Biomedical subjects

J B Emans

Publications and source records attributed to J B Emans.

46 records · Page 3Linked to original sources

PubMedDate not supplied

Slipped capital femoral epiphysis: assessment of epiphyseal displacement and angulation.

Nineteen hips with slipped capital femoral epiphysis underwent assessment of the severity of epiphyseal displacement on anteroposterior and lateral roentgenograms and by computerized tomography. The head-shaft angle, the percentage of maximal epiphyseal displacement, and the computed tomographic head-neck angle were determined. The head-shaft angle showed great variability when compared with the percentage of epiphyseal displacement and with the head-neck angle. The percentage of epiphyseal displacement showed less variability when compared with the computerized tomographic head-neck angle; however, the range of error was still significant. These data suggest that the computerized tomographic measurement of degree of slip is more accurate than previously described techniques. We believe that the computerized tomographic measurement of head-neck angle achieves greater accuracy and therefore reproducibility by virtue of a decrease in position dependency. This measurement may be indicated as a reproducible standard for assessing slip severity in the horizontal plane.

Adolescent↗

PubMedDate not supplied

Treatment of severe spondylolisthesis in children by reduction and L4-S4 posterior segmental hyperextension fixation.

Twenty children with severe lumbosacral spondylolisthesis underwent reduction, posterolateral fusion, and posterior fixation with an L4 to S2, 3, and 4 sublaminar wired rectangular rod to lessen lumbosacral kyphosis, allow early ambulation, and maintain correction. All patients had a postural deformity, 10 had preoperative neurologic findings, and 8 had severe pain. The average percentage of slip improved from 76% preoperatively to 55% postoperatively, and the slip angle improved from 25 degrees to 5 degrees (p < 0.0001). All patients had solid fusion by 6 months and no progression at 43 month follow-up on the average. We conclude that this technique reliably provides partial reduction, solid fixation, and fusion for patients with severe spondylolisthesis while allowing early ambulation. As with any spondylolisthesis reduction technique, neurologic risk should limit this procedure to well-selected patients.

Adolescent↗

PubMedDate not supplied

Neurovascular injury and displacement in type III supracondylar humerus fractures.

From July 1987 to January 1991, 59 consecutive type III supracondylar humerus fractures in children were identified at Children's Hospital, Boston. Twenty-nine patients (49%) had evidence of neurovascular compromise. The median nerve was involved in 15 (52%) of these patients and was associated with posterolateral displacement in 87% of cases. The radial nerve was involved in eight (28%) of these patients and was associated with posteromedial displacement in every case. Injuries to the brachial artery occurred in 11 (38%) of these patients and was associated with posterolateral displacement in 64% and posteromedial displacement in 36% of cases. We conclude that posterolateral displacement in type III supracondylar humerus fractures is strongly associated with median nerve injuries. Posteromedial displacement is responsible for injuries. Posteromedial displacement is responsible for injuries to the radial nerve in virtually every instance. Brachial artery injuries may occur with either type of displacement. Neurovascular injury is higher than previously reported in these fractures.

Blood Vessels↗

PubMedDate not supplied

The Pavlik harness and developmental dysplasia of the hip: has ultrasound changed treatment patterns?

Monitoring Pavlik harness therapy for developmental dysplasia of the hip (DDH) has been used at our institution since 1986. In this study, we compared Pavlik therapy for DDH without ultrasound monitoring (group A) to similar therapy with ultrasound monitoring (group B). Both groups had similar age at diagnosis. Treatment failure was recognized earlier in group B than in group A (4.9 vs. 9.3 weeks). The total number of radiographs was significantly decreased in group B. The duration of therapy was less in group B than in group A. Successfully treated hips had an average increase in alpha angle of 8.4 degrees per month. The average failure rate in hips resting in a dislocated position at the onset of Pavlik therapy was unchanged by Pavlik monitoring.

Braces↗

PubMedDate not supplied

Scoliosis: diagnosis and current treatment.

The most common form of scoliosis (lateral curvature of the spine) is adolescent idiopathic scoliosis (AIS). The prevalence of AIS is 10-20 individuals per 1,000 population screened. Progressive AIS affects females more frequently than males. Only 1-2 per 1,000 individuals have progressive AIS and need brace or surgical treatment. Early screening programs for scoliosis and other spinal deformities are instituted in schools in the fifth to ninth grades to achieve early detection of progressive AIS. If detected early, progressive AIS can in most cases be successfully treated by use of an external spinal brace. More severe scoliosis is successfully treated with surgical instrumentation and spinal fusion. Although much progress has been made in understanding the natural history of AIS, its cause remains unknown.

Adolescent↗

PubMedDate not supplied

Early failure of Pavlik harness treatment for developmental hip dysplasia: clinical and ultrasound predictors.

A cohort of 93 patients with developmental dysplasia of the hip (DDH) treated with a Pavlik harness were evaluated to determine predictors of treatment failure. Failure was defined as failure to achieve or maintain hip reduction in the Pavlik harness. Of 93 patients (137 hips), 17 (26 hips) failed Pavlik harness treatment. Univariate risk factors for failure included bilaterality, initial clinical exam, and initial ultrasound (US) percent coverage. Clinical exam and initial percent coverage were multivariate risk factors for failure. Among initially clinically dislocatable hips, a low initial US alpha angle correlated with an increased likelihood of failure. All (6/6) patients with an initially irreducible hip and an initial coverage of <20% by US eventually failed treatment. Gender, side of pathology, and age at diagnosis and initiation of treatment did not correlate with failure. Irreducibility by physical exam combined with US coverage of <20% identified a patient group that uniformly failed Pavlik harness treatment. These patients may be candidates for alternative bracing, traction, or closed or open reduction.

Age Factors↗

PubMedDate not supplied

A comparison between spinous process and sublaminar wiring combined with Harrington distraction instrumentation in the management of adolescent idiopathic scoliosis.

A study of the efficacy of two techniques of spinal instrumentation on patients with adolescent idiopathic scoliosis was performed. Twenty consecutive patients treated with a single Harrington distraction rod and sublaminar wiring (H-SL) were compared with 20 consecutive patients treated with a single Harrington distraction and spinous process wiring (H-SP). The patients in both groups were similar in age, curve magnitude, curve flexibility, and curve type. The immediate postoperative correction (61% H-SL, 58% H-SP) and follow-up correction (50% H-SL, 49% H-SP) were equivalent. No pseudarthroses were recognized in either group. One patient with H-SL had transient postoperative paresthesias.

Adolescent↗

PubMedDate not supplied

Segmental spinal dysgenesis: early neurologic deterioration and treatment.

Segmental spinal dysgenesis is a rare congenital condition of the lumbar or thoracolumbar spine that can be associated with significant progressive or permanent neurologic defects, including paraplegia. In the past, both bracing and surgery have been recommended. Of the seven children we have seen with this problem, three have lost motor function between presentation and the time of surgery. Our experience suggests that to prevent catastrophic neurologic deterioration, surgery is indicated once the diagnosis is made.

Abnormalities, Multiple↗

PubMedDate not supplied

Increasing lordosis of the occipitocervical junction after arthrodesis in young children: the occipitocervical crankshaft phenomenon.

Five children were treated before age 6 years with occipitocervical fusion for occipitocervical instability. Long-term (average, 11.8 years; range, 8.4-14.5 years) follow-up revealed increasing lordosis across the fused segment in four of the patients, a finding we here refer to as the occipitocervical crankshaft phenomenon. On average, occipitocervical lordosis increased 1.06 degrees per level fused per year until skeletal maturity. Although such a progression might be expected, to our knowledge this is the first report of its occurrence. Compensatory subaxial motion was able to overcome this increase in all of the patients. We recommend occipitocervical fusion in a neutral or slightly flexed position in the very young child to account for this predictable increase in lordosis.

Arthrodesis↗

PubMedDate not supplied

Adverse urologic consequences of spinal cord resection at the time of kyphectomy: value of preoperative urodynamic evaluation.

Four children with thoracic level paraplegia and severe myelokyphosis underwent distal spinal cord resection at the time of kyphectomy. All four children were continent before spinal cord resection and became incontinent immediately afterward. Two children in retrospect had preoperative urodynamics that showed intact innervation to the external sphincter, and two had no preoperative urodynamic studies. All four had evidence of lower urinary tract denervation on urodynamic studies performed after cord resection. The urologic and urodynamic consequences of spinal cord resection at the time of kyphectomy in children with myelodysplasia are reviewed. Resection of the distal spinal cord in thoracic level myelodysplasia may cause postoperative incontinence in some previously continent patients. Preoperative urodynamic evaluation and urologic consultation is recommended. If individual evaluation indicates that residual sacral function is beneficial to urologic management, kyphectomy without cord resection is preferable.

Child↗