Correlation of idiopathic scoliosis assessments between newly developed Milwaukee Topographic Scanner and Quantec.

The Milwaukee Topographic Scanner (MTS) is a newly developed system, which utilizes laser technology to obtain three-dimensional topographic evaluation of the spine. The goal of this study was to determine the correlation of topographic measurements between MTS and Quantec Spinal Imaging System. Twelve parameters generated by the MTS and Quantec Spinal Imaging System was compared to each other using the Pearson Coefficient. Twenty patients between the ages 16-18 with scoliosis were evaluated with the MTS and Quantec. There were several parameters, which showed high correlations especially back height (0.972), coronal curve (0.952), and left trunk volume (0.905). MTS is a reliable three-dimensional topographic alternative to radiographs without the exposure to radiation.

Functional classification of patients with idiopathic scoliosis assessed by the Quantec system: a discriminant functional analysis to determine patient curve magnitude.

STUDY DESIGN: A stepwise discriminant analysis was used to define a spinal deformity score based on three-dimensional measurements by the Quantec spinal image system (raster stereophotograph). OBJECTIVE: To provide functional classification of spinal deformity in patients with mild idiopathic scoliosis without using radiographs. SUMMARY OF BACKGROUND DATA: Most studies classify the degree of spinal deformity in terms of coronal plane radiograph without analyzing transverse rotation. To the authors' knowledge, no studies investigating classification of spinal deformity in idiopathic scoliosis using Quantec system measurements have been documented. METHODS: In this study, 129 patients with a single curve and 119 patients with a double curve were divided into three groups according to Cobb angle: Group 1 (less than 10 degrees ), Group 2 (10-20 degrees ), and Group 3 (greater than 20 degrees ). RESULTS: The patients were assigned to the group with the highest scores after application of a stepwise discriminant analysis. The accuracy of the classification system by functional scores for the patients with a single curve was 85% for Group 1, 63.5% for Group 2, and 71.7% for Group 3. The accuracy of classification by functional scores for the patients with a double curve was 87.1% for Group 2 and 76.1% for Group 3. CONCLUSION: The back surface image study is a method for providing a quantitative assessment of mild spinal deformity, allowing evaluation of patients by integrated three-dimensional parameters with no reference to radiographs.

Relationship between Quantec measurement and Cobb angle in patients with idiopathic scoliosis.

The Quantec Spinal Imaging System (QSIS) is a raster stereography used to measure three-dimensional trunk images. The Q angle, a coronal plane measurement generated by the Quantec Spinal Imaging System (QSIS), was compared with the Cobb angle in assessment of scoliosis curve magnitude. One hundred forty-nine patients with idiopathic scoliosis were evaluated using both the Quantec system and plane radiographs. The Cobb and Q angles demonstrated significant correlation in the thoracic region (r = 0.65, p < 0.05), lumbar region (r = 0.63, p < 0.05), and in the thoracolumbar region (r = 0.70, p < 0.05). The difference between the Q and Cobb angles was small when the Cobb angle was <21 degrees with less than 6 degrees of axial surface rotation, as measured by the QSIS method. For smaller curves with minimal rotation, there is close correlation between the Cobb angle and the Quantec angle.

Three-dimensional rotations of the thoracic spine after distraction with and without rib resection: a kinematic evaluation of the apical vertebra in rabbits with induced scoliosis.

An experimental model of induced scoliosis in New Zealand rabbits was studied to evaluate the effects of rib resection on the apical vertebra during distraction for scoliosis surgery. After concave distraction, three-dimensional rotations of the apical vertebra were measured using a motion analysis system, which included three cameras and six reflective markers. Distraction with rib resection on the convexity produced minimal rotations in the coronal plane (0.77 degrees), sagittal plane (0.96 degrees), and transverse plane (0.61 degrees) compared with no rib resection. The distraction maneuver with rib resection has no significant effect on derotation of the apical vertebra in the coronal and transverse plane, but slightly greater forward rotation was apparent in the sagittal plane (p < 0.05). Resection of three convex ribs directly corrects the rib prominence and does not seem to improve derotation.

Variability in three-dimensional measurements of back contour with raster stereography in normal subjects.

Forty normal children with a mean age of 9.1 years were investigated by using a Quantec Spinal Image System (QSIS). The QSIS uses computerized raster stereography technology to acquire three-dimensional measurements of back contour. Within a 95-percentile confidence interval (a) coronal-plane QSIS angles ranged from 0.05 to 2.36 degrees; (b) transverse-plane QSIS angles ranged from 0.03 to 1.96 degrees; and (c) sagittal-plane QSIS angles ranged from 36.8 to 44.8 degrees. Trunk-alignment deviation ranged from 3.51 to 7.45 mm within a 95-percentile confidence interval. An intraobserver standard deviation of +/-4.2 degrees was noted across all angular metrics. Normal ranges of QSIS-determined values for a population of 40 children without clinical evidence of pathology are reported.

Photopenic bone scan osteomyelitis: a clinical perspective.

Eighty-one pediatric patients had nuclear bone-imaging studies confirmatory of osteomyelitis during the past 10 years. Seven (8.6%) of 81 had "cold" osteomyelitis. These seven patients were all toxic [mean temperature (T), 39.9 degrees C; heart rate (HR), 145 beats/min], all had markedly elevated erythrocyte sedimentation rates (mean ESR, 76 mm/h), and six of seven had both confirmatory bone and blood cultures. All patients required surgical intervention. The average length of hospital stay for these seven patients was 32 days (range, 8-65 days). A control group of matched patients with "hot" osteomyelitis was constructed for statistical evaluation. This analysis confirmed significantly increased temperature, resting pulse rate, ESR, length of hospital stay, and rate of surgical intervention in patients with cold versus hot osteomyelitis. Patients with osteomyelitis presenting as a cold defect on bone imaging appeared to have a more aggressive type of bone infection, often requiring aggressive medical and surgical intervention adequately to control this infectious process.

Microbiological tolerance in orthopaedic infections: delayed response of septic arthritis and osteomyelitis of the hip due to infection with tolerant Staphylococcus aureus.

A 14-year-old boy presented to another hospital with a clinical picture of septic arthritis. After aspiration of purulent material from the joint, empiric antibiotic treatment was initiated and an arthrotomy was performed. Antibiotic treatment was then modified to nafcillin according to microbiological sensitivity results of the isolated Staphylococcus aureus as determined by minimal inhibitory concentration testing. One week later purulent drainage recurred and open drainage had to be repeated; an abscess anterior to the joint was noted. Once again the infection failed to resolve, and the patient was transferred to our institution where a third arthrotomy had to be performed. The organism isolated at the first aspiration was reexamined and found to have a minimal bactericidal concentration to minimal inhibitory concentration ratio of 32, implying a tolerant organism. The antibiotic treatment was modified to an antibiotic not subject to the tolerance phenomenon, and the infection resolved without additional surgical intervention.

A case of recurrent Caffey's disease treated with naproxen.

Caffey's disease (infantile cortical hyperostosis) is considered to be a benign self-limiting disease of uncertain etiology that typically appears in early infancy. The following case of Caffey's disease in a young girl is significant from 2 standpoints. First, the course of the disease is atypical because of its severe recurrent nature. The patient experienced 6 highly symptomatic episodes of cortical hyperostosis involving multiple new sites and previously healed lesions. These recurrent episodes persisted into her fourth year of life. In general, the reported cases of late recurrence of Caffey's disease describe patients with minimal symptoms and mild bony involvement. The second area of significance involves the successful use of naproxen to control the symptoms and arrest the progression of the patient's disease. Reports of hyperostosis in patients receiving prostaglandin E to maintain a patent ductus arteriosus suggest that prostaglandins may play a role in the etiology of Caffey's disease. Given this evidence, it seems plausible that there may be a therapeutic role for prostaglandin inhibitors in the successful treatment of Caffey's disease. The patient in this case had immediate and complete resolution of her symptoms while receiving naproxen with no recurrent bone formation while being treated with antiinflammatory drugs.

Osteomalacia with hypophosphatemia and hypercalciuria: a possible new variant of osteomalacia.

A 12-year-old girl had a severe genu valgum deformity and osteomalacia with hypophosphatemia, hypercalciuria, and modestly elevated levels of 1,25-dihydroxyvitamin D3 and intact parathyroid hormone. This patient seems to have a different type of hypophosphatemic osteomalacia from that previously described.

Deformity of the calcaneocuboid joint in patients who have talipes equinovarus.

A retrospective analysis was done of the records and radiographs of 100 club feet (in sixty-six patients) that had been consecutively treated with an operation. Twenty-six feet (26 per cent) had had a Grade-II deformity of the calcaneocuboid joint, as determined with a radiographic classification that had been developed on the basis of the degree of medial displacement of the cuboid. When the calcaneocuboid joint is in normal alignment, the central point of the cuboid ossification center lies on the mid-longitudinal axis of the calcaneus; when there is a Grade-I deformity, the mid-point of the cuboid ossification center lies lateral to the medial tangent but medial to the longitudinal axis of the calcaneus; and when there is a Grade-II deformity, the central point of the cuboid lies on or medial to the medial tangent of the calcaneus. Although a Grade-I deformity of the calcaneocuboid joint need not be corrected, a Grade-II deformity should be treated with release of the calcaneocuboid joint, which in this series was performed in conjunction with a complete subtalar release (including a talonavicular release). Sixteen of the twenty-six feet that had a Grade-II deformity had a complete release of the calcaneocuboid joint at the time of the operation; the release was not done in the remaining ten feet, some of which were operated on early in the series, before the importance of the deformity at the calcaneocuboid joint had been recognized.(ABSTRACT TRUNCATED AT 250 WORDS)

Osteomyelitis and septic arthritis caused by Haemophilus influenzae, type f, in a young girl.

A 4-year-old girl with Legg-Calve Perthes' disease and immunoglobin G1 subclass deficiency developed osteomyelitis of the proximal femur and septic arthritis of the hip secondary to Haemophilus influenzae, type f. This microorganism is a rare cause of invasive infections in children, primarily of the central nervous system (CNS) and respiratory track. It has not previously been associated with bone and joint infections.

Techniques for direct radiographic visualization during closed pinning of supracondylar humerus fractures in children.

After reduction of a displaced supracondylar humerus fracture, the distal humerus must be easy to visualize; radiographic techniques in which the forearm overlaps the distal humerus make interpretation of fracture reduction difficult. Eighteen patients with displaced supracondylar humerus fractures were treated with reduction that was maintained manually with a variant of Dunlop's extension traction. This allows direct fluoroscopic evaluation of Baumann's angle, the contour of the distal humerus, the pin insertion site, and the angle of pin insertion. In young patients with a thin distal humerus and swollen elbow, the easiest pin placement may be achieved by inserting the pin on the lateral view (after the anteroposterior view confirms a satisfactory reduction).

Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy.

To study the natural history of scoliosis in institutionalized adults who have cerebral palsy, we reviewed retrospectively the cases of fifty-one patients. The patients were followed for at least four years (mean, 16.3 years; range, four to forty years) after they had reached skeletal maturity. The individuals in whom the curve eventually progressed the most had had the largest curves at the time of skeletal maturity. The rate of progression was 0.8 degree each year in the patients in whom the curve was less than 50 degrees at the time of skeletal maturity and 1.4 degrees in those in whom the curve was more than 50 degrees (p less than 0.04). The patients who had the largest curves at the time of skeletal maturity had spastic quadriplegia and either a thoracolumbar or a lumbar curve, and they were bedridden.

Long-term follow-up of the flexor carpi ulnaris transfer in spastic hemiplegic children.

A retrospective study was performed on 25 patients with cerebral palsy who underwent transfer of the flexor carpi ulnaris to the radial wrist extendors. The mean age at the time of surgery was 8 years 1 month. The mean follow-up was 8 years 7 months. At follow-up, the mean active wrist dorsiflexion was 44.2 degrees, palmar flexion was 19.0 degrees, supination was 40.2 degrees, and pronation was 53.4 degrees. According to a modification of Green's evaluation system, there were six excellent, nine good, five fair, and five poor results. Two patients required further surgery to correct a supination, dorsiflexion contracture. We found the transfer to be quite effective in improving wrist dorsiflexion, although there was often a significant loss of active palmar flexion postoperatively. The patient therefore should have good digital extension (with the wrist extended passively above neutral) to be considered for the transfer.

A comparison between spinous process and sublaminar wiring combined with Harrington distraction instrumentation in the management of adolescent idiopathic scoliosis.

A study of the efficacy of two techniques of spinal instrumentation on patients with adolescent idiopathic scoliosis was performed. Twenty consecutive patients treated with a single Harrington distraction rod and sublaminar wiring (H-SL) were compared with 20 consecutive patients treated with a single Harrington distraction and spinous process wiring (H-SP). The patients in both groups were similar in age, curve magnitude, curve flexibility, and curve type. The immediate postoperative correction (61% H-SL, 58% H-SP) and follow-up correction (50% H-SL, 49% H-SP) were equivalent. No pseudarthroses were recognized in either group. One patient with H-SL had transient postoperative paresthesias.