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Biomedical subjects

K E Wilkins

Publications and source records attributed to K E Wilkins.

16 recordsLinked to original sources
PubMed1997

Supracondylar fractures: what's new?

In the past 5 to 7 years many advances have been made in the treatment of type III supracondylar fractures of the humerus. Gartland's three-type classification has continued to be used as a valuable tool to determine the aggressiveness of treatment. Use of cast immobilization for type III injuries has been shown to produce inferior results. Percutaneous pin fixation for reduced fractures has been established as the ideal treatment for most type III displaced fractures. Mediolateral or three lateral pin constructs provide the most rigid fixation. It is now apparent that the anterior interosseous nerve is probably the most commonly injured nerve. Recent technology in evaluating the vascular system has shown that the incidence of injuries to the brachial artery is probably higher than originally suspected. However, the management of these arterial injuries in patients who appear to have adequate profusion of the forearm musculature for normal function is still controversial, with recommendations varying from simple observation to aggressive primary arterial repair. Cubitus varus has been found to be due primarily to angulation in the coronal plane. Fortunately the incidence of complications after corrective osteotomies with this deformity has decreased from 50% to less than 15%. Although ipsilateral fractures are usually the result of greater forces of trauma, the incidence of associated neurovascular compromise does not appear to be any greater. Better recognition of flexion-type injuries has shown that the incidence is greater than originally suspected. A large percentage of these completely displaced flexion injuries may require open surgical intervention to obtain adequate reduction.

Brachial Artery↗
PubMed1996

Suction injuries in children leading to acute compartment syndrome of the interosseous muscles of the hand: case reports.

Compartment syndromes of the interosseous musculature in the hands of children is a relatively rare phenomenon and is usually associated with crush injury, severe burn, or ischemic events. Two cases of intrinsic compartment syndrome in children, secondary to suction injuries of the hand, are presented. Two children experienced suction injuries to the upper extremity when their hands were caught in a swimming-pool intake pipe filtration system. The filtration system intake suction developed enough negative pressure to induce an acute compartment syndrome of the interosseous muscles, requiring acute surgical decompression. Early diagnosis, prompt surgical decompression, and early postoperative rehabilitation of this unusual etiology of compartment syndrome of the hand provided a favorable and functional outcome.

Accidents↗
PubMed1991

The elbow.

Explore the source record for details and available documents.

Adult↗
PubMed1991

Changing patterns in the management of fractures in children.

Advances in radiographic imagery have greatly facilitated the diagnosis and treatment of pediatric musculoskeletal injuries. In recent years, the indications for operative intervention in the treatment of children's fractures have become more clearly defined.

Child↗
PubMed1990

The operative management of supracondylar fractures.

Supracondylar fractures of the humerus occur in either an extension or flexion pattern. Both patterns have three types distinguished by the degree of displacement. Extension fractures, type III patterns in which there is complete displacement, usually require operative intervention in the form of a closed reduction with percutaneous pin fixation. In those in which an adequate reduction is not achieved, an open reduction is the preferred alternative treatment. Recognition of the role of the anterior periosteum in interfering with an adequate reduction is important. In addition, determination of the posteromedial or posterolateral displacement of the distal fragment is important in recognizing which neurovascular structures are more likely to be injured, which pin to place first, and which surgical approach is proper for an open reduction. Flexion fractures, type II displaced fractures, often require pin fixation, and type III displaced fractures usually require an open reduction.

Adolescent↗
PubMed1990

Residuals of elbow trauma in children.

Residuals of trauma involving the distal humerus in children are mostly the result of delayed treatment or incomplete reduction of the fracture fragments. Cubitus varus after supracondylar fractures is primarily a cosmetic problem. Correction of this deformity is possible surgically but requires strict attention to detail because a high incidence of complications are associated with performance of a supracondylar osteotomy. Cubitus valgus, on the other hand, does have some functional problems. Thus, there is more of a functional reason to correct cubitus valgus deformities. The biologic complications of lateral condyle fractures such as lateral spur formation and the mild cubitus varus that occurs usually do not require surgical intervention. Those problems associated with techniques of treatment, such as a delayed open reduction, non-union, and angulation, again can be remedied surgically. Specific basic principles, as outlined in this article, however, must be followed to achieve success.

Adolescent↗
PubMed1986

Bowlegs.

The bowed appearance of the lower extremities is most often caused by internal rotation of the tibia in relationship to the femur. It is most commonly seen as the infant commences ambulation. This so-called physiologic bowing usually spontaneously resolves with growth and the maturity of the lower extremities. In older children, tibia varum may occur, in which there is a local arrest of growth on the posterior medial aspect of the tibia producing a true structural angulation. In certain long-standing metabolic or genetic bone disorders, the effects of weight bearing produce a true bowing of the extremities with changes about the hips, knees, and ankles. The most important aspect in the evaluation of a child with a bowed appearance of the lower extremities is to determine which conditions require aggressive treatment and which ones require simply giving the parents reassurance that the condition will spontaneously regress.

Bone Diseases↗
PubMed1984

Deformity following distal humeral fracture in childhood.

We are reporting five cases of a seldom-reported complication following fracture of the distal end of the humerus during childhood. The complication consists of dissolution of a variable portion of the trochlea at a variable time after fracture. The fractures ranged from non-displaced to severely displaced supra-condylar fractures along with a lateral condylar fracture and a Salter-Harris Type-I fracture. The severity of the fracture did not correlate with the severity of the deformity. When the defect in the trochlea was wide enough to permit migration of the ulna proximally, the range of flexion and extension was severely affected. Excision of the olecranon in one twelve-year-old boy resulted in a moderate increase in extension.

Child, Preschool↗
PubMed1980

Fracture-separation of the distal humeral epiphysis.

Sixteen patients were seen with fracture-separation of the distal humeral epiphysis. The difficulty that may be encountered in making the diagnosis is thought to be partly responsible for the relative paucity of previous reports of this condition. All sixteen patients revealed posteromedial displacement of the distal humeral epiphysis on the initial roentgenogram. Child-abuse was documented or suspected as a cause in six of the sixteen fractures. Treatment consisted of closed reduction and immobilization with the elbow in 90 degrees of flexion and the forearm pronated, for three weeks. Post-injury cubitus varus, which developed in three patients and was thought to be due to inadequate reduction, did not progress.

Child↗
PubMed1976

The patterns of spinal deformity in Duchenne muscular dystrophy.

In a clinical and roentgenographic study of spinal deformities in sixty-two patients in the later stages of Duchenne muscular dystrophy, many patients had marked scoliosis and kyphosis, while others with hyperextended spines had comparatively little scoliosis. Based on an analysis of the data, it is suggested that the development of spinal deformity in patients with Duchenne muscular dystrophy may progress in two ways: one leading to the early establishment of a position of extension and a maximum intrinsic stability with minor deformity, and the other leading to progressive deformity. It was concluded that management for these patients should be designed to guide the early straight spine toward the late extended pattern by attempting to prevent kyphosis and pelvic obliquity.

Adolescent↗
PubMed1975

The management of spinal deformities in Duchenne muscular dystrophy. A new concept of spinal bracing.

A clinical study of 62 patients with Duchenne Muscular Dystrophy has suggested 2 pathways in the pathogenesis of the spinal deformities. In the first pathway, the patients develop an initial kyphosis due to the loss of paravertebral muscle thus placing the intrinsic ligamentous spine in an unstable position. The spine then develops a lateral curve accentuated by pelvic obliquity. In the final form, axial rotation of the spine and pelvis occurs to produce a severe deformity. In the second pathway the intrinsic spine assumes the more stable position of hyperextension with a level pelvis. This position remains relatively unchanged during the period of wheelchair confinement even though muscle deterioration progresses. A significant increase in the severity of the deformity occurs with age in those patients with unstable spines. None of the other factors examined affected the severity of the lateral curvature. A spinal brace has been designed to keep the spine extended and the pelvis level while the patients sits in his wheelchair. The purpose is to encourage the inexorable progression of muscular deficiencies to follow the second pathway. Various modifications of wheelchairs also may help to maintain spinal stability.

Activities of Daily Living↗
PubMedDate not supplied

Femur fractures in infants: a new therapeutic approach.

Fourteen patients with 16 femur fractures sustained between birth and 18 months of age were treated with a Pavlik harness rather than traditional casting methods. All of the fractures went on to stable union within 5 weeks. Eleven fractures have been followed-up for > 12 months, with a range of 12-30 months, and a mean of 20.1 months. All of the fractures healed in good alignment, with leg-length discrepancies < 1 cm. There have been no adverse results or complications as a result of treatment with the Pavlik harness to treat femur fractures, including fractures of the proximal and middle thirds of the femur; nonambulatory infants; < 4 months old at the start of treatment or small size in selected infants up to 6 months old; and shortening of < 2 cm. Advantages of the use of the Pavlik harness include ease of application without general anesthesia, minimal hospitalization, ease of reduction, ability to adjust the harness (and therefore the fracture alignment) if the reduction is lost, minimal cost, and ease of nursing, bonding with, and changing diapers on the infant.

Birth Injuries↗
PubMedDate not supplied

The uniqueness of the young athlete: musculoskeletal injuries.

There is considerable difference in the management of musculoskeletal injuries in the pediatric athlete. The biomechanical characteristics of the growing bone react differently to applied stresses. Plastic deformation, green-stick, torus, and epiphyseal fractures are types seen only in the pediatric age group. The pediatric athlete fortunately has a much greater remodeling capacity, thus, altering the approach to the treatment of injuries. An understanding of the different types of injuries in the skeletally immature athlete is essential for those treating this age group.

Adolescent↗