PubMed Health⌕ Search

Biomedical subjects

A Strongwater

Publications and source records attributed to A Strongwater.

16 recordsLinked to original sources
PubMed1997

Salter-Harris type III fracture-dislocation of the proximal humerus.

Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result.

Child↗
PubMed1994

Pediatric elbow fractures: MRI evaluation.

Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. Elbow injuries in children may be difficult to diagnose by routine clinical and radiographic techniques [1, 4, 12, 14]. Diagnostic difficulty is due to the presence of multiple ossification centers of the distal humeral epiphysis and proximal radius and ulna; these are mostly cartilaginous until the age of 11-12 years and therefore invisible on radiographs. Following distal radial and distal tibial physeal fractures, epiphyseal elbow injuries are the most frequent epiphyseal injuries [8, 16]. These fractures tend to be unstable and often require surgical intervention. In addition, lasting sequelae such as cubitus valgus and delayed ulnar nerve palsy can occur if these fractures are not treated properly [8].(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1993

Diagnosis of osteoid osteoma in the child.

Fifty-two cases of osteoid osteoma in children under 5 years of age were collected from the English literature and reviewed, along with seven cases from the Hospital for Joint Diseases. Analytic emphasis was placed on the clinical and radiologic difficulties encountered in the diagnosis of osteoid osteoma in children. Diagnosis is especially challenging in patients that are just beginning to walk. Osteoid osteoma is often confused with many other entities. Although pain was the most frequent clinical manifestation, it was absent in 12% of cases; limp tenderness, swelling, and atrophy were the next most frequent findings. When standard radiographic findings proved negative for this condition, technetium bone scans were of considerable efficacy in identifying the tumor. When used, computerized tomograms permitted visualization and precise localization of the tumors in all cases. Bone deformities and leg-length discrepancies were found in more than 25% of the cases. Mini-block excision is recommended at diagnosis.

Bone Diseases, Developmental↗
PubMed1993

Osteoid osteoma under the age of five years. The difficulty of diagnosis.

Ninety-one cases of histologically confirmed osteoid osteoma were collected during an 11-year period; of them, seven (7.6%) had onset of symptoms while younger than five years of age. Special diagnostic difficulties were found in this specific age group: most cases were misdiagnosed or diagnosed incorrectly. The time between the onset of symptoms and the diagnosis varied from three months to five years. Although pain was present in six patients, in four cases, other concomitant signs and symptoms attracted more attention and led to a misdiagnosis and unnecessary invasive procedures. Gait disturbance (limp) was the second most frequent sign and was always present when the lower extremity was affected. In five cases, initial radiographs were not conclusive. Bone scans were very sensitive and conclusive in three cases where radiographs were atypical. Computerized tomograms always located the tumor.

Algorithms↗
PubMed1993

Avascular necrosis of the femoral head as sequela of fracture of the greater trochanter. A case report and review of the literature.

After a fall from a tree, a 12-year-old boy sustained a fracture of the greater trochanter and was subsequently treated by open reduction. Twenty months after surgery, the hip developed to a flexion contracture, limb-length discrepancy, a collapsed, irregular-shaped femoral head with sclerotic areas, and a metaphyseal cyst. A growing child with avascular necrosis of the femoral head after fracture of the greater trochanter seems not to have been reported in the English language literature.

Child↗
PubMed1993

Tarsal navicular position after complete soft-tissue clubfoot release.

The navicular position was evaluated (according to Simons' criteria) on anteroposterior and lateral roentgenograms of 45 clubfeet that were treated with complete soft-tissue release without internal fixation. The evaluation was performed an average of 28 months after surgery. Position of the navicular correlates well with the functional rating score system. Navicular position can be viewed as an indicator for clubfoot correction. Internal fixation of the talonavicular joint was correlated with favorable correction of deformity.

Child, Preschool↗
PubMed1992

New method of limb deformities correction in children.

A new "bloodless" technique (Ilizarov) was used to correct 36 limb deformities in 29 children. There were six leg length discrepancies, five achondroplasias, four deformed feet, five joint contractures, one rotational deformity of tibia, and in three the apparatus was used as an external fixator after corrective osteotomy. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus 11 cm (40%). Bony union was achieved in two out of five pseudoarthroses. Four deformed feet were fully corrected. Joint contractures were corrected in four out of five. The complication rate is as high as in other methods but with the Ilizarov apparatus, longer segments of bone were lengthened and more complex deformities were treated. Complications lessened as experience was gained.

Achondroplasia↗
PubMed1991

Treatment of complex limb deformities in children with the Ilizarov technique.

Twenty-nine children underwent 36 Ilizarov procedures for a variety of limb deformities. We present the results in 11 patients, six with leg length discrepancies and five with achondroplasia, who underwent lengthening procedures using the Ilizarov method. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus length 11 cm (40%). Eleven complications occurred. The most common were pin tract infections (4), joint contractures (2), transient nerve injury (4), premature consolidation (5), and three fractures of the regenerated bone. The complication rate was as high as in other methods, but with the Ilizarov apparatus longer segments of bone were lengthened and more complex deformities were treated. The number of complications were lessened as experience was gained.

Achondroplasia↗
PubMed1990

Revision surgery in clubfeet.

Twenty-nine reoperated clubfeet were reviewed. The age range of the patients at the time of the revision surgery was 1-12 years. The average follow-up period was 30 months (range 9-36 months). The surgical procedure used most often in the revision surgery was complete soft tissue release alone or combined with plantar release, calcaneocuboid fusion, and capsulotomies of the navicular first-cuneiform joint and the first-cuneiform first-metatarsal joint. In 27 of 29 feet the results were considered acceptable (19 of 29 were rated excellent or good). An algorithm that suggests surgical solutions to a variety of clubfoot deformities in different age groups has been developed, as well as an objective functional rating system to evaluate long-term results in revision clubfoot surgery.

Child↗
PubMed1990

Pediatric update #12. A simplified method for percutaneous epiphysiodesis.

Nine patients have undergone percutaneous epiphysiodesis using a 4.5-mm drill and image intensification fluoroscopy. The minimal surgical exposure resulted in minimal postoperative discomfort, excellent cosmesis, and complete closure of the physis in all patients in three to five months. No complications were encountered. The procedure is easy to perform and reliable.

Adolescent↗
PubMed1989

Treatment of slipped capital femoral epiphysis with a cannulated-screw technique.

Sixty patients (eighty hips) who had slipped capital femoral epiphysis were treated by epiphyseodesis with a cannulated-screw technique. Forty-nine patients (sixty-seven hips) were available for follow-up, forty-four (sixty hips) of whom were followed for a minimum of two years. Thirty-five patients (forty-six hips) were followed until the hardware was removed. Of seventy-two hips in which contrast medium was injected, arthrographic results were obtained in three. In these three hips, there was evidence of pre-existing narrowing of the joint space. Four patients (six hips) who did not have evidence of penetration by a screw or guide-wire had evidence of either pre-existing chondrolysis or osteoarthrosis. Chondrolysis did not develop postoperatively in any patient who had no evidence of it preoperatively.

Adolescent↗
PubMedDate not supplied

Anterolateral approach for moderate to severe slipped capital femoral epiphysis.

The efficacy of the anterolateral pinning of moderate and severe slipped capital femoral epiphysis (SCFE) was studied both mechanically and clinically. The mechanical stability of anterolateral pinning was equivalent to that of conventional lateral pinning as shown by study in 16 immature porcine hips. The clinical results in the group pinned from the anterolateral approach were superior in that fewer complications occurred as compared with the traditional lateral approach. The group with anterolateral pinning had 2 complications in 13 hips, whereas lateral pinnings resulted in 8 complications in 28 hips. We recommend the anterolateral approach rather than the conventional lateral approach in pinning of moderate and severe SCFE.

Adolescent↗
PubMedDate not supplied

Neck metaphyseal angle guidance in proximal femoral varus osteotomy.

An angle within the femoral arch is defined, and its line is described in selecting the osteotomy site and the position of the fixation device in performing a femoral varus osteotomy. This neck metaphyseal angle was measured with varying degrees of rotation on seven pediatric femurs; it was also studied on 283 randomly selected hip radiographs. The angle varied 25-40 degrees in 90% of the patients and was not age related. The angle is stable within 5 degrees as long as the landmarks, base of the great trochanter, and medial metaphysis of the femoral neck are definable (0-30 degrees of rotation).

Adolescent↗
PubMedDate not supplied

Selection of an animal model for implant fixation studies: anatomical aspects.

A number of different animal models have been employed by investigators to study the biology of the bone-cement interface as it relates to the problem of hip implant loosening in humans. This study compares to the human three species (baboon, dog, and sheep) currently under use as experimental animal models from an anatomical point of view. A number of parameters, important for the dimensional design of a femoral prosthesis, loads at the hip joint and its subsequent performance, were used for comparing external and internal femoral anatomy. The baboon and dog femora were found to be most similar to the human femur in their external anatomy. The quantification of cancellous bone distribution within the medullary canal revealed that, of the species studied, the sheep femur provided the least support to the prosthesis. The results suggest that the dog and baboon are anatomically appropriate for studying hip implant biomechanics experimentally. Thus, from an anatomical point of view, the current extensive use of the dog as an experimental animal appears appropriate.

Animals↗