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Biomedical subjects

W O Southwick

Publications and source records attributed to W O Southwick.

At least 19 recordsLinked to original sources

A patient registry for orthopedic surgery.

Identification of patient subpopulations for retrospective clinical studies, documentation of residents' clinical experience, and other administrative purposes can be difficult and time consuming. The problem of identification is exacerbated when a teaching program involves several hospitals or when the desired subpopulation is not adequately defined by standard diagnosis or procedure codes used by the institution. A useful patient registry system is reported here for the storage and retrieval of data on orthopedic patients treated by surgical residents at a major teaching hospital and its affiliates. The registry uses a simple, yet powerful encoding scheme to describe patient entries. In addition to a multidimensional encoded description based on SNOMED, the system supports the entry of free text to provide greater detail. This combination gives the patient registry both power and versatility.

Hospital Information Systems

The anterior retropharyngeal approach to the upper part of the cervical spine.

Since 1959, we have used a superior extension of the anterior approach to the cervical spine of Robinson and Smith in a consecutive series of seventeen patients. This approach provided anterior access to the neural elements from the clivus to the body of the third cervical vertebra, without the need for posterior dissection of the carotid sheath or entrance into the hypopharynx or oral cavity. It also provided adequate exposure for the insertion of iliac or fibular strut grafts, which was necessary in thirteen patients. The approach gave excellent exposure for anterior intralesional excision of a tumor in ten patients, marginal excision of an osteochondroma, two corpectomies of the second cervical vertebra combined with removal of the odontoid process, corpectomy of the second cervical vertebra for the treatment of fixed atlanto-axial subluxation, removal of a bullet anterior to the clivus, reduction of a dislocation of the second on the third cervical vertebra secondary to an unstable fracture of the pedicles of the second cervical vertebra, and anterior débridement for treatment of pyogenic vertebral osteomyelitis. In contrast to the reported results of transmucosal approaches to the atlas and axis, there were no infections or iatrogenic neurological deficits of the spine in the present series. Twelve patients who were followed for two years or more had a solid anterior fusion and no subsequent loss of cervical stability. Pain in the neck was relieved in all of the patients who had had a pathological or traumatic fracture.

Adolescent

Robert A. Robinson.

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History, 20th Century

Congenital and infantile scoliosis in triplets.

Presumed monozygotic triplets presented with discordant, "mirrow-image," hemivertebral congenital scoliosis in 2 infants and an idiopathic (infantile) scoliosis, without recognized developmental abnormalities, in the third. The findings suggest extragenetic causality in all 3--problems of cleavage/somite formation in the 2 with hemivertebrae, and intrauterine positioning in the third.

Female

Anterior subluxation of the lateral tibial plateau. A diagnostic test and operative repair.

Recurrent anterior subluxation of the lateral tibial plateau is a common type of chronic knee instability resulting from trauma. It can be reproduced by the clinical test described and corrected by a surgical procedure called the sling and reef operation, in which a strip of iliotibial tract is used to create a sling and to reef the posterolateral capsule. From 1971 to 1978, eighty-four patients were operated on, of whom fifty had been evaluated at one to six and one-half years after operation. The results were: forty-one good, six fair, and three poor. The lesions found in the thirty-seven knees in which arthrotomy was performed included a tear of the anterior cruciate in every case, a tear of the medial meniscus in fifteen and of the lateral meniscus in eleven, a notch in the articular surface of the lateral femoral condyle in fifteen, and a lateral marginal tibial (Segond) fracture in three. No definite lateral capsular tears were visualized--only stretching comparable to that seen in recurrent dislocation of the shoulder.

Adolescent

Metastatic tumors involving the cervical vertebrae: surgical palliation.

Pain, weakness, or paralysis from involvement of the spinal cord and nerve roots secondary to invasion of the vertebrae by a malignant tumor often can be avoided or alleviated by stabilization of the spine. Twelve patients with neoplastic infiltration of the cervical vertebrae were so treated. The operation of wiring, augmentation bone-grafting, and decompression of the spinal cord was successful after conservative methods failed. Indications for operation were: (1) unremitting pain in the neck, not relieved by bracing or radiation therapy; (2) a major degree of vertebral destruction with loss, or impending loss, of support for the head; (3) collapse of a vertebral body; or (4) neural deficit from local tumor invasion. A classification of our twelve patients into three groups helped to delineate the surgical procedure needed. The value of obtaining spinal stability and a solid fusion above and below the tumor was evident in eleven patients. For almost all of their survival time, they were comfortable. Surgical treatment may not appreciably extend the lenght of a patient's survival, but it generally improves the patient's quality of life.

Adult

Cervical facet fusion for control of instability following laminectomy.

Cervical laminectomy may compromise the stability of the spine. Posterolateral facet fusion can be used to stabilize the spine after laminectomy and prevent progressive deformity. The procedure includes passing wires through drill holes in the articular processes and binding two longitudinal struts of bone to the posterior columns of the articular processes. Sixty-three p atients with cervical laminectomy and facet fusion were reviewed, and fifty-two of them were followed for one to seventeen years. The reasons for fusion were to control overt spinal instability and deformity or to eliminate motion which may contribute to spondylosis. Solid fusion occurred in fifty of fifty-two patients at a mean of 6.5 months and provided continuing stability without progressive deformity. Although facet fusion is a complex procedure, it provides secure stabilization, does not interfere with decompression, and permits early mobilization of the patient.

Adolescent

The four biomechanical stages of fracture repair.

Based on analysis of the torque-angle curves and roentgenographic findings in fifty-three healing tibial fractures in rabbits tested in torsion to failure, four biomechanical stages of fracture healing were defined, as follows: Stage I--failure through original fracture site, with low stiffness; Stage II--failure through original fracture site, with high stiffness; Stage III--failure partially through original fracture site and partially through intact bone, with high stiffness; and Stage IV--failure entirely through intact bone, with high stiffness. These stages correlated with the progressive increases in the average torque and energy absorption to failure as healing progressed and also with the average times since the original experimental fracture. It is hoped that this system of staging will provide both a standard by which important variables related to ultimate strength of healing fractures can be correlated and an objective way to predict delayed unions and non-unions and to determine the level of activity that is safe for patients with a healing fracture.

Animals

Cervical orthoses. A study comparing their effectiveness in restricting cervical motion in normal subjects.

The effectiveness of five cervical orthoses in restricting cervical motion was evaluated quantitatively in normal subjects using roentgenograms and overhead photographs made at the extremes of three planes of motion, while the effectiveness of the halo with a plastic body-vest was studied in seven patients with cervical fractures or local fusions. Flexion and extension were measured at each cervical intervertebral joint and combined cervical motion was measured for rotation and lateral bending. The best conventional braces restricted only 45 per cent of flexion-extension at the atlanto-axial joint; the halo restricted 75 per cent. The conventional braces were more effective in the middle and lower portions of the cervical spine. The results may prove to be useful guidelines for the selection of an appropriate orthosis to control motion in different planes and at different levels of the spine.

Adult

Effects of preload on load displacement curves of the lumbar spine.

Elastic mechanical properties of the spine are a function of the axial preload as well as the physiologic loads. The published literature does not take into account the effect of the preload. In this study we have presented a new technique for applying large preloads together with 12 physiologic loads and for measuring the resulting three dimensional motion. Some of the conclusions regarding the elastic behavior of the lumbar spine are: (1) The application of any one of the 12 physiologic loads produces a three dimensional motion consisting of three translations and three rotations. (2) The main as well as the coupled motion curve is affected by the inclusion of preloads. (3) As represented by the main motion curves, the spine becomes more flexible in the presence of preloads with the physiologic forces directed laterally or anteriorly, or moments producing lateral bending or flexion. (4) The spine becomes less flexible in the presence of preload when it is subjected to axial tension or axial torsion. (5) No appreciable change due to the preloads is noticed in the load displacement curves when axial compression, posteriorly directed force, or extension moment is applied.

Biomechanical Phenomena

Osgood-Schlatter's disease and tibial tuberosity development.

The growth plate of the tibial tuberosity does not develop until several months after birth and is structurally different than most growth plates that are loaded primarily in compression. Histologically, it is particularly different from the juxtaposed proximal tibial growth plate. The physis of the tibial tuberosity is composed primarily of fibrocartilage and fibrous tissue, with bone being added to the anterior portion of the tibial metaphysis by membranous bone formation. Initially very little of the growth plate is comprised of columnated cells, but by the time of maturation of the tuberosity, with the exception being the most distal region, the columnar portion has extended distally and is found under most of the tuberosity. These structural features would be an adaptation to the strong tensile forces exerted in this region. That human "traction" apophyses may be histologically different from "compression" epiphyses seems not to have been demonstrated previously. Osgood-Schlatter's disease would appear to be an inability of the developing secondary ossification center to withstand tensile forces, resulting in avulsion of segments of the ossification center, and eventual formation of extra bone(s) between the fragments.

Adolescent

Indicators of recovery from fractures of the hip.

Patients with similar injuries who were at a similar level of function before the injury differ in the extent of recovery. In an attempt to identify important factors that affect recovery, we collected extensive physical, psychological and sociological data on a group of 108 elderly people with fractures of the hip in order to study the influence of the many variables on their recovery. We found that of all the items studied, those that best indicated the degree of recovery were: (1) the physical therapist's rating of functional ability; (2) how often the patient got outside the home prior to injury; (3) the patient's mental clarity.

Aged

Contraposed curve patterns in monozygotic twins.

Monozygotic twins with Marfan's disease presented with opposing lumbar curve patterns. Differences in degrees of curvature correspond to the levels of severity of other clinical manifestations of the disease.

Adolescent