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Biomedical subjects

E E Bleck

Publications and source records attributed to E E Bleck.

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

Prevention of spastic paralytic dislocation of the hip.

In a retrospective review of 99 children with spastic cerebral palsy, the efficacy of soft-tissue procedures alone in reducing early subluxation of the hip and preventing further subluxation and dislocation was determined. The indication for surgery was early subluxation of one or both hips. Surgery was either adductor tenotomy with or without anterior branch obturator neurectomy, or adductor tenotomy in combination with iliopsoas recession. Results were poor for 64 per cent after adductor tenotomy and anterior branch obturator neurectomy. For patients who also had iliopsoas recession the success rate was 72 per cent. Radiographic analysis showed that uncovering of the femoral head had halted or improved in 80 per cent of patients following iliopsoas recession.

Adolescent↗
PubMed1985

The etiology of arthrogryposis (multiple congenital contracture).

In laboratory animals, prenatal contractures have been induced by viruses, neuromuscular blocking agents, toxins, insecticides, hyperthermia, and limb immobilization. In agricultural animals, prenatal contractures are related to pregnant animals foraging on plants containing toxic alkaloids. Epizootics of prenatal contractures in cattle have been related to Akabane viral infections, which can now be prevented by vaccination. Human arthrogryposis (multiple congenital contracture) may occur in any synovial joint in a large variety of combinations. Several lethal syndromes commonly associated with prenatal contractures (Pena Shokeir 1 and 11, Potter's) provide supportive evidence for the following concept of prenatal contracture etiology. Evidence is provided that indicates that the following multiple etiologic factors are related to production of human arthrogryposis: mutagenic agents, mitotic abnormalities, toxic chemicals or drugs, hyperthermia, neuromuscular blocking agents, and mechanical immobilization. These multiple factors mediate their effect via the central nervous system (craniospinal motor neuraxis), motor end-plates, or by primary degeneration of muscle. The resultant effect is loss of muscle mass with imbalance of muscle power at the joints, which provokes a collagenic response (Law of the Connective Tissue). The collagenic response consists of partial replacement of muscle volume and collagenous thickening of the joint capsules. The latter process leads to joint fixation.

Abnormalities, Drug-Induced↗
PubMed1984

School screening for scoliosis. One experience in California using clinical examination and moiré photography.

In 1980 the legislature of the state of California mandated that school screening programs for scoliosis be implemented. This law resulted in variations in methods and efficacy of the programs. One such program using clinical examination and moiré photography was administered to adolescent girls in two secondary schools in Santa Clara County. The findings of 10% of the clinical examinations were ruled to be "positive," 18% on moiré photography alone and 8% on both examinations. The correlation between the two diagnostic procedures was poor (r = .16). Follow-up was done to determine the outcome of the "positive" cases. In all, 25% of the children classified as having scoliosis had no medical follow-up one year from the request by the screening program team. The documented false-positive rate was 15% based on the screening examination. Definitive radiographic evaluation was reported in very few of the positive cases. Our experience shows the weakness of local programs that have no subject follow-up. It is suggested that public education may be a more effective solution than mass school screening mandates.

Adolescent↗
PubMed1984

Acetabular osteomyelitis in children.

The clinical, laboratory, and roentgenographic features of acetabular osteomyelitis were present in a 20-month-old boy and a five-year-old girl. The clinical and laboratory parameters were similar in extracapsular acetabular osteomyelitis and septic arthritis of the hip. A secondary effusion was evident in roentgenograms in both conditions. Acetabular osteomyelitis responded to selected intravenous antibiotic therapy. Septic arthritis of the hip required immediate surgical drainage as well as appropriate antibiotic coverage.

Acetabulum↗
PubMed1983

The cisterna chyli in orthopaedic surgery.

The cisterna chyli is normally hidden in prevertebral tissue and rarely encountered by orthopaedic surgeons. However, hyperextension injury and anterior surgical approach to the spine can result in injury and the complication of chylothorax. Prevention of postoperative chylothorax is mainly through awareness of normal anatomic distribution. If a chylothorax occurs, conservative treatment should be instituted (ie, thoracentesis and/or intercostal tube drainage). If drainage persists, exploration may be required to ligate ducts. Intraoperative discovery of an injury can be treated with ligation or repair. Ten orthopaedic spine surgeons were surveyed (estimated 1000 anterior spinal approaches) disclosing observation of the structure 12 times and chylothorax on only three occasions. When using the anterior approach in both spinal trauma and deformity, one must be aware of the structure and the potential complication of injury.

Adolescent↗
PubMed1983

Persistent medial deviation of the neck of the talus: a common cause of in-toeing in children.

We studied 117 in-toed children and found external tibial-fibular torsion and internal axial deviation of the foot from the midsagittal plane. Based on studies of newborn infants, radiographs, and anatomical specimens, we concluded that a major cause of in-toed gait in children was persistence of the fetal medial deviation of the talar neck and not internal tibial torsion. Spontaneous correction can be anticipated in children up to the age of 3 years if the internal axial rotation is less than 10 degrees. If it is greater than 10 degrees, prognosis for correction with orthoses is age related. In children over the age of 6 years, little correction seems possible.

Adolescent↗
PubMed1983

Radiographic determination of lordosis and kyphosis in normal and scoliotic children.

We conducted a radiographic retrospective study in children to determine spinal lordosis and kyphosis. A total of 218 lateral standing full-length radiographs were studied: 104 normal and 114 scoliotic patients. Normal X-ray films were defined as those obtained for suspected disorder (e.g., scoliosis) with no abnormalities detected by the radiologist or orthopedist. Thoracic kyphosis is defined as the angle between perpendiculars drawn from the inferior endplate of T5 and the superior endplate of T12. Lordosis is the angle between perpendiculars from the inferior endplate of L1 and the superior endplate of L5. The angle between the inferior endplate of L5 and the top of the sacrum is the L5-S1 angle. Statistical analysis was undertaken to compare lordosis and kyphosis radiographic measurements with age, sex, height, and weight employing the SAS package program. No significant relationships were noted between degree of scoliosis, age, sex, height or weight, and kyphosis, lordosis, or L5-S1 angle. Neither could correlations among the three radiographic measurements be made. Lordosis measured 40 degrees (range 31-49.5 degrees) in normal and 48.5 degrees (range 40-55 degrees) in scoliotic patients. Kyphosis measured 27 degrees (range 21-33 degrees) in normal and 28 degrees (range 16.5-36 degrees) in scoliotic patients.

Adolescent↗
PubMed1983

Idiopathic chondrolysis of the hip.

The cases of nine patients (eleven hips) with idiopathic chondrolysis of the hip were studied. Seven of the patients were white and two were Hispanic. The age at onset ranged from eight to sixteen years (mean, 11.5 years). Four patients were boys and five were girls. All patients had a decreased passive range of motion of the hip, and radiographic examination showed regional osteoporosis, premature closure of the femoral capital physis, narrowing of the joint space, and lateral overgrowth of the femoral head on the neck. All laboratory examinations were negative for evidence of infection or rheumatoid arthritis. An arthrotomy was done in seven patients. Specimens of the synovial tissue showed no growth on culture, and the histological studies revealed only minimum signs of inflammation. Histological studies of the articular cartilage were normal. Treatment consisted of administration of acetylsalicylic acid in therapeutic dosages to maintain a blood salicylate level of fifteen to twenty-five milligrams per cent, active non-loading exercise of the hip, protected weight-bearing with crutches, short-term traction to overcome or relieve contractures after biopsy, iliopsoas tenotomy or lengthening in three patients, and an adductor myotomy in one patient. At follow-up, 2.3 to 9.4 years after onset (mean, 6.2 years), six patients had either no symptoms or only minor intermittent discomfort in the hip. On radiographic examination, although these six patients had restoration of the joint space they did have lateral overgrowth of the femoral head (lateral buttressing) and overgrowth of the lateral acetabular margin (lateral osteophyte). In three patients who had disabling pain, joint deterioration was evident on the radiographic examination. One of these patients had a resurfacing arthroplasty to relieve pain.

Adolescent↗
PubMed1983

Metatarsus adductus: classification and relationship to outcomes of treatment.

In a retrospective study of results of treatment in 160 children (265 feet) who had metatarsus adductus prospectively defined by severity and flexibility, we found that in 147 patients treated with plaster casts or casts followed by derotation splints the only significant predictor of a good outcome was the age of the patient. Results were statistically significantly better when treatment was begun from ages 1 day to 8 months. No significant correlations with poor results were found using the severity and flexibility grading systems. Given the public attitude toward deformity, it seems wiser to treat in infancy those feet graded "moderate" or "severe." If treatment is not commenced until the child is old enough to preclude conservative treatment, extensive surgery will be necessary to correct a "severe" deformity.

Age Factors↗
PubMed1982

[True orientation of the acetabulum as determined by CAT scan. Preliminary results (author's transl)].

Valid clinical correlations with biomechanical data require three-dimensional visualization of a joint, in order to determine the true spatial configuration of the various segments of the part studied. The CAT scan has opened a new pathway in this direction, as it supplies precise mathematical information on the segments explored. An original analytical programme was employed in humans to establish the true spatial orientation of the acetabular cavity. The validity of the method was confirmed by comparing results in 31 subjects with the rare cases where such measurements were made, reported in the published literature. The method could be extended to other body regions.

Acetabulum↗
PubMed1982

Developmental orthopaedics. III: Toddlers.

The most common orthopaedic problems seen in toddlers are: (1) in-toeing due to femoral torsion, internal tibial torsion, talar torsion (persistent medial deviation of the neck of the talus), or metatarsus adductus; (2) genu valgus (bow-leg) and genu varus (knock-knee); and (3) pes valgus (flat-feet). In most cases these conditions will resolve spontaneously, as has been substantiated by a number of published studies. However, a small percentage of the disorders will persist if untreated. To prevent the deformity from becoming established and irreversible, treatment must begun while the patient is still young. Therefore the orthopaedist needs objective criteria to select those children in whom the deformity is likely to persist and who thus require prompt management. If femoral torsion persists, it becomes fixed by the time the child reaches eight years of age. Surgery is the only definitive treatment which can be offered, although gait training by augmented feedback methods may result in correcting by increasing the range of external rotation of the hip. Internal tibial torsion or talar torsion usually resolve spontaneously before the children reach seven years of age. However, in 8 per cent of cases in-toeing persists; it is cosmetically objectionable in the adult. I advise simple brace treatment in infants up to the age of 18 months if the medical deviation of the foot from the mid-sagittal plane is greater than 10 degrees. Because metatarsus adductus corrects spontaneously in many cases, some authors suggest that this condition should not be treated. However, I think it is prudent to use serial plaster-casts for infants under eight months of age in whom the deformity is moderate or severe. If treatment is withheld while the patient is observed, and if spontaneous correction does not occur, the deformity will become fixed and correctable only with surgery. Genu valgus and varus correct without treatment in the majority of patients. However, some cases of genu varus appear to develop into the progressive form of the disorder, Blount's disease. When the varus femoral-tibial angle exceeds the norm for age, early treatment with the Danish night-splint appears to prevent the development of this serious disease. 'Flat foot' (pes valgus) must be defined carefully by physical and radiographic examination. Treatment and radiographic examination. Treatment might be considered only for those feet classified as pes valgus with plantar flexed talus of 50 degrees or more. For children with this disorder between the ages of two and six years, a corrective moulded plastic shoe-insert may help to improve the abnormal anatomy while natural ligamentous tightening occurs.

Adolescent↗
PubMed1981

Increased blood viscosity in patients with Legg-Perthes disease: a preliminary report.

Based on studies by others, it appears that Legg-Perthes disease is an avascular necrosis of the femoral head due to occlusion of the blood supply. In an effort to delineate the pathogenesis of the disorder, we determined blood viscosity and percent platelet aggregation in 22 patients with Legg-Perthes disease and 21 control patients. Statistically significant higher blood viscosities were found in our patients with Legg-Perthes when compared with normals. No difference was found in the platelet aggregation studies. In accordance with Poiseuille's law, we propose that increased blood viscosity in patients with the affliction could lead to a diminution in blood flow to the capital femoral epiphysis, ultimately resulting in osteonecrosis and symptomatic manifestations of the disease.

Adolescent↗
PubMed1981

Tarsal coalitions: review of the literature and case report of bilateral dual calcaneonavicular and talocalcaneal coalitions.

Inasmuch as midfoot coalitions do not occur frequently, a preadolescent or early adolescent patient who has persistent complaints of painful flat foot with peroneal or anterior tibial muscle spasm warrants special evaluation. The patient may complain of becoming easily tired or report the onset of pain with increased activity. Clinical examination may reveal local tenderness over the area of the coalition, but this is not a consistent finding. Restricted inversion of the foot with spasm of the peroneals, forefoot abduction or pronation should alert the examining physician that a tarsal coalition may be present. Appropriate roentgenograms examining all of the possibly involved joints should be obtained. These include 45 degrees oblique views of the foot, which usually give a satisfactory view of the calcaneonavicular joint. Coalitions may occur in any of the facets of the talocalcaneal joint and therefore all facets must be evaluated. The anatomic location of the facets can be variable and multiple-angle axial views may be required. We recommend a 45 degrees axial view to visualize the posterior and middle facets, since they are normally parallel in the axial view. If fibrous coalitions are present, the middle facet may be oblique. Tomography is necessary to visualize the anterior facet or to confirm a coalition either in the middle or in the posterior facets.

Adolescent↗
PubMed1981

Nonoperative treatment of osteogenesis imperfecta: orthotic and mobility management.

The problem of osteoporosis superimposed on the basic collagen defect of osteogenesis imperfecta has been approached by the use of plastic containment orthoses for the lower limbs, in addition to developmentally staged mobility devices that assist early standing and walking. The purpose of forcing early weight-bearing is to provide stress to the lower limb bones in order to minimize osteoporosis, prevent refracture and deformity, and curb subsequent immobilization osteoporosis, thus breaking a vicious cycle. Management goals are based upon adult needs for independence: efficiency in daily living activities and in mobility. These goals were reached in most of our patients via use of plastic orthoses, early weight-bearing, and electrically powered wheelchairs. Manual osteoclasis of the tibia followed by plastic orthoses utilizing principles of fluid compression to support fractured or structurally weak bones appeared successful at the time of follow-up. Intramedullary rodding of the femur was necessary in most of the 12 children with osteogenesis imperfecta congenita. Supplementary plastic orthoses have reduced the refracture rate in both the tibia and the femur. Social integration of the children was reflected by the fact that among the 12 OI congenita cases, ten were attending regular educational institutions. Twelve OI tarda children fared well, all attaining complete independence in daily living, mobility and ambulation. Seven of this group were treated with intramedullary rodding of the femur or tibia and with plastic orthoses. Five patients required no treatment.

Activities of Daily Living↗
PubMed1980

Surgical correction of equinus deformity in cerebral palsy.

Sixty-seven children who had been operated on for equinus deformity due to spastic cerebral palsy were studied retrospectively. The recurrence rate of equinus after 51 Baker-Strayer gastrocnemius lengthenings was 29 per cent, and aftef the sliding Hoke type of tendo calcaneus lengthenings it was 9 per cent. In both groups the postoperative care was the same: no bracing, no night splints, and no stretching. The recurrence rate of equinus after tendo calcaneus lengthening is comparable with other reported series.

Cerebral Palsy↗