Congenital pseudarthrosis of the radius.
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Child, Preschool↗
Biomedical subjects
J W Roach
Publications and source records attributed to J W Roach.
Slipped capital femoral epiphysis associated with hyperparathyroidism.
Slippage of the upper femoral epiphysis can occur in association with multiple endocrine imbalances. This report documents the second case of primary parathyroid adenoma with hyperparathyroidism and symptomatic concomitant slipped capital femoral epiphyses. In the evaluation of children with slipped capital femoral epiphysis, care must be taken to eliminate other treatable disease states that are known to be associated with this phenomenon. The capital femoral physes in this child with hyperparathyroidism promptly closed following removal of the parathyroid adenoma.
Adenoma↗
Extension-abduction contracture of the spastic hip.
Patients with cerebral palsy and fixed hip extension are often unable to sit and therefore lose social and educational opportunities. At Texas Scottish Rite Hospital (Dallas, TX, U.S.A.), 29 patients had hip extension-abduction contractures. Eleven patients with mild involvement were managed with physical therapy. Six patients had moderate involvement and required wheelchair modification to maintain sitting. Twelve patients demonstrated severe contractures that required major soft tissue releases and often femoral shortening osteotomies to regain flexion. Patients with athetosis or rigidity were identified as those most likely to develop extension-abduction contractures either spontaneously or following adductor releases.
Adolescent↗
A simple method of hip arthrodesis.
A technique of intraarticular hip arthrodesis using a cancellous screw to provide compression across the joint is introduced. We present four patients in whom this method was successful, resulting in solid fusion and pain relief at follow-up.
Adolescent↗
Promoting independence in adolescent paraplegics: a 2-week "camping" experience.
In the summer of 1982, Texas Scottish Rite Hospital (Dallas, TX, U.S.A.) sponsored a camp for paraplegic adolescents. Six patients, three boys and three girls 14-17 years of age, participated in a 2-week program that was designed to improve their self-esteem, independence, and eventual employability. In their pre- and postcamp psychological evaluations, the campers demonstrated improvement in social skills and self-concept testing as compared with the scores of a matched control group, although this improvement did not reach statistical significance. We believe the camp was immensely successful, an opinion that was shared by both the campers and their parents.
Activities of Daily Living↗
Treatment of acquired hip subluxation in cerebral palsy.
Fifty-seven children with cerebral palsy and subluxated hips underwent soft tissue releases to obtain hip reductions. Eight patients in Group I (preoperatively mildly subluxated hips) had postoperative bracing, all with good results. Twenty-two unbraced patients in Group I had 14 good, 5 fair, and 3 poor results. Thirteen patients in Group II (preoperatively severely subluxated hips) received postoperative splinting with nine good, one fair, and three poor results. The 14 unbraced patients in Group II had one fair and 13 poor results. This study indicates that even severely subluxated hips in spastic children less than 6 years of age can eventually achieve stable reductions provided long-term abduction bracing is used following adequate soft tissue releases.
Casts, Surgical↗
Sensitivity of spinal cord monitoring to intraoperative events.
Intraoperative somatosensory evoked potentials in 50 patients were reviewed; each waveform was correlated with intraoperative surgical events and conditions. Twenty-two patients maintained reproducible waveforms and awoke without neurological deficit. Two patients had random waveform changes not correlated with a surgical event and awoke without deficit. Twelve patients showed waveform changes temporally related to circumstances that might endanger cord function; two of these awoke with transient neurological abnormality. Satisfactory waveforms were not obtained from 14 patients. Somatosensory evoked potential monitoring in scoliosis surgery appears to be sensitive, but may not be sufficiently specific; waveform changes do not necessarily indicate objective neurological damage.
Adolescent↗
Acetabular coverage: three-dimensional anatomy and radiographic evaluation.
The three-dimensional relationship between acetabulum and femoral head, known as coverage, was evaluated radiographically using a modified inlet view of the pelvis. The relationship of the anterior edge, the center of the femoral head, and the posterior edge of the acetabulum is a straight line (180 degrees) in normal coverage but less in dysplastic hips. This radiographic method provides anatomical information concerning anterior and posterior coverage. Evaluation of 26 hips delineated problems, including possible danger of anterolateral rotation of the acetabulum in the face of posterior deficiency and inadequacy of posterior coverage after Chiari osteotomy.
Acetabulum↗
Teratologic dislocation of the hip.
We reviewed 27 teratologic hip dislocations in 17 patients. Four hips underwent closed reduction, 10 hips had medial adductor open reduction, 9 hips had iliofemoral open reduction, and 4 hips had iliofemoral open reduction and femoral shortening. Avascular necrosis occurred in 48%, redislocation in 19%, and subluxation in 22% of the hips. Results were best in those hips treated by anterior open reduction and femoral shortening and worst in those having closed reduction. Poor results correlated with multiple other involved joints, hypotonia, developmental delay, and poor head control.
Arthrogryposis↗
Magnetic resonance imaging of the spinal cord in spinal dysraphisms.
Magnetic resonance imaging (MRI) was performed 49 times in 42 patients with spinal dysraphism. Scoliosis and a changing neurological picture were the primary indications. Spinal cord anomalies included hydromyelia, diastematomyelia, lipoma, thickened filum terminali, and spinal cord atrophy. All but one patient exhibited Arnold-Chiari malformation. Twenty-two of the 42 patients had computed tomography (CT) scans, myelograms, or operations that corroborated the 41 MRI findings. Three false-positive MRI findings of hydromyelia and no false-negative studies were observed. MRI is a noninvasive investigative technique that provides more information than myelography or CT in defining spinal cord anatomy in spinal dysraphism.
Arnold-Chiari Malformation↗
Corrective osteotomy for cubitus varus deformity.
Between 1970 and 1992, 23 patients with cubitus varus deformities following elbow fractures underwent 26 corrective lateral-wedge osteotomies at Texas Scottish Rite Hospital. Internal fixation was most commonly provided by either small Steinmann pins, two screws and a figure-of-eight wire, or a small two-hole plate. Sixteen patients had a good result and 10 were judged to have poor results. Two of the 10 patients with poor results had inadequate intraoperative correction. Unstable internal fixation allowed osteotomy fragments to slip into varus in the remaining eight poor results (three with Steinmann pins and five with figure-of-eight wire). Nonrigid internal fixation was obvious even in the patients who received good correction of their cubitus varus. Of the 16 patients with good postoperative results, six demonstrated loss of fixation with extension of the distal fragment. In addition, seven patients with poor results also had slippage of the distal osteotomy fragment into extension. These patients had between 5 and 15 degrees of apparent elbow hyperextension with concomitant loss of elbow fixation. We now recommend a two-hole lateral plate and a percutaneous medial pin to enhance the stability of internal fixation.
Child↗
Surgical correction of myelomeningocele scoliosis: a critical appraisal of various spinal instrumentation systems.
A retrospective review of 38 patients with myelomeningocele scoliosis, focusing on the incidence of eventual fusion, curve correction, and change in pelvic obliquity, was performed. Single stage anterior or posterior fusion was compared to combined anterior and posterior spinal fusion. Single stage anterior or posterior procedures resulted in only a 50% fusion rate compared to rates of 83 to 100% for various combinations of combined anterior and posterior fusions. Similarly, average curve correction and change in pelvic obliquity were much improved with a two-stage approach. No statistical difference in fusion rate, curve correction, or change in pelvic obliquity was noted between the various combinations of two-stage anterior and posterior fusions.
Adolescent↗
Congenital dislocation of the knee.
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Female↗