Biomedical subjects

Mark Eidelman

Publications and source records attributed to Mark Eidelman.

11 recordsLinked to original sources

PubMed2006

Correction of deformities in children using the Taylor spatial frame.

The Taylor spatial frame is a unique external fixator. Despite its growing popularity, few reports on its use have been published. We evaluated the effectiveness of the Taylor spatial frame in the treatment of various deformities in 31 children and adolescents. All but one patient were anatomically corrected. Complications included superficial pin tract infection (45%), three fractures of the femoral regenerate, transient peroneal palsy, and injury to the genicular artery. Despite many challenging problems, our results compared favorably with the results achieved by others. We believe that the Taylor spatial frame is a very capable and accurate fixator for the precise correction of complex deformities.

Adolescent↗

PubMed2006

Sonography of the hip-joint by the emergency physician: its role in the evaluation of children presenting with acute limp.

OBJECTIVE: To describe a new imaging bedside test called Sonography of the Hip-joint by the Emergency Physician (SHEP) and to examine if its use as a triage tool for the presence of fluid in the hip joint can guide the emergency physician to the right diagnosis. METHODS: Case series of 5 children presented to the ED with an acute onset of limp. In addition to a careful clinical history and physical examination, each child received SHEP. RESULTS: Follow-up confirmed that the presumptive diagnosis made in the ED was correct. The SHEP tests were found helpful in diagnosing transient synovitis (3 cases), septic arthritis (1 case), and osteomyelitis of the femur (1 case). CONCLUSIONS: The SHEP tests provided additional information that narrowed the differential diagnosis, and minimized unnecessary blood tests and diagnostic imaging studies.

Acute Disease↗

PubMed2006

A novel elastic exsanguination tourniquet as an alternative to the pneumatic cuff in pediatric orthopedic limb surgery.

We describe our experience with a novel surgical exsanguination tourniquet (S-MART; OHK Medical Devices, Haifa, Israel) in clinical pediatric orthopedics. We evaluated the surgical exsanguination tourniquet's properties and clinical use in 51 patients and compared our observations with our long-standing experience with the Esmarch bandage, pneumatic tourniquet and sterile stockinet. Using the surgical exsanguination tourniquet, we found superior exsanguination quality, quick application and the ability to place the occlusion ring closer to the surgical field. No side effects or ischemic complications were observed. After removal, the skin under the ring was intact in all cases. We conclude that the surgical exsanguination tourniquet is safe and valuable in our practice.

Adolescent↗

PubMed2005

Hemiepiphysiodesis around the knee by percutaneously guided and grooved staple.

One option for correcting angular deformities around the knee is hemiepiphyseal stapling. We have invented a percutaneously guided grooved staple which allows placing of the staple exactly, with a minimal incision and little surgical time. We used this technique on five children (16 bones). The deformities were fully corrected in all except one patient in whom staples were used to postpone definitive surgery until skeletal maturity. The mean time of surgery per physis was 7 min (range, 4-13 min). Less than 10 min was required to insert each staple. Using grooved staples allowed the surgeon to perform hemiepiphysiodesis efficiently and precisely.

Bone Diseases, Developmental↗

PubMed2005

[Principles of deformity correction using the Taylor Spatial Frame].

Developed in the fifties, the Ilizarov ring external fixator was first introduced to the West in the eighties of the twentieth century. The technique has become widely accepted for the treatment of a wide variety of limb pathologies including complex fractures, deformity correction and limb lengthening. The Taylor Spatial Frame (TSF) was developed by Charles Taylor in the mid nineties. This system is basically a ring external fixator, drawing on the theoretic foundation from the theory of projected geometry and the mechanical bases from the Stewart platforms. This combination provides a stable external fixation device with an outstanding ability for manipulation of the bone fragments in any given direction, and correction of the most complex deformities. Following the application of the frame, internet-based software will provide an instant treatment plane for the correction of the deformity. This will then be carried out by the patient himself until the achievement of an anatomical reduction of the fracture, lengthening or deformity correction. This combination of a stable external fixation device and the accuracy of the computer based technology, makes the TSF the treatment of choice in the precise correction of limb deformities. This review presents an overview of the theoretical foundation and methods of using the TSF, with an emphasis on the advantages of this system and the capabilities in the correction of skeletal deformities.

Equipment Design↗

PubMed2004

Acute rupture of achilles tendon in a 7-year-old girl.

Ruptures of Achilles tendon are a relatively common injury. Ruptures typically occur after the age of 30 years, and are more frequent in people of middle age or older. In children, rupture of the tendon is usually due to avulsion of the tendon from the calcaneus but not within the tendon itself. We describe a 7-year-old girl successfully treated conservatively for acute tear of her Achilles tendon. No general predisposing disease was found. We were unable to find any description of an acute rupture of the Achilles tendon in a child under the age of 10 years.

Achilles Tendon↗

PubMed2004

[Practical significance of sonographic type IIa of dysplastic hip joint according to Graf's classifications].

Hip joint assessment in newborns and neonates is currently performed with ultrasonography due to the high degree of sensitivity and specificity of this technology as compared to the usual radiography. Measuring the alpha and beta angles is indicative in assessing the hip joint. The alpha angle represents the bony acetabular components and the beta angle represents the cartilaginous roof. According to Graf's classifications, type IIa is subdivided into two subgroups; type IIa- and IIa+. This study examined the need for following-up on these hip joints in newborn and neonate. The study population included the newborns and neonates born in our facility between the period 1/1/1999 to 1/4/2002. We routinely screened 10,432 newborns both clinically and ultrasonographically. This included a total of 20,862 hip joints, of which 915 were pathological according to Graf's classifications. Type IIa was diagnosed in 232 newborns and a total of 330 hip joints. The follow-up examinations were performed at 6 and 12 weeks of age, and at six months of age. Each follow-up visit included clinical and sonographic evaluation and alpha angle measuring. The incidence of type IIa was 1.6% of all hips and 36.9% of the pathological hip joints. These joints were divided into two subgroups. Group A included 254 hip joints among 156 newborns, 116 girls [74.3%] and 40 boys [25.6%]. Group A members had bilateral or unilateral type IIa hip joints. In the latter case, the other joint was type I-normal. Group B included 76 hip joints among 76 newborns, 72 girls [94.5%] and four boys [5.5%]. Group B members had one type IIa hip joint and a second more severely graded hip joint. Follow-up only was required in 88% of the type IIa hip joints and 12% were treated using Pavlik's method. Surprisingly, all the joints with unilateral type IIa hips developed into normal or type I by six months of age without treatment, independent of the alpha angle value, and the pathology on the opposite side.

Female↗

PubMed2003

Treatment of true developmental dysplasia of the hip using Pavlik's method.

Ultrasound is the most sensitive method for detecting hip pathology in the first year of life. However, it has been shown that neonatal sonography, or combined sonographic-clinical screening, can cause some over-diagnosis which, when not used properly, can lead to over-treatment. We developed the concept of 'true developmental dysplasia of the hip' on the basis of our experience. Despite the still-growing popularity of Pavlik's method in the treatment of the condition, we were unable to find a study dealing with the relationship between sex, sonographic and clinical pathology, age at the start of treatment, and duration and outcome of treatment. To answer these questions, we assessed patients we had treated using Pavlik's method in a 5-year period at a special developmental dysplasia of the hip clinic. The influence of sex, clinical stability, severity of sonographic pathology and age when treatment was started was assessed according to duration, outcome of treatment and rate of avascular necrosis. In spite of the relatively small number of hips treated in this study, some conclusions can be drawn. The short period of treatment for clinically unstable hips can be surprising. As treatment was started before the age of 14 weeks, the favorable results can be attributed to this fact. There are hips which, according to our theory, will not improve spontaneously to normal; therefore, we believe that our figures reflect the real results of treatment using Pavlik's method. Practically 0% avascular necorosis for all the treated population (only one child had transient avascular necorosis of type 1) is, in our opinion, due to this fact. The high rate of success (98%) can also be attributed to early treatment.

Algorithms↗

PubMed2003

[Method not stirrups--treating DDH according to Pavlik].

Developmental dysplasia of the hip (DDH), previously termed "congenital dislocation of the hip" (CDH), encompasses a group of related pediatric disorders, some diagnosed soon after birth or later. These include clinical instability of the hip, with or without anatomical dysplasia, subluxation or dislocation. These days, such disorders are usually diagnosed soon after birth, and can develop to normal or worsen to severe disability in time. Most of the hips are not dislocated but all pathological hips show some degree of dysplasia and a minority is dislocated. The keystone to successful treatment of DDH is early diagnosis. Screening is successful only if followed by correct early treatment. Various methods and devices have been proposed for the treatment of DDH. After closed reduction of the hip is done, sometimes with violence, rigid fixation might cause avascular necrosis of the femoral head (AVN). These methods are used less and less, having been replaced by Pavliks method, whereby, if strictly used, the AVN rates are almost zero.

Disease Progression↗

PubMed2003

Plantar puncture wounds in children: analysis of 80 hospitalized patients and late sequelae.

BACKGROUND: Puncture wounds in the feet of children present a clinical dilemma. OBJECTIVES: To evaluate our approach, we reviewed the charts and all available images of 80 children admitted to our institution because of plantar punctures from 1988 to 1999. METHODS: The charts of 80 children were reviewed retrospectively. RESULTS: Three groups of patients were found: 59 with superficial cellulitis, 11 with retained foreign bodies, and 10 with osteoinyelitis and/or septic arthritis. There was a significant presentation delay in patients from the second and third groups. Most common organisms were Staphylococcus aureus or Group A Streptococcus. Of the 80 children, 34 were treated surgically and 46 were treated with antibiotic therapy alone. All patients with osteomyelitis and septic arthritis were re-examined; at follow-up, all but one were asymptomatic apart from residual radiologic sequelae in four. CONCLUSIONS: Patients with an established infection 24-36 hours after a plantar puncture should be admitted to hospital for parenteral antibiotic therapy. Delayed presentation is a significant marker for deep-seated infection. Further infection or relapse after initial improvement suggests the presence of osteomyelitis or a retained foreign body. A bone scan is advisable in all patients with suspected osteomyelitis: a positive bone scan necessitates aggressive early debridement combined with appropriate antibiotics; while negative bone scan, X-ray and exploration suggest that the infection is due to a foreign body, which can be detected by computed tomography.

Adolescent↗

PubMed2002

Developmental dysplasia of the hip incidence in Ethiopian Jews revisited: 7-year prospective study.

We describe the sonographic and true incidence of developmental dysplasia of the hip among Ethiopian Jews compared with the general Israeli population. Previous results were based on a small number of Jewish Ethiopian children; this study is based on over 7 years of experience, during which 34,048 newborns, 768 of whom were Ethiopian, were examined clinically and sonographically. The incidence of sonographic developmental hip dysplasia was 5.5% in the general Israeli population, compared with 1.24% for the Ethiopian Jews. True developmental hip dysplasia incidence for Arabs and other Jews was 0.51%, as compared with 0.15% in the Ethiopians. Our data support the theory that either a single unknown gene or a multiple gene system plays a major role in the incidence of the dysplasia.

Arabs↗