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Biomedical subjects

P L Schoenecker

Publications and source records attributed to P L Schoenecker.

At least 19 recordsLinked to original sources
PubMed2006

Obstructive sleep apnoea syndrome in morbidly obese children with tibia vara.

Morbid obesity and its association with obstructive sleep apnoea syndrome have been increasingly recognised in children. Orthopaedic surgeons are often the primary medical contact for older children with tibia vara, which has long been associated with obesity, but are unfamiliar with the evaluation and treatment of sleep apnoea in children. We reviewed all children with tibia vara treated surgically at one of our institutions over a period of five years. Thirty-seven patients were identified; 18 were nine years of age or older and 13 of these (72%) had morbid obesity and a history of snoring. Eleven children were diagnosed as having sleep apnoea on polysomnography. The incidence of this syndrome in the 18 children aged nine years or older with tibia vara, was 61%. All these patients required pre-operative non-invasive positive-pressure ventilation; tonsillectomy and adenoidectomy were necessary in five (45%). No peri-operative complications related to the airway occurred. There is a high incidence of sleep apnoea in morbidly obese patients with tibia vara. These patients should be screened for snoring and, if present, should be further evaluated for sleep apnoea before corrective surgery is undertaken.

Adenoidectomy↗
PubMed2000

Isolated thoracolumbar and lumbar hyperlordosis in a patient with cerebral palsy.

A severe isolated thoracolumbar and lumbar hyperlordosis spinal deformity occurring in a patient with cerebral palsy is rare and has not been reported before. The authors describe the presentation, operative considerations, and treatment of patients with this unusual hyperlordotic spinal deformity, particularly those with cerebral palsy. A multiple-stage surgical reconstruction was required to correct this complex spinal deformity. The patient underwent bilateral femoral extension osteotomies along with spinal extensor myotomies to ensure proper prone positioning for his anticipated spinal surgery. Then he had staged anterior releases and spinal fusion from T8 to the sacrum followed by 2 weeks of "90-90" femoral skeletal traction. Finally, a posterior spinal fusion with instrumentation from T2 to the pelvis definitively corrected his deformity. The patient responded well to surgical intervention without complications and continues to have stable correction of his hyperlordosis deformity 2 years after surgery. Severe lordotic sagittal plane spinal deformities can be treated with anterior and posterior spinal fusion and instrumentation with intervening traction in the properly selected and prepared patient who has cerebral palsy.

Adolescent↗
PubMed2000

Painful idiopathic rigid flatfoot in children and adolescents.

Nine patients (13 feet) were identified whose primary complaints were of atraumatic-onset, chronic pain in the hindfoot exacerbated with increased activity and who had the diagnosis of idiopathic rigid flatfeet. Eight of 11 were greater than the 95th percentile in weight for their age. Exam under anesthesia showed moderate to significant improvement in hindfoot motion in 9 feet; 4 feet required fractional peroneal lengthenings. Only 5 of 11 patients have had sustained relief of pain and report unlimited activity level. Children and adolescents with painful idiopathic rigid flatfeet without known causation can have significant, persistent, disability and do not uniformly respond well to traditionally-described nonoperative Interventions.

Adolescent↗
PubMed1998

The prognostic importance of the ossific nucleus in the treatment of congenital dysplasia of the hip.

Ischemic necrosis of the femoral head occurring after the treatment of congenital dysplasia of the hip can negatively affect the long-term prognosis of the involved hip. Some investigators have suggested that the presence of the ossific nucleus of the femoral head at the time of closed or open reduction is associated with a lower rate of ischemic necrosis. This finding, if verified, could lead to a delay in the treatment of a dislocated hip until ossification of the femoral head has begun, which may be well after the age when the patient has started to walk. We conducted a computerized search of the medical records at our two tertiary-care children's hospitals to identify all patients with congenital dysplasia of the hip who had had a closed or open reduction between January 1, 1979, and December 31, 1993. One hundred and twenty-four patients (153 hips) who satisfied the criteria for inclusion were identified. The ossific nucleus was present in ninety hips and absent in sixty-three. Closed reduction was used in 112 hips and open reduction, in forty-one. Ischemic necrosis was identified in five hips (3 percent): four (6 percent) of the sixty-three hips that did not have an ossific nucleus and one (1 percent) of the ninety hips that had an ossific nucleus at the time of the reduction. With the numbers available for study, we could not detect a difference between these two groups. The age at reduction (p > 0.99), the method of reduction (p = 0.611), previous treatment with a Pavlik harness (p = 0.592), the use of preliminary traction (p = 0.602), concomitant procedures (p > 0.99), and a failure of the primary closed reduction (p = 0.579) were not associated with the development of ischemic necrosis after reduction. In our analysis of patients who were managed over a fifteen-year period, the data did not support the hypothesis that the presence of an ossific nucleus at the time of reduction of a congenitally dislocated hip is associated with a lower prevalence of ischemic necrosis of the femoral head. Sound operative principles dictate that operative reduction of a congenitally displaced hip should be performed when the child can be safely placed under anesthesia and without regard to the presence or absence of the ossific nucleus.

Case-Control Studies↗
PubMed1998

Polyarticular pigmented villonodular synovitis in a child.

Pigmented villonodular synovitis is rare in the younger child. Polyarticular involvement in this condition, regardless of patient age, is distinctly uncommon. The authors describe a case of pigmented villonodular synovitis involving multiple joints in a young boy who also had congenital anomalies of the genitourinary tract. Although rare, pigmented villonodular synovitis should be considered in the differential diagnosis of multiple joint swellings in children with congenital anomalies.

Ankle Joint↗
PubMed1997

Intra-articular hip arthrodesis without subtrochanteric osteotomy in adolescents: technique and short-term follow-up.

Twenty-five patients, 11 to 19 years in age, were treated with hip arthrodesis for an incapacitating painful and stiff hip. Clinical diagnoses included avascular necrosis (AVN) associated with slipped capital femoral epiphysis (SCFE) (7 patients), posttraumatic AVN (6), septic arthritis (4), complication of treatment of developmental dysplasia of the hip (DDH) (4), pathologic fracture of femoral neck through bone cyst with resulting AVN (2), Perthes disease (1), and idiopathic chondrolysis (1). Preoperative motion was minimal or absent in 13 patients, limited in 12, and very painful in 23 patients. A two-incision surgical approach was utilized, providing for an intra-articular fusion technique and internal fixation with precise positioning. The surgical technique described avoids any dissection of the hip abductor musculature or a deforming osteotomy of the proximal femur. Twelve complications occurred in 10 patients, 9 of which required additional operative treatment. At an average postoperative follow-up of 6 years, 10 months, the overall activity level was greatly increased over the preoperative activity level secondary to the relief of pain. Hip arthrodesis is the acceptable salvage procedure for the otherwise healthy, active adolescent or young adult with unilateral hip disease characterized by incapacitating pain and/or an unacceptable fixed position.

Adolescent↗
PubMed1996

Pulseless arm in association with totally displaced supracondylar fracture.

Seven children (3-10 years of age) were treated for a type III supracondylar fracture of the humerus. All fractures were reduced and pinned. Closed reduction was performed in four patients; three required open reduction. Before reduction six of the seven patients did not have a distal palpable pulse in the involved forearm. After reduction of the fractures all patients had a pulseless arm and a seemingly viable hand. Doppler pulses were absent or greatly diminished compared with the normal side in all involved extremities. Six patients underwent immediate antecubital fossa exploration of the brachial artery without arteriogram; one patient, referred to us from another facility, underwent angiography followed by immediate exploration. In three patients the brachial artery was directly damaged or transected and was repaired via saphenous vein graft, with reestablishment of distal pulses in each case. In the other four patients the brachial artery was kinked or entrapped at the fracture site, necessitating microdissection to mobilize the vessel and reestablish pulses in each case. At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. Immediate exploration of the antecubital fossa should be considered if an extremity remains pulseless (to palpation and Doppler) after reduction and stabilization of significantly displaced supracondylar fractures of the humerus.

Algorithms↗
PubMed1996

Pemberton pelvic osteotomy and varus rotational osteotomy in the treatment of acetabular dysplasia in patients who have static encephalopathy.

Forty-four patients (fifty-two hips) who had static encephalopathy and acetabular dysplasia were managed with a Pemberton osteotomy as part of a comprehensive operative approach. Thirty-three patients had quadriplegia and were unable to walk; the remaining eleven patients had diplegia and could walk. The age at the time of the operation ranged from four years and five months to sixteen years and five months, as an open triradiate cartilage is a prerequisite for the Pemberton procedure. Concomitant operative procedures included a varus rotational osteotomy in fifty of the involved hips, a soft-tissue release in thirty-seven hips, and an open reduction in thirteen hips. The mean center-edge angle preoperatively was -11 degrees (range, -80 to 17 degrees), which improved to a mean of 27 degrees (range, 5 to 62 degrees) at the time of the latest follow-up. The mean duration of follow-up was four years (range, two years to eight years and eight months). At the time of writing, none of the hips had redislocated but one hip had subluxated. Eight of the hips had been painful preoperatively, but none of these was painful at the time of the most recent follow-up. One patient who had not had pain in the hip preoperatively had pain at the time of the follow-up evaluation. There were no complications attributable to posterior uncovering of the hip. The age of the patient at the time of the operation had no discernible effect on the result.

Acetabulum↗
PubMed1995

The acetabular response to proximal femoral varus rotational osteotomy. Results after failure of post-reduction abduction splinting in patients who had congenital dislocation of the hip.

The acetabular response to proximal femoral varus rotational osteotomy was studied radiographically in twenty-eight patients who had had thirty-three congenitally dislocated hips. All of the patients had previously been managed with open or closed reduction followed by use of a spica cast and had worn an abduction orthosis for at least one year after the reduction. The indications for the femoral osteotomy were a persistently increased acetabular index or subluxation, or both. The average of the patients at the time of the femoral osteotomy was twenty-five months. The average preoperative acetabular index was 32 degrees. At an average of seven years after the osteotomy, the acetabular index had improved to an average of 16 degrees. Four hips had had one subsequent procedure for persistent acetabular dysplasia. Despite a failure of the acetabulum to respond to use of an abduction splint, the proximal femoral varus rotational osteotomy stimulated improvement in the acetabular index to within normal limits in twenty-nine of the thirty-three hips.

Acetabulum↗
PubMed1995

Para-articular osteochondroma.

An unusual case of a para-articular osteochondroma in the vicinity of the knee is reported. Typical presentation and differential diagnosis of bone-forming lesions about the knee are discussed. Confirmed diagnosis should combine clinical presentation and appearance, laboratory data, radiographic evaluation, and possible biopsy of the lesion.

Adolescent↗
PubMed1995

A 9-year-old girl with swelling and pain in the leg.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are presented on this page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Bone Neoplasms↗
PubMed1994

Intracanalicular osteochondroma producing spinal cord compression in hereditary multiple exostoses.

Spinal cord compression is an unusual but potentially catastrophic manifestation of hereditary multiple exostoses (HMEs). Isolated, osteochondromas are usually of little significance. However, if they are located near neurologic structures, they may cause irritation due to mechanical compression. In patients with HMEs who present with neck or back pain, and particularly in those who have neurologic symptoms in the upper or lower extremities, a diagnosis of intracanalicular osteochondroma should be presumed until proven otherwise. Prompt diagnosis and surgical excision affords the best prognosis for these patients who have spinal cord compression secondary to intracanalicular osteochondroma.

Adolescent↗
PubMed1993

Ability of Cotrel-Dubousset instrumentation to preserve distal lumbar motion segments in adolescent idiopathic scoliosis.

Between 1985 and 1990, 44 patients with adolescent idiopathic scoliosis were treated with Cotrel-Dubousset instrumentation when Harrington instrumentation would have extended into the distal lumbar spine (L3, L4, or L5) for these curve patterns. Twenty-four of these 44 (group I) patients had one distal fusion level preserved using Cotrel-Dubousset instrumentation, whereas the other 20 patients (group II) were instrumented/fused with Cotrel-Dubousset instrumentation to the expected Harrington instrumentation level in the lower lumbar spine. All patients have a minimum 2-year follow-up, and the average follow-up is 39 months (range 24-74). The characteristics of the group I curves that allowed us to stop the instrumentation a level short included minimal rotation and tilt of the anticipated lowest instrumented vertebra, overall coronal curve flexibility, and nonstructural components to the lumbosacral region of the spine. There were no major differences between these two groups when comparing postoperative coronal and sagittal balance parameters at the most recent follow-up. In select cases, dependent on the preoperative criteria to be discussed, Cotrel-Dubousset instrumentation (vs. traditional Harrington instrumentation) does allow distal lumbar fusion levels to be saved while maintaining acceptable coronal and sagittal balance.

Adolescent↗
PubMed1993

Use of the metaphyseal-diaphyseal angle in the evaluation of bowed legs.

We evaluated the accuracy of the angle described by Levine and Drennan, the metaphyseal-diaphyseal angle of the proximal aspect of the tibia, for the differentiation of physiological bowing from Blount disease. We compared this angle, as measured at presentation, in 106 children (179 extremities) who had physiological bowing with the angle in nineteen children (thirty-two extremities) who had documented Blount disease. The angle averaged 9 +/- 3.9 degrees for the patients who had physiological bowing and 19 +/- 5.7 degrees for the patients who had Blount disease (p < 0.0000001). Linear regression analysis, performed to evaluate any changes in the metaphyseal-diaphyseal angle in relation to age, showed that the older the child was at the time of presentation the more likely it was that the angle would be smaller in a child who had physiological bowing and larger in a child who had Blount disease. The chance for false-positive and false-negative errors was greater than 5 per cent if the angle was more than 9 degrees but less than 16 degrees. Sixty-six (37 percent) of the 179 extremities in the group that had physiological bowing had an angle of at least 11 degrees; one extremity affected by Blount disease had an angle of less than 11 degrees. In this study, we found that the metaphyseal-diaphyseal angle may be helpful in the identification of Blount disease but should not be the sole criterion used to determine the diagnosis.

Age Factors↗
PubMed1993

A 19-month-old female with unilateral bowed leg.

The following case is presented to illustrate the roentgenographic findings of a condition of interest to the radiologist and orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are presented, along with the final histologic and roentgenographic differential diagnosis.

Bone Diseases, Developmental↗