Biomedical subjects

G W Westin

Publications and source records attributed to G W Westin.

At least 19 recordsLinked to original sources

PubMed1989

Acetabular development in the infant's dislocated hips.

The course of development of acetabulae after the reduction of congenitally dislocated hips was investigated to identify factors that might predict the need for acetabuloplasty. One hundred five congenitally dislocated hips in 83 children were followed roentgenographically for an average of eight years after reduction. While the percentage of children requiring later acetabuloplasty increased somewhat with advancing age at the time of reduction, numerous acetabulae in the older groups developed satisfactorily without later surgery. The prereduction acetabular index proved a much more reliable predictor of the need for later acetabuloplasty. Sixty percent of those with an acetabular index greater than 37 degrees required later pelvic surgery, compared with 17% of those with a prereduction index less than 30 degrees. The major acetabular response occurred in the first year after reduction in children whose hips were reduced before the age of three years, whereas the maximal response in children whose hips were reduced after three years of age occurred in the second through fourth years. A further drop can be expected in all reduced hips of children between the ages of eight and 11 years.

Acetabulum↗

PubMed1988

The results of tenodesis of the tendo achillis to the fibula for paralytic pes calcaneus.

Sixty-six consecutive tenodeses of the tendo achillis to the fibula were done in sixty patients who had paralytic pes calcaneus. The patients were followed for an average of 5.7 years (range, two to 10.8 years). The preoperative disturbance of gait was eliminated in all of the patients, and radiographic improvement was noted in the feet that had been operated on. Sixteen feet (23 per cent) required revision of the tenodesis because equinus deformity had developed. The development of equinus deformity was found to occur more often in patients who had the procedure at a younger age and in patients in whom the calcaneotibial angle measured more than 70 degrees at the time of the tenodesis. Residual cavovarus deformity was successfully treated by a plantar release.

Achilles Tendon↗

PubMed1986

Further experience with Grice subtalar arthrodesis.

Between 1952 and 1973, 302 Grice-type subtalar arthrodeses were performed with a minimum follow-up evaluation of two years and a maximum follow-up evaluation of 22 years. Seventy-three feet were followed more than ten years. Seventy-three percent of the 244 operations done for poliomyelitis residuals were considered satisfactory. The number of cases in other diagnostic groups ranged from six to 18 and showed unpredictable results. The major reasons for an unsatisfactory result were fusion in unacceptable position (usually varus) and nonunion of the arthrodesis. Correct positioning of the subtalar joint at surgery is essential for a satisfactory result, and recommendations are made as to how to obtain such a position. Minimal degenerative arthritis of adjacent joints occurred in feet fused in acceptable positions.

Adolescent↗

PubMed1986

The Chiari osteotomy. A review of 58 cases.

Fifty-eight Chiari osteotomies performed in 51 patients were reviewed retrospectively. The indications for surgery were painful subluxation, instability, or poor acetabular coverage. The average age at surgery was 16 years (range, 7-45), and the average follow-up period was 40 months. The majority of the patients had congenital hip dislocation, but also included were patients with cerebral palsy, Legg-Calvé-Perthes disease, polio, infection, coxa vara, and epiphyseal dysplasia. Supplemental bone grafts were applied as needed. The functional results were unrelated to age, with 26 excellent, 28 good, and four poorly functional hips. After operation, 39 out of 41 had total pain relief, 41 out of 58 had a normal acetabular index, and 54 out of 58 had a normal center-edge angle. Trendelenburg gaits were unchanged by the Chiari osteotomy, but trochanteric transfer improved the gait in few cases.

Acetabulum↗

PubMed1986

Missed or developmental dislocation of the hip.

In 15 documented cases, subluxation or dislocation of the hip was discovered months or years after previous multiple normal physical examinations. The examiners were unique in that six were professors specializing in childrens' orthopedics, four were board-certified orthopedists, and five were pediatricians. An increased acetabular index, subluxation, and early dislocation may not always be detected on physical examination. Delayed diagnosis of dislocation is not evidence that an inadequate physical examination was performed. An increased acetabular index may allow the femoral head to move laterally out of the acetabulum and become a delayed dislocation. The delayed subluxed or dislocated hip constitutes an entity not necessarily related to the neonatal subluxable or dislocatable hip.

Child, Preschool↗

PubMed1985

A combination pelvic osteotomy for acetabular dysplasia in children.

Several surgical procedures have been devised to increase acetabular coverage of the femoral head in children with dysplasia of the hip. In this report we describe an acetabuloplasty that combines the key aspects of the Pemberton and Salter osteotomies. It has been used at the Los Angeles Unit of the Shriners Hospital for Crippled Children since the late 1960's. To assess the results of this combination procedure, fifty hips in forty-four children were evaluated at an average of six years postoperatively. The average age at operation was 7.3 years, and 62 per cent of the patients had had prior surgery. Clinically, thirty-two hips in which there had been no or slight symptoms preoperatively remained unchanged, twelve that had had preoperative limitations improved, and six showed some deterioration in terms of slight loss of motion, mild pain, and a limp. Roentgenographically, acetabular dysplasia (as measured by the acetabular index and by the center-edge angle of Wiberg) improved in more than 90 per cent of the hips. The roentgenographic results were comparable with those obtained by innominate or pericapsular osteotomy. The combination osteotomy has the advantages of both the Pemberton procedure and the Salter operation and proved to be an excellent surgical procedure for older children whose acetabular development did not progress as well as was expected.

Acetabulum↗

PubMed1984

Syme amputation in children: indications, results, and long-term follow-up.

Syme amputations are not always effective. Heel pad migration, skin sloughs, and problems with prosthetic fitting may complicate a seemingly simple procedure. We reviewed 69 Syme amputations performed in 62 children at the Los Angeles Shriners Hospital between 1956 and 1980. The major indication was leg length discrepancy, due to either paraxial fibula hemimelia (33 cases) or proximal focal femoral deficiency (19 cases). The average age at amputation was 5.6 years, with an average follow-up of 10.5 years (range 1-25 years). The results were assessed by a combination of chart review, patient recall examinations, and questionnaires. Satisfaction in adulthood was high. Early complications included three skin sloughs and one infection. Late complications included 2 retained os calcis apophyses, 1 exostosis, and 16 cases of heel pad migration. Only one of the heel pad group required revision; prosthetic adjustment resolved the others. Prosthetic knees were often too low because of failure to limit the length of the stump appropriately. Syme amputation should be considered a primary reconstructive procedure, rather than a last resort, in fibula hemimelia and proximal femoral focal deficiency.

Adolescent↗

PubMed1983

Muscular torticollis. A modified surgical approach.

Since 1967 twelve children with muscular torticollis were treated at the Los Angeles Shriners Hospital for Crippled Children with a modified bipolar release of the sternocleidomastoid muscle. The results of the procedure were compared with the results in twenty-two other patients who had had either conservative treatment or other types of operations and who were seen between 1952 and 1981. The average follow-up was nine years (range, one to thirty-three years). Fourteen patients, most of them less than one year old, were treated non-operatively and had 86 per cent good or excellent results. The bipolar release and z-plasty was performed either when conservative treatment had failed or in older children who had had other operations, and it yielded 92 per cent good or excellent results. Only 15 per cent good and 77 per cent fair results were obtained when surgical procedures other than bipolar release were performed.

Child↗

PubMed1982

Surgical management of resistant congenital talipes equinovarus deformities.

We evaluated the results of surgery for resistant congenital talipes equinovarus deformity in 164 children (244 feet). No patient was followed for less than two years. They were divided into three groups for analysis, based on their treatment. Group 1 consisted of seventy-five children (112 feet) who had incomplete releases only; Group 2 consisted of twenty-three children (thirty-nine feet) who had had a failed incomplete release followed by a one-stage complete posteromedial plantar release, without internal fixation, and serial application of casts; and Group 3 consisted of sixty-six children (ninety-three feet) who had the complete posteromedial plantar release as the initial surgical procedure. Group 1 had 42 per cent, Group 2 had 79 per cent, and Group 3 had 86 per cent satisfactory (excellent or good) long-term results. The radiographic measurements that correlated best with the clinical results were the anteroposterior talocalcaneal overlap, the lateral talocalcaneal angle, and the positions of the navicular and calcaneus. The results in our series emphasize the complex interrelationship of the pathological anatomy and the need for complete simultaneous release of all components of the deformity.

Adolescent↗

PubMed1981

Plantar release in the correction of deformities of the foot in childhood.

One hundred and ninety-one feet with residual cavovarus deformities from club foot or poliomyelitis were treated by a plantar release followed by correction with serial cast application. Roentgenographically, there was significant improvement in the adduction of the fore part of the foot and the cavus deformity, but the varus angulation of the hind part of the foot did not improve. In children more than six years old with deformities resulting from club foot, the plantar release was particularly effective in alleviating residual cavus deformity. In cavus deformity resulting from poliomyelitis, preliminary data indicate a positive effect in feet with pure cavus deformity and cavus deformity associated with equinus angulation of the hind part of the foot, while the results in feet with a cavus deformity and associated calcaneal deformity of the hind part of the foot typically were unsatisfactory.

Adolescent↗

PubMed1980

"Missed" or late-diagnosed congenital dislocation of the hip. A clinical entity.

Reported series of neonatal examinations of the hip by trained orthopedic surgeons reveal cases of dislocation of the hip discovered many months after the previous normal examination. The possibility of delayed dislocation of the hip needs further study and its recognition is important for the medical and legal professions. Physicians may be blamed erroneously for failure to diagnose CDH at an early stage. In 10 documented cases, early examinations by qualified experts revealed normal hip findings, although the patients were later discovered to have CDH. In five instances, the physical examinations were done by specialists in children's orthopedics. In one case of a child being examined for knock-knee, X-rays accidently included the hips and showed CDH. Thus, clinical signs are not infallible and an occasional case will be missed on examination even in children older than one year. Congenital dysplasia of the hip is a dynamic process and parents should be warned of the possibility of delayed dislocation. Repeated examinations of the hips are recommended.

Female↗

PubMed1980

Skeletal traction vs. femoral shortening in treatment of older children with congenital hip dislocation.

A review of skeletal traction compared with femoral shortening in treatment of older patients with congenital dislocation of the hip clearly favors femoral shortening. During the period 1952-74, 30 hips in 22 patients (average age, 6 6/12 years) were treated with skeletal traction, and during 1971-77, 17 hips in 12 patients (average age, 6 8/12 years) were treated with femoral shortening. In those treated with skeletal traction, avascular necrosis developed in 57%; redislocation or subluxation in 30%; an X-ray rating (Severin) of poor in 43%; and the incidence of pin and skin complications was 27%. The average follow-up was 11 1/2 years. In the group treated with femoral shortening, there were no cases of avascular necrosis and none with a poor rating on X-ray. The average follow-up was three years and seven months and it was never less than one year. Complications included one refracture at the osteotomy site six weeks after surgery, one late resubluxation, and two redislocations (early in the series prior to routine use of Steinmann pin fixation). The redislocations were easily reduced. Acceptable leg length inequality was present in all unilateral cases except in one 12-year-old patient who required a contralateral epiphysiodesis. One patient with late subluxation had open reduction and acetabuloplasty.

Bone Nails↗

PubMed1980

Factors influencing the results of acetabuloplasty in children.

If inadequate acetabular coverage of a femoral head does not resolve spontaneously, acetabuloplasty can be performed to correct it. An understanding of what type of patient is likely to benefit from this procedure will lead to better timing of the operative intervention. In this review of 152 acetabuloplasties, four factors were found to adversely influence the effects of the operation: age of nine years or older, subluxation or dislocation of the femoral head, deformity of the femoral head, and restricted range of hip motion. Based on these data, we recommend observing the inadequately covered hip for spontaneous improvement in coverage until the age of eight years, except in patients with subluxation or in those with worsening of femoral head deformity or progressively decreasing range of motion.

Acetabulum↗

PubMed1980

Greater trochanteric hip arthroplasty in children with loss of the femoral head.

In seventeen children with catastrophic loss of the femoral head, the hip was salvaged by greater trochanteric arthroplasty. The average follow-up of these patients was eleven years, and fourteen patients were followed to skeletal maturity or longer. In Group I, consisting of four patients with greater trochanteric arthroplasty alone, good initial stability gradually deteriorated as subluxation occurred, accompanied by a proportionate return of abductor limp, loss of hip motion, and an increased rate of degenerative changes in the joint. Group II, consisting of eight patients who had either acetabuloplasty or innominate osteotomy in addition to greater trochanteric arthroplasty, had only slightly improved hip containment and results similar to those in Group I. Spontaneous ankylosis of the hip occurred in six of the patients in those two groups. The best results were obtained in five patients in Groups III and IV who had the procedure supplemented by proximal femoral varus osteotomy.

Adolescent↗

PubMed1979

Tendon transfers in the paralytic hip.

We analyzed the results of transfers of the iliopsoas or external oblique muscles performed to augment the abductor power of the hips in 149 patients with flaccid paralysis of the hips. More than 800 supplemental procedures were performed on the lower extremities of these patients. Twenty-three of the thirty-eight hips that had been subluxated or dislocated became stable in the reduced position after the transfer operation. Every hip that had been stable before the transfer remained stable, and thirty-seven patients who had been brace-dependent became brace-free. We concluded that transfers of the iliopsoas or external oblique muscles are useful adjuncts in the treatment of paralytic disorders of the hips.

Adolescent↗

PubMed1978

Scoliosis in arthrogryposis multiplex congenita.

Scoliosis was evident in eighteen of eighty-eight patients with arthrogryposis multiplex congenita. The predominant pattern of spinal deformity was a structural thoracolumbar double curve that extended to the sacrum and was associated with pelvic obliquity and lumbar hyperlordosis. Significant contractures about the hips, dislocation of the hip, or both were present in all patients but one. Most of the curves were progressive and they became rigid and fixed at an early age. There was progression of the pelvic obliquity coincident with progression of the curve. Treatment by corrective casts or a Milwaukee brace was ineffective and if surgical treatment directed at the pelvic obliquity did not correct that deformity, spine fusion to the sacrum appeared necessary.

Adolescent↗

PubMed1977

Elongating intramedullary rods in the treatment of osteogenesis imperfecta.

Patients with osteogenesis imperfecta who have undergone multiple osteotomies with realignment and intramedullary rod fixation of a deformed bone frequently require replacement of the rod because the bone grows and angulates when the rod no longer is long enough to support the bone from metaphysis to metaphysis. The Bailey-Dubow intramedullary rod, which elongates with growth, is an attempt to solve this problem. This is a review of 153 rod-fixations in seventy-two bones (twenty patients), forty-seven being Bailey-Dubow rods. Use of the elongating rod effectively increased the average length of time between replacement operations, yielded a lower removal rate, and showed no additional adverse effects. The Bailey-Dubow rod represents a measurable improvement over non-elongating rods.

Adolescent↗

PubMed1976

Congenital longitudinal deficiency of the fibula: follow-up of treatment by Syme amputation.

Congenital longitudinal deficiency of the fibula presented two major problems in management: severe shortening of the limb and equinovalgus deformity of the ankle and foot. When the deformity was severe, our attempts at reducing the deformities of the foot and ankle with soft-tissue procedures and our attempts at achieving limb-length equality with various lengthening procedures were unsuccessful. Our best results in these patients were achieved with an early Syme amputation. The pattern of the deformity and the determination of the growth inhibition factor in the involved limb now enable us to make an early estimate of the deformity and plan appropriately. Syme amputation is definitive and allows the patient to have nearly normal function of the limb and a prosthesis of excellent appearance.

Abnormalities, Multiple↗