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Biomedical subjects

H H Sherk

Publications and source records attributed to H H Sherk.

At least 55 records · Page 3Linked to original sources
PubMed1981

Congenital dislocation of the hip. A review.

Congenital dislocation of the hip usually results from capsular stretching caused by fetal malposition and crouching late in the third trimester. Early recognition of hip dislocation or instability soon after birth permits prompt treatment. Ortolani's and Barlow's maneuvers, respectively, reduce into and displace from the acetabulum a femoral head that is insecurely contained therein. The diagnosis of CDH in the first month of life usually depends on these clinical components of the physical examination of the newborn, because similar device, in this age group can usually maintain the displaced hip in sufficient flexion and abduction to permit reduction and normal development. By 3 months of age, the nuclei of the pelvis and upper femur have ossified enough to permit radiologic diagnosis of CDH. Problems related to treatment increase as the child grows older. In infants up to 6 months of age, closed methods with a harness usually succeed. Beyond 6 months, the soft tissues shorten and prevent easy reduction. These patients almost always require pre-reduction traction. An adductor tenotomy also facilitates reduction and apparently lessens compressive forces on the femoral head, an important consideration in preventing avascular necrosis of the head. Children over 1 year old develop bony changes, such as excessive femoral valgus and anteversion and deformity of the acetabulum. Treatment in these patients requires realignment of bony deformities with femoral or pelvic osteotomies in addition to the measures noted previously. The gentleness and high success rate of early treatment make early diagnosis of CDH an important consideration in infants and newborns.

Acetabulum↗
PubMed1981

The thoracic outlet syndrome produced by costochondritis.

Thoracic outlet syndrome (TOS) is a rare condition in children. Compression of the neurovascular bundle as it passes from the neck through the thorax into the arm may be produced by numerous anatomic and structural abnormalities. This case represents compression produced by spasm of the pectoralis minor muscle originating from costochondritis.

Adolescent↗
PubMed1979

Internal fixation versus nontreatment of hip fractures in senile patients.

Institutionalized senile patients with hip fractures have a high mortality regardless of whether treatment consists of internal stabilization or is non-operative. In an effort to select the best therapeutic approach in this type of patient, 150 patients were examined in 3 comparable groups. In the first group of 50 patients treatment consisted of surgical stabilization of the fracture. In the second group of 45 patients treatment was non-operative; mortality in these 2 groups was over 50% at the end of 16 weeks. In an effort to improve this degree of risk we transferred 53 patients from the psychiatric hospital to a general hospital for prompt internal stabilization of the hip fractures. There was a striking decrease in mortality to 28% in the third group. We have concluded that under optimal conditions, prompt surgical stabilization of hip fractures in elderly senile individuals offers them the best opportunity of surviving the injury and is preferable to nontreatment.

Aged↗
PubMed1979

Kyphectomy in myelodysplasia.

The techniques used and results obtained in the surgical treatment of the kyphotic deformities of fourteen patients with paraplegia and myelomeningocele are presented. The best results were obtained by vertebral resection at the apex of the deformity, wiring together the facing vertebrae to promote interbody fusion, and correction and maintenance of the realignment with a Harrington distraction rod.

Child↗
PubMed1978

Vertebra plana and eosinophilic granuloma of the cervical spine in children.

Eosinophilic granuloma of the cervical spine in children is a rare lesion which presents both diagnostic and therapeutic problems. The report describes three additional cases. Open biopsy is recommended instead of attempted needle aspiration in children. Laminectomy is likely to result in spinal deformity, and is not advised unless a second stage fusion is planned. Radiotherapy is effective in controlling the lesion. The ultimate outcome is usually good.

Adolescent↗
PubMed1978

Fractures of the odontoid process in young children.

We reviewed eleven patients less than seven years old with fractures of the odontoid process in an effort to establish a more standard form of treatment for the injury and to determine what complications, if any, occur as a result of fractures of the odontoid process in pediatric patients. Our study showed that children with odontoid fractures that are recognized and treated promptly usually do well. The fracture can usually be reduced by passive manipulation or by the "hanging head technique". Support in the reduced position for two to three months in a Minerva jacket or halo cast should be long enough to permit healing. Our study suggests that fractures of the odontoid process in young patients almost always heal.

Age Factors↗
PubMed1977

Treatment of severe rigid contractures of cerebral palsied upper limbs.

Flexion contractures caused by cerebral palsy in adult patients can become so rigid and so severe that skin breakdown and infection on the flexor surfaces of the palm and elbow can result. In 11 such patients we have utilized tendon resections, ray amputations, elbow resection arthroplasties and other techniques to correct deformities. Because improvement of hygiene and not functional rehabilitation was the goal in these patients, these aggressive measures could be utilized more freely than usual without fear of jeopardizing the patient's ability to use the hand post-operatively. Treatment of combined intrinsic and extrinsic contracture usually required resection of the sublimi and metacarpal head resection. Thumb-in-palm deformities were difficult to correct and required osteotomies of the first metacarpal or greater multangular resection. Elbow resection was useful in correcting flexion deformities of that joint but deformity recurred unless the biceps tendon was released as part of the procedure.

Cerebral Palsy↗
PubMed1976

Fractures and dislocations of the cervical spine in children.

Correct diagnosis of fractures and dislocations of the cervical spine in children requires an awareness of the pseudosubluxation and other normal variants noted in x-ray films of patients in this age group. Fractures of the odontoid process occur frequently and almost always can be treated by closed reduction and external fixation until union occurs. Fractures of the lower cervical spine are difficult to detect roentgenographically, and x-ray changes can belie the severity of soft tissue injury and cord trauma. Instability tends to persist in adolescent patients after cervical spine injury because of the combination of epiphyseal and posterior ligamentous disruption. Neoplastic, inflammatory, and congenital lesions render the cervical spine vulnerable to injury and can permit major damage to result from minor stress.

Adult↗
PubMed1975

Lesions of the atlas and axis.

The atlas and axis support the head on the lower cervical spine while providing for considerable mobility in flexion, extension, rotation and lateral bending. The first two vertebrae also function as conduits for the cervical cord and vertebral arteries. Lesions of the atlas and axis, therefore, can cause instability with loss of support and encroachment on the upper cord and vertebral arteries, or less often stiffness with restricted motion. Congenital lesions of the occipito-cervical spine such as occipitalization of the atlas or accessory occipital vertebrae can constrict the upper cord with osseous, dural, or fibrous compression. Such encroachment on the cord at this level produces a varying array of clinical complaints and findings frequently difficult to interpret. Instability of the upper cervical spine can result from congenital, traumatic, inflammatory or neoplastic disruptions of the interlocking mechanism of the atlas and axis. Such factors as the loss of structural integrity of the dens or stretching or tearing of the transverse ligament can permit instability with cord involvement. Because of the serious potential of these lesions, patients with abnormalities of the atlas and axis require prompt recognition and treatment.

Adolescent↗
PubMed1975

Fractures of the proximal humeral epiphysis.

Displacements of the proximal humeral epiphysis at the epiphyseal plate result from extension injuries. The configuration of the epiphyseal plate and the thickness of the periosteum surrounding the epiphysis make slight to moderate displacements relatively stable injuries, which can be treated successfully with external support. In patients with more severe displacement, flexion, abduction, and slight external rotation of the distal fragment bring the metaphysis into alignment with the proximal fragment, correcting the anterior angulation. The thick periosteal sleeve attached to the physis through which the metaphysis tears out anteriorly has great potential for remodeling the persistant bowing that remains after healing of the fracture. Although shortening and residual angulation results from closed treatment are almost always good and open surgery is rarely indicated.

Adolescent↗