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Biomedical subjects

R M Letts

Publications and source records attributed to R M Letts.

At least 19 recordsLinked to original sources
PubMed1990

Pediatric Chance fractures: association with intra-abdominal injuries and seatbelt use.

Seven cases of Chance fractures of the spine in children are presented, with their association to intra-abdominal injuries secondary to seatbelt use. A discussion and review of the literature suggest an increasing frequency of this particular injury with a high association given the clinical sign known as the "seatbelt sign." Also reviewed is the association of intra-abdominal injuries secondary to seatbelt restraints, and particular attention is paid to the concurrence of intra-abdominal injury with Chance fractures of the spine. The unique features of the pediatric anatomy in relation to the design of the adult seat restraint as it relates to the vertebral fracture and intra-abdominal injuries are noted. A review of the literature discusses the development of a classification for this flexion-distraction type of vertebral injury, and supports our experience of the increasing frequency of these particular injuries with increasing seatbelt use.

Abdominal Injuries↗
PubMed1989

Pediatric update #7. The orthopaedic manifestations of head injury in children.

The incidence of significant head injury has been estimated at 220/100,000 children. Over 90% of these will recover with little residual disability. The purpose of this study is to re-examine the small but significant percentage of head injured children with permanent total body involvement to identify patterns of deformity and temporal sequences and to develop preventive treatment regimens. Sixteen head injured children with residual spastic quadriplegia were examined. All exhibited musculoskeletal abnormalities. Hip adduction contractures were most common leading to hip subluxation in eight children, followed by pes equinus, scoliosis, pelvic obliquity, and knee flexion contracture. The average time to onset of permanent foot deformity was 11 months after head injury, for scoliosis an average of 22 months postinjury, and for hip subluxation an average of 31 months postinjury. Hamstring contractures occurred later, at an average of 37 months, but caused the most interference with good seating. The physical problems of the head injured child have some similarities to those of the child with cerebral palsy, but with distinct differences. An aggressive surgical approach to prevention and treatment of fixed deformity in these children is recommended at an early stage with postoperative orthotic management and stable seating in abduction.

Child↗
PubMed1987

1-Desamino-8-D-arginine vasopressin (desmopressin) decreases operative blood loss in patients having Harrington rod spinal fusion surgery. A randomized, double-blinded, controlled trial.

To evaluate the effect of 1-desamino-8-D-arginine vasopressin (desmopressin) on blood loss in surgery, we conducted a randomized, double-blind trial of the drug in 35 patients with normal hemostatic function who were having spinal fusion with Harrington rod instrumentation. Seventeen patients were designated to receive 10 micrograms/m2 of desmopressin, and 18, to receive a placebo. Preoperative testing showed that desmopressin increased factor VIII coagulant activity, von Willebrand antigen concentrations, glass bead platelet retention, and prothrombin consumption and decreased the partial thromboplastin and bleeding times (p less than or equal to 0.0003). During surgery, desmopressin reduced blood loss by 32.5% (547 mL; 95% confidence interval [CI], 19 to 1075; p = 0.015) and reduced the need for concentrated erythrocyte transfusions by 25.6% (0.86 units; 95% CI, 0.08 to 1.65; p = 0.022). After surgery, desmopressin reduced the duration of treatment with analgesic agents by 13.1% (34.0 hours; 95% CI, -5.2 to 72.7; p = 0.105), presumably by decreasing bleeding in the surgical wound. When adjusted for the origin of the scoliosis by two-way analysis of variance, this effect was even more evident (p = 0.014). Multiple regression analysis showed that the best three predictors of blood loss in surgery and transfusion requirements were the bleeding time, glass bead platelet retention, and the use of desmopressin.

Adolescent↗
PubMed1987

Computer corner #16. Computer as an aid in orthopaedic slide production.

The state of the art in the field of graphics presentation is increasing almost monthly. At the present time, however, there is the software capability to allow orthopaedic surgeons to become quite competent in the production of quality graphic material, especially the production of 35-mm slides of a quality that can be presented at any orthopaedic meeting for a modest cost and minimal production time.

Audiovisual Aids↗
PubMed1986

Computer corner #13. Computerized examinations in orthopaedics.

Computerized examinations can play an important role in the evaluation and education of trainees in orthopaedics. Several centers in the United States and Canada are currently using these, thus allowing an exchange of examination questions. Once a system is set up, only minimal involvement on the part of the instructor and office staff is required. All participants--trainees and instructors--can benefit from computerized examinations.

Computer-Assisted Instruction↗
PubMed1986

Computer corner #15. The AAOS: request for computer system proposal.

The Committee on Computer Science and Practice Management of the American Academy of Orthopaedic Surgeons has provided an excellent format to ensure a happy relationship between the vendor and the orthopaedic office using this package. Problems in communication and understanding between the vendor and the orthopaedic surgeon will undoubtedly be significantly reduced. How the system will work is the vendor's problem, but what you want it to do for you is your problem, and both of these issues are addressed in these questionnaires. It is recommended in the computer package that three vendor proposals be invited. Since the most frequent cause of computer problems is improper evaluation of what functions the computer system must perform in order to meet the needs of the orthopaedic office, this series of questionnaires is important. In addition to recommending this computer package, I would also emphasize that if at all possible--in spite of what may appear to be an excellent system on paper--try to visit an office in which the system has been in use over the past six to 12 months.

Humans↗
PubMed1978

Auger injuries in children.

A 6-year review of auger injuries in Manitoba children revealed that 23 children sustained major injuries resulting in amputation of 17 limbs. Auger injuries are the main cause of traumatic amputation in children in Manitoba. Improved safety education for the entire farm family as well as better design of safety shields would decrease this carnage.

Agriculture↗
PubMed1978

Skeletal diseases associated with angiomatosis.

Basically, there are two conditions in which angiomatosis is associated with underlying skeletal disease. The first is Maffucci's syndrome in which angiomatosis is associated with multiple enchondromatosis. Two patients with this disease are presented and its clinical and radiologic features are reviewed. The second is "congenital angiectatic hypertrophy" in which angiomatosis is associated with localized hypertrophy of underlying bones, soft tissues and occasionally internal vercera. Four patients with this condition are presented, illustrating the subtypes of closely related diseases within a broad spectrum.

Angiomatosis↗
PubMed1978

The assessment of the internal rotation gait in cerebral palsy: an electromyographic gait analysis.

A study of 12 cerebral palsied children with internal rotation revealed three patterns of electromyographic activity: (1) Diagnostic pattern--where a simple muscle group stood out as the responsible agent--notably the medial hamstrings; (2) Nondiagnostic pattern--nonrecurring pattern; (3) Nondiagnostic pattern--recurring "mass limb reflex" pattern. In all cases, electromyography was useful for: (1) confirmation of clinical impressions. Electromyographic confirmation of phasic hamstring overactivity gives a firm basis for tendon surgery with expectancy of good results. (2) Detection of the responsible muscle group where clinical methods fail to do so. It detects the "at risk" patients, where follow up with tendon surgery at the appropriate time could be performed with predictable results. (3) Selection of patients who are likely to respond to tendon surgery, and those unlikely to benefit from it. The adductors and internal rotators may play only a secondary role in children whose predominant problem is internal rotation during gait. The medial hamstrings stand out as the most important single muscle group causing this problem. Consequently, it is important to analyze gait problems with the patient walking, and examine electromyographs during walking in the overall assessment of a patient with dynamic gait problem.

Adolescent↗
PubMed1978

Epiphysiolysis as a method of limb lengthening.

Epiphysiolysis followed by distraction was performed at the proximal tibial growth plates in 18 young rabbits. Union across the distracted plate occurred in all animals. In 12 rabbits skeletally immature at operation, premature fusion of the separated plate resulted in growth arrest of the operated limb. The contralateral control limb was longer at maturity by an average 1.10 cm. In 6 rabbits near skeletal maturity at epiphysiolysis, the operated limb was the longer at maturity by the amount distracted, an average of 0.62 cm. In all animals a permanent loss of joint motion resulted. Epiphyseal distraction in the very young rabbit does not appear to be practical due to consistent premature fusion of the distracted growth plate. It is possible to lengthen the limbs of rabbits near skeletal maturity with this procedure. An added advantage is that union between the epiphysis and the metaphysis always occurred, eliminated the problem of delayed ana non union found in diaphyseal lengthening. However, at this time, until the effects of distraction and compression on the adjacent joint can be minimized, epiphysiolysis as a method of limb lengthening is not recommended in children.

Age Factors↗
PubMed1977

Lawnmower injuries in children.

Over an 8-year period 31 children in the Winnipeg area were admitted to hospital with lawnmower injuries. The accidents were always preventable and were caused by patient or parent carelessness. The wounds were severe, often resulting in amputation of a portion of an extremity. Infection was common; prophylaxis with a broad-spectrum antibiotic and human antitetanus globulin is recommended. Radiography, débridement of the wound with thorough exploration under general anesthesia, and defatting and reapplication of degloved skin should be done initially, then the wound should be reinspected and redressed at 2 to 3 days, and finally closed or skin grafted at 6 to 8 days. Children must be educated about the dangers of lawnmowers and prevented from riding on tractor mowers. The grass catcher should be used and the path cleared of missiles. Hand controls should be mounted on the mower's handle and the blade should be kept sharp so that the machine's speed can be reduced.

Accidents↗
PubMed1977

Orthopaedic treatment of hemangiomatous hypertrophy of the lower extremity.

The triad of varicose veins, hypertrophy of soft tissue and bone, and cutaneous hemangiomas (The Klippel-Trenaunay syndrome) often results in major malformations. A review of eleven children treated for this condition showed that the overgrowth of the limb was a major problem in management. In three patients the altered hemodynamics resulted in cardiac complications. Venous stripping, excision of the arteriovenous fistulae, and radiation therapy should be avoided.

Amputation, Surgical↗
PubMed1977

Delayed paresis following spinal fusion with Harrington instrumentation.

Immediate postoperative paresis following spinal fusion for scoliosis is uncommon. This neurological disaster can occur either within hours or days after surgical correction of the curvature. Paresis of the right lower extremity occurred on the third postoperative day in a 15-year-old boy who underwent spinal fusion for a pseudarthrosis of a previous fusion and in whom a Harrington rod was inserted for stability but not correction. The rod was removed within four hours of recognition of the paresis; within 18 months the child made an almost complete recovery of all motor function; slight residual weakness of the anterior dorsiflexors of the foot still remain.

Adolescent↗
PubMed1976

Gunshot wounds of the extremities in children.

A ten-year review of gunshot trauma in Manitoba was prompted by an increasing incidence in gunshot trauma in children. Of 54 children treated from 1964 through 1973 60% sustained injury to one or more extremities. Fifteen children sustained long bone fractures, usually complete and often comminuted. All fractures united and there was only one instance of osteomyelitis. The major complication in gunshot wounds to the skeletally immature was limb length inequality secondary to epiphyseal plate injuries. This complication occurred in nine children. In three children there was in epiphyseal growth disturbance, even though the missile did not appear to pass through the plate but only in close proximity to it. Joint contractures secondary to skin loss and resulting subsequent skin contracture were also common. The amount of debridement required following gunshot trauma in children appears to be somewhat less than is recommended for similar injuries sustained by adults in time of war.

Adolescent↗
PubMed1976

Clinical telemetry of EMG and temporal information during gait.

Multichannel telemetry has formed an integral part of the clinical assessment of children's walking problems. EMG signals and temporal information from foot switches are transmitted from a small belt-pack unit which provides almost complete freedom of movement for the child. Although patients with various crippling diseases have been studied, the investigation of problems resulting from cerebral palsy has been most valuable clinically. The effects of orthopaedic surgery to release or transfer muscles can be asssessed more positively and the causes of some unexplained gait patterns can be investigated more thoroughly.

Cerebral Palsy↗
PubMed1976

Mobility aids for the paraplegic child.

Paraplegic children derive many benefits from upright bracing during their growing years. Physiological advantages include the prevention of joint contractures, decreased osteoporosis, prevention of urinary tract infections, increased cardiopulmonary tolerance, and the development of trunk and head control. The quality of life is enhanced because the child has increased self-esteem and participates in group activities with greater independence. Two new devices, the stand-up wheelchair and the shuttlebug, have been employed with success in the Winnipeg Child Paraplegic Program.

Braces↗