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Biomedical subjects

Benjamin Joseph

Publications and source records attributed to Benjamin Joseph.

15 recordsLinked to original sources
PubMed2006

Measurement of tissue hardness: can this be a method of diagnosing compartment syndrome noninvasively in children?

In order to assess the feasibility of using the measurement of tissue hardness as a method of diagnosing compartment syndrome noninvasively in children, a simple hand-held device to measure tissue hardness was fabricated. The relationship between hardness and compartmental pressure was studied in an experimental model and in three fresh amputated lower limbs. Normal tissue hardness of the forearm was measured in 189 children and 20 adults to identify the factors that influence normal tissue hardness. The reproducibility of measurement of tissue hardness was assessed on the experimental model, on the amputated limbs and in normal individuals. Experimental data from this study suggest that there is a nonlinear relationship between intracompartmental pressure and tissue hardness. The study also shows that tissue hardness can be measured reproducibly in the forearm of children with the device. Several factors influence tissue hardness such as the age of the child, the site of measurement on the limb, the hand dominance and active muscle contraction. These factors may affect the specificity of this measure as a screening tool for diagnosing compartment syndrome. Further refinement of the measuring device and well designed clinical trials are needed to establish whether compartmental syndrome can be diagnosed reliably by measuring tissue hardness noninvasively.

Adolescent↗
PubMed2006

Recurrent migratory sympathetically maintained pain syndrome in a child: a case report.

A 10-year-old boy presented with pain and swelling of short duration in his right hand. A traumatic cause was ruled out. He had clinical features suggestive of sympathetic overactivity in the form of hyperesthesia, edema and dry skin. The results of a few baseline investigations performed at this stage were all within normal limits. A provisional diagnosis of sympathetically maintained pain syndrome (SMPS) was made. He responded dramatically to a stellate ganglion block. His symptoms recurred within 3 weeks, though now in the lower limb. Again the clinical features were consistent with SMPS. His response to a lumbar sympathetic block was again dramatic. This case illustrates that the diagnosis of SMPS is essentially clinical and that prompt diagnosis and treatment with sympathetic blocks can be very rewarding.

Autonomic Nerve Block↗
PubMed2006

The use of a working model for teaching functional and applied surgical anatomy of the subtalar joint.

BACKGROUND: Some aspects of functional and applied anatomy may be difficult to conceptualize if taught by conventional methods. In such situations, alternative methods of teaching may need to be adopted. This study was undertaken to evaluate whether a working model can facilitate understanding of the functional and applied surgical anatomy of the subtalar joint. METHODS: A working model of the articulated talus and calcaneus was constructed and used to explain the mechanics of motion of the subtalar joint, the rationale of release of structures to correct hindfoot deformity in clubfoot, principles of tendon transfers, and the rationale of extra-articular subtalar joint arthrodesis. Twenty-four orthopedic residents were divided into two groups (A and B). Group A was taught these specific concepts of functional and applied anatomy with the help of the model, while Group B was taught the same concepts with a written text and diagrams. The level of knowledge of both groups was evaluated by a test with multiple-choice questions. A week later, Group A was given the text while Group B was shown the model. Both groups then answered a questionnaire assessing the value of the model in enhancing their understanding of the subject. RESULTS: In the test, the performance of students in Group A was better than those in Group B. Students of both groups felt that the model gave them a much clearer understanding of the functional anatomy of the subtalar joint. CONCLUSIONS: We conclude that this simple, inexpensive model is a valuable teaching aid that helps students to understand the surgical anatomy of the subtalar joint. CLINICAL RELEVANCE: Surgeons can use this model to effectively teach trainees in this field about the mechanics and anatomy of the subtalar joint and other relevant applications.

Adult↗
PubMed2005

How does a femoral varus osteotomy alter the natural evolution of Perthes' disease?

To study how a femoral osteotomy alters the natural evolution of Perthes' disease, records and radiographs of 640 patients with Perthes' disease were analyzed. The data of 314 patients who underwent femoral osteotomy were compared with those of non-operated patients. A new modification of classification of the stages of evolution of the disease was used to identify the timing of surgery and to monitor the progress of the disease following surgery. The duration of each stage of the disease, the extent of epiphyseal extrusion, the extent of widening of the femoral metaphysis and the dimensions of the acetabulum were noted on sequential radiographs. The changes in the femoral epiphysis and metaphysis and changes in the acetabulum were also noted. It was observed that a varus osteotomy clearly alters the natural evolution of Perthes' disease. Of patients who were operated in the stage of avascular necrosis, 34% bypassed the stage of fragmentation. The duration of the disease was shorter in these patients. The duration of the stage of fragmentation was reduced in operated children who passed through the stage of fragmentation. The extent of femoral head extrusion was minimized at the stage when it was most vulnerable for deformation. Metaphyseal widening and subsequent femoral head enlargement were also minimized in children who underwent a femoral osteotomy. The chances of retaining the sphericity of the femoral head were much higher in those children who had a femoral osteotomy. These beneficial effects of a varus osteotomy, were most evident when the operation was performed either in the stage of avascular necrosis or in the early stage of fragmentation.

Case-Control Studies↗
PubMed2005

The choice of intramedullary devices for the femur and the tibia in osteogenesis imperfecta.

The results of intramedullary rodding of 50 femoral and 25 tibial segments were analyzed retrospectively. The techniques of femoral rodding included single Rush rodding, dual Rush rodding and Sheffield telescoping rodding. Single Rush rods or Sheffield rods were used in the tibia. The frequencies of fractures following rodding and implant-related complications and the interval between initial rodding and rod revision were analyzed. The longevity of the rods was evaluated by survival analysis. In the femur, dual Rush rods and Sheffield rods were equally effective and both were superior to a single Rush rod with reference to each of the outcome variables. The technique of dual Rush rodding was more demanding than telescoping rodding. In the tibia, a single Rush rod was as effective as a Sheffield telescoping rod. Based on our results, a single Rush rod would be the preferred implant in the tibia while in the femur, dual Rush rods or a Sheffield telescoping rod may be preferred.

Adolescent↗
PubMed2005

Non-union in osteogenesis imperfecta.

A retrospective study of 44 patients with osteogenesis imperfecta treated over a 14-year period was undertaken to determine the frequency and pattern of non-unions of long bones in these patients. Nine non-unions were encountered in eight patients. Four of these non-unions developed at sites of osteotomies performed at the time of intramedullary rodding. These children have remained asymptomatic, however, without appreciable limitations in spite of the non-union. Five atrophic or gap non-unions that occurred in the humerus were following inadequately treated fractures. These children were disabled on account of the non-unions. In three patients all attempts at obtaining union failed. The other two patients were braced. We conclude that non-union in osteogenesis imperfecta is not a very rare phenomenon. We also recommend that all fractures in children with osteogenesis imperfecta must be treated with appropriate immobilization to prevent a gap non-union developing, since gap non-unions are exceedingly difficult to treat.

Adolescent↗
PubMed2002

Congenital distal humeral dysplasia: a case report.

Congenital dysplasia of the humerus is very rare. It is characteristically seen in omodysplasia and has also been reported as one of the associated features of Larsen's syndrome. We report a 4-year-old girl with bilateral humero-ulnar dysplasia, with dislocation of the elbows, facial dysmorphism, ball-and-socket ankles and foot deformities. Although the elbow dysplasia is similar to that seen in Larsen's syndrome, other pathognomic features of Larsen's syndrome were absent. The changes seen in the elbows in this patient are also different from those encountered in omodysplasia. We believe that this condition may be a distinct form of skeletal dysplasia hitherto undescribed.

Abnormalities, Multiple↗
PubMed2002

Grebe syndrome with bilateral fibular hemimelia and thumb duplication.

Grebe syndrome is a rare recessively inherited form of short-limbed dwarfism. Among the skeletal anomalies reported in the past, complete fibular hemimelia and thumb duplication have not been documented. We report a case of Grebe syndrome with these associated anomalies and review the various skeletal anomalies reported in the literature related to this syndrome. Awareness of the skeletal anomalies that can occur in this syndrome should enable an accurate diagnosis.

Diagnosis, Differential↗
PubMedDate not supplied

Natural evolution of Perthes disease: a study of 610 children under 12 years of age at disease onset.

Records and 2,634 pairs of radiographs (anteroposterior and lateral) of 610 patients with Perthes disease were reviewed. The evolution of the disease was divided into seven stages (stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV) based on plain radiographic appearances. Intraobserver and interobserver reproducibility of this new classification system was assessed. The duration of each stage of the disease was noted. The stages at which epiphyseal extrusion and widening of the metaphysis occurred and the stages at which metaphyseal and acetabular changes appeared were identified. The shape and the size of the femoral head, the extent of trochanteric overgrowth, and the radius of the acetabulum were assessed in hips that had healed. The new classification system of the evolution of Perthes disease was reproducible and helped to identify when crucial events occur during the course of the disease. The median duration of each stage varied between 95 and 335 days. Epiphyseal extrusion and metaphyseal widening was modest in stages Ia, Ib, and IIa but increased dramatically after stage IIb. More than 20% extrusion occurred in 70% of the hips by stage IIIa. Metaphyseal changes were most frequently encountered in stage IIb, while acetabular changes were most prevalent in stage IIIa. At healing, only 24% of untreated patients had spherical femoral heads, while 52% had irregular femoral heads. The timing of epiphyseal extrusion, metaphyseal widening, and the appearance of adverse metaphyseal and acetabular changes suggest that femoral head deformation occurs by stage IIIa in untreated hips. Hence, if containment were to succeed, it should be achieved before this stage.

Age of Onset↗
PubMedDate not supplied

Optimal timing for containment surgery for Perthes disease.

To identify the optimal timing for containment surgery for Perthes disease, the outcomes following femoral osteotomy of 97 children were analyzed. Univariate and multivariate analyses were employed to identify variables that influenced the shape and size of the femoral head at healing. The timing of surgery was an important variable that had a bearing on the outcome. The chances of retaining a spherical femoral head were much higher in children operated on either during the stage of avascular necrosis or in the early part of the fragmentation stage than in those operated later. The authors conclude that containment surgery aimed at preventing femoral head deformation in Perthes disease should be performed before the advanced stage of fragmentation. Further, any study on the outcome of containment treatment of Perthes disease must consider the timing of containment as a variable that influences the outcome while interpreting the results.

Arthroscopy↗
PubMedDate not supplied

Management of congenital pseudarthrosis of the tibia in children under 3 years of age: effect of early surgery on union of the pseudarthrosis and growth of the limb.

The study was undertaken to determine whether the results of treatment of pseudarthrosis of the tibia in children under age 3 are so poor as to recommend that surgery be deferred until after 3 years of age. Radiographs and case records of 26 consecutive patients with Crawford type IV congenital pseudarthrosis of the tibia who were treated operatively were reviewed. Growth abnormalities of the tibia, fibula, and femur of the affected limb at presentation were identified. The outcome of treatment, in terms of union of the pseudarthrosis, refracture rate, and limb length, in 13 children treated operatively before age 3 years was compared with those operated on later. Union of the pseudarthrosis occurred in 12 of 13 children (92%) who were treated before 3 years of age by excision of the pseudarthrosis, intramedullary rodding, and dual-onlay cortical bone grafting. Union occurred in only five of seven children who underwent the same procedure between the ages of 3 and 12 years. The extent of shortening of the limb at the time of surgery was least in children younger than 3 years. The limb length discrepancy remained virtually static in 11 children who had transarticular Rush rodding before age 3. Growth abnormalities of the fibula, tibia, and femur were less pronounced in children operated on early. The study suggests that there is no need to defer surgery for pseudarthrosis of the tibia until the child is older than 3 years.

Child↗
PubMedDate not supplied

Evaluation of outcome of treatment of congenital clubfoot.

The study was undertaken to determine whether existing systems of outcome evaluation of clubfoot are comparable; to determine the relationship between the shape of the foot, its function, and radiological tarsal relationships; and to identify which objective variables used in the assessment of clubfeet are reproducible. Fifty treated idiopathic clubfeet were assessed by the scoring systems of Laaveg and Ponseti, McKay, Magone, and Ghanem and Seringe. Although there was a good correlation between the scores, there was very poor agreement between the grading of feet by these different systems. The feet were also evaluated using a new scoring system that has 3 domains of evaluation, viz, morphological, functional, and radiological. Comparison of the scores in each of these domains showed that there was a correlation between morphology, function, and radiological measurements of tarsal alignment. Several of the criteria used in this new scoring system were reproducible.

Ankle Joint↗