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Biomedical subjects

D L Skaggs

Publications and source records attributed to D L Skaggs.

At least 37 records · Page 2Linked to original sources
PubMed1999

Lengthening of pediatric forearm deformities using the Ilizarov technique: functional and cosmetic results.

Eight patients (average age, 10 years) had a unilateral forearm lengthening procedure using the technique developed by Ilizarov. The procedure was performed in 4 patients with radial agenesis, in 2 with multiple hereditary exostosis, in 1 with ulnar agenesis, and in 1 with multiple enchondromatosis. Patients underwent distraction osteogenesis through either a unifocal or bifocal corticotomy. Forearm length increased on average 6.0 cm (range, 3.6-8.1 cm) or 54% (range, 21% to 94%) with a lengthening index of 1.3 months per centimeter (range, 0.6-1.9 months per centimeter). The length of follow-up averaged 4.5 years and involved office examinations with task evaluation and a questionnaire addressing function and appearance. Limb length discrepancy at follow-up measured 3.7 cm (range, 0.0-8.0 cm). Lengthening of the forearm was found to improve upper extremity function; it allowed the patient to reach distant body parts and to perform select activities requiring near-equal arm length. Forearm lengthening also improved the appearance of the arm if adequate soft tissue was preserved. Full restoration of arm length was not a requirement for a successful outcome and patient satisfaction with the results of the procedure was high.

Adolescent↗
PubMed1999

The posterior fat pad sign in association with occult fracture of the elbow in children.

BACKGROUND: An elevated posterior fat pad visible on a lateral radiograph of a child's elbow following trauma is generally considered to be suggestive of an intracapsular fracture about the elbow. However, in previous studies, the prevalence of fracture in elbows with an elevated posterior fat pad and no other radiographic evidence of fracture has ranged from only 6 percent (two of thirty-one) to 29 percent (nine of thirty-one). We are not aware of any prospective studies, limited to children, on the value of an elevated posterior fat pad as an indicator of an occult fracture about the elbow. While it is common practice to manage children who have radiographic evidence of an elevated posterior fat pad as if they have a fracture, scientific evidence for this approach is lacking. METHODS: Forty-five consecutive children who had an average age of four and a half years, a history of trauma to the elbow, and an elevated posterior fat pad without other radiographic evidence of a fracture were enrolled in the study. At an average of three weeks after the injury, anteroposterior, lateral, and two oblique radiographs were made and evaluated for evidence of fracture-healing. If there was evidence of new-bone formation on any of these four radiographs, it was considered to indicate a fracture of the elbow. RESULTS: Thirty-four (76 percent) of the forty-five patients had evidence of a fracture. Eighteen (53 percent) of the thirty-four had a supracondylar fracture of the humerus; nine (26 percent), a fracture of the proximal part of the ulna; four (12 percent), a fracture of the lateral condyle; and three (9 percent), a fracture of the radial neck. CONCLUSIONS: This prospective study demonstrated that the posterior fat pad sign was predictive of an occult fracture of the elbow following trauma in thirty-four (76 percent) of forty-five children who had no other evidence of fracture on anteroposterior, lateral, and oblique radiographs after the injury. This finding is in contrast to those of previous studies, in which the highest prevalence of fracture in elbows with an elevated posterior fat pad and no other radiographic evidence of fracture was 29 percent (nine of thirty-one elbows). Our results support the practice of managing children who have a history of trauma to the elbow, an elevated posterior fat pad, and no other radiographic evidence of fracture as if they have a nondisplaced fracture about the elbow.

Child, Preschool↗
PubMed1998

Supracondylar humerus fractures in children.

Supracondylar fractures of the humerus are the most common fractures in children that require surgery. A significant advancement in the field of pediatric orthopedics has been closed reduction and percutaneous pinning of these fractures. This technique, using high quality fluoroscopic imaging, allows for a near anatomical reduction of fractures without the need for an open surgical procedure or prolonged traction. Supracondylar fractures in children are often associated with neurologic and vascular damage that must be recognized before fracture reduction. Nursing staff members' skill with pediatric patients can greatly aid the surgeon in the timely and safe treatment of these fractures.

Child, Preschool↗
PubMed1998

Use of a hybrid external fixator for a severely comminuted juxta-articular fracture of the distal humerus.

Severely comminuted, juxta-articular fractures present a difficult management dilemma for orthopaedic surgeons. Recently, hybrid external fixators have been used for treatment of such fractures in the lower extremity, particularly in the tibial plateau and the tibial plafond. The same technique may be applied to the upper extremity with gratifying results. This technique has the advantage of minimal dissection while restoring limb alignment and permitting immediate joint motion. The proximity of neurovascular structures to the humerus requires careful attention to anatomic detail when placing such a fixator.

Adolescent↗
PubMed1998

Differential effect of race on the axial and appendicular skeletons of children.

The prevalence of osteoporosis and the incidence of fractures are substantially lower in black than in white subjects, a finding generally attributed to racial differences in adult bone mass. Whether these racial differences are present in childhood is the subject of considerable interest, as the amount of bone gained during growth is a major determinant of future susceptibility to fractures. We measured the density and size of the vertebrae and femurs of 80 black and 80 white healthy children, 8-18 yr of age, matched for age, gender, height, weight, and stage of sexual development, using computed tomography. Race had a significant and differential effect on the bones in the axial and appendicular skeletons. In the axial skeleton, black children had greater cancellous bone density, but similar cross-sectional area of the vertebral bodies. In contrast, in the appendicular skeleton, black children had greater femoral cross-sectional area, but similar cortical bone area and cortical bone density. Compared to white children, vertebral bone density and femoral cross-sectional area at sexual maturity were, on the average, 10.75% and 5.7% higher, respectively, in black children. Such significant variations may contribute to the racial differences in the prevalence of osteoporosis between black and white adults.

Adolescent↗
PubMed1998

The pediatric Monteggia fracture.

Since Monteggia first described the fracture bearing his name in 1814, the association of radial head dislocation with ipsilateral ulnar fracture has been well described. Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. This article describes the diagnosis, treatment, and potential pitfalls encountered in the treatment of Monteggia fractures.

Child↗
PubMed1997

Psoas over the brim lengthenings. Anatomic investigation and surgical technique.

Lengthening of the psoas tendon commonly is performed for various conditions of the hip including developmental dysplasia and neuromuscular contractures and instability. Anecdotal reports of injury to surrounding neurovascular structures suggest an investigation of the local anatomy is warranted. Using magnetic resonance images from 54 children younger than 10 years, the authors examined the anatomic relationship between major neurovascular structures (femoral artery and vein, external iliac artery and vein, femoral nerve) and the psoas tendon. The mean distance between the neurovascular structures and the psoas tendon in the over the brim position is 1 cm, although it may be as close as 4 mm in a child. The mean distance is 3.1 cm at the tendon's insertion at the lesser trochanter. Surgeons performing psoas over the brim lengthenings should be aware that major neurovascular structures may be only 4 mm from the psoas tendon. The recommended surgical technique is presented.

Cadaver↗
PubMed1997

Laser Doppler flowmetry during open reduction for developmental dysplasia of the hip.

Laser Doppler flowmetry was used intraoperatively to monitor femoral head perfusion during open reduction of 13 congenital hip dislocations in 11 patients. Laser Doppler determinations ranged from 12 to 400 mV before reduction and 30 to 300 mV after reduction. Three patients had magnitude changes in excess of 50%. One had increased perfusion, and two had decreased blood flow. Avascular necrosis of the hip occurred in one patient that was not predicted by laser Doppler flowmetry. Femoral head perfusion measured 175 mV for the dislocated hip and 180 mV after reduction of the femoral head and completion of the pelvic osteotomy. The authors conclude that laser Doppler flowmetry is not a reliable method for monitoring femoral head perfusion during open reduction of the hip for developmental hip dysplasia.

Child, Preschool↗
PubMed1996

Adolescent idiopathic scoliosis: an update.

Adolescent idiopathic scoliosis is defined as a lateral spinal curvature of greater than 10 degrees, for which no pathologic cause can be determined. The initial assessment of adolescents with scoliosis focuses on identification of any treatable underlying pathology. Adolescents with scoliosis typically are asymptomatic and have normal neurologic and physical examinations, with the exception of curvature of the spine. Treatment strategies are determined by the risk of progression. This risk depends on the extent of the curvature and anticipated future spinal growth. The extent of the curvature may be estimated by use of a scoliometer and verified by calculation of the Cobb angle on radiographic evaluation. Skeletal maturity may be estimated by several methods, including radiologic estimates of ossification by bone atlas or Risser sign. Treatment strategies include bracing and surgery.

Adolescent↗
PubMed1994

Regional variation in tensile properties and biochemical composition of the human lumbar anulus fibrosus.

STUDY DESIGN: The structure-function relationship of anulus fibrosus of nondegenerate lumbar intervertebral discs was investigated. OBJECTIVES: The tensile properties and biochemical composition of single lamella specimens from human anulus fibrosus and their variations with anatomic region were determined. SUMMARY OF BACKGROUND DATA: Regional differences in composition and ultrastructure suggest differences in tensile properties. METHODS: Single lamella specimens were isolated from the anulus, equilibrated in 0.15 mol/L NaCl and tested in uniaxial tension using a slow strain-rate protocol. Adjacent specimens were used to determine biochemical composition (including hydration, collagen, proteoglycan, and hydroxypyridinium crosslink density). Tensile properties, biochemical composition, and anatomic location were compared. RESULTS: Significant radial and circumferential variations in tensile properties of anulus were detected, with the anterior being stiffer than the posterolateral regions, and the outer being stiffer than the inner regions. CONCLUSIONS: The regional differences in tensile properties may result predominantly from structural rather than compositional variations and may contribute to the clinical frequency of anulus failure in the posterolateral region.

Collagen↗
PubMed1994

Radial tie fibers influence the tensile properties of the bovine medial meniscus.

Although collagen fibers are arranged predominantly in the circumferential direction in the knee meniscus, there is evidence for radially oriented fibers within human menisci. A bovine medial meniscus model was used to study the hypothesis that radial fibers alter the radial tensile properties of the meniscus. The architecture of the collagen network and tensile properties of the bovine medial meniscus were examined; attention was given to large "radial tie fibers" and their regional variation. Menisci were sectioned serially into slices 400 microns thick. Polarized light microscopy showed that the distribution of radial tie fibers varied greatly among the anterior, central, and posterior regions. These radial tie fibers were larger and more frequent in the posterior region. Radial fibers persisted over many adjacent sections with similar architecture, which led to our hypothesis that they may be arranged in continuous sheets in which the morphology varies by region. Radially oriented specimens for tensile testing were grouped according to the number of radial tie fibers (full, partial, and no fiber) and region (anterior, central, and posterior). Uniaxial tensile testing was performed on a testing machine at a strain rate of 0.00017 sec-1 until failure. The tensile modulus, ultimate tensile stress, and ultimate tensile strain were determined. The presence of radial tie fibers in the specimen had a significant effect on the tensile modulus and ultimate tensile stress. Specimens containing full radial tie fibers were stiffest and failed at the lowest strains; in specimens from the posterior region, the tensile modulus was 392%, the ultimate tensile stress was 314%, and the ultimate tensile strain was 68% that of the specimens with no radial fibers. In no-fiber specimens, the tensile modulus in the posterior region was 225% of the modulus in the anterior region, and the ultimate tensile strain in the posterior region was 68% that of the strain in the anterior region. The abundance of radial tie fibers in the posterior region seems to contribute to the increased stiffness of this region. The preferential stiffening of the posterior region by these radial fibrous sheets may be well suited to the manner in which the bovine medial meniscus functions in load-bearing.

Animals↗
PubMed1993

Use of a sheathed knife in hip arthroscopy.

Use of a sheathed knife to enter the hip joint during arthroscopy is described. It is a safe alternative to a sharp trochar, because the blade is only deployed after its position is verified with imaging.

Arthroscopes↗
PubMedDate not supplied

The effect of femoral rotation on the projected femoral neck-shaft angle.

Femoral neck-shaft angle (NSA) was measured in a series of anteroposterior (AP) hip radiographs of a cadaveric femur in varying degrees of rotation. A mathematical model was developed to predict NSA on an AP radiograph in varying degrees of femoral rotation. The predictions of the model were found to correlate well with the experimental data (correlation coefficient = 0.94). Based on the mathematical model, a wide range of patient positioning was found to result in a <10 degrees error in the measurement of femoral NSA. Coxa vara, increased femoral anteversion, cerebral palsy, and developmental dislocation of the hip resulted in a more restricted range of acceptable femoral positioning. External rotation of the femur should be avoided during patient positioning because as little as 7 degrees can cause a > 10 degrees change in the apparent NSA. For all patient populations, internally rotating the femur will allow for determination of the femoral NSA to within 10 degrees .

Adult↗
PubMedDate not supplied

Variability in gait analysis interpretation.

The purpose of this study was to assess the reliability of interpretation of gait analysis data between physicians and institutions. Gait analysis data from seven patients were reviewed by 12 experienced gait laboratory physicians from six institutions. Reviewers identified problems and made treatment recommendations based on the data provided. Agreement among physicians for the most commonly diagnosed problems was slight to moderate (kappa range, 0.14-0.46). Physicians agreed on identification of soft tissue more than bony problems (intraclass correlation, 0.56 vs. 0.37). Variability regarding surgical recommendations for soft-tissue procedures (kappa range, 0.20-0.64) was similar to that for diagnosis of both soft-tissue and bone problems, although recommendation for hamstring lengthening showed substantial agreement (kappa = 0.64). There was less agreement in recommendation of osteotomies (kappa range, 0.13-0.22). Physicians agreed more on the number of soft-tissue procedures than bone procedures recommended (intraclass correlation, 0.65 vs. 0.19). There was an interinstitutional difference in the frequency of soft-tissue (p = 0.0152) and osseous problem identification (p = 0.0002), as well as in the frequency of recommendations for soft-tissue surgery (p = 0.0004) and osteotomies (p < 0.0001). Although gait analysis data are themselves objective, this study demonstrates some subjectivity in their interpretation. The interobserver variability reported here is similar to that reported for established classification systems of various orthopedic conditions.

Adolescent↗
PubMedDate not supplied

Reliability of a modified Gartland classification of supracondylar humerus fractures.

Fracture-classification systems are used to recommend treatment and predict outcomes. In this study, a modified Gartland classification system of supracondylar humerus fractures in children was assessed for intraobserver and interobserver variability. Five observers classified radiographs of 50 consecutive children with extension supracondylar humerus fractures on three separate occasions. After a 2-week interval, 90% of fractures were classified the same on both readings, with and intraobserver kappa value of 0.84. After a 36-week interval, 89% of the fractures were classified the same, with a kappa value of 0.81. Interobserver reliability was evaluated by pairwise comparison among observers, resulting in an overall kappa value of 0.74. The reliability of the Gartland classification for supracondylar humerus fractures in children is better than that published for other fracture-classification systems. However, 10% of the time, a second reading by the same observer is different. This makes treatment recommendations based only on fracture type imprecise.

Child↗
PubMedDate not supplied

Developmental dysplasia of the hip from six months to four years of age.

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathologic conditions, ranging from subtle acetabular dysplasia to irreducible hip dislocation. When DDH is recognized in the first 6 months of life, treatment with a Pavlik harness frequently results in an excellent outcome. In children older than 6 months, achieving a concentrically reduced hip while minimizing complications is more challenging. Bracing, traction, closed reduction, open reduction, and femoral or pelvic osteotomies are frequently used treatment modalities for children aged 6 months to 4 years. In the past, treatment recommendations have often been based on the patient's age. However, recent practice has placed more emphasis on addressing the specific disorder and avoiding iatrogenic osteonecrosis. The incidence of osteonecrosis of the femoral head has been reduced by avoiding immobilization of the hip in extreme abduction and by using femur-shortening osteotomies when appropriate. Pelvic osteotomy continues to gain favor for the treatment of selected patients over 18 months of age.

Acetabulum↗