PubMed Health⌕ Search

Biomedical subjects

L T Staheli

Publications and source records attributed to L T Staheli.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Natural history of flexion deformity of the hip in myelodysplasia.

For definition of the incidence and natural history of hip flexion contracture, 5,147 serial measurements of the range of hip extension in 966 patients with spina bifida were analyzed. Contractures were generally present in the first few months of life (physiologic flexion posture); this then diminished during the first 27 months in all but those with thoracic lesions. Hence, surgical management is seldom appropriate until after that age. In general, contractures reappear or worsen between the ages of 3 and 6 years, but few patients with sacral lesions develop this deformity. Our findings also demonstrate that hip flexion contracture is not merely due to muscle imbalance, sitting posture, or these factors in combination.

Adolescent↗
PubMedDate not supplied

Medial femoral torsion and osteoarthritis.

We investigated the hypothesis that medial femoral torsion is a predisposing factor to osteoarthritis of the hip. Anteversion was measured by biplane radiography in 44 hips (32 patients) with idiopathic osteoarthritis of the hip and a control group of 98 normal hips (49 adults). The mean and range of anteversion measures were similar in both groups. The mean was 22 degrees for osteoarthritic hips (range 3 degrees-49 degrees) and 19 degrees for normal controls (range -2 degrees-49 degrees). This difference was not significant. This study disagrees with others that propose an association between increased anterversion and osteoarthritis of the hip. Prophylactic operative correction of femoral torsion for osteoarthritis is not recommended.

Adult↗
PubMedDate not supplied

Combined osteotomy as a salvage procedure for severe Legg-Calvé-Perthes disease.

Combined Salter innominate and varus femoral osteotomies were performed on 14 patients with severe Legg-Calvé-Perthes disease. The mean patient age was 8 years 4 months. Nine hips were Catterall class III, five class IV, and all had three or more head-at-risk signs. The average preoperative epiphyseal index was 30%. Mean follow-up was 8 years. Eleven of 14 patients had a good clinical result, and radiographs showed progressive spherical remodeling of the femoral head. Seven hips demonstrated spherical congruency at follow-up. The epiphyseal extrusion index at follow-up was less than 20% in 13 of 14 hips. We conclude that combined osteotomy is a safe and effective salvage procedure in severe Legg-Calvé-Perthes disease.

Child↗
PubMedDate not supplied

Periarticular fractures after manipulation for knee contractures in children.

We report two cases, each of which sustained two separate periarticular fractures from overzealous manipulation for knee contracture. The four fractures reported in this study involve one normal child sustaining asynchronous ipsilateral distal femoral and proximal tibial fractures and a child with the diagnosis of amyoplasia sustaining bilateral proximal tibial fractures. The child with knee contracture must be treated carefully and not exposed to overzealous physiotherapy or manipulation. The child who has developed a joint contracture secondary to lengthy immobilization may be at increased risk for periarticular fracture secondary to disuse osteopenia. The knee joint is at particular risk because of the long lever arm of the leg. These concerns should be conveyed to anyone involved in the patient's care, including the parents, therapists, nurses, and physicians. Passive range of motion in the child should never be painful. Normal children often can obtain maximal range of motion if left alone and not restricted.

Arthrogryposis↗
PubMedDate not supplied

Femoral neck stress fractures in children and adolescents.

Five new cases of femoral neck stress fracture in children and adolescents are added to seven cases in the literature. All patients were involved in increased repetitive activity without evidence of violent trauma. Most fractures healed uneventfully with appropriate treatment. However, increased morbidity from displacement of the fracture, delayed union, nonunion, or avascular necrosis does occur in this age group and needs to be avoided. A delayed union healed after treatment in a spica cast; a nonunion and a displaced fracture healed after internal fixation. All patients returned to their previous level of activity. Our treatment algorithm addresses the unique differences associated with this injury in immature patients and allows for early diagnosis and treatment to prevent complications.

Adolescent↗
PubMedDate not supplied

Torsional problems in cerebral palsy.

Lower limb rotational problems in the patient with cerebral palsy represent a diagnostic and therapeutic challenge to the clinician. A literature review suggests that increased muscle tone may be the cause of these problems. This article proposes a simple diagnostic plan and discusses the various treatment plans and options.

Cerebral Palsy↗
PubMedDate not supplied

Slotted acetabular augmentation in childhood and adolescence.

During an 18-year period, 157 hips in 140 patients with hip dysplasia underwent a slotted acetabular augmentation (SAA or shelf) procedure. Indication for the procedure was pain in 71, progressive subluxation in 52, and acetabular insufficiency in 34 hips. Follow-up of 24-168 months (mean 60 months) was obtained in 108 hips in 98 patients. Good or excellent results were recorded in 83% of the hips. Unsatisfactory results were usually due to excessive breadth or insufficient thickness of the augmentation. The SAA is an alternative to the Chiari osteotomy when lateralization of the hip is not excessive.

Acetabulum↗
PubMedDate not supplied

Effects of lateral rotation splinting on lower extremity bone growth: an in vivo study in rabbits.

To study the effect of lateral splinting on limb development, 14 immature rabbit femurs and tibias were marked with six parallel pins. Of these, the lower limbs of seven rabbits were splinted in lateral rotation for 3 weeks (1-year human equivalent). The static position of the foot in the splinted group was 23 degrees more lateral (p greater than 0.05) than in the control group. No significant difference was found in the axial alignment of the pins across the growth plate or diaphyses between the splinted or control groups. This study suggests that night splinting alters the joint relationships and not the shape of the femur or tibia.

Animals↗
PubMedDate not supplied

Partial physeal growth arrest: treatment by bridge resection and fat interposition.

Twenty-eight skeletally immature patients underwent 29 primary physeal bridge resections at Children's Hospital and Medical Center in Seattle, Washington. Twenty-two resections were followed for 2 years. There were 11 excellent, five good, two fair, and four poor results. Overall mean growth was 83% with 98% in the excellent group and 96% in the good group. Physeal bridge resection is an effective method of treating partial physeal growth arrest. Results with fat compare favorably with results of other interposition materials without the disadvantages of local reaction and implant removal.

Adipose Tissue↗
PubMedDate not supplied

Management of hip dislocations in children with arthrogryposis.

From a review of 131 children with arthrogryposis, we studied 18 patients with hip dislocations. Fourteen patients (10 unilateral, four bilateral) were treated by open reduction. Mean age at surgery was 9.7 months, and follow-up ranged from 9 to 245 months. Range of motion of patients treated by open reduction following the medial approach was greater than in those treated by anterolateral incision and greater than in bilateral cases treated by closed reduction. Acetabular development was satisfactory following the medial approach and there were no re-dislocations, but one hip developed avascular necrosis.

Arthrogryposis↗
PubMedDate not supplied

Early spica cast management of femoral shaft fractures in young children. A technique utilizing bilateral fixed skin traction.

A review was made of 20 of 27 consecutively treated patients under 9 years of age with femoral shaft fractures treated by early application of bilateral fixed skin traction spica cast. The patients were re-evaluated two or more years after treatment, clinically and radiologically. All patients were asymptomatic and unaware of any disability. Orthodiagrams revealed no disparity of leg length greater than 7 mm. Residual anterior bow of 12 degrees was present in two patients and in 5 rotational malalignment of 10 to 20 degrees was present. As compared with results treated in traction, this method provides improved length control, comparable control of angular and rotational alignment and considerably shortened hospital stay. The technique should only be used by experienced, careful orthopedists in individually selected cases.

Casts, Surgical↗
PubMedDate not supplied

Medial femoral torsion: experience with operative treatment.

Seventy-eight patients who had undergone bilateral derotational osteotomy of the femur for medial femoral torsion were reviewed to evaluate the procedure and to determine the frequency of postoperative complications. Patients averaged 6 years of age at the time of the procedure; girls predominated. Before derotational osteotomy, the mean hip rotation measurements were 84 degrees medially and 16 degrees laterally; following the procedure, mean hip rotations were 41 degrees medially and 51 degrees laterally. Medial femoral torsion was reduced from 54 degrees mean to 14 degrees. Balancing these favorable results, however, was a 15% risk of complications; 12 of our patients had problems associated with loss of fixation, errors in amount of correction, fractures, heel ulcer, or infection. Derotational osteotomy is only justified for the child with a persistent severe disability from medial femoral torsion. The parents should be aware of the significant risks and the lack of evidence for any long-term adverse effects if moderate MFT is left uncorrected.

Adolescent↗