Fractures of the femur in children.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
S T Canale
Publications and source records attributed to S T Canale.
Ruptures of the proximal biceps tendon in middle-aged patients.
Treatment of ruptures of the proximal biceps tendon has been based on clinical observations, with little objective data to substantiate treatment guidelines. Evaluation of 25 patients (all > 40 years of age) at an average of 7.9 years after injury found few objective or subjective differences between those treated nonoperatively and those treated operatively. Only 1 patient (treated nonoperatively) was dissatisfied with the result, and her dissatisfaction was with a cosmetic defect. Objective manual muscle testing and Cybex II (Cybex Corporation, Ronkonkoma, New York) evaluation of 19 patients found no significant differences in supination or elbow flexion strength in the two groups.
Adult↗
Iselin's disease.
Iselin's disease (traction apophysitis of the tuberosity of the fifth metatarsal) has been reported rarely, but is probably more common than appreciated. It appears to be more common in athletically active older children and adolescents. Four patients with this condition were treated conservatively and all had resolution or improvement of symptoms. In one, however, nonunion developed and continues to cause intermittent pain at age 20 years. Early recognition and treatment may prevent long-term complications.
Adolescent↗
Fractures of the neck of the talus.
Talar neck fractures should be managed with meticulous attention to detail, and anatomical reduction is mandatory. Most type I fractures can be treated closed, unless there is loss of reduction, but type II, III, and IV, especially if displaced, usually require open reduction and internal fixation. Closed reduction may be attempted, but if the reduction is lost, or satisfactory reduction cannot be obtained, open reduction should be performed. Two incisions may be necessary to confirm accurate anatomical reduction. Poor results occur because of avascular necrosis, malunion, subtalar arthritis, and infection. Attention to detail can decrease the incidence of the latter three of these complications; the development of avascular necrosis does not seem to be related to the type of treatment. Though the most serious complication, avascular necrosis, may not require surgical intervention, many of the authors' patients have done well with conservative treatment.
Fractures, Bone↗
Fractures of the hip in children and adolescents.
Hip fractures account for fewer than 1% of all fractures in children, and many can be successfully treated nonoperatively. Transepiphyseal, transcervical, and displaced cervicotrochanteric fractures, however, generally require closed reduction or open reduction and internal fixation to avoid complications of coxa vara deformity and nonunion. Avascular necrosis appears to be related to the severity of the initial injury and unaffected by treatment.
Adolescent↗
Orthopaedic aspects of myelomeningocele.
Explore the source record for details and available documents.
Child↗
Techniques for epiphysiodesis about the knee.
Percutaneous epiphysiodesis is an attractive alternative to traditional open procedures. With the aid of image intensification, the procedure is simple and reliable, has little morbidity, and produces a more pleasing cosmetic result.
Child↗
Problems and complications of slipped capital femoral epiphysis.
In summary, epiphysiodesis, by either "pinning" or "pegging," seems to be necessary to further prevent displacement of the SCFE. To minimize complications, aggressive closed reduction, open reduction, pin penetration, and unnecessary drill holes should be avoided. Avascular necrosis and chondrolysis, the most frequent and devastating complications, appear to be related to the severity of the slip and the type of treatment.
Bone Nails↗
Synovectomy of the knee in young patients with hemophilia.
We performed 16 synovectomies of the knee in 14 children, adolescents, and young adults with hemophilia A for boggy synovium due to hemophilia. Pain was eliminated or decreased in all patients postoperatively. The number of bleeding episodes was dramatically decreased in all patients at three-year follow-up. Some knee motion was lost in five patients. A continuous passive motion machine used in patients operated upon later in the series appears to be beneficial in regaining motion. Synovectomy did not appear to alter the course of joint destruction, especially if done late.
Adolescent↗
The orthopaedic implications of purpura fulminans.
The syndrome of purpura fulminans has frequently been reported in the surgical and pediatric literature, but rarely in the orthopaedic literature. The mortality rate has decreased dramatically from early reports of approximately 90 per cent to more recent reports of 18 per cent. Amputation of a portion of the involved extremities, however, is usually required in the patients who survive. Over a twelve-month period, we treated four patients who had purpura fulminans, with resultant vasospasm and secondary ischemic gangrene. In three of the patients the syndrome developed following a one to two-day febrile illness, and in one, following varicella. All four patients survived, but two required a bilateral lower-limb amputation; one, a Syme amputation and a partial hand amputation; and one, an amputation of the fore part of the foot. Autoamputation of multiple fingertips and toes occurred in two of the four patients.
Age Factors↗
Coventry screw fixation of osteotomies about the pediatric hip.
Osteotomies of the hip fixed with the Coventry lag screw were performed in 29 patients (38 hips) from May 1976 to June 1981. The ages of the children ranged from 24 months to 15 years, with an average of 7.3 years. There were 15 boys and 14 girls. Follow-up averaged 24 months, with a range of 11 to 67 months, and all patients were followed to union. The osteotomies were most commonly indicated for hip deformities associated with cerebral palsy, congenital deformities of the hip, congenital dislocation of the hip, neuromuscular abnormalities, post-traumatic deformities, and other miscellaneous conditions. Results were analyzed according to the bone disorder. All of the osteotomies united, averaging 10.5 weeks to union. Complications included one nonunion which required grafting before the osteotomy united, and two malunions. Following union, there was one fracture distal to the plate, and subcutaneous prominence of the screw developed in three patients. The Coventry lag screw is technically easy to use, is tolerated well, and produced satisfactory fixation in the majority of the patients in this study.
Adolescent↗
Proximal femoral osteotomy: a trigonometric analysis of effect on leg length.
A trigonometric analysis of the effect of a proximal femoral osteotomy, either dome or cuneiform, on leg length was done to aid the preoperative planning for this surgery. Change in leg length may be determined for a dome osteotomy by multiplying the length of the head-neck segment by the difference between the cosines of the preoperative and postoperative neck-shaft angles as measured from the vertical. A series of determinations are tabulated for a variety of head-neck lengths and angulation changes. When a cuneiform osteotomy is being done, the effect of the wedge can be determined and should be considered. Also to be considered are a tendency for spontaneous correction and growth stimulation from the osteotomy.
Adolescent↗
Angulation osteotomy. A trigonometric analysis.
An analysis of an angular deformity of a long bone and a corrective osteotomy is presented to demonstrate that the effective length of a long bone is significantly shortened by an angular deformity, and that this amount of shortening can be easily calculated. A comparison of proximal versus distal sites for corrective osteotomy is made to demonstrate that a proximal site is generally advantageous. A method of precisely calculating the length of the base of the appropriate corrective wedge is defined. It is shown that a closing wedge osteotomy can result in a significant increase in the effective length of an angulated bone.
Child↗
Congenital muscular torticollis. A long-term follow-up.
Fifty-seven patients with congenital muscular torticollis who were treated between 1941 and 1977 were evaluated after an average follow-up of 18.9 years. We found that if congenital muscular torticollis persisted beyond the age of one year, it did not resolve spontaneously. Children with torticollis who were treated during the first year of life had better results than those treated later, and an exercise program was more likely to be successful when the restriction of motion was less than 30 degrees and there was no facial asymmetry or the facial asymmetry was noted only by the examiner. Non-operative therapy after the age of one year was rarely successful. Regardless of the type of treatment, established facial asymmetry and limitation of motion of more than 30 degrees at the beginning of treatment usually precluded a good result. While these fifty-seven patients had little functional abnormality at follow-up (some of those with a persistent head tilt had mild, asymptomatic compensatory scoliosis), noticeable cosmetic deformity was present in approximately 31 per cent of the patients.
Adolescent↗
Biotrigonometric analysis and practical applications of osteotomies of tibia in children.
Explore the source record for details and available documents.
Biomechanical Phenomena↗
Neonatal osteomyelitis of the os calcis: a complication of repeated heel punctures.
Neonatal osteomyelitis has been frequently reported, but only rarely as a complication of repeated heel punctures. The need for constant monitoring of premature newborns and those having low birthweight and serious deformities necessitates repeated blood samples, usually obtained by heel puncture. Os calcis osteomyelitis occurred in three patients, possibly secondary to heel puncture. A swollen lower extremity in newborns should alert clinicians to the possibility of infection originating in the heel. Treatment involves adequate doses of appropriate antibiotics, but if the infection does not respond within 48 hours, then surgical drainage is indicated. Secondary extension to more proximal areas can and may occur with catastrophic consequences. Orthopedic surgeons should help other physicians become aware that repeated heel punctures may cause os calcis osteomyelitis and that they should be avoided.
Calcaneus↗
Traumatic dislocations and fracture-dislocations of the hip in children.
Explore the source record for details and available documents.
Adolescent↗
Osteochondral lesions of the talus.
In a retrospective study of thirty-one ankles in twenty-nine patients with osteochondral lesions, we found that lateral lesions were associated with inversion or inversion-dorsiflexion trauma, were morphologically shallow, and were more likely to become displaced in the joint and to have persistent symptoms. Medial lesions were both traumatic and atraumatic in origin, morphologically deep, and less symptomatic. Using the classification system of Berndt and Harty, it appeared that Stage-I and Stage-II lesions should be treated non-operatively, regardless of location. Stage-III medial lesions should be treated non-operatively initially but if symptoms persist surgical excision and curettage are indicated. Stage-III lateral lesions and all Stage-IV lesions should be treated by early operation. Long-term results indicated that few lesions unite when treated non-operatively. Degenerative changes in the ankle joint, whether symptomatic or not, were common (50 per cent of the ankles) regardless of the type of treatment.
Ankle↗