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Biomedical subjects

D S Weiner

Publications and source records attributed to D S Weiner.

At least 19 recordsLinked to original sources
PubMed1993

Management of metatarsus adductovarus.

A retrospective analysis of 795 patients treated for metatarsus adductovarus by a standardized outpatient approach by one of the authors (D.S.W.) from 1970 to 1983 was conducted to evaluate the efficacy of a straight metal bar and attached reverse last shoe protocol. Criteria for inclusion were developed excluding those milder cases in which spontaneous resolution was expected and indeed occurred. Nearly uniform excellent results were encountered, with a 99% likelihood of obtaining a fully corrected foot. Surgical intervention was deemed necessary in under 1% of cases seen. The authors also examined birth weights and rank in relation to metatarsus adductovarus. Those children with the deformity had a mean birth weight of 7.6 pounds, without statistical variance from normal average birth weights. We were unable to establish any statistical association with birth rank. In light of the results of this study, which compare favorably with serial casting, we recommend this approach as a more economical and less disruptive and cumbersome technique for parent, patient, and physician.

Adolescent↗
PubMed1993

The treatment of rigid metatarsus adductovarus with the use of a new hinged adjustable shoe orthosis.

A retrospective review of the early results of treatment of metatarsus adductovarus with a new hinged adjustable shoe orthosis, the Bebax shoe, is presented. The results in 120 cases (210 feet) are included in the study. Criteria for severity of the initial deformity were developed, and all cases of true clubfoot and those cases with prior treatment were excluded. The average age at institution of treatment was 4.5 months, and treatment time averaged 2.7 months (range 1-7 months). Overall, 96% of the cases were completely resolved with the use of the orthotic alone, 3% required additional casting, and 1% required a bar and shoes for complete correction of the deformity. No treatment complications were encountered except some minor problems with hinge loosening, particularly in the child of walking age. We believe that the Bebax shoe is a lightweight, convenient, safe, and both cost- and treatment-effective device in the management of metatarsus adductovarus.

Female↗
PubMed1990

Hazards of internal fixation in the treatment of slipped capital femoral epiphysis.

We reviewed the records of 202 patients (308 hips) in whom a slipped capital femoral epiphysis had been fixed with pins or screws. A serious complication that was directly related to the use of internal fixation developed in eighty hips (26 per cent). The rate of complications in the 202 patients was 40 per cent. In thirty-six (18 per cent) of the 202 patients, an additional procedure was done to correct a pin-related complication. Forty-one hip joints had been penetrated by a pin. Other complications included avascular necrosis (fourteen hips), chondrolysis (nine), fracture (one), infection (one), further slippage (one), sciatic-nerve injury (one), and breakage of a screw (eight). Ways of decreasing the incidence of complications of fixation were explored.

Bone Nails↗
PubMed1985

Osteochondrosis of the tarsal cuneiforms.

The osteochondroses are a conglomerate of bony lesions that share similar clinical, radiographic, and pathologic features. While almost any bone may demonstrate the features of this disease process, involvement of the tarsal bone is very rare. Some type of disorder of enchondral ossification is thought to be the common etiologic link in the development and manifestation of tarsal cuneiform osteochondrosis. The course of the disease process is benign and self-limited. The treatment is symptomatic.

Child↗
PubMed1984

A 30-year experience with bone graft epiphysiodesis in the treatment of slipped capital femoral epiphysis.

A retrospective review was carried out of all cases treated by bone graft epiphysiodesis for slipped capital femoral epiphysis at Children's Hospital Medical Center of Akron between the years 1950 and 1980. Only those cases followed for a minimum of 1 year following treatment were included in the review and evaluated as to their status of avascular necrosis, acute cartilage necrosis, or other complications attendant to the surgical approach. One hundred seventy-six patients representing 207 hips underwent bone graft epiphysiodesis over this 30-year period. One hundred fifty-nine patients representing 185 hips were followed a minimum of 1 year and were included in this study. There were 25 cases of acute slipping representing 26 hips and 134 patients representing 159 hips involved with the chronic slipping process. In the acute group of patients representing 26 hips, there were two cases of avascular necrosis and one case of acute cartilage necrosis. In the chronic group of 159 hips, there were four cases of reslipping, one due to graft resorption, one due to placement of the graft short the growth plate, and two that went on to acute slipping. All cases were salvaged with good results. There was one case of avascular necrosis in the chronic group; not a single case of acute cartilage necrosis was encountered. Owing to the rapid nature of growth plate closure following bone graft epiphysiodesis, the avoidance of hardware removal or pin penetration, and the extremely low incidence of overall complications, we suggest that bone graft epiphysiodesis is at least as good as multiple pin fixation in the treatment of slipped capital femoral epiphysis.

Adolescent↗
PubMed1983

When is arthrography indicated in Legg-Calvé-Perthes disease?

We evaluated plain radiographs and arthrograms of twenty-one children with active Legg-Calvé-Perthes disease in order to determine the value of the arthrography. We found that when epiphyseal protrusion was shown by the arthrograms it could be seen on the plain radiographs as well in all patients. Also, an acetabulum-head index of less than 90 or an acetabulum-head quotient of less than 92 as determined on plain radiographs correlated well with a diagnosis of protrusion. Thus, an arthrogram is not necessary to make the diagnosis of protrusion in most patients. The arthrogram is more useful in delineating changes in the articular surface for prognoses concerning arthritis and in tailoring the treatment to the individual patient.

Child↗
PubMed1982

The "fabella syndrome": an update.

Sixteen adolescents presented with symptoms referable to the posterior lateral compartment of the knee, specifically the region of the fabella. The salient features of the syndrome include intermittent pain in the posterolateral region, accentuated by knee extension and localized tenderness when the fabella is compressed against the femoral condyle. The condition appears to be unique to late adolescence (15-17 years of age). Five patients responded to conservative measures. Eleven patients required surgery, all of whom obtained immediate relief of symptoms with removal of the ossified fabella, cartilaginous fabella, or thickened gastrocnemius fibers.

Adolescent↗
PubMed1981

Treatment of congenital dysplasia-subluxation of the hip in children under one year of age.

A retrospective review of 128 cases of dysplasia-subluxation of the hip in 123 patients seen and initially treated under 1 year of age was conducted to determine the incidence of avascular necrosis and its potential relationship to treatment. Not a single case of avascular necrosis was uncovered utilizing a semi-rigid Ilfeld splint. In view of this finding, the beneficial effects of treating rather than observing every case of dysplasia-subluxation of the hip are discussed and viewed in contrast with the potential adverse sequelae of with-holding treatment, specifically as it relates to development of late diagnosis of congenital dislocation of the hip and premature osteoarthritis of the hip.

Female↗
PubMed1980

Practical considerations in the use of computed tomography in the measurement of femoral anteversion.

A new technique is presented for measuring femoral anteversion by computed tomography, which has advantages over earlier techniques. Computed tomography allows the visual portrayal of the cervical axis to be superimposed on the diacondylar axis for direct goniometric measurement of the anteversion angle. In addition to being accurate, the procedure requires no complicated positioning framework and can be done in a brief span of time. Clinical experience with 111 hips in 56 patients has produced accurate data, particularly with regard to congenital dislocation of the hip and Legg-Calvé-Perthes disease.

Femur↗
PubMed1980

Avascular necrosis as a treatment complication in congenital dislocation of the hip in children under one year of age.

A retrospective review of 289 frank congenital dislocations of the hip in 241 patients seen and initially treated at less than one year of age was conducted to evaluate factors involved in the development of avascular necrosis. Premanipulation traction was found to be of significant benefit in reducing the incidence of avascular necrosis but not in eliminating it. It is suggested that the rigid plaster immobilization is the major causative agent in the residual cases of avascular necrosis. It is also apparent that the very young child, under three months of age, is even more susceptible.

Casts, Surgical↗
PubMed1978

Proximal tibiofibular synostosis.

The occurrence of a proximal tibiofibular synostosis is indeed a rare condition with only 2 cases unassociated with other diseases reported to our knowledge to date. Two skeletally immature patients presented with a synostosis of the proximal tibiofibular region associated with shortening of the limb in the affected segments. Although the shortening and the synostosis seem interrelated no explanation of their relationship is evident from these 2 cases.

Child↗
PubMed1977

Congenital dislocation of the hip. The relationship of premanipulation traction and age to avascular necrosis of the femoral head.

A retrospective study involving 276 patients with 319 congenitally dislocated hips was undertaken to assess whether premanipulation fraction prevents avascular necrosis. Roentgenographic criteria were utilized and only cases of frank dislocation unassociated with other disorders were included. It was found that in a child less than one year old, premanipulation traction of twenty-one days or more substantially reduces the incidence of avascular necrosis. For the child more than a year old, however, the prognosis is not as good, even if premanipulation traction is prescribed for twenty-one days or more. We found a 14 per cent incidence of avascular necrosis in children less than three months old and suggest that the cartilaginous femoral head prior to the appearance of the ossific nucleus is particularly vulnerable to vascular injury.

Age Factors↗