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Biomedical subjects

A H Crawford

Publications and source records attributed to A H Crawford.

At least 19 recordsLinked to original sources
PubMed1992

Hip involvement in juvenile rheumatoid arthritis.

We followed 386 children who met the criteria for juvenile rheumatoid arthritis (JRA) an average of 89 months. Hip involvement in JRA results in poor functional capacity. The prognosis for the pauciarticular group is good, but patients with onset at age greater than 6 years appear to do worse than those aged less than 6 years. In the polyarticular group, age of onset did not change the prognosis, whereas the systemic-onset group aged less than 6 years had a worse prognosis and more frequent radiographic changes than the older group.

Adolescent↗
PubMed1991

Diskitis in children.

Thirty-six patients diagnosed with diskitis from 1978 to 1988 and followed for an average of 29.2 months were reviewed. The study included 23 boys and 13 girls with an average age of 5.3 years. The initial symptoms varied, but distinct clinical patterns emerged and were identifiable in different age groups. Both the leukocyte count and sedimentation rate were elevated. Routine roentgenograms were positive for intervertebral disk space narrowing in 82% of cases, technetium bone scans positive in 72%, and magnetic resonance imaging positive in all recent cases. Treatment consisted of bed rest for all patients, plaster casts for 50%, antibiotics for 40%, and traction for 23%. Regardless of the treatment combination, the course of the disease in most children is benign. At the completion of the study, all patients were asymptomatic including three children who had recurrences. In spite of being asymptomatic, 74% had persistent roentgenographic changes. The administration of antibiotics appears to be appropriate when indicated, i.e., failure to respond to immobilization. Disk space aspiration or biopsy should be reserved for those cases that are refractory to immobilization and antibiotics.

Adolescent↗
PubMed1990

Operative treatment of spine fractures in children.

Spinal column fractures in children are unusual. This article presents concise methods of evaluation and management of these injuries with regard to their alignment, stability, and possible spinal canal compromise. The role of radiographic imaging is defined and illustrated by example. The author recommends the techniques outlined in this chapter for stabilization of those spinal column injuries in children when surgery is thought to be indicated.

Adolescent↗
PubMed1990

Operative management of fractures of the shaft of the radius and ulna.

Diaphyseal fractures of the radius and ulna usually can be managed by closed reduction and immobilization in a long arm cast. Open fractures may benefit from pinning if the reduction will be difficult to maintain. Fractures that cannot be reduced or for which satisfactory alignment maintained are best managed operatively. Our preference is for intramedullary fixation. Operative management will be necessary most frequently in children older than age 10.

Adolescent↗
PubMed1990

Subtalar stabilization of the planovalgus foot by staple arthroereisis in young children who have neuromuscular problems.

A new approach was developed for the treatment of planovalgus feet in children who have spastic cerebral palsy and are less than six years old. The procedure consists of subtalar stabilization (arthroereisis) with a Vitallium staple, and it corrects alignment, restores balance, and allows continued function. It is safe, technically simple, and efficient. Between 1980 and 1988, forty-eight arthroereises were done. The results of thirty-one procedures in twenty patients who were two to ten years and ten months old at the time of the operation were followed for an average of 4.1 years (range, two to seven years). Approximately 85 per cent of the results were excellent or good. Only one foot needed a revision; this was due to migration of the staple. At the most recent follow-up, the talocalcaneal angle had not changed in about 50 per cent of the feet. In another seven, the change ranged from 5 to 10 degrees. All of these patients had a satisfactory result. In all but three feet, the goal of maintaining the stability of the talocalcaneal joint without orthotics or osseous fusion was achieved. Originally, the procedure was done only in patients who were less than six years old, but, because of its success, the indications were extended to children of any age who had severely involved and neurologically compromised feet. Satisfactory results were obtained in the older children as well.

Cerebral Palsy↗
PubMed1989

Pitfalls of spinal deformities associated with neurofibromatosis in children.

A study of 116 patients younger than 12 years of age conclusively diagnosed as having neurofibromatosis was undertaken to determine the incidence of significant orthopedic problems. Deformities of the spine comprised the most common skeletal problem. Seventy-four patients (64%) had spinal deformities. Forty-six patients were treated by posterior spinal fusion. Ten required exploration for pseudarthrosis; six were found to have pseudarthrotic defects in the fusion mass. Eight patients had more kyphosis than scoliosis. Only three patients with kyphoscoliosis obtained a solid posterior spinal fusion after multiple surgical procedures. Anteroposterior and lateral roentgenograms of the cervical spine are recommended at the time of initial evaluation of all spinal deformities. Four patients had severe cervical spine deformities, only one of whom was initially identified as having a cervical spine disorder while under treatment for scoliosis. Three of these patients were seen by other surgical services for neck masses. Following removal of posterior elements, the osseous structures were unstable. Only one patient developed spondylolisthesis. Because of the exceedingly high incidence of pseudarthrosis and spinal instability following attempts at spinal fusion, certain guidelines have evolved for the management of these deformities. High-volume computed tomographic myelography in the prone, lateral, and supine positions or magnetic resonance imaging should be performed on all patients prior to surgical treatment. Anterior disc excision and bone graft followed by posterior arthrodesis with instrumentation are indicated if the kyphotic angle is greater than 50 degrees or if scoliosis is greater than 80 degrees. Even combined anterior and posterior arthrodesis operations did not guarantee successful permanent spinal stability in young patients with neurofibromatosis.

Child↗
PubMed1989

Summary of patient data from a multidisciplinary neurofibromatosis clinic.

The Neurofibromatosis Clinic of the Children's Hospital Medical Center in Cincinnati, Ohio, is a multidisciplinary clinic which provides comprehensive care for persons affected with neurofibromatosis. Data are presented on 78 patients who fulfill the diagnostic criteria for neurofibromatosis-1. The information reported includes patient characteristics, complications and testing results.

Clinical Protocols↗
PubMed1989

Pediatric update #6. False aneurysm arising from a closed femur fracture in a child.

A 10-year-old boy presented to the emergency room with a closed left femur fracture after being hit by an automobile. Because of diminishing pulses in his extremity, an arteriogram was performed revealing a 2.5 x 2.0 cm pseudoaneurysm of the popliteal artery. To our knowledge, this is the first case report of a young child with this type of injury.

Aneurysm↗
PubMed1988

Pitfalls and complications of fractures of the distal radius and ulna in childhood.

Fortunately, most bone forearm fractures in children heal with minimal functional disability. My approach to management of the most common injuries is presented. By following the guidelines outlined in this article, the generalist as well as the most sophisticated upper extremity surgeon should be able to avoid pitfalls and complications when managing forearm fractures in children.

Child↗
PubMed1987

Foot and ankle problems.

The most common reason for children presenting to the general or the pediatric orthopedist has to do with foot problems. The usual age group ranges from the neonate to preschool. The authors have made an attempt to present guidelines for our approach to foot problems other than clubfoot in these age groups and have rendered our recommendations for treatment. We feel that pediatric and general orthopedists will be able to utilize our methods in the management of the pediatric patient with the more commonly presenting foot disorders.

Ankle↗