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Biomedical subjects

G W Simons

Publications and source records attributed to G W Simons.

At least 19 recordsLinked to original sources
PubMed1995

Calcaneocuboid joint deformity in talipes equinovarus: an overview and update.

The calcaneocuboid joint is significantly malaligned in some clubfeet. Calcaneocuboid deformity appears to be a combination of medial angulation of the calcaneocuboid joint with medial subluxation of the cuboid on the calcaneus. In moderate and severe cases, incomplete treatment of this deformity may result in rotary valgus of the hindfoot. One hundred consecutive cases of clubfeet requiring operative intervention, all treated at the Medical College of Wisconsin at Milwaukee between 1984 and 1988 were reviewed for incidence and treatment of calcaneocuboid abnormalities. A radiographic system of evaluation was devised, encompassing a normal grade of 0 and three grades of deformity based on the extent to which the midpoint of the cuboid had deviated from the longitudinal axis of the calcaneus or beyond the tangent defined by the edge of the calcaneus. The author's preferred surgical technique is described. Grade 1 deformity does not require operation; grade 2 deformity required extensive soft tissue release, and grade 3 deformity required a bone procedure in addition to extensive soft tissue release. The results demonstrated that partial release of the calcaneocuboid cuboid joint is never indicated because it may produce valgus of the hindfoot. Based on this sample, approximately 25% of all patients requiring operation will require calcaneocuboid release. Operation should be performed without placing undue pressure on the joints, which may produce late fusion; plantar release may be indicated as a means of reducing pressure on the joint surfaces. Operation before ossification of the cuboid should be avoided.

Child, Preschool↗
PubMed1993

Deformity of the calcaneocuboid joint in patients who have talipes equinovarus.

A retrospective analysis was done of the records and radiographs of 100 club feet (in sixty-six patients) that had been consecutively treated with an operation. Twenty-six feet (26 per cent) had had a Grade-II deformity of the calcaneocuboid joint, as determined with a radiographic classification that had been developed on the basis of the degree of medial displacement of the cuboid. When the calcaneocuboid joint is in normal alignment, the central point of the cuboid ossification center lies on the mid-longitudinal axis of the calcaneus; when there is a Grade-I deformity, the mid-point of the cuboid ossification center lies lateral to the medial tangent but medial to the longitudinal axis of the calcaneus; and when there is a Grade-II deformity, the central point of the cuboid lies on or medial to the medial tangent of the calcaneus. Although a Grade-I deformity of the calcaneocuboid joint need not be corrected, a Grade-II deformity should be treated with release of the calcaneocuboid joint, which in this series was performed in conjunction with a complete subtalar release (including a talonavicular release). Sixteen of the twenty-six feet that had a Grade-II deformity had a complete release of the calcaneocuboid joint at the time of the operation; the release was not done in the remaining ten feet, some of which were operated on early in the series, before the importance of the deformity at the calcaneocuboid joint had been recognized.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1987

The complete subtalar release in clubfeet.

CSTR is a release of the subtalar joint and the talonavicular joint that corrects calcaneal rotation, a major deformity of the clubfoot, as well as the other major deformities of the midfoot and hindfoot. Indications for the CSTR are presented. These include failure of conservative treatment or unsatisfactory surgical results with residual varus deformity, and a foot longer than 8 cm. Contraindications to CSTR include radiographic evidence of a flat-top talus and uncorrected anterior ankle contractures. The Cincinnati incision, which permits excellent visualization of all the relevant structures and good cosmesis, is described and compared with other approaches. The technique of the CSTR is described in detail. Key steps include marking the knee for later alignment with the foot (a major advantage of this procedure), superficial medial dissection, posterior dissection, lateral dissection, and deep medial dissection. Technical details and criteria for evaluation are provided. Four supplemental procedures and their indications are described. These include metatarsal osteotomy, calcaneocuboid capsulotomy, calcaneal wedge osteotomy, and plantar release. Procedures for pinning and casting are described, with special attention to accuracy of realigning the foot and measures for avoiding avascular necrosis and other complications. The importance of intraoperative radiographs is presented, together with methods for obtaining and assessing these films to assure that surgical correction is complete. It is imperative that these films be taken before tendon repair or wound closure so that pinning procedures can be repeated, if necessary.

Bone Nails↗
PubMed1985

Treatment with aztreonam or tobramycin in critical care patients with nosocomial gram-negative pneumonia.

During the course of one year, 47 critical care patients with gram-negative bacillary pneumonia at Millard Fillmore Hospital were randomly assigned to aztreonam or tobramycin therapy (two to one). Of these, 40 were fully evaluable for microbiologic and clinical response. All evaluable patients had gram-negative organisms in tracheal aspirate culture specimens and confirmed susceptibility of the organism to both study drugs. There was no difference between the two groups with respect to the percentage of patients who received concurrent antibiotics for gram-positive organisms. More than 60 percent of the patients received mechanical ventilation. Essentially, all had new lung infiltrates as shown by chest radiography, leukocytosis, recent onset of fever, and increased volume of purulent secretions. Half had multilobar pulmonary infiltrates. Their mean age was 73 years, with none under age 50. Most had chronic obstructive pulmonary disease, congestive heart failure, or both. By the prognostic nutritional index criteria, over 70 percent were nutritionally deficient at entry. The majority of infections were caused by Pseudomonas, Enterobacter, Klebsiella, and Escherichia coli. Aztreonam eradicated 92 percent of the causative gram-negative organisms, compared with 57 percent for tobramycin (p less than 0.05). Aztreonam produced a favorable clinical response (cure or improvement) in 93 percent of patients, compared with 50 percent for tobramycin (p less than 0.05). There were no differences in the minor adverse effects observed in the two treatment groups. Overall, aztreonam was superior to tobramycin for treatment of pneumonia due to susceptible gram-negative bacteria in these critical care patients.

Aged↗
PubMed1985

Complete subtalar release in club feet. Part I--A preliminary report.

The complete subtalar release is an extensive soft-tissue procedure for the treatment of club foot that non-surgical methods have not corrected. It is a more extensive surgical procedure than others currently in use. Two advantages of this procedure are that it produces a greater degree of correction than other procedures and that it provides superior alignment between the foot and leg. The main disadvantage is a tendency to overcorrection. In this report I present the steps in performing the procedure and the anatomical concept on which it is based.

Bone Nails↗
PubMed1985

Complete subtalar release in club feet. Part II--Comparison with less extensive procedures.

A comparison of the complete subtalar release with less extensive soft-tissue releases in the treatment of idiopathic club foot was done in two groups of patients. Group I consisted of seventeen patients (twenty-six feet), of whom fourteen patients (twenty-one feet) had a posteromedial and lateral release. Group II consisted of seventeen patients (twenty-five feet) who had a complete subtalar release. All patients were followed for a minimum of two years. The complete subtalar release provided a higher percentage of both radiographically and clinically satisfactory results than did the less extensive soft-tissue procedures, but with the former procedure there was a tendency to overcorrection unless the bones were precisely repositioned at the end of the procedure.

Child, Preschool↗
PubMed1984

Occult fracture of the calcaneus--another toddler's fracture.

Fractures of the calcaneus have been considered rare among children. We feel this may be erroneous since in the last 12 months we have seen 10 such fractures among children, 19 and 41 months of age, who presented with acute limping. The fractures were detected with bone imaging which was performed when initial radiographs were noncontributory. Subsequent radiographs of the calcaneus were positive for fracture in 4 of 10 while follow up radiographs confirmed healing fractures in the two children so evaluated. The sensitivity of bone imaging for the detection of occult fractures in toddlers is emphasized.

Bone and Bones↗
PubMed1984

Iliacus abscess.

Iliacus muscle abscess originating from the sacroiliac joint was diagnosed prior to operation in a 13-year-old boy with the assistance of technetium-99m bone imaging and computerized tomography. Preoperative identification of the iliacus abscess enabled the surgeon to select an anterior (apophyseal splitting) retroperitoneal approach, which permitted drainage of both the ilium and the iliacus muscle.

Abscess↗
PubMed1984

Rotary malunion of the proximal femur following femoral osteotomy.

Malunion of the proximal femur developed in a three-year-old girl with congenital dislocation of the hip following osteotomy and the use of inadequate internal fixation. The deformity was diagnosed by computerized tomographic scanning. The proximal femur had rotated 90 degrees around its long axis before uniting with the femoral shaft. The deformity required three-dimensional correction with adequate internal fixation.

Bone Diseases, Developmental↗
PubMed1983

Intraoperative bone imaging in the treatment of osteoid osteoma of the femoral neck.

An osteoid osteoma of the femoral neck in a 7-year-old girl was successfully excised using intraoperative 99mTc bone imaging. Since the nidus of the lesion was not seen with conventional radiography, linear tomography, and computed tomography, these techniques could not be used during surgery to localize the lesion or to indicate when its removal was complete. Postoperative bone imaging demonstrated that avascular necrosis of the femoral head had not occurred.

Child↗
PubMed1983

Retroperitoneal and retrofascial abscesses. A review.

The anatomy of retrofascial and retroperitoneal abscesses is not widely understood by orthopaedic surgeons because these abscesses are encountered infrequently and may cause symptoms at their points of extension rather than at their origin. Recent developments in bone-imaging and computed tomographic scanning have made it easier to diagnose and treat these abscesses and to identify their origins. These same diagnostic techniques have also made it easier to distinguish retrofascial from retroperitoneal abscesses. In this paper we define the retrofascial and retroperitoneal spaces, enumerate the possible sources of infection and the pathways of drainage, identify the pelvic spaces where the abscesses collect, and list the peripheral extrapelvic areas where these abscesses cause symptoms. The clinical signs and symptoms of retrofascial and retroperitoneal infection differ from those of osseous infection of the pelvis and spine, the two most common sources of retrofascial infection. The diagnostic value of the various radiographic methods is discussed, the prognoses for various types of abscesses are reported, and approaches to treatment are presented.

Abscess↗
PubMed1983

The microsurgical dissection of a stillborn fetal clubfoot.

A microsurgical dissection was performed on a clubfoot of a seven-month-old stillborn fetus with camptomelic dysplasia. The most important anatomic alteration was marked rotation of the calcaneus beneath the talus. The calcaneus was rotated around a vertical axis. Its anterior aspect was rotated medially, while its posterior aspect was rotated laterally. A series of photographs obtained during the dissection shows the degree of realignment achieved by each stage of the progressive or stepwise surgical dissection. Dissection simulating a posteromedial release and plantar release failed to realign the hindfoot. A complete subtalar release was necessary to reposition the bones of the hindfoot completely. In this specimen, metatarsal capsulotomies were required to realign the forefoot, and the osteotomies of the tibia and tibula were required to straighten the angular deformities characteristic of camptomelic dysplasia, as well as the significant external torsion of these bones.

Clubfoot↗
PubMed1980

A comparative evaluation of the current methods for open reduction of the congenitally displaced hip.

The history of open reduction for congenital dislocation of the hips is reviewed. There are currently five procedures used for open reduction of the hip. Each of these procedures is reviewed as to rationale, anatomic approach, and advantages. An attempt is made to review the literature concerning the complications and results associated with these various procedures. The author concludes by attempting to formulate the indications for each of the five procedures.

Acetabulum↗