Biomedical subjects
J J Wiley
Publications and source records attributed to J J Wiley.
Isolated dislocation of the radial head.
Fifty-four patients (12 bilateral) with isolated dislocations of the radial head were encountered over a 20-year period. The congenital varieties (26 patients) included isolated unilateral, familial, synostosis-related, and syndrome-related. The acquired types (28 patients) involved trauma, neuromuscular impairment, or adaptive dislodgments. Acute, traumatic dislocation (17 patients) was the most common presentation. Others were diagnosed incidentally, or associated with discomfort, dysfunction, or deformity. Closed reduction of an acute traumatic dislocation was generally successful (16 of 17 patients). Realignment attempts (three cases) on late diagnosed traumatic cases and isolated congenital types were invariably unsuccessful, eventually requiring radial head excision. Four patients underwent excision of the head of the radius as primary treatment.
Tibial spine fractures in children.
Fractures of the intercondylar eminence of the tibia are not uncommon in the pediatric age group. This eminence consists of two projecting tibial spines: the anterior cruciate ligament being attached to the medial one. In spite of an avulsion of this bony fragment and its attached ligament, cruciate laxity does not appear to be a significant clinical finding on follow-up examination, regardless of the type of fracture, method of treatment, or mode of injury. Computed instrumental testing of these knees, however, revealed measurable degrees of residual cruciate laxity in spite of the absence of patient symptoms. In the pediatric age group, treatment by closed or open methods is directed toward reattachment of the loose fragment and achievement of some degree of joint congruity rather than restoration of cruciate integrity.
Fractures of the tibial spine in children. An evaluation of knee stability.
Forty-five patients with fractures of the tibial spine were reviewed 3 to 10 years after injury in order to determine the degree of residual laxity of the cruciate or collateral ligaments. After fractures which had been partially or completely displaced, some anterior cruciate laxity was evident, even if patients were asymptomatic. It was also found that an anatomical reduction did not prevent either laxity or some loss of full extension of the knee.
The late results of tarsometatarsal joint injuries.
The late results of tarsometatarsal injuries in 33 patients have been reviewed. The average follow-up period was 15 years (range 11 to 20 years). Methods of treatment included cast immobilisation, and closed or open reduction with or without internal fixation. All patients noted diminishing symptoms after injury and all but six returned to their former occupation. Neither the initial fracture type nor the treatment had any apparent bearing on subsequent function; nor was there any correlation between radiographic assessment of the injury and the patient's symptoms.
The dangers of off-road vehicles to young drivers.
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Injuries associated with off-road vehicles among children.
Off-road vehicles have attained growing popularity, expanding markets and increasing rates of associated injury, especially among young people. In 1984-85, 148 patients were treated at the Children's Hospital of Eastern Ontario, Ottawa, for injuries suffered in off-road vehicle accidents. The average age of the patients was 14 years. Soft-tissue injuries occurred in 33 patients, 21 of whom had severe injuries. There were 179 fractures in 133 patients. One patient died as a result of his injuries. The most common mechanism of injury was losing control of and tumbling from the machine. Seventeen patients were struck by their own vehicles, and 39 collided with objects such as cars, trees or people. The health care costs of these accidents are no less serious than the concerns for the appropriate legislation to protect consumers, particularly the young.
Fractures of the proximal humeral epiphysis. Their influence on humeral growth.
We have reviewed the notes and radiographs of 57 patients with fractures of the proximal humeral epiphysis and examined 30 of them at 2 to 8 years after injury. Regardless of treatment the maximum shortening of the humerus was 2 cm and residual varus angulation was insignificant. Manipulation of a displaced, fresh fracture did not improve the final outcome with respect to humeral growth or function; and open reduction is very rarely indicated.
Monteggia injuries in children.
Forty-six children with Monteggia fracture-dislocations have been studied. The circumstances of the accident could rarely be recalled so that the mechanism of injury remains unclear. The study did, however, confirm the importance of conservative management of the injury in children; unlike the adult variety, this gave very satisfactory results. Our review also supports the classification into three basic types of Monteggia lesion according to the direction of displacement of the dislocated radial head. For simplicity, all other types, variations or equivalents can be regarded as belonging to these basic patterns; in particular we include those controversial cases in which the radiohumeral dislocation is combined with a fractured olecranon.
Acquired spondylolysis after spinal fusion.
Spondylolysis occurring after a spinal fusion is considered to result from operative damage to the pars interarticularis on both sides. Fourteen cases are reported, and compared with the 23 cases which have previously been published. The defects are usually recognised within five years of fusion, and usually occur immediately above the fusion mass. Other contributory causes may be: fatigue fracture from concentration of stress; damage and altered function of the posterior ligament complex; and degenerative disc disease immediately above or below the fusion. Fusion technique is critical, since virtually all cases occurred after posterior interlaminar fusions. This complication is easily overlooked in patients with recurrent back pain after an originally successful posterior spinal fusion.
Fractures of the os calcis in children.
Thirty-four os calcis fractures were encountered in 32 children between 1974 and 1982. As commonly occurs in adults, a fall striking the heel was the most common mechanism of injury. Both intra-articular and extra-articular fractures were noted and classified accordingly. Involvement of the posterior subtalar joint was common, occurring in 28 fractures. The joint involvement in the childhood injury was often subtle and the fracture easily overlooked on initial radiographic examination. Minor involvement of the posterior subtalar joint was usually identified by a bursting of the lateral wall of the os calcis, producing a longitudinal silver of bone noted on the axial os calcis radiograph. All cases were treated conservatively, including those with marked deformities of the subtalar joint. Follow-up assessment revealed very satisfactory results in those cases with extra-articular fractures or minor posterior subtalar joint involvement. Patients with more marked joint displacement revealed persisting limitation of subtalar joint motion, but an absence of discomfort or pain.
Fracture-separation of the distal humeral epiphysis.
Fracture-separation of the distal humeral epiphysis presents problems in diagnosis, radiologic interpretation, and management. All of these problems are affected by the arbitrary division of the affected patients into three age groups. Fortunately, although easily misdiagnosed, this fracture does not bear the inherent disasters of the ununited lateral condylar fracture, the malunited supracondylar fracture, or the untreated elbow dislocation. As with most uncomplicated Type II epiphyseal injuries, healing and childhood remodeling result in satisfactory elbow function. Although rare in incidence, this condition warrants the same critical assessment of, and appropriate attention to detail, as any other elbow problem of childhood.
Tarso-metatarsal joint injuries in children.
Tarso-metatarsal joint injuries do occur in the pediatric age group, and the mechanisms and patterns of injury are similar to the adult variety. Surgical reduction is indicated in those cases with obvious displacement. Unstable reductions are best managed by percutaneous pin fixation across the tarso-metatarsal joint. The short-term results are generally good in spite of extensive disruption at the tarso-metatarsal joint complex. Only a long range follow-up will reveal the realistic results of these injuries.
The bipartite tarsal scaphoid.
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Septic arthritis in childhood.
In the first 4 years (1974 to 1978) of operation of the Children's Hospital of Eastern Ontario, in Ottawa, 50 children were treated for septic arthritis. The neonatal group (birth to 6 months) of three patients had the most severe involvement and the worst prognosis. The early childhood group (6 months to 4 years) of 15 patients was characterized by sepsis due to Hemophilus influenzae. The 32 older children (4 to 16 years), more susceptible to staphylococcal infections, commonly presented with atypical and unusual symptoms. The erythrocyte sedimentation rate was the most reliable laboratory investigation. Positive joint cultures were obtained in 66% of patients. Arthrotomy with drainage was the most reliable form of treatment, particularly in cases of hip joint sepsis. Six patients have substantial residual joint damage with some degree of permanent disability. Early diagnosis of the condition and rapid removal of pus are mandatory for the survival of the joint.
Myelotomy in the management of spasticity.
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Traumatic dislocation of the radius at the elbow.
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The mechanism of tarso-metatarsal joint injuries.
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