Biomedical subjects

C T Price

Publications and source records attributed to C T Price.

46 records · Page 3Linked to original sources

PubMedDate not supplied

Behavioral sequelae of bracing versus surgery for Legg-Calvé-Perthes disease.

The Louisville Behavioral Checklist was administered to 23 white boys between the ages of 7 and 12 years who completed treatment for Perthes disease by bracing or surgery at the Florida Elks Children's Hospital. The groups were comparable, with 11 children in the surgery group and 12 in the bracing group. Results indicated statistically significant differences (p = 0.05) between the groups in three areas. Patients in the bracing group were more likely to demonstrate deficits in social, academic, and sexual behavior as compared with patients in the surgery group.

Analysis of Variance↗

PubMedDate not supplied

Limb lengthening for achondroplasia: early experience.

Three adolescent patients underwent limb lengthening for achondroplasia by the DeBastiani technique. Average increase in length was 15.4 cm (37.7%) per limb. Bone formation was excellent, and there were no neurovascular complications or infections. Numerous problems were encountered during treatment, but there were only two residual complications in one patient. Soft tissue tension and contractures precluded further lengthening in each case. Thirty-five percent lengthening may be the maximum that can be safely achieved for achondroplasia, and though it may produce cosmetic and psychological benefits, the functional benefits may not justify the expense, morbidity, and risk of the procedure.

Achondroplasia↗

PubMedDate not supplied

Malunited forearm fractures in children.

From 1971 to 1986, 80 skeletally immature patients with severe diaphyseal both-bone forearm fractures were treated at Orlando Regional Medical Center. Greenstick, Monteggia, and Galeazzi fractures were excluded. Seventy-nine fractures were managed by closed means. When anatomic reduction could not be obtained, the best position was accepted. There were 47 patients with malunions of whom 39 returned for follow-up evaluation greater than 2 years after injury. They form the basis of this study. There were no delayed unions or nonunions in the entire group. Average follow-up in the group reported was 5 years 9 months (range 2 years to 13 years 10 months). All patients were satisfied with their functional and cosmetic results regardless of age, angulation, complete displacement, or loss of radial bow at time of union. Only nine patients had loss of motion. By our criteria, 36 patients (92%) had good or excellent results, with 32 excellent and four good results. Three patients (8%) had fair results, and there were no poor results. Age at time of injury did not correlate with recovery of motion. Distal fractures were found to have a better prognosis than proximal fractures. Based on the results of this study, closed reduction is the treatment of choice for skeletally immature patients with diaphyseal fractures of the radius and ulna.

Adolescent↗

PubMedDate not supplied

A simple demonstration of hindfoot flexibility in the cavovarus foot.

A simple prone examination for demonstrating both hindfoot flexibility and the "tripod" effect in the cavovarus foot has been implemented. This clinical evaluation can be performed without the use of any special equipment. Prone positioning also allows easy demonstration of deformity to family members.

Foot Deformities↗

PubMedDate not supplied

Forearm and distal radius fractures in children.

Pediatric forearm and distal radius fractures are common injuries. Resultant deformities are usually a product of indirect trauma involving angular loading combined with rotational displacement. Fractures are classified by location, completeness, angular and rotational deformity, and fragment displacement. Successful outcomes are based on restoration of adequate pronation and supination and, to a lesser degree, acceptable cosmesis. When several important concepts are kept in mind, these goals are usually met with conservative treatment by reduction and immobilization. Greenstick fractures are reduced by rotating the forearm such that the palm is directed toward the fracture apex. Complete fractures are manipulated and reduced with traction and rotation; extremities are then immobilized in well-molded plaster casts until healing, which usually takes about 6 weeks. Radiographs should be obtained between 1 and 2 weeks after initial reduction to detect early angulation. In fractures in any level in children less than 9 years of age, complete displacement, 15 degrees of angulation, and 45 degrees of malrotation are acceptable. In children 9 years of age or older, 30 degrees of malrotation is acceptable, with 10 degrees of angulation for proximal fractures and 15 degrees for more distal fractures. Complete bayonet apposition is acceptable, especially for distal radius fractures, as long as angulation does not exceed 20 degrees and 2 years of growth remains. Operative intervention is used when the fracture is open and when acceptable alignment cannot be achieved or maintained. Single-bone intramedullary fixation has proven useful.

Anesthesia↗

PubMedDate not supplied

Results of femoral varus osteotomy in children older than 9 years of age with Perthes disease.

We review the results of varus osteotomy in 17 patients older than 9 years of age with 18 hips affected by Perthes disease. Seventeen hips were judged as Catterall 3 or 4, and 14 hips had partial or complete loss of the lateral pillar. At an average follow-up of 10 years (4.2-17.8 years), 3 hips were rated Stulberg 1, 3 were Stulberg 2, 4 were Stulberg 3, and 8 were Stulberg 4 or 5. At follow-up, 7 hips were considered good or fair based on the use of Mose circles. Statistical analysis indicated better results in patients younger than 10 years of age compared with those older than 10 years of age. Varus osteotomy as a method of containment for Perthes disease provides improved results in children older than 9 years compared with natural history studies or studies of noncontainment methods. However, it seems likely that there is an upper age limit for effectiveness of containment treatment.

Adolescent↗

PubMedDate not supplied

Unilateral external fixation for corrective osteotomies in patients with hypophosphatemic rickets.

Extremity deformities in patients with hypophosphatemic rickets (HPR) are often complex and multiplanar. Described methods for correcting these deformities are imprecise and require interruption of the medical management of the condition. Corrective osteotomies were performed on 29 bones in nine children with HPR. Use of the Orthofix external fixator enabled precise correction of the deformities without interruption of medical management.

Adolescent↗

PubMedDate not supplied

Dynamic axial external fixation in the surgical treatment of tibia vara.

Osteotomy is the well-established treatment of Blount's disease (tibia vara), although the types of fixation used vary considerably. The use of dynamic axial external fixation to stabilize osteotomies for tibia vara until solid union occurs without the use of supplemental casting has not been reported by other authors. From 1985 until the present, we have used osteotomy with dynamic axial external fixation as treatment of 31 tibiae in 23 patients. All osteotomies healed and there was no postoperative loss of correction. There was an average correction of 20 degrees between the pre- and postoperative mechanical axis. Advantages of dynamic axial external fixation include ease of application, adjustability, early weight bearing, the ability to lengthen the extremity, and no second operation for removal of hardware. Based on our results, we believe that dynamic axial external fixation is an excellent form of osteotomy stabilization in the surgical treatment of tibia vara.

Adolescent↗

PubMedDate not supplied

Acute correction and distraction osteogenesis for the malaligned and shortened lower extremity.

In limbs with combined shortening with angulation or malrotation, deformity may be quickly or slowly corrected before lengthening with external fixation. We examined a series of 35 patients with 40 limbs that underwent acute deformity correction and subsequent gradual lengthening. The average deformity corrected was 19 degrees, with subsequent average lengthening of 4.1 cm. Good radiographic callus formation was noted in 34 of the 40 segments studied. The magnitude of deformity correction had no effect on the quality of lengthened bone, incidence of complications, or the healing index. Skeletally mature segments had statistically significant decreased bone formation (p = 0.001), increased prevalence of callus complications (p = 0.001), and a higher healing index (p = 0.003). Based on this experience, it is our conclusion that immediate correction and lengthening is suitable in children and adolescents who have malaligned and shortened lower extremities. Because of poorer results in older patients, we believe that other techniques should be considered in adults.

Adolescent↗

PubMedDate not supplied

Nighttime bracing for adolescent idiopathic scoliosis with the Charleston Bending Brace: long-term follow-up.

We report long-term experience with the Charleston Bending Brace for treatment of adolescent idiopathic scoliosis. This brace holds the patient in maximal side-bending correction and is worn at nighttime only. Patients included in this prospective multicenter study met all of the following criteria: skeletal immaturity (Risser 0, 1, or 2), curvature >25 degrees before bracing, no prior treatment, and >1-year follow-up since completion of bracing (skeletal maturity or progression to surgery). All curves were monitored and reported. There were 149 structural curves in 98 patients. Sixty-five (66%) patients showed improvement or <5 degrees change in curvature. Seventeen (17%) patients progressed to the point of requiring surgery for their scoliosis. Based on these long-term results and improvement of the natural history of adolescent idiopathic scoliosis, continued use of the Charleston Bending Brace is justified.

Adolescent↗