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Biomedical subjects

L T Staheli

Publications and source records attributed to L T Staheli.

At least 19 recordsLinked to original sources
PubMed1995

Fracture of the cuboid in children. A source of leg symptoms.

We report eight cases of fracture of the cuboid in seven children under four years of age, collected during a two-year period. There was no history of trauma in five of the patients. This fracture is rarely diagnosed and has probably been under-reported. Small children are poor historians and difficult to examine, and early radiographs may be normal or have only subtle abnormalities. Cuboid fracture should be considered in the differential diagnosis of limping toddlers, and a bone scan may be needed to confirm the diagnosis earlier than radiography. These fractures heal completely, without sequelae. Treatment in a short-leg walking cast is recommended, primarily for reasons of comfort.

Casts, Surgical↗
PubMed1992

Tibial rotational osteotomy for idiopathic torsion. A comparison of the proximal and distal osteotomy levels.

A retrospective analysis was done of 52 rotational tibial osteotomies (RTOs) performed on 35 patients with severe idiopathic tibial torsion. Thirty-nine osteotomies were performed at the proximal or midtibial level. Thirteen were performed at the distal tibial level with a technique previously described by one of the authors. Serious complications occurred in five (13%) of the proximal and in none of the distal RTOs. For severe and persisting idiopathic tibial torsion, the authors recommend correction by RTO at the distal level. Proximal level osteotomy is indicated only when a varus or valgus deformity required concurrent correction.

Bone Diseases↗
PubMed1992

Pain of musculoskeletal origin in children.

Pain in infants and children may be manifest by deformity, altered function, or discomfort. These manifestations are highly age related. Pseudoparalysis may be the only manifestation of septic arthritis of the hip in the neonate; a limp is often the presenting complaint in Perthes' disease, and scoliosis may be the primary manifestation of a herniated disc in an adolescent. New imaging methods aid in diagnosis. Ultrasound is helpful in assessing joint effusions; bone scans localize the cause of a limp; and magnetic resonance imaging shows spinal cord and root lesions. The traditional methods of assessment have not been replaced. History and physical examination are most essential to provide a rational basis on which to select the appropriate imaging study.

Back Pain↗
PubMed1991

Shoes for children: a review.

1. Optimum foot development occurs in the barefoot environment. 2. The primary role of shoes is to protect the foot from injury and infection. 3. Stiff and compressive footwear may cause deformity, weakness, and loss of mobility. 4. The term "corrective shoes" is a misnomer. 5. Shock absorption, load distribution, and elevation are valid indications for shoe modifications. 6. Shoe selection for children should be based on the barefoot model. 7. Physicians should avoid and discourage the commercialization and "media"-ization of footwear. Merchandising of the "corrective shoe" is harmful to the child, expensive for the family, and a discredit to the medical profession.

Child↗
PubMed1991

Surgical management of acetabular dysplasia.

Dysplasia of the acetabulum can be caused by malposition, insufficiency, or incongruity. The decision to correct acetabular dysplasia is based on the severity of the condition or on the condition's failure to improve and is made after several years of observation. Correction is best when performed in childhood and should be designed to meet the individual needs of the patient after careful consideration of the pathology, anatomy, patient's age, and skill and experience of the surgeon.

Acetabulum↗
PubMed1989

Management of congenital hip dysplasia.

In summary, congenital hip dysplasia remains a worldwide health problem, which has not been resolved by neonatal screening programs. The primary care physician's role is critical for early diagnosis. An understanding of the need for repeated examinations, the age related signs, and continued diligence is essential. The common use of the triple diaper treatment is not recommended.

Female↗
PubMed1989

Torsion--treatment indications.

Rotational problems, when outside the normal range, are referred to as torsional deformity. These deformities are relatively common in infancy and childhood, generally resolve spontaneously with growth, and rarely persist into adult life. There are few situations in which treatment is necessary. (1) Rigid metatarsus adductus that does not resolve during the first six months should be corrected by casting. The long leg cast is most effective, as it controls the rotation of the tibia. With the tibia stabilized, the foot can be laterally rotated and abducted, which usually allows correction using one or two casts. (2) Persistent, severe tibial medial or lateral torsion after the age of eight years may be corrected by a supramalleolar tibial rotational osteotomy. This is indicated for medial torsion beyond 15 degrees and for lateral torsion beyond 30 degrees. Fixation is provided by crossed, smooth pins and a long leg cast. Compartment syndromes and peroneal nerve injury are avoided by the distal correction. (3) Persistent, severe femoral antetorsion of more than 50 degrees after the age of eight years may justify correction. For operative correction, medial rotation should exceed 85 degrees and lateral rotation should be less than 10 degrees. The osteotomy for correction is fixed by threaded Steinmann pins cut off below the skin and supplemented with a spica cast.

Femur↗
PubMed1988

Effects of 'tone-reducing' vs. standard plaster-casts on gait improvement of children with cerebral palsy.

The relative effects of 'tone-reducing' (inhibitive) and standard casts on the gait patterns and functional motor activities of two children with cerebral palsy were examined in a repeated measures (single-subject) design. Both children's stride length improved in the tone-reducing casts, compared with standard casts, but there were no significant difference between the two casts in step length ratio, base of support or foot progression angle. From videotapes, clinicians noted mildly improved gait and function over baseline levels for one child during the tone-reducing cast phase. They also consistently rated this child's performance as being better with the tone-reducing casts than with the standard casts. Parents and therapists also favoured the tone-reducing casts. However, further evidence is needed for the efficacy of tone-reducing casts in the management of children with cerebral palsy.

Casts, Surgical↗
PubMed1988

Measurements on radiographs of the foot in normal infants and children.

Radiographs were made of the feet of seventy-four normal infants and children who ranged in age from six to 127 months, and various angles were measured. Means and deviations of the measurements were calculated for eleven clinically useful angles. On the anteroposterior radiographs the talocalcaneal, talus-first metatarsal, and calcaneus-fifth metatarsal angles were recorded, and on the lateral radiograph the talocalcaneal, tibiocalcaneal, tibiotalar, talus-first metatarsal, and talohorizontal angles were documented. On lateral radiographs that were made with the foot in maximum dorsiflexion, the talocalcaneal and tibiocalcaneal angles were documented and the talocalcaneal index was recorded. The mean values and the ranges of normal values changed with age. These data provide a standard for assessment of initial and residual deformity in patients who have club foot, vertical talus, metatarsus adductus, or other deformities.

Calcaneus↗
PubMed1987

Rotational problems of the lower extremities.

Rotational problems are common, often the source of great parental concern, but only occasionally is active treatment required. Cast correction of rigid metatarsus adductus in infancy and operative correction in middle to late childhood are occasionally appropriate for severe deformity.

Bone Diseases↗
PubMed1987

Desmoid tumors in childhood.

Eight cases of extraabdominal desmoid tumors in children are reviewed. Seven were located in the pelvis or forearm, and the most common presenting complaint was a slowly enlarging mass. In all cases, diagnosis was established by open biopsy, and initial treatment was by surgical excision. At follow-up (average, 5.8 years), six patients were tumor free. Desmoids are benign tumors that usually carry a good prognosis. There is no difference between the tumor behavior in children and adults. The treatment of choice is wide local excision. If vital structures are involved, it may be more appropriate to preserve function by performing partial tumor excision. For quiescent recurrent tumors, observation is appropriate management, but if further treatment is required, reexcision or radiotherapy may be tried.

Adolescent↗
PubMed1987

The longitudinal arch. A survey of eight hundred and eighty-two feet in normal children and adults.

Both feet of 441 normal subjects, who ranged in age from one to eighty years, were studied to document the configuration of the longitudinal arch. The findings showed that flat feet are usual in infants, common in children, and within the normal range of the observations made in adult feet. Documentation and observation is the recommended management of the flexible flat foot that falls within the normal range.

Adolescent↗
PubMed1986

Philosophy of care.

An accurate diagnosis is essential in managing musculoskeletal problems in children. Active treatment is only occasionally necessary and should meet the criteria of being essential, effective, and prudent.

Bone Diseases↗
PubMed1986

Torsional deformity.

Torsional deformity should be localized, quantitated, and usually managed by "observation," an approach that is set forth in detail in this article. Shoe modifications and daytime braces are inappropriate. Night splints or operative procedures are rarely indicated.

Child↗
PubMed1986

The effectiveness of the Salter innominate osteotomy in the treatment of congenital dislocation of the hip.

A retrospective review of sixty-eight innominate osteotomies that were performed in fifty-four patients at a university teaching hospital was undertaken to compare the results of these operations with those published by Salter and by his colleagues and to see if the results were different when the procedure was combined with open reduction compared with when it was performed after open reduction. Over-all, nearly three-quarters of the patients had excellent or good radiographic and clinical results. Avascular necrosis occurred in four patients after open reduction and innominate osteotomy. Postoperatively, eight complications developed in seven patients. Innominate osteotomy improved coverage of the femoral head. There was no noticeable difference between the results of innominate osteotomy combined with open reduction and those of innominate osteotomy performed after a previous open reduction. The patients who had an open reduction combined with innominate osteotomy before the age of four years had better results and required fewer subsequent procedures than did patients who had the operation after that age.

Age Factors↗
PubMed1985

Lower-extremity rotational problems in children. Normal values to guide management.

We studied 1,000 normal lower extremities of children and adults in order to establish normal values for the rotational profile. The intrauterine position of the fetus molds the femur by rotating it laterally and molds the tibia by rotating it medially. These molding effects usually resolve spontaneously during infancy, and then genetically determined individual differences are unmasked. Rotational problems should be clinically evaluated and the findings compared with the normal values provided by this study. Out-toeing in infants, medial tibial torsion in toddlers, and medial femoral torsion in young children are extremes of a normal developmental pattern. In the vast majority, these rotational variations fall within the broad range of normal and require no treatment.

Adolescent↗
PubMed1984

Acetabular augmentation for progressive hip subluxation in cerebral palsy.

Between 1969 and 1981, 20 acetabular augmentations were performed on 17 cerebral palsied patients with progressive hip instability. Average follow-up was 41.5 months, with a range from 24 to 147 months. Evaluation of results was based on assessment of hip stability, center edge (CE) angle, range of motion, and postoperative complications. Eighteen hips were rated good, one fair, and one poor. Stability was achieved in 19 hips. The CE angle was increased from a preoperative mean of -17 degrees to a follow-up mean of 50 degrees. There was no significant difference between preoperative and follow-up hip range of motion. The only complication encountered was a supracondylar femur fracture sustained after spica cast immobilization. Acetabular augmentation can be used effectively in the treatment of progressive hip instability in patients with cerebral palsy.

Acetabulum↗