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Biomedical subjects

F R Dietz

Publications and source records attributed to F R Dietz.

30 records · Page 2Linked to original sources
PubMed1989

Long-term follow-up after fractures of the tibial and fibular shafts.

Thirty-seven patients who sustained a closed or a Grade-I open tibial and fibular fracture were evaluated an average of twenty-nine years after injury. All of the patients had had uncomplicated treatment with a plaster cast. Clinically, 78 per cent of the ankles were rated good or excellent, and 92 per cent of the knees were rated excellent. Radiographic assessment for osteoarthritic changes revealed a good or excellent result for 76 per cent of the ankles and an excellent result for 92 per cent of the knees. The clinical and radiographic outcomes were unaffected by the amounts of anterior or posterior and of varus or valgus angulation, as well as by the level of the fracture. The length of immobilization, which did not exceed one year, also did not affect the outcomes.

Adolescent↗
PubMed1988

Spike osteotomy for angular deformities of the long bones in children.

We reviewed the results of fifty consecutive spike osteotomies that were performed in thirty-five children for the treatment of angular deformity of a long bone. After forty-three of the procedures, the radiographs were adequate to assess the stability of the fragments. At the time of healing, the average loss of correction from the position that had been accepted at operation was 2 degrees in the anterior-posterior plane and 1.2 degrees in the lateral plane. In four limbs, more than 5 degrees of correction had been lost. No patient lost more than 10 degrees of correction. The rates of complications and of recurrence were similar to those of other reported series. We concluded that the spike osteotomy is safe and effective.

Adolescent↗
PubMed1987

Effect of peripheral nerve on limb development.

The effect of peripheral nerve on limb growth and maturation has received little attention after the limb differentiation stage. This study used an amphibian model (Rana pipiens) to examine the effect of temporary denervation on the development of limb muscle and bone tissues. Quantitative microscopic techniques were employed to evaluate bone and muscle size and cellularity between denervated and control limbs. A 15% decrease in tibial length and a 17% decrease in cross-sectional area were found in the temporarily denervated limbs as compared with the control limbs during the growing period studied. A 26% increase in tibial osteocyte density was found in the denervated limbs, although total osteocyte number was the same. The same differences were found on comparing less and more mature limbs from normal animals. Gastrocnemius muscle from temporarily denervated limbs had a 46% lesser cross-sectional surface area and a 66% greater muscle fiber density as compared with control limbs. Total muscle fiber number was the same. Similar findings were observed comparing limbs of different maturities from normal unoperated animals. This study suggests that the absence of peripheral nerves decreases the rate of bone maturation, which effect may be responsible for the diminished size of denervated limbs. This work demonstrates a model for regional growth disturbances that may aid in understanding such disorders as idiopathic leg length discrepancy, hemihypertrophy, clubfoot, and the limb deformities created by paralytic diseases.

Animals↗
PubMed1986

Posterior atlantooccipital subluxation in Down syndrome.

Three Down syndrome patients with posterior atlantooccipital (AO) subluxation are described. All are asymptomatic. The subluxation becomes manifest during active extension of the neck and reduces in flexion. Methods of assessing posterior AO subluxation are discussed. The abnormality is attributed to ligamentous laxity in patients with Down syndrome.

Adolescent↗
PubMed1985

On the pathogenesis of clubfoot.

Empirical testing has not revealed an indisputable cause of clubfoot. Evidence put forward for intrauterine moulding as a cause of idiopathic clubfoot does not stand up to scrutiny. The hypothesis that a regional growth disturbance is the cause of clubfoot would explain clinical and existing research data.

Amniotic Fluid↗
PubMed1983

Morphometric study of clubfoot tendon sheaths.

The clinical characteristics of clubfoot suggest a relative hypoplasia of the posterior and medial foot and leg. To test this hypothesis we compared quantitative cell and organelle characteristics between anterior and posterior tibial tendon sheaths from four clubfeet and two normal feet. Clubfoot posterior tibial tendon sheath had significantly less cell and cytoplasm volume than did clubfoot anterior sheath. Normal posterior tibial tendon sheath had significantly greater cell and cytoplasm volume than did normal anterior sheath. A similar tendency was found for nuclear volume and cell number, although not all samples reached statistical significance. No difference in organelle characteristics between anterior and posterior sheaths was found. We interpret this morphologic difference as suggesting a relative inactivity of clubfoot posterior tibial tendon sheath cells. This supports the hypothesis of a regional growth disturbance as the cause of clubfoot.

Cell Count↗
PubMed1979

Where does the owner fit in the construction management process?

The construction management approach enables the owner to be involved in the building project from the initial design stage through project completion. He participates in cost-benefit decisions, helping to ensure that the best possible building is constructed at the lowest possible cost.

Contract Services↗
PubMedDate not supplied

Long-term follow-up of Chiari pelvic osteotomy in myelomeningocele.

The management of hip instability in myelomeningocele patients is controversial. The purpose of this study is to review our long-term results of isolated Chiari osteotomies in the treatment of hip instability in children with myelomeningocele. Between 1975 and 1988, 11 patients underwent 13 Chiari osteotomies for reducible hip subluxation or dislocation and acetabular deficiency. The patients returned for follow-up clinical examinations, interviews, and radiographs. The average age at the time of surgery was 9.4 years (range, 5-18). The average age at follow-up was 18 years (range, 13-23). The average follow-up was 11.4 years (range, 2-18). The mean preoperative center-edge (CE) angle was -38 degrees. The mean immediate postoperative CE angle was 41 degrees. At final follow-up, the mean CE angle was 4.6 degrees. Only three of the 10 hips had a normal CE angle of > or = 25 degrees. The Chiari osteotomy alone did not achieve long-term hip stability in the majority of patients. Several, if not most, of our patients may progress to frank dislocation with longer follow-up.

Adolescent↗
PubMedDate not supplied

Rapid progression of hip subluxation in cerebral palsy after selective posterior rhizotomy.

Rapid progression of hip subluxation was noted in the year after selective dorsal rhizotomy in seven hips (six patients). The hips that subluxed progressed from a lateral extrusion index averaging 25% preoperatively as compared with 50% after rhizotomy. Although preexistent hip dysplasia was a predisposing factor, hips with an intermediate degree of preoperative lateral extrusion (12-25%) had variable results. Ongoing and more frequent evaluation of hip stability is necessary after dorsal rhizotomy.

Adolescent↗
PubMedDate not supplied

Chiari pelvic osteotomy in cerebral palsy.

Hip subluxation and dislocation in patients with cerebral palsy are challenging problems. The Chiari pelvic osteotomy has been commonly recommended as a technique for hip stabilization when acetabular dysplasia is present. We evaluated the results of Chiari osteotomy without concomitant femoral osteotomy in 24 hips in 23 patients with an average follow-up of > 7 years. Evaluation consisted of a pain and function questionnaire, chart review, physical examination, and review of serial radiographs. At final follow-up, 19 of 24 (79%) of the hips were painless, and 21 of 24 hips (88%) permitted unlimited sitting. Seven of 24 (29%) of hips, however, had a migration index of > or = 30%. Painful hips were associated with a greater migration index preoperatively, at 1 year postoperatively, and at final follow-up, and a greater height of the osteotomy above the edge of the acetabulum. Deterioration in the migration index (resubluxation) occurred largely in the first year postoperatively. Alternative acetabular procedures, simultaneous femoral osteotomies, or both may improve on these results. Long-term follow-up studies are necessary to compare the results of different treatments for spastic hip subluxation and dislocation to determine optimal treatment.

Adolescent↗
PubMedDate not supplied

Indications for osteotomy of the tibia in children.

Osteotomy for deformity of the legs is a commonly performed operation for which many techniques have been described. Indications for osteotomy, however, are lacking. To assess the amount of angulation compatible with good long-term function and avoidance of osteoarthritis we followed a group of patients with fractured tibias a mean of 29 years from injury. Clinical and radiographic outcomes were unaffected by the amount of angulation or by whether there was varus or valgus angulation. Our data suggest that angular deformities less than 10-15 degrees are well tolerated long term with respect to development of osteoarthritis.

Activities of Daily Living↗