Biomedical subjects

A M Capelli

Publications and source records attributed to A M Capelli.

24 records · Page 2Linked to original sources

PubMedDate not supplied

Premature closure of the triradiate cartilage: a potential complication of pericapsular acetabuloplasty.

A case of premature triradiate cartilage closure secondary to a Gill acetabuloplasty performed at age 14 months is reported. The deficiency in acetabular development and failure of the pelvis to grow to its anticipated height is documented. A proximal femoral redirectional osteotomy and an innominate osteotomy performed near maturity improved femoral head coverage and hip biomechanics. Acetabuloplasties performed adjacent to the triradiate cartilage typically do not have any adverse effect on its function. Despite this low risk of injury to the triradiate cartilage after a Gill or Pemberton acetabuloplasty, long-term follow-up is recommended to observe acetabular development. Premature closure is most likely to occur if the bone graft used to maintain fragment displacement crosses the triradiate cartilage.

Acetabulum↗

PubMedDate not supplied

Blount's disease: a retrospective review and recommendations for treatment.

Thirty-two patients treated for Blount's disease were retrospectively reviewed. The results of treatment were assessed by clinical and radiographic parameters and arbitrarily classified good, fair, or poor. Five patients were definitively treated with braces; five extremities were rated good and one poor. Twelve patients were treated with a proximal tibial osteotomy performed before their fifth birthday. Nineteen extremities were rated good, one fair, and three poor. Fifteen patients had their initial surgical procedure after the fifth birthday. Eight extremities were rated good, six fair, and seven poor. Recurrence of the varus deformity secondary to an unsuspected medial bony physeal bar occurred in four patients. Resection of this bony bridge concomitant with a varus correcting osteotomy may be indicated. For severe deformity in older children, several different salvage procedures were used.

Adolescent↗

PubMedDate not supplied

Management of lower-extremity deformities in osteogenesis imperfecta with extensible intramedullary rod technique: a 20-year experience.

Twelve patients (seven boys, five girls) who had osteogenesis imperfecta were treated with an extensible-rod system in 21 femurs and 15 tibias. Indications for use of extensible rods were multiple fractures, long-bone deformity prohibiting bracing and ambulation, and significant remaining linear growth. The average patient age at the time of placement of the extensible rods was 6 + 8 years (range, 2 + 4-10 + 10). Six femurs were treated with overlapping Rush rods; Bailey-Dubow rods were used in the remaining femurs and in all tibias. The average length of follow-up was 5 + 9 years (range, 2 + 0-3 + 2). Preoperatively, four of the 12 patients had never walked; postoperatively, all were ambulators with varying levels of assistance. Fourteen complications occurred, 12 of which required operative revision of the extensible rods. The average time between primary extensible rodding and revision was 5 + 1 years. No complications have occurred to date related to the use of overlapping Rush rods. No growth disturbance resulted from the use of the extensible-rod systems.

Bone Diseases, Developmental↗

PubMedDate not supplied

Pemberton osteotomy for the treatment of developmental dysplasia of the hip in older children.

A retrospective analysis was done of the results of the Pemberton osteotomy for the treatment of developmental dysplasia of the hip in 16 hips of 14 children older than 7 years. The average age of the patients at the time of surgery was 11+6 years and the average follow-up was 4+10 years. Eleven hips required one or more surgical procedures concomitant with the Pemberton osteotomy to achieve a concentric and congruous reduction of the hip joint. None of the hips developed avascular necrosis of the acetabular fragment. The center-edge angle improved from a preoperative average of 1 degree to an average of 30 degrees at the most recent follow-up. Correction of acetabular dysplasia was noted in 14 of the 16 hips, as demonstrated by the improvement in the acetabular index, the center-edge angle, and the Severin class. We believe that the Pemberton osteotomy can be a safe and effective procedure for the treatment of developmental dysplasia of the hip in the older child.

Adolescent↗

PubMedDate not supplied

Subtalar arthroereisis for the correction of planovalgus foot in children with neuromuscular disorders.

We studied the results of 140 STA-peg arthroereisis procedures performed for the treatment of planovalgus foot deformity in 78 ambulatory children with neuromuscular disease. Patient age at surgery ranged from 2 + 2 to 14 + 11 years, with a mean of 7 + 9 years. Patients were followed up for an average of 4 + 6 years. The ultrahigh-molecular-weight polyethylene (UHMWPE) STA-peg implant is inserted laterally into the subtalar joint such that its stem extends inferiorly into the calcaneus and its collar abuts the inferior surface of the lateral process of the talus, thereby blocking excessive valgus tilt of the calcaneus. All but five patients (nine feet) had concomitant soft-tissue procedures to balance the foot. The talocalcaneal angle and the talar declination angle were measured on lateral radiographs preoperatively, postoperatively, and at the latest follow-up visit. Patients were evaluated for the presence of pain and hindfoot valgus deformity. Satisfactory results were achieved in 135 (96.4%) feet. Results were unsatisfactory in one foot of each of five patients who had bilateral procedures; one was painful, and four developed varus. The STA-peg was removed in these five patients. No infections or adverse tissue reactions to the STA-peg implant were observed. STA-peg arthroereisis, combined with satisfactory muscle-balancing procedures, can predictably achieve control of planovalgus foot deformity in children with neuromuscular disorders and may obviate the need for long-term orthotic wear.

Adolescent↗

PubMedDate not supplied

The effect of unilateral varus rotational osteotomy with or without pelvic osteotomy on the contralateral hip in patients with perinatal static encephalopathy.

Forty-eight patients with perinatal static encephalopathy were treated with unilateral varus rotational femoral osteotomy for hip subluxation. Twenty-one of the 48 also had concomitant pelvic osteotomy. Twenty-seven of the patients were nonambulators. Bilateral soft-tissue releases had been performed previously in 20 patients. At the time of varus rotational osteotomy, the mean age was 8 years, 11 months. The indication for a varus rotational osteotomy was femoral head subluxation or dislocation in all cases. The preoperative center-edge angle ranged from -8 degrees to 18 degrees (mean, 4 degrees), and on the contralateral side, the center-edge angle ranged from 0 degree to 32 degrees (mean, 19 degrees). The center-edge angle on the operative side at follow-up averaged 25 degrees (-10 degrees to 78 degrees), an improvement of 21 degrees, and on the contralateral side averaged 27 degrees (range, 9 degrees-40 degrees), an improvement of 8 degrees. Forty-seven patients have had no subsequent surgery on the contralateral hip. One patient had a varus rotational osteotomy on the contralateral hip 5 years postoperatively; however, this hip was subluxated at the time of the index procedure. Twelve patients have had no surgery at any time on the contralateral side. None of these patients had deterioration of the contralateral hip. Surgery on one hip should not, in itself, be an indication for surgery on the contralateral concentrically reduced hip with adequate abduction in patients with acetabular dysplasia secondary to perinatal static encephalopathy.

Adolescent↗