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J Eric Gordon

Publications and source records attributed to J Eric Gordon.

33 records · Page 2Linked to original sources
PubMed2002

Surgical correction of the snapping iliopsoas tendon in adolescents.

BACKGROUND: There have been very few reports regarding symptomatic snapping of the iliopsoas tendon, and none of those reports have dealt exclusively with an adolescent population. We report our experience with the surgical treatment of this entity in a group of patients who had an average age of fifteen years. METHODS: Nine adolescent patients (eleven hips) underwent fractional lengthening of the iliopsoas tendon at the musculotendinous junction because of persistent painful snapping of the hip. A modified iliofemoral approach to the iliopsoas tendon was used. The diagnosis in all cases was made on the basis of the history and a physical examination. Plain radiographs were made for all patients to rule out an osseous intra-articular loose body. Follow-up consisted of personal interviews and physical examinations performed at least two years postoperatively. RESULTS: Preoperatively, all patients had audible snapping with pain localized to the anterior part of the groin. The average duration of symptoms was 2.3 years. Prior to the onset of symptoms, all but one of the patients had been involved in competitive athletic activities. Postoperatively, all patients were able to return to the preoperative level of activity without subjective weakness. The average duration of postoperative follow-up was four years. Hip-flexion strength was noted to be nearly equal to that on the contralateral side. All patients reported that they would have the operation again under similar circumstances. One patient had recurrent snapping but stated that it was less frequent and less painful than the preoperative snapping. Two patients had transient sensory loss in the anterolateral aspect of the thigh. CONCLUSIONS: We conclude that fractional lengthening of the iliopsoas tendon at the musculotendinous junction is an effective and safe approach for adolescent patients with persistent symptomatic snapping of the iliopsoas tendon that is unresponsive to conservative measures.

Adolescent↗
PubMed2002

Femoral lengthening over a humeral intramedullary nail in preadolescent children.

BACKGROUND: Femoral lengthening over an intramedullary nail has been described in adults. A technique of femoral lengthening over a humeral intramedullary nail in children is described, and the results and complications are presented. METHODS: Nine preadolescent patients (average age, nine years and ten months) with femoral length discrepancy were treated with femoral lengthening over a humeral intramedullary nail. After nail insertion, a monolateral external fixator was placed with half-pins either anterior or posterior to the intramedullary nail, and lengthening was performed through a proximal osteotomy. RESULTS: The femora were lengthened a mean of 6.1 cm (range, 5.0 to 8.0 cm), 19.5% (range, 15.9% to 26.2%) of the preoperative femoral length. Patients had a mean lengthening index of 12.2 days/cm of length (range, 9.5 to 16.9 days/cm of length). Five complications including osteomyelitis, failure of the distal interlocking site, and femoral fracture at the distal end of the nail occurred in four patients; four of the complications led to surgical intervention. No case of proximal femoral valgus secondary to nailing through the greater trochanter had developed by the time of final follow-up. All patients were followed for a minimum of two years postoperatively, with a mean of 128 weeks (range, 111 to 161 weeks). CONCLUSIONS: The technique is effective but has a high rate of complications, including osteomyelitis, which developed in two of the nine patients. No avascular necrosis or proximal femoral valgus was noted.

Bone Lengthening↗
PubMedDate not supplied

Soft-tissue distraction with a ring external fixator before centralization for radial longitudinal deficiency.

PURPOSE: To review the techniques and evaluate the use of soft-tissue distraction with a ringed fixator for radial longitudinal deficiency (RLD) before centralization. METHODS: Eight extremities in 6 patients with severe RLD were treated with ring fixator distraction followed by centralization. A clinical examination was performed and radiographic data were obtained prospectively and at an average follow-up period of 17 months. The techniques and the early objective (range of motion, position) and radiographic outcome were evaluated. RESULTS: The preoperative ring fixator accomplished an average of 16 mm of distraction and allowed the centralization procedure to be performed effectively and without tension. Clinical alignment was improved markedly. The hand-forearm angle improved from 72 degrees radial to 8 degrees ulnar after surgery. The volar carpal subluxation improved by an average of 6 mm. CONCLUSIONS: Precentralization ring fixator distraction allows the performance of a tensionless centralization procedure with good early radiographic and clinical outcome in patients severely affected with RLD. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗
PubMedDate not supplied

Complications and outcomes of open pediatric forearm fractures.

Few reports have documented the complications and outcomes of open pediatric forearm fractures. The authors completed of all patients (1987-1999) with open forearm fractures. Sixty-five patients with 65 injured extremities were identified, with an average age of 10.3 years. Fifty-two open fractures were grade I, 12 were grade II, and 1 was grade IIIA. Implants stabilized 40 extremities (62%), which improved alignment but not outcome. Forearms initially stabilized with implants did not undergo additional realignment procedures (0%), compared with 18.5% of forearms without stabilization. Eleven patients (16.9%) experienced complications. Overall, 47 (72%) were classified as having excellent results, 11 (17%) as good, and 7 (11%) as fair. Open pediatric forearm fractures have a high percentage of excellent and good outcomes. Early, thorough surgical débridement produces a low frequency of deep infections, and bony stabilization can be a safe technique, permitting more anatomic alignment and preventing the need for reoperation due to malalignment.

Adolescent↗
PubMedDate not supplied

Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity.

Ponseti demonstrated correction of most clubfeet in infants using proper manipulative techniques followed by application of well-molded long-leg plaster casts and a percutaneous tendoachilles tenotomy to correct residual equinus contracture. Medical complications occurring as a result of this technique have not to our knowledge been reported. The authors retrospectively reviewed 134 consecutive infants with 219 idiopathic clubfeet treated with the Ponseti method. A percutaneous tendoachilles tenotomy was performed on 200 clubfeet (91%) at a mean age of 16 weeks (range, 6-77 weeks) when less than 10 degress of ankle dorsiflexion was present after casting. A total of 4 patients had serious bleeding complications following the percutaneous tendoachillis tenotomy--3 due to presumed injury to the peroneal artery and 1 due to injury to the lesser saphenous vein. The authors detail the technique of performing a percutaneous tendoachilles tenotomy and offer guidelines that may help others avoid this same complication.

Achilles Tendon↗
PubMedDate not supplied

Flexor digitorum accessorius longus muscle is associated with familial idiopathic clubfoot.

The etiology of idiopathic and familial clubfoot remains elusive. The purpose of this study was to document the prevalence of the flexor digitorum accessorius longus muscle in a large series of children treated with an extensive soft tissue release for idiopathic clubfoot deformity and compare those patients with and without this anomalous muscle in terms of various demographic data, including a positive family history of clubfoot. A retrospective review was conducted to identify infants treated with an extensive soft tissue release for idiopathic clubfoot deformity at the authors' institutions between 1980 and 2000. Patient characteristics and family demographic data were analyzed using multiple logistic regression analysis modeling the probability of having the anomalous flexor muscle. A flexor digitorum accessorius longus muscle was identified in 55 (6.6%) of the 835 patients at the time of surgical correction of the clubfoot deformity. It was present in 4.5% of patients without a family history (33/741) and 23.4% of patients with a family history (22/94) (P < 0.0001). Children with first-degree relatives with clubfoot are 6.6 times more likely to have the anomalous flexor muscle than children without first-degree relatives with clubfoot (odds ratio 6.6; 95% confidence interval 3.63-11.84; P < 0.0001).

Clubfoot↗
PubMedDate not supplied

Diaphyseal derotational osteotomy with intramedullary fixation for correction of excessive femoral anteversion in children.

Nearly all children with femoral anteversion spontaneously remodel by age 8. Femoral derotational osteotomies are performed in older children with persistent excessive femoral anteversion when children or adolescents are limited in activities of daily living or sports. Procedures for correction of the anteversion vary, and no one procedure has been shown to be superior. Since 1997 the authors have corrected idiopathic excessive femoral anteversion thorough a diaphyseal osteotomy with fixation using a rigid intramedullary pediatric femoral nail. The purpose of this study was to describe the technique and results of this new technique. A retrospective study was conducted of all femoral derotational osteotomies performed with a pediatric femoral nail in 13 consecutive patients and 21 affected limbs. All patients complained preoperatively of frequent tripping during sports and activities of daily living. The mean preoperative rotation included internal rotation of 77 degrees and external rotation of 15 degrees. Standing AP radiographs of all patients were obtained at final follow-up. All patients were evaluated clinically and radiographically at a minimum of 1 year after surgery. All patients noted improvement in the ability to participate in activities without tripping. No patient limped at final follow-up. No intraoperative or postoperative complications occurred. Healing of the osteotomy was present at a mean of 6 weeks. All osteotomies healed in anatomic alignment. Mean final hip rotation included internal rotation of 40 degrees and external rotation of 57 degrees. No patient had substantial changes of valgus or femoral neck narrowing at final follow-up. Femoral derotational osteotomy with fixation using a small-diameter rigid intramedullary nail placed through the lateral aspect of the greater trochanter is a safe, accurate, and effective method of correcting excessive femoral anteversion in symptomatic children.

Adolescent↗
PubMedDate not supplied

Causes of false-negative ultrasound scans in the diagnosis of septic arthritis of the hip in children.

Ultrasound scans of the hip were carried out in 132 children with hip pain during an 18-month period to evaluate the hip for the presence of an effusion. Seventy-three of these patients were followed up long enough to ascertain the presence or absence of septic arthritis. The remaining 59 patients were discharged with diagnoses other than septic arthritis but could not be located to confirm the ultimate accuracy of the diagnosis. Four patients were initially determined to have no effusion but subsequently were diagnosed with septic arthritis (false-negative rate of 5%). Two of these patients had inadequate initial ultrasound examinations. Two children had ultrasound examinations that even on retrospective review did not reveal an effusion. Both of these children had had symptoms for <24 hours, and one had a contralateral hip effusion. The authors recommend using the negative results of an ultrasound scan as evidence of the absence of septic arthritis in children with caution when symptoms have been present for <24 hours or when bilateral disease exists.

Adolescent↗
PubMedDate not supplied

Early reduction, arthrotomy, and cannulated screw fixation in unstable slipped capital femoral epiphysis treatment.

Sixteen consecutive cases of unstable slipped capital femoral epiphysis treated with urgent reduction and pinning during a 7-year period are presented. In 2 of the 16 patients, avascular necrosis of the femoral head developed. Ten of the 16 patients were treated within 24 hours after the onset of acute symptoms by reduction, arthrotomy, and cannulated screw fixation of the hip using two screws. In none of these patients did avascular necrosis of the femoral head develop. Two patients required hardware removal for persistent pain, and one required a revision pinning after a nondisplaced femoral neck fracture. Chondrolysis did not develop in any patient, and no hip progressed after fixation. At last follow-up (mean 27 months after surgery), two patients walked with a moderate limp. Three reported persistent mild pain in the affected hip. Early reduction of unstable hips with arthrotomy and pinning using two cannulated screws to minimize the risk of avascular necrosis is recommended.

Adolescent↗
PubMedDate not supplied

Treatment of rigid hypertrophic posttraumatic pseudarthrosis of the tibia in children using distraction osteogenesis.

Posttraumatic tibial pseudarthrosis is a relatively uncommon complication of tibia fractures in children. Although reported as a successful method of treating tibial nonunions in adults, distraction osteogenesis through a nonunion site via ring external fixation has not been described in children. The authors report three consecutive cases of distraction through an angulated, shortened, hypertrophic, posttraumatic nonunion to achieve successful union and concurrent correction of deformity. Distraction was carried out using a ring fixator with computer-guided correction. Union was achieved in each of the three patients with complete correction of deformity and length. Lengthening of 8 to 31 mm was achieved. The length of time in the external fixator ranged from 7 to 27 weeks. Pin tract infections developed in all patients; they were treated successfully using oral antibiotics. No deep infections or other significant complications developed. Each patient was followed up for at least 1 year.

Accidents, Traffic↗
PubMedDate not supplied

Combined midfoot osteotomy for severe forefoot adductus.

A one-stage procedure combining a closing wedge osteotomy of the cuboid with an opening wedge of the medial cuneiform was used for the treatment of severe forefoot adductus. Results were reviewed in 33 patients (50 feet) followed-up for at least 2 years postoperatively. Clinical and radiographic improvement in forefoot position was achieved in 90% of cases. The mean calcaneo-second metatarsal angle improved from 37 degrees preoperatively to 18 degrees at final follow-up. The mean talo-first metatarsal angle improved from 15 degrees preoperatively to 3 degrees at final follow-up. The medial to lateral column ratio demonstrated 33% improvement after surgical treatment. Two feet were unimproved because of graft migration. Patients younger than age 5 years without a well-defined medial cuneiform ossific nucleus had a high rate of medial graft extrusion with loss of correction. This procedure should be reserved for patients aged 5 years or older. Ten patients followed-up for more than 6 years had no deterioration in results. This procedure provides effective, safe, predictable, and lasting correction of forefoot adductus.

Adolescent↗
PubMedDate not supplied

Septic arthritis of the hip in infancy: long-term follow-up.

At a mean 15-year follow-up, the authors evaluated five hips in five patients who had complete destruction of the femoral head and neck from septic arthritis when they were 3 months old. All patients were treated with a trochanteric arthroplasty in combination with a proximal femoral varus osteotomy at a mean age of 30 months in an attempt to salvage a femoral-pelvic articulation. Results suggest this treatment can provide a stable, painless, and functional hip, with an improved gait and less leg-length discrepancy than predicted if no reconstructive effort were attempted.

Arthritis, Infectious↗
PubMedDate not supplied

Severely displaced proximal humeral epiphyseal fractures.

The purpose of this study was to document the late outcome of a group of patients with Neer grade III/IV proximal humeral physeal fractures who were treated with reduction of the fracture and maintenance of reduction until fracture consolidation. A total of 28 patients treated between 1984 and 1999 at a large children's hospital were included in this study. Nineteen of the 28 patients were 15 years or older (range 5-16 y). All patients were treated in the operating room with closed reduction followed by immobilization (n = 3), closed reduction and pin fixation (n = 20), open reduction and screw fixation (n = 3), or open reduction and pin fixation (n = 2). Postoperatively, all had Neer grade I or II displacement, which was maintained until fracture union. No operative or postoperative complications occurred. At an average follow-up of 4 years, all patients had near-normal glenohumeral motion and excellent strength and uniformly reported regaining full preinjury functional use of the involved extremity. Achieving and maintaining reduction in Neer grade III/IV proximal humeral epiphyseal fractures can be safely performed and results in excellent long-term shoulder function. This is of particular significance in the older adolescent who has minimal remodeling potential.

Adolescent↗
PubMedDate not supplied

Complications of titanium elastic nails for pediatric femoral shaft fractures.

Limited data exist about complications of titanium elastic nails (TNs) for femur fracture management in pediatric patients. Thirty-nine patients with 43 femoral shaft fractures were identified whose average age was 6.0 years. There were 21 complications (1 intraoperative, 20 postoperative) in 43 femur fractures (49%). There were two major postoperative complications: one septic arthritis after nail removal and one hypertrophic nonunion. Minor postoperative complications were pain at the nails in 13 extremities, nail erosion through the skin in 4, and one delayed union. There was an association between the prominence of TNs and nail pain or skin erosion. Fracture angulation and outcome were associated with the patient's weight and size of the nails implanted. Technical pitfalls exist with this implant and can be minimized by leaving less than 2.5 cm of nail out of the femur and by using the largest nail sizes possible.

Analysis of Variance↗