Biomedical subjects

Linda I Pugh

Publications and source records attributed to Linda I Pugh.

7 recordsLinked to original sources

PubMed2005

Length changes in tibial osteotomy with angular correction.

Twelve boys, aged 11-17 years, who underwent percutaneus proximal tibial osteotomy with acute angular correction and application of external fixator for unilateral Blount's disease were retrospectively reviewed. Preoperative radiographs were compared with radiographs at healing to evaluate changes in tibial length and overall limb length. Angular correction increased overall limb length by a mean of 1.4 cm (range -0.4 cm to 3.2 cm). This increase was a mean 0.7 cm less than was predicted by adding the preoperative tibial and femoral lengths. This failure to achieve the predicted limb length occurs due to shortening in the tibia and should be considered when planning an osteotomy.

Adolescent↗

PubMed2004

Tibia vara: results of hemiepiphyseodesis.

Tibia vara is a condition characterized by progressive deformity of the proximal tibia resulting in varus malalignment of the lower extremity. An alternative treatment strategy involving lateral hemiepiphyseodesis of the proximal tibia in the skeletally immature has been utilized at our institution for the last 10 years. The study group consisted of 23 patients (16 male, seven female) with 33 involved extremities. The median age at surgery was 11.8 years (range, 7.0-17.3). The median follow-up was 3.1 years (range, 0.8-6.2). Of the patients, 82.6% had a weight greater than the 95th percentile. The preoperative mechanical axis had a median value of 18.0 degrees (range, 5.0-31.0) and at the most recent follow up, a median value of 7.0 degrees (range, -12.0 to 46.0). In 18 (54.5%) extremities, the mechanical axis improved by more than 5 degrees . There was no progression of the overall deformity in 11 (33.3%) extremities. Four (12.1%) extremities had worsening of the deformity. At the time of latest follow up, nine (27.2%) extremities had required corrective osteotomy. Twenty-four (72.7%) were skeletally mature and had not required any further treatment. Goals of hemiepiphyseodesis in adolescent tibia vara or late sequelae of infantile tibia vara include (1) correction of deformity to avoid need for osteotomy, and (2) prevention of progression of the deformity to facilitate subsequent surgery. In this series of patients, 87.8% had either improvement or stabilization of the degree of their deformity.

Adolescent↗

PubMed2002

Spine behavior caudal to instrumentation in King II and IV curves.

This retrospective review of children surgically treated for King Type II or IV curvature of the spine required a minimum lumbar Cobb angle of 40 degrees and a minimum lumbar inclination (the angle formed between a line through the spinous processes of the three most caudal lumbar vertebrae and a line perpendicular to the floor) of 10 degrees. Twenty children had combined anterior thoracolumbar and posterior instrumentations whereas 20 had only posterior instrumentation. Children who had combined surgery had significantly better corrections of their lumbar Cobb angles. They had a mean correction of 43.3 degrees compared with 26.7 degrees in children with posterior instrumentation only. These superior corrections of the lumbar Cobb angles did not result in significantly better improvements in the lumbar inclinations. Patients who had the combined procedures had a mean improvement of 10.1 degrees, whereas patients who had posterior instrumentation only had a mean improvement of 8.0 degrees in lumbar inclination. Instead of having superior corrections of the lumbar inclinations, the combined surgeries resulted in a significant worsening of the angle between the end plates of the last instrumented vertebra and the next most caudal end plate. In patients who had combined surgery this angle averaged 8.4 degrees, whereas in patients who had posterior instrumentation only this angle averaged 4.1 degrees.

Adolescent↗

PubMedDate not supplied

Quantitative segmental analysis of weight-bearing radiographs of the foot and ankle for children: normal alignment.

Clinical decision-making for the management of foot deformities in children is primarily based upon the analysis of weight-bearing radiographs of the foot and ankle. However, a comprehensive quantitative technique for the analysis of such radiographs has not been described. Ten radiographic measurements were developed and applied to the foot and ankle radiographs of a normal foot and ankle in 60 children (mean age 10 years, range 5-17 years). Intraobserver variability and interobserver variability were determined for 10 cases. Mean values for the 10 measurements were calculated from the entire study group. Intraobserver variability was excellent, with correlation coefficients for the 10 measurements ranging from 0.89 to 0.99. The absolute value of the mean differences in angular measurements ranged from 0.8 to 2.5 degrees. Interobserver variability was also excellent, with correlation coefficients ranging from 0.86 to 0.99. The absolute value of the mean differences in angular measurements ranged from 0.5 to 3.2 degrees. The mean values, standard deviations, and ranges for the 10 radiographic parameters from the 60 normal feet have been determined. Clinically acceptable variability of 10 selected radiographic measurements of the foot and ankle was achieved, and normal values and ranges for these measurements were determined. Quantitative segmental analysis of foot and ankle alignment, using these 10 radiographic measurements, can be used to describe common malalignment patterns, and this may assist in clinical decision-making and assessment of outcome.

Adolescent↗

PubMedDate not supplied

Effectiveness of serial stretch casting for resistant or recurrent knee flexion contractures following hamstring lengthening in children with cerebral palsy.

A retrospective review of all cerebral palsy (CP) patients with resistant or recurrent knee flexion contractures treated with serial stretch casting was performed. The protocol consisted of sequential wedging (5 degrees per week) of fiberglass casts until maximum knee extension had been achieved. Measurements were made prior to the initiation of casting, at completion of the casting, and at 1 year after the casting. Forty-six subjects, with 75 involved extremities, met the study inclusion criteria. Mean age at the time of initiation of casting was 12.7 years. Using radiographic measurements, the mean initial degree of knee flexion contracture was -17.6 degrees. At the completion of casting, the mean knee flexion angle was -8.1 degrees. The mean duration of casting was 30 days. At 1 year after completion of the casting, the mean knee flexion angle was -12.2 degrees. Initial correction to within 10 degrees of full extension was achieved in 76% of extremities. Age less than 12 years and initial flexion contracture of less than -15 degrees were statistically significant factors related to maintenance of correction at 1 year. Complications included soft tissue compromise in 13 extremities (17%), transient neurapraxia in 9 extremities (12%), and tibial subluxation in 1 extremity (1%). Serial stretch casting was successful in correcting resistant knee flexion contractures in the majority of cases. Casting was less effective in teenagers and those with larger contractures. Complications were minimized by proper casting technique and controlled rate of correction.

Adolescent↗

PubMedDate not supplied

Function of children with myelodysplasia and lower extremity amputations.

This is a retrospective study of the functional status of children who underwent a lower extremity amputation for complications of myelodysplasia. With a computerized surgical database, 12 children with myelodysplasia who underwent an amputation at the Boyd level or above at a single children's referral hospital between 1983 and 2001 were identified. Four patients could not be contacted, but the remaining 8 patients were evaluated through chart review and interview to assess the impact of the amputation on their function. With a mean follow-up time of 9 years (range, 5-15 years), all 6 of the patients with a below-knee or Boyd amputation continued to ambulate using a prosthesis. Most patients occasionally reported having ulcers on their residual limb, but these cases were easily managed and did not result in amputation revisions.The only patient in this series with an above-knee amputation and the only patient with a knee disarticulation were exclusively wheelchair ambulators and no longer owned a prosthesis. This study supports the notion that children with myelodysplasia can have amputations and successfully wear a prosthesis to maintain their ambulation.

Adolescent↗

PubMedDate not supplied

Clubfoot and developmental dysplasia of the hip: value of screening hip radiographs in children with clubfoot.

Clubfoot and hip dislocations are common conditions seen by pediatric orthopedists. In the evaluation of a child with clubfoot, most texts recommend a hip screening radiograph to rule out occult hip dysplasia. Between 1983 and 1998, 349 patients were treated for idiopathic clubfoot. Almost all feet required surgical correction. The average follow-up was 8.4 years. Of these patients, 127 had hip screening x-rays during their treatment of clubfoot. The remaining 222 patients were followed clinically for an average of 9.6 years. Of the 127 patients with hip screening x-rays, 1 was found to have hip dysplasia (0.8%). Of the 222 without hip screening x-rays, none developed signs or symptoms of hip pathology during their clinical follow-up period. The overall rate of hip dysplasia in the idiopathic clubfoot population in this series was less than 1.0%. Screening hip radiographs in the idiopathic clubfoot population are probably not warranted.

Adolescent↗