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Biomedical subjects

J R Gage

Publications and source records attributed to J R Gage.

47 records · Page 3Linked to original sources
PubMedDate not supplied

Open reduction for congenital hip dislocation: the risk of avascular necrosis with three different approaches.

A review of 49 hips with congenital dislocation that were treated with anterior open reduction after traction and arthrogram showed that partial avascular necrosis can occur even when adequate decompression of the femoral head is obtained. When femoral osteotomy is done in conjunction with open reduction, the rate of avascular necrosis is not greater than for open reduction alone. Open reduction combined with innominate osteotomy had the highest rate of partial avascular necrosis and also the highest rate of additional surgery required.

Child↗
PubMedDate not supplied

The fate of the nonoperated hip in cerebral palsy.

Thirty-six cerebral palsied patients who underwent a unilateral operative procedure for spastic hip subluxation or dislocation were reviewed for assessment of the effect on the nonoperated hip. Unilateral soft tissue procedures on patients less than 9 years of age had a definite untoward effect on the contralateral, nonoperated hip (progressive subluxation and development of a windswept pelvis deformity). The effect of unilateral bony procedures on the nonoperated hip was not statistically significant. Following unilateral surgery, nonambulators are at increased risk of demonstrating deterioration of the nonoperated hip in comparison to ambulators.

Cerebral Palsy↗
PubMedDate not supplied

A comparative study of ambulation-abduction bracing and varus derotation osteotomy in the treatment of severe Legg-Calvé-Perthes disease in children over 6 years of age.

Thirty-six patients with severe Legg-Calvé-Perthes disease were reviewed retrospectively to compare the results of ambulation-abduction bracing with varus derotation osteotomy. There were 17 brace patients and 19 osteotomy patients, and all were aged greater than 6.9 years. Treatment results were equal. The percentage of acetabular coverage, extent of lateral femoral subluxation, and the age of the patient affected outcome. The varus neck-shaft angle and leg length discrepancy resulting from the osteotomy were not permanent. The articular trochanteric distance appeared to be affected more by the neck-shaft angle recovery than by epiphysiodesis of the greater trochanter.

Adolescent↗
PubMedDate not supplied

Rectus femoris surgery in children with cerebral palsy. Part I: The effect of rectus femoris transfer location on knee motion.

Rectus femoris transfer was performed in 78 children (105 sides) with cerebral palsy (CP) at the same time as other surgical procedures as appropriate. The transfer was either medial to the sartorius (62 sides), semitendinosus (19 sides), or the gracilis (14 sides) muscles, or laterally to the iliotibial band (10 sides). Gait analysis performed before and 1 year after operation demonstrated increased knee range of motion (ROM) with increased extension at initial contact and in midstance and maintained knee flexion in swing. There were no statistically significant differences between the four transfer sites in the effect on those variables. Therefore, the choice of rectus femoris transfer site can be dictated by surgical preference or by the nature of other simultaneous procedures. There was no consistent change in transverse plane motion of the hip or foot progression angles between the two gait analyses, suggesting that rectus femoris transfer does not affect gait abnormalities observed in the transverse plane.

Adolescent↗
PubMedDate not supplied

Rectus femoris surgery in children with cerebral palsy. Part II: A comparison between the effect of transfer and release of the distal rectus femoris on knee motion.

Rectus femoris muscle (RF) surgery was performed in 98 children (136 sides) with cerebral palsy (CP). RF transfer was performed in 105 lower limbs, and distal RF release was performed in 31. Eleven (20 sides) similarly affected children had no RF procedure and are included for comparison. Gait analysis was performed just before and approximately 1 year after surgery. All children underwent other orthopaedic surgery at the time of the RF procedure. When preoperative knee range of motion (ROM) was > 80% of normal, there were no significant changes in knee motion in either the RF transfer or distal release groups. In patients with < 80% of normal knee ROM preoperatively, RF transfer was followed by maintained knee flexion in swing; patients who underwent distal RF release or no RF procedure showed a decrease (10 degrees and 6 degrees, respectively) in knee flexion postoperatively. These results suggest that the RF should be transferred and not released when knee ROM is < 80%.

Adolescent↗
PubMedDate not supplied

Kinematic and kinetic evaluation of the ankle after lengthening of the gastrocnemius fascia in children with cerebral palsy.

The effect of surgical lengthening of the gastrocnemius fascia on ankle joint kinematics and kinetics during gait in patients with cerebral palsy (CP) was evaluated. Twenty independent ambulators (24 sides) were included in this retrospective study. The evaluation included clinical examination, calculation of joint kinematics and kinetics, and collection of surface electromyography (EMG) during gait. Postoperative improvements were noted in static heelcord range of motion (ROM), with an associated increase in dorsiflexion in stance and swing. Kinetic analysis showed a decrease in the abnormal energy generated around the ankle in midstance and a statistically significant increase in the energy generated in late stance for push-off.

Adolescent↗
PubMedDate not supplied

Three-dimensional lower extremity joint kinetics in normal pediatric gait.

Gait analysis is becoming a more integral part of the decision-making process in treatment of children with neuromuscular problems. A normal reference, however, must be available for comparison when one makes decisions. We wished to develop a normal pediatric database for joint kinematics and kinetics which could then be used as a reference for clinical gait analysis. Thirty-one normal children underwent a complete gait analysis including calculations of three-dimensional joint kinematics and kinetics. The pediatric data were similar to that of normal adults.

Adolescent↗
PubMedDate not supplied

Differentiation of idiopathic toe-walking and cerebral palsy.

Kinematic data were collected on two groups of children with diagnoses of idiopathic toe-walking and mild spastic diplegia. Although both groups lacked a heel strike at initial contact, two distinct gait patterns were found. The toe-walkers displayed a variable pattern of ankle motion with moderate to severe plantarflexion at stance. The cerebral palsy patients showed a repeatable gait pattern with only minimal deviation from normal. The absence of a heel strike in this group is due to the sustained knee flexion at terminal swing and initial contact, which was significantly greater than in the toe-walkers.

Ankle↗
PubMedDate not supplied

Ambulation-abduction treatment in Legg-Calvé-Perthes disease (LCPD).

Ambulation-abduction treatment in LCPD was proven to be highly successful under conditions of careful selection and proper application. Biologic plasticity of the regenerating capital femoral epiphysis is responsive to the molding forces of a normal acetabulum when the epiphysis is properly centralized. Anatomic studies indicate that less than 50% of the articular surface of the femoral head is in contact with the acetabular surface at a given time, leading to points of high pressure on the contacting surfaces which may adversely affect anatomic recovery. Accordingly, recent trends have been toward ambulation-abduction with preserved motion in the hip joint. This article is a report of 2 recent series of patients treated by ambulation-abduction; one group was treated with a fixed device and the other with a mobile device. The results suggest superior anatomic restitution when some degree of hip motion is allowed in the orthosis.

Braces↗
PubMedDate not supplied

Effects of selective dorsal rhizotomy on gait in children with cerebral palsy.

We wished to examine the effects of selective dorsal rhizotomy (SDR) on the gait patterns of children with cerebral palsy (CP). Nineteen ambulatory children underwent preoperative and 1-year postoperative gait analyses that included clinical assessment of joint range of motion (ROM) and muscle tone, three-dimensional motion analysis, and dynamic electromyography (EMG). The children were divided into two groups: independent ambulators (n = 11) and dependent ambulators (requiring a walking aid) (n = 8). Improvements in joint passive ROM and a reduction in lower extremity spasticity were noted. In both groups, positive pre- to postoperative improvements were noted in sagittal plane hip, knee, and ankle motion and there was a greater incidence of a plantar-grade foot position in stance. There was no change in the coronal plane motion of the pelvis and hip. A mean increase in anterior pelvic tilt for the independent ambulators was the only major negative change observed in this study. We conclude that SDR improves specific gait parameters in children with CP.

Ankle Joint↗