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Biomedical subjects

J B Emans

Publications and source records attributed to J B Emans.

At least 37 records · Page 2Linked to original sources
PubMed1992

Sitting balance in spinal deformity.

A computerized pressure plate system was used to analyze the sitting pressure distribution and balance of 100 subjects with both normal and abnormal spines. Normal subjects had a balanced sitting posture with the weight taken evenly on each ischial tuberosity. Patients with idiopathic scoliosis showed significant sitting imbalance especially in the presence of lumbar curves. Bracing improved the sitting balance and stability in most patients. Abnormal sitting patterns were seen with the spinal deformities of myelodysplasia or cerebral palsy. Some patients with severe scoliosis had very asymmetric patterns, which correlated with their loss of sitting stability. The kyphosis of myelodysplasia produced an abnormal tripod sitting pattern due to pelvic flexion and a hyperlordosis of cerebral palsy a pubic sitting pattern due to pelvic extension. The patients studied after spinal fusion also had poor sitting balance and occasionally persisting decubitus ulceration.

Cerebral Palsy↗
PubMed1992

Excision of the radial head for congenital dislocation.

Eight elbows in six patients who had had excision of the radial head for congenital dislocation were evaluated an average of seven years postoperatively. The average age of the patients at the time of the excision was thirteen years (range, ten to 15.5 years). The dislocation was posterior in five elbows and posterolateral in three. The over-all increase in the arc of flexion-extension postoperatively compared with preoperatively was 11 degrees (p greater than 0.1): The over-all increase in the arc of rotation was significant at 53 degrees (p less than 0.002). Pain in the elbow had decreased compared with preoperatively, but all patients had minor pain in the wrist. The result was rated good in five elbows, fair in two, and poor in one. One patient had a repeat excision of the radial head after it re-formed, and this was the reason for the poor result. All patients were satisfied with the outcome of the operation. Contrary to previously published data, excision of the radial head for congenital dislocation resulted in an increased range of motion and a decrease in pain in the elbow in our patients.

Adolescent↗
PubMed1991

Myelodysplasia--the musculoskeletal problem: habilitation from infancy to adulthood.

The physical therapy and orthopedic management of patients with myelodysplasia from infancy to adulthood are reviewed. The overall goal for the child with myelodysplasia is functional independence. Physical therapy and orthopedic intervention enable the individual to achieve this goal. Associated problems, however, such as Arnold-Chiari malformation, hydrocephalus, and tethered spinal cord, influence functional expectations. Physical therapy management begins in the neonatal period and continues through adolescence. Treatment is modified at the various stages of development. Knowledge of current orthotic and adaptive equipment is necessary to achieve optimal locomotor function. Orthopedic management decisions are based on musculoskeletal and neurologic assessments, to which the physical therapist provides a significant contribution. Controversies exist over the orthopedic management of dislocated hips, scoliosis, and kyphosis.

Adolescent↗
PubMed1990

Management of vascular injuries in displaced supracondylar humerus fractures without arteriography.

One hundred forty-three displaced (type III) supracondylar fractures of the humerus in children were treated over a 5.5-year period with 17 (11.9%) having signs of vascular impairment at the time of presentation. Rapid reduction and Kirschner wire stabilization without arteriogram was performed in each case. In three cases in which satisfactory blood supply to the hand was not present after reduction, circulation was restored after exploration of the brachial artery revealed two intimal tears and one arterial entrapment. The remaining 14 patients were normal at follow-up with no late vascular compromise. Based on these findings, we feel prereduction arteriography is not indicated in this injury.

Arm↗
PubMed1988

Disorders of the sacro-iliac joint in children.

The cases of seventeen children whose ages ranged from two to eighteen years and who were treated for a disorder of a sacro-iliac joint between 1975 and 1983 were reviewed retrospectively. Thirteen children were acutely ill, with a temperature of more than 38 degrees Celsius, and four had chronic symptoms that had persisted for three weeks to one year. Pain in the hip, thigh, and buttock was the most common symptom. Of the thirteen acutely ill patients, eleven had septic arthritis of a sacro-iliac joint, while one who had ankylosing spondylitis and one who had juvenile rheumatoid arthritis had acutely painful arthritis of a sacro-iliac joint. Of the four patients who had chronic symptoms, two had septic arthritis of a sacro-iliac joint; one, ankylosing spondylitis with sacro-iliac involvement; and one, eosinophilic granuloma of the ilium. Thus, thirteen patients had septic arthritis of a sacro-iliac joint and four had some other disorder. For the seventeen children who had acute or chronic symptoms, at admission the white blood-cell count ranged from 3,500 to 26,200 per cubic millimeter (average, 11,100 per cubic millimeter) and the sedimentation rate, as determined by the Westergren technique, ranged from twenty-two to sixty-five millimeters per hour (average, fifty millimeters per hour). Twelve of the plain radiographs of the seventeen patients were negative. The initial bone scans of all seventeen patients were positive in eleven and negative in six. Of these six, five had septic arthritis and one, juvenile rheumatoid arthritis. A computed tomographic scan was performed in four patients and was positive in all of them: three had septic arthritis and one had ankylosing spondylitis. Organisms were cultured successfully from blood, from material aspirated from the sacro-iliac joint, or from stool of all thirteen patients who had sepsis. The thirteen infections responded well to appropriate antibiotics, which were administered intravenously to seven patients and first intravenously and then orally to six.

Adolescent↗
PubMed1987

Intra-articular entrapment of the median nerve after elbow dislocation in children.

Two cases of intra-articular median nerve entrapment after reduction of elbow dislocations in children are described. The diagnosis of median nerve entrapment is often delayed. A proximal median nerve deficit, limited passive elbow motion, and an associated medial epicondyle avulsion after reduction of a child's posterior elbow dislocation should alert the surgeon to the possibility of nerve entrapment. Optimal management of this problem consists of early surgical exploration and nerve release.

Adolescent↗
PubMed1986

The Boston bracing system for idiopathic scoliosis. Follow-up results in 295 patients.

A total of 295 patients treated with the Boston bracing system with follow-up of at least 1 year after completion of bracing are reviewed. Pre-brace curves ranged from 20-59 degrees Cobb. Mean age at brace initiation was 13.2 years with a mean treatment time of 2.9 years and mean follow-up of 1.4 years. Mean best in-brace correction averaged 50% with correction averaging 23% at the initiation of weaning from the brace. By the time of brace discontinuance, average curve correction was 15%. At follow-up, average correction was 11%. A comparison of follow-up with pre-brace values of major curves showed that 49% were unchanged +/- 5 degree, 39% achieved final correction of 5-15 degrees, 4% achieved final correction of 15 degrees or more, 4% of patients lost 5-15 degrees, and 3% lost more than 15 degrees by the time of follow-up. Eleven percent of patients underwent surgery during the period of bracing; 1% had surgery during follow-up period. Correction and control of major curves with apexes below T8 and above L2 were best. A strong correlation between best, or initial in-brace correction, and follow-up correction was noted. Young age at the initiation of bracing and higher degrees of pre-brace curvature increased the incidence of surgery. Those curves that had corrected most at the end of bracing were most at risk for loss of correction after bracing. Partial compliance with brace wear appeared as effective as full-time wear. Boston braces without superstructure appeared to be as effective as braces with superstructure for curves with apexes below T7.

Adolescent↗
PubMed1986

Further evaluation of the Scolitron treatment of idiopathic adolescent scoliosis.

One hundred forty-two patients were treated by the Scolitron method of lateral electric surface stimulation (LESS) for scoliosis. Using 10 degrees progression as a failure point, clinicians reported the following: 56.3% of patients were classified as failures, 26.8% as successes; and 16.9% were still under treatment. When broken down into individual groups, true protocol patients, at risk for progression, had the lowest success rate; whereas those that were nonprotocol, and least at risk, had the highest success rate. This method should still be considered experimental and cannot be considered an alternative to bracing at this time.

Adolescent↗
PubMed1985

En-bloc resection for proximal humerus osteogenic sarcoma.

From 1975 to 1982, 101 children were treated for osteogenic sarcoma at the Children's Hospital of the Medical Center and Dana Farber Cancer Institute, Boston. 12 of these patients presented proximal humerus localisation and 8 underwent a local en-bloc resection. In the past these lesions were surgically treated by disarticulation of the shoulder or by interscapulothoracic amputation (forequarter amputation); the death rate was very high. Nowadays, high-dosage chemotherapy and resection of lung metastases carry new hopes for better and prolonged survival, and also for a higher rate of complete remissions. The quality of this prolonged life can be improved if en-bloc resection of the shoulder with upper limb preservation is performed.

Adolescent↗
PubMed1985

Bone scintigraphy and radiography in young athletes with low back pain.

Radiographs and bone scans of 40 young athletes with low back pain were reviewed retrospectively to correlate the imaging findings and assess the value of scintigraphy in the diagnosis of these patients. The radiographs were positive for spondylolysis with or without spondylolisthesis in 15 (38%), and scintigraphy showed focal disease in the posterior vertebral elements in 14 (35%). Five patients had positive radiographic studies but normal scans, indicating old injuries; four patients had positive scintigrams but normal radiographs, suggesting early or active injuries. The authors use radiography as the initial examination in the evaluation of patients with low back pain. Scintigraphy is most useful in early stages, when radiographs may be normal; and in cases in which the age and activity of a radiologic abnormality cannot otherwise be accurately determined before therapy.

Adolescent↗
PubMedDate not supplied

A prospective evaluation of idiopathic left thoracic scoliosis with magnetic resonance imaging.

Twenty-nine consecutive patients with idiopathic left thoracic scoliosis were prospectively studied using magnetic resonance imaging (MRI). T1-weighted sagittal and axial images were obtained on all patients from the brainstem to the tip of the conus. Two patients (7%) had a syrinx on MRI. The remaining 27 patients had normal MRIs. The prevalence of brainstem and spinal cord anomalies was much less common than reported in previous retrospective reviews.

Adolescent↗
PubMedDate not supplied

Chronic physeal fractures in myelodysplasia: magnetic resonance analysis, histologic description, treatment, and outcome.

Thirteen myelodysplastic children with 19 chronic physeal fractures were treated. All were treated with prolonged immobilization (average, 5.8 months; range, 3-18 months) in either braces or casts; four of the fractures required operative fixation to facilitate healing. All were healed at 4.8-years follow-up but, in four of the fractures, the growth plate closed prematurely. Three of the children underwent magnetic resonance imaging (MRI) of the injured physes, and one underwent physeal biopsy as part of her operative epiphysiodesis. Histologic analysis revealed three distinct zones of physeal pathoanatomy: a normal zone of proliferation; a thickened, disorganized zone of hypertrophy; and a vascularized zone of fibrous tissue adjacent to the metaphysis. On MRI, there was thickening of the physis and irregularity of the zone of provisional calcification. The physeal cartilage and the juxtametaphyseal fibrovascular tissue enhanced with gadolinium. These findings corroborate earlier mechanistic proposals for physeal injury in myelodysplasia: chronic stress or trauma to the poorly sensate limb produces micromotion at the zone of hypertrophy, yielding a widened, disorganized physis, and leading to fracture, displacement, and delayed union.

Child, Preschool↗
PubMedDate not supplied

Combined anterior and posterior fusion for Scheuermann's kyphosis.

Combine anterior and posterior fusion provides and maintains good correction in patients with Scheuermann's kyphosis. A fusion which includes the entire deformity, especially at lower end, is a requisite for a satisfactory result. Intervening halofemoral traction may not improve results. Pulmonary functions may decrease somewhat postoperatively but, in the large majority of cases, still remain within normal limits. We think that anterior and posterior fusion remains the procedure of choice in severe or rigid Scheuermann's kyphosis.

Adolescent↗