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Biomedical subjects

R D Blasier

Publications and source records attributed to R D Blasier.

At least 19 recordsLinked to original sources
PubMed2000

Disruption of the pelvic ring in pediatric patients.

Pelvic ring disruptions are rare in children. Generally, nonoperative treatment has been recommended for children with these injuries. The authors retrospectively reviewed the medical records and radiographs of 189 patients with pelvic ring disruptions who were evaluated at a tertiary care children's hospital during a 10-year period. Of the 189 patients, 57 were identified with unstable pelvic fractures. These fractures were classified according to Tile, and Torode and Zieg. Forty-three of these patients were available to complete a subjective evaluation of their treatment at midterm followup. Thirteen patients were treated operatively and 30 were treated nonoperatively. There was no significant difference in subjective scoring between the two groups for pain at rest, pain with activity, limp, leg length discrepancy, and overall satisfaction with treatment. Overall, there were 92% good or excellent results in the patients who were treated operatively and 80% good or excellent results in the patients who were treated nonoperatively. Patients in both groups reported a high level of satisfaction with their outcome regardless of their fracture classification and treatment method.

Adolescent↗
PubMed1996

Age as a prognostic factor in open tibial fractures in children.

Thirty-one consecutive open fractures of the tibia were reviewed prospectively. Duration from injury until last examination averaged 3.7 years. The patients were divided into 2 groups for comparison: Group A consisted of children younger than 12 years of age and Group B of patients 12 years of age or older. The fractures were graded according to the system of Gustilo and Anderson. The severity of patient injuries in each group was similar. The treatments were likewise similar, but for all parameters studied, the younger patients fared better than their older counterparts. This study suggests that open fractures in children younger than 12 years of age require less aggressive surgical treatment, heal faster, are more resistant to infection, and have fewer complications than those in older children.

Adolescent↗
PubMed1996

Intravenous regional anesthesia for management of children's extremity fractures in the emergency department.

OBJECTIVE: To determine if intravenous regional anesthesia (Bier block) is safe and efficacious for the management of children's extremity fractures in the emergency department (ED). DESIGN: Retrospective review of 470 ED records of children presenting with extremity fractures reduced with intravenous regional anesthesia from 1989 through 1994. SETTING: ED of a 256-bed teriary care children's hospital. PATIENTS: Four hundred seventy children treated in the ED from 1989 through 1994 for extremity fractures reduced with Bier block anesthesia. Three hundred eleven boys and 159 girls with a mean age of 9.4 years (range two-19 years) were included in the review. INTERVENTION: Utilization of intravenous regional anesthesia for fracture reduction of affected extremity. MAIN OUTCOME MEASURES: ED records and orthopaedic consultation notes were reviewed for adequacy of reduction, number of reduction attempts, efficacy of anesthesia, and any associated untoward effects or complications, and review of operative notes of any children who required a subsequent procedure in the operating room (OR) under general anesthesia. RESULTS: Ninety-nine percent (467) had adequate anesthesia for fracture reduction. There were no complications noted. Specifically, there were no incidents of hypotension, tachycardia, seizures, or arrhythmia. Bier block anesthesia was aborted in three patients because venous access could not be obtained in the affected extremity. Less than 2% (8) required a general anesthetic in the OR for further treatment. All of the children taken to the OR underwent internal fixation of the fracture. CONCLUSIONS: Intravenous regional anesthesia (Bier block) is safe and efficacious in the treatment of children's extremity fractures in the ED.

Adolescent↗
PubMed1996

The triceps-splitting approach for repair of distal humeral malunion in children. A report of a technique.

Repair of cubitus varus in a child requires a distal humeral osteotomy. The triceps-splitting surgical approach was used for repair of distal humeral malunion in 10 children. Six patients had repair of cubitus varus, 3 had fixation of a fresh fracture, and 1 had repair of a nonunion. No problems with healing were noted. Triceps weakness and elbow stiffness did not occur. The triceps-splitting approach is particularly well suited for repair of cubitus varus in children because, compared with the lateral approach, it is cosmetically favorable, avoids ulnar and cutaneous nerves, does not damage extensor function, provides excellent visualization of the osteotomy site, and does not result in joint stiffness.

Child↗
PubMed1994

Fractures in children.

The literature published in the past year on fractures in children has helped us to increase our understanding of the natural history of fracture healing in children and introduced new techniques for fracture treatment. There is an impetus for operative fixation of femur fractures in children. The possibility is raised of growth derangement as a result of intramedullary nailing. Supracondylar fractures of the elbow continue to be a frequent topic for discussion. The benefits of adequate reduction and internal fixation have been reinforced. The incidence of nerve palsy, especially that of the anterior interosseous nerve, has been emphasized. New radiographic parameters for determining intraoperative reduction have been described. The management of radial neck fracture has been improved with percutaneous reduction proposed as an alternative to complication-fraught open reduction. New information has been brought to the forefront regarding knee injuries, in particular the implications of hemarthrosis and tibial eminence fractures. Biodegradable implants have become important as they prove to be useful in children's fracture management. Such implants have been shown to be useful in fractures that do not require rigid fixation. However, biodegradable devices may be associated with foreign body reactions.

Child↗
PubMed1991

Osteomyelitis in children with sickle cell disease: early diagnosis with contrast-enhanced CT.

Two children with sickle cell disease and osteomyelitis were treated. In one child, definitive treatment was delayed until computed tomography (CT) revealed a subperiosteal abscess. Early performance of CT in the other child resulted in prompt diagnosis and treatment. Before the appearance of the characteristic plain radiographic findings, diagnosis of osteomyelitis in patients with sickle cell disease can be difficult because the clinical manifestations of infarction and osteomyelitis can be similar. Radionuclide scans have yielded mixed results. In equivocal cases, early performance of CT can help establish the diagnosis of osteomyelitis to avoid significant morbidity.

Abscess↗
PubMed1986

Multiple myxomata of soft tissue associated with polyostotic fibrous dysplasia. A case report.

Polyostotic fibrous dysplasia with associated myxomata of soft tissue has been reported rarely. In most cases, the patient appears first with fibrous dysplasia and many years later presents with soft-tissue tumors. This is a report of a 57-year-old woman--an unusual case of soft-tissue myxomas with fibrous dysplasia. This case suggests that a patient developing myxomatous tumors of the soft tissues might be evaluated for the possibility of associated fibrous dysplasia.

Female↗
PubMedDate not supplied

Direct reduction with indirect fixation of distal tibial physeal fractures: a report of a technique.

Displaced intraarticular fractures of the distal tibia in children often require open reduction and internal fixation. Displaced epiphyseal fractures in the sagittal plane may be difficult directly to visualize from a standard medial malleolar incision, so accurate reduction may be impossible. Approaching the ankle joint by anterior arthrotomy, the fracture line can be directly visualized and accurately manipulated and reduced. However, access to the medial malleolus for insertion of internal fixation devices may be difficult from an anterior incision. We have found that after anterior arthrotomy and open reduction, rigid fixation can be placed percutaneously from medially or, in exceptional cases, from laterally under fluoroscopic control. The physis and talocrural joint can be seen and avoided in the growing child. Thirteen cases fixed by this method are reported. At 12.2-month average follow-up, clinical results were excellent. There were no instances of joint degenerative changes but one growth derangement.

Ankle Joint↗
PubMedDate not supplied

Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications.

Titanium elastic nailing is used instead of traction and casting in many European centers, but limited availability has prevented widespread use in North America. Before a planned general release in America, titanium elastic nails (TENs) were trialed at several major pediatric trauma centers. This multicenter study is a critical analysis of early results and complications of the initial experience. Overall, TENs allowed rapid mobilization with few complications. The results were excellent or satisfactory in 57 of the 58 cases. No child lost rotational alignment in the postoperative period. Irritation of the soft tissue near the knee by the nail tip occurred in four patients, leading to a deeper infection in two cases. As indications, implantation technique, and aftercare are refined, TENs may prove to be the ideal implant to stabilize many pediatric femur fractures, avoiding the prolonged immobilization and complications of traction and spica casting.

Adolescent↗
PubMedDate not supplied

Acquired spondylolysis after posterolateral spinal fusion.

A case of spondylolysis occurring immediately above a posterolateral lumbar spinal fusion in a 12-year-old girl is described. This case illustrates a potential problem of stress concentration at the pars interarticularis, previously only described after posterior interlaminar fusion.

Child↗
PubMedDate not supplied

Postoperative fever in pediatric orthopaedic patients.

Fever in hospitalized patients causes a great deal of concern. Its value in predicting complications, however, is questionable. For this reason, a retrospective analysis was performed on 200 records of children's orthopaedic admissions. Demographic data, would status, fever work-up, and daily peak temperatures were recorded. There were 174 patients who underwent surgical procedures and 26 patients who did not have surgery. Seventy-three percent (127/174) of the surgical patients had postoperative fever [temperature > 38 degrees C (100.4 degrees F)] Twenty-seven percent of the nonsurgical patients had fever. There were only three acute complications--one pneumonia and two wound infections. Complications were easily diagnosed by clinical means. In postoperative patients, the accuracy in predicting complications was 28%. Postoperative fever is a poor predictor of complications, and, therefore, should not delay discharge or indicate investigation for sepsis.

Child↗