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Biomedical subjects

M M Hoffer

Publications and source records attributed to M M Hoffer.

At least 37 records · Page 2Linked to original sources
PubMed1988

Brachial-plexus palsy in the newborn.

Twenty-one patients who had twenty-three brachial-plexus palsies resulting from trauma at birth were studied over a three and one-half year period, between July 1983 and December 1986. The incidence of this group of injuries was 2.5 per 1,000 live births. There were fourteen palsies of the fifth and sixth cervical nerves; eight of the fifth, sixth, and seventh cervical nerves; and one of the entire brachial plexus. Two patients were lost to follow-up shortly after birth. Of the remaining nineteen patients (twenty-one palsies), fifteen (seventeen palsies) had full recovery at an average of three months (range, two weeks to twelve months), and four (four palsies) had residual paralysis of the upper extremity at more than twenty-six months. We concluded that the newborn who has a brachial-plexus palsy has a favorable prognosis for complete recovery.

Apgar Score↗
PubMed1987

Clavicle fractures in head-injured children.

Between the years 1960 and 1985, 499 children were treated at Rancho Los Amigos Hospital for residuals of head trauma. Of these, 35 had fractures of the clavicle (38 total fractures). Two of the patients had lateral physeal injuries and subsequently developed a "double" clavicle. All of the clavicle fractures healed without immobilization and exhibited excellent remodeling. All patients recovered complete range of motion of the shoulder. Only one of the patients required surgery (for removal of a tender bony prominence after the formation of a "double" clavicle).

Adolescent↗
PubMed1987

Tibial fractures in head-injured children.

Twenty-nine tibia fractures in 28 pediatric patients with head injuries were reviewed for mechanism of injury, age, time to healing, deformity, and functional ability. The most frequent cause was auto versus pedestrian accidents and the average patient age was ten years. Most had major associated injuries. Fractures of the middle third of the tibia comprised 75% of the group and healed after 20 weeks. There were few deformities in this group despite the fact that most were treated by closed methods.

Accidents, Traffic↗
PubMed1987

Contractures in cerebral palsy.

Contractures in cerebral palsy (CP) are usually in flexion at the hips and knees, and in plantar flexion at the ankles. When correctly indicated, surgical release is appropriate. Occasionally, extension contractures of the hip and knee develop, and dorsiflexion contractures of the ankle may ensue. In CP, the management of each of these deformities may require different sets of operative procedures.

Adolescent↗
PubMed1986

Long-term follow-up on tendon transfers to the extensors of the wrist and fingers in patients with cerebral palsy.

Thirty-eight patients with cerebral palsy had tendon transfers to improve extension of the wrist and fingers. The 10 patients who had poor hand placement, sensibility, or motor control failed to improve in functional grasp or release. The remaining 28 patients, with better preoperative criteria, had improved function. On long-term follow-up, 5 of the 12 patients with transfers to the wrist extensor had extension contractures with difficulty in release, and in seventeen patients transfers to the finger extensors resulted in improved finger extension and release, with no sacrifice in the ability to grasp.

Adolescent↗
PubMed1986

Predictive value of manual muscle testing and gait analysis in normal ankles by dynamic electromyography.

Eight muscles about the ankle of seven normal subjects were assessed by electromyography (EMG) during manual muscle testing (MMT) and walking. Three strength levels (normal, fair, trace) and three gait velocities (free, fast, slow) were tested. The muscles studied included the gastrocnemius, soleus, posterior tibialis, flexor digitorum longus, flexor hallucis longus, anterior tibialis, extensor digitorum longus, and extensor hallucis longus. Relative intensity of muscle action was quantitated visually (using an eight-point scale based on amplitude and density of the signal). The data showed that EMG activity increased directly as more muscle force was required during the different manual muscle test levels and increased walking speeds. No MMT isolated activity to the specific muscle though being tested. Instead, there always was a synergistic response. Both the gastrocnemius and soleus contributed significantly to plantarflexion regardless of knee position. The intensity of muscle action during walking related to the manual muscle test grades. Walking at the normal free velocity (meters/min) required fair (grade 3) muscle action. During slow gait the muscle functioned at a poor (grade 2) level. Fast walking necessitated muscle action midway between fair and normal, which was interpreted as good (grade 4).

Ankle↗
PubMed1985

Femoral varus-derotation osteotomy in spastic cerebral palsy.

Twenty children (twenty hips) with spastic cerebral palsy underwent femoral varus-derotation osteotomy for which the principal indication was inadequate coverage of the femoral head. Other infrequent indications included pain, valgus angulation of the femoral neck, and dislocation of the hip. The age at surgery ranged from four to fifteen years. Each child had muscle releases before the osteotomy was done. At follow-up, at least seven years later, the femoral head in twenty hips was well centered. Four hips remained subluxated but were less subluxated than before the osteotomy. One hip remained dislocated. The center-edge angle averaged -8 degrees preoperatively and +17 degrees at follow-up. The neck-shaft angle averaged 155 degrees preoperatively, 114 degrees immediately post-operatively, and 125 degrees at follow-up. Femoral varus-derotation osteotomy, when combined with muscle releases, can allow children with spastic cerebral palsy to maintain their ambulatory status and may decrease pain about the hip.

Adolescent↗
PubMed1983

Ambulation in severe arthrogryposis.

Functional ambulation occurred in 22 of 36 severely affected arthrogrypotic patients. Functional ambulation in these patients required hip motion to within 30 degrees of full extension and knee motion to within 20 degrees of full extension. Ambulation also required hip extensor strength of good (grade 4), quadriceps strength of fair (grade 3), or crutchable upper extremities and orthotic substitutes. Foot and spine deformities also interfered with ambulatory ability.

Adolescent↗
PubMed1983

Adduction contracture of the thumb in cerebral palsy. A preoperative electromyographic study.

In twenty-three patients with cerebral palsy and functional spastic hemiplegia, the contracted thenar-adductor space of the involved hand was evaluated by electromyography. The needle electromyogram was used to determine if the patient had selective control of the adductor muscle. In eight patients only partial myotomy of the adductor muscle during z-plasty of the web was performed because selective control of that muscle was present during either grasp or release. In four patients a complete release was done, and in two of them the ability to pinch was impaired.

Adolescent↗
PubMed1982

Posterior tibial tendon transfer: a review of the literature and analysis of 74 procedures.

At Rancho Los Amigos Hospital on the Children's Orthopedic Service, 43 patients underwent anterior transfer of the posterior tibial tendon through the interosseous membrane between 1969 and 1979. This included 74 procedures for the following diagnoses: Duchenne muscular dystrophy, club-foot, cerebrospastic disease (cerebral palsy and head injury), Charcot-Marie-Tooth disease, scapuloperoneal dystrophy, and peroneal palsy. The purpose of this paper is to present the 54 of these transfers that have a minimum 2 year follow-up were performed with a uniform surgical technique, and had uniform postoperative management. This series is analyzed and compared with a review of the literature in order to set down guidelines for the use of the procedure. The analysis reveals that the patient with Duchenne muscular dystrophy who has decreasing gait function or brace fitting problems is the ideal candidate for the procedure with 26 of 28 satisfactory results. Gait electromyography was critical to the selection of the cerebrospastic patient for the transfer with those patients demonstrating swing-phase function of the posterior tibialis muscle yielding the best results. Finally, posterior tibial tendon transfer is generally not indicated in congenital clubfoot with six unsatisfactory results in 10 procedures, and the procedure should not be done in Charcot-Marie-Tooth disease as part of staged treatment that includes a possible future hindfoot stabilization.

Cerebral Palsy↗
PubMed1981

Functional recovery and orthopedic management of brachial plexus palsies.

Functional recovery in 133 patients with brachial palsy is documented over a five-year period. Clinical examination is more reliable than electromyogram or myelogram for obtaining prognostic information. Erb's C V, VI palsies have improved function with cuff transfers and elbow flexor plasties. Posterior cord palsies often require extension plasties of the hand and glenohumeral fusions. C V, VI, VII palsies may require all of these procedures. Klumpke C VIII-T I palsies develop arm-trunk holding power. Adults with total palsies often complain of continued pain, which may be relieved by orthoses.

Adolescent↗
PubMed1981

The functional and social significance of orthopedic rehabilitation of mentally retarded patients with cerebral palsy.

The 14 outpatients transferred for surgery on the hips and legs also made significant gains, primarily in hygiene and sitting tolerance. Unfortunately, they required two to four times the period of hospitalization of similarly involved nonretarded children. This is an important consideration in the outpatient group, perhaps less so in the previously institutionalized child. In the entire group of patients, including those followed for less than five years, we have had three deaths. Two were due to pneumonia, two months and four months after the hip procedure. One was due to osteosarcoma of the operated femur four years postoperatively.

Adolescent↗
PubMed1980

Joint motion limitation in newborns.

Fifty neonates were evaluated and followed for 2 years with attention to the passive range of joint motion. Passive range of motion was symmetrical throughout this period. Only the hips were noted to have persistent contractures in flexion and external rotation during these 2 years. Such deformities of the hip make judgements about anteversion in infancy difficult. They also help explain the peculiarity of the lordotic, externally rotated gait seen initially in many toddlers.

Ankle Joint↗
PubMed1980

Cerebral palsy: the first three years.

The orthopedic surgeion should be an integral part of a medical team for evaluation and treatment of young children with cerebral palsy. Surgical procedures in this first three years of life are usually limited to the adductor releases about the hip. Stretching and plastic splints about the ankle and knee followed by ankle-foot orthoses are frequently effective in correction of deformity.

Cerebral Palsy↗
PubMed1979

Dynamic electromyography and decision-making for surgery in the upper extremity of patients with cerebral palsy.

Seventeen children with cerebral palsy were selected for improvement in upper extremity function. Each had normal or nearly normal intelligence; each hand had good or mildly impaired sensibility; each arm had relatively good placement. Electromyograms with wire electrodes were utilized to study the patterns of activity of the planned tendon transfers. Only muscles with isolated activity in grasp were utilized to transfer in hands with weak grasp. Only muscles with isolated activity in release were utilized to transfer in hands with poor release.

Adolescent↗