Biomedical subjects

K J Guidera

Publications and source records attributed to K J Guidera.

At least 19 recordsLinked to original sources

PubMed1999

Use of allograft bone for posterior spinal fusion in idiopathic scoliosis.

Eighty-seven adolescents with idiopathic scoliosis (77 female and 10 male patients) who underwent posterior spinal fusion with instrumentation using only allograft bone for graft material were evaluated retrospectively. The average age at surgery was 14 years 3 months. Each patient had a minimum 2-year followup, with an average of 3 years 5 months followup. The average preoperative curve was 59 degrees thoracic (range, 31 degrees-90 degrees) and 52 degrees lumbar (range, 21 degrees-65 degrees). At followup, the thoracic curve measured an average of 35 degrees and the lumbar curve measured an average of 34 degrees. The average loss of correction from the immediate postoperative period until last followup was 6.5 degrees or 11% in the thoracic curve and 10 degrees or 19% in the lumbar curve. There were seven reoperations; one of these reoperations involved repair of a pseudarthrosis. There was one clinical infection. The typical patient had a 2-ounce allograft at an average cost of $800. The patients' average loss of correction, complication rate, and reoperation rate compare favorably with results reported in other series using autograft bone. The authors of this study showed the ability of allograft bone to produce reliable results with a satisfactory outcome. The potential advantages of using allograft must be weighed against the potential disadvantages before recommending its routine use.

Adolescent↗

PubMed1995

Management of pediatric limb length inequality.

The treatment of limb length inequality in pediatric patients is a complicated and long-term procedure, and careful evaluation is necessary over several visits. A team approach with an involved family is essential, as is knowledge and familiarity with the various conservative and surgical options. Treatment must not be rushed, and it is important to realize that not everyone needs a lengthening. Soft tissue and osseous complications are significant in these procedures, so shoe lifts and shortening procedures are attractive alternatives in smaller discrepancies. This condition is in a growing child and therefore not static. Future growth may dictate that procedures be staged. Most importantly, we must carefully equalize limb length in a manner that is neither physically nor emotionally scarring (Fig 26). These children are best served by a well-thought out plan that minimizes both kinds of trauma, decreases hospital and treatment time, and involves the family and patient in the planning and understanding of the proposed intervention and potential complications.

Arm↗

PubMed1994

The embryology of lower-extremity torsion.

The presence of torsional deformities in the lower extremities of otherwise normal children is based on a variety of developmental processes. With intrauterine maturation, both rotation and external compression of the extremities take place. These forces result in the normal molding and final position of the limbs. Torsion of the extremities is, thus, a normal embryological process. It is imperative for the treating physician to understand these factors in human development to decide which cases are significant deviations from normal torsion. Knowledge of the embryology and natural history of these conditions is a key to appropriate treatment of patients with torsional or angular malalignments.

Bone Diseases, Developmental↗

PubMed1993

Cotrel-Dubousset instrumentation. Results in 52 patients.

Fifty-two posterior spinal fusions were performed for pediatric idiopathic, congenital, and neuromuscular scoliotic curves. Cotrel-Dubousset instrumentation was used in all patients. Nine had prior anterior spinal releases and fusions. The patterns were mixed, with a predominance of right thoracic curvatures. The average preoperative curve measured 60.6 degrees, with correction to 29. Seven patients required revision surgery, and 17 wore orthoses after operation. There were 17 complications in this group, including hook pullout, prominent hardware, infection, pseudarthrosis, and two cases of broken Cotrel-Dubousset instrumentation rods. Fatigue failure of this instrumentation, secondary to pseudarthrosis, has not been reported previously, and these two cases are presented in detail. The operative morbidity and difficulty were increased in the larger idiopathic curves and in neuromuscular and congenital scoliosis. Cotrel-Dubousset instrumentation is an overall excellent tool for the multiplanar correction of scoliosis and is amenable to revision surgery.

Adolescent↗

PubMed1991

Radiographic changes in arthrogrypotic knees.

We evaluated the knees of 62 patients with arthrogryposis multiplex congenita radiographically. Abnormal radiographs were noted in 34. The abnormalities consisted of both congenital and chronic changes secondary to long-standing clinical deformities including patellar elongation, malposition, flattening of the femoral condyles, joint incongruity, tibial plateau irregularities, tibial and femoral fractures, fibula hypoplasia, soft-tissue thickening, valgus deformity, and dislocation. The radiographic findings were consistent with the degree of longstanding physical deformity and can be used as a guide to the severity of the condition and the need for treatment.

Arthrogryposis↗

PubMed1991

Shark attack.

Shark attacks are rare but devastating. This case had major injuries that included an open femoral fracture, massive hemorrhage, sciatic nerve laceration, and significant skin and muscle damage. The patient required 15 operative procedures, extensive physical therapy, and orthotic assistance. A review of the literature pertaining to shark bites is included.

Animals↗

PubMed1990

Magnetic resonance imaging evaluation of congenital dislocation of the hips.

Magnetic resonance (MR) images were obtained preoperatively and postoperatively for 12 pediatric patients with congenital dislocation of the hip (CDH). The images were compared with arthrograms and computed tomography scans. The MR images were more accurate in defining soft-tissue anatomy, hip position, and obstructive factors to relocation. MR imaging is an efficient diagnostic tool in CDH.

Arthrography↗

PubMed1985

Foot and ankle deformities in arthrogryposis multiplex congenita.

When 51 patients with arthrogryposis multiplex congenita followed an average of 12 years were reviewed, talipes equinovarus was the most common foot and ankle deformity. The best results were obtained by talectomy. The majority of tendo Achillis lengthenings, posteromedial releases, and triple arthrodeses were unsuccessful and were associated with a high complication rate. Congenital convex pes valgus was the second most common deformity. Surgical treatment by open reduction generally resulted in unsuccessful outcomes. Ambulation was achieved in 46 patients. Residual foot deformity was the primary reason for persistent difficulties in walking.

Achilles Tendon↗

PubMedDate not supplied

Ilizarov treatment of congenital pseudarthroses of the tibia.

Eleven children with congenital pseudarthrosis of the tibia were treated with the Ilizarov device. This was successful in nine of 11 patients with an average of 322 days in the fixator and 1.6 additional surgeries. Two patients eventually had amputations. These results demonstrate this to be an effective tool for this complex condition, but amputation should be considered if union is not achievable with this method and other procedures have previously been attempted.

Adolescent↗

PubMedDate not supplied

Orthotic treatment of infantile tibia vara.

Difficulty differentiating physiologic genu varum from early Blount's disease persists. Drennan's metaphyseal-diaphyseal (MD) angle remains the most consistently valuable radiographic parameter despite measurement error. Clinical risk factors also should be considered. All patients receiving orthoses for genu varum since 1985 were reviewed. The focus of the study was those patients with an MD angle of >16 degrees or between 9 and 16 degrees with a clinical risk factor for progression. Risk factors considered were ligamentous instability, obesity, asymmetry, and being female, black, or Hispanic. Thirty-eight patients with 60 tibiae were included. The success rate was 90%. Risk factors for failure (six cases) were instability, obesity, and delayed bracing. In cases with MD angles >16 degrees, the success rate was 86%. The results of orthotic treatment, restricted to patients meeting the stated parameters, represent improvement on the reported natural history.

Body Weight↗

PubMedDate not supplied

Operative treatment of congenital pseudarthrosis of the clavicle.

Eight children were treated operatively with resection of fibrous pseudarthrosis and sclerotic bone ends, careful dissection and preservation of the periosteal sleeve to maintain continuity, and approximation of bone ends. None had additional bone grafts or internal fixation. All had bridging ossification 6-8 weeks postoperatively, and all were solidly healed by 14 weeks after surgery. Follow-up has ranged from 2 to 14 years, with no evidence of recurrence. Remodeling of the prominence occurred slowly in 2-5 years, with the distal clavicle variably underdeveloped in all patients. Early resection of fibrous pseudarthrosis probably does not require the extensive grafting and internal fixation that has been recommended for older children.

Bone Development↗

PubMedDate not supplied

Orthopaedic manifestations of Rett syndrome.

We reviewed nine patients with Rett syndrome, a progressive encephalopathy that is being diagnosed more frequently in the United States. It occurs in females, causing mental deterioration, autistic behavior, and classic hand-wringing motion. The orthopaedic manifestations include scoliosis, lower extremity contracture, and coxa valga. Bracing and surgery are indicated to prevent or correct deformity and maintain ambulation.

Adolescent↗

PubMedDate not supplied

Hypoplastic clavicles and lateral scapular redirection.

Three patients with bilateral hypoplastic clavicles and anterolateral displacement of the shoulders and scapulas on the thoracic cage are described. One patient had no family history of the disorder. The mother of the other patient had the same condition, suggesting an autosomal dominant inheritance pattern. In all three patients, the clavicle was underdeveloped and the scapula was redirected onto the lateral rather than the posterior thorax, bringing the entire shoulder forward. None of the patients have any significant functional restriction.

Bone Diseases, Developmental↗

PubMedDate not supplied

Use of the reciprocating gait orthosis in myelodysplasia.

There are advantages to an upright posture and ambulation in pediatric myelodysplasia patients. The reciprocating gait orthosis (RGO) is a useful tool to enable this activity in selected individuals. We evaluated the long-term usage, pitfalls, and contraindications of this orthosis. Mean daily usage was 6.9 h/day, requiring an average of 10 min to don or doff; all patients required assistance. Obesity, advanced age, lack of patient or family motivation, scoliosis, and spasticity were significant negative factors in long-term usage of the RGO. Good upper extremity strength, trunk balance, previous standing or walking, and active hip flexion were important positive variables. Eleven of 21 patients did not persist with long-term usage of this orthosis, averaging 25.8 months of usage. An energy study was performed on three patients, comparing the efficiency of reciprocating gait and swing-through gait. All three were more energy efficient and two were faster with the swing-through gait but each preferred the reciprocating pattern. Care should be taken when selecting patients for RGO usage because not all children with myelomeningocele are able to function effectively with this orthosis.

Braces↗

PubMedDate not supplied

Overgrowth management in Klippel-Trenaunay-Weber and Proteus syndromes.

Twenty-eight patients with limb overgrowth and the diagnosis of Klippel-Trenaunay-Weber or Proteus syndromes were evaluated retrospectively. These disorders are part of the phakomatosis spectrum of syndromes. The orthopedic problems consisted of asymmetric limb overgrowth, localized gigantism, angular deformities, scoliosis, vascular malformations, and skin anomalies. Systemic abnormalities are common and deserve full evaluation before treatment. Surgical treatment consisted of epiphysiodesis, osteotomies, debulking procedures, and amputation. Mixed results were obtained with surgery, and conservative or supportive treatment should be the primary mode of orthopedic care.

Adolescent↗

PubMedDate not supplied

Hypertension following orthopaedic surgery in children.

Five patients developed hypertension after undergoing orthopaedic surgery. Three of four patients in whom serum renin was assayed had significant elevation, suggesting a possible renal-mediated etiology. Two patients required the addition of an angiotensin-converting enzyme (ACE) inhibitor to control hypertension while continuing the prolonged orthopaedic procedures. The need for careful blood-pressure monitoring of children undergoing orthopaedic surgery is emphasized in this article.

Adolescent↗

PubMedDate not supplied

Tibia valga after proximal metaphyseal fractures in childhood: a normal biologic response.

Seventeen children with 19 proximal tibial metaphyseal fractures were followed-up between 2 and 7 years after injury. Detailed measurements of the metaphyseal/diaphyseal/metaphyseal distances medially and laterally on the injured and noninjured sides demonstrated overgrowth. In four patients, the medial distance of the injured tibia was longer than the lateral distance, which was the same distance as the uninjured tibia. In 11 patients, there was an overgrowth of both the medial and lateral sides of the injured tibia, compared to the unijured tibia, and in each instance, the medial distance of the injured tibia was always longer than the lateral. In a patient with bilateral metaphyseal fractures, the medial length exceeded the lateral length in both tibias. In the child with metaphyseal and diaphyseal fractures, the medial side of the tibia with the metaphyseal fracture was the longest of the four measurements. In five of six patients with Harris lines, there was distal as well as proximal tibial metaphyseal overgrowth, but the distal line was always parallel to the physis and did not contribute to the valgus angulation. Thus there was not only a generalized increased growth proximally and distally, but there also was an eccentric proximal medial overgrowth in every patient.

Adolescent↗

PubMedDate not supplied

Orthopaedic manifestations in congenitally insensate patients.

The spectrum of orthopaedic problems in eight congenitally insensate patients was reviewed. The conditions included congenital insensitivity to pain, Riley-Day syndrome, and Lesch-Nyhan syndrome. In each of these conditions, the patient has an abnormality of interpretation of painful stimuli or lacks normal pain avoidance, leading to self-inflicted damage. The orthopaedic problems and complications included fracture, self-mutilation, autoamputation, osteomyelitis, septic arthritis, Charcot joints, scoliosis, and dislocation. Effective management consists of early diagnosis and patient/parent education to prevent as many complications as possible. Fractures may be treated conservatively, while progressive scoliosis requires operative intervention. Osteomyelitis, septic arthritis, and Charcot joints require appropriate operative treatment.

Adolescent↗