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Biomedical subjects

G P Mitchell

Publications and source records attributed to G P Mitchell.

17 recordsLinked to original sources
PubMed1982

Radiographic features of neonatal congenital dislocation of the hip.

Over the 10-year period 1969 to 1978, 271 consecutive cases of congenital dislocation of the hip were diagnosed at birth. Standard anteroposterior radiographs of the pelvis were obtained routinely and were analysed retrospectively. The medial gap, a measure of the separation between the proximal femur and the pelvic wall, was found to be significantly increased in cases with unilateral or bilateral dislocation when compared to normal. A medial greater than five millimetres is indicative of femoral head displacement and is of value where the clinical diagnosis is uncertain. The rate of missed dislocation at birth was 0.6 cases per thousand. Treatment with the Malmo splint was the normal routine. The Pavlik harness was applied if splintage was poorly tolerated by the infant, or in the rare instance of limited hip abduction. Failure to maintain reduction by splintage occurred in 3.3 per cent. The incidence of pressure deformities of the femoral head was 2.95 per cent and there was a residual deformity in later childhood of 1.1 per cent. It is presumed that this lesion can be attributed to the effect of splintage and it was notably avoided in the later period of the review when greater mobility of the abducted hips was encouraged.

Femur↗
PubMed1981

Exercise testing after the Chiari pelvic osteotomy.

The work capacity of 26 women after a Chiari pelvic osteotomy for symptomatic unilateral subluxation of the hip was assessed using two simple exercise tests: the maximal walking speed during a 12-minute test and the time taken to climb stairs. A significant linear decline in walking speed occurred with increasing age, despite the operation, and only one patient over the age of 25 years was able to walk at a normal rate. Compared to the results in a control group of women of similar age the stair climbing time was increased in 54 per cent of the patients and showed a significant negative correlation with the maximal walking speed. Age-adjusted walking speed was closely associated with the degree of pain experienced but there was no relationship between observed function and conventional clinical assessment based on the range of movement and the radiographic appearances of the hip.

Adolescent↗
PubMed1981

Late congenital dislocation of the hip.

Congenital dislocation of the hip in a child over the age of 4 may be discovered as a late untreated displacement, presenting with subluxation or dislocation, or as a late treated displacement presenting as a subluxating or subluxated hip. Conservative treatment is inadequate in untreated dislocations. Surgical reduction is the only possible procedure, associated with shortening femoral. The procedure may be used up to the age of 7 in bilateral cases, and up to the age of 12 in unilateral cases. Subluxating hips are recognised on the anteroposterior radiograph by a break in Shenton's line. A delayed Trendelenburg sign may also been seen. In such cases, innominate osteotomy or femoral derotation osteotomy should be performed, according to the anatomical defects present. Femoral shortening may be indicated in cases of increased length of the lower limb, associated with residual coxa valga or over growth following a previous rotation osteotomy to avoid the mechanical effects on the opposite hip. In cases of subluxated hip, varus upper femoral osteotomy may be indicated, or a Chiari osteotomy in painful hips. It is concluded that routine follow-up radiography is necessary, surgery being indicated as soon as a loss of acetabularcover of the femoral head is detected.

Adolescent↗
PubMed1980

Abductor hallucis release in congenital metatarsus varus.

Adduction of the forefoot diagnosed in the young child generally corrects spontaneously. Resistant forefoot adduction is usually combined with a degree of supination of the forefoot and described as congenital metatarsus varus. In true congenital metatarsus varus there is a contraction or shortening of the abductor hallucis muscle and tendon which is considered to be the primary deforming factor. In the early severe or resistant deformity correction can be achieved by either division of the tendon with release of its capsular attachment, or, in the more severe deformity, by complete release of the abductor hallucis muscle from its extensive attachment to bone and soft tissues.

Child↗
PubMed1977

Posterior displacement osteotomy of the calcaneus.

In cases of established calcaneus after anterior poliomyelitis the deformity can be greatly reduced by combining an extensive plantar release with an oblique transverse osteotomy of the calcaneus that permits displacement upwards and backwards of the posterior weight-bearing part of the bone. The procedure greatly improves the mechanical advantage of subsequent tendon transplantations to the heel. Between 1956 and 1969 fifteen such osteotomies were carried out and the long-term results have been reviewed.

Adolescent↗
PubMedDate not supplied

Spasmodic flatfoot.

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Ankle↗