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Biomedical subjects

M M Hoffer

Publications and source records attributed to M M Hoffer.

69 records · Page 4Linked to original sources
PubMedDate not supplied

Latissimus dorsi and teres major transfer to rotator cuff for Erb's palsy.

During a 20-year period the authors operated on 56 patients with Erb's palsy to create active external rotation of the shoulder. Thirty-five patients had a follow-up period longer than 2 years (average 5 years), which allowed comparison with preoperative motion and strength. Preoperative passive external rotation averaged 5 degrees, whereas active abduction averaged 74 degrees. Preoperative external rotation strength was less than grade 2, whereas preoperative abduction strength was grade 2 or 3 in 33 of the 35 patients. Postoperative active external rotation averaged 31 degrees with only two recurrent internal rotation contractures. Postoperative active abduction averaged 120 degrees. Postoperative strength in external rotation increased in 29 of the 35 patients, with abduction strength increasing one or more grades in 13 of the 35 patients. Four complications occurred. Three patients continued to lose external rotation and required further surgical procedures, and a fourth had a superficial infection. This procedure compares well with the classic transfers to the proximal humerus in that it provides active external rotation in most cases and in some increases shoulder abduction strength.

Adolescent↗
PubMedDate not supplied

Orthopedic management of acquired cerebrospasticity in childhood.

Of 221 children with head injuries and resultant deep coma followed for long-term problems, 156 became totally independent, functional individuals, only 61 lacking normal cognition and speech. Reconstructive surgical procedures for residual spasticity was necessary in 45 patients. Achilles lengthenings were the most common procedure performed; after Achilles lengthenings, toe flexor releases were most often required. Twenty children had anoxia from drowning or anesthesia problems; 7 of these had spastic hip deformities or dislocations, all within 6 months of the anoxic event. Progressive cerebrospastic syndromes and post-infectious cerebrospasticity most often require orthotic devices for their orthopedic management.

Achilles Tendon↗
PubMedDate not supplied

Surgery about the elbow for brachial palsy.

The results of surgical procedures performed on 21 children to improve their elbow function were reviewed. Five flexor-plasties were performed in children with weak elbow flexors. In five patients with anterior dislocations of the radial head and supination contractures, transfers of the biceps to the ulna were performed. In eight patients with supination contractures and located radial heads, turnabout transfers to make the biceps a pronator were performed. Four of the five children with flexor-plasties had significant functional gains. All five biceps to ulna transfers had increased ability to flex without the necessity of supinating. The eight patients who had the turnabout procedure of the biceps had excellent flexion with the ability to pronate the forearm.

Adolescent↗
PubMedDate not supplied

Chiari osteotomy in cerebral palsy.

Twelve cerebrospastic patients underwent 13 Chiari osteotomies for the treatment of subluxed or dislocated hips. Twelve of these 13 hips were reexamined 24-80 months later. Ten patients had painless located hips. The two failures had pelvic obliquity that resulted in redislocation.

Adolescent↗
PubMedDate not supplied

Arthrodesis of the paralytic shoulder.

Five children, aged 7-15 years, with brachial palsies and flail shoulders, had fusions performed. Four of the five had improved function; however, there was progressive loss of fused abduction position over time.

Adolescent↗
PubMedDate not supplied

Latissimus dorsi and teres major tendons: separate or conjoint tendons?

Latissimus dorsi and teres major are used for tendon transfer about the shoulder in treating weakness that results from brachial plexus palsy. Anatomy textbooks describe separate insertion sites for these two tendons. During a surgical procedure, which included releasing these two tendons off the humerus from a posterior approach, they appeared to be joined together. Cadaver shoulders were subsequently dissected to determine if the tendons had conjoint or separate insertions. We found that although the two tendons do have separate insertion sites, they were joined to one another and difficult to separate. For this reason, when performing releases or transfers with these muscles, surgeons should consider the two as one structure in order to avoid damage to the important surrounding neurovascular structures (axillary and radial nerves, posterior humeral circumflex artery).

Brachial Plexus↗
PubMedDate not supplied

Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children's elbows.

From 1991 to 1994, 375 supracondylar fractures had percutaneous pinning after closed or open reduction. Nineteen of these with normal preoprative neurologic examinations had postoperative ulnar nerve palsies. All but two of the 19 were followed up. These 17 patients had complete return of function. Only four of the 17 had the medial pins removed, and two others had explorations, which showed no interruption of the nerve. Many of these patients did not have complete return of function until after 4 months. From this and other studies, it is clear that ulnar nerve palsies occurring after percutaneous pinning of the supracondylar fracture usually resolve spontaneously.

Child↗
PubMedDate not supplied

Nonoperative treatment for minimally and nondisplaced lateral humeral condyle fractures in children.

The radiographic and clinical records of 95 children with nondisplaced or minimally displaced fractures of the lateral humeral condyle treated on a nonoperative protocol were reviewed. Acute nondisplaced or minimally displaced fractures were defined as < 24 h old on initial evaluation and displaced < 2 mm in three radiographic planes (anteroposterior, lateral, and internal oblique). Closed treatment and close follow-up in a long-arm cast or splint resulted in a union rate of 98% in 3-7 weeks. Two of the fractures displaced required open reduction and internal fixation and then subsequently went on to union without complications.

Adolescent↗