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Biomedical subjects

G D MacEwen

Publications and source records attributed to G D MacEwen.

At least 19 recordsLinked to original sources
PubMed1992

Stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails (a technique paper).

The indications for surgical stabilization of a pediatric diaphyseal femur fracture are expanding. Children with multiple system injuries, a head injury, and/or multiple fractures have fewer local and distant complications if the femur fracture is treated operatively. Other indications include a pathological fracture in osteoporotic bone, a fracture in a child with a preexisting condition that prevents the application of a spica cast, a child older than 10 years of age, or a child less than 10 years of age who cannot be kept adequately aligned using conventional (traction/casting) methods of fracture management. Here we describe a technique of stabilizing pediatric diaphyseal femur fractures using flexible intramedullary nails (Ender). This technique can be used in children of all ages and with all patterns of diaphyseal fractures.

Bone Nails↗
PubMed1992

Transpedicular convex anterior hemiepiphysiodesis and posterior arthrodesis for progressive congenital scoliosis.

Nine children with progressive congenital scoliosis underwent bilateral posterior spinal fusion supplemented with transpedicular convex anterior hemiepiphysiodesis. The average preoperative curve was 52 degrees. The average age at surgery was 9 years and 1 month and the average follow-up period was 3 years and 6 months. Curve progression was arrested in all cases, and curve correction greater than 10 degrees was achieved in four patients.

Adolescent↗
PubMed1992

Unusual orthopedic manifestations of neurofibromatosis.

Forty-four children with neurofibromatosis were found to have three previously underdescribed conditions: thoracic lordoscoliosis, protrusio acetabuli, and monomelia neurofibromatosis. Thirty-four patients (77%) had scoliosis; of these, nine had dystrophic scoliosis (Group I, 26%), six had dystrophic lordoscoliosis (Group II, 18%), eight had dystrophic kyphoscoliosis (Group III, 24%), and 11 had nondystrophic scoliosis (Group IV, 32%). Group III curves were severe and progressive, rendering them difficult to stabilize even with anterior and posterior spinal fusions. Group II curves were progressive but stabilized by posterior spinal fusion alone. Group I curves were less progressive than Groups II and III, but required surgery more often than those of Group IV, which were generally controlled by orthoses. Protrusio acetabuli of varying severity occurred in 13 patients (21 hips). Three patients had involvement of a single limb (monomelic neurofibromatosis).

Acetabulum↗
PubMed1991

The limping child.

Evaluation of a limping child requires careful consideration and a basic knowledge of potential problems affecting the child. The most important point is not to miss or delay diagnosis of the septic hip. This is truly an orthopedic emergency. Complaints of knee pain should not throw the physician off the track of a diagnosis of hip disease. It is also important to be aware of how the medical history affects the musculoskeletal system. Many causes of limp are best analyzed by repeat examination and stepwise laboratory and radiographic evaluation. One should realize that a painful limp can be caused by something as mundane as a thorn in the heel or as serious as a tumor of the spine: Be suspicious.

Bone Diseases↗
PubMed1991

Growth disturbance of the proximal part of the femur after treatment for congenital dislocation of the hip.

The radiographs of ninety patients in whom treatment of unilateral congenital dislocation of the hip was complicated by disturbance of growth of the proximal part of the femur were studied retrospectively. All patients were followed until closure of the affected proximal femoral physis. We divided the patients into three groups, according to the degree of vascular insufficiency: patients who had mild vascular insufficiency of the hip, which had little effect on growth; those who had moderate vascular insufficiency, which produces partial arrest of growth; and those who had severe vascular insufficiency, which causes complete arrest of growth. Good correlation was found between the initial degree of vascular insufficiency and the radiographic results at the most recent follow-up. The radiographic signs that were used to predict the extent of physeal involvement were a crescent-shaped epiphysis, medial bowing of the femoral neck (a shorter and more concave curve between the lesser trochanter and the proximal femoral metaphysis [the lateral portion of the Shenton line]), lateral tilting of the capital epiphysis, and premature physeal closure. Signs that were diagnostic of existing physeal involvement were elevation of the greater trochanter and shortening of the affected extremity. The presence and severity of these signs correlated well with the degree of vascular insufficiency. Medial bowing was the most reliable prognostic factor for the determination of the fate of the hip joint at maturity.

Adolescent↗
PubMed1990

Congenital dislocation of the hip.

Early diagnosis and treatment are the keys to a successful result in infants with congenital dislocation of the hip. In the neonatal period, a majority of infants with hips that would later be found to be dislocated can be detected and effectively treated. With the use of ultrasonography to supplement clinical suspicion, the number of children with congenital dislocation of the hip diagnosed in the newborn period should be expected to increase. Repeated examination, especially during the first 6 months of life, can be expected to detect those additional children with congenital dislocation of the hip who were not detected in the nursery. The Pavlik harness has been shown to obtain a successful result in most children younger than 6 months of age while holding the incidence of avascular necrosis to nearly zero. Even though these results are encouraging, the problem must be discovered early for the child with congenital dislocation of the hip to be treated optimally. Thus, it is of the utmost importance that the physician have an awareness of this problem. The primary physician must also continue to conscientiously examine the hips of patients on a regular basis even after the initial examination and, when necessary, use the added modalities available to him or her to accurately diagnose questionable hip conditions of patients.

Female↗
PubMed1990

The effects of contrast dye on bacterial growth: an in vitro model.

We devised an in vitro model to examine the effects of Conray 60 contrast dye on microorganisms commonly found in septic arthritis. Using 42 culture plates in aerobic and anaerobic environments, we found no adverse effect on bacterial growth using 30, 7.5, 3.75, and 1.875% concentrations of Conray 60 contrast dye on cultures of Staphylococcus aureus, Hemophilus influenza, and Streptococcus pneumonia.

Arthritis, Infectious↗
PubMed1990

Subacute osteomyelitis.

Subacute osteomyelitis is a chronic low-grade infection of bone characterized by a lack of systemic manifestations. The onset is insidious. Pain is the most common symptom, and has usually been present for several months before the initial evaluation. Swelling and tenderness over the area of involved bone may also be seen. Laboratory evaluation is unrevealing, with a normal white blood cell count and differential. The erythrocyte sedimentation rate may also be normal. The most common organism cultured from a subacute osteomyelitis is a staphylococcus species. Twenty-five percent of subacute bone infections are sterile. The most common manifestation of a subacute osteomyelitis in a child is a geographic lytic metaphyseal lesion (Brodie's abscess). Treatment of a culture positive infection includes surgical debridement and antibiotic therapy. A sterile abscess can be treated conservatively without antibiotics, provided the patient's symptoms are improving and the lesion is regressing radiographically.

Adolescent↗
PubMed1990

Perthes-like disease and the tricho-rhino-phalangeal syndromes: the first black patient.

The TRPS I has been reported in European, Asian, Australian, and North American populations. To the best of our knowledge, this is the first case reported in the black population. Like many patients with this syndrome, it was the presence of "Perthes-like" disease that eventually lead to the diagnosis. This hip complication is very common, and often bilateral. A review of the literature stresses the importance of early diagnosis in that many patients are presenting late with severe degenerative arthritis. When present, "Perthes-like" changes should direct the observer to look for the abnormal hair and facies that are typical of these syndromes. Radiographs of the hands should also be obtained which will usually reveal the characteristic cone-shaped epiphyses. Clinical or radiographic evidence of multiple cartilaginous exostoses is diagnostic of TRPS II in the presence of other stigmata of the tricho-rhino-phalangeal syndrome (TRPS I).

Braces↗
PubMed1989

Unicameral bone cysts. Natural history and the risk of fracture.

Unicameral bone cysts in 57 patients, seen at the Alfred I. duPont Institute between 1949 and 1982, were studied retrospectively. We present the natural history in several patients and report a "cyst index" which allows the progress of the cyst to be followed and makes it possible to determine whether there is a significant risk of fracture which would warrant treatment. We have found that measuring the cyst index in patients treated by injections of methylprednisolone acetate helps to assess the response to treatment.

Adolescent↗
PubMed1989

Pseudomalignant myositis ossificans.

PMO is characterized by the following: no history of antecedent trauma, localized expanding soft tissue mass, peripheral calcification surrounding a radiolucent center on plain radiographs and CT scans, microscopic evidence of zonation, and self limited natural history.

Adolescent↗
PubMed1989

Idiopathic scoliosis. An 11-year follow-up study of the role of the Milwaukee brace in curve control and trunco-pelvic alignment.

One hundred and fifty-two patients with idiopathic scoliosis were treated at the Alfred I. duPont Institute with the Milwaukee brace between 1961 and 1972. This study includes 94 patients and was undertaken to evaluate the effectiveness of Milwaukee brace treatment in managing various sequelae associated with idiopathic scoliosis, such as degree of curvature and trunco-pelvic alignment, and to assess the degree of spinal stability after treatment. Good results were obtained in patients with curves less 30 degrees; in addition, there was improvement in trunco-pelvic alignment and curve correction. However, results varied considerably among patients and were unpredictable. Double major curve patterns were found to have a poor response to bracing. After bracing is stopped, rate of curve progression appears to decrease with time.

Adolescent↗
PubMed1989

Congenital dislocation of the hip. Recent advances and current problems.

This article reviews changes that have occurred in the understanding and treatment of congenital dislocation of the hip (CDH). It is now recognized that CDH is a spectrum of diseases with differing etiologies, pathologies, and natural histories that, as a result, require different treatment approaches. The etiology of CDH involves genetic, hormonal, mechanical, and environmental influences. This recognition of mechanical factors that predispose to CDH has allowed the identification of high-risk patients. Screening for CDH in the new born has resulted in many more patients being diagnosed earlier. Ultrasonography has added a new dimension to CDH diagnosis, since it has demonstrated abnormal hips in otherwise normal children. In the newborn, the use of ultrasonography may be the single most important recent contribution to the study of this disease. The natural history of CDH is well-known: The disease often can lead to early coxarthrosis. However, avascular necrosis is a complication of treatment and results in a hip that may be worse than one not treated at all. Treatment of CDH includes gentle closed reduction in the majority of patients. In patients under six months of age, this can usually be achieved with the Pavlik harness. Up to the age of three years, gentle manipulative closed reduction after traction is successful in the majority of patients. The trend toward the use of home traction and away from inpatient skeletal traction has been documented by many centers to be successful. Open reduction is becoming infrequently required and has specific indications.(ABSTRACT TRUNCATED AT 250 WORDS)

Hip Dislocation, Congenital↗
PubMed1989

Multiple osteoid osteomas of the fifth lumbar vertebra. A case report.

Two distinct osteoid osteomas occurred near each other in the same lumbar vertebra of an 18-year-old man. The tumors exhibited different levels of maturation in roentgenographic appearance and scintigraphic activity. Two surgical procedures were required to resect the lesions.

Adolescent↗