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Biomedical subjects

G E Fulford

Publications and source records attributed to G E Fulford.

16 recordsLinked to original sources
PubMed1990

Surgical management of ankle and foot deformities in cerebral palsy.

A system of surgical treatment of deformities of the ankle and foot in cerebral palsy is presented on the basis of experience with 420 children. The aim of surgery is prevention or correction of deformities. There are three types of deformity (fixed, dynamic, and mixed), each of which is treated differently. Surgery should be delayed as long as there is functional improvement. The most common indication for foot surgery is equinus deformity, which makes it difficult to keep the heel in the shoe. Tendo Achillis lengthening is satisfactory for fixed equinus, and transfer of the medial belly and the tendon of the gastrocnemius to the dorsum of the foot is appropriate for dynamic equinus. Hindfoot valgus in hypertonic cerebral palsy is treated by peroneus brevis elongation when moderate and in combination with subtalar arthrodesis when severe. Hindfoot valgus in hypotonic cerebral palsy is treated by subtalar arthrodesis only. Hindfoot varus is treated by tibialis posterior lengthening, usually in combination with (1) tendo Achillis lengthening, (2) a Steindler plantar release, or (3) valgus calcaneal osteotomy. Dynamic forefoot supination is treated by split-tibialis anterior tendon transfer or, when associated with dorsiflexion of the hallux, by extensor hallucis longus transfer.

Achilles Tendon↗
PubMed1984

Treatment of valgus hindfoot in cerebral palsy by peroneus brevis lengthening.

Twenty cerebral-palsied patients (30 feet) with hindfoot valgus due to muscle imbalance were reviewed and it was shown that the deformity can be reduced by peroneus brevis lengthening. The method of choice is intramuscular lengthening, which reduces the power of peroneus brevis by one point on the MRC grading and corrects the hindfoot valgus by one grade of severity. For full correction by tendon lengthening, the deformity must be treated while it is still mild. Repeat lengthening may be necessary if there is a severe muscle imbalance.

Adolescent↗
PubMed1983

Bilateral failure of the capital femoral epiphysis: bilateral Perthes disease, multiple epiphyseal dysplasia, pseudoachondroplasia, and spondyloepiphyseal dysplasia congenita and tarda.

A radiographic survey of 25 patients with bilateral Perthes disease is compared with four inherited skeletal dysplasias also affecting the hip joints (45 patients with multiple epiphyseal dysplasia, 22 with spondyloepiphyseal dysplasia tarda, 18 with pseudoachondroplasia, and 17 with spondyloepiphyseal dysplasia congenita). The distinguishing features in relation to the pelvis and hip joint in the growing child are ascertained, in view of the importance of differentiating as early as possible the transient disorder of Perthes disease from the more serious progressive disorders.

Acetabulum↗
PubMed1982

A review of the morphology of Perthes' disease.

There are differences of opinion about the pathogenesis of Perthes' disease. All are agreed that it is due to ischaemia, but the cause of this and the size and number of infarctions are in dispute. Through the generosity of the contributors six whole femoral heads and core biopsies of five other cases have been studied radiographically and histologically. The findings ranged from an ischaemic arrest of ossification in the capital articular cartilage without infarction to multiple complete infarctions of the epiphysial bone. The ensuing reparative process contributes to the pathology, which is of a range to warrant grading or grouping.

Cartilage, Articular↗
PubMed1982

Clinical variation in dyschondrosteosis. A report on 13 individuals in 8 families.

Thirteen patients with dyschondrosteosis from eight families are reviewed and their clinical and radiographic variation noted. Inheritance is likely to be autosomal dominant but with only 50 per cent penetrance. Stature was moderately reduced, due to shortening of the bones of the leg. Radio-ulnar shortening could either involve both bones equally or the radius predominantly, in which case a typical Madelung deformity was seen. Tibio-fibular disproportion was present in half the patients, two of them having severe deformity associated with tibia varum and a long fibula. The treatment of one of these patients is described. It is recommended that patients with dyschondrosteosis should be kept under surveillance during the growing period. Problems in the limbs, especially the legs, may require operations to equalise the length of the two bones.

Adolescent↗
PubMed1978

The problems associated with flail feet in children and their treatment with orthoses.

Children with flail feet who have control of their hips and knees are able to walk but are unable to stand still and find it difficult to walk slowly. These problems have been overcome in fifty-three children with flail feet due to myelomeningocele by fitting them with below-knee orthoses which provide maximum stability and yet allow normal walking. The biomechanical principles and the development of the orthoses are discussed.

Biomechanical Phenomena↗
PubMed1976

Subtalar arthrodesis by cancellous grafts and metallic internal fixation.

A technique of subtalar arthrodesis by means of metallic internal stabilisation and autogenous cancellous bone grafting is described. Of forty-eight feet with mobile pes planus treated by this method forty-five gained union after an average of seven and a half weeks in a below-knee weight-bearing plaster, and forty-three had satisfactory correction of the deformity.

Adolescent↗
PubMed1975

Quadrilateral shaped brims made from high-density polyethylene for long leg calipers.

Quadrilateral shaped brims made of high-density polyethylene have been used with satisfactory results on more than 120 patients who needed ischial-bearing long leg calipers. At first the fitting technique was the same as that used for thigh amputees. Subsequently it has been possible to fit most patients from a range of pre-formed brims. The properties of high-density polyethylene allow the caliper side irons to be riveted directly to the brim which, with the use of ready-made brims, allows a patient to be fitted rapidly with a comfortable and effective caliper.

Adult↗
PubMedDate not supplied

A prospective study of nonoperative and operative management for Perthes' disease.

Two groups of children with Perthes' disease, randomized according to their source of referral, were treated by bed rest and skin traction, followed by either use of a weight-relieving caliper or a proximal femoral varus osteotomy. The outcome was similar in both groups and could be predicted more effectively by the arthrographic shape of the femoral head at presentation than by the Catterall grouping. The principal influences were the age of the child when treated and the sphericity of the femoral head. Walking speed at time of review was related to the height of the child and, at this age, was not affected by the shape of the healed femoral head.

Age Factors↗
PubMedDate not supplied

A study of normal baby movements.

Twenty-five normal newborns aged between 3 and 6 days had their movements recorded by clinical observation in a controlled environment, chart recording from an automatic movement mattress over 4 hours, and cine photography triggered by the movement mattress. Over 80 different individual types of movement were grouped into six categories: progression movements (obligatory reciprocal movements), symmetrical movements (slower flexion or extension movements), startle movements, asymmetrical tonic neck reflex and 'Moro', facial movements and athetoid movements. The normal newborn's motor activity is significantly related to the level of arousal, gestational age, and environmental variables such as position, temperature, light and noise.

Arousal↗