PubMed Health⌕ Search

Biomedical subjects

Stuart L Weinstein

Publications and source records attributed to Stuart L Weinstein.

26 records · Page 2Linked to original sources
PubMed2003

Sprengel's deformity: long-term follow-up study of 22 cases.

This study examines the long-term results of 22 patients treated between 1938 and 1974 either surgically or by observation. Fourteen patients (16 scapulas) were treated by observation, seven patients (seven scapulas) were treated surgically by various methods, and one bilateral case was treated conservatively on one side and surgically on the other. The average follow-up was 26 years (range, 10-55) and the average age at follow-up was 32 years (range, 18-67). Shoulder abduction and cosmesis did not change appreciably over the years for the patients that did not undergo surgery, but the surgical patients did demonstrate an average improvement in shoulder abduction of 38 degrees. Seven of eight patients treated surgically reported a subjective improvement in the cosmetic appearance at follow-up, although four patients had an unsightly surgical scar. Pain in the affected shoulder was uncommon at follow-up in either group. We feel that the final result should be assessed from the viewpoint of the functional outcome and cosmetic appearance, independent of the radiographic aspect. Surgical treatment for patients with Sprengel's deformity is indicated when patient and family expectations are either improved cosmesis or improved function.

Adolescent↗
PubMed2002

Intramedullary fixation and bone grafting for congenital pseudarthrosis of the tibia.

Eleven consecutive patients with 12 congenital pseudarthroses of the tibia had intramedullary fixation and autogenous bone grafting as an initial treatment. None of these patients had previous surgeries or other concomitant procedures. The average age of the patients at the time of surgery was 2.5 years (range, 0.5-8.8 years). Four patients achieved initial union after the first index operation; two patients achieved union with no additional procedures, and three patients required an exchange intramedullary fixation for persistent nonunion after refractures that eventually healed. Seven patients did not achieve union after the first index operation; four patients achieved healing after multiple procedures including repeat intramedullary fixation, free vascularized fibular grafting, or both; two patients eventually had below-knee amputations after multiple procedures failed; and one patient did not achieve union of the pseudarthrosis. The important factors leading to failure of union were the distal location of the tibial pseudarthrosis and the presence of concomitant pseudarthrosis of the fibula.

Bone Transplantation↗
PubMed2002

Prophylactic pinning of the contralateral hip in slipped capital femoral epiphysis : evaluation of long-term outcome for the contralateral hip with use of decision analysis.

BACKGROUND: The risk of a contralateral slip in patients who are first seen with a unilateral slipped capital femoral epiphysis has been reported to be 2335 times higher than the risk of an initial slip. The overall prevalence of bilaterality varies widely throughout the literature, with some reports indicating rates as high as 80%. This finding has led many authors to recommend prophylactic pinning of the contralateral asymptomatic hip in patients presenting with a unilateral slipped capital femoral epiphysis. METHODS: A decision analysis model with probabilities for the occurrence of contralateral slip and for the severity of slip at different intervals of follow-up was used in the present study. These probabilities were compared with those for various outcomes when the contralateral hip is prophylactically pinned. Scores representing long-term outcome, according to the Iowa hip-rating system, were used in the model as a measure of utility. The probabilities of contralateral slip and the rates of slip severity were taken from large retrospective series. All meaningful clinical scenarios with regard to long-term outcome for the hip were considered in the model. Variables of uncertainty were subjected to sensitivity analyses in order to explore the effect on outcome over the range of plausible values for variables of interest. RESULTS: The results showed a benefit in the long-term outcome for patients who had prophylactic pinning of the contralateral hip. The threshold level at which a benefit is obtained with prophylactic pinning is expressed according to the rates of sequential slip, rates of slips overlooked at follow-up, and complications associated with prophylactic pinning of the contralateral hip. CONCLUSIONS: The decision model shows that, when pooled data are used to predict probabilities of sequential slip, treatment of the contralateral hip with prophylactic pinning is beneficial to the long-term outcome for that hip. When considering prophylactic pinning of the contralateral hip, the clinician should use sound clinical judgment with respect to the age, sex, and endocrine status of the patient. Long-term follow-up studies are needed to establish the efficacy of prophylactic pinning, but the predictions in the present study, which are based on findings in the literature, support the safety of this procedure.

Bone Nails↗
PubMed2002

Prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis.

BACKGROUND: Although reports in the literature have demonstrated an approximately 20% prevalence of neural axis abnormalities in patients with juvenile idiopathic scoliosis who have a curve of >20 degrees, the prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis is not well documented. In two previous studies involving a total of only ten patients with infantile idiopathic scoliosis, five patients were noted to have a neural axis abnormality on magnetic resonance images. METHODS: The records of forty-six consecutive patients who were seen between 1992 and 2000 at three spinal deformity clinics were retrospectively reviewed. The inclusion criteria included presumed idiopathic scoliosis at the time of presentation, an age of three years or less, a curve magnitude of > or = 20 degrees, normal neurological findings, no associated syndromes, and no congenital abnormalities. All patients were evaluated with a total spine magnetic resonance imaging protocol for examination of neural axis abnormalities from the skull to the coccyx. RESULTS: Ten (21.7%) of the forty-six patients were found to have a neural axis abnormality on magnetic resonance imaging. This group included five patients with an Arnold-Chiari malformation and an associated cervicothoracic syrinx, three with syringomyelia, one with a low-lying conus, and one with a brainstem tumor. Eight of these ten patients needed neurosurgical intervention for treatment of the abnormality. CONCLUSIONS: The 21.7% prevalence of neural axis abnormalities in this group of patients with infantile idiopathic scoliosis was found to be almost identical to that reported in the literature on patients with juvenile idiopathic scoliosis. Because of the high prevalence of abnormalities and the fact that eight of the ten patients with abnormal findings on magnetic resonance images required neurosurgical intervention, a total spine magnetic resonance imaging evaluation at the time of presentation is recommended for all patients with infantile idiopathic scoliosis who have a curve measuring > or = 20 degrees.

Child, Preschool↗
PubMedDate not supplied

Subcutaneous rodding for progressive spinal curvatures: early results.

This study retrospectively reviewed the clinical records and radiographs of 11 patients with progressive early-onset scoliosis who failed to respond to nonoperative management and who underwent consecutive distraction of subcutaneous rods. Eleven children were treated by consecutive distraction of subcutaneous rods, and in two patients with rodding and anterior apical fusion. At surgery, the average patient age was 5.66 years, with a mean Cobb angle of 74 degrees and an average Pedriole angle of 39 degrees. The etiology of the scoliosis included four syndromic and one each congenital, post-rib resection, post-spinal tumor resection, neurofibromatosis, myelomeningocele, infantile idiopathic, and juvenile idiopathic. Subcutaneous rodding halted curve progression in all patients. At an average of 5.1 years after surgery, one patient showed no deterioration of the curve and nine patients showed an improvement of > or =40% in the magnitude of the original curvature. Eight of these patients had already had definitive surgery performed with segmental spinal instrumentation and fusion. Spinal growth occurred in all 11 patients and ranged from 0.5 to 4.5 cm (mean 2.0). Early results from these patients show that subcutaneous rodding with consecutive distraction allows correction of progressive early-onset scoliosis that failed to respond to nonsurgical management, preserving the individual growth potential of the spinal column and delaying definitive surgical treatment. Rotational deformity did not deteriorate radiographically, but clinical deformity increased subjectively. The amount of growth achieved and the number of procedures required to obtain these results raises the question of whether patients would be better served by a single anterior, posterior fusion and instrumentation at a young age.

Child↗
PubMedDate not supplied

Radiographic measurements in developmental dysplasia of the hip: reliability and validity of a digitizing program.

A fundamental goal of research in developmental dysplasia of the hip (DDH) has been the identification of radiographic quantitative factors predictive of long-term outcome. The rapid development of digital imaging modalities opens the possibility for more systematic, automated measurement of radiographs. The authors have developed a software program for the study of DDH that integrates a user interface to select, store, and edit prescribed landmarks on digital radiographs. These points are used to construct and display reference lines analogous to those commonly drawn on physical films. Measurements are stored as a printable text file and as a data record. The results of this study demonstrated very good intrarater and interrater reliability coefficients and intermethod validity coefficients for the digitizing program. If this program is added to a software reporting system, measurements can be done on a real-time basis and can be included in the patient's medical record.

Body Weights and Measures↗