A new bending device for luque rods.
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Humans↗
Biomedical subjects
J G Gamble
Publications and source records attributed to J G Gamble.
Combined occipitoatlantoaxial hypermobility with anterior and posterior arch defects of the atlas in Pierre-Robin syndrome.
Combined occipitoatlantoaxial instability of the cervical spine occurred in a 8-year-3-month old boy with Pierre-Robin syndrome. He also had failure of ossification of both the anterior and posterior arches of the atlas. An in situ fusion from the occiput to C2 restored cervical spine stability. This case is discussed in relation to other hypermobility and instability syndromes of the cervical spine.
Atlanto-Axial Joint↗
Coxa magna following surgical treatment of congenital hip dislocation.
We studied coxa magna after operative treatment of congenital dislocation of the hip, including incidence, relationship to treatment, and influence of coxa magna on the acetabulum. Coxa magna was defined as a femoral head with a horizontal diameter at least 15% greater than the symmetrical position on the opposite side. Coxa magna developed in 16 hips (33%). The mean increase was 20.9% (range 15-30%). Three factors correlated with coxa magna: femoral osteotomy (100%), open reduction (75%), and operation at a younger age (mean 15.6 vs. 35.8 months). Four of the 16 hips developed coxa magna following Type 1 avascular necrosis; no other growth deformities appeared. At follow-up, the acetabular indices and the center edge angles were not statistically different between the coxa magna and the control groups. One must avoid confusing coxa magna with hip subluxation or inadequate reduction, of which the latter requires appropriate treatment. Coxa magna gives a good hip if a concentric, congruous reduction is obtained, providing the acetabulum has enough growth potential for remodeling.
Child↗
Segmental instrumentation without fusion in children with progressive scoliosis.
Nine young children had segmental spinal stabilization without fusion for progressive scoliosis. External bracing was not used. There were no immediate complications, but at a mean follow-up of 28 months, the mean loss of correction was 32% and only four patients maintained the initial correction. The mean interval spinal growth was only 0.8 cm. Rods failed in three patients, requiring revision and fusion. Thus, the early results of this technique are discouraging.
Braces↗
Chronic recurrent multifocal osteomyelitis: a distinct clinical entity.
We reviewed the cases of five children with the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) and compared and contrasted them to 11 cases of subacute osteomyelitis. Significant differences were found between these two groups in the number of cases with positive biopsy cultures, number of clinical episodes, and number of bones involved. In CRMO, cultures are negative, and recurrent clinical episodes involve different bones at different times. The data indicate that CRMO is a distinct clinical entity, different from subacute osteomyelitis; it is a benign, self-limiting inflammatory disease of bone, and no chronic problems have occurred as a result of CRMO. Restraint in antibiotic treatment and in performing repeated biopsies is indicated in CRMO.
Adolescent↗
Kingella kingae infection in healthy children.
Kingella kingae is a gram-negative occasional, but normal, inhabitant of the nasopharynx. We present two new cases of this infection that occurred in previously healthy children, and compare and contrast them to other cases reported in the literature. K. kingae osteomyelitis generally has an insidious, subacute onset, whereas septic arthritis has an acute presentation. To date, all strains of K. kingae have been sensitive to penicillin, and no residual damage has been reported following osteomyelitis or septic arthritis, except that residual disk space narrowing did occur after K. kingae discitis.
Acute Disease↗
Complications of intramedullary rods in osteogenesis imperfecta: Bailey-Dubow rods versus nonelongating rods.
Twenty-nine patients with osteogenesis imperfecta underwent 108 intramedullary roddings with 42 Bailey-Dubow rods and 66 nonelongating rods. The average age at insertion of the first rod was 5 years; average follow-up was 3.1 years (range 1-9 years). The overall complication rate was 60%-69% for Bailey-Dubow rods and 55% for nonelongating rods. Forty-seven percent of bones receiving rods required reoperation. Nonelongating rods had a 29% reoperation rate and a 24% replacement rate; Bailey-Dubow rods had a 19% reoperation rate and a 12% replacement rate.
Adolescent↗
Simultaneous correction of pelvic obliquity, frontal plane, and sagittal plane deformities in neuromuscular scoliosis using a unit rod with segmental sublaminar wires: a preliminary report.
Ten patients with neuromuscular scoliosis and pelvic obliquity had segmental spinal instrumentation using a unit Luque rod with sublaminar wires and fixation into the pelvis. Nine of the 10 patients also had anterior spinal fusion without instrumentation before the posterior procedure. Average preoperative pelvic obliquity was 42 degrees which was corrected to 6 degrees (82% correction). Average preoperative scoliosis was 92 degrees, which was corrected to 16 degrees (81% correction). Complications included a wound hematoma in one patient and a superficial wound dehiscence in another. There have been no pseudarthroses or hardware failures to date. Excellent correction of the pelvic obliquity and the spinal curve in neuromuscular scoliosis can be obtained with use of a unit rod and without use of anterior instrumentation.
Adolescent↗
Transverse cervicopertrochanteric hip fracture.
A 3-year-old boy sustained a previously undescribed transverse hip fracture that involved the cervical, cervicotrochanteric, and intertrochanteric regions. The fracture was successfully treated with skeletal traction for 4 weeks using a Steinmann pin placed through the distal femoral metaphysis followed by spica cast immobilization. The 3-year follow-up examination demonstrated satisfactory growth and remodeling of the proximal femur with no evidence of osteonecrosis, premature physeal closure, or coxa vara.
Casts, Surgical↗
Enzymatic adaptation in ligaments during immobilization.
Ligaments are a composite of fibroblasts and collagen in a proteoglycan matrix. Seventy-five percent of the organic solid is collagen and 23% is proteoglycan. Fibroblasts are responsible for the overall composition of the ligament, that is the synthesis and the degradation of macromolecular components. Like muscle and bone, ligaments are dynamic, undergoing hypertrophy with exercise and atrophy with immobilization. This paper reviews the structure and composition of ligaments and discusses the cellular events responsible for atrophy of ligaments with immobilization. As an experimental model, one knee of New Zealand White rabbits was immobilized with a pin. After 2, 4, and 8 weeks of immobility, the medial collateral ligaments were isolated and enzyme analysis was performed. Gross and microscopic changes were apparent after 2 weeks. As for enzyme changes, lactic dehydrogenase and malic dehydrogenase decreased in activity. The lysosomal hydrolases responsible for glycosaminoglycan degradation increased in activity, suggesting that enzymatic adaptations mediate the physical and chemical changes in the ligament. The cells switch from an anabolic synthetic state to a catabolic, degradative state during immobility. It would seem from the biochemical viewpoint that, whenever possible, cast-bracing and functional splints may be preferable to rigid plasters in many sports-related ligamentous injuries.
Animals↗
Symptomatic dorsal defect of the patella in a runner.
The dorsal defect of the patella is a benign lesion characteristically located in the superolateral corner of the patella. The microscopic pathology shows fibrous tissue, reactive woven bone, and stringy, eosinophilic, extracellular debris. Although the lesion is usually asymptomatic, the juxtaarticular location in the patella can provoke symptoms in the athlete. Excision of the lesion and cancellous bone graft of the defect resolved the problem in a competitive adolescent runner.
Adolescent↗
Electromyographic differentiation of diplegic cerebral palsy from idiopathic toe walking: involuntary coactivation of the quadriceps and gastrocnemius.
Clinical differentiation of patients with mild diplegic cerebral palsy (CP) and idiopathic toe walking (ITW) can be difficult. However, an involuntary extensor pattern may be a distinguishing sign. The purpose of this study was to determine if selected gait parameters or patterns of electromyogram (EMG) timing of quadriceps, gastrocnemius, and tibialis anterior during knee extension while sitting can distinguish between these patients. The hypothesis was that EMG testing for selective control of the quadriceps and gastrocnemius could differentiate patients with diplegic CP from normal controls and from patients with ITW. We evaluated 10 control, eight CP, and eight ITW subjects. Measurements included walking speed, energy expenditure index (EEI), ankle position during stance, and EMG of the quadriceps, gastrocnemius, and tibialis anterior during gait and during knee extension while sitting. Dynamic EMG timing during gait showed significant differences in the mean onset of the gastrocnemius between subjects with CP and ITW, but there was considerable overlap. More consistent differences were found during active and active-resisted knee extension while sitting. Mean values for gastrocnemius EMG timing recorded as a percentage of duration of quadriceps EMG while sitting were 0 and 0.4% for controls, 0 and 3.9% for ITW subjects, and 84.3% and 93.4% for CP subjects. Patterns of EMG timing of the quadriceps and gastrocnemius during knee extension while sitting can help to differentiate patients with mild diplegic CP from those with ITW.
Cerebral Palsy↗
Intravenous regional anesthesia: a safe and cost-effective outpatient anesthetic for upper extremity fracture treatment in children.
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Anesthesia, Conduction↗
Financial aspects of medical care.
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Cost-Benefit Analysis↗
The energy expenditure index: a method to quantitate and compare walking energy expenditure for children and adolescents.
We used heart rate and walking speed to calculate an energy expenditure index (EEI), the ratio of heart rate per meter walked, for 102 normal subjects, age 6-18 years. Heart rate was measured at self-selected slow, comfortable, and fast walking speeds on the floor and on a motor-driven treadmill. At slow walking speeds (37 +/- 10 m/min) the EEI was elevated (0.71 +/- 0.32 beats/m), indicating poor economy. At comfortable speeds (70 +/- 11 m/min) the EEI values decreased to the maximum economy (0.47 +/- 0.13 beats/m). At fast speeds (101 +/- 13 m/min), the EEI increased (0.61 +/- 0.17 beats/m), indicating poor economy relative to comfortable speeds. A graph of the EEI versus walking speed provides a way to evaluate and compare energy expenditure in a clinical setting.
Adolescent↗
Simple method of documenting metatarsus adductus.
A simple, accurate, and inexpensive method of documenting metatarsus adductus involves taking photocopies of the foot in the weightbearing position. Subsequently, treatment progress can be assessed objectively by reviewing serial photocopies. Some caution is urged because the strength of the glass copying surface of photocopying machines is unknown.
Copying Processes↗
Osteomyelitis of the patella in children.
The early diagnosis of osteomyelitis of the patella in children can be difficult due to the rarity of this infection and to the vagaries of presentation which may be either acute with systemic signs or insidious with mild local signs. We present four cases of patellar osteomyelitis to illustrate the spectrum of this disorder. There should be a high index of suspicion with persistent pain and swelling above the knee, septic prepatellar bursitis, and septic knees that do not respond to conventional management. Management parallels treatment of osteomyelitis of other bones.
Child↗
Energy cost of walking in normal children and in those with cerebral palsy: comparison of heart rate and oxygen uptake.
The rate of oxygen uptake can be used to assess energy expenditure during walking, but the necessary instrumentation is cumbersome, expensive, and usually unavailable in the clinical setting. Heart rate is an easily measured parameter, but its use as an index of energy expenditure in children has not been validated previously. We found that the relationship between oxygen uptake and heart rate was linear throughout a wide range of walking speeds for both children with cerebral palsy and normal children. There was no significant difference between the slope or the gamma-intercept of the lines for the two groups. These findings validate the use of heart rate as an index of energy expenditure for normal children and for children with cerebral palsy.
Adolescent↗