Biomedical subjects

K J Guidera

Publications and source records attributed to K J Guidera.

11 recordsLinked to original sources

PubMed1991

Radiographic changes in arthrogrypotic knees.

We evaluated the knees of 62 patients with arthrogryposis multiplex congenita radiographically. Abnormal radiographs were noted in 34. The abnormalities consisted of both congenital and chronic changes secondary to long-standing clinical deformities including patellar elongation, malposition, flattening of the femoral condyles, joint incongruity, tibial plateau irregularities, tibial and femoral fractures, fibula hypoplasia, soft-tissue thickening, valgus deformity, and dislocation. The radiographic findings were consistent with the degree of longstanding physical deformity and can be used as a guide to the severity of the condition and the need for treatment.

Arthrogryposis↗

PubMed1991

Shark attack.

Shark attacks are rare but devastating. This case had major injuries that included an open femoral fracture, massive hemorrhage, sciatic nerve laceration, and significant skin and muscle damage. The patient required 15 operative procedures, extensive physical therapy, and orthotic assistance. A review of the literature pertaining to shark bites is included.

Animals↗

PubMed1990

Magnetic resonance imaging evaluation of congenital dislocation of the hips.

Magnetic resonance (MR) images were obtained preoperatively and postoperatively for 12 pediatric patients with congenital dislocation of the hip (CDH). The images were compared with arthrograms and computed tomography scans. The MR images were more accurate in defining soft-tissue anatomy, hip position, and obstructive factors to relocation. MR imaging is an efficient diagnostic tool in CDH.

Arthrography↗

PubMedDate not supplied

Operative treatment of congenital pseudarthrosis of the clavicle.

Eight children were treated operatively with resection of fibrous pseudarthrosis and sclerotic bone ends, careful dissection and preservation of the periosteal sleeve to maintain continuity, and approximation of bone ends. None had additional bone grafts or internal fixation. All had bridging ossification 6-8 weeks postoperatively, and all were solidly healed by 14 weeks after surgery. Follow-up has ranged from 2 to 14 years, with no evidence of recurrence. Remodeling of the prominence occurred slowly in 2-5 years, with the distal clavicle variably underdeveloped in all patients. Early resection of fibrous pseudarthrosis probably does not require the extensive grafting and internal fixation that has been recommended for older children.

Bone Development↗

PubMedDate not supplied

Orthopaedic manifestations of Rett syndrome.

We reviewed nine patients with Rett syndrome, a progressive encephalopathy that is being diagnosed more frequently in the United States. It occurs in females, causing mental deterioration, autistic behavior, and classic hand-wringing motion. The orthopaedic manifestations include scoliosis, lower extremity contracture, and coxa valga. Bracing and surgery are indicated to prevent or correct deformity and maintain ambulation.

Adolescent↗

PubMedDate not supplied

Hypoplastic clavicles and lateral scapular redirection.

Three patients with bilateral hypoplastic clavicles and anterolateral displacement of the shoulders and scapulas on the thoracic cage are described. One patient had no family history of the disorder. The mother of the other patient had the same condition, suggesting an autosomal dominant inheritance pattern. In all three patients, the clavicle was underdeveloped and the scapula was redirected onto the lateral rather than the posterior thorax, bringing the entire shoulder forward. None of the patients have any significant functional restriction.

Bone Diseases, Developmental↗

PubMedDate not supplied

Orthopaedic manifestations in congenitally insensate patients.

The spectrum of orthopaedic problems in eight congenitally insensate patients was reviewed. The conditions included congenital insensitivity to pain, Riley-Day syndrome, and Lesch-Nyhan syndrome. In each of these conditions, the patient has an abnormality of interpretation of painful stimuli or lacks normal pain avoidance, leading to self-inflicted damage. The orthopaedic problems and complications included fracture, self-mutilation, autoamputation, osteomyelitis, septic arthritis, Charcot joints, scoliosis, and dislocation. Effective management consists of early diagnosis and patient/parent education to prevent as many complications as possible. Fractures may be treated conservatively, while progressive scoliosis requires operative intervention. Osteomyelitis, septic arthritis, and Charcot joints require appropriate operative treatment.

Adolescent↗

PubMedDate not supplied

Nail patella syndrome: a review of 44 orthopaedic patients.

Nail patella syndrome is a rare dysplasia with characteristic findings of finger nail abnormalities, hypoplastic patellas, radial head dislocations, and iliac horns. We reviewed the problems and treatment of 44 patients with this syndrome from 13 Shriners Hospital units. The inheritance pattern is autosomal dominant, with foot abnormalities as the chief presenting complaint. All patients were ambulatory. Twenty of the patients underwent knee operations, and 24 underwent operations to correct foot and ankle deformities. Knee extensor realignments and foot posteromedial releases had overall good results. Knee flexion contractures required full posterior capsular releases. Elbow reconstructive procedures were rarely indicated.

Child↗

PubMedDate not supplied

Caudal regression: a review of seven cases, including the mermaid syndrome.

Caudal regression consists of sacral agenesis combined with variable lower extremity deformities. The patients have contractures of the lower extremities, hip dislocations, neurologic impairment, and spine instability. Treatment consists of soft tissue releases, osteotomies, or orthotics. The goal of orthopaedic intervention is proper seating and standing, which may be achieved without amputation. In our patients, the lower extremity deformities were corrected surgically, but long-term function is unknown. We report the problems and treatment of seven patients with caudal regression syndrome, including the only known survivor with sirenomelia (mermaid syndrome), who underwent separation of the lower extremities.

Abnormalities, Multiple↗

PubMedDate not supplied

Extremity lengthening: results and complications with the Orthofix system.

Twenty-four patients underwent extremity lengthening with the Orthofix for congenital, posttraumatic, or postinfective defects. All were followed to completion of treatment. Length gain and time of treatment were quite acceptable with the Orthofix, but the complication rate was high. This incidence was significantly greater than previously reported by the developers of the technique but equivalent to that reported with other methods.

Adolescent↗

PubMedDate not supplied

Use of continuous passive motion in pediatric orthopedics.

Continuous passive motion (CPM) was used to maintain or gain hip and knee range of motion in 18 postoperative or postinjury pediatric orthopedic patients. Continuous passive motion was started in the early postoperative period and augmented with physical therapy. The device was well-tolerated in 16 of the 18 patients. In all but one, motion was improved with a progressive decrease in joint pain. In these patients, CPM was found to be a valuable tool in rehabilitation, and did not interfere with traction, open wounds, nursing care, nor external fixation devices.

Adolescent↗