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T Terjesen

Publications and source records attributed to T Terjesen.

At least 19 recordsLinked to original sources
PubMed2006

The epidemiology and aetiology of Perthes' disease in Norway. A nationwide study of 425 patients.

A nationwide study of Perthes' disease in Norway was undertaken over a five-year period from January 1996. There were 425 patients registered, which represents a mean annual incidence of 9.2 per 100 000 in subjects under 15 years of age, and an occurrence rate of 1:714 for the country as a whole. There were marked regional variations. The lowest incidence was found in the northern region (5.4 per 100 000 per year) and the highest in the central and western regions (10.8 and 11.3 per 100 000 per year, respectively). There was a trend towards a higher incidence in urban (9.5 per 100 000 per year) compared with rural areas (8.9 per 100 000 per year). The mean age at onset was 5.8 years (1.3 to 15.2) and the male:female ratio was 3.3:1. We compared 402 patients with a matched control group of non-affected children (n = 1 025 952) from the Norwegian Medical Birth Registry and analysed maternal data (age at delivery, parity, duration of pregnancy), birth length and weight, birth presentation, head circumference, ponderal index and the presence of congenital anomalies. Children with Perthes' disease were significantly shorter at birth and had an increased frequency of congenital anomalies. Applying Sartwell's log-normal model of incubation periods to the distribution of age at onset of Perthes' disease showed a good fit to the log-normal curve. Our findings point toward a single cause, either genetic or environmental, acting prenatally in the aetiology of Perthes' disease.

Adolescent↗
PubMed2002

Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15,529 newborn infants.

The aim of this study was to evaluate whether universal (all neonates) or selective (neonates belonging to the risk groups) ultrasound screening of the hips should be recommended at birth. We carried out a prospective, randomised trial between 1988 and 1992, including all newborn infants at our hospital. A total of 15 529 infants was randomised to either clinical screening and ultrasound examination of all hips or clinical screening of all hips and ultrasound examination only of those at risk. The effect of the screening was assessed by the rate of late detection of congenital or developmental hip dysplasia in the two groups. During follow-up of between six and 11 years, only one late-detected hip dysplasia was seen in the universal group, compared with five in the subjective group, representing a rate of 0.13 and 0.65 per 1,000, respectively. The difference in late detection between the two groups was not statistically significant (p = 0.22). When clinical screening is of high quality, as in our study, the effect of an additional ultrasound examination, measured as late-presenting hip dysplasia, is marginal. Under such circumstances, we consider that universal ultrasound screening is not necessary, but recommend selective ultrasound screening for neonates with abnormal or suspicious clinical findings and those with risk factors for hip dysplasia.

Algorithms↗
PubMed2001

Good results after treatment with the Frejka pillow for hip dysplasia in newborns: a 3-year to 6-year follow-up study.

Because there is no consensus with regard to the efficiency of the Frejka pillow in the treatment of hip joint dysplasia in newborns, the aim of the present study was to evaluate our results with this device. During the 3-year period 1988 to 1990, the Frejka pillow was used in 108 newborns with clinically unstable hips verified by ultrasonography. There were three treatment failures (2.8%), defined as infants who needed additional treatment with an abduction splint or hip-spica cast. Avascular necrosis of the femoral head occurred in one patient (0.9%). At an age of 3 years to 6 years, 85 of the children attended a follow-up examination. An intoeing gait was observed in 17% and slightly reduced hip mobility in 20% of the patients. Compared with normal children, the patients had somewhat lower coverage of the femoral head by radiography, indicated by a lower centre-edge angle and a higher migration percentage, but the coverage was within the normal range in all cases. The mean anteversion angle was larger than that of normal children but only three patients had abnormally high anteversion angles. In conclusion, the results with the Frejka pillow were good, with few treatment failures and complications, and it is the most simple abduction device for the parents to handle. More rigid devices like the von Rosen splint seem to involve a slightly lower failure rate, but a higher risk of avascular necrosis. Therefore, we recommend the Frejka pillow when treatment is started within a few days of birth.

Age Factors↗
PubMed2000

The role of fluoroscopy in avoiding rotational deformity of treated femoral shaft fractures: an anatomical and clinical study.

In the first part of the study we examined the accuracy of femoral anteversion (AV) determined by fluoroscopy, simulating a method used in closed intramedullary femoral nailing. Twenty cadaveric femora were used. The condyles and posterior trochanteric area were resting on a horizontal table. The proximal femur was imaged using a C-arm image intensifier with horizontal X-ray beam at an angle of 30, 45, or 60 degrees to the long axis of the femoral shaft. To evaluate the reliability of the measurements, the real AV angle was determined by radiography. A small difference (mean 2 degrees ) was found between the real AV angle and the angle between the horizontal plane and the central head-neck axis (NH angle) as displayed by the image intensifier. In a separate clinical study, the NH angle was assessed and used as a guide to intraoperative rotational reduction in ten patients with femoral shaft fracture using the aforementioned method. Follow-up examinations of the AV angle showed that rotational deformities of clinical significance were avoided.

Aged↗
PubMed2000

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy.

To evaluate the clinical results of the treatment and to assess the factors that influenced the rate of scoliosis progression, a retrospective study of spinal orthosis in 86 patients with spastic quadriplegic cerebral palsy was performed. The mean age of the patients was 13.8 years (range 5 to 33 years). Their scoliotic deformities were treated with custom-moulded, polypropylene thoraco-lumbar-sacral orthoses. Cobb angles were measured on radiographs taken in a sitting position before treatment, in orthosis, and during follow-up. The mean initial Cobb angle was 68.4 degrees (range 25 to 131 degrees). The mean correction in orthosis was 25 degrees (range 3 to 60 degrees). Seventy-two patients had a follow-up period of more than 2 years. At the latest follow-up, average 6.3 years (range 2 to 14 years) after the start of treatment, the mean Cobb angle without orthosis was 93.1 degrees (range 40 to 145 degrees). The mean progression per year was 4.2 degrees (range -3 to 21 degrees). Linear multiple regression revealed that age and initial correction in orthosis were the only variables that significantly influenced the rate of progression. Twenty-two patients had no progression or progression <1.0 degrees per year. Correction in orthosis was the only variable that predicted progression <1.0 degrees per year in both age groups (<15 years and > or =15 years). Of the 57 patients who were still alive and had not undergone surgical fusion, 72% used their orthoses at a mean age of 22 years. Parents and caregivers expressed satisfaction with the use of orthosis, mainly because of improved sitting stability which gave better overall function.

Adolescent↗
PubMed1999

The use of ultrasound in determining the initiation of treatment in instability of the hip in neonates.

We have evaluated the effect of the use of ultrasound in determining the initiation of treatment in neonatal instability of the hip. A total of 99 newborn infants (1.5% of all live births) with neonatal hip instability did not have treatment from birth, but were re-examined at eight to 15 days. In the 31 who had persisting clinical instability and ultrasound abnormality, treatment was then started with a Frejka pillow. The hips in the remaining 68 infants showed spontaneous clinical stabilisation and improvement of the ultrasound findings. Treatment was therefore withheld. There was a marked trend towards normal development in mildly unstable hips, whereas no hips with severe instability did so spontaneously. Further follow-up showed normal development in all the hips which had been treated, and in all except five of the 68 untreated infants. These five infants showed persistent hip dysplasia on both ultrasound and radiological examination at four to five months of age. Treatment with an abduction splint was then started and their hips developed normally. Ultrasound is very useful in deciding on treatment if the examiners have adequate experience with the method. Its use substantially reduces the rate of treatment. Spontaneous resolution occurred in more than half of the unstable hips. Since five of the untreated infants developed hip dysplasia a strict follow-up is essential to identify and treat these cases.

Female↗
PubMed1999

Reliability of ultrasonography in the follow-up of hip dysplasia in children above 2 years of age.

PURPOSE: The aim of the present study was to assess whether ultrasonography (US) was reliable in the follow-up of children above 2 years of age who had previously been treated for congenital or developmental hip dislocation or dysplasia (HD). MATERIAL AND METHODS: As part of the routine follow-up, we examined 53 children (106 hips), aged 2-12 years (mean 6 years). Using US, the coverage of the femoral head was assessed by the distance from the lateral tangent of the ossified femoral head to the lateral bony acetabular rim (lateral head distance, LHD). The corresponding distance was measured on radiographs (LHDR). The radiographic femoral head coverage was assessed by the migration percentage (MP) and the center-edge (CE) angle. RESULTS: We found a good accordance between sonographic LHD and the radiographic parameters MP and CE in all age groups, indicating that femoral head coverage was reliably assessed by US. There was also a high correlation between LHD and LHDR (r=0.85). All hips with subluxation were detected by US. In 11 hips that appeared normal on US, but with dysplasia or uncertain findings by radiography, the condition spontaneously normalized in 9 out of 9 examined hips with further follow-up. CONCLUSION: Because a reliable assessment of the hip is obtained, we recommend that US should be used as the primary imaging technique in the routine follow-up of children above 2 years of age with previous HD. Radiography should be omitted when US shows normal findings and is only needed when the US LHD is above the upper normal limit or the hip looks abnormal or suspicious by subjective evaluation.

Analysis of Variance↗
PubMed1999

The natural history of hip abnormalities detected by ultrasound in clinically normal newborns: a 6-8 year radiographic follow-up study of 93 children.

Ultrasound screening for hip dysplasia or dislocation has revealed a group of children with clinically normal hips, but with abnormal or suspicious ultrasound. During the 3-year period 1988-90, we found 170 children with this combination. We evaluated the natural history of these hips. 93 children were examined clinically and with standard radiography 6-8 years after birth. The center edge (CE) angle of Wiberg and migration percentage (MP) were measured on the radiographs. 87 children had not undergone any treatment, whereas treatment with an abduction orthosis had been initiated at approximately 4 months of age because of persisting dysplasia in 6 cases. All hips were radiographically normal at this follow-up. The mean CE value was 24 degrees (SD 6.5) and the mean MP was 13% (SD 5.2). 73 children had no complaints in their lower extremities, whereas 12 had intoeing gait, 1 had outtoeing gait, 2 had hip or knee pain, and 5 had other complaints not relevant to hip dysplasia. We conclude that infants with sonographically abnormal or suspicious hips, but with normal clinical findings, do not need immediate treatment because spontaneous resolution occurs in most of them. Postponement of treatment in the few with persistent dysplasia does not seem to affect the outcome.

Female↗
PubMed1998

[Leg length inequality and rotational deformity after traction treatment of femoral shaft fractures in children].

87 patients who experienced femoral shaft fracture at the age of two to 14 years were reviewed, on average, seven (three to 12) years after the injury occurred. Three methods of treatment had been used: Bryant skin traction, and skeletal traction using either the Weber table or the Braun frame. Patients two to three years of age at the time of injury had significantly less leg length inequality than those aged four to ten years. The reason was that in the youngest group, where which 16 out of 21 patients had been treated with skin traction, the effect of traction was less efficient and there was therefore a larger overlap of the fragments at fracture healing than in the older group, where all patients had had skeletal traction. Among ten to 14 year olds there was also less leg length inequality than among four to ten year olds. This was because of lack of growth stimulation in the oldest patients after fracture healing. The results indicate that an initial overlap of approximately 10 mm should be aimed at in patients under 11 years of age, whereas overlap should be avoided in older patients. Rotational deformity, defined as side difference in anteversion angle of 15 degrees or more, occurred in seven patients (8%), but none of them had any complaints. We conclude that traction treatment gives good results, with few complications. Over-growth remains a significant problem in children under 11 years of age.

Adolescent↗
PubMed1998

[Femoral shortening osteotomy for chronic hip dislocation in patients with cerebral palsy].

Hip dislocation of several years duration in cerebral palsy needs treatment only if the patient has serious complaints. With the aim of reducing pain and problems with sitting function and perineal hygiene, we performed shortening osteotomy of the femur in 15 patients (12 girls and 3 boys) with spastic quadriplegia or diplegia at mean age of 14 (8-26) years. The patients were severely mentally and physically retarded, and only one patient had gait function, with support. A subtrochanteric shortening osteotomy of 3-5 cm was performed. The mean follow-up period was 5 (1-10) years. The symptomatic effect of the operation was good. The patients and parents were satisfied because the pain disappeared and the patients had less spasticity and stiffness. Complications were seen in two patients in the form of skin necrosis under both heels; this was caused by the plaster. Although reduction of the dislocation was not the aim of the surgery, radiographs at follow-up of 16 operated hips showed that five hips were reduced, whereas 11 hips remained subluxated or dislocated. We conclude that shortening osteotomy of the femur produces good symptomatic effects, probably due to reduction of the abnormally high muscle tension across the hip joint.

Adolescent↗
PubMed1997

[Anisomelia. Clinical consequences and treatment].

The hypothesis that a causal relationship exists between unequal leg length and disorders in the back or lower extremities has been hard to prove. However, at the present time there is scientific documentation of an association between a difference in length of more than 1 cm and low back pain. Thus, in children with one leg one centimetre or more longer than the other, and in adults with symptoms, the discrepancy should be adjusted, especially if a lumbar scoliosis in the standing position has been documented radiographically. A difference in length of less than 2 cm should be treated by raising the shoe. An established or estimated difference of more than this is usually corrected by surgery, either by epiphysiodesis or by shortening or lengthening osteotomy. In adults with a moderate difference in leg length, a raised shoe test is recommended in order to evaluate the effect of a correction in practice before osteotomy is performed.

Adult↗
PubMed1997

Ultrasonography of clinically unstable hips. A prospective study of 143 neonates at birth and early follow-up.

We evaluated the ability of ultrasonography to reduce the treatment rate of hips with clinical instability or uncertain findings at birth. Among 9,514 live births during the period 1988-1990, unstable hips were detected in 143 neonates by the Ortolani and Barlow tests, whereas the physical examination was inconclusive in 59 cases. These 202 neonates were also examined by ultrasound and instability was confirmed in 108 neonates who were treated with the Frejka pillow. The mean femoral head coverage (FHC) was 37%, indicating slight subluxation in the majority of unstable hips. The remaining 94 infants had normal ultrasonographic findings and were not treated. Their mean FHC was 53% and all these hips developed normally, except in 2 girls, who were treated with an abduction splint from age 4-5 months because subluxation developed. We conclude that ultrasound improved the reliability of the neonatal hip evaluation, thus markedly reducing the number of treated infants. Sonography also reduced the use of radiography during followup.

Female↗
PubMed1996

[Treatment of clubfoot].

48 patients (70 club-feet) were reviewed clinically between the age of 4 and 14 years. The primary treatment had been serial plaster casts in the case of 43 feet and additional neonatal tenotomies in 27 feet. Operative treatment after the neonatal period was performed on 53 feet (75%) at a median age of ten months (2-60 months). Surgical procedures were posterior release in 29 and postero-medial release in 24 feet. Further surgery was required in the case of 18 feet. Satisfactory results (excellent and good) were obtained for 42 feet (60%), but fair results for 17 feet (24%) and poor results for 11 feet (16%). The results were significantly better when the release operation was performed before the patient was 2 years of age.

Adolescent↗
PubMed1996

Ultrasound as the primary imaging method in the diagnosis of hip dysplasia in children aged < 2 years.

The aims of this study were to evaluate the usefulness of ultrasonography as the primary imaging method for hip joints and to establish the limits of normal variation of ultrasound measurements. Five hundred sixty-six children aged 1-23 months who had been referred for clinical suspicion of developmental dysplasia of the hip (DDH) were examined. In the youngest infants, the percentage cover of the cartilaginous femoral head by the bony acetabular roof (femoral head cover, FHC) was measured. When the ossification center had appeared, the cover was measured indirectly by the distance from the lateral tangent to the ossification center to the lateral acetabular rim (lateral head distance, LHD). The FHC of normal hips increased with age; the lower normal limit (mean -2 SD) was 46% in the youngest infants and 52% at age 4-5 months. The LHD also increased with age; the upper normal limit (mean +2 SD) was 3 mm in patients aged < 1 year of age and 4 mm in the oldest patients. Radiographs were obtained when ultrasound examination showed pathological hips and the radiographic findings were in good accordance with the ultrasound findings. Ultrasonography based on measurements of the cover of the femoral head represents a rapid and reliable technique for evaluation of hips in children in their first and second year of life. If ultrasonography is used as the primary imaging method, radiography can be omitted in approximately 95% of patients referred for clinical suspicion of DDH, because their hip joints are normal.

Female↗
PubMed1996

Ultrasonographic evaluation of breech presentation as a risk factor for hip dysplasia.

In order to gain more information of breech position as a risk factor for congenital hip dysplasia or dislocation, the hips of 408 newborns delivered in the breech position were examined by ultrasound. Clinical examination was performed by both experienced paediatricians and orthopaedic surgeons. The infants were re-examined by ultrasound at 2-3 months of age. Twenty-five newborns (6.1%) had neonatal hip instability. Breech presentation as a risk factor was confirmed, with first borns, breech position with extended knees, and high birthweight as special high-risk groups. Ultrasound showed subluxation in most of the unstable hips. The main benefit of using ultrasound was that direct visualization permitted more reliable evaluation, especially when the clinical findings were uncertain. Normal ultrasound findings in false positive and uncertain Ortolani tests reduced the frequency of unnecessary treatment. Because ultrasound was used in follow-up, the need of radiography was reduced. There were no late-detected cases of hip dysplasia or dislocation, indicating that routine follow-up is not necessary in breech infants with normal hips at birth, provided that the neonatal screening is optimal.

Birth Weight↗
PubMed1996

11 femoral fractures with vascular injury: good outcome with early vascular repair and internal fixation.

We reviewed 11 consecutive cases with combined femoral fracture and vascular injury presenting with acute ischemia. 6 cases had ischemia exceeding 8 hours and 4 of them developed massive muscle necrosis in the lower leg. 5 cases with ischemia less than 8 hours had no muscle necrosis. Vascular repair preceded fracture stabilization in 5 cases; there were no vascular complications during the subsequent fracture stabilization. 6 fractures treated with internal fixation had uneventful fracture-healing, whereas the 4 which were treated with external fixation needed later reoperations to obtain fracture-healing. We conclude that the limb must be reperfused within 6-8 hours. Vascular repair should be the first procedure, and fracture fixation by internal fixation is then preferred.

Adolescent↗
PubMed1996

Hip abnormalities detected by ultrasound in clinically normal newborn infants.

We have followed the natural progress of newborn infants in whom ultrasound examination showed abnormalities in hips which appeared to be clinically normal. Over six years we saw 306 such children out of 9952 examined (31 per 1000 live births). The examination was repeated at two to three months and those who still showed an abnormality were followed up further. At four to five months a standard radiograph was obtained, and treatment began if this and another ultrasound scan were both abnormal. At this stage, 291 infants had normal hips. In the 15 infants with abnormal hips there was no pronounced deterioration, none developed a frank dislocation, and all became normal after treatment in an abduction splint. Newborn infants with abnormal and suspicious ultrasound findings who are normal on clinical examination do not need treatment from birth; most of these hips will settle spontaneously. Treatment can be postponed until the age of four to five months unless clinical instability develops or ultrasound shows dislocation. The criteria for treatment should be based on measurements by both ultrasound and radiography: both should show an abnormality before intervention is considered necessary.

Female↗