Developmental dysplasia of the hip: diagnosis and treatment in children younger than 6 months.
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Hip Dislocation, Congenital↗
Biomedical subjects
W L Hennrikus
Publications and source records attributed to W L Hennrikus.
Relationship between ligamentous laxity and the site of upper extremity fractures in children: extension supracondylar fracture versus distal forearm fracture.
Eighty children who had fallen on an outstretched hand and sustained either a displaced supracondylar fracture (group 1) or a displaced distal forearm fracture (group 2) were prospectively studied. Ligamentous laxity in these 80 patients was determined by four methods: (a) contralateral elbow hyperextension, (b) knee hyperextension, (c) the ability to touch the thumb to the ipsilateral forearm, and (d) the ability to extend the thumb past the ulnar border of the clenched fist. Elbow hyperextension averaged 10.5 degrees in group 1 and 4.4 degrees in group 2 (P < 0.0001). Knee hyperextension averaged 7.2 degrees in group 1 and 2.4 degrees in group 2 (P < 0.001). Twenty-one of 38 patients in group 1 (55%) compared with 8 of 42 patients in group 2 (19%) could touch the thumb to the ipsilateral forearm (P < 0.001). Twenty-seven of 38 patients in group 1 (71%) compared with 5 of 42 patients in group 2 (12%) could extend the thumb past the ulnar border of the clenched fist (P < 0.001). The authors conclude that a child who demonstrates ligamentous laxity is more likely to sustain an extension supracondylar humerus fracture than a distal forearm fracture when he or she falls on the outstretched hand to break the force of the fall.
Accidental Falls↗
A comparison of three methods for measuring patella malalignment in children.
This study compared the Insall-Salvati (IS), Blackburne-Peel (BP), and Koshino-Sugimoto (KS) methods for measuring patellar malalignment in children. The IS and BP methods were inaccurate because the traditional landmarks for measurement were absent in the incompletely ossified pediatric knee. The KS method is based on the midpoint of the patella, the distal femoral physis, and the proximal tibial physis. The KS method applied to the extended knee was also inaccurate because of laxity in the patella ligament. However, the KS method applied to the flexed knee was the most accurate method for measuring patella malalignment in children.
Adolescent↗
Newborn clavicle fractures.
A prospective screening program of 9106 newborns identified 43 infants with clavicle fractures for a prevalence of 1 fracture in every 213 live births (0.5%). The fractures were equally distributed by right and left side involvement, and male and female sex. All fractures occurred during vaginal deliveries. None were breech presentation. Risk factors for fracture included large birth-weight, shoulder dystocia, mechanically assisted delivery, and prolonged gestational age. One in 11 newborns with a clavicle fracture also had a brachial plexus palsy.
Birth Injuries↗
Arthroscopically assisted treatment of acute septic knees in infants using the Micro-Joint Arthroscope.
Five infants with an acute hematogenous septic arthritis of the knee were treated with arthroscopically assisted drainage using the Micro-Joint Arthroscope (MJA; Linvatec, Largo, FL) combined with antibiotic therapy and early postoperative motion. The average patient age was 16 months (range, 4 to 24 months). No surgical or anesthetic complications occurred. All knees were clinically and radiologically normal at an average follow-up of 26 months.
Acute Disease↗
Postaxial type-B polydactyly. Prevalence and treatment.
A prospective screening program of 11,161 newborns identified twenty-one infants who had postaxial type-B polydactyly (a prevalence of one in 531 live births). Sixteen infants (76 per cent) had bilateral postaxial type-B polydactyly. Eighteen infants (86 per cent) had a family history of the anomaly. The racial prevalence was one in 143 live births of black infants and one in 1339 live births of white infants. The duplicated small fingers were treated in the newborn nursery with suture ligation at the base of the pedicle. One infant had a second procedure to remove a blackened digit that remained firmly attached one month after the initial treatment. No other complications occurred. Fifteen patients (twenty-eight fingers) were reexamined at an average age of twenty months (range, twelve to thirty-seven months). Twelve fingers (43 per cent) had a residual bump, with an average diameter of two millimeters (range, one to six millimeters). Despite the residual bumps, all of the parents were satisfied with the cosmetic result.
Finger Joint↗
Complications when using the cannulated 3.5 mm screw system.
Five patients with breakage of instrumentation when using the cannulated 3.5 mm screw system for fracture fixation are reported. Four 1.25 mm guide wires were sheared off by the cannulated drill and one 3.5 mm cannulated tap sleeve fractured. This article presents potential dangers when using the cannulated 3.5 mm screw system for general fracture care.
Adolescent↗
Parent satisfaction comparing two bandage materials used during serial casting in infants.
Plaster of Paris was compared with semirigid fiberglass casting material during serial casting in 17 infants with clubfoot or rigid metatarsus adductus. Semirigid fiberglass was statistically superior in its durability, convenience, performance, and ease of removal. The average amount of time for home cast removal by the parents was 55 minutes for plaster of Paris and 21 minutes for semirigid fiberglass. Complications such as skin abrasions and cast slip-off were similar for both casting materials. Ninety-four percent of parents strongly preferred semirigid fiberglass rather than plaster of Paris for their child's serial casting.
Casts, Surgical↗
Acquired thumb flexion contracture in children: congenital trigger thumb.
We examined prospectively 4719 newborn infants to determine the congenital incidence of trigger thumb. No cases were found. Fifteen other children aged from 15 to 51 months had surgery for this condition. The anomaly had not been seen at birth and all thumbs presented with a flexion contracture without triggering. The condition is usually seen after birth as a flexion contracture of the interphalangeal joint. The term 'congenital' is a misnomer because patients acquire the deformity after birth. The term 'trigger' is inaccurate as most thumbs show a fixed-flexion contracture without triggering. We suggest that rather than 'congenital trigger thumb' a more appropriate description of this disorder is 'acquired thumb flexion contracture in children'. If the contracture persists after one year of age, treatment by dividing the A-1 pulley is simple and effective.
Child, Preschool↗
A 2-month-old infant with acute swelling of the extremities and mandible.
The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. The initial history, physical findings, and roentgenographic examinations are found on the first two pages. The clinical and roentgenographic diagnoses are presented on the following pages.
Acute Disease↗
Self-administered nitrous oxide and a hematoma block for analgesia in the outpatient reduction of fractures in children.
We prospectively studied the efficacy and safety of self-administered nitrous oxide combined with a hematoma block in 100 children who had a closed reduction of a fracture in the emergency department. No child was excluded from the study because of the type of fracture. The average Children's Hospital of Eastern Ontario pain score (CHEOPS), as determined by the emergency-medicine physician who observed the reduction, was 6.8 points (range, 4 to 12 points). The average grade for pain, as recalled by the patient and indicated on a visual-analogue pain scale that ranged from 0 to 10 points, was 6.5 points before the patient received any analgesia and 1.2 points immediately after reduction of the fracture and application of a cast. Ninety-seven patients obtained an analgesic effect from the combination of nitrous oxide and a hematoma block. The three remaining children obtained no effect, and the fracture was reduced with use of general anesthesia. Three additional reductions were technically unsuccessful because of rotational or angular malalignment, and a second reduction was performed with general anesthesia. There were no complications such as vomiting, respiratory depression, a change in the oxygen-saturation level, infection, or nerve injury. We concluded that self-administration of nitrous oxide combined with use of a hematoma block is a safe and effective technique of analgesia for the outpatient reduction of fractures in children.
Adolescent↗
Patella infera following arthroscopic anterior cruciate ligament reconstruction.
Fifty patients who had an arthroscopic anterior cruciate ligament reconstruction for chronic insufficiency were reviewed at an average of 13.6 months following surgery. Among these patients, 32% complained of anterior knee pain that interfered with daily activities. Radiographic patella infera was present in 12% of patients using the Insall-Salvati ratio and in 16% using the Blackburne-Peel ratio. Radiographic patella infera did not correlate with the clinical problem of postoperative anterior knee pain. However, loss of knee extension of greater than 5 degrees correlated highly with pain (p=0.002).
Adolescent↗
The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old.
Thirty-three patients who had been managed for an isolated, closed fracture of the femoral shaft when they were less than seventeen years old were examined at an average of thirty-three months (range, eighteen to fifty-six months) after the injury. Thirteen patients (39 per cent) had a persistent deficit in the strength of the quadriceps of the fractured limb, as identified on testing with a Cybex-II isokinetic dynamometer. Six patients (18 per cent) had a deficit according to the one-leg-hop for distance test, fourteen (42 per cent) had an average loss of ten millimeters in the circumference of the thigh, and sixteen (48 per cent) had an average loss of 10 degrees of flexion of the knee. The etiological factors that were thought to possibly be responsible for the weakness of the quadriceps were evaluated. The amount of maximum displacement of the fracture, as seen on the initial radiographs, was the only factor that was significant for the prediction of weakness of the quadriceps (p = 0.006) at both test speeds of the Cybex dynamometer and in all statistical analyses. Despite the persistent weakness of the quadriceps, none of the patients had a clinical problem at the latest follow-up examination. A subclinical deficit in the strength of the quadriceps may be related to damage sustained by the muscle at the time of the fracture. On the basis of the results of this study, we do not recommend a change from the traditional methods of treatment, which involve early application of a spica cast or use of traction followed by application of a spica cast.
Adolescent↗
The dinner fork technique for treating displaced lateral condylar fractures of the humerus in children.
A simple, inexpensive fracture-reduction instrument and guide for Kirschner wire insertion can be constructed using a "dinner fork" and pliers. The modified dinner fork is particularly useful as an aid for reducing, compressing, and fixing displaced lateral condylar fractures of the distal humerus in children. This device is effective and simple to use; it can be applied to other pediatric fractures as well.
Bone Wires↗
A skin and soft-tissue protector for intramedullary reaming.
A 60-mL plastic syringe can be modified to make a reliable and inexpensive skin and soft-tissue protector for use during intramedullary reaming of the femur. This device is effective and simple to use. It frees the surgeon's hands during reaming and does not require any attachment to the drapes to prevent the device from falling onto the operating room floor.
Equipment Design↗
The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature.
The piriformis syndrome (PS) is a controversial cause of hip pain because of the lack of objective findings to support the diagnosis. Computed tomography (CT) and magnetic resonance (MR) imaging revealed PS in a 27-year-old woman. This case may be one of the first reports in the literature on a piriformis muscle enlargement documented by CT and MR imaging.
Adult↗
A dressing for repair of acute nail bed injury.
The use of a temporary metal foil stent after primary repair of acute nail bed injuries is a simple and dependable method for restoration of the smooth nail bed. The stent prevents adherence of the proximal nail fold to the underlying matrix, promoting patient comfort during subsequent dressing changes.
Bandages↗
Four cases of injury involving soda vending machines.
Injuries resulting from rocking soda vending machines are severe and potentially fatal. Four cases of significant trauma stemming from soda vending machine accidents are reported: One patient died, one is disabled, and two healed uneventfully. As a result, we recommend securing heavy soda vending machines to prevent further injuries. To our knowledge, this is the first report on a mechanism of injury resulting from soda machines.
Accident Prevention↗