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Biomedical subjects

Carl L Stanitski

Publications and source records attributed to Carl L Stanitski.

At least 19 recordsLinked to original sources
PubMed2003

Acute tibial tubercle avulsion fractures.

Acute tibial tubercle avulsion fractures are uncommon, and these injuries typically occur in mature-appearing adolescent boys involved in jumping sports, particularly basketball. The developmental anatomy of the tibial tuberosity and the changes surrounding normal physiologic epiphysiodesis render this structure susceptible to acute avulsion fractures. Possible associated injuries include patellar and quadriceps avulsions, collateral and cruciate ligament tears, and meniscal damage. The treatment of this injury is based on the amount of displacement and associated injuries. Nondisplaced fractures are treated nonoperatively with cast immobilization. Displaced fractures require open reduction and internal fixation. Even in Type III injuries, the outcome is usually excellent.

Acute Disease↗
PubMed2003

Anterior cruciate ligament injury in the skeletally immature.

Although ACL injuries in truly skeletally immature patients are relatively uncommon events, they are experienced more frequently than initially reported--especially in the adolescent population. Natural history data is limited but appears to mirror the natural history in adults with this injury if return to high-risk activity is allowed. Treatment of this injury presents unique challenges because of the substantial growth that occurs through the distal femoral and proximal tibial physes. The physiologic skeletal maturity of the patient must be determined prior to deciding treatment. Techniques of reconstruction include physeal sparing, partial transphyseal, and transphyseal methods. Reconstruction is recommended for any patient with an "ACL +" knee (a complete ACL tear and concomitant meniscal injury) or one who is non-compliant with a nonoperative treatment program and develops symptoms of persistent instability. Short-term outcomes of functional return postreconstruction appear promising, but study numbers are small and follow-up times relatively brief in truly immature patients. Long-term outcome studies are still needed.

Adolescent↗
PubMedDate not supplied

Slipped capital femoral epiphysis: physeal histologic features before and after fixation.

Physeal histopathologic changes following slipped capital femoral epiphysis (SCFE) are usually considered permanent. This assumption may not be correct, since radiographic signs of proximal femoral neck growth and remodeling are commonly seen after fixation. This work analyzed the physeal histologic features of chondroepiphyseal biopsies before and after SCFE surgical fixation but before complete physiologic epiphysiodesis. Eighteen patients, nine with unstable and nine with stable SCFE of varying severity, had pretreatment biopsies. Three patients had postfixation biopsies prior to total physiologic proximal femoral epiphysiodesis. Pretreatment biopsies showed varied degrees of histoarchitectural changes ranging from almost normal arrangement to markedly deranged physeal morphology. Postfixation biopsies showed improved physeal organization in a case of moderate unstable SCFE. In one severe unstable case and one severe stable case, nearly normal physeal architecture was seen. Physeal histopathologic changes appear to improve after fixation. Progressive modulation of the recovering physis after fixation helps explain the remodeling and growth changes seen radiographically after chondroepiphyseal fixation.

Arthroscopy↗
PubMedDate not supplied

Acute tibial tubercle avulsion fractures.

A retrospective analysis of 18 patients with 19 acute tibial tubercle avulsion fractures was performed. Mean age at injury was 13 years 8 months. Mean follow-up time was 2 years 8 months. A group of four preadolescent patients ages 9 to 12 years at injury was identified. Participation in athletics, particularly basketball, resulted in 77% of fractures. There were one type IA, three type IB, two type IIA, six type IIB, two type IIIA, four type IIIB, and one type IV fractures. Fifteen fractures were treated with open reduction and internal fixation and four by closed reduction and cylinder cast immobilization. Three cases (15.7%) of extensor mechanism disruption were noted, two patellar tendon avulsions and one quadriceps avulsion. Final outcome was good in all patients regardless of fracture type or treatment. There were no complications.

Adolescent↗
PubMedDate not supplied

Osteochondritis dissecans: Wilson's sign revisited.

BACKGROUND: In 1967, Wilson described a clinical sign that he thought was diagnostic of medial femoral osteochondritis dissecans. He postulated that impingement of the tibial eminence on the osteochondritic lesion caused pain and a resultant compensatory lateral rotation during gait. He described reproducing the pain by internally rotating the patient's tibia during knee extension between 90 degrees and 30 degrees of flexion and then relieving that pain by externally rotating the tibia. He correlated healing of the lesion with conversion of the sign from positive to negative. PURPOSE: To assess the validity of Wilson's assertions. STUDY DESIGN: Retrospective clinical and radiographic case analysis. METHODS: Case records from 17 juvenile patients (ages 9 to 12) and 15 adolescent patients (ages 13 to 17) with medial femoral osteochondritis dissecans were reviewed for the presence or absence of Wilson's sign at initial and subsequent visits. RESULTS: Of the 32 patients, 24 (75%) with radiographically evident osteochondritis dissecans at the initial visit had negative signs. The remaining eight patients with positive signs had conversion of the sign to negative with lesion resolution. CONCLUSIONS: In this series, Wilson's sign was of minimal clinical diagnostic value. When positive, the sign is useful as a clinical monitor during treatment.

Adolescent↗
PubMedDate not supplied

Preoperative evaluation and anterior cruciate ligament reconstruction technique for skeletally immature patients in Tanner stages 2 and 3.

BACKGROUND: Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients carries the risk of adverse sequelae. PURPOSE: 1) To provide clinical and radiographic methods to identify skeletally immature patients with significant remaining lower limb growth. 2) To provide a method for calculating the percent area lesion created by a 6-mm distal femoral physeal tunnel. 3) To present a method of partial transphyseal intraarticular anterior cruciate ligament reconstruction with bipolar graft fixation in these patients. 4) To report on clinical, functional, and radiographic results at skeletal maturity. METHODS: Fourteen adolescents with symptomatic anterior cruciate ligament instability who were identified as being in Tanner stages 2 and 3 underwent partial transphyseal intraarticular anterior cruciate ligament reconstruction with the use of hamstring tendon grafts (transphyseal only in the femur and through the epiphysis in the tibia). RESULTS: At skeletal maturity, 10 patients were asymptomatic and fully active in sports. No patient had significant leg-length inequality or angular deformity after use of a 6-mm femoral physeal tunnel, which represented 1) less than 7% of the frontal plane and 2) less than 1% of the transverse plane cross-sectional femoral physeal areas. CONCLUSIONS: The choice of the exposed technique and the method used to select patients permitted us to avoid adverse sequelae.

Adolescent↗
PubMedDate not supplied

Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents.

BACKGROUND: In the very young patient in need of anterior cruciate ligament reconstruction, the option of reconstruction with physeal-sparing techniques is valid because it is not known what percentage of physeal transgression causes adverse growth consequences. PURPOSE: To report our experience with an intraarticular technique for anterior cruciate ligament reconstruction that spares the open femoral and tibial physes yet allows soft tissue graft fixation in the femoral and tibial tunnels. METHODS: Eight preadolescents underwent physeal-sparing intraarticular reconstruction for anterior cruciate ligament insufficiency with the use of semitendinosus and gracilis tendon grafts. All eight patients were in Tanner stage 1 with an average chronologic age of 11.15 years and average bone age of 10.9 years. Preoperative prediction of lower limb growth averaged 10.8 cm. RESULTS: Five of the eight patients had reached skeletal maturity at follow-up, which was at an average of 69.2 months postoperatively. For these five, the Orthopadische Arbeitsgruppe Knie (OAK) score averaged 97 and the average KT-2000 arthrometer difference was 1.8 mm. Average growth in total height from surgery to final follow-up was 21.7 cm. No patient had a leg-length discrepancy or angular deformity, as verified by clinical or teleroentgenogram measurements. CONCLUSIONS: The technique presented in this study provided graft isometry and stability without adverse physeal consequences. Additional research is needed to determine the threshold percentage of physeal transgression for avoiding growth disturbances in humans.

Anterior Cruciate Ligament↗