Biomedical subjects
L D Lutter
Publications and source records attributed to L D Lutter.
The knee and running.
Forty per cent of all injuries in our series are related to the knee area. A great number of people in the United States, estimated at 20 million, are running regularly. Sixty to 70 per cent of the individuals who are running regularly are injured severely enough that they must temporarily stop running. A large number of individuals who are running regularly are seeking treatment for their knee problems. The significance of the data is related to the number not the type of injuries. An underlying biomechanical abnormality must be sought and treated or symptoms will return. Biomechanical understanding and anatomic evaluation can provide a rational basis for treatment that manages the acute problem and prevents future ones.
The tricho-rhino-phalangeal syndrome with exostoses (or Langer-Giedion syndrome): four additional patients without mental retardation and review of the literature.
We report on four patients with tricho-rhino-phalangeal syndrome with exostoses (TRPSE) who were not mentally retarded and review 32 previously published cases. These data enable more complete delineation of the phenotype and document the variability of the clinical and radiographic manifestations. Information on the genetics and the association with del(8q) is discussed, as are management and avenues for further investigation. The apparent variability of intelligence in TRPSE patients together with the high incidence of other problems, including significant delay in speech development and hearing loss, make systematic multidisciplinary evaluation and long-term treatment necessary to achieve the best outcome.
Runner's knee injuries.
In our series of running injuries 40% of all injuries have been related to the knee area. Over 20 million people in the United States run on a regular basis. Figures from large running sources show that 60% to 70% of individuals running regularly are injured severely enough to temporarily stop running. The figures are significant, not in the seriousness of the knee injury, but in the fact that seeking treatment for their knee problems. Orthopaedic surgeons, because of their ability to evaluate the entire lower extremity, become the central component for treatment of this large group of injured runners. As has been noted, the underlying biomechanical abnormality must be sought and dealt with or the symptoms return. By identification of the injured structure(s) integrated with biomechanical understanding, treatment can be developed on a rational basis, dealing with acute problems and prevention of future ones.
Pes planus: radiographic changes with foot orthoses and shoes.
Radiographic evaluation of 10 children with bilateral pes planus was performed. Radiographs taken barefoot, with a Thomas heel, with an over-the-counter insert, with two specially molded plastic foot orthoses were used. No significant change was seen after the donning of these appliances in their comparison to barefoot evaluation. The conclusion is that there was not a significant change radiographically of these feet by the utilization of any of the appliances.
Running symposium.
The running symposium has been designed to demonstrate to the reader the basic mechanics of the running gait, as compared to normal walking. It is imperative in order to understand the nature of the problems seen in runners to understand the forces and motions which are occurring in the various joints of the lower extremity, so that as much as possible, treatment can be based upon accurate anatomical diagnoses, rather than empiric treatment. The second part of this symposium discusses the nature of the injuries seen in the lower extremity in runners. Suggestions are made as to how to manage the problems as well as their prevention. Finally, a comment is included on the nature of the running shoe and on shoe selection.
Cavus foot in runners.
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Foot-related knee problems in the long distance runner.
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Children with short stature.
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Neurological symptoms in achondroplastic dwarfs--surgical treatment.
Fourteen patients who had neurological symptoms associated with achondroplastic dwarfism and who had spine surgery were analyzed, as were an additional twenty-nine cases reported in the literature. Four types of neurological patterns emerged, based on the onset, symptoms, and physical examination. Some etiological correlation between the anatomical lesion and the result was made in each category, and a reliable prognosis related to the pattern is now possible. Early and appropriately extensive surgery may well be recommended, based on the patients treated.
Post-traumatic hip redislocation.
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A simple method for obtaining multiple blood samples.
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Spinal deformities in patients with spinal muscle atrophy: a review of 36 patients.
Thirty-six patients diagnosed as having spinal muscle atrophy were reviewed. The process was usually recognized in infancy, and spinal deformity commonly developed by age 6, kyphosis developed before age 3, and scoliosis or kyphoscoliosis thereafter. Orthotics may slow progression in most cases, but very young patients must be carefully monitored for chest-wall deformity. Surgery was utilized to stabilize orthotically uncontrollable curves, orthotically controlled curves after maturation, and the severely involved when risks were acceptable. Complications were noted in older or more deformed patients and less frequently in younger, less involved ones. A stabilized spine with head centered over pelvis was usually achieved.
Recurrent compartment syndrome in the posterior thigh. Report of a case.
Recurrent compartment syndromes of the lower extremity, which usually occur in conjunction with intense use of muscle groups, can be briefly defined as an uncomfortable circulatory disturbance associated with a pathologic increase in total intramuscular pressure. This syndrome has been reported in each of the four compartments of the leg but not in the thigh. Characteristic features of clinical presentation and physical examination are reviewed in this report. We have found that an intracompartmental pressure test (Whitesides Jr, TE, Haney TC, Morimoto K, et al: Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 113: 43-51, 1975) is an invaluable diagnostic aid. A case involving the medial hamstring groups, with characteristic historical presentation, intracompartmental pressure elevation, and excellent response to fasciotomy, is presented and discussed. The only effective treatment in this case was fasciotomy.
Surgical decisions in athletes' subcalcaneal pain.
A group of 182 patients with subcalcaneal pain related to sports activity was studied to determine injury types and patterns. Running/jogging produced the greatest percentage of subcalcaneal injuries, 76%. A survey was done of the specific types of heel pain, plantar fasciitis and median calcaneal neuritis. A review of each entity was given and surgical approach was detailed. Subcalcaneal surgical decision making is based on six specific tenets: correct diagnosis; approximately 12 months of conservative treatment; EMG for diagnosis and appropriate nerve blocks; thorough knowledge of the anatomy or complete review; patient understanding that surgery may not give a good enough result to allow the return to high performance athletics; and correct and appropriately directed surgery.
Running athlete in office practice.
The running athlete has different needs from other athletes in terms of determination of his/her specific injury. Causation determination can be done through history. Specific pointers in terms of physical examination are noted to lead one to the diagnosis. Basic general treatment modalities are noted.
Larsen syndrome: clinical features and treatment--a report of two cases.
The literature on reported clinical and radiographic findings of Larsen syndrome is reviewed in detail. Two patients with Larsen syndrome who exhibited previously unreported skeletal deformities and such characteristic features as flattened facies, palate defects, and multiple joint dislocations are reported. Persistent difficulties in wound healing are discussed.