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Biomedical subjects

P M Waters

Publications and source records attributed to P M Waters.

At least 19 recordsLinked to original sources
PubMed2001

Elbow arthroscopy in the pediatric and adolescent population.

PURPOSE: The purpose of this study was to show the diagnostic and therapeutic benefits of elbow arthroscopy in athletically active pediatric patients. We describe our techniques for elbow arthroscopy in young patients. TYPE OF STUDY: Case series of 47 patients. METHODS: We reviewed 49 cases of elbow arthroscopies performed in 47 pediatric and adolescent patients retrospectively over a 16-year period. Charts were reviewed to identify the age of patients at the time of surgery, side involved, hand dominance, diagnosis, complications, the primary sport involved, and the average volume of loose bodies if surgical removal was performed. Each patient was contacted after a minimum of 2 years after surgery and a modified Andrews elbow scoring system was used to rate elbow function. RESULTS: The average age of this group was 14.0 years (range, 3.5 to 17.0 years) with an average follow-up of 4.7 years. Elbow arthroscopy was performed for osteochondritis dissecans (58%), arthrofibrosis and joint contracture (20%), synovitis (10%), acute trauma (10%), and posterior olecranon impingement syndrome (5%). Based on a modified Andrews elbow scoring system, 85% of patients had good or excellent result with 90% of the children returning to sports without limitation. No patient experienced nerve injury, infection, or loss of elbow motion as a postoperative complication. CONCLUSIONS: This series shows that elbow arthroscopy has a safe and effective role in the treatment of selective elbow pathologies in the pediatric and adolescent population when performed by experienced small joint arthroscopists.

Adolescent↗
PubMed2000

Shoulder injuries in the childhood athlete.

Shoulder dysfunction in the young athlete usually is manifested differently than the adult counterpart. The physiology and biomechanics of a growing child and adolescents result in different injury patterns that require different and thoughtful approaches to diagnosis and treatment. Most of these conditions are served well by nonsurgical treatment modalities. Judicious use of surgical interventions, however, can significantly improve patient outcome and return them to their sport of interest. Postoperative rehabilitation, and proper training techniques are essential to ensure continued participation of the athlete.

Adolescent↗
PubMed2000

Posttraumatic reconstruction of the elbow in the pediatric patient.

The elbow in a pediatric patient does not usually have the propensity for stiffness like that of the elbow in an adult. There are some posttraumatic conditions of the elbow in the pediatric patient that do require reconstruction. These include reconstruction for malunion after supracondylar humerus fractures and after Monteggia fractures. Nonunion of lateral condyle fractures also may require reconstruction. The posttraumatic elbow contracture in the pediatric patient is an operative challenge when the patient does not respond to conservative treatment. Patients with osteochondritis dissecans resulting in osteochondral loose bodies, significant loss of motion, or radiocapitellar subluxation will benefit from surgery. An entrapped median nerve or medial epicondyle after an elbow fracture or dislocation is an impending disaster that requires reconstruction immediately on recognition.

Child↗
PubMed2000

Upper extremity injuries in the paediatric athlete.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Adolescent↗
PubMed2000

A case of recurrent trigger thumb.

In this report we present a case of recurrent trigger thumb after surgical release. A 3-year-old girl underwent surgical release of the first annular pulley at another institution. The resected first annular pulley had been confirmed by pathologic analysis. After surgery the triggering and locking recurred, and she developed limited function due to persistent pain. The second operative release revealed a fibrous band in the region of the previous first annular pulley and a thickened flexor tendon sheath.

Child, Preschool↗
PubMed1999

Pediatric elbow trauma.

This article provides a summary of the acute management of pediatric elbow trauma. Treatment options are reviewed for all pediatric fractures, specific recommendations are outlined, and complications are addressed. Particular emphasis is placed on the common, but often complicated supracondylar fracture of the distal humerus.

Child↗
PubMed1999

Shoulder reconstruction in patients with chronic brachial plexus birth palsy. A case control study.

Patients with chronic brachial plexus birth palsy and persistent peripheral neurologic deficits frequently have problems related to their shoulder. Specifically, internal rotation and adduction contractures develop because of the loss of muscle balance about the glenohumeral joint. With time, progressive and predictable deformity of the glenohumeral joint occurs. The authors reviewed their results in treating patients with persistent functional deficits with either soft tissue procedures (tendon transfers and muscle releases) or rotational humeral osteotomies based on criteria incorporating patient age and degree of glenohumeral deformity. Patients in each group were evaluated prospectively and compared with each other. In all cases, patients in both groups experienced substantial improvements in global shoulder function. In the patients in the tendon transfer group, global Mallet scores improved from an average of 9.5 to 15.6. Patients undergoing humeral osteotomies also had improvements in global Mallet score from an average of 9.5 to 15.1. This study confirms that both operations, when appropriately applied, will predictably improve shoulder function.

Activities of Daily Living↗
PubMed1999

Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy.

BACKGROUND: The purposes of this study were to document the natural history of brachial plexus birth palsy, in relation to the recovery of biceps function, in the first six months of life; to assess the outcome after microsurgical repair of the brachial plexus in patients who had no recovery of biceps function at six months; and to compare the results of transfer of the latissimus dorsi and teres major tendons with the results of derotation osteotomy of the humerus and to compare the results of the tendon transfers and the osteotomy with the natural history of the disorder. METHODS: Sixty-six patients (sixty-seven lesions) who had brachial plexus birth palsy were seen for an initial evaluation when they were less than three months old. The time of recovery of biceps function was recorded for each month of life for six months from the date of birth. The patients were divided into groups according to the month of life during which recovery of biceps strength was noted. A physical examination and an assessment with use of the functional criteria of Mallet were performed each month. Microsurgical repair of the brachial plexus was performed in six infants who had no evidence of biceps function within the first six months of life. Another group of twenty-seven patients were referred for evaluation of chronic neuropathy after they were six months old. A transfer of the latissimus dorsi and teres major tendons to the rotator cuff was performed in nine of these patients and a derotation osteotomy of the humerus was performed in seven because of an internal rotation contracture or functional weakness of the external rotators of the shoulder. RESULTS: Twenty-two infants had recovery of biceps function within the first three months of life and had normal function at the time of the latest evaluation. Infants who had recovery of biceps function during the fourth, fifth, or sixth month of life later had significantly worse function, according to the criteria described by Mallet, than those who had had recovery in the first three months (p<0.005). The clinical results for the six patients who had had microsurgical repair six months after birth were significantly better (p<0.04) than those for the fifteen patients who had had recovery of biceps function in the fifth month of life. However, the results for the patients who had had repair of the brachial plexus were not found to be better than those for the eleven patients who had had recovery of biceps function in the fourth month of life. The improvement in function, as assessed with use of the Mallet criteria, after tendon transfer (p<0.001) and humeral osteotomy (p<0.0001) was significant. CONCLUSIONS: The present study confirms the observation of Gilbert and Tassin that it is rare for infants who have recovery of biceps function after the age of three months to have complete neurological recovery. Microsurgical repair was effective in improving function in the small subgroup of patients who had no evidence of recovery of biceps function within the first six months of life.

Arm↗
PubMed1998

Surgical treatment of arthrogryposis of the elbow.

The purpose of this study was to analyze our results of surgical treatment of arthrogryposis of the elbow and to compare our tendon transfer results using range of motion (ROM) criteria versus functional use criteria. Eighteen tendon transfers for elbow flexion in 14 children with arthrogryposis with an average follow-up period of 4 years (range, 1-14 years) and 6 elbow capsulotomies with triceps lengthening in 6 children with arthrogryposis with an average follow-up period of 5 years (range, 2-9 years) were evaluated. Each child was assessed by a questionnaire regarding functional use of the upper extremity, physical examination of ROM and strength, and a videotaped activities of daily living evaluation. Tendon transfer results were classified and compared using 2 methods of evaluation: postoperative strength and ROM and effective functional use of the tendon transfer to perform activities of daily living. The 6 elbow capsulotomies improved from an average preoperative arc of 17 degrees of motion (average extension, -2 degrees; average flexion, 19 degrees) to an average final follow-up arc of 67 degrees (average extension, -25 degrees; average flexion, 92 degrees). The 18 tendon transfers evaluated by strength and ROM criteria showed 9 triceps to biceps transfers in 9 arms (7 good, 1 fair, and 1 poor), 5 pectoralis to biceps transfers in 4 arms (1 good, 3 fair, and 1 poor), and 4 latissimus dorsi to biceps transfers in 3 arms (2 good and 2 fair). Evaluation by functional use criteria gave the same result in 13 transfers and downgraded the result in 5; the downgraded results were due to resultant flexion contracture or limited functional use because the transfer was in the nondominant arm. Based on this review, optimal surgical candidates for tendon transfer are children older than 4 years, who have full passive ROM of the elbow in the dominant arm, and at least grade 4 strength of the muscle to be transferred.

Activities of Daily Living↗
PubMed1998

Triangular fibrocartilage injuries in pediatric and adolescent patients.

This is a retrospective review of 29 posttraumatic pediatric and adolescent patients with surgically documented triangular fibrocartilage complex tears. All patients complained of ulnar wrist pain. Fifteen patients (52%) sustained distal radius fracture at the time of the original injury. Twenty-three (79%) of the triangular fibrocartilage complex tears were Palmer 1B lesions. There were 31A, 11C, and 21D lesions. All 1B, 1C, and 1D tears were repaired. Coexisting pathology was present in 25 patients (86%). This pathology included ulnar styloid nonunion, distal radioulnar joint instability, ulnocarpal impaction, distal radius deformity, and intercarpal ligament tears, which were treated by ulnar styloid nonunion excision, distal radioulnar joint stabilization, ulnar shortening, radius corrective osteotomy, and intercarpal ligament debridement, respectively. The length of the follow-up period averaged 21 months. Three patients were lost to follow-up. Outcomes were graded by a modification of the Mayo wrist score. Twenty-four patients (89%) had excellent results, 3 had good results.

Accidental Falls↗
PubMed1998

Glenohumeral deformity secondary to brachial plexus birth palsy.

Ninety-four patients who had brachial plexus birth palsy were entered into a prospective study to evaluate the association between persistent palsy, age-related musculoskeletal deformity, and functional limitations. Of these patients, forty-two had either computerized tomography or magnetic resonance imaging to assess the presence and degree of incongruity of the glenohumeral joint, deformity of the humeral head, and hypoplasia of the glenoid as part of the preoperative planning for a reconstructive operation. Functional ability was rated with use of the classification of Mallet, on a scale of 1 to 5. The mean glenoscapular angle (the degree of retroversion of the glenoid) on the affected side was -25.7 degrees compared with -5.5 degrees on the unaffected side. Twenty-six (62 per cent) of the forty-two shoulders had evidence of posterior subluxation of the humeral head, with a mean of only 25 per cent (range, 0 to 50 per cent) of the head being intersected by the scapular line. Progressive deformity was found with increasing age (p < 0.001). The natural history of untreated brachial plexus birth palsy with residual weakness is progressive glenohumeral deformity due to persistent muscle imbalance. The status of the glenohumeral joint must be addressed when the choice between tendon transfer and humeral derotation osteotomy for reconstruction of the shoulder is considered for these patients.

Adolescent↗
PubMed1998

Spastic hemiplegia of the upper extremity in children.

Care of upper extremity problems in hemiplegic children requires careful evaluation and planning. This article focuses on the evaluation and treatment of spastic hemiplegia attributable to cerebral palsy. All treatments must take into consideration the level of static and dynamic motor deformity; levels of discriminatory sensibility, intelligence, and motivation; and overall level of function. The treatments discussed are designed to improve the child's musculoskeletal condition but do not cure the underlying disease.

Arm↗
PubMed1998

Upper extremity pediatric compartment syndromes.

Fractures are associated with the majority of compartment syndromes in children. Respect for associated soft-tissue injuries and recognition of specific fractures that can put a limb at risk for compartment syndrome are essential for prevention or successful treatment with early decompressive fasciotomies. In those limbs at risk for compartment syndrome, percutaneous pinning or intramedullary fixation provides fracture stabilization and prevents problems noted with standard cast treatment. Any condition that causes increased tissue pressure within a limited space can lead to compartment syndrome, however. It therefore is important to identify the injured, ill, or hospitalized child with unexplained changes in pain status or soft tissues. In particular, the agitated child with increasing analgesia requirements requires a thorough evaluation. The child's behavior should not be attributed to young age, fear, or fracture pain. This is a trap that must be avoided to prevent the disastrous outcomes of a missed compartment syndrome.

Child↗
PubMed1997

Noninvasive measurement of distal radius instability.

Except for subjective clinical criteria, there is no formal definition of distal radius fracture instability in the literature. The purposes of this ex vivo biomechanical study were (1) to provide an objective mechanical definition of fracture instability and (2) to demonstrate a noninvasive method that allows for direct measurement of instability. The following 3 questions are addressed: (1) Can the stability of distal radius fractures be measured using computed tomography (CT)? (2) Are the stability measurements reproducible? (3) How does external fixation change stability? A CT technique is described that was used to measure displacement of fracture fragments and measure the compliance of ex vivo distal radius fractures before and after external fixation. Validation studies of the CT technique revealed a mean coefficient of variation of 0.38. There was a linear relationship between measured and known displacements for all 3 orthogonal planes (coefficient of determination 0.99; p < .01). There was significant fracture displacement with loads as small as 20 N. The slope of the load-displacement curve (structural compliance) provided a quantitative measure of fracture instability. Fracture compliance decreased up to 69% after application of an external fixator.

Biomechanical Phenomena↗
PubMed1997

MR imaging of the normal developmental anatomy of the elbow.

Growth and ossification of the elbow are complex. Interpreting MR images of the elbow in children requires a knowledge of the elbow's developmental changes. This article discusses the basic principles of growth and development of the distal humerus, proximal radius, and ulna. The signal characteristics of cartilage and marrow in the immature skeleton are described. Technical factors related to imaging of growth cartilage are outlined, and specific challenges during imaging of the pediatric elbow are emphasized. The changing MR appearance of the elbow due to ossification and physeal closure is described. The article also explains several pitfalls encountered.

Bone Development↗
PubMed1996

Chronic Monteggia lesions in children. Complications and results of reconstruction.

We retrospectively reviewed the results of operative treatment of chronic Monteggia lesions (Bado type I or the equivalent) with anterior radiocapitellar dislocation in seven patients. The mean age at the time of the reconstruction was six years and nine months (range, eleven months to twelve years), and the mean time from the injury to the operation was twelve months (range, five weeks to thirty-nine months). The mean duration of follow-up was four years and six months (range, two years to eleven years and three months). There were fourteen complications, including malunion of the ulnar shaft in one patient; residual radiocapitellar subluxation in two patients (one anterior and one posterolateral); radiocapitellar dislocation (dynamic anterior subluxation of the radial head in supination) in one patient; transient ulnar-nerve palsy in three patients (with residual weakness in two); partial laceration of the radial nerve in one patient; loss of the fixation in two patients; and non-union of the ulnar osteotomy site, compartment syndrome, conversion reaction, and possible fibrous synostosis of the forearm in one patient each. The patients lost a mean of 36 degrees of pronation and a mean of 27 degrees of supination of the forearm compared with the contralateral, uninjured extremity. Two patients demonstrated a loss of flexion of the elbow of 8 and 13 degrees and three had a loss of extension (mean, 15 degrees) compared with the contralateral side. There were three good, two fair, and two poor results.

Age Factors↗