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Biomedical subjects

N S Broughton

Publications and source records attributed to N S Broughton.

At least 19 recordsLinked to original sources
PubMed2000

Idiopathic toe-walking: does treatment alter the natural history?

Outcomes from observation or cast or surgical treatment of idiopathic toe-walking were determined in 136 children. With patient-determined outcomes, for the observation group, gait was normal in 6%, improved in 45%, and unchanged in 49%. Physician-determined outcomes demonstrated normal gait in 12% of children. Outcomes were similar in the cast group. With patient-determined outcomes in the surgical group, 22% walked normally, 50% had improved, 26% were unchanged, and 2% had deteriorated; with physician-determined outcomes, 37% walked normally. The natural history, determined from the observation group, was for idiopathic toe-walking to persist, albeit with improvement in 50%. Cast treatment did not alter the natural history. Surgical treatment may influence the outcome, but indications for surgery need to be clarified.

Achilles Tendon↗
PubMed1999

Age-related walking in children with spina bifida.

The aim of this study was to examine children with myelomeningocele (spina bifida) who were investigated according to the level of neurosegmental lesion and to determine the number who walked and their average age at commencement/cessation of walking. The data have been collected since 1978 at the Royal Children's Hospital, Melbourne during annual evaluations of patients with spina bifida and high-level paralysis. After screening for established criteria and assigning to a neurosegmental lesion level, 173 children were examined for their ability to walk, with or without aids, in a community setting. Thirty-five children had lesions at the thoracic level, and seven walked at a mean age of 4 years 6 months. Three children with a lesion at the thoracic level ceased walking at a mean age of 7 years 6 months. Ten children had lesions at the high-lumbar level (L1/2), and five walked at a mean age of 5 years 2 months. Three children who had lesions at the high-lumbar level ceased walking at a mean age of 6 years 11 months. Fifteen children had lesions at the mid-lumbar level (L3) and nine walked at a mean age of 5 years. Three ceased walking at a mean age of 7 years. Forty-five children had lesions at the low-lumbar level (L4/5) and 38 walked at a mean age of 3 years 10 months. Five ceased walking at a mean age of 9 years 1 month. Sixty-eight children had lesions at the sacral level; all of whom walked at an average age of 2 years 2 months. None had ceased walking by the end of the study period. Delay in achieving ambulation can be expected in all children with spina bifida, including those with low neurosegmental level lesions. Furthermore, some children with high lesion level, given the opportunity, might be expected to ambulate effectively in the community but may cease walking after 3 to 4 years of this activity, which is earlier than previously recorded.

Adolescent↗
PubMed1996

Surgical release of knee flexion contractures in myelomeningocele.

We report the results of a prospective study of the surgical release of 45 knee flexion contractures in 28 patients with myelomeningocele. The neurosegmental level was thoracic in ten patients, L1/2 in one, L3/4 in 11, and L5/S1 in six. In walkers the indication for surgery was a fixed flexion contracture impeding walking, and in non-walking patients it was a flexion contracture impeding transfers or sitting balance, or likely to do so with increasing deformity. The mean age at surgery was 6.4 years (3 to 21) and the mean period of follow-up 13 years (4 to 20). The mean knee flexion contracture before surgery was 39 (25 to 70) which improved to 5 degrees at maximum correction and to 13 degrees at latest follow-up. We conclude that surgical release of knee flexion contractures in myelomeningocele improves gait in all children who walk, particularly those with low lumbar lesions. Recurrence of knee flexion contractures after surgical release is most common in those with thoracic lesions who do not achieve independent walking.

Adolescent↗
PubMed1996

Anterior release for fixed flexion deformity of the hip in spina bifida.

We reviewed the results of anterior hip release for fixed flexion deformity in 57 hips in 38 children with spina bifida at an average follow-up of 8.9 years (2 to 22). The indication for this operation was a fixed flexion deformity of more then 30 degrees which interfered with function. In 43 hips there was a good outcome in that the fixed flexion deformity remained less than 30 degrees at follow-up. Four hips had a good initial result but deteriorated after an average of five years, and ten had a poor outcome with deformity of over 30 degrees. Six hips required a repeated anterior hip release and two of these were successful. The success of anterior hip release could not be related to the neurological level or the age at operation. Successful surgery correlated with the walking ability of the child at the latest follow-up.

Child↗
PubMed1995

Unilateral dislocation of the hip in spina bifida. A long-term follow-up.

We reviewed 16 patients with spina bifida and unilateral dislocation of the hip at an average age of 17 years. Nine had a high neurological level (thoracic to L3) and seven a low lesion (L4 to sacral). We assessed the influence of unilateral dislocation of the hip on leg-length discrepancy, hip pain, hip stiffness and pressure sores of the ischial tuberosity. In non-walking patients with high-level lesions, unilateral dislocation gave little functional disability and did not appear to require reduction. In walking patients with low-level lesions, leg-length discrepancy led to a poor gait and functional problems which could be prevented by reduction of the dislocation. In all patients with low lesions, surgery was successful in maintaining reduction; in two of five patients with high lesions it was unsuccessful.

Adolescent↗
PubMed1995

Reciprocating orthoses for children with myelomeningocele. A comparison of two types.

Since 1987, 22 children with myelomeningocele have been fitted with reciprocating orthoses. The level of the spinal lesions ranged from T10 to L4 and 13 had associated spinal deformities. Twelve of the patients currently use a Reciprocating Gait Orthosis, seven use a Hip Guidance Orthosis or Parawalker, one has progressed to a Knee Ankle Foot Orthosis, one has died and one has been lost to follow-up. The reciprocating orthoses are worn for a mean of 3.5 hours per day (1 to 6.5); daily usage by girls is almost twice that by boys. The mean daily usage by community walkers is 4.2 hours (13 children) as against 2.8 hours by household ambulators (8 children). Active hip flexion is not essential and fixed-flexion contractures up to 35 degrees can be accommodated. The average breakdown rate is 0.45 per year with an average of 1.5 adjustments each year. The average annual cost of a reciprocating orthosis is Aus$750 (375 pounds, US$570); this includes fabrication, adjustments and repairs.

Adolescent↗
PubMed1994

The high incidence of foot deformity in patients with high-level spina bifida.

In a consecutive series of 124 children with spina bifida we found that 220 (89%) of the 248 feet were deformed: 70 had a calcaneus deformity; 126 were in equinus; 16 were in valgus; 3 were in varus; and 5 had convex pes valgus. Operations were performed on 171 (78%) of the deformed feet. Spasticity of the muscles controlling the foot was detected in 36 (51%) of the 70 calcaneus feet and in 22 (17%) of the 126 equinus feet. The deformities were symmetrical in 94 children. There is a high incidence of foot deformity in patients with spina bifida who have no voluntary activity in the motors of the feet.

Child, Preschool↗
PubMed1993

The natural history of hip deformity in myelomeningocele.

We studied 1061 children with myelomeningocele, reviewing 3184 pelvic radiographs from 802 patients. Hip dislocation had occurred by the age of 11 years in 28% of children with a thoracic neurosegmental level, 30% of those with an L1/2 level, 36% of L3, 22% of L4, 7% of L5 and only 1% of those with sacral levels. Hip dislocation was not inevitable even when there was maximal muscle imbalance about the hip. The average hip flexion contracture in children aged 9 to 11 years was significantly greater in those with thoracic (22 degrees) and L1/2 (33 degrees) levels than in those with L4 (9 degrees), L5 (5 degrees) or sacral (4 degrees) levels. Our findings indicate that muscle imbalance is not a significant factor in the production of flexion deformity or dislocation of the hip; both are commonly seen in the absence of imbalance. The restoration of muscle balance should no longer be considered to be the principal aim of the management of the hip in children with myelomeningocele.

Follow-Up Studies↗
PubMed1991

Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems.

We performed a randomised prospective trial to compare the results of 27 cemented and 26 uncemented bipolar hemiarthroplasties in active patients with displaced subcapital fractures of the femoral neck. After a mean follow-up of 17 months, significantly more of the uncemented group were experiencing pain in the hip and using more walking aids than the patients in the cemented group. The incidence of postoperative complications, the early mortality rate and the operating time and blood loss were not significantly different. Using otherwise identical prostheses the early results were much better with a cemented Thompson stem than with an uncemented Austin Moore stem.

Aged↗
PubMed1990

Keller's arthroplasty and Mitchell osteotomy: a comparison with first metatarsal osteotomy of the long-term results for hallux valgus deformity in the younger female.

We have made a retrospective comparison between the results of 37 Keller's arthroplasties and 36 distal transverse first metatarsal osteotomies performed in female patients between the ages of 25 and 50 years, for the treatment of hallux valgus. The choice of operation depended on the policy of the consultant responsible for treatment, but analysis of the preoperative findings showed that the two groups were similar, allowing comparative assessment of Keller's procedure in the younger middle-aged patient. All patients were assessed 3 to 5 years after operation using an objective scoring system of symptoms, clinical examination, anteroposterior standing radiographs and walking footprints from a Harris Beath mat. The results following a Keller's arthroplasty were excellent in 7 (19%), good in 22 (60%), poor in 6 (16%), and needed revision in 2 cases (5%). In the osteotomy group, 11 (30.5%) were excellent, 19 (52.5%) were good, 5 (14%) were poor, and 1 (3%) required revision.

Adult↗
PubMed1990

Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long-term follow-up.

We studied the pathogenesis, incidence and consequences of avascular necrosis in 184 children treated for congenital dislocation of the hip. Of 210 hips, 99 (47%) had some evidence of avascular necrosis (total 81, partial 18). The incidence was not influenced by the age at reduction, the duration of traction or the use of adductor tenotomy. Patients treated by closed reduction without preliminary traction did not have a higher incidence of avascular necrosis. At long-term clinical and radiological review of 81 hips, early avascular necrosis significantly increased the chance of a poor outcome but did not predispose to acetabular dysplasia. If review includes minor forms of avascular necrosis, then this condition is common after closed reduction. Its presence is an important determinant of long-term radiological and clinical outcome.

Child, Preschool↗
PubMed1989

Acromioclavicular dislocation associated with fracture of the coracoid process.

Two cases of acromioclavicular dislocation associated with fracture of the coracoid process are described. This association is unusual and the coracoid fracture may only be recognised on an axillary radiograph of the shoulder. Both the cases were treated conservatively, with good results. The management and outcome of other cases described in the literature are reviewed and discussed.

Acromioclavicular Joint↗
PubMed1989

Silastic ball spacer arthroplasty in the management of hallux valgus and hallux rigidus.

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.

Adult↗
PubMed1989

Epiphyseolysis for partial growth plate arrest. Results after four years or at maturity.

We reviewed 13 children with partial growth plate arrest who had been treated by epiphyseolysis. Eight were followed to skeletal maturity and five for at least four years. In three cases the affected limb was restored to normal and in five the operation was successful in improving angular deformity and leg length discrepancy such that further surgery was not necessary. In the five failures, angular deformity had progressed or limb length discrepancy had increased. There were no significant complications and the procedure did not prevent subsequent osteotomy or limb length equalisation. Epiphyseolysis was most effective for small bars and those affecting only the central area of the plate.

Adolescent↗