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Biomedical subjects

D P Grogan

Publications and source records attributed to D P Grogan.

At least 19 recordsLinked to original sources
PubMed2000

Sever-L'Episcopo tendon transfer in obstetric brachial plexus palsy.

Obstetric brachial plexus palsy produces functional and cosmetic impairment. The Sever-L'Episcopo procedure has been successfully used to improve external rotation, primarily in younger patients. Previous studies have shown steady improvement in motion and function for 1 year from the date of surgery, with little additional change beyond this period. This is a retrospective study of 7 patients who have had the procedure at the Shriners Hospital for Children in Tampa, Florida. Functional and cosmetic results have been uniformly excellent at an average follow-up of 1 year 3 months. No complications have occurred. In addition, the degree of improvement seen in our relatively older patient population has not been previously detailed in the literature.

Brachial Plexus Neuropathies↗
PubMed1999

Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients.

STUDY DESIGN: An outcome questionnaire was constructed to evaluate patient satisfaction and performance and to discriminate among patients with adolescent idiopathic scoliosis. OBJECTIVES: To determine reliability and validity in a new quality-of-life instrument for measuring progress among scoliosis patients. SUMMARY OF BACKGROUND DATA: Meta-analysis of the surgical treatment of adolescent idiopathic scoliosis determined that a uniform assessment of outcome did not exist. In addition, patient measures of well-being as opposed to process measures (e.g., radiographs) were not consistently reported. This established the need for a standardized questionnaire to assess patient measures in conjunction with process measures. METHODS: The instrument consists of 24 questions divided into seven equally weighted domains as determined by factor analysis: pain, general self-image, postoperative self-image, general function, overall level of activity, postoperative function, and satisfaction. The questionnaire takes approximately 5 minutes to complete and is taken at predetermined time intervals. A total of 244 of patients from three different sites responded to the questionnaire. RESULTS: The reliability based on internal consistency was confirmed with a Cronbach's alpha coefficient greater than 0.6 for each domain. In addition, acceptable correlation coefficient values greater than 0.68 were obtained for each domain by the test-retest method on normal controls. Similarly; to establish validity of the questionnaire, responses of normal high school students were compared with that of the patients. Consistent differences were noted in the domains between the two groups with P < 0.003. The largest differences were in pain (control, 29.96 +/- 0.20; patient, 13.23 +/- 5.55) and general level of activity (control, 14.96 +/- 0.20; patient, 12.16 +/- 3.23). Examination of the relationship between the domains and patient satisfaction showed that pain correlates with satisfaction to the greatest degree (Pearson's correlation co-efficient, r = -0.511; P < 0.001), followed by self-image (r = 0.412; P < 0.001). CONCLUSIONS: This questionnaire addresses patient measures for evaluation of outcome in adolescent idiopathic scoliosis surgery by examining several domains. It also allows for dynamic monitoring of scoliosis patients as they become adults. This is a validated instrument with good reliability measures.

Adolescent↗
PubMed1999

Use of allograft bone for posterior spinal fusion in idiopathic scoliosis.

Eighty-seven adolescents with idiopathic scoliosis (77 female and 10 male patients) who underwent posterior spinal fusion with instrumentation using only allograft bone for graft material were evaluated retrospectively. The average age at surgery was 14 years 3 months. Each patient had a minimum 2-year followup, with an average of 3 years 5 months followup. The average preoperative curve was 59 degrees thoracic (range, 31 degrees-90 degrees) and 52 degrees lumbar (range, 21 degrees-65 degrees). At followup, the thoracic curve measured an average of 35 degrees and the lumbar curve measured an average of 34 degrees. The average loss of correction from the immediate postoperative period until last followup was 6.5 degrees or 11% in the thoracic curve and 10 degrees or 19% in the lumbar curve. There were seven reoperations; one of these reoperations involved repair of a pseudarthrosis. There was one clinical infection. The typical patient had a 2-ounce allograft at an average cost of $800. The patients' average loss of correction, complication rate, and reoperation rate compare favorably with results reported in other series using autograft bone. The authors of this study showed the ability of allograft bone to produce reliable results with a satisfactory outcome. The potential advantages of using allograft must be weighed against the potential disadvantages before recommending its routine use.

Adolescent↗
PubMed1997

Effect of proximal phalangeal epiphysiodesis in the treatment of macrodactyly.

The recommended treatment for macrodactyly of the foot will often include epiphysiodesis of the proximal phalanx in an attempt to halt further longitudinal growth of the toe. Nine patients who underwent open epiphysiodesis and debulking of the excess soft tissues involving 11 toes were reviewed to evaluate the effectiveness of this procedure. In 9 of 11 toes, overall length of the proximal phalanx did not change after surgery. Two toes demonstrated continued growth; one of these toes underwent a repeat epiphysiodesis of the phalanx, and the other foot underwent epiphysiodesis of the affected metatarsal. Overall, this surgical approach led to radiographic results that satisfied the surgical goals.

Animals↗
PubMed1996

Effect of intrathecal opioids on somatosensory-evoked potentials during spinal fusion in children.

STUDY DESIGN: Intraoperative recording of somatosensory-evoked potentials is useful for monitoring spinal cord tolerance during spinal fusion with instrumentation. Volatile anesthetic agents are known to have prominent suppressive effects on somatosensory-evoked potentials. This study evaluates the effect of intrathecal administration of opioid, consisting of morphine sulfate and sufentanil, on somatosensory-evoked potential monitoring. OBJECTIVES: To study the effect of different anesthesia techniques on somatosensory-evoked potentials during spinal fusion. SUMMARY OF BACKGROUND DATA: The effect of intravenous narcotic administration on somatosensory-evoked potentials has been well studied and reported. This study shows the effect of intrathecal opioids on somatosensory-evoked potentials. METHODS: Ten patients scheduled for spinal fusion with Cotrel-Dubousset instrumentation were induced with thiopental and maintained with intrathecal morphine sulfate (20 micrograms/kg) and sufentanil 50 micrograms, supplemented with isoflurane 0.5% air and oxygen. Routine monitoring was done, including arterial line and continuous somatosensory-evoked potentials. Anesthesia was maintained constant, with a mean blood pressure of 55 mm Hg. Normocarbia and normothermia were maintained. Baseline somatosensory-evoked potentials were recorded using bilateral posterior tibial nerve stimulation, with constant somatosensory-evoked potential monitoring after the induction of anesthesia. RESULTS: There were no significant changes in either latencies or amplitudes in cortical somatosensory-evoked potentials after opioid injection at any time during the surgical procedures. CONCLUSIONS: Somatosensory-evoked potential monitoring was possible in all patients undergoing extensive spinal surgery. Intrathecal opioid anesthesia with low concentrations of isoflurane in air and oxygen seems to have no effects on somatosensory-evoked potentials.

Adolescent↗
PubMed1994

Talocalcaneal coalition in patients who have fibular hemimelia or proximal femoral focal deficiency. A comparison of the radiographic and pathological findings.

The prevalence of congenital anomalies of the foot was studied in ninety-nine children (105 limbs) who had fibular hemimelia or proximal femoral focal deficiency, or both. Twenty-six of these patients had had a Syme amputation at our institution and the specimens were analyzed anatomically; they were found to include fourteen talocalcaneal coalitions (54 per cent). The preoperative radiographs of these same patients, however, revealed only four such coalitions (15 per cent). Thirty-seven of the ninety-nine patients had had a Syme amputation previously at another facility (with subsequent follow-up at our institution), and ten of them (ten feet) had radiographs that were adequate for analysis of congenital anomalies. Forty-two feet that had not yet been amputated were also analyzed radiographically. Nine of these fifty-two feet included in the radiographic analysis had a talocalcaneal coalition, a radiographic prevalence similar to that found on the preoperative radiographs of the twenty-six patients included in the anatomical analysis. The true prevalence of talocalcaneal coalition remains to be determined; however, this can be done only at the time of skeletal maturity. Examination of the twenty-six amputation specimens revealed only one talocalcaneal coalition in the nine patients who had proximal femoral focal deficiency alone, six such coalitions in the eight patients who had only fibular hemimelia, and seven coalitions in the nine patients who had both proximal femoral focal deficiency and fibular hemimelia. These findings should be useful in the evaluation of the radiographic anatomy of the feet in children who have proximal femoral focal deficiency or fibular hemimelia, or both, particularly if limb-lengthening is considered as a treatment option.

Calcaneus↗
PubMed1991

Congenital lipofibromatosis associated with macrodactyly of the foot.

Congenital lipofibromatosis of the foot, a type of paracrine growth disorder, is a distinct clinical entity that must be differentiated from other causes of macrodactyly, with specific diagnostic and therapeutic considerations. Eleven skeletally immature patients with congenital lipofibromatosis and macrodactyly of the foot were studied. Diagnostic histopathologic criteria were documented. The most specific pathologic finding of congenital lipofibromatosis is an overabundance of fibrofatty tissue on the plantar aspect of the foot and involved toes. Surgical defatting or debulking procedures, ray resection, and phalangeal epiphysiodesis produced significant cosmetic improvement. Syndactylization and phalangeal resection were not as beneficial.

Adolescent↗
PubMed1990

Fractures of the calcaneal apophysis.

Eleven patients with 12 open or closed fractures of the calcaneal apophysis were reviewed. The patterns of fracture varied, although all could be classified by a scheme similar to that used for physeal injuries in the long bones. Open injuries involved young children and were associated with subsequent maldevelopment of the posterior (nonarticular) portion of the calcaneus due to growth mechanism damage. The other susceptible age group, adolescence, had two patients with slipped calcaneal apophysis (type 1 injury), similar to slipped capital femoral epiphysis, and three patients with a splitting fracture through the apophysis and physis into the main part of the calcaneus (type 4 injury). Microscopic physeal injury was also observed in the calcaneus of a fatally injured boy.

Adolescent↗
PubMed1989

The painful accessory navicular: a clinical and histopathological study.

Twenty-two skeletally immature patients with 39 accessory tarsal navicular bones were seen over a 4-yr period. Twenty-five of the feet with accessory naviculars were symptomatic and, after failure of conservative treatment, were treated by excision of the accessory bone, the synchondrosis, and the prominent portion of the main navicular ossification process. No attempt was made to reroute the posterior tibial tendon. All 25 operative feet were completely relieved of the preoperative pain. The external oblique view was found to be the best radiographic view to demonstrate the accessory navicular. Histological findings in the surgical specimens included areas of micro-fracture through the cartilaginous synchondrosis, acute and chronic inflammation, and cellular proliferation indicative of attempted repair. These changes are consistent with the theory that chronic chondro-osseous tensile failure can occur in this condition and is responsible for the clinical findings.

Adolescent↗
PubMed1989

Chondro-osseous growth abnormalities after meningococcemia. A clinical and histopathological study.

The cases of nine children who survived the acute stage of meningococcal septicemia and secondary disseminated intravascular coagulation were reviewed. All of the children had major orthopaedic problems as a result of the acute disease. Detailed histological studies were performed on specimens of bone and cartilage, obtained when these patients had either acute amputation for gangrene or subsequent revision for a chondro-osseous deformity. In the specimens that were obtained from the children who had acute gangrene, the histological changes included small-vessel thrombi, osteonecrosis, subperiosteal new-bone formation, cortical disruption, cellular disorganization in the physis, and medullary inflammation. These findings were compatible with a combination of inflammation (acute osteomyelitis) and ischemia. In the specimens that were obtained during revision of the amputation, three years or more after the initial infectious or ischemic process, the clinically relevant findings involved the epiphyses and physes. The growth plates showed variable permanent ischemic damage. Bone bridges connecting the epiphysis and metaphysis were observed in various stages of formation, including several early bridges with involvement of only the physis and metaphysis. Endosteal and cortical bone, in contrast, showed complete recovery with no evidence of permanent ischemic damage. We concluded that children who survive meningococcal septicemia are at high risk for complex orthopaedic problems, both acute and chronic. The disseminated intravascular coagulation and focal infections of the acute phase are primarily responsible for the vascular injuries to the growing chondro-osseous tissues. Ischemic changes also selectively involve the physeal circulation, but may take several years to adversely affect longitudinal and transverse growth of bone.

Adolescent↗
PubMed1988

Lawn-mower injuries in children.

The power lawn mower is capable of inflicting serious injury, particularly to the pediatric population. A total of 27 patients who had sustained lawn-mower injuries were reviewed to identify those factors responsible for power-mower accidents and to determine an effective treatment regimen for these patients. The injuries included amputations in 19, major lacerations in 34, and fractures in 23 extremities. Aggressive treatment of both the soft tissue and bony injuries was necessary. Fractures were treated with either open reduction and internal fixation or external fixation, as appropriate, and early soft tissue coverage. The results were satisfactory in the majority of patients, but often required multiple surgical procedures over a number of years. The incidence of these injuries can be reduced by educating the public about the potential dangers of these machines, and by encouraging the use of proper safety procedures.

Accidents, Home↗
PubMed1988

Post-traumatic fracture of polymethylmethacrylate surrounding a Harrington hook site. A radiolucent cause of instability and pain.

As polymethylmethacrylate (PMMA) is used more often in spine surgery, problems associated with its use are likely to be encountered. A case is presented of a young patient with myelomeningocele and scoliosis. The patient presented with instability and pain associated with fractured PMMA surrounding the lower Harrington hook site. Since the PMMA was radiolucent, the fractures were not visible on radiographs. The patient required surgical exploration and revision. The stability achieved with PMMA may present future liabilities, therefore, its use should be limited to those unusual cases with specific indications.

Child↗
PubMed1987

Congenital malformations of the lower extremities.

An understanding of the normal and pathologic development of the lower limb allows the physician a fuller appreciation of the clinical and functional disabilities that each congenital malformation may present. Treatment to allow achievement of each child's fullest potential may then be better attained.

Child↗
PubMed1985

Innominate osteotomy and varus derotational osteotomy in the treatment of congenital dysplasia of the hip.

The long-term functional and radiographic outcome of congenital hip dysplasia in patients previously diagnosed and nonoperatively treated, who subsequently underwent operative treatment after walking age was retrospectively reviewed in 94 patients (87% return). Innominate osteotomy (75 hips, 15.2 years mean follow up) yielded satisfactory late radiographic results in 33% of the subluxated hips and 50% of the dislocated hips, despite more encouraging results at one year (56% and 63.6% respectively). Varus derotational femoral osteotomy (35 hips, 10.8 years mean follow up) yielded a satisfactory radiographic outcome in 55.6% of the subluxated hips and 38.5% of the dislocated hips, with little change from the results at one year. Late diagnosis, late operative treatment, and complications of treatment, particularly ischemic necrosis of the femoral head, were predictive of poor outcome. Combined procedures (10 hips, 12 years mean follow up) or secondary open procedures were ineffective. Although Severin radiographic grade varied with time, functional status remained virtually the same throughout individual follow up. Those patients followed beyond skeletal maturity who developed gross articular incongruity or osteoarthritis, showed a decline in functional status.

Adolescent↗
PubMed1984

Transient idiopathic periosteal reaction associated with dysproteinemia.

Periosteal reaction with new bone formation in a child is a radiographic finding with an extensive differential diagnosis. The present case is that of a child who presented with a clinical syndrome of fever, bone pain in the forearm and leg, bony tenderness in these areas, radiographic evidence of a periosteal reaction in both tibiae and ulnae, and an abnormality of serum proteins. It was a self-limited disease process requiring no specific treatment, with eventual return to normal of both the radiographic and serum protein abnormalities. Its relationship to Caffey's disease remains to be defined.

Child↗
PubMed1983

The congenital undescended scapula. Surgical correction by the woodward procedure.

At The Hospital for Sick Children in Toronto, 21 undescended scapulae were corrected by the Woodward procedure in 20 patients over the past 18 years. The average age at operation was six years six months. The average follow-up period after operation was 8 years 9 months. Fifteen patients were girls and five were boys. All the patients had other associated abnormalities. Only one patient had a concomitant clavicular osteotomy. The average increase in glenohumeral abduction was 37 degrees. The average scapular lowering was two centimetres. Excellent or good cosmetic results were obtained in 80 per cent of patients. Ninety-three per cent of patients expressed satisfaction with the operative results. Complications were few. The Woodward procedure is a safe and relatively straightforward surgical means to effect a good cosmetic and functional improvement in a patient with a congenital undescended scapula. We do not recommend clavicular osteotomy as a routine, but it may be added to gain more correction with less risk of neurovascular compression.

Abnormalities, Multiple↗