Biomedical subjects
Publications and source records attributed to E P Schwentker.
Dysplasia epiphysealis hemimelica is a rare developmental abnormality involving aberrant epiphyseal cartilage growth. This is the first known case report describing dysplasia epiphysealis hemimelica arising from the sacroiliac joint. The operative technique described through an indirect computed tomography guided approach limited the exposure and potential morbidity involving the sacroiliac joint.
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METHODS: A wire-holding frame developed for sublaminar segmental instrumentation (SSI) has been used at the authors' institution for 14 years. RESULTS: In addition to careful technique of sublaminar wire passage, the frame reduces the risk of potential neurologic injury after wire passage by keeping the wires taut against the undersurface of the lamina. CONCLUSION: Operative efficiency is increased by organizing the sequence of the wires. The risk of glove perforation is also reduced by keeping the sharp ends of the wires away from the operative field.
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A retrospective review of 47 patients with neurofibromatosis was performed to evaluate the effects of that disease on patient function and disability. Clinical manifestations were distributed as follows: cafe-au-lait markings were the most prevalent manifestation (87%), followed by a positive family history (49%), scoliosis (53%), neurofibromata (19%), and pseudarthrosis of the tibia (19%). The classic scoliosis was resistant to brace treatment; bracing failed in 70% of patients, necessitating spinal fusion. Pseudarthrosis of the tibia can be subdivided into normal, narrow sclerotic, and cystic medullary canal groups. This study supported the theory that tibias with narrow sclerotic medullary canals should be prophylactically braced until skeletal maturity to prevent fracture. Once fractured, the incidence of non-union is high regardless of treatment mode. Eighty percent of patients with pseudarthrosis of the tibia did not heal with multiple bone grafts and were amputated below the knee. Many patients in this study were educable or only mildly mentally retarded, and performed quite well in activities of daily living.
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Idiopathic scoliosis was treated by an automated portable posture-training device that incorporated precise behavioral principles and enabled therapeutic training to be given in the patients' normal environment throughout the entire day. Twenty-one patient-years of training were completed with a group of 12 adolescent girls selected as being imminently likely to require a brace because of the way their spinal curves had been progressing. As an alternative to conventional brace therapy, patients found the posture-training device considerably less physically restraining and more cosmetically acceptable. Most patients wore it 23 hr per day for at least 1 year and adapted well to the constant physical and psychological presence of the instrument. For 10 patients, the outcome was entirely successful; they were discharged from this pilot study as satisfactorily corrected. Progression of the scoliotic curve was arrested; in fact, there was an average slight improvement in the Cobb angle (a measure of spinal curvature) as measured by x-ray radiography.
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Serious injuries from riding power mowers were sustained by 18 children. Eleven children were passangers on the mower and fell into its path. The injuries required an extensive number of hospitalizations and reconstructive procedures. Fifteen patients suffered considerable residual deformities. Operating riding power mowers in the vicinity of children must be actively discouraged.
To clarify the role of the orthopaedic surgeon in the management of spinal muscular atrophy, the records of 130 patients were reviewed. Seventy-three had died. Of the remaining fifty-seven, fifty were re-examined. The clinical manifestations of the disease, particularly those giving rise to orthopaedic problems, were studied. At the time of review the average age of the patients was 11.5 years. Thirty-five could not walk and all had some degree of muscle weakness, more marked proximally and in the lower limbs. The most common medical problem was repeated respiratory infection and the major orthopaedic problem was scoliosis, often severe. Nine of the thirty-five patients with scoliosis had had spine fusion. Most of them suffered some functional loss in attaining spinal stability.
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Real-time ultrasound (US) is the imaging method of choice for diagnosis and follow-up of congenital dislocation of the infant hip (CDH). Clinical aspects and the role of imaging are reviewed. Technique and anatomy, both normal and abnormal, are illustrated, as well as, the use of sonography during treatment with Pavlik harness and spica cast. Correlation of ultrasound findings with clinical examination, other available imaging studies and long-term patient follow-up shows 100% sensitivity and 100% specificity for real-time US diagnosis of CDH.
We retrospectively reviewed the results of open or closed reduction for developmental dysplasia of the hip (DDH) in 49 children younger than 12 months old, who had 57 hip dislocations. Group A (18 hips) developed partial or complete avascular necrosis (AVN), and group B (39 hips) did not develop AVN. Thirty-eight hips were treated by closed reduction, and 17 had open reduction. One patient with bilateral hip dislocation initially had closed reductions followed by bilateral open reduction 3 months later. With the numbers available for study, there was no significant difference in the occurrence of AVN with respect to variables such as preliminary traction, closed versus open reduction, Pavlik harness use, and age at the time of operative intervention. However, the presence of the ossific nucleus before reduction, detected either by radiographs (p < 0.001) or ultrasonography (p = 0.033) was statistically significant in predicting AVN. Only one (4%) of 25 hips with an ossific nucleus developed AVN, whereas 17 (53%) of 32 hips without an ossific nucleus before reduction developed AVN. Our results suggest that the presence of the ossific nucleus before closed or open reduction for DDH may decrease the risk of AVN.
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This retrospective study surveys patients treated between 1960 and 1978 for slipped capital femoral epiphyses. The parameters reported are fusion time, blood replacement, hospitalization time, aseptic necrosis, cartilage necrosis, and complications. Twenty-eight hips (24 patients) were treated by pinning, and three hips (three patients) were treated by Smith-Petersen nails. The Heyman or Howorth bone pegging procedures were performed in 48 hips in 41 patients. The average fusion time was 9.4 months for hips treated with Knowles pins, 3.7 months for Hagie or Tachdjian pins, and 4.8 months for bone pegging procedures. Blood loss, hospitalization time, surgical scars, and duration of anesthesia were greater for the bone pegging procedures.