Biomedical subjects

Brian T Carney

Publications and source records attributed to Brian T Carney.

16 recordsLinked to original sources

PubMed2006

Sagittal knee kinematics after hamstring lengthening.

The purpose of this study was to analyze sagittal knee kinematics after hamstring lengthening. A retrospective analysis was performed of 16 children (32 knees) with cerebral palsy who underwent hamstring lengthening as an isolated surgical procedure. Gait analysis was performed before surgery and at a minimum of 1 year after surgery. Decreased stance maximum knee flexion, stance minimum knee flexion, swing maximum knee flexion, and swing minimum knee flexion were noted. Total knee excursion increased. The present study confirmed the previously reported increased total knee excursion with decreased stance minimum and swing maximum knee flexion.

Adolescent↗

PubMed2006

Fate of the normal uninvolved hip opposite closed reduction of unilateral developmental dislocation of the hip.

The purpose of this study was to determine the incidence of avascular necrosis and acetabular dysplasia in the normal uninvolved contralateral hip opposite a unilateral dislocated hip. Thirty-five children with unilateral developmental dislocation of the hip underwent closed reduction. Medical records were reviewed for gender, side, age at reduction, and presence of the ossific nucleus at reduction. Avascular necrosis was reported as present if there was proximal femoral deformity on postoperative radiographs. Acetabular dysplasia was noted as present based on reported values. The mean age at reduction was 10 months. The mean age at time of follow-up radiograph was 101 months. There was no evidence of avascular necrosis in any of the uninvolved hips. Acetabular dysplasia was present in 22 (63%) uninvolved hips.

Acetabulum↗

PubMed2006

Comparison of fracture versus radiolucent table in the treatment of slipped capital femoral epiphysis.

PURPOSE: Compare slipped capital femoral epiphysis stabilized on fracture versus radiolucent table. METHODS: Twenty unilateral stable mild slipped capital femoral epiphyses were stabilized in-situ with a single screw. Age, sex, side, body-mass index, type of table, anesthesia time, surgery time, fluoroscopy time, number of fluoroscopy images, preoperative/postoperative lateral head-shaft angle, and number of screw threads engaging the epiphysis were noted. RESULTS: There were no differences in the measured parameters. CONCLUSIONS: Stabilization of mild slipped capital femoral epiphysis can be accomplished reliably and safely with the use of either a radiolucent or fracture table.

Adolescent↗

PubMed2006

Sagittal knee kinematics following hamstring lengthening.

The purpose of this study was to analyze sagittal knee kinematics following hamstring lengthening. A retrospective analysis was performed of 16 children (32 knees) with cerebral palsy who underwent hamstring lengthening as an isolated surgical procedure. Gait analysis was performed prior to surgery and at a minimum of one year after surgery. Decreased stance maximum knee flexion, stance minimum knee flexion, swing maximum knee flexion, and swing minimum knee flexion were noted. Total knee excursion increased. The present study confirmed the previously reported increase in total knee excursion with decrease in stance minimum and swing maximum knee flexion after hamstring lengthening.

Adolescent↗

PubMed2006

Incidence of hip dysplasia in idiopathic clubfoot.

There is reported to be no increased risk for developmental dysplasia of the hip in children with idiopathic clubfoot. The purpose of this study was to determine the incidence of radiographic hip dysplasia in infants with idiopathic clubfoot. Fifty-one children with idiopathic clubfoot who underwent surgical release by a single surgeon had anterior-posterior pelvis radiographs obtained at 4 or more months of age to screen for developmental dysplasia of the hip. The acetabular index measured more than 28 degrees in eight children (16%). This study suggests an association between idiopathic clubfoot and developmental dysplasia of the hip.

Child, Preschool↗

PubMed2005

Reliability of acetabular measures in developmental dysplasia of the hip.

The purpose of this study was to determine the reliability in the measurement of the acetabular index and the acetabular angle in children with developmental dysplasia of the hip. Seventeen children with unilateral developmental dislocation of the hip treated by closed reduction were reviewed. The acetabular index and the acetabular angle of 34 hips were measured twice by two observers. The method of Bland and Altman as outlined by Loder was used to calculate reliability. Mean age at reduction was 9 months. Radiographs were reviewed at a mean of 58 months following reduction. The intraobserver reliability of the acetabular index in involved hips was +/-4.1 degrees. The intraobserver reliability of the acetabular angle for involved hips was +/-3.6 degrees. The interobserver reliability of the acetabular index in involved hips was +/-13.7 degrees. The interobserver reliability of the acetabular angle for involved hips was +/-7.8 degrees. To ensure true change, a single observer should document at least an 8 degrees change in the acetabular index or a 7 degrees change in acetabular angle between two radiographs.

Acetabulum↗

PubMed2005

Acetabular dysplasia following closed reduction of developmental dislocation of the hip.

The purpose of this study was to determine the incidence of acetabular dysplasia following closed reduction of developmental dislocation of the hip, particularly as it relates to the age at reduction and the presence of the ossific nucleus. Thirty-five children with unilateral developmental dislocation of the hip underwent closed reduction. Medical records were reviewed for gender, side, age at reduction, use of Pavlik harness, prereduction traction, presence/absence of the ossific nucleus, and whether adductor longus tenotomy was performed. Acetabular index was measured. The mean age at reduction was 10 months. The mean length of follow-up was 91 months. Following closed reduction, the incidence of acetabular dysplasia was 69% (24 hips). No statistically significant relationship between acetabular dysplasia and age at reduction or presence of the ossific nucleus was demonstrated.

Acetabulum↗

PubMed2005

Measurement variability of the lateral head-shaft angle in slipped capital femoral epiphysis.

The lateral head-shaft angle as described by Southwick is used to assess the severity of slipped capital femoral epiphysis and to measure progression. Intraobserver variability in measuring the lateral head-shaft angle may influence decision making. The purpose of this study was to determine intraobserver variability in the measurement of the lateral head-shaft angle of slipped capital femoral epiphysis. The lateral head-shaft angle of 108 hips was measured twice by three observers. The two-way analysis of variance method of Bland and Altman as outlined by Loder was used to determine the intraobserver variability. For the lateral head-shaft angle in slipped capital femoral epiphysis, the intraobserver variability was +/-5.9 degrees . To ensure true change, a single observer should document at least a 12 degrees change in the lateral head-shaft angle between two radiographs.

Adolescent↗

PubMed2004

Nonsurgical treatment to regain hip abduction motion in Perthes disease: a retrospective review.

The purpose of this study was to document the ability of a nonsurgical program to improve restricted passive hip abduction in children with Perthes disease. Containment as a form of treatment was recommended if passive hip abduction of 30 degrees or more could be achieved. Medical records and radiographs were retrospectively reviewed for 74 children. Age at admission and onset, side, length of stay, and measurement of passive hip abduction at admission/discharge were recorded. The average increase in abduction with the hip extended was 13 degrees. Forty-two children achieved 30 degrees or more of abduction with the hip extended. Average length of stay was 13 days. Management of restricted abduction in an inpatient setting can allow consideration of containment in 61% of children previously not thought to have the required motion.

Adolescent↗

PubMed2004

Is the absence of the ossific nucleus prognostic for avascular necrosis after closed reduction of developmental dysplasia of the hip?

The presence of the ossific nucleus before reduction of developmental dysplasia of the hip may reduce the rate of avascular necrosis. Forty-eight hips in 45 children who underwent successful closed reduction had at least a 2-year follow-up. Medical records were reviewed for sex, side, Pavlik harness, traction, age at reduction, adductor tenotomy, cast duration, length of follow-up, and subsequent surgery. Prereduction radiographs were reviewed for presence or absence of the ossific nucleus. Avascular necrosis was noted as present if there was evidence of Bucholz and Ogden type II, III, or IV on the postreduction radiographs. Avascular necrosis was noted postreduction in 17 hips. Adductor tenotomy may reduce the rate of avascular necrosis following closed reduction. Delaying closed reduction until the presence of the ossific nucleus can be detected radiographically may reduce the rate of avascular necrosis. The presence of avascular necrosis increases the need for subsequent surgery.

Female↗

PubMed2003

Sagittal knee kinematics following combined hamstring lengthening and rectus femoris transfer.

The purpose of this study was to review knee kinematics following combined hamstring lengthening and rectus femoris transfer. Previous findings reported in the literature include kinematic changes in the magnitude of stance-phase maximum knee flexion, stance-phase minimum knee flexion (extension), and swing-phase maximum knee flexion; the timing of swing-phase maximum knee flexion and swing-phase minimum knee flexion (extension); and total knee excursion. Twenty-three children underwent bilateral (22) or unilateral (1) hamstring lengthening and rectus femoris transfer (45 knees) at the Shriners Hospitals for Children in Lexington, KY between January 1996 and December 2001. Sagittal knee kinematic data were obtained as part of a complete gait study accomplished before surgery and at 1 year after surgery. Values were compared using a paired t test method set at a p < .05 level to determine statistical significance. Changes were seen in the magnitude of stance-phase maximum knee flexion, stance-phase minimum knee flexion (extension), swing-phase maximum knee flexion, and swing-phase minimum knee flexion (extension); in the timing of swing-phase maximum knee flexion; and in total knee excursion.

Adolescent↗

PubMed2002

A retrospective review of congenital pseudarthrosis of the tibia.

Thirty-three children with congenital pseudarthrosis of the tibia seen from 1970 to 1997 at the Shriners Hospitals for Children in Lexington, KY were retrospectively reviewed. Twelve children were excluded due to follow-up of less than 2 years. Data was collected on age, sex, side and associated neurofibromatosis from the medical records of the remaining 21 children. Lesions were classified as to status at birth. The number of surgical attempts for union was recorded. Presence of bony union, deformity, and limb length discrepancy was noted. The mean age at last follow-up was 13 years. Union was reported in 10 children (48%). There was no union after more than 3 surgical attempts. The 11 children without union had an average of 4 surgical attempts (range 2-6). Amputation was performed in 7 of the 11 children without union. No predictor for nonunion was identified. Amputation was frequently needed.

Child↗

PubMedDate not supplied

Slip progression after in situ single screw fixation for stable slipped capital femoral epiphysis.

The medical records and frog-leg lateral radiographs of 37 children with 46 stable slips treated with in situ single cannulated screw fixation at the Shriners Hospitals for Children, Lexington, from 1990 to 1998 were reviewed. The first postoperative frog-leg lateral radiograph was used to determine the head-shaft angle, the screw position, and the number of screw threads that engaged the epiphysis. The mean age at surgery was 12.3 years. The mean age when a frog-leg lateral radiograph first demonstrated physeal closure was 14.0 years. Nine slips (20%) demonstrated progression of more than 10 degrees from the first postoperative frog-leg lateral radiograph to the frog-leg lateral radiograph at first physeal closure. Slip progression appears inversely related to the number of screw threads engaging the epiphysis on the postoperative frog-leg lateral radiograph. The nine hips that progressed all had less than five screw threads engaging the epiphysis on the first postoperative frog-leg lateral radiograph. None of the 24 hips with five or more screw threads engaging the epiphysis on the first postoperative frog-leg lateral radiograph demonstrated progression. Slip progression was not related to screw position. Time to physeal closure was not related to screw position or the number of screw threads that engaged the epiphysis on the first postoperative frog-leg lateral radiograph. Screw advancement until five threads engage the epiphysis appears appropriate.

Adolescent↗

PubMedDate not supplied

Is operative blood loss associated with valproic acid? Analysis of bilateral femoral osteotomy in children with total involvement cerebral palsy.

Valproic acid (VPA) may increase surgical bleeding. The purpose of this study was to review the effect of VPA on blood loss during bilateral femoral osteotomy in children with cerebral palsy. The medical records of 29 children were retrospectively reviewed. Blood volume, total blood loss, and postoperative blood loss were calculated. Fourteen children were taking no anticonvulsant medications, nine children were taking anticonvulsant medications other than VPA, and six children were taking anticonvulsant medications including VPA. The group taking anticonvulsant medications including VPA had significantly lower preoperative platelet counts (204,000) and a significantly greater incidence of transfusion (50%). Compared with the group taking no anticonvulsant medications, the group taking anticonvulsant medications including VPA had a significantly greater change in hematocrit and greater blood loss. Blood loss and the need for transfusion should be anticipated for in children with cerebral palsy taking VPA who undergo femoral osteotomy.

Anticonvulsants↗

PubMedDate not supplied

Demographics of idiopathic clubfoot: is there a seasonal variation?

A seasonal variation in the incidence of idiopathic clubfoot has been reported. The purpose of this study was to determine whether a seasonal variation existed in the authors' population. The medical records of 245 children who presented with idiopathic clubfoot were reviewed. Expected month of birth, month of conception, and season of birth were determined. National Vital Statistics Reports for Births: Final Data for 2001 provided comparison data. The authors' group differed from the national data, with a male predominance and a greater percentage of mothers less than 25 years old at delivery, but was similar in regard to infants born preterm, cesarean delivery, and low birthweight. Analysis failed to identify a monthly or seasonal variation in the authors' population.

Adolescent↗

PubMedDate not supplied

Sagittal knee kinematics after rectus femoris transfer without hamstring lengthening.

The purpose of this study was to assess the sagittal knee kinematics of rectus femoris transfer without hamstring lengthening. A retrospective review of seventeen children (29 knees) was performed. Gait analysis was performed prior to surgery and repeated at a minimum of one year after surgery. Sagittal knee kinematics were analyzed. Stance minimum knee flexion increased 7 degrees; swing maximum knee flexion increased 5 degrees; and swing minimum knee flexion increased 5 degrees. The present study confirmed previously reported increases in swing maximum knee flexion. Increases in stance minimum knee flexion and swing minimum knee flexion were also found. These findings have not been previously reported.

Adult↗