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Biomedical subjects

M B Millis

Publications and source records attributed to M B Millis.

At least 37 records · Page 2Linked to original sources
PubMed1992

Use of computed tomographic reconstruction in planning osteotomies of the hip.

Certain deformities of the hip joint seem to predispose the hip to the development of osteoarthrosis. Successful surgical correction of these deformities before the onset of osteoarthrosis requires accurate characterization of the anatomic deviations from normal as the first step in planning corrective osteotomy. Three-dimensional computed tomography (CT) reconstruction in planning reconstructive hip osteotomy has most often been employed in developmental dysplasia of the hip. Computed tomography scanning with three-dimensional reconstruction can characterize the often complex deviations from normal in shape and attitude of acetabulum and femoral head in cases with residual hip dysplasia. Three-dimensional reconstruction also allows simulation of redirectional femoral or pelvic osteotomies to facilitate precise application of newer powerful surgical techniques for reorienting the acetabulum.

Adolescent↗
PubMed1992

Use of ultrasonography in dysplasia of the immature hip.

Real-time ultrasonography reconstruction is an imaging technique of relatively recent origin that has dramatically affected the diagnosis and treatment of patients with hip dysplasia. Ultrasonography is replacing conventional radiography as the primary method of diagnosing hip dysplasia and evaluating its treatment during the first six to nine months of life. While conventional radiography reveals a familiar two-dimensional image of ossified structures and to a much lesser extent, soft-tissue structures, it has disadvantages that include ionizing radiation, a relative inability to evaluate unossified tissues, and an inability to gain three-dimensional information without supplemental techniques.

Child↗
PubMed1990

[Transiliac leg lengthening: experiences with a modified Salter osteotomy].

Transiliac limb lengthening osteotomy is a modified Salter innominate osteotomy which uses a trapezoidal interposition bone graft instead of the usual triangular graft to achieve up to 3 cm of intrapelvic lengthening. It allows correction of certain forms of postural imbalance and pelvic obliquity, as well as allowing an optimal and variable amount of acetabular redirection. This review of 105 patients who have undergone the procedure at our institution revealed the following indications: decompensated scoliosis, 26 patients; acetabular dysplasia with ipsilateral femoral shortening, 34 patients; intrapelvic asymmetry, 7 patients; pure limb length inequality, 38 patients. Intrapelvic lengthening averaged 2.5 cm. Correction of decompensated scoliotic curves averaged 7 degrees reduction in Cobb angle. Improvement in center-edge angle in patients with hip dysplasia averaged 17 degrees. Reduction in size of shoe lift required to balance the trunk in all cases was correlated closely with the intrapelvic lengthening achieved. Complications included two transient neurapraxias (one femoral, one femoral and sciatic), two cases of sacroiliac subluxation (one patient with myelodysplasia, and one patient with polio), three cases of partial graft collapse, and six instances of broken fixation pins, and three deep wound infections. No patient had chondrolysis or avascular necrosis of the femoral head. After average follow-up of nearly 5 years (minimum follow-up 2 years), patients who underwent transiliac limb lengthening osteotomy for correction of postural imbalance for various causes retained satisfactory correction.

Adolescent↗
PubMed1990

Acetabular dysplasia in the adolescent and young adult.

Hip dysplasia is a major cause of osteoarthrosis in adults. Early aggressive osteotomy has the potential of preventing the development of arthritis, but carries with it significant risks. The problem is further complicated because the surgeon has no means of quantifying the dysplastic deformity or of predicting what a particular combination of osteotomies would do to correct the deformity. This study describes methods of quantifying hip-joint geometry in three dimensions based on computed tomography and magnetic resonance studies, and of simulating pelvic osteotomy to correct the deformities. The study analyzes 49 normal hip joints and 20 dysplastic hip joints. The results show that the normal acetabulum is nearly a full hemisphere, which is anteverted 20 degrees and abducted 53 degrees. The normal lateral center-edge angle is 37 degrees. The dysplastic acetabulum is not anterolaterally maldirected, as has been assumed, but is globally dysplastic. Analysis of the individual dysplastic hip joints showed a wide variability. Some patients were deficient globally, some anterolaterally, and some posterolaterally. Methods of analyzing a patient's hip joint, quantifying abnormalities, simulating surgery, and predicting results are demonstrated in a case example.

Acetabulum↗
PubMed1989

Abnormalities of proximal femoral growth after severe Perthes' disease.

We studied the pattern of proximal femoral growth after severe Perthes' disease (Catterall grade III or IV) by retrospective analysis of serial radiographs in 52 hips (46 patients). Our aim was to determine the relationship between proximal femoral growth abnormalities and metaphyseal cysts, epiphyseal extrusion, physeal narrowing, and extensive epiphyseal necrosis. The average follow-up after treatment was 9.8 years (range 4 to 16 years), and 37 of the hips were followed to skeletal maturity. Slowing of proximal femoral growth was common: symmetrical abnormality was seen in 26 hips and asymmetrical abnormality in nine. However, definite premature closure of the proximal femoral physis was seen in only three hips. Abnormality seemed to be due to altered growth velocity rather than to bar formation in most cases. Metaphyseal cysts, epiphyseal extrusion and physeal narrowing during the active stage of the disease, alone or in combination, were found to be neither sensitive nor specific predictors of the subsequent growth pattern.

Adolescent↗
PubMed1988

Hip and pelvic injuries in the young athlete.

Hip and pelvic injuries are relatively rare in the young athlete. Contusions and musculotendinous sprains are the most common injuries about the hip and pelvis. Apophyseal avulsion fractures and stress fractures are the most frequently encountered skeletal injuries. Each of these entities can be successfully treated with guided physical therapy following conservative management with rest, anti-inflammatory medications, and ice massage until the patient is pain free. Epiphyseal, diaphyseal, or pathologic fractures are rare entities that are secondary to violent trauma. These injuries are severe and often require operative intervention. Femoral neck fractures have a high rate of complications from avascular necrosis, nonunion, or malunion. Pelvic fractures have frequent associated genitourinary, abdominal, neurologic, and musculoskeletal injuries. Pathologic fractures are most commonly secondary to benign lesions, such as unicameral bone cysts, and less likely owing to malignancy. Finally, in children with hip pain during athletic activities, even with antecedent trauma, the sports clinician must screen for slipped capital femoral epiphysis, Perthes' disease, congenital subluxation of the hip, toxic synovitis, systemic neoplasia, or infectious process.

Adolescent↗
PubMed1988

Comparison of femoral and innominate osteotomies for the treatment of Legg-Calvé-Perthes disease.

The outcomes of forty-two femoral osteotomies and forty-nine innominate osteotomies for the treatment of Catterall grade-III or IV Legg-Calvé-Perthes disease were compared. The average length of follow-up was nine years (range, three to seventeen years). For the patients who were less than ten years old at the onset of the disease, there was no difference in the results of the two procedures, even when the results were analyzed according to age. However, the center-edge angle, neck-shaft angle, lengths of the limbs, range of abduction, and total range of motion were closer to normal after an innominate osteotomy. There was no difference in the ratings when the results of the two operations were compared according to the several parameters that have been proved to be associated with the long-term outcome for hips in patients who have Legg-Calvé-Perthes disease. However, the innominate osteotomy seemed to be the better procedure when involvement of the growth plate was likely to cause coxa vara or a substantial discrepancy in the lengths of the limbs. The patients who were more than ten years old at the onset of the disease had a poor result with either procedure.

Casts, Surgical↗
PubMed1986

The early identification and classification of growth disturbances of the proximal end of the femur.

An analysis of the serial radiographs of sixty-eight patients who were treated for congenital dislocation of the hip revealed that a growth disturbance of the proximal end of the femur that was caused by partial or complete physeal closure developed in thirty-three of these patients. The disturbances were related to the character of the metaphyseal growth-disturbance lines and were subsequently classified according to the site and extent of physeal closure. In order to study this problem, we divided the physis of the proximal end of the femur into two contiguous sections: a medial and a lateral portion. Two typical patterns of premature closure were identified: one located at the junction of the medial and lateral portions of the physis and the other located in the area of the medial portion of the physis alone. The pattern of physeal closure, together with the age of the patient at the time of closure, determines the subsequent growth of the proximal end of the femur. The final outcome of growth of the proximal end of the femur can be predicted within six months after the initial treatment. Epiphyseal changes were found to be of no prognostic significance in the absence of physeal closure.

Adolescent↗
PubMed1984

Supracondylar fracture of the humerus in children. Further experience with a study in orthopaedic decision-making.

In a study of the results of each therapeutic act in the treatment program of displaced supracondylar fractures of the humerus, 108 consecutive children were analyzed. An initial attempt at closed reduction was noted in 101 cases, with the attempt successful in 61. Of these elbows, 19 were flexed at least 120 degrees following reduction, with all 19 maintaining reduction. Twenty-two of the remaining reduced fractures were splinted in less than 120 degrees of flexion; 19 lost reduction. Traction alone, via olecranon pin or skin, was unsuccessful in achieving reduction and unreliable in maintaining reduction once achieved. Crossed Kirschner wires, placed percutaneously or under direct visualization, were uniformly successful in maintaining reduction. From these data an algorithm has been constructed to facilitate objective decision-making in the treatment of this challenging fracture.

Adolescent↗
PubMed1980

Ankle arthrodesis in the management of traumatic ankle arthrosis: a long-term retrospective study.

A retrospective study was carried out of 48 patients who underwent ankle arthrodesis for tramatic arthritis from January 1967 through January 1976. Following ankle fusion, the most common complaint was subtalar pain and the most frequent finding was limitation of subtalar motion (56%). Subtalar or triple arthrodesis was required in 12 patients, with good results in the majority of the cases. An infection rate of 22% was encountered, felt to be consequent to the failure to properly employ prophylactic antibiotics; which, when employed, were associated with less than 6% incidence of sepsis 69% of patients were improved from their status before ankle arthrodesis; 12% had come to below-knee amputation (three for resistant pain, two for chronic osteomyelitis, and one for vascular insufficiency). Fusion of the subtalar joint seems curative, and early mobilization of the subtalar joint, by ankle fusion techniques that do not immobilize the entire foot may play a preventive role.

Adult↗
PubMed1979

Transiliac lengthening of the lower extremity. A modified innominate osteotomy for the treatment of postural imbalance.

A modified innominate osteotomy was employed to treat postural imbalance by a hemipelvic lengthening in twenty patients, five to twenty years old. Diagnoses associated with the postural imbalance included acetabular dysplasia with ipsilateral femoral shortening, pure limb-length inequality, primary intrapelvic asymmetry, and decompensated scoliosis. The functionally low hemipelvis was lengthened as much as three centimeters by distraction at the osteotomy and insertion of a quadrangular bone graft. The option of a variable amount of acetabular redirection was especially useful in patients with ipsilateral acetabular dysplasia. Review of the patients after two to six years revealed that an average lengthening of 2.3 centimeters had been achieved. Fourteen patients had a balanced stance without a lift postoperatively, and the size of the lift required in the other six patients was greatly reduced.

Acetabulum↗
PubMed1976

Stiffness of the proximal interphalangeal joints in rheumatoid arthritis. The role of flexor tenosynovitis.

In nineteen hands (seventy-four fingers) of eleven women and one man with rheumatoid arthritis there was restriction of active and passive motion of the proximal interphalangeal joints, with signs of flexor tenosynovitis but no clinical or roentgenographic evidence of involvement of the joint. The nineteen hands were treated by flexor tenosynovectomy (palm only in nine, palm and carpal tunnel in five, both palm and digits in four, and digit, palm, and wrist in one) combined with manipulation of the joint under regional anesthesia. After an average follow-up of twenty-one months (range, six to thirty-six months), the average range of active motion had increased from 40 to 84 degrees and the average range of passive motions, from 57 to 87 degrees. Only three patients had unsatisfactory results, one because of persistent unexplained swelling and two because of recurrence of the tenosynovitis.

Adolescent↗
PubMedDate not supplied

The planning of orthopaedic reconstructive surgery using computer-aided simulation and design.

Three-dimensional reconstructions from computed tomographic (CT) images are currently being used clinically in a wide variety of orthopaedic surgical applications. The computer may be used to select the optimum standard artificial joint replacement or to design a custom artificial joint replacement for a particular patient. Where large bony defects exist, the computer may be used to design bone allografts for joint reconstruction and to manufacture models of the bones for use in planning the surgery. In cases where osteotomies are performed to improve the mechanics of the joint, each proposed osteotomy may be simulated on the computer to identify the surgical plan that will optimally normalize the diseased joint.

Adolescent↗
PubMedDate not supplied

Postreduction computed tomography in developmental dislocation of the hip: part I: analysis of measurement reliability.

Twenty computed tomographic (CT) scans of infants in spica casts after closed or open reduction for developmental hip dislocation (DDH) were analyzed for intra- and interrater reliability. Ten measurements of infant hip anatomy were assessed by three raters by using standard statistical analysis. All six measurements of acetabular anteversion and lateral or posterior displacement of the femoral metaphysis from the acetabulum or from a modified Shenton's line drawn from the pubic rami demonstrated both intra- and interrater reliability. All four measurements of acetabular structure could not be reliably measured either within or between observers. We also introduced a new measurement based on the principle of Shenton's line to aid in the assessment of femoral-head location after reduction in patients with DDH; this was reliably determined both within and among observers.

Female↗
PubMedDate not supplied

Postreduction computed tomography in developmental dislocation of the hip: part II: predictive value for outcome.

Computed tomographic (CT) scans were performed after closed reduction of 68 dislocated hips in 53 infants in spica casts with developmental hip dislocation (DDH). Ten measurements were made on the CT scans including acetabular indices and anteversion, hip-abduction angle, lateral and posterior displacement of the femur from the acetabulum, and femoral displacement from a modified Shenton's line drawn from the pubic rami. By using analysis of variance, the correlation of each variable with outcome after reduction was determined, including the development of avascular necrosis or the need for further surgery because of residual dysplasia. None of the variables was predictive of the outcome of persistent hip dysplasia. The subsequent development of avascular necrosis was statistically associated with hip-abduction angles >55 degrees as measured on postreduction CT scans, with 20% of the involved hips developing avascular necrosis on subsequent follow-up.

Analysis of Variance↗
PubMedDate not supplied

Slipped capital femoral epiphysis: assessment of epiphyseal displacement and angulation.

Nineteen hips with slipped capital femoral epiphysis underwent assessment of the severity of epiphyseal displacement on anteroposterior and lateral roentgenograms and by computerized tomography. The head-shaft angle, the percentage of maximal epiphyseal displacement, and the computed tomographic head-neck angle were determined. The head-shaft angle showed great variability when compared with the percentage of epiphyseal displacement and with the head-neck angle. The percentage of epiphyseal displacement showed less variability when compared with the computerized tomographic head-neck angle; however, the range of error was still significant. These data suggest that the computerized tomographic measurement of degree of slip is more accurate than previously described techniques. We believe that the computerized tomographic measurement of head-neck angle achieves greater accuracy and therefore reproducibility by virtue of a decrease in position dependency. This measurement may be indicated as a reproducible standard for assessing slip severity in the horizontal plane.

Adolescent↗
PubMedDate not supplied

Neurovascular injury and displacement in type III supracondylar humerus fractures.

From July 1987 to January 1991, 59 consecutive type III supracondylar humerus fractures in children were identified at Children's Hospital, Boston. Twenty-nine patients (49%) had evidence of neurovascular compromise. The median nerve was involved in 15 (52%) of these patients and was associated with posterolateral displacement in 87% of cases. The radial nerve was involved in eight (28%) of these patients and was associated with posteromedial displacement in every case. Injuries to the brachial artery occurred in 11 (38%) of these patients and was associated with posterolateral displacement in 64% and posteromedial displacement in 36% of cases. We conclude that posterolateral displacement in type III supracondylar humerus fractures is strongly associated with median nerve injuries. Posteromedial displacement is responsible for injuries. Posteromedial displacement is responsible for injuries to the radial nerve in virtually every instance. Brachial artery injuries may occur with either type of displacement. Neurovascular injury is higher than previously reported in these fractures.

Blood Vessels↗