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Biomedical subjects

B S Richards

Publications and source records attributed to B S Richards.

32 records · Page 2Linked to original sources
PubMed1989

Frontal plane and sagittal plane balance following Cotrel-Dubousset instrumentation for idiopathic scoliosis.

Postoperative decompensation has been reported following Cotrel-Dubousset instrumentation for right thoracic idiopathic scoliosis. The authors examined balance in the frontal and sagittal planes in 53 patients to determine optimal levels for fusion. King et al Type II curves, particularly larger ones, shifted to the left when the thoracic curve was fused to the stable vertebra or just below. Most Type III curves balanced well regardless of the levels fused. One-third of all patients developed mild radiographic junctional kyphosis at the lower level instrumented, more commonly when instrumentation ended at or above T12. The authors recommend fusing one segment short of the stable vertebra in most Type II curves. Large Type II curves need both curves fused for optimal balance. Type III curves can be fused short of the stable vertebra.

Adolescent↗
PubMed1988

Anterior perineal dislocation of the hip with fracture of the femoral head. A case report.

Traumatic anterior perineal hip dislocation with an associated fracture of the femoral head is a rare entity. A 26-year-old man injured in a motorcycle accident was treated by closed reduction of the dislocation within three hours after admission. However, several reports of patients with anterior hip dislocation with associated femoral head fractures were treated nonoperatively and had unfavorable results when treatment failed to achieve anatomical position of the fragments. Consequently, this patient was treated by open reduction and internal fixation of the fractured fragment. Follow-up examination three and one-half years after the operation showed painless functional range of hip motion with only minimal discomfort after prolonged exertion.

Adult↗
PubMed1987

Subluxation of the femoral head in coxa plana.

Twenty-two patients who had severe coxa plana had closed reduction for lateral subluxation of the femoral head, as determined radiographically. All had painful limitation of motion of the hip that prevented proper positioning of the femoral head using a brace. The average age when the patients were first seen was eight years and six months. General anesthesia was required in order to obtain the reduction, and percutaneous tenotomy of the adductor longus was done whenever necessary. After the reduction, a Petrie cast was worn for several months. The length of follow-up averaged three years and eight months (range, two years to six years and eight months). Radiographic evaluation at the time of the last follow-up showed nine hips to be spherically congruent, twelve to be spherically congruent, and one to be incongruent. Thus, in 95 per cent of the hips, a congruent joint was obtained using this method of treatment. These results strongly support the concept that all treatment should be directed at containing the femoral head within the acetabulum during the clinically active phase of coxa plana.

Casts, Surgical↗
PubMed1976

Associative and conceptual organization in thought disorder.

Thought disorder has frequently been described either as a disturbance of associative response hierarchies or as an inability to deal with objects or events as representative of classes. The tendency of normal subjects to organize free recall by clustering associatively or conceptually related words suggested the recall task as a means to investigate these views of thought disorder. Two groups of psychiatric patients, one with high scores on Lovibond's version of the OST, one with low (thought-disordered and non-thought-disordered, respectively), were presented with randomly ordered word lists containing pairs related associatively and pairs related taxonomically. Thought-disordered and non-thought-disordered groups were not differentiated by any tendency to cluster more of one kind of pair than another. Rather, the thought-disordered showed a general lack of organization in recall, and significantly less improvement over trials in amount recalled. The results do not support the view that thought disorder is specifically a disorder of concept use or conceptual mediation. Research needs to be addressed to variables which affect the activation or inhibition of mediational links in thinking.

Adult↗
PubMedDate not supplied

Intermediate follow-up of a simple method of hip arthrodesis in adolescent patients.

Thirteen male patients (average age, 15.6 years) underwent intraarticular hip arthrodesis for unilateral disabling hip disease. Follow-up averaged 6.6 years. Seven patients had excellent or good Harris hip scores. Ten patients had low back pain, and seven patients had knee pain on the side of the fused hip. Limb-length discrepancy averaged 3.7 cm. A progressive hip adduction drift (average, 7 degrees) occurred during follow-up. Patients whose hips were fused in a position of 20-25 degrees flexion and whose limb-length discrepancies were < 2 cm had significantly lower incidences of back pain. Cybex muscle testing revealed significantly decreased quadriceps strength (29%) on the hip-fusion side. Gait laboratory analysis demonstrated decreased velocity, stride length, and cadence. There were two mildly symptomatic nonunions. Based on these results, we recommend that the hip fusion be positioned in 20 degrees flexion and 0 degree abduction. The joint must be completely debrided down to viable bone to maximize chances for union. Maintaining a limb-length discrepancy of < 2 cm is essential to minimize the incidence of low back pain, quadriceps deficiency, and abnormal gait parameters.

Adolescent↗
PubMedDate not supplied

Orthopedic aspects of Rett syndrome: a multicenter review.

Twenty-three of 36 patients (64%) with Rett syndrome showed orthopedic problems at an average age of 8 years 7 months. Sixteen patients had spinal deformities (45%), six had scoliosis, one had sagittal deformity, and nine had scoliosis with sagittal deformity. Eight patients with scoliosis have shown progression, with two patients requiring surgery. Thirteen patients (36%) exhibited joint contractures; three of them have required surgery. Ten fractures occurred in five patients (14%). Coxa valga was present in all 14 hips. Skeletal ages in four preadolescent patients were normal.

Adolescent↗
PubMedDate not supplied

Complications after posterior spinal fusion in Duchenne's muscular dystrophy.

Patients with Duchenne's muscular dystrophy often develop progressive scoliosis. Should spinal stabilization be necessary, these patients are considered at high risk for surgically related complications. This retrospective study of 30 patients with Duchenne's examined the prevalence and types of complications associated with posterior spinal fusion and determined the percentage of patients who lived > or = 2 years beyond surgery. Major complications related to cardiopulmonary compromise, infection, or hardware complications occurred in 27%, and minor complications occurred in another 16%. Seventy-seven percent of the patients lived > or = 2 years beyond their surgery. The majority of patients and their families, including half of those who had major complications, reported that surgery resulted in an improvement in their quality of life. Although complications are common, the benefits realized by the patient with Duchenne's muscular dystrophy with scoliosis reinforce the importance of surgical stabilization.

Adolescent↗
PubMedDate not supplied

Effectiveness of brace treatment in early infantile Blount's disease.

In an effort to determine whether bracing is effective in reversing early infantile Blount's disease, 27 patients with Langenskiold stage II disease were studied. Ten patients had bilateral disease (two of these patients had stage III disease affecting one side). Age at brace initiation averaged 2.1 years (range, 1.5-3.2). The duration of bracing averaged 9.7 months. Follow-up averaged 5.9 years. Successful outcomes (improved alignment without the need for osteotomy) were achieved in 19 (70%) patients, the majority of them having unilateral disease. Of the 37 affected extremities, 24 (65%) had successful outcomes. Eight patients (13 extremities) required tibial osteotomies and were classified as bracing failures. Of the 10 patients with bilateral involvement, seven (70%) required osteotomies for one or both extremities, whereas only one (6%) of 17 patients with unilateral involvement required osteotomy. Bracing appears to be effective in stage II infantile Blount's disease, particularly in those with unilateral involvement. Children with bilateral disease are most at risk for requiring subsequent corrective osteotomy.

Bone Diseases, Developmental↗