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Biomedical subjects

S L Weinstein

Publications and source records attributed to S L Weinstein.

104 records · Page 6Linked to original sources
PubMed1975

Treatment for fixation complications: Femoral neck fractures.

Of 102 hips with femoral neck fracture complications, 75 required major secondary procedures such as total hip replacement, femoral prosthesis, cup arthroplasty, tibial bone grafting, and head and neck resection. The method chosen depended on the specific problem: nonunion, aseptic necrosis, infection, degenerative arthritis, or a failed primary prosthesis. Other factors influencing treatment were the patient's chronological and physiological age, his general health, his life pattern, and the familiarity of the surgeon with the technique and the advantages and disadvantages of the various salvage procedures.

Adult↗
PubMedDate not supplied

Long-term follow-up of Chiari pelvic osteotomy in myelomeningocele.

The management of hip instability in myelomeningocele patients is controversial. The purpose of this study is to review our long-term results of isolated Chiari osteotomies in the treatment of hip instability in children with myelomeningocele. Between 1975 and 1988, 11 patients underwent 13 Chiari osteotomies for reducible hip subluxation or dislocation and acetabular deficiency. The patients returned for follow-up clinical examinations, interviews, and radiographs. The average age at the time of surgery was 9.4 years (range, 5-18). The average age at follow-up was 18 years (range, 13-23). The average follow-up was 11.4 years (range, 2-18). The mean preoperative center-edge (CE) angle was -38 degrees. The mean immediate postoperative CE angle was 41 degrees. At final follow-up, the mean CE angle was 4.6 degrees. Only three of the 10 hips had a normal CE angle of > or = 25 degrees. The Chiari osteotomy alone did not achieve long-term hip stability in the majority of patients. Several, if not most, of our patients may progress to frank dislocation with longer follow-up.

Adolescent↗
PubMedDate not supplied

Thoracolumbar spine fractures. Results of treatment.

Sixty-three patients with thoracolumbar spine fractures treated between 1972 and 1978 were placed into six treatment groups: fusion and instrumentation alone, laminectomy with fusion and instrumentation, laminectomy alone, laminectomy with fusion without instrumentation, fusion alone, and no operation. Patients were interviewed and examined and their histories reviewed; new radiographs were obtained, and a detailed questionnaire was answered. No treatment method improved neurologic function. Fusion with instrumentation allowed earliest ambulation with least spinal deformity. Most patients in all treatment groups adjusted effectively to their injuries and remained active in employment and hobbies. A detailed, thorough rehabilitation program gave best functional results and patient attitudes.

Adolescent↗
PubMedDate not supplied

Hip fractures in children: a long-term follow-up study.

University of Iowa Hospital records from 1926 to 1988 were searched for cases of hip fractures in otherwise healthy children aged between 1 and 16 years. Twenty-six cases were identified. Nineteen patients were available for clinical and radiographic follow-up evaluation. The average follow-up was 16 years postinjury. There were four type I (transepiphyseal), nine type II (transcervical), three type III (cervicotrochanteric), and three type IV (intertrochanteric) femoral fractures. Avascular necrosis (AVN) of the femoral head complicated nine of the 19 fractures (47%). Seventy-eight percent of patients who developed AVN required additional surgical intervention to obtain acceptable hip function.

Adolescent↗
PubMedDate not supplied

Radiologic pelvic asymmetry in unilateral late-diagnosed developmental dysplasia of the hip.

Eighty-three cases of unilateral late-diagnosed (older than 4 months of age) developmental dysplasia of the hip (DDH) were studied to evaluate pelvic shape and innominate bone relationships in the initial anteroposterior radiograph. To be included, each initial radiograph had to have no lumbar pedicle rotation, lumbar scoliosis, gas shadows, or metallic protectors. Measurements were done using as reference a medial pelvic line, which divides the pelvis into two innominate bones. Lineal parameters were defined to assess pelvic radiologic shape; angular parameters defined the relationship between the ilium, ischium and pubis, and sacrum. Statistically significant differences were observed in most cases, and pelvis asymmetry was evident. The asymmetry was more obvious in cases in which the teardrop had a negative value and in low dislocations. Similar changes have been observed in experimental dislocation of the hip secondary to a triplane pelvic deformity. We suggest that similar alterations of pelvic shape occur in DDH, possibly secondary to growth disturbance in the triradiate cartilage.

Age Factors↗
PubMedDate not supplied

Histiocytosis X with scoliosis and osteolysis.

Histiocytosis X can exhibit a variety of musculoskeletal manifestations. Nonetheless, this case exhibits two striking features. Severe progressive scoliosis and massive osteolysis of both femoral shafts occurred in conjunction with the Hand-Schüller-Christian form of histiocytosis X. The scoliosis was treated successfully by posterior fusion and instrumentation. The clinical features of histiocytosis X are reviewed. Speculation as to the etiology of these features is presented.

Bone Resorption↗
PubMedDate not supplied

Correlation between arthrograms and operative findings in congenital dislocation of the hip.

Forty-two patients with congenital dislocation of the hip demonstrated good correlation between the arthrograms and the operative findings of a large ligamentum teres, an hourglass constriction of the capsule, a prominent transverse ligament and an acetabular bulge. The number of hips found at operation to have an inturned labrum was smaller than had been predicted on arthrogram. Larger percentages of hips with inturned labrum found at operation have been reported by other authors. We noted an acetabular bulge in a sizeable number of our patients. On arthrogram an inturned labrum has to be differentiated from the acetabular bulge and from an hourglass constriction. Open reduction is indicated when arthrogram indicates an interposition of a large ligamentum teres, an hourglass constriction, or a prominent transverse ligament. Isolated findings of an acetabular bulge or an inturned labrum on arthrogram are not indications for open reduction.

Child, Preschool↗
PubMedDate not supplied

The pelvic tear-figure: a three-dimensional analysis of the anatomy and effects of rotation.

Fluoroscopy and three-dimensional CT analysis were used to define the contributing anatomy and changes in appearance of the tear-figure with rotation of a pelvis. The tear-figure is a cortical structure of iliac and ischial bone that appears on anteroposterior (AP) roentgenograms of the pelvis. The contribution of these cortices to the pelvic tear-figure changes with rotation of a pelvis in a radiographic field. Cortices contributing to the tear-figure are not continuous throughout. The lateral border, inferior margin, and inferior one third of the medial border of the tear-figure is formed by a continuous segment of cortical bone extending from the deepest portion of the acetabulum around the cylindric acetabular notch, and along the inferior medial wall of the ischium. The superior two thirds of the medial border of the tear-figure consists of cortical bone extending superiorly along the medial wall of the ilium, which is not in continuity with the remainder of the components of the tear-figure. The tear-figure is not a structure of constant radiographic dimension. Its apparent dimensions change with rotation of the pelvis. The positioning of the patient for the AP pelvic roentgenogram is thus important when studying the effects of acetabular pathology on the appearance of the pelvic tear-figure.

Fluoroscopy↗
PubMedDate not supplied

Long-term psychosocial characteristics of patients treated for idiopathic scoliosis.

Psychosocial characteristics of 95 female patients treated with Milwaukee bracing for idiopathic scoliosis were examined using a battery of five psychosocial scales. Sixty-five patients treated with bracing alone and 30 patients who also underwent arthrodesis for curve progression were compared with 49 age-matched female controls. At an average follow-up of 7 years, no differences in depression or health locus of control existed. Significant perceptions of discrimination and a lower satisfaction of overall appearance was recalled during the treatment phase. By final follow-up, there was no longer any difference between the patients and controls in these areas. Significantly, differences in body-image scores persisted at follow-up. Operative patients had a more negative body image of the axial skeleton in comparison with the braced and control groups. We conclude that transient psychological effects are often present during treatment, and a lower body image may persist for several years in surgical patients.

Adaptation, Psychological↗