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Biomedical subjects

C L Stanitski

Publications and source records attributed to C L Stanitski.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Surgical correction of spinal deformity in cerebral palsy.

Thirteen patients with cerebral palsy underwent surgical correction of spinal deformity at the Children's Hospital Medical Center in Boston. Arthrodesis of the spine was achieved in all cases. Staged anterior fusion and instrumentation with posterior instrumentation and fusion increased the amount of curve correction and reduced the pseudarthrosis rate. All patients with back pain had their pain eliminated following fusion. In all patients, curve progression was arrested, and the objective of improved sitting or standing balance was achieved.

Adolescent↗
PubMedDate not supplied

Noninvasive vascular studies in clubfoot.

A two-phase study investigated vascularity in idiopathic clubfeet (talipes equinovarus, TEV) undergoing a comprehensive soft tissue release. Great toe O2 saturation was measured by pulse oximetry in a consecutive series of 50 TEV (34 patients) in three foot positions: in feet at rest, in feet in maximal passive correction, and in feet immediately postoperatively. Oxygen saturation was between 94 and 100% in 100% of feet at rest, 95-100% in 90% of feet at maximal passive correction, 95-100% in 98% of feet immediately postoperatively, and 97-100% in 100% of feet 3 weeks' postoperatively. Doppler ultrasound studies were performed on 38 TEV. Dorsalis pedis (DP), posterior tibial (PT), and peroneal (P) pulses were recorded at preoperative resting posture, preoperative maximal passive correction, and 3 weeks postoperatively. At rest, DP pulse was present in 37 of 38 feet, PT pulse was present in all feet, and P pulse was present in 20 of 30 tested (67%), whereas 72% PT, 61% DP, and 50% P pulses were unchanged. Pulse oximetry and Doppler assessment are readily available, noninvasive, and reproducible means of monitoring vascular integrity in TEV.

Clubfoot↗
PubMedDate not supplied

Observations on acute knee hemarthrosis in children and adolescents.

Diagnostic knee arthroscopic findings in 70 children aged 7-18 years with acute traumatic knee hemarthroses showed a high incidence of intraarticular lesions. Forty-seven percent of preadolescents (aged 7-12 years) had meniscal tears, and 47% had anterior cruciate ligament (ACL) tears. Forty-five percent of adolescents (aged 13-18 years) had meniscal tears and 65% had ACL tears. Osteochondral fractures accounted for 7% of the lesions. Meniscal and ACL pathology is common in children, especially adolescents. Because arthroscopy provided accurate diagnosis, specific treatment could be instituted.

Adolescent↗
PubMedDate not supplied

Spondylolisthesis in myelomeningocele.

Radiographic spinal evaluations were done on 305 patients with myelodysplasia. Asymptomatic spondylolisthesis, which averaged 37.1% translation, was seen in 5.9% of the patients. The prevalence of spondylolisthesis increased to 15.6% of patients with L5-S1 motor levels. Patients with myelodysplasia do develop spondylolisthesis. Increased lumbar lordosis and concomitant diminished thoracic kyphosis were commonly seen in the patients with spondylolisthesis.

Adolescent↗
PubMedDate not supplied

Tibial torsion in chronic, stable slipped capital femoral epiphyses: evaluation by CT scan.

Externally rotated gait is a hallmark of slipped capital femoral epiphysis (SCFE) attributed to the change of proximal femur structure. This study investigated the potential role of abnormal tibial torsion in 44 patients with chronic, stable SCFE. Comparison of the tibiae of the involved side with the uninvolved side and with previously published normal values showed no evidence of tibial torsional abnormalities in these patients.

Adolescent↗
PubMedDate not supplied

On the nature of stress fractures.

It is felt that stress fractures are caused by excessive, repetitive muscle forces acting across the affected bone. These fractures should be suspected in participants of athletic endeavors who present with a history of persistent, focal, activity-related pain regardless of their stage of physical conditioning. Associated physical findings are localized tenderness and swelling without evidence of a generalized systemic response. Bone scans and serial roentgenograms including specialized views may be required for documentation. Limitation of the athletic activity is the hallmark of the treatment program.

Adolescent↗
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Articular hypermobility and chondral injury in patients with acute patellar dislocation.

Thirty adolescents with acute, primary patellar dislocation were assessed for a relationship between articular hypermobility and chondral injury. The 15 patients without articular hypermobility had a 2.5 times increased frequency of articular lesions when compared with 15 patients with hypermobility. Assessment of articular hypermobility should be part of the examination in patients with patellar dislocation.

Acute Disease↗
PubMedDate not supplied

Correlation of arthroscopic and clinical examinations with magnetic resonance imaging findings of injured knees in children and adolescents.

This study evaluated the correlation among clinical diagnosis, magnetic resonance imaging reports, and arthroscopic findings in 28 patients aged 8 to 17 years (average, 14.4) with knee injuries. Meniscal, anterior cruciate ligament, and articular surface injuries were evaluated. A highly positive correlation (78.5%) was found between clinical and arthroscopic findings. A highly negative correlation was found between arthroscopic and magnetic resonance imaging findings (78.5%) and between clinical and magnetic resonance imaging findings (75%). In this series, accuracy, positive predictive value, negative predictive value, sensitivity, and specificity data were much more favorable from clinical examination than from magnetic resonance imaging. Overall, magnetic resonance imaging diagnoses added little guidance to patient management and at times provided spurious information.

Adolescent↗
PubMedDate not supplied

Articular cartilage injury with acute patellar dislocation in adolescents. Arthroscopic and radiographic correlation.

Acute patellar dislocation and relocation produces major forces at the articular surfaces. Articular injury was assessed in 48 patients, 24 boys and 24 girls (mean age, 14 years), with acute, initial, noncontact patellar dislocations. Correlation of the findings of radiographic and arthroscopic examinations was done. Eleven of the 48 patients (23%) had radiologic diagnoses of articular injuries. Thirty-four of the 48 patients (71%) had arthroscopic evidence of articular damage, 32 osteochondral and 2 chondral injuries. Eight of the 28 (29%) arthroscopically identified osteochondral loose bodies (4 to 20 mm) were identified radiologically. Overall, only 11 of the 34 (32%) arthroscopically documented articular injuries were defined by preoperative radiographs. These standard radiographs provided limited information for management decisions. Poor results after patellar dislocation treatment may involve nonrecognition of articular compromise.

Acute Disease↗
PubMedDate not supplied

The prognostic value of quantitative bone scan in knee osteochondritis dissecans. A preliminary experience.

We reviewed the records of 12 patients ages 9 to 16 years with knee osteochondritis dissecans. All patients had clinical histories and examinations, four radiographic views of the knee, and technetium-99m diphosphonate quantitative bone scans. Scan results (symmetric, increased, or decreased activity), clinical course, healing time, and final outcome were correlated to determine the prognostic value of the scan. We divided the patients into those with open physes (distal femoral and proximal tibial) and those with closed physes. Four of the six patients with open physes had increased activity on the bone scan. All four of these knees healed with nonsurgical treatment. The other two patients had decreased activity on bone scan, and both required surgical treatment after nonsurgical treatment failed. Of the six patients with closed physes, all had increased activity on the bone scan, but only two patients had healing of the osteochondral lesion without surgery. Quantitative bone scanning had a 100% predictive value for the prognosis in osteochondritis dissecans patients with open physes, but for those with closed physes the predictive value was less. Because the natural history in the adolescent group is less predictable, it is in this group that the quantitative scan would be most helpful. In this small group of patients, quantitative bone scanning had limited prognostic value.

Adolescent↗
PubMedDate not supplied

Interpretation of radiographs in a pediatric limb deformity practice: do radiologists contribute?

Orthopaedic surgeons make treatment decisions based on their interpretation of patient radiographs. Radiologists' reports of these radiographs are routine but may add little to the patient's management. The authors prospectively compared data initially recorded by a pediatric orthopaedist in the assessment of teleoroentgenograms obtained over a 3-month period in a limb deformity clinic with the subsequent reports of these studies by pediatric radiologists. Two hundred and sixty-four (100%) anatomic axes of femora and tibiae were measured and reported by the surgeon compared to 1.9% by the radiologist. Limb lengths were recorded 100% of the time by the orthopaedist and by the radiologist in 80% of cases. Abnormal bone quality was present in 43 of 264 (16.2%) limb segments and reported in all involved cases by the orthopaedist. Only 26 (9.8%) of the abnormalities were noted by the radiologist. Only eight of 20 (35%) physeal abnormalities such as rickets were noted by the radiologist in contrast to 20 of 20 (100%) noted by the surgeon. There were no findings described by the radiologist not previously reported by the orthopaedic surgeon. In no case did the radiology interpretation influence clinical management decisions.

Child↗