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Biomedical subjects

R T Morrissy

Publications and source records attributed to R T Morrissy.

47 records · Page 3Linked to original sources
PubMedDate not supplied

Femoral shaft fracture treatment in patients age 6 to 16 years.

Traction followed by spica casting, the one method used to treat femoral shaft fractures in children that was used in the past, has given way to a multiplicity of methods today. To evaluate the morbidity and costs of these various methods, 85 fractures in 81 patients age six to 16 years were evaluated. Early spica casting gave excellent results with low complications and low costs. All surgical treatments cost approximately the same: 3 times the cost of early spica casting and equivalent to traction followed by spica casting. Intramedullary flexible rods resulted in quicker healing and return to full weight bearing than did external fixation, which had the highest complication rate. One case of avascular necrosis in an 11-year-old girl treated with a reamed intramedullary rod suggests that this method is best reserved for children at or near skeletal maturity.

Adolescent↗
PubMedDate not supplied

Slipped capital femoral epiphysis.

Slipped capital femoral epiphysis (SCFE) is an unusual disorder in which the epiphysis of the proximal femur slips through the growth plate in a posterior direction. Significant derangement of hip function results and can be accompanied by two complications: avascular necrosis and chondrolysis. The cause remains elusive although many theories have been advanced. This article provides an overview of the disease process, diagnostic guidelines, and current treatment considerations. A case study is included.

Child↗
PubMedDate not supplied

Slipped capital femoral epiphysis: rationale for the technique of percutaneous in situ fixation.

In pinning a slipped capital femoral epiphysis (SCFE), the position of the pin within the center of the femoral head is important for two reasons. The pin may disrupt the lateral epiphyseal artery and cause avascular necrosis (AVN), or pin penetration in certain locations may go unrecognized on radiographs. To place the pin accurately, the surgeon must be aware of where the femoral head lies in relation to the femoral neck and the shaft. Radiographs of models and of patients in various positions support the view that the femoral head in most cases of chronic SCFE rotates around the axis of the femoral neck and does not slip inferiorly. Therefore, the starting point for an in situ fixation device is the anterior femoral neck, the exact location depending on the amount of slipping.

Bone Nails↗
PubMedDate not supplied

Slipped capital femoral epiphysis technique of percutaneous in situ fixation.

The technique for percutaneous in situ fixation of chronic slipped capital femoral epiphysis (SCFE) is described. It is based on the anatomy of the slip. The technique utilizes a cannulated screw, which obviates the need for an incision and allows variation of the starting point of the screw depending on the degree of slippage.

Bone Screws↗
PubMedDate not supplied

Acute hematogenous osteomyelitis: a model with trauma as an etiology.

The etiology of acute hematogenous osteomyelitis (AHO) remains unknown, and the disease has no laboratory model. We describe an AHO model in the rabbit which resembles the human disease. The model was developed on the premise that previous attempts had omitted an essential etiologic factor other than the bacteria. Six-week-old white New Zealand rabbits were divided into three different groups. Group I received an injury to the proximal tibial physeal plate, group II received a standardized bacteremia with Staphylococcus aureus, and group III received both the fracture and the bacteremia. The physeal plate injuries healed within 7 days. The animals with bacteremia only had occasional small foci of osteomyelitis identified histologically. The animals with fracture and bacteremia developed significant osteomyelitis in almost all cases.

Acute Disease↗
PubMedDate not supplied

Arthroscopy of the knee in children.

The complaint of knee pain is frequent in children. The difficulty of obtaining an accurate history from the younger child adds to the already-difficult problem of establishing an accurate diagnosis from clinical examination and routine radiographs in this group. This report is a prospective study of 32 children less than 18 years of age who underwent arthroscopy either because their symptoms failed to resolve with conservative treatment or because knee surgery was planned. The findings suggested some important differences between these children over 13 years of age and those age 13 years or younger. In the preadolescent group, 36% gave a history of trauma, 27% were correctly diagnosed before arthroscopy, and the correct diagnosis was delayed for an average of 18 months, as compared to 20%, 61% and nine months, respectively, for the older group. Three major problem areas were identified in the preadolescent group that could be solved by arthroscopy: serious intraarticular damage from long-unrecognized internal derangements; the difficulty of diagnosing the cause of synovitis; and the syndrome of persistent pain with no demonstrable knee pathology. Arthroscopy in the preadolescent patient is a safe and useful tool in those unusual cases with persistent and undiagnosed knee symptoms.

Adolescent↗
PubMedDate not supplied

Clinical experience with the technetium-99 scan in children.

A study of 86 bone scans in 79 patients was conducted to determine ways to enhance the usefulness of this test and learn what factors influence its results. While the overall value of the bone scan as we initially used it was not what we had hoped, it could be improved substantially by utilizing all initial clinical information when ordering as well as interpreting the scan. Its main value in suspected sepsis is to localize affected areas in and around the pelvis and spine. The scan is often unnecessary in the diagnosis of long-bone osteomyelitis and is seldom indicated when diagnosing cellulitis or synovitis. In occult trauma it is valuable for further investigation of specific areas with possible nondisplaced fractures. Needle aspiration of the bone or joint does not seem to alter the scan. We conclude that the bone scan is chiefly valuable in locating focal areas of skeletal pathophysiology.

Bone Diseases↗
PubMedDate not supplied

Torticollis and hip dislocation.

Reports in the literature suggest that there is an association between two childhood disorders: torticollis, an easily recognized clinical deformity, and developmental dislocation or dysplasia of the hip, an occult disorder. The identification of the obvious disease, torticollis, may prompt a search for the occult disease, developmental dislocation of the hip. If the association of these two disorders is common, it may be justified to expend resources to diagnose the occult disorder in all cases in which the more obviously noticed disorder is recognized. The reported association varies between 2 and 29%. We retrospectively reviewed 70 patients with the diagnosis of congenital muscular torticollis to determine the incidence of hip dislocation or subluxation in these patients. Fifty-four patients had radiographs of their hips. Forty-one patients were available for follow-up at an average of age 3+4 years. Six patients were noted to have hip subluxation or dislocation, all at presentation. Of these, four had been referred for diagnosed hip disease, whereas two were referred for torticollis, and the hip disease was then diagnosed by the pediatric orthopaedist. No patient had abnormal radiographs or physical findings at follow-up. We conclude that the rate of hip disease in those with torticollis is approximately 8% and is lower than the 20% often quoted.

Child↗
PubMedDate not supplied

Late metachronous involvement of the contralateral hip in Legg-Calvé-Perthes disease.

Bilateral hip involvement in Legg-Calvé-Perthes disease occurs in approximately 10-13% of cases. Although both synchronous and metachronous involvement of the two hips have been described, metachronous involvement is rare and generally occurs within 6 months to 4 years of initial diagnosis. We report the cases of two patients diagnosed with late metachronous involvement of the contralateral hip 8.5 and 9.8 years after initial presentation. This is later than previously reported metachronous involvement in Legg-Calvé-Perthes disease and emphasizes that patients with Legg-Calvé-Perthes disease may be at prolonged risk for recurrent disease.

Child, Preschool↗