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Biomedical subjects

William J Shaughnessy

Publications and source records attributed to William J Shaughnessy.

9 recordsLinked to original sources
PubMed2007

Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center.

Femoral neck fractures in children are severe injuries associated with the potentially disastrous complication of femoral head osseous necrosis. Our primary goal was to identify what factors contribute to the occurrence of femoral head osteonecrosis in skeletally immature patients with femoral neck fractures. We evaluated a large consecutive series of pediatric patients with femoral neck fractures. Between 1970 and 2000, 20 patients with a mean age of 11 years (range, 4-15 years) with femoral neck fractures were identified. All traumatic epiphyseal, transcervical, and basicervical (Types I, II, and III) fractures were included. There were 14 male patients and six female patients. The mean followup was 7 years (range, 1-28 years). Timing of surgery, type of fixation, and quality of reduction were analyzed with respect to the primary outcome measure-radiographic evidence of femoral head osteonecrosis. Eighteen of 20 hip fractures healed without complication; all had good or excellent reductions. Two patients had osteonecrosis develop; both had fair or poor reductions. Five patients were treated more than 48 hours after injury, including the two patients who had osteonecrosis develop. The mean time to fixation for the remaining patients was 12 hours. There was no relationship between capsular decompression and osteonecrosis development. Quality of reduction and timing of reduction influenced the risk of osteonecrosis.

Adolescent↗
PubMed2006

A quantitative composite scoring tool for orthopaedic residency screening and selection.

The ability to accurately screen and select orthopaedic resident applicants with eventual successful outcomes has been historically difficult. Many preresidency selection variables are subjective in nature and a more standardized objective scoring method seems desirable. A quantitative composite scoring tool (QCST) to be used in a standardized manner to help predict orthopaedic residency performance from application materials was developed. In 64 orthopaedic residents, four predictors (United States Medical Licensing Examination [USMLE] Part I scores, Alpha Omega Alpha status, junior year clinical clerkship honors grades, and the QCST score) were analyzed with respect to four residency outcomes assessments. The outcomes included three standardized assessments, the orthopaedic in-training examination scores (OITE), the American Board of Orthopaedic Surgery (ABOS) written and oral examinations, and an internal outcomes assessment, attainment of satisfactory chief resident associate (CRA) status. Collectively, the QCST score had the strongest association as a predictor for all three standardized outcomes assessments (p < 0.001). Honors grades during junior years clinical clerkships was most strongly associated with satisfactory CRA status (p < 0.001). A composite scoring tool that is an effective predictor of orthopaedic resident outcomes can be developed. Additional work is still required to refine this scoring tool for orthopaedic residency screening and selection.

Clinical Competence↗
PubMed2005

Trisomy 20 mosaicism caused by a maternal meiosis II error is associated with normal intellect but multiple congenital anomalies.

Mosaicism for trisomy 20 is generally ascertained following prenatal sampling and rarely is associated with significant phenotypic abnormalities. Uniparental disomy for chromosome 20 in the euploid lines has been found in several cases, which showed relatively mild clinical features, primarily growth delay. Here we report on a case of mosaic trisomy 20 in a child with normal neurologic development who was ascertained because of multiple physical anomalies including spinal segmentation anomalies and altered skin pigmentation. Trisomic cells were found in buccal epithelial cells and in cultured skin fibroblasts but not in peripheral blood. Molecular analysis of blood cells, fibroblasts, and parental cells gave evidence of a maternal meiosis II error as the cause of the trisomy. Disomic cells presumably arose through trisomy rescue, and no evidence was found for uniparental disomy in these cells.

Abnormalities, Multiple↗
PubMed2005

Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors.

UNLABELLED: Four children and six adults required en bloc resection of the lateral malleolus for malignant tumors. There were four osteosarcomas, three chondrosarcomas, two Ewing's sarcomas, and one adamantinoma. Surgical margins were wide in seven patients, marginal in two, and intralesional in one. A primary ankle arthrodesis was done in four adults and bracing without any reconstruction was done in four children and two adults. During a mean followup of 14.5 years (range, 3-30 years), there were two local recurrences (two of 10 patients) after a marginal excision and an intralesional excision. One patient had reoperation for a skip osteosarcoma lesion in the proximal fibula. Other complications included chronic osteomyelitis, a lateral talus subluxation and cavovarus deformity, and recurrent ankle instability and degenerative changes of the ankle. At the latest followup, all 10 patients showed no evidence of disease. Five patients who had primary or late ankle arthrodesis had a Musculoskeletal Tumor Society and International Society of Limb Salvage functional score of 28 points (92%), and two adolescents who had postoperative bracing alone had a functional score of 24 points (80%). The three remaining patients had a salvage amputation. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2004

Total hip arthroplasty in patients with dwarfism.

BACKGROUND: Patients with short stature and osseous deformities resulting from osteochondrodysplasia frequently have premature development of advanced degenerative disease of the hip and thus may require total hip arthroplasty. The outcome of total hip arthroplasty in this group of young patients is unknown. In this study, we evaluated the long-term clinical and radiographic outcomes of total hip arthroplasty in patients with osteochondrodysplasia. METHODS: Between 1971 and 1997, sixty-two total hip arthroplasties were performed at our institution in thirty-seven patients with severe osteoarthritis secondary to osteochondrodysplasia. There were seventeen female patients and twenty male patients. Their average height was 142 cm, and their average age at the time of the index arthroplasty was thirty-seven years. The patients were followed clinically with use of the Harris hip score for a mean of 12.8 years, and they were followed radiographically for a mean of 11.5 years. RESULTS: The mean Harris hip score improved significantly (p < 0.0001), from 57 points preoperatively to 87 points at the time of the latest follow-up. Of the sixty hips available for follow-up, eighteen (30%) had required revision arthroplasty: fourteen required it because of aseptic loosening of one or both components; two, because of deep infection; one, because of periprosthetic fracture; and one, because of extensive osteolysis. There were two additional periprosthetic femoral fractures, which were treated with open reduction and internal fixation with retention of the components. The majority of patients had other functionally limiting conditions, such as spinal deformities, in addition to the degenerative arthritis. CONCLUSIONS: There was a high prevalence of complications, periprosthetic fractures, and mechanical failure in these patients with osteochondrodysplasia who underwent total hip arthroplasty. Young age, severe deformity, and multiple joint involvement may in part explain these findings. Nonetheless, total hip arthroplasty proved to be reliable for alleviating pain and improving function in patients with advanced symptomatic arthritis of the hip secondary to osteochondrodysplasia.

Adolescent↗
PubMed2003

Arterial-esophageal fistula: a complication of nasogastric tube placement after lumbar spine surgery: a case report.

STUDY DESIGN: A case of arterial-esophageal fistula related to nasogastric tube placement in a 13-year-old girl after surgical correction of her progressive congenital lumbar kyphosis is presented. OBJECTIVES: This case report illustrates the importance of early recognition of "sentinel" hematemesis before massive hemorrhage, as this may allow for timely surgical intervention to prevent fatal exsanguination. The proposed pathogenesis of the arterial-esophageal fistula in the reported patient is discussed. SUMMARY OF BACKGROUND DATA: Although arterial-esophageal fistula formation has been recognized as an unusual complication of prolonged nasogastric intubation, to the authors' knowledge, this is the only case that illustrates an association of this complication with short-term nasogastric tube placement. METHODS: A 13-year-old girl was evaluated for progressive congenital lumbar kyphosis. Failure of segmentation and an anterior bar at L4-L5 was diagnosed when the patient was 7 years of age. At that time, she showed 28 degrees of kyphosis from L3 to L5. Because of her cardiopulmonary status at the time, she was deemed not to be a candidate for a corrective surgical procedure and followed conservatively until the age of 13 years. At that time, her gibbus deformity was 56 degrees from L3 to L5. She had significant ventral sagittal imbalance, which in combination with her cardiopulmonary abnormalities created difficulty with ambulation. Her preoperative neurologic examination was within normal limits. The patient had an extensive history of congenital cyanotic cardiopulmonary disease. She was born with pulmonary atresia, right-sided aortic arch with mirror image branching, a large coronary sinus type atrial septal defect, and a large ventricular septal defect. She had history of multiple surgical procedures for correction of her congenital cardiopulmonary abnormalities. The patient underwent posterior L3 and L5 wedge pedicle reduction osteotomies with posterior instrumentation and fusion from L2 to S1 using pedicle screw segmental fixation. A nasogastric tube was placed after surgery. On postoperative day 7, profuse bleeding from the patient's mouth and nose developed, which subsequently ceased. Shortly afterward, she became hypotensive and tachycardic. Upper gastrointestinal endoscopy showed a large amount of blood in her stomach without an active source. Cardiac arrest then developed, and she could not be resuscitated. The autopsy findings were consistent with an arterial-esophageal fistula. RESULTS: In the reported patient, the anomalous aortic arch system provided direct contact between the aorta and the esophagus. Dense fibrous adhesions between the aorta and esophagus resulting from multiple previous thoracic surgeries also may have facilitated the development of the fistula by the nasogastric tube in this patient. CONCLUSIONS: Patients with congenital cardiac abnormalities frequently also have congenital spinal deformities. These patients may undergo spinal correction procedures requiring nasogastric intubation. Increased awareness of arterial-esophageal fistula among the spine surgery community may enhance early recognition and treatment of this potentially lethal condition.

Arteries↗
PubMed2003

Total knee arthroplasty in young patients with juvenile rheumatoid arthritis.

BACKGROUND: Juvenile rheumatoid arthritis is a disabling and destructive condition that commonly affects the knee during childhood. Total knee arthroplasty occasionally may be necessary for the treatment of end-stage disabling arthritis of the knee in young patients. There is a paucity of available data on the results of total knee arthroplasty in adolescents. We report our experience with total knee arthroplasty in patients under the age of twenty years who had juvenile rheumatoid arthritis. MATERIALS AND METHODS: We reviewed the results of twenty-five consecutive total knee arthroplasties that had been performed at our institution between 1982 to 1997 in thirteen patients (mean age, seventeen years) with juvenile rheumatoid arthritis. The average duration of clinical follow-up was 10.7 years, and the average duration of radiographic follow-up was 6.5 years. RESULTS: The mean Knee Society pain score improved markedly from 27.6 to 88.3 points, and the mean Knee Society function score improved modestly from 14.8 to 39.2 points. There was a slight improvement in the range of motion. Symptomatic and progressive radiolucent lines were noted in two knees, one of which was revised. Two knees (one patient) required exchange of the polyethylene liner at thirteen years. There were four additional reoperations, including manipulation under general anesthesia (two knees in one patient), lysis of adhesions (one knee), and extensor mechanism realignment (one knee). CONCLUSIONS: Despite a substantial number of postoperative complications, total knee arthroplasty provided excellent relief of pain and improvement in function in this group of adolescent patients with juvenile rheumatoid arthritis.

Adolescent↗
PubMedDate not supplied

Farm-related limb amputations in children.

The purpose of this study was to review results for children sustaining traumatic farm-related limb amputations. Farm machinery accidents were responsible for 12 limb amputations among 260 consecutive childhood traumatic amputations. All amputations resulted in open, grade III-C fractures. Treatment consisted of operative debridement, antibiotics, possible replantation, and delayed wound closure. Mean follow-up was 8 years (range 1-20). Wound closure was achieved at a mean of 22 days (range 2-88) after an average of seven operative procedures (range, 2-11 operations). Skin grafting was necessary for 9 of the 12 limbs. Blood replacement was necessary for all but one patient. Initial wound cultures revealed polymicrobial contamination in all patients. Clinical infections developed exclusively and in all (6/6) patients who underwent attempted replantation. Replantation was considered in all cases and was attempted for six limbs but was successful in only two patients. Failure of replantation in four limbs was due to vascular insufficiency and infection. The surviving replanted limbs have continued to grow and have regained protective sensation. Prosthetic use ranges from excellent to intermittent among the 10 patients with permanent amputation. Farm-related limb amputations are among the most severe orthopaedic injuries sustained by children. Despite massive contamination, infection occurred only in replanted limbs. Because of the mutilating nature of these amputations, less than 20% can be successfully replanted.

Adolescent↗