Residency education in surgery.
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Canada↗
Biomedical subjects
J H Wedge
Publications and source records attributed to J H Wedge.
Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled tria.
Selective dorsal rhizotomy (SDR) is widely used to treat spasticity in children with diplegic cerebral palsy (CP) but has never been shown conclusively to improve functional outcome. The study was designed to measure changes in gross motor function in children 1 year following rhizotomy compared with a control group receiving equivalent physiotherapy (PT) and occupational therapy (OT) with the exception that the rhizotomy group initially underwent a 6-week postoperative in-patient therapy program. Twenty-four children (mean age 58 months) with mild to moderate CP with spastic diplegia were randomly assigned to a therapy-only control group (CG) (N=12) or rhizotomy and therapy group (RG) (N=12). The Gross Motor Function Measure (GMFM) was administered at the baseline, 6-, and 12-month assessments. Extremity tone, range of motion (ROM), biomechanics of the ankle-stretch reflex, isometric contraction, and temporal gait components were also evaluated. GMFM scores in the RG improved by 12.1 percentage points versus 4.4 percentage points in the CG (P<0.02). RG knee and ankle tone was significantly reduced (P<0.005), associated with increased passive ankle ROM (P<0.001), and decreased soleus EMG reflex activity on forced dorsiflexion (P<0.008). Foot-floor contact pattern improved in the RG compared with the CG (P<0.05). In conclusion, SDR combined with PT and OT leads to significantly greater functional motor improvement at 1 year following surgery compared with PT and OT alone. This was achieved in part through reduced knee and ankle tone, increased ankle dorsiflexion ROM, and more normal foot-floor contact during walking.
Analysis of Variance↗
Primary arthroplasty of the hip in patients younger than 21 years of age.
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Adolescent↗
Osteotomy of the pelvis for the management of hip disease in young adults.
Alternatives to total hip arthroplasty should always be considered for patients younger than 45 years. The indications for pelvic osteotomy are painful acetabular dysplasia with subluxation of the hip and early secondary degenerative arthritis, in which the majority of the deformity is on the acetabular side of the joint. For more severe deformity combined pelvic and femoral osteotomies may be necessary. Depending on the extent of the acetabular deformity there are a number of pelvic osteotomies available. With careful patient selection, correct indications and precise operative technique, significant relief of symptoms and excellent function may be obtained in most patients for 8 to 10 years after the operation. Pelvic osteotomy thus postpones the need for total hip arthroplasty to a stage in life at which results are better, and it enhances the bone stock to support the acetabular component.
Acetabulum↗
Iliac osteotomy: a model to compare the options in bladder and cloacal exstrophy reconstruction.
Bladder exstrophy and cloacal exstrophy present challenging reconstructive problems. Traditionally, bilateral posterior iliac osteotomy has been performed in the majority of patients undergoing primary closure for these abnormalities. Recently, 2 anterior osteotomy approaches have been proposed: 1) incision of the ilium transversely above the acetabulum (transverse osteotomy) and 2) incision of the superior ramus of the pubis (superior ramus osteotomy). We devised a new anterior mid-iliac diagonal osteotomy that provides a more functional pelvic closure. To provide a fair comparison of the procedures we developed a pelvic exstrophy model based on data from a 3-dimensional computerized tomogram of a 3-year-old patient with classical bladder exstrophy. The different osteotomies were then performed on the model and the results were compared. Our new anterior mid-iliac diagonal osteotomy correction allowed the best surgical approach, provided the best correction of the flattened ilia bony deformities, was performed in the thinnest area of marrow bone and resulted in the best pelvic symmetry.
Bladder Exstrophy↗
The impact of health care reform on orthopaedic surgery in the United States and Canada.
Health care reform is not unique to the United States but reflects fundamental changes in attitudes to health care worldwide. Orthopaedic surgery must examine its role in the context of the overall health care delivery system, rather than in the narrow focus of our specialty, if we are to grow and continue to improve in the future. This lecture describes the evolution of the Canadian Health Care system and draws parallels to the current American environment from which valuable lessons may be learned. There are 5 reasons why health care costs more in the United States than in all other countries which are independent of the fact that the United States has the highest quality of medical care available in the world. These are excessive administrative costs and manpower; oversupply (and hence underutilization) of expensive technology and services; the "medicalization" of social costs; and the tremendous cost of medical liability and malpractice litigation. There are a number of steps that can be taken to enhance the role of orthopaedic surgery in health care without eliminating choice and impairing innovation, which are the critical elements in a high-quality health care system. The Canadian and American systems will be more similar in the future despite the different paths that we are taking in reform, and I believe we can look to the future with optimism and confidence if appropriate measures are taken to ensure that our contributions are effective and efficient.
Canada↗
Classification of femoral abnormalities in total hip arthroplasty.
Bony abnormalities of the femur can significantly complicate total hip arthroplasty both for the primary and revision operations. No standard nomenclature exists for the description of these femoral abnormalities. A classification system is presented to standardize nomenclature, assist in preoperative planning, and to assist in the reporting of these defects.
Bone Malalignment↗
The fate of traumatic anterior dislocation of the shoulder in children.
The cases of twenty-one patients who had open physes and were treated for radiographic evidence of traumatic anterior dislocation of the shoulder at either the Adelaide Childrens Hospital or The Hospital for Sick Children, Toronto, during a fifteen-year period, were reviewed. All twenty-one patients had had one or more recurrent dislocations. Treatment, which included immobilization in a sling and swathe for as long as six weeks, had no effect on the rate of recurrence.
Adolescent↗
Minor anatomic abnormalities of the hip joint persisting from childhood and their possible relationship to idiopathic osteoarthrosis.
A retrospective review was made of roentgenograms from 30 patients with idiopathic osteoarthrosis of the hip. The roentgenograms were taken before the onset or very early in the course of the disease. Nine measurements were made on the anteroposterior and cross-table lateral roentgenograms. These were compared to 54 hips from normal patients. Twenty-nine of 30 patients had abnormal measurements, with as many as seven in a single individual, when compared to normal patients. There were no abnormalities in the control group. The availability of lateral views allowed an additional dimension to be added to previous studies in the literature. This study lends further support to the biomechanical theory of the etiology of idiopathic osteoarthrosis of the hip.
Adolescent↗
Anatomy and management of the leg and foot in Apert syndrome.
The involvement of the lower extremity in acrocephalosyndactyly has received less attention than the craniofacial and upper extremity anomalies. The lower extremity deformities are progressive and require greater attention as the patient grows older. The stiffness of the hips and mild to moderate genu valgum rarely, if ever, require intervention. Foot and toe deformities lead to difficulty with malalignment, painful stresses, and shoe wear. Each of these must be dealt with individually, placing emphasis on the underlying bony abnormality.
Acrocephalosyndactylia↗
Classification and management of acetabular abnormalities in total hip arthroplasty.
Total hip arthroplasty, for both primary and revision operations, frequently involves bony abnormalities of the acetabulum. No standard nomenclature currently exists for the definition of acetabular deficiencies. A classification system is presented to assist in the preoperative evaluation and to provide a treatment protocol for these defects.
Acetabulum↗
Anteversion of the femur and idiopathic osteoarthrosis of the hip.
We studied the radiographs of 220 consecutive cadavera that were used for dissection by medical students over an eleven-year period. Anteversion of the femur was measured by a reproducible direct method after dissection of forty-eight idiopathic osteoarthrotic hips and twenty control hips. We were unable to find a significant difference between the degree of anteversion of the neck of the femur in the two groups.
Adult↗
Epidemiology of fractures of the distal end of the radius in children as associated with growth.
We determined the annual incidence of fracture of the distal end of the radius for patients of all ages and both sexes in the province of Saskatchewan, using two data sets: data on hospital admissions for 1970 through 1984, and data on physician billing for 1978 through 1985. The rate of occurrence of this fracture in children, by age and sex, was compared with longitudinal data on the velocity of growth that was collected during the same time for children from the same population. We compared the incidences of the fracture with the results of studies on the levels of activity in children and adolescents during growth. We also compared the age-specific incidence of the fracture in children with the incidence in adults. For both data sets, the age at the peak incidence of fracture of the distal end of the radius almost perfectly matched the age at which peak velocity of growth in height occurs for boys and girls. For girls, the peak incidence occurred between the ages of 11.5 and 12.5 years and for boys, between 13.5 and 14.5 years; these ages corresponded to the mean peak velocity of growth at 11.9 years for girls and 14.3 years for boys. The age-adjusted incidence of the fracture in male subjects was highest at fourteen years and was not exceeded by that in female subjects until fifty-three to fifty-four years.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Chronic injury to the distal ulnar and radial growth plates in an adolescent gymnast. A case report.
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Adolescent↗
Hip pain in adolescence.
No single pelvic or femoral osteotomy can be expected to correct the range of deformity encountered in the adolescent with a subluxed hip or the sequelae of treatment at a younger age. A range of pelvic and femoral osteotomies on both sides of the joint are required when there is marked deformity. The principles of management of the anatomic derangement of the painful adolescent hip are different from those in the younger child. Anatomic and biomechanical restoration at skeletal maturity must be perfect for the hip to function well in the long term. The plasticity and capacity for remodeling is much less than in the child. Postoperative immobilization must be avoided if joint stiffness is to be avoided. While the results of arthroplasty are the standard to which osteotomy must be compared, the high failure rate in young adults and pessimistic prospects of revision make biologic alternatives more attractive. The success of osteotomy depends on correct indications, careful preoperative planning, precise technique, rigid fixation, and early postoperative movement. When the indications for osteotomy cannot be met, arthrodesis is still the best solution for unilateral hip disease in patients younger than 30 years of age of either sex.
Adolescent↗
Hereditary motor sensory neuropathy type I presenting as scapuloperoneal atrophy (Davidenkow syndrome) electrophysiological and pathological studies.
A 14 year old boy with scapuloperoneal muscular atrophy, pes cavus, areflexia and distal sensory loss (Davidenkow syndrome) is described. Nerve conduction velocities were diminished. Sural nerve biopsy demonstrated a reduction in the number of myelinated fibers and early "onion-bulb" formation. These observations support the hypothesis that the scapuloperoneal amyotrophy associated with distal sensory loss may represent a variant of type I hereditary motor sensory neuropathy.
Adolescent↗
Experimental methods of repairing injured menisci.
A longitudinal incision resembling a bucket-handle tear was made in the menisci of 8 rabbits, 6 dogs, 11 pigs and 12 sheep. In some of the animals of each species the cut was repaired by suturing, and in others it was not. Gross inspection, as well as examination by light and electron microscopy, showed that no healing had occurred after six months in the sutured or the unsutured wounds and that the meniscus was incapable of significant intrinsic repair. In a second experiment longitudinal, transverse and T-shaped cuts were made in the menisci of 12 sheep, and a flap of synovium was sutured into the wound. Three months later there was clear evidence of healing by the formation of cartilaginous tissue. Examination by light and electron microscopy showed that the newly formed repair tissue, possibly derived by metaplasia from the synovium, had a morphology intermediate between hyaline cartilage and fibrocartilage. Synovial implantation may therefore be considered as an alternative to meniscectomy in the management of the torn meniscus.
Animals↗
An algorithm for the management of scoliosis.
Scoliosis is a lateral and rotary deformity of the spine that is often found in children. Treatment of this deformity is based on the principle of early recognition and prevention, although surgical correction may be warranted in the case of progressive curves. There is no scientific evidence that spinal manipulative therapy (SMT) has any effect on curve progression in patients with idiopathic scoliosis; however, there is clinical evidence that SMT is a useful treatment for those patients who have an associated mechanical backache. This paper reviews the classification, natural history, pathogenesis, and clinical and radiological assessment of scoliosis. An algorithm for the management of scoliosis by chiropractors is presented, and illustrative cases from a scoliosis clinic in a university hospital are used to reinforce important clinical principles.
Adolescent↗