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Biomedical subjects

D R Wenger

Publications and source records attributed to D R Wenger.

At least 37 records · Page 2Linked to original sources
PubMed1985

Arthrogryposis multiplex congenita. A long-term follow-up study.

Most patients with arthrogryposis function well in adult life; however, many remain partially dependent upon others (parents, relatives, government subsidy). This dependency was more closely related to personality, education, and overall coping skills than to degree of physical deformity. Properly sequenced corrective surgical procedures are required to maximize musculoskeletal function. In addition to appropriate surgical correction, good family support, a proper educational environment, and promotion of independence at an early age are required to achieve maximal adult function.

Activities of Daily Living↗
PubMed1984

The evolution and histopathology of adolescent tibia vara.

This clinical, radiographic, and histologic study clarifies the evolution of the distinct clinical and radiographic disorder known as adolescent tibia vara (Blount's disease). Although previous reports have suggested that the disorder occurs in a limb that has been normally aligned until adolescence, we have found that most children with adolescent tibia vara maintain a mild degree of infantile physiologic genu varum. Then, concurrent with the adolescent growth spurt, certain children with predisposing factors, such as obesity, extreme activity, or rapid growth, injure the posteromedial physis as a result of repetitive trauma due to normal use of a limb already in mild varus. The result is growth suppression, further varus, and a classic radiographic presentation. Histologic examination in two cases suggests injury to the growth plate as demonstrated by fissuring and clefts in the physis as well as fibrovascular and cartilaginous repair tissue at the physeal-metaphyseal junction. Transverse trabeculae, resembling growth arrest lines, were noted in the adjacent metaphysis; however, true bony bridging of the growth plate was not seen. Recommended treatment is corrective osteotomy below the growth plate.

Adolescent↗
PubMed1984

Surgical anatomy of selected physes.

Recent advances have allowed successful resection of partial physeal arrest in children whose physes have been damaged by trauma, infection, irradiation, and other causes. Underlying physeal anatomy and the relationship of overlying structures to the physis are vital in preparing for precise surgical excision of the bony bar. The cadaver of a 5-year-old child was dissected with special emphasis on the surgical accessibility of the physes and adjacent metaphyses of the distal radius, distal femur, proximal tibia, and distal tibia and fibula. The physis of the distal radius was found to be completely extracapsular. The synovial reflection of the suprapatellar pouch obscured portions of the anterior, medial, and lateral aspects of the distal femur. The capsular attachment extended to the level of the physis anteriorly and posteriorly. The capsular attachment to the medial distal femur was more distal and peripheral than to the lateral. The insertion of the adductor magnus tendon medially and the intermuscular septum laterally served as landmarks to the level of the physis. The physis of the proximal tibia was completely extracapsular. The posterior aspects of the physis and the metaphysis were obscured in the midline by the popliteus muscle, and this posterolateral region was the least surgically accessible of any of the regions studied. The distal tibial physis was entirely extracapsular. The anterior and posterior tibiofibular ligaments inserted across the anterolateral and posterolateral aspects of the physis of the distal fibula. This physis on its medial aspect lay intraarticularly at the level of the articular cartilage of the distal tibia.(ABSTRACT TRUNCATED AT 250 WORDS)

Cartilage, Articular↗
PubMed1984

Atlanto-axial instability and spinal cord compression in children--diagnosis by computerized tomography.

Five children who were at risk for atlanto-axial instability underwent computerized tomography scanning of the cervical spine in flexion and extension to document the degree of bone instability and the presence or absence of spinal cord compression. Two patients had Morquio's syndrome, two had os odontoideum , and one had Klippel-Feil syndrome, and in all five the lateral radiographs of the cervical spine in flexion and extension were equivocal with regard to instability or were difficult to interpret because of the bone anomalies. The computerized tomography scan then provided a diagnosis by a non-invasion technique and quantitated the amount of compromise of the spinal cord by delineating flattening of the cord. The scan therefore helped the surgeon to decide if the spinal cord was at significant risk and if atlanto-axial fusion was advisable.

Atlanto-Axial Joint↗
PubMed1984

The mechanics of thoracolumbar fractures stabilized by segmental fixation.

Patients with unstable thoracolumbar spine fractures greatly benefit from the rapid mobilization made possible by surgical reduction and secure internal fixation. The Harrington distraction method provides excellent hook fixation to the spine but is attached only to the proximal and distal ends of the instrumental segment and is dependent on an intact anterior longitudinal ligament. Because the spine is multisegmented and viscoelastic, a distraction method alone may not provide persistent tension on the anterior longitudinal ligament. Segmental spinal instrumentation (Luque) is less efficient in obtaining reduction because it has no built in distractive mechanism. In addition, the lack of laminar hook attachments is a significant disadvantage in maintaining a distractive force. A combined system consisting of Harrington distraction rods segmentally attached to all available motion segments improves the currently available mechanical construct for obtaining and maintaining reduction in unstable thoracolumbar fractures.

Fracture Fixation, Internal↗
PubMed1984

A mapping method to prepare for surgical excision of a partial physeal arrest.

Acquired bony bridging of a physis is best documented by biplane polytomography. Treatment decisions require clear comprehension of the cross-sectional dimensions of the bridge in the transverse plane. This article presents a short practical method for producing a cross-sectional map from the data provided by biplane polytomograms.

Child↗
PubMed1983

Fresh autogenous grafts and osteochondral allografts for the treatment of segmental collapse in osteonecrosis of the hip.

The treatment of femoral head osteonecrosis and segmental collapse with fresh autogenous grafts and osteochondral allografts is in the experimental stages. The early results suggest that the grafts may be a satisfactory intermediate conservative alternative to radical surgery. Strict adherence to the criteria for selection of candidates for grafting and meticulous surgical technique are essential prerequisites if optimal results are to be achieved. Factors favoring the choice of autologous or allogeneic grafts in osteonecrosis of the hip are the clinically insignificant immunologic reaction and viable hyaline cartilage. Immunosuppressive agents are nonessential. Failure does not preclude artificial resurfacing, endoprosthetic replacement, or total hip arthroplasty.

Adolescent↗
PubMed1981

Selective surgical containment for Legg-Perthes disease: recognition and management of complications.

Surgical containment is often selected for older children with "at risk" Legg-Perthes disease because healing time is long and abduction bracing is poorly tolerated. This review of 19 older children (mean age, 9.6 years) treated by surgical containment, selected from a total of 167 patients with Legg-Perthes disease, demonstrates the frequency of complications when only older children with severe involvement are surgically contained. The radiographic results (37% good, 26% fair, 37% poor) are mediocre when compared with reported series in which patients were not selected critically for "at risk" factors or in which the means age was lower. Although surgically contained, the femoral head in certain older children with "at risk" Legg-Perthes disease is unable to tolerate full activity. The avascular head responds in much the same manner as the adult femoral head with avascular necrosis (slow repair, marked collapse): therefore, older children treated surgically must be followed closely. Failure of containment, with head collapse, following surgical containment is heralded by a loss of hip motion and must be treated vigorously by reinstituting the usual nonsurgical protocol (hospitalization, traction, muscle release, arthrogram. Petrie casts, abduction bracing). Obviously, prior to surgical containment, the family should be advised of the possible later need for rehospitalization and a return to abduction casts or braces.

Adolescent↗
PubMed1981

Bilateral femoral head collapse in an adolescent with brachydactyly (multiple epiphyseal dysplasia tarda type 1c).

Children with femoral head radiographic changes suggestive of bilateral avascular necrosis require a careful differential diagnosis. Although the child may be found to have an epiphyseal dysplasia, the course may not be benign. At adolescence, in certain of the multiple epiphyseal dysplasia tarda forms, rapid destruction of the femoral head occurs with clinical and radiographic features indistinguishable from avascular necrosis. A possible interrelationship between epiphyseal dysplasia and avascular necrosis is considered.

Adolescent↗
PubMed1981

Posteromedial bowing of the tibia. Progression of discrepancy in leg lengths.

Thirteen children with posteromedial bowing of the tibia were followed clinically and radiographically for a mean of four years from the time of original diagnosis. At follow-up, the discrepancy in leg lengths as determined by scanograms ranged from 1.9 to 5.6 centimeters, with a mean of 3.1 centimeters; usually there was progression of the discrepancy. Nine of the thirteen children had a discrepancy of more than 2.5 centimeters. There appeared to be a direct relationship between the degree of initial tibial bowing and the severity of the subsequent leg-length discrepancy.

Aging↗
PubMed1980

Minimal Perthes' disease.

Of 193 children with Perthes' disease at the Texas Scottish Rite Hospital for Cripppled Children, 24 were found to have only minimal changes. The cases were grouped relative to the area of the femoral head involved, with 10 involving the anterior portion, seven the posteromedial, three the lateral, and four the central portion. Almost all hips lost some height as measured by the epiphysial index but all had good results by the Mose criteria irrespective of treatment. The anterior lesion is the same as that described by Catterall as Group 1. The three additional groups have a similar benign natural history but distinct radiographic features. The need for early recognition of these patterns is emphasised if unnecessary treatment is to be avoided. Possible correlations of these lesions with the segmental blood supply of the femoral head are proposed and an hypothesis relating the Catterall classifications to the blood supply is put forward.

Child↗
PubMed1980

The guarded prognosis of physeal injury in paraplegic children.

Unrecognized injury of the physis in neurologically impaired children, followed by repetitive trauma due to lack of sensation, results in a bizarre roentgenographic appearance which may resemble that of osteomyelitis or a malignant tumor (sarcoma or leukemia). The prolonged process of injury and repair in the injured physis and adjacent metaphysis is similar to that seen in Charcot neuroarthropathy. Lack of awareness of these roentgenographic features resulted in unnecessary diagnostic biopsy in two of the nine patients with such fractures reported in this study. Delayed healing is characteristic of this lesion and is a result of inadequate immobilization and failure to restrict weight-bearing. Premature closure of the physis occurred in five of nine patients. Early recognition and adequate immobilization allow more normal healing of this unusual injury.

Child↗
PubMed1979

Surgical management of thoracic kyphosis in adolescents.

Twenty-seven patients of a group of twenty-nine who underwent posterior spine fusion using Harrington compression instrumentation for Scheuermann's disease or postural roundback deformity were reviewed with a mean follow-up of 27.6 months. The mean curve before operation was 72 degrees and at review, 46.1 degrees. The mean loss of correction in the fusion from initial examination to final follow-up was 5.7 degrees. This procedure can achieve satisfactory correction of deformity as well as pain relief. We think that Harrington compression instrumentation and spine fusion is indicated in selected cases of roundback deformity.

Adolescent↗
PubMed1979

Acetabular development after reduction in congenital dislocation of the hip.

A study of acetabular development in 148 patients with 185 congenitally dislocated hips treated by closed reduction from 1940 to 1968 showed that eight years after reduction the acetabular index was normal (less than 20 degrees) in 49.2 per cent, satisfactory (from 20 to 24 degrees) in 34 per cent, and poor (more than 24 degrees) in 16.7 per cent. Early treatment led to the best acetabular development. Significant and continuing improvement of the acetabular index was observed between two and eight years after reduction when the femoral head remained concentrically reduced. Failure to maintain proper reduction and necrosis of the femoral head led to poor results.

Acetabulum↗
PubMed1978

The spectrum of intervertebral disc-space infection in children.

Discitis, intervertebral disc-space infection, and vertebral osteomyelitis form a spectrum of disorders with a probably common bacterial etiology. We studied forty-one children who had symptomatic narrowing of the disc space associated with fever and an elevated erythrocyte sedimentation rate and found that the diagnosis of infection in the spine was usually delayed. Technetium 99m polyphosphate bone-scanning proved to be an accurate, rapid, and safe method of establishing an early diagnosis of infection. A positive culture of blood or biopsy material was found in 34 per cent of all the patients (half of the patients for whom cultures were obtained). The clinical and roentgenographic picture that develops is determined both by the virulence and extent of infection and by the resistance and regenerative capacity of the host. Discitis in children is a vertebral osteomyelitis with disc involvement.

Abdomen↗