Biomedical subjects
Publications and source records attributed to M A Rosman.
Radiographs, computed tomograms, and radionuclide bone scans were obtained preoperatively in three children with fibromatosis involving the bones and soft tissues of the extremities. Two of the children had identical scar-like bone lesions of the proximal tibia, which, to the authors' knowledge, have not been reported before in this disease. The lesions recurred in two children.
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Osteofibrous dysplasia is a benign, slowly progressive lesion which generally involves one tibia of an infant or young child, and presents as anterior bowing associated with a painless mass. Surgical intervention is usually not indicated but, when carried out, recurrences are common. Osteofibrous dysplasia is readily distinguished histologically from fibrous dysplasia by fibrous stroma, containing bone trabeculae which are rimmed by osteoblasts, and by a "zonal architecture." The radiographic appearance is that of a benign, lucent, intracortical lesion which is expansile and produces bowing of the tibia. Four patients with this condition are presented.
Aneurysmal bone cyst, a benign lesion, is difficult to diagnose radiologically, particularly in the spine, but has a characteristic microscopic appearance. Treatment of spinal lesions consists of curettage, with or without bone grafting, together with irradiation at low doses (1000 to 2000 rads). The author reports a case of aneurysmal bone cyst of the neural arch associated with neurologic complication, which illustrates some typical features of such cysts of the spine. The condition should always be considered in patients with lytic lesions of the spine, and prompt surgical intervention is recommended.
Fracture of the carpal scaphoid is uncommon in children, but does occur and may fail to unite. Eight patients with established non-union have been reiewed, with an average follow-up of almost four years. All non-unions were grafted with autogenous bone. Excellent clinical and radiological results have been obtained. It is concluded that non-union in children is best managed by bone grafting through the anterior approach. Possible aetiological factors concerned in non-union of scaphoid fractures in this age group are discussed.
The results of treatment of 64 congenital hip dislocations, diagnosed after the children were of walking age, were assessed anatomically, using two criteria--general femoral head shape and the C.E. angle of Wiberg. Results were also related to age at diagnosis and treatment methods. Radiologically 62% of the hips had normal or good results, and of these, 82% were obtained when the diagnosis was made and treatment started before the age of 36 months. In this series no correlation existed between anatomical result and treatment method.
A review of 50 children with fractures of the medial humeral epicondyle facilitated a simple classification of this injury and its management. The "apparent isolated" fracture of the medial humeral epicondyle is uncommon; it is more frequently associated with elbow dislocation, with or without spontaneous reduction, at the time of injury. Analysis of the results of treatment of medial humeral epicondylar fractures in this group of children showed that, in the case of those with an "apparent isolated" injury, treatment with a sling only gave good results in 90% whereas poorer results followed open treatment or fractures associated with dislocation. Closed treatment is therefore recommended. Open reduction is indicated only with (a) ulnar neuritis at the time of injury or (b) intra-articular fragment.
A 10-year-old boy was treated for a chondromyxoid fibroma of the left femur by curettage, and 2 months later complete healing was demonstrated radiographically. Three years after operation, radiographs revealed replacement of the ilium, ischium and upper femur, and destruction of the left hip by a soft-tissue and bony mass; a left hemipelvectomy was performed for what was shown to be a chondrosarcoma. Follow-up 10 years after the initial operation and 7 years after the hemipelvectomy has confirmed uneventful recovery in this rare case of malignant degeneration of a proven chondromyxoid fibroma of bone.
We reviewed the cases of 60 children with acute osteomyelitis with an average follow-up of 34 months. All patients were treated initially with high-dose intravenous (i.v.) antibiotics. Eight patients did not respond to this treatment within 48 h and had surgical drainage. The remaining 52 patients were divided into two subgroups: (a) 35 patients received i.v. antibiotics for an average of 21 days; (b) 17 patients received i.v. antibiotics for an average of 8 days followed by 4 weeks of oral therapy with monitoring of serum bactericidal levels. The incidence of chronic infection (12% for the operatively treated group and 4% for the nonoperatively treated group) depended more on the time interval between the presentation of symptoms and the onset of treatment than it did on the route of antibiotic administration.