Biomedical subjects

P D Sponseller

Publications and source records attributed to P D Sponseller.

82 records · Page 5Linked to original sources

PubMedDate not supplied

The acetabulum in congenital and neuromuscular hip instability.

Acetabular morphology in congenital and neuromuscular hip instability was evaluated with computed tomography (CT) and plain radiography. Thirty-three unstable hips in 27 children with congenital hip dysplasia, cerebral palsy, or spina bifida were studied. Fourteen normal hips in 14 children served as controls. Unstable hips in the children with congenital hip dysplasia demonstrated anterior and superior acetabular deficiency with increased acetabular anteversion. Global deficiency was present in acetabuli of cerebral palsy and spina bifida patients with anterior, posterior, and superior deficiencies. The acetabuli in cerebral palsy patients had significant posterior deficiency and were the shallowest of the groups evaluated.

Acetabulum↗

PubMedDate not supplied

A prospective study of early spica casting outcomes in the treatment of femoral shaft fractures in children.

We analyzed the early spica casting outcomes of 50 children age 2 to 10 years with uncomplicated femoral shaft fractures treated at Johns Hopkins Hospital between October 1987 and October 1990. Our objective was to develop criteria for the prospective identification of patients who can be safely and dependably treated with early spica casting without excessive shortening of the fracture fragments. Forty-one (82%) children had an acceptable outcome and nine (18%) had an unacceptable outcome according to our definition of > 25 mm of fracture fragment overlap at 3 to 4 weeks follow-up. A new clinical test, the telescope test, was statistically significant (p < 0.001) for association with spica casting outcome. Age, sex, fracture location, mechanism of injury, fracture type, and resting roentgenogram fracture fragment overlap were not statistically significant (p > 0.10). The telescope test had a sensitivity of 78%, a specificity of 85%, and a negative predictive value of 95% for predicting spica casting outcome. The relative risk of failing spica casting after a positive telescope test was 20.4 (95% CI, 2.74-225.10). We conclude that children 2 to 10 years of age with uncomplicated femoral shaft fractures and a negative telescope test can be safely treated with early spica casting and have a 95% change of having a successful outcome with this treatment.

Casts, Surgical↗

PubMedDate not supplied

Pediatric femur fractures: effects of spica cast treatment on family and community.

Twenty-three consecutive children with isolated closed femur fractures treated with early spica casts were studied to determine the impact of this treatment on family, school, and other support systems. Mobility was identified by families as the major problem. In families with two working parents, a mean of 3 weeks time off work was needed. None of the children was accepted into school in cast. Home tutoring for a mean of 8 weeks was used, with 48 tutor-hours per child. Despite this, none of the children fell permanently behind their class, and only two temporarily. No child required physical therapy beyond instruction in walking, and 12 had no physical therapy at all. Mean time to independent walking was 5 days and to running, 25 days; skills returned faster in younger children. All aspects of spica treatment were easier for preschool children. This study highlights some of the adaptations necessary with this treatment method and aids in advance planning.

Activities of Daily Living↗

PubMedDate not supplied

Orthopedic problems in Lesch-Nyhan syndrome.

Lesch-Nyhan syndrome is an X-linked disorder of purine metabolism. The orthopedic problems and results of treatment of nine Lesch-Nyhan patients are reviewed. Associated orthopedic problems included hip subluxation or dislocation (nine of 18 hips), fractures (three), autoamputation, infections (three), minor scoliosis, and contractures. Lesch-Nyhan patients can safely undergo orthopedic procedures and the results of surgery are satisfactory and similar to those of patients with spastic cerebral palsy. All of the seven operated-on hips maintained good reduction at 6-year mean follow-up. With adequate cast technique, fractures and hip subluxation/dislocation may be treated successfully. The treating orthopedist should be aware of the increased incidence of heterotopic ossification in this population, as well as the potential for serious complications such as hardware failure or femur fracture, if appropriate immobilization is not used.

Adolescent↗

PubMedDate not supplied

Open femur fractures in children: treatment, complications, and results.

We evaluated retrospectively the treatment of 44 open femur fractures occurring between the lesser trochanter and the distal femoral physis in 43 children aged 16 years and younger. Fractures that involved the physis or that were a consequence of gunshot wounds were excluded. There were 25 grade I, 9 grade II, and 9 grade III fractures. The mean age at injury was 9.5 years. Ninety percent of the fractures were automobile related. More than 70% of the children had associated injuries. The average time to healing for all fractures in this study was 17 weeks. Our data indicate that there is a statistically significant increased time to heal with increasing age of the child (p = 0.04). Additionally, grade III fractures healed more slowly than grade I or II fractures (p = 0.0006). Fractures treated with external fixation took longer to unite than those treated with other methods (p = 0.05). The presence of complications increased the time to fracture union (p = 0.00001). Grade III injuries were the most difficult to manage; 50% of the fractures in this group developed osteomyelitis and 20% malunited. In contrast, none of the fractures in either the grade I or II groups developed deep infection. After aggressive debridement, grade I and grade II fractures may be stabilized with age-appropriate fixation methods. Grade III injuries should be managed with vigorous debridement and vigilance, as these injuries are prone to deep infection and malunion. The optimal method of skeletal stabilization in grade III fractures remains unresolved.

Adolescent↗

PubMedDate not supplied

The hip in adults with classic bladder exstrophy: a biomechanical analysis.

We studied the untreated pelvic deformity in 14 adult patients with bladder exstrophy to determine the relative hip-joint force and stress and their effects on the clinical status of the hip. Pelvic radiographs were used for biomechanical analysis to calculate joint force and joint stress (force/area) relative to partial body weight, which allowed comparison between patients and age-matched controls. IOWA hip ratings were used for clinical evaluation, and hips were scored radiographically for degenerative joint disease. The mean relative joint force and joint stress was significantly higher for exstrophy patients (p < 0.001). In addition, the mean distance from the body center to the center of the femoral head was significantly increased (p < 0.001) in bladder exstrophy patients. An increase in diastasis correlated with an approximate 30% increase in the distance from the center of the femoral head to the body midline. The mean distance from the greater trochanter to the femoral head center was significantly less (p < 0.02) and the center-edge angle was significantly decreased in exstrophy patients (p < 0.05). Two patients' hips showed significant subluxation, and one of these showed degenerative hip disease in association with poor IOWA and radiographic scores. The force and stress on the hip joint are increased in untreated adult bladder exstrophy patients. Further longitudinal study is indicated to validate these findings and to determine whether clinically important degenerative changes are occurring. This could affect treatment recommendations in childhood.

Adolescent↗

PubMedDate not supplied

Motor milestones in children with diastrophic dysplasia.

Diastrophic dysplasia (DD), an autosomal recessive skeletal dysplasia, results in short-limbed short stature, generalized joint dysplasia, and spinal, hand, foot, and ear deformities. Children with DD experience both growth and motor developmental delays. To quantify the motor developmental delays, data on motor milestone attainment and other important characteristics were collected by retrospective questionnaire on 25 individuals with DD. Means and standard deviations were calculated for time to motor milestone attainment and are presented with minimum, maximum, 25th, 50th, 75th, and 90th percentile values. Percentages of individuals who could perform daily living and recreational tasks were tabulated. The mean times to milestone attainment for children with DD are all significantly longer than published means for nonaffected children. Notably, children with DD roll over at 5.2 +/- 2.2 months, sit unsupported at 8.3 +/- 2.3 months, pull up to a stand at 13.5 +/- 5.8 months, and walk at 24.4 +/- 9.2 months. The data presented here should be useful as preliminary reference standards for motor milestone attainment in children with DD.

Activities of Daily Living↗

PubMedDate not supplied

The hip in Stickler syndrome.

Stickler syndrome is an autosomal dominant connective tissue disorder with a prevalence similar to that of Marfan syndrome. No previous study has examined hip pain or abnormalities in a large series of patients with Stickler syndrome. The purpose of this study was to describe hip abnormalities and their correlation with age and chronic hip pain in a cohort of 51 patients followed at the National Institutes of Health. Ten percent of patients had protrusio acetabuli, 21% coxa valga, and 34% of adults had hip osteoarthritis. Sixty-three percent of all patients and 79% of adults had chronic hip pain. In addition, 16% of adult patients had a history of femoral head failure during youth. Arthritic changes and adult age were associated with hip pain. In summary, hip abnormalities are commonly observed in Stickler syndrome. Young patients require careful evaluation of hip pain, and regular screening of children with Stickler syndrome may be indicated for early detection of hip complications.

Abnormalities, Multiple↗

PubMedDate not supplied

Acetabular and pelvic fractures in the pediatric patient: value of two- and three-dimensional imaging.

Pediatric trauma is a significant source of morbidity and mortality in pediatric patients. Prompt and accurate assessment of injuries is necessary for the best outcome. Computed tomography (CT) has become a well-accepted, rapid, relatively noninvasive way to assess the trauma patient. In certain cases of pelvic trauma, two- and three-dimensional CT (2D/3D CT) adds detail not otherwise obtainable or appreciated. Although the benefits must be balanced against the slight increase in delivered radiation dose, we believe that 2D/3D CT is often an important part of patient management.

Acetabulum↗

PubMedDate not supplied

The foot in Marfan syndrome: clinical findings and weight-distribution patterns.

The feet of Marfan patients are typically described as pes planovalgus. We evaluated the single-leg-stance footprint of 124 feet in 63 patients with the Marfan syndrome by using pressure-sensitive film and a Harris mat. Forty feet in 21 people with no history of foot problems were evaluated as normal controls. The medial and lateral aspects of the fore-, mid-, and hindfoot were assessed. The midfoot was further analyzed by dividing the medial midfoot force by the total midfoot force. The mean medial midfoot force/total midfoot force (MM/TM) in the control population was 11.1% (SD, 6.5%). Pes planus was defined as the MM/TM force > 24.0% (mean + 2 SD). The mean MM/TM force in the Marfan group was not statistically different (16.0%) from controls. The distribution, however, revealed two distinct types of weight-bearing patterns. Of the Marfan group, 74.8% had medial forces within the standard distribution of the normal control population. Only 25.2% of the Marfan patients had forces that were outside the range of normal midfoot forces and were defined as pes planus. Analysis of the patient's ligamentous laxity and the foot function in the Marfan population revealed no statistically significant correlation to the type of weight-bearing pattern of the foot.

Adult↗