projectile vomiting. All of the patients underwent posterior arthrodesis of the occiput to the first or second cervical vertebra. In the patients who had trauma-related instability, surgery was performed when immobilization in a cast failed to stabilize the spine; in the patients who had a congenital abnormality, arthrodesis was indicated because of persistent symptoms and the potential for catastrophe with minor trauma. Based on our experience, we recommend surgical stabilization by posterior arthrodesis when this form of instability of the cervical spine is diagnosed.


Subject(s)
Atlanto-Occipital Joint , Joint Instability/surgery , Spinal Fusion/methods , Adolescent , Atlanto-Occipital Joint/abnormalities , Atlanto-Occipital Joint/diagnostic imaging , Child , Child, Preschool , Female , Humans , Joint Instability/complications , Joint Instability/etiology , Male , Radiography , Spinal Injuries/complications
16.
J Bone Joint Surg Am ; 68(6): 892-6, 1986 Jul.
Article in English | MEDLINE | ID: mdl-3733778

ABSTRACT

We report the cases of five children, six to eighteen months old, who had bilateral fracture of the pedicles of the second cervical vertebra. The children were treated with gentle cervical traction in mild extension or were maintained in near-anatomical reduction in a Minerva jacket or halo cast. The fractures united in four patients. One patient underwent fusion to stabilize the spine.


Subject(s)
Cervical Vertebrae/injuries , Fractures, Bone/therapy , Braces , Casts, Surgical , Cervical Vertebrae/diagnostic imaging , Female , Fracture Fixation/methods , Fractures, Bone/diagnostic imaging , Humans , Immobilization , Infant , Male , Radiography , Traction
17.
J Pediatr Orthop ; 6(3): 311-6, 1986.
Article in English | MEDLINE | ID: mdl-3519675

ABSTRACT

Previous reports of posterolateral fusion for treatment of adolescent spondylolisthesis at L5-S1 suggest that persistent slippage is a significant problem in the postoperative period. Of 40 adolescent patients who underwent posterolateral fusion for L5-S1 spondylolisthesis, 23 demonstrated Grade 3 slip or worse. Two patients had progression of the slip postoperatively with subsequent spontaneous healing. All patients had complete incorporation of bone graft with resolution of neurologic deficits and pain. Improvement in results is attributed to the surgical technique and to postoperative casting. The displacement index, a new method to document relative L5-S1 position, is described.


Subject(s)
Lumbar Vertebrae/surgery , Sacrum/surgery , Spinal Fusion/methods , Spondylolisthesis/surgery , Adolescent , Adult , Bone Transplantation , Child , Female , Follow-Up Studies , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Postoperative Complications/diagnostic imaging , Radiography , Sacrum/diagnostic imaging , Spondylolisthesis/diagnostic imaging , Wound Healing
18.
Spine (Phila Pa 1976) ; 10(3): 250-2, 1985 Apr.
Article in English | MEDLINE | ID: mdl-3992343

ABSTRACT

Numerous surgical techniques have been described for the treatment of spondylolysis and spondylolisthesis. This case report involves the use of a technique for pars defect repair originally described by James Scott of Edinburgh. Our patient, an 18-year-old woman, was initially treated for bilateral injury to the pars interarticularis with non-operative methods, but the results proved unsuccessful. She then underwent bilateral pars repair at L3 and L4 using iliac bone grafting and wiring of the transverse processes and spinous processes of the involved vertebrae. Follow-up radiographs showed complete fusion of the right pars defects at L3 and L4 and incomplete fusion of the left pars defect. The procedure effectively restored spine stability and repaired the pars defects.


Subject(s)
Lumbar Vertebrae/injuries , Spinal Fusion/methods , Spondylolisthesis/surgery , Spondylolysis/surgery , Adolescent , Female , Humans , Ilium/transplantation , Lumbar Vertebrae/diagnostic imaging , Radiography , Spondylolysis/etiology
19.
Am J Sports Med ; 11(3): 111-5, 1983.
Article in English | MEDLINE | ID: mdl-6688155

ABSTRACT

In order to more accurately document the effects of meniscus removal, 20 children and adolescents with isolated meniscal tears were examined an average of 5.5 years after surgery. All patients with concomitant ligamentous injuries and a history of prior surgery on either knee, and those with bilateral knee pathology or knee pathology outside the meniscus, were excluded. At followup, 60% of the 20 study patients had unsatisfactory results. The clinical results did not correlate with the site of meniscectomy, the type of meniscal tear, the severity of radiographic changes, or whether the patient had total or partial meniscectomy. Evaluation of lower extremity muscle function revealed a statistically significant (P less than 0.05) decrease in hip abductor strength in patients with unsatisfactory results. This study indicates that meniscectomy in the child or adolescent is not a benign procedure, and that failure to rehabilitate hip abductor strength to normal levels significantly comprises the clinical end results.


Subject(s)
Athletic Injuries/surgery , Knee Injuries/surgery , Menisci, Tibial/surgery , Adolescent , Athletic Injuries/physiopathology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Knee Injuries/physiopathology , Knee Joint/physiopathology , Male , Movement , Postoperative Complications , Tibial Meniscus Injuries
20.
J Pediatr Orthop ; 2(5): 496-9, 1982.
Article in English | MEDLINE | ID: mdl-6761366

ABSTRACT

Seventy index patients and 222 first-degree relatives with spondylolysis or spondylolisthesis have been studied by means of interview and clinical and radiological examinations. The index patients had an average age of 18 years, and included 43 females and 27 males. Following Wiltse's classification, 18 patients had dysplastic lesions and 52 had isthmic defects. The first-degree relatives included 99 parents and 125 siblings and children of the index patients. Both isthmic and dysplastic defects occurred in most families, regardless of the classification of the index patient. Isthmic defects were consistently more frequent than dysplastic defects. Spina bifida occulta occurred at the lumbosacral area in 61% of the index patients; in the first-degree relatives, spina bifida occulta was most common among the siblings and children of index patients, and occurred more often in relatives of index patients with dysplastic lesions than in those with isthmic lesions.


Subject(s)
Spondylolisthesis/genetics , Spondylolysis/genetics , Adolescent , Adult , Child , Female , Humans , Male , Spina Bifida Occulta/complications , Spina Bifida Occulta/pathology , Spine/pathology , Spondylolisthesis/complications , Spondylolisthesis/pathology , Spondylolysis/complications , Spondylolysis/pathology
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