Biomedical subjects

K J Guidera

Publications and source records attributed to K J Guidera.

25 records · Page 2Linked to original sources

PubMedDate not supplied

Nail patella syndrome: a review of 44 orthopaedic patients.

Nail patella syndrome is a rare dysplasia with characteristic findings of finger nail abnormalities, hypoplastic patellas, radial head dislocations, and iliac horns. We reviewed the problems and treatment of 44 patients with this syndrome from 13 Shriners Hospital units. The inheritance pattern is autosomal dominant, with foot abnormalities as the chief presenting complaint. All patients were ambulatory. Twenty of the patients underwent knee operations, and 24 underwent operations to correct foot and ankle deformities. Knee extensor realignments and foot posteromedial releases had overall good results. Knee flexion contractures required full posterior capsular releases. Elbow reconstructive procedures were rarely indicated.

Child↗

PubMedDate not supplied

Caudal regression: a review of seven cases, including the mermaid syndrome.

Caudal regression consists of sacral agenesis combined with variable lower extremity deformities. The patients have contractures of the lower extremities, hip dislocations, neurologic impairment, and spine instability. Treatment consists of soft tissue releases, osteotomies, or orthotics. The goal of orthopaedic intervention is proper seating and standing, which may be achieved without amputation. In our patients, the lower extremity deformities were corrected surgically, but long-term function is unknown. We report the problems and treatment of seven patients with caudal regression syndrome, including the only known survivor with sirenomelia (mermaid syndrome), who underwent separation of the lower extremities.

Abnormalities, Multiple↗

PubMedDate not supplied

Extremity lengthening: results and complications with the Orthofix system.

Twenty-four patients underwent extremity lengthening with the Orthofix for congenital, posttraumatic, or postinfective defects. All were followed to completion of treatment. Length gain and time of treatment were quite acceptable with the Orthofix, but the complication rate was high. This incidence was significantly greater than previously reported by the developers of the technique but equivalent to that reported with other methods.

Adolescent↗

PubMedDate not supplied

Use of continuous passive motion in pediatric orthopedics.

Continuous passive motion (CPM) was used to maintain or gain hip and knee range of motion in 18 postoperative or postinjury pediatric orthopedic patients. Continuous passive motion was started in the early postoperative period and augmented with physical therapy. The device was well-tolerated in 16 of the 18 patients. In all but one, motion was improved with a progressive decrease in joint pain. In these patients, CPM was found to be a valuable tool in rehabilitation, and did not interfere with traction, open wounds, nursing care, nor external fixation devices.

Adolescent↗

PubMedDate not supplied

Residual bone cysts after correction of severe foot deformities with the Ilizarov technique.

Fourteen patients with severe foot deformity treated by application of the Ilizarov device were evaluated for residual bone changes in the foot. Cyst formation was noted in all patients, most commonly in the base of the fifth metatarsal. These cysts did not develop in the area of bone penetrated by the wires. In an average follow-up of 3.4 years after device removal, the cysts did not resolve. Histologic examination of one resected cyst demonstrated an empty lacuna with no cell lining, as seen in the "cysts" associated with osteoarthrosis.

Bone Cysts↗

PubMedDate not supplied

Contiguous discitis and osteomyelitis in children.

Magnetic resonance imaging of 16 patients with contiguous discitis and osteomyelitis provided a specific diagnosis and defined the anatomic extent of vertebral and soft-tissue involvement. Altered signal changes were evident in the disc, adjacent vertebra in the end plate and metaphyseal equivalent regions, and the anterior prevertebral tissues. Significant posterior spread and disc herniation were not evident. Fourteen patients had lumbar involvement; two had cervical involvement. The patients were followed-up for an average of 4 years 5 months. Scoliosis has developed in one patient, and four continue to have a loss of lumbar lordosis. By comparing serial roentgenograms, the mean decrease of disc-space height after the acute episode was 43% (range, 51-61%). There was no restitution of normal disc-space height at the latest follow-up roentgenogram in any of the patients. A 14% (average) narrowing of the vertebral foramina was evident in seven cases. In one patient, a fusion progressively developed 7 years after the acute episode (before full skeletal maturity). However, several patients appear to be progressing toward fusion of adjacent vertebra. A study of histologic specimens elucidated vascular anatomy of the immature vertebra that further explain the disease characteristics.

Adolescent↗

PubMedDate not supplied

Pathologic morphology of the dislocated proximal femur in children with cerebral palsy.

We describe the gross and microscopic anatomic changes in the hip that result from the deforming forces in children with neuromuscular imbalance. Twelve dislocated proximal femora that had been resected from children with spastic diplegia or tetraplegia were evaluated with respect to their gross, microscopic, and radiographic structure. The epiphyses were wedge shaped with deformation of the femoral head apparent in all cases. In addition to a severe loss of articular cartilage, a furrowed erosion of epiphyseal bone suggested a sustained, blunt, band-like force across the surface of the hip where it opposed the acetabular labrum. The underlying physis of the capital femur was irregular with aberrant histologic structure, whereas that of the lesser trochanter was hypertrophic and angulated in a superior and anterior direction. A significant degree of valgus was not noticeable in most specimens. In summary, the spastic adductor and iliopsoas, responsible for the changes in the lesser trochanter, work in conjunction with the hip flexor and internal rotator muscles to subluxate the proximal femur. In the process, the superior rim of the acetabulum and capsule causes focal deformation of the superolateral femoral head, creating a fulcrum upon which the hip then progressively subluxates. The indentation locks the femoral head at the lateral acetabular margin, preventing complete dislocation, but leading to bone pain consequent to cartilage erosion.

Adolescent↗