Biomedical subjects
J R Gage
Publications and source records attributed to J R Gage.
Rectus femoris transfer to improve knee function of children with cerebral palsy.
Stance phase stability and swing phase clearance, prerequisites for normal ambulation, often are lost in the gait of children with cerebral palsy. Lengthening of the hamstrings usually will improve stance-phase knee extension but will not greatly alter swing-phase knee flexion. This paper presents the outcome of transfer of the distal end of the rectus femoris in conjunction with hamstrings lengthening in 37 knees, and compares it with a control group of 24 knees in which only hamstrings lengthening was done. In the first group swing-phase knee flexion was improved by 16.0 +/- 14.4 degrees, compared to 9.5 +/- 7.5 degrees in the control group, and residual knee flexion in stance was reduced to 8.9 +/- 8.1 degrees, compared to 15.1 +/- 13.8 degrees in the controls. Poor outcome in the transfer-plus-lengthening group was associated mainly with foot rotation in excess of 8 degrees internally or externally, or postoperative knee flexion in stance. Criteria for selection of cases and methods of improving surgical outcome are discussed.
Gait patterns in spastic hemiplegia in children and young adults.
Four homogeneous patterns of gait were defined in forty-six patients who had spastic hemiplegia secondary to cerebral palsy or other neurological disorders by analyzing kinematic data in the sagittal plane and electromyographic data. In Group I (twenty patients) the primary abnormality was a drop foot in the swing phase. The thirteen patients in Group II had a tight heel cord in the stance phase as well as a drop foot in the swing phase. The five patients in Group III also had more proximal involvement (that is, restricted motion of the knee) as well as an equinus deformity of the ankle. In Group IV, the eight patients had, in addition, restricted motion of the hip.
Swing phase control with knee friction in juvenile amputees.
Above-knee amputees have a slower than normal walking velocity. In conventional prostheses the solution has been to apply knee friction to attempt to match the cadence of the prosthetic limb to the sound limb. Using kinematic data, we investigated the effect of variable knee friction on the swing phase of gait in juvenile amputees. The subjects were instructed to walk at a comfortable pace and were tested repeatedly with varying amounts of knee friction. We found that the excursion of the prosthetic shank as measured by knee range of motion was altered by changing the amount of knee friction. The period of the prosthetic shank remained constant when measured as a physical pendulum and when measured dynamically during gait. Therefore, knee friction is an effective means of providing the amputee with a more symmetrical appearing gait by matching the heel rise of the prosthetic limb to the sound limb. It is not an effective means, however, of matching the cadence of the prosthetic limb to the sound limb.
Pre- and postoperative gait analysis in patients with spastic diplegia: a preliminary report.
The benefits of using computerized gait analysis to plan and evaluate operations were assessed by studying the data from 20 children with spastic diplegia and examining the changes in estimated external work of walking, stride length, walking velocity, and joint rotations pre- and postoperatively. Of the 20 patients, 13 improved, 6 were unchanged, and 1 was worse. None of the patients walked in a crouch postoperatively. By clinical evaluation, 19 of the 20 patients were better. Thus objective gait analysis imposed much more stringent criteria for improvement. Computerized gait analysis has enabled us to be more objective in the evaluation and documentation of outcome.
Extraarticular subtalar arthrodesis with internal fixation.
Forty extraarticular subtalar arthrodeses with internal fixation were performed in 26 patients with cerebral palsy who had a mobile, paralytic planovalgus deformity. We assessed the correction achieved and maintained by evaluating the clinical status, improvement in gait, correction of deformity, and foot stability. Union was achieved in a mean interval of 10 weeks with no instance of mechanical failure of the fixation screw. At a mean follow-up of 30 months, 38 feet (95%) were rated excellent or good and two were rated fair. The advantages of this technique of extraarticular subtalar arthrodesis warrant continued use of this procedure.
Gait analysis for decision-making in cerebral palsy.
Gait analysis offers objective assessment of complex neuromuscular conditions such as cerebral palsy. With such assessment, more predictable treatment outcomes should be possible with less "staging of surgery." This article presents prerequisites and specifications of the Newington Children's Hospital laboratory. Three cases are presented to demonstrate the clinical applications.
Idiopathic juvenile osteoporosis and scoliosis.
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The correlation of idiopathic lumbar scoliosis and lumbar lordosis.
A definite correlation exists between the presence of idiopathic lumbar scoliosis and hyperlordosis of the lumbar spine. Present data do not reveal whether hyperlordosis constitutes an element which makes a "spine at risk" for developing scoliosis. However, the presence of an extreme lordosis suggests that in any comprehensive plan of treatment of idiopathic lumbar scoliosis, provision should be made for correction of severe deformities of the lumbar spine.
Treatment concepts for proximal femoral ischemic necrosis complicating congenital hip disease.
A retrospective review of fifty-three congenitally dislocated hips (in forty-four patients) in which ischemic necrosis developed was undertaken to assess patterns of growth disturbance and to establish treatment protocols. We utilized the Bucholz and Ogden classification of the four roentgenographic patterns of ischemic necrosis complicating the treatment of congenital hip disease. Patients with Type-I disease had transient ischemia with early recovery. Significant growth disturbances requiring surgical treatment were not observed. Limb-length discrepancy, increased height of the greater trochanter relative to the femoral neck and head, and problems with femoral head coverage were more likely to develop in hips with Type-II or Type-III ischemic necrosis. Equalization of limb lengths, trochanteric epiphyseodesis, and surgical means of improving femoral head coverage were also more commonly indicated in these patients. In patients with Type-IV disease, mild deformities of the femoral head and occasional limb-length discrepancies developed; other sequelae were uncommon and surgical intervention was rarely required.
An update: detection of congenital dysplasia of the hip.
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Primary hypophosphatemic rickets. Effect of oral phosphate and vitamin D on growth and surgical treatment.
Failure to diagnose and treat hypophosphatemic rickets during childhood resulted in stunted growth and progressive deformities of the lower limb. When the deformities were treated surgically, recurrent deformity and non-union of osteotomies developed, and further major opeative procedures were required to remedy these complications. Treatment from early childhood with oral phosphate and vitamin D improved the rate of growth and controlled the progression of bowleg deformity. Residual varus deformity was corrected by osteotomy through the proximal tibial metaphysis at skeletal maturity, when the results were predictable. Genu valgum deformity was corrected by stapling the medial part of the distal femoral epiphysis prior to skeletal maturity. With early postoperative mobilization and adequate medication, the complications of delayed tibial union and failure to correct the femoral valgus deformity were avoided.
The effects of trochanteric epiphyseodesis on growth of the proximal end of the femur following necrosis of the capital femoral epiphysis.
Avascular necrosis of the hip was evaluated in two groups of patients. On group had sustained the insult to the epiphysis in infancy and had a mean growth loss in the proximal end of the femur of 21.5 millimeters at a mean age of 11.7 years. The other group had sustained the insult in mid-childhood (due to Legg-Perthes disease) and had a mean growth loss of seven millimeters at 12.4 years. Based on this evaluation, we concluded that trochanteric epiphyseodesis was nary in the latter group.
School screening for the early detection of scoliosis in children.
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Complications after cuneiform osteotomy for moderately or severely slipped capital femoral epiphysis.
Wedge osteotomy of the femoral neck for slipped capital femoral epiphysis was performed in seventy-seven hips of seventy-one children at Gillette Children's Hospital during the period 1938 to 1973. The major complications were avascular necrosis (28.5 per cent) and cartilage necrosis (37.6 per cent). This high incidence of severe complications led to the use of an osteotomy through the base of the neck for the treatment of severely slipped capital femoral epiphysis which has given satisfactory results in six hips to date.
Long-term follow-up of Perthes' disease treated nonoperatively.
Forty-six patients with Perthes disease treated nonoperatively were reviewed 10 to 43 years later. The median follow-up was 17 years. The patients were analyzed according to sex, age of onset, quantity of head involvement, type of treatment, duration of treatment, functional end result based on the Harris hip scale, and anatomic end result based on Mose templete evaluation. Most patients were treated with an ischial weight-bearing brace. The anatomic results of this treatment tended to be poor, probably worse than no treatment at all. In general, poor results were correlated with late onset, greater quantity of head involvement, and lateral subluxation of the femoral head. As reported in other series, the anatomic results did not correlate well with the functional results, only two patients having Harris hip scales below 70.
Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip. A critical review of twenty years' experience at Gillette Children's Hospital.
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Os calcis fractures. An analysis of 37.
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