Biomedical subjects

M B Menelaus

Publications and source records attributed to M B Menelaus.

At least 55 records · Page 3Linked to original sources

PubMed1986

Lessons learned in the management of Legg-Calvé-Perthes disease.

In the assessment of Legg-Calvé-Perthes disease, true lateral radiographs of the femoral head are required. Lack of head sphericity does not preclude good range of motion, which may mislead one into expecting a favorable outcome in very young patients; nor does head flattening prevent successful surgical containment and restoration of sphericity in some older children. Slings and springs, broomstick casts, soft tissue releases, and day or night bracing all have a place in obtaining and retaining a good range of abduction. If orthotic management is to be employed, it must be consistently effective throughout all everyday circumstances. Surgical containment procedures may shorten the clinical course of the disease. If innominate osteotomy is to be performed, there must be a near-normal range of hip motion, whereas femoral osteotomy does not have this prerequisite. Successful containment may be achieved by extension derotation femoral osteotomy, thereby avoiding the undesirable persistent deformity that may follow varus osteotomy. The cooperation of the family in management programs is important and greatly depends upon parental understanding. This understanding is enhanced by presenting parents with an explanatory booklet, written in everyday language, and by leisurely consultations.

Braces↗

PubMed1986

The results of transfer of the tibialis anterior to the heel in patients who have a myelomeningocele.

To study the long-term utility of transfer of the tibialis anterior tendon to the heel in patients who have a myelomeningocele, we reviewed the cases of twenty-five patients who had reached maturity. Forty-six transfers had been performed in these patients, and all of the patients had been followed for at least twelve years. At follow-up, four of the forty-six transferred muscles were functioning in a foot that was plantigrade, eleven were functioning but the foot had a persistent calcaneal deformity, and seventeen transferred muscles had never functioned. Of the fourteen remaining feet, eight had required a release of the transferred tendon because of progressive equinus deformity after the transfer and six had a minor degree of the same deformity but additional surgical treatment was not deemed necessary for them. Patients who had been operated on after the age of five years generally benefited more from the operation, in that additional surgical procedures were not necessary and the transfer was functional at the time of our review. Most of the patients in whom an equinus deformity developed after the procedure were later found to have spasticity in some of the muscles of the leg. It is likely that these patients originally had unrecognized spasticity in the transferred muscles.

Adult↗

PubMed1985

Fragmentation of the proximal pole of the patella. Another manifestation of juvenile traction osteochondritis?

Six boys with fragmentation of the proximal pole of the patella are reported; the condition was bilateral in one. Four of the six presented with symptoms of Osgood-Schlatter's disease or Larsen-Johansson disease of the same or of the contralateral knee, but they had no symptoms or signs relating to the proximal pole of the patella; one also had features suggesting minimal chondromalacia patellae. Two boys had no objective abnormality in either knee. It is suggested that the fragmentation may be a further form of traction osteochondritis of the attachments of the quadriceps mechanism. Attention is drawn to its characteristic radiographic appearance, its association with other forms of juvenile traction osteochondritis (which are commonly symptomatic), and to its occurrence in boys aged 10 or 11 years.

Child↗

PubMed1985

Tibia vara caused by focal fibrocartilaginous dysplasia. Three case reports.

We present three cases of a previously undescribed condition characterised by unilateral tibia vara associated with an area of focal fibrocartilaginous dysplasia in the medial aspect of the proximal tibia. The three children affected were aged 9, 15 and 27 months respectively. Two required tibial osteotomy, but in one the deformity resolved without treatment. The pathogenesis of the focal lesion remains conjectural; the most likely explanation is that the mesenchymal anlage of the tibial metaphysis has, for unknown reasons, developed abnormally at the insertion of the pes anserinus.

Cartilage Diseases↗

PubMed1984

Walking ability after transplantation of the iliopsoas. A long-term follow-up.

Of 47 patients with spina bifida who had had transplantation of the iliopsoas more than 10 years previously, 32 (68%) were community walkers, 3 were household walkers and 12 were non-walkers. Comparison with other published reports showed that, at the very least, the patients reviewed had not had their walking ability jeopardized by the inevitable loss of hip flexor power. Furthermore, all but three of the community walkers were able to climb and descend stairs. There was a high proportion of non-walkers in those patients whose operation had been performed in the first year of life and such early surgery is no longer recommended. We also found that the pre-operative assessment of muscle power had, in some patients, been inaccurate. Finally, we found that, at review, the power of the transferred muscles was poor, suggesting that transplantation is beneficial because it achieves permanent and major reduction in hip flexor power; this usually prevents recurrent hip flexion deformity and dislocation.

Child↗

PubMed1984

Open flexor tenotomy for hammer toes and curly toes in childhood.

Sixty-two children were reviewed between 3 and 14 years (average 9.8 years) after flexor tenotomy for curly toes or hammer toes. No patients were aware of loss of flexor power in the toes. In only 5% of 188 toes was the operation unsuccessful. When the cause of failure was identifiable it proved to be that the scar crossed one or more flexor creases. None of the operated toes had an abnormally extended posture; only one toe was stiff and this resulted from tethering by a scar. It is concluded that open flexor tenotomy is an effective method for correcting curly toes and hammer toes in childhood. Pre-operative assessment must demonstrate that the resting length of the flexor tendons is unduly short, and that this shortening is the only cause of the deformity.

Child↗

PubMed1983

Walking ability in mature patients with spina bifida.

The ambulatory status of 50 patients, aged 15 years and older, with spina bifida is assessed and related to the level of the lesion, the stability and presence of deformity at the hip joints, and the presence of pelvic obliquity and of scoliosis. A retrospective study was made of these variables for the year the child began walking and, when applicable, the year the child stopped walking. More than two-thirds of the group were community ambulators. Lesion review, and there were no household or nonfunctional ambulators. Lesion levels of the ambulators ranged from T11 to S2-S3, whereas lesion levels of the nonambulators ranged from T12 to L3-L4/L4. Most of the hips were not dislocated because the patients had undergone early surgery to restore muscle balance at the hip and, thus, to prevent dislocation. Some had undergone surgery to reduce hip dislocation, although it appears that such surgery is unnecessary for those with high lesions who use long calipers and whose hips require only flexion and extension ability in ambulation. Surgery resulted in significant limitation of flexion range at the hip in one instance only. Those ambulators with high lesions were compared with nonambulators, almost all of whom also had high lesions. The combination of hip flexion deformity, pelvic obliquity, and scoliosis is likely to preclude walking as is the presence of any one of these factors to a severe degree.

Adolescent↗

PubMed1983

Correction of combined tibial torsion and valgus deformity of the foot.

Patients with spina bifida cystica commonly have significant disability from a combination of valgus deformity of the ankle and subtalar joints with lateral tibial torsion and plano-abduction deformity of the foot. These deformities can be corrected by a single procedure which combines a supramalleolar tibial osteotomy with a lateral inlay triple fusion. This procedure was carried out on 20 feet in 15 patients and the results were reviewed after an average of three years (range 18 months to 7 years). In 75 per cent of feet the combination of deformities was fully corrected, ulcers and callosities were eliminated in 95 per cent, the use of calipers minimised in 95 per cent, and in all patients the problem of shoe-wrecking was reduced. Complications included recurrent valgus deformity, delayed union of the tibial osteotomy and failure of midtarsal fusion.

Adolescent↗

PubMed1981

A simple calculation for the timing of epiphysial arrest: a further report.

The accuracy of a previously described calculation for the timing of epiphysiodesis, in the management of leg length discrepancy, has been improved modifications in the way in which the calculation has been applied. The value of the method is confirmed by a study of 94 patients who had reached maturity; 94.1 per cent of these then had discrepancies within three-quarters of an inch of that calculated and 85.1 per cent within half an inch. Over-retardation of growth was more common than insufficient retardation and was partially compensated by calculating for a discrepancy at maturity. A further 34 patients were not available for assessment at maturity but were included in analyses of the conditions for which epiphysiodesis was performed and of early complications from the operation. Both early and late complications were minor and infrequent.

Adolescent↗

PubMed1980

Subcutaneous rupture of the tendon of tibialis anterior.

Subcutaneous rupture of the tendon of tibialis anterior immediately proximal to its insertion affects patients over the age of 45 years and is most common in the seventh decade. The symptoms at the time of rupture are milder than is the case with rupture of the calcaneal tendon and the early disability is slight. Thus, affected patients commonly present several weeks or months after rupture and at a stage when reattachment of the tendon to its normal site of insertion (the most satisfactory surgical management) is impossible. Although the disability is slight if repair is not performed, there should be no disability after surgical repair and this should be offered to those patients who lead an active life and who present in the first three months after rupture. The relevant literature is reviewed and experience with four further patients is recounted.

Aged↗

PubMed1980

Progress in the management of the paralytic hip in myelomeningocele.

1. The primary aim of management at the hip joint in the patient with myelomeningocele is the prevention and correction of deformity, usually a flexion deformity. 2. It is necessary to treat both flexion deformity and the causative muscle imbalance; correction of this imbalance will also prevent subsequent dislocation of the lip. 3. The psoas tendon is generally excised; transfer is reserved for a few children with excellent walking potential and a good prognosis from all viewpoints. 4. Flexion deformity is treated by a soft tissue release procedure (for children under the age of eight years and for deformities of less than 45 degrees) or extension osteotomy. 5. Hip dislocation is seldom treated if it is bilateral. Whether to treat dislocation depends also on the potential of the child and the degree of dislocation.

Adolescent↗

PubMed1978

The surgical management of kyphosis in older children with myelomeningocele.

An operative technique for correction of the severe kyphosis that may develop in cases of myelomeningocele is described. It includes excision of the apical vertebrae, correction of the full length of the kyphotic segment and of rigid compensatory curves, and extensive fusion aided by internal fixation with longitudinal threaded wires. The technique evolved during the management of eleven children. Of these, in the first two the internal fixation employed was inadequate; two others died; and in the remainder good correction was maintained up to the time of review one to six years later.

Bone Screws↗

PubMed1978

The assessment of prognosis in Perthes' disease.

Seventy children who had suffered from Perthes' disease were reviewed clinically and radiologically three to eight years from the onset of the condition in order to determine retrospectively the most satisfactory method of assessing the prognosis and the correlation between the clinical and radiological result. In younger children the femoral head was more likely to be spherical at the conclusion of the pathological process but not necessarily of normal proportions nor normally covered by the acetabulum. The prognosis was significantly poorer for girls than for boys. Clinical factors were not an aid to prognosis in the individual cases, but overall there was a close correlation between the clinical and the radiological end-results. The most reliable radiological factors indicating the prognosis were the extent of uncovering of the femoral head, the Catterall grouping, the presence of calcification lateral to the outer limit of the acetabulum and lateral displacement of the femoral head, as measured by comparing the head to tear-drop distances on each side.

Age Factors↗

PubMed1977

Triple arthrodesis by inlay grafting--a method suitable for the undeformed or valgus foot.

A method of triple arthrodesis is described which involves inlay of the subtalar and midtarsal joints. It is applicable to the undeformed and valgus foot as is encountered in poliomyelitis, spasmodic flat foot, cerebral palsy and spina bifida. The operation was successful in controlling deformity and pain. The only significant complication was failure of fusion of the midtarsal joint which occurred in three of eighty-five feet (3-5%).

Adolescent↗

PubMed1976

The treatment of intoed gait in spina bifida patients by lateral transfer of the medial hamstrings.

The operation of lateral transfer of the medial hamstring muscles is described. Its applicating in the management of intoed gait in spina bifida is discussed, and the results of eight such operations, performed on four children, are recorded. The operation was effective in correcting the intoed gait in all; however, there was no activity in the transferred muscles in one child.

Child, Preschool↗

PubMed1976

Orthopaedic management of children with myelomeningocele: a plea for realistic goals.

The aims and principles of orthopaedic management of children with a myelomeningocele are discussed. The primary aim is to establish stable posture, and details are given of the various operative procedures used to bring about stable posture. The management described has resulted in reductions in the number of operations for each child, in the incidence of post-immobilisation fractures, in the number of hospital admissions and in the number of bed-days spent in hospital.

Child, Preschool↗

PubMed1976

Radial club hand with absence of the biceps muscle treated by centralisation of the ulna and triceps transfer. Report of two cases.

Two children with radial club hand and absence of the biceps muscle were treated by centralisation of the ulna into the carpus and triceps transfer. The two operations were performed only a short time apart so that the period between the procedures could be used to stretch the triceps and to enable the children to adapt to an altered position of the wrist and to mobility of the elbow at one step and following a single period of plaster immobilisation. It is very likely that function is better than it would have been had the condition remained untreated. Before operation the children had only a crude hook function of the hand against the forearm and could not bring the hand to the mouth. Even if function is not much improved, the improvement in appearance is considerable and is by itself sufficient to justify the procedures.

Abnormalities, Multiple↗

PubMed1976

The hip in myelomeningocele. Management directed towards a minimum number of operations and a minimum period of immobilisation.

The hip problems in 116 children with myelomeningocele are discussed. The management described stresses the importance of selection of the type of operation; major surgery is appropriate only for those children who benefit significantly, and this generally means only those with strong quadriceps muscles on both sides. Some children with acetabular dysplasia gain immediate stability if acetabuloplasty is combined with other hip operations. Children who lack strong quadriceps muscles are best served by simpler procedures, such as tendon excision, designed to rid them of fixed deformity and to prevent recurrent deformity. The operations described are performed whenever possible under one anaesthetic and are combined with any other limb operation that may be necessary. It is suggested that the aim in management is not the treatment of paralytic dislocation of the hip but the correction of fixed deformity so that the child can stand with a stable posture. Subluxation and dislocation are treated incidentally to procedures designed to prevent or correct fixed deformity.

Acetabulum↗