Hip spica application for the treatment of congenital dislocation of the hip.
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Bandages↗
Biomedical subjects
S J Kumar
Publications and source records attributed to S J Kumar.
The limping child: a manifestation of acute leukemia.
Nine patients who presented to our institution with the chief complaint of a limp and no history of trauma were subsequently diagnosed with leukemia. A review of these patients identified clinical and laboratory findings that helped to establish the diagnosis. The presence of an antalgic gait with complaints of pain of variable intensity and duration, an irritable hip or knee, a mild to moderate elevation in body temperature, lymphadenopathy, hepatosplenomegaly, an increased erythrocyte sedimentation rate, thrombocytopenia, anemia, decreased neutrophils, increased lymphocytes, or blast cells on the peripheral blood smear should cause the physician to suspect leukemia in a limping child. Bone marrow biopsy confirms the diagnosis.
Adolescent↗
Universal lower-extremity positioning device for the spica frame.
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Casts, Surgical↗
Symptomatic talonavicular coalition.
Talonavicular coalition is reported as an asymptomatic congenital anomaly of the foot that is noticed incidentally on radiographs of the foot, and is often associated with symphalangism, clinodactyly, ball-and-socket ankle joint, a great toe that is shorter than the second toe, and an autosomal dominant inheritance pattern. We describe here three patients with five involved feet. All three patients had chronic foot pain not secondary to trauma, and all five feet required treatment to alleviate the pain.
Adolescent↗
Scoliosis in arthrogryposis multiplex congenita: results after nonsurgical and surgical treatment.
Forty-six patients (25 male and 21 female) with arthrogryposis multiplex congenita who were seen at the Alfred I. duPont Hospital for Children between the years 1940 and 1997 were evaluated to assess the prevalence and patterns of scoliosis and the long-term results after both nonsurgical and surgical treatment methods. We found the prevalence of scoliosis to be 65.9% (32 of 46 patients). A single thoracolumbar curve was the predominant curve pattern. No congenital curve types or vertebral anomalies were seen in our group of patients. In the nonsurgical group, the mean curve was <30 degrees at follow-up. In the surgical group, the mean primary curve before spinal arthrodesis was 78.5 degrees. Three patients in the surgical group who were nonambulators have become household ambulators at the most recent follow-up. We recommend bracing in patients who are ambulators and have a curve of <30 degrees. Combined anterior and posterior spinal arthrodesis gave the best results.
Adolescent↗
Triple osteotomy of the innominate bone for the treatment of congenital hip dysplasia.
Triple osteotomy of the innominate bone was performed on 12 hips to correct significant, symptomatic hip dysplasia. The procedure used was a modification of Steel's operation, with the modification being removal of a segment of the ischial ramus to facilitate medial displacement and the addition of an acetabular shelf. The patients' ages at surgery ranged from 9 to 22 years, with follow-up of 3-10 years. All patients had clinical improvement in both pain and limp. Radiographically, the average center edge angle improved from 5 to 36.6 degrees. The shelf that was added to buttress further the acetabulum contributed approximately 10 degrees to this improvement in the center edge angle.
Adolescent↗
Intraspinal tumors in children presenting primarily with hip symptoms: a report of three cases.
Although intraspinal tumors in children are better understood now than in the past, there is still a considerable delay between onset of symptoms and diagnosis because of the varied initial clinical presentations. Intraspinal tumors presenting primarily with hip pathology have not been described. The purpose of this article is to report on three children who presented with symptoms referable to the hip. Two of these children also had operation to correct the hip pathology. All three subsequently were diagnosed as having intraspinal tumors.
Child↗
Late acetabular dysplasia following early successful Pavlik harness treatment of congenital dislocation of the hip.
We present the long-term results of Pavlik harness treatment in 61 patients with 74 affected hips. At the beginning of treatment, the hips were either dislocated and reducible or dislocated and irreducible. The average age of patients at follow-up was 12 years (range, 10-16 years). At 3- and 5-year follow-up, all of the hips appeared radiographically normal. However, at latest follow-up, 17% of the hips demonstrated changes in the acetabulum (an upward tilt of the outer portion of the acetabular roof or sclerosis in this area). This study emphasizes the importance of continued follow-up until patients treated for congenital dislocation of the hip reach skeletal maturity.
Acetabulum↗
Transepiphyseal fractures of the neck of the femur in very young children.
Five severely displaced transepiphyseal fractures of the neck of the femur in five very young children were treated nonoperatively with a spica cast. Four of these fractures healed in varus, but two with an open proximal femoral physis corrected with growth. One fracture had an 18-month delay in diagnosis and treatment, but subsequently healed after a valgus osteotomy of the proximal femur and bone grafting. There was no case of avascular necrosis. We recommend initial nonoperative treatment with hip spica cast immobilization for this type of fracture in the very young child. If correction of residual coxa vara or limb length discrepancy is indicated, it may be done later.
Casts, Surgical↗
Complications associated with fracture of the neck of the femur in children.
We reviewed 16 children with 16 displaced fractures of the femoral neck associated with complications. One was a transepiphyseal fracture, 12 were transcervical fractures, and three were basocervical fractures. The mean age at time of fracture was 11 years 7 months (range, 4 years 6 months to 16 years), and the mean length of follow-up after fracture was 6 years 11 months (range, 2-24 years). Complications in this series were avascular necrosis (AVN) (14 patients), nonunion (seven patients), premature physeal closure (15 patients), chondrolysis (seven patients), and coxa vara (two patients). Avascular necrosis, nonunion, and chondrolysis were associated with a poor outcome. Coxa vara or premature physeal closure alone was not responsible for a poor result.
Adolescent↗
Triple osteotomy of the innominate bone in treatment of developmental dysplasia of the hip.
Ten children (11 hips) who underwent triple innominate osteotomy between the ages of 11 and 16 years for treatment of symptomatic acetabular dysplasia and who had > 10 years of follow-up since operation were reviewed to determine if satisfactory results reported in an earlier review were maintained. The mean length of follow-up was 12 years (range 10-16 years). All hips were examined roentgenographically, and functional assessment was made with the Iowa hip scoring system. Ten of the 11 hips improved roentgenographically and eight improved functionally after operation. One hip required replacement arthroplasty 16 years after triple innominate osteotomy.
Adolescent↗
Fibular transfer for congenital absence of the tibia.
Twelve patients (13 extremities) who had complete congenital absence of the tibia were treated between 1963 and 1989. Three patients (three extremities) had a knee disarticulation performed as the primary procedure because they had no quadriceps function. Nine patients (10 extremities) underwent centralization of fibula under the femoral condyles (Brown procedure). Four of these 10 extremities developed a severe flexion contracture of the knee (> 25 degrees) and underwent subsequent knee disarticulation. One patient with a short stump secondary to an ipsilateral proximal femoral focal deficiency had a femorofibular arthrodesis. Five of these 10 extremities had a satisfactory result when reviewed at an average follow-up of 18 years. The patients were evaluated in reference to gait, range of motion (ROM) of the knee, quadriceps strength, prosthetic needs, and peer group sports activities. A strong quadriceps (> grade 4) was noted in all five patients who had a satisfactory result. Flexion contracture of the knee, when < 25 degrees, did not compromise the result.
Female↗
Congenital kyphosis in myelomeningocele: results following operative and nonoperative treatment.
We reviewed the cases of 16 patients with myelomeningocele and congenital kyphosis. Ten patients underwent kyphectomy with wire fixation and spinal fusion for severe-curve progression and problems with decubiti ulcers. The average curve magnitude at presentation for these 10 patients was 87 degrees (range 47-146 degrees); at an average follow-up of 5 + 8 years (range 2 + 9 to 9 + 9 years) after surgery, it was 60 degrees (range 15-80 degrees). A stable fusion was achieved in nine patients, and all 10 had improved status of their skin at their last follow-up. Six patients were managed by nonoperative means such as modified wheelchairs and orthoses. The average curve magnitude at the presentation for this group was 70 degrees (range 42 degrees - 93 degrees); at an average follow-up of 19 years (range 5 + 5 to 27 + 3 years), it was 106 degrees (range 65 degrees - 130 degrees). Two of these patients continue to have problems with skin breakdown. Kyphectomy enables patients to sit straighter and is the proper treatment for these patients. If operative treatment is prohibitive or denied for some reason, then suitable wheelchair modifications can enable these patients to function with reasonable comfort.
Activities of Daily Living↗
A radiolucent spine frame: a modification of the Relton-Hall spine frame.
A radiolucent spine frame for obtaining intraoperative spine radiographs while performing surgery for scoliosis has been designed at the Alfred I. duPont Institute and is described here. This frame, constructed of strong radiolucent plastic compounds, is easy to use and maintain.
Child↗
Clubfeet associated with congenital constriction bands of the ipsilateral lower extremity.
The purpose of this study was to examine the outcome of treatment of clubfeet distal to a lower extremity constriction band. Eighteen patients with 21 clubfeet distal to a lower extremity constriction band were treated during the years 1946 to 1992. Three types of bands (I to III) were defined. Three grades of feet (A to C), based on the severity of the deformity, were recognized. After treatment, the feet were classified as good, fair, or poor. At follow-up, six of 18 feet were classified as good, six as fair, and nine as poor. These results were correlated with the type of band and the grade of the foot. A grade A foot associated with type III band had the best result.
Amniotic Band Syndrome↗
Salter-Harris type III fracture of the proximal fibula. A case report.
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Adolescent↗
The Stryker knee arthrometer in clinical practice.
The Stryker knee arthrometer was assessed in the environment of a nonspecialized National Health Service clinic by junior doctors in training. Forty percent of proven anterior cruciate deficient knees had a measured anterior excursion of 2 mm or less compared with the normal side under the same circumstances. Twenty percent of normal knees tested showed more than this variation between knees when different observers were compared and also when the same observers were compared at three week intervals. There is thus a question about the use of this machine in a general orthopaedic clinic with different observers.
Biomechanical Phenomena↗
Wedge-shaped distal tibial epiphysis in the pathogenesis of equinovalgus deformity of the foot and ankle in tibial lengthening for fibular hemimelia.
Fibular hemimelia is associated with an equinovalgus deformity of the foot and ankle and different degrees of wedging of the distal tibial epiphysis. This deformity is often a major problem during lengthening of the shortened tibia. To determine the significance of the wedge-shaped distal tibial epiphysis in the pathogenesis of the equinovalgus deformity of the foot and ankle during and after lengthening, we reviewed 20 patients who had undergone tibial lengthening by either the Wagner or the Ilizarov technique. The mean duration of follow-up after removal of the fixator was 5.2 years (range, 2.3-9.7 years). Three types of wedge-shaped distal tibial epiphyses were identified. A mildly wedged (type I) epiphysis was found in seven patients, a moderately wedged (type II) epiphysis was found in seven patients, and a severely wedged (type III) epiphysis, in six patients. Premature fusion of the lateral part of the distal tibial physis and growth retardation of the tibia were common after lengthening in patients with the type II or type III epiphysis. After lengthening, all patients with a type II or type III epiphysis had a recurrence or aggravation of foot deformities that existed before lengthening. This usually necessitated various secondary operative procedures to obtain a plantigrade foot. We believe that after lengthening, one should anticipate varying degrees of mild growth retardation and minimal foot deformity in patients with type I epiphysis, worsened asymmetric growth retardation and progressive foot deformity in patients with type II epiphysis, and severe growth retardation and severe foot deformity in patients with type III epiphysis.
Adolescent↗