We have reviewed the early complications of 121 surgically treated closed ankle fractures; the complication rate was 30%, with 14 major and 22 minor complications. Fractures with skin blisters or abrasions had more than double the overall complication rate. Fracture-dislocations had three times as many major complications as simple fractures, and those not fixed within 24 hours had a 44% major complication rate compared to 5.3% in those operated upon as emergencies. Patients transferred from another medical facility had high complication rates, especially if they had fracture-dislocations. We conclude that operative treatment of ankle fractures must be delivered in a timely fashion, especially in severe fractures. We would caution against the practice of transferring patients with serious ankle fractures before completion of definitive care.

Adolescent↗

PubMed1991

The formation of the orthopaedic physician and surgeon.

Explore the source record for details and available documents.

Curriculum↗

PubMed1990

Factors affecting independence of the physically disabled.

Explore the source record for details and available documents.

Persons with Disabilities↗

PubMed1990

Established hip dislocations in children with cerebral palsy.

Hip dislocation in children with cerebral palsy is caused by a combination of factors, including spastic muscle imbalance, persistent fetal femoral geometry, acetabular dysplasia, and flexion-adduction contracture. The incidence of dislocation correlates with the severity of the spasticity, and the prevalence is close to 50% in neurologically immature, spastic quadriplegic children. Successful hip reductions improve muscular balance, provide satisfactory reduction of the femoral head, and establish good pelvic coverage. In 31 occurrences of established hip dislocation in 24 patients, the most successful operations used a combined procedure consisting of soft-tissue release, open reduction, femoral varus derotation and shortening osteotomy, and pelvic osteotomy.

Cerebral Palsy↗

PubMed1990

Biomechanical analysis of the Chiari pelvic osteotomy. Preserving hip abductor strength.

Although the Chiari osteotomy is usually effective in reducing pain, many patients are left with a long-term limp. The postoperative limp can at times be caused by hip abductors that have strength insufficient to counteract the torque from body weight during single-leg stance. To study how the surgical technique affects the hip abductor muscles, a biomechanical model was developed that computes the postsurgery pelvic geometry and the resulting hip abductor torque given three surgical parameters: angulation of the osteotomy, distance of medical displacement, and angle of internal rotation. The computer simulations of the Chiari osteotomy showed that some sets of surgical parameters conserve abductor torque while others greatly reduce it. Simulated surgeries with high angulation and large medial displacement reduce gluteus medius abductor torque by up to 65%. Therefore, this combination of surgical parameters may account for some instances of the postoperative limp. In the model, high angulation reduces the length of the gluteus medius and is the primary cause of reduced abductor strength. Simulated horizontal osteotomies (0 degrees to 10 degrees) were found to best conserve both muscle length and abductor torque.

Biomechanical Phenomena↗

PubMed1990

Management of the lower extremities in children who have cerebral palsy.

Explore the source record for details and available documents.

Cerebral Palsy↗

PubMed1989

Gait electromyograms and surgical decisions for paralytic deformities of the foot.

Twenty-one patients who had 23 gait electromyographic (EMG) examinations for paralytic deformities of the foot had surgical procedures performed. Outcome of the surgery was analysed with respect to the value of the pre-operative gait studies in deciding on appropriate surgical procedures. When outcome at follow-up (mean 3.6 years) was satisfactory and surgery had been in accordance with the EMG findings, or when outcome was unsatisfactory when the EMG had been disregarded, the value was deemed positive. Conversely, if the EMG data had been disregarded but outcome was satisfactory, the value was negative. Using these criteria, 70 per cent of the EMGs of the four muscles tested (tibialis anterior and posterior, peroneal and gastrocnemius) were a positive contribution to the evaluation and decision for the particular surgical procedure.

Adolescent↗

PubMed1989

Comparison of stereognosis and two-point discrimination testing of the hands of children with cerebral palsy.

The authors compared tests of stereognosis using shape recognition and two-point discrimination with a paper-clip in evaluating sensation in the fingers of 51 patients with cerebral palsy between the ages of six and 20 years, and of 170 controls in the same age-range. The two-point discrimination test had significantly higher sensitivity in detecting tactile sensation than shape recognition, with slightly less specificity. Testing hand sensation should be part of the assessment of patients when considering reconstructive surgery, therapy, or the teaching of specific hand-skills. The two-point discrimination test with a paper-clip is a simple and reliable method of doing so.

Adolescent↗

PubMed1988

Non-union of fractures in children who have osteogenesis imperfecta.

Although a fracture rarely fails to unite in a healthy child, non-union is not a rare occurrence in a child who has osteogenesis imperfecta. We identified twelve non-unions in ten patients from a population of fifty-two patients who had osteogenesis imperfecta. The average age of these patients when the diagnosis of non-union was made nine years, and the average age at the time of treatment was 12.5 years. All of the patients had had a decrease in functional ability as a result of the non-union. There were five femoral, four humeral, one radial, one ulnar, and one pubic non-union. Five of the non-unions were hypertrophic, and seven were atrophic. Eight of the nine ununited fractures that were operated on healed after excision of the non-union, intramedullary nailing, and bone-grafting. Three of the non-unions (in two patients) were not operated on, and the one patient in whom surgery failed had an amputation. Non-union was frequently associated with repeated fractures at a progressively deforming site.

Adolescent↗

PubMed1986

Balance reactions and eye-hand coordination in idiopathic scoliosis.

We undertook this study to determine if subclinical postural control mechanisms were abnormal in idiopathic scoliosis. Ninety-one female patients and fifty-seven age-matched female controls were examined. We used a force plate ataxiometer to quantitate postural sway in the standing position and recorded the displacement and acceleration of the center of pressure during static stance and under perturbation with eyes opened and closed. A joystick-controlled video system was used to measure reaction time and eye-hand motor coordination. The scoliosis group demonstrated significantly less sway during two of the eight standing balance conditions and on the remaining balance tests there was a similar trend, albeit nonsignificant. The reaction time for the scoliosis group was also significantly slower, but the accuracy was not significantly worse. We noted no statistical differences between progressive and nonprogressive or between braced and unbraced patients. The subgroup of patients whose curves progressed despite bracing had a tendency to demonstrate greater stability on all standing tests. They also exhibited faster reaction times and less error in eye-hand coordination than other patient groups. No correlation existed between severity of curve and test performance. We found no indication of deficient balance in idiopathic scoliosis, and the tests could not predict curve progression.

Adolescent↗