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Biomedical subjects

Frances A Farley

Publications and source records attributed to Frances A Farley.

11 recordsLinked to original sources
PubMed2006

The case for patient-centered care in orthopaedics.

Now is a critical time to develop a patient-centered care model in the field of orthopaedic surgery. Patient-centered care is defined by the American Academy of Orthopaedic Surgeons as the provision of safe, effective, and timely musculoskeletal care achieved through cooperation between the orthopaedic surgeon; an informed, respected patient (and family); and a coordinated health care team. Patient-centered care, a paradigm shift from disease-centered care, is being championed by government agencies, patient advocacy groups, and insurance companies. Orthopaedic organizations must develop a comprehensive education program to provide surgeons the tools they need to navigate this paradigm shift.

Adult↗
PubMed2005

Tectorial membrane injuries in children.

We report three cases of tectorial membrane injury in children. An increased interspinous ratio was identified on cervical spine radiographs. The tectorial membrane injuries were diagnosed by magnetic resonance imaging. The three children were restrained passengers in high-speed motor vehicle accidents, and all sustained polytrauma. Two children with partial tears of the tectorial membrane were immobilized in a halo, and one with a longitudinal tear of the tectorial membrane had an occiput-to-C2 fusion.

Accidents, Traffic↗
PubMed2002

Low-dose ketorolac improves analgesia and reduces morphine requirements following posterior spinal fusion in adolescents.

PURPOSE: To determine if low-dose ketorolac would improve analgesia while minimizing unwanted side effects in adolescents following posterior spinal fusion (PSF). METHODS: A prospective randomized double-blind placebo-controlled trial assessed the analgesic effects of low-dose ketorolac following PSF. Thirty-five adolescents aged 11-17 yr were randomly assigned to receive placebo or 0.5 mg x kg(-1) ketorolac (maximum of 15 mg) six hourly postoperatively for 36 hr in conjunction with standard morphine patient controlled analgesia (PCA). Pain and sedation were assessed twice daily for the first three postoperative days (POD). The incidence of side effects related to both non-steroidal anti-inflammatory agents and opioids were recorded. RESULTS: Adolescents in the ketorolac group received an average dose of 0.2 mg x kg(-1) (average exposure 1.2 mg x kg(-1)), had lower pain scores on POD one and two (P < 0.05) and consumed less morphine in the postanesthesia care unit and on POD two. There was no difference in the incidence of pruritus, nausea, vomiting or constipation, but patients in the ketorolac group tolerated activity better on POD one (P < 0.05). There were no differences between groups with regard to postoperative blood loss or transfusion requirements. Fourteen patients were followed for two years and the incidence of curve progression, hardware failure or back pain at final follow-up was not different. CONCLUSION: Low-dose ketorolac in conjunction with morphine PCA improved the quality of analgesia and reduced morphine requirements following PSF compared to placebo without increasing the incidence of non-steroidal anti-inflammatory side effects.

Adolescent↗
PubMed2002

Focal pyomyositis of the perisciatic muscles in children.

OBJECTIVE: The purpose of this report is to describe the role of MR imaging in the diagnosis of focal pyomyositis surrounding the sciatic nerve in children. CONCLUSION: In the absence of joint effusion on sonography, MR imaging should be considered in pediatric patients who present with a febrile illness and incapacitating pelvic pain.

Acute Disease↗
PubMedDate not supplied

Radiographic assessment of pediatric proximal radius fractures: interrater and intrarater reliability.

Three methods of measuring pediatric proximal radius fracture radiographs were compared using injury films of 32 patients. Angulation and displacement were independently measured by four physicians. One physician measured the films by each method a second time 2 months later. Values for interrater and intrarater reliability were determined using inter- and intra-class coefficients (ICC). Interrater reliability was poor for methods using the axis of the proximal radial fragment or the proximal radial physis as a reference (ICC = 0.47 and 0.42, respectively). Measurement of the angle between a line parallel to the proximal radius articular surface and the radial shaft had the highest interrater reliability (0.76); measurement of displacement had the lowest interrater reliability (0.09). The intrarater reliability was excellent for all methods (0.93-0.99) and was also highest when the proximal articular surface reference was used. Of described methods, use of the proximal radius articular surface and the radial shaft as references had the highest interrater and intrarater reliability.

Adolescent↗
PubMedDate not supplied

Characteristics of congenital scoliosis in a mouse model.

Pregnant mice were exposed to 600 ppm of carbon monoxide on gestation day 9. The carbon monoxide exposure produced 38 spinal anomalies in 17 offspring with congenital scoliosis. Microcomputer tomography improved the identification of spinal anomalies and detected more affected animals, as compared when magnified radiographs were used. The curves were measured and ranged from mild to moderate at an age that corresponds to childhood and, on average, remained at the range of mild to moderate through near-maturity. The group of mice with congenital anomalies near maturity contained severe curves. The bone mineral density (BMD) determined by microcomputer tomography in the mice with congenital scoliosis was the same as that in the controls. The cervical spine BMD was higher than the thoracic BMD, which was higher than the lumbar region in the controls and affected animals. The BMD was highest in the apex of the congenital curves in the animals that were near maturity. This relationship was not seen in the younger mice with congenital curves. Histology revealed growth rates in the hemivertebrae, which, over the last half of the growth period measured, had one-third less growth than the adjacent vertebrae. The hemivertebrae were wedged, but the adjacent disks were not.

Animals↗
PubMedDate not supplied

Complications and problems in halo treatment of toddlers: limited ambulation is recommended.

Although halo fixation in children aged 3 years or younger is described, no study has reported results in this age group. A retrospective review was conducted among children aged 3 years and younger and treated with halo ring fixation. Thirteen patients were identified, with an average age of 26 months (range, 16-43 months) at halo application. Six patients were treated for trauma, 6 for stabilization after cervical arthrodesis, and 1 for traction for progressive infantile scoliosis. All the children required custom or modified rings and vests. On average, 8 pins (range, 6-12) were used for fixation with torque from 2 to 4 in-lbs. Nine (69%) of the 13 patients had complications including 6 pin infections, 3 falls, and 1 respiratory difficulty. Only 1 child required further surgery. None developed posttreatment skull deformity. Halo ring fixation is safe in children aged 3 years and younger and has a complication rate similar to that in older children. Pin problems can be treated effectively by standard means. Unique to this age group, toddlers may be more prone to falls than older children, and limited ambulation should be recommended.

Atlanto-Axial Joint↗
PubMedDate not supplied

Sagittal profiles of the spine in scoliosis associated with an Arnold-Chiari malformation with or without syringomyelia.

The sagittal spine of children with Arnold-Chiari I malformation with or without syringomyelia and associated scoliosis (ACS) has been poorly studied. A retrospective review of scoliosis secondary to ACS from three centers was undertaken. Sagittal and coronal plane variables were measured from standing radiographs. There were 30 ACS children (19 girls, 11 boys) with an average curve of 50 +/- 20 degrees and age of 11.2 +/- 3.2 years. Syringomyelia was present in 26 (87%). The scoliosis was thoracic in 25, thoracolumbar in 3 and lumbar in 2; 18 curves were right and 12 were left. A positive correlation was noted between cervical lordosis (CL) and thoracic kyphosis (TK). The 30 children with ACS scoliosis were compared with 26 children with adolescent idiopathic scoliosis (AID). The ACS group had more left curves (40% vs. 0%, P = 0.0002), more boys (37% vs. 8%, P = 0.01), and was younger (11.3 +/- 3.7 years vs. 14.2 +/- 1.8 years, P = 0.004). TK and CL were increased in ACS (TK: 40 +/- 13 degrees vs. 30 +/- 13 degrees, P = 0.005; CL: 16 +/- 21 degrees vs. -5 +/- 12 degrees, P < 0.0001). The ACS and AID groups were subdivided by CL >0 degrees and <0 degrees. In the ACS group, 19% (5 of 21) had CL <0 degrees, in the AID group 77% (20 of 26) had CL <0 degrees (P = 0.0001). When cervical lordosis is >0 degrees or thoracic kyphosis is >40 degrees (Cobb method), the clinician should strongly suspect the presence of an Arnold-Chiari I malformation with or without syringomyelia.

Adolescent↗
PubMedDate not supplied

Compression plating of pediatric femoral shaft fractures.

The authors conducted a retrospective review of 60 children under the age of 16 years with femoral shaft fractures treated with compression plate fixation. All patients were followed to hardware removal. The 100% union rate and low complication rate after compression plate fixation of pediatric femur fractures compared favorably to the literature of other treatment options. Compression plate fixation is a safe and effective treatment in children with both isolated femoral shaft fractures and those associated with multiple injuries.

Adolescent↗