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Biomedical subjects

M Letts

Publications and source records attributed to M Letts.

At least 37 records · Page 2Linked to original sources
PubMed1998

Periosteal augmentation of the acetabulum.

The periosteum in children and especially infants has significant osteogenic potential. To determine the efficacy of periosteal flaps to assist in improving acetabular coverage in children with acetabular dysplasia, a series of experiments were designed using young rabbits. Three groups of five rabbits each had periosteal flaps fashioned and brought down from the anterolateral aspect of the innominate bone superior to the acetabulum and sutured to the capsule of the hip. The study was designed to examine the effects of the periosteal cambium layer in the formation of new bone to augment the acetabulum and to determine the effects of a periosteal flap plus cancellous bone graft. A control group of five rabbits underwent a sham operation of an open arthrotomy of the hip. Radiographic and histologic examination at 12 weeks revealed augmentation of the acetabulum with periosteal flaps that resulted in an average improvement of the acetabular index of 3.5 degrees and 6.6 degrees, without and with bone graft, respectively. New bone formation from the rim of the acetabulum averaged 3.9 mm with periosteal flaps alone and 4.6 mm with bone graft added. Periosteal augmentation of the acetabulum in conjunction with established procedures for augmenting acetabular coverage would appear to be a useful procedure for improving coverage of the femoral head in children with acetabular dysplasia.

Acetabulum↗
PubMed1998

Subungual exostosis: diagnosis and treatment in children.

Subungual exostosis is a benign bone tumor of the distal phalanx occurring beneath or adjacent to the nail. The exostosis occurs most commonly in the toes, most frequently involving the distal phalanx of the hallux. The majority of the lesions occur in the second or third decade of life. From 1975 to 1995, 21 children were treated for subungual exostosis at the Children's Hospital of Eastern Ontario, 20 of whom underwent local excision. One patient required an amputation of the affected distal phalanx due to recurrence of the lesion. The subungual exostosis occurred on the hallux in 14 children, the second toe in three children, the third toe in two children, and the fourth toe in two children. No lesion was encountered in the little toe. The exostosis is very rare in patients under 7 years of age; the average age in this review being 12 years and 6 months. The lesion recurred in three children. Removal of the nail over the exostosis facilitates the mandatory entire removal of the lesion.

Adolescent↗
PubMed1998

An analysis of open reduction of irreducible supracondylar fractures of the humerus in children.

OBJECTIVES: To review experience with irreducible supracondylar fractures requiring open reduction in children, and to propose guidelines for an open approach to supracondylar fractures. DESIGN: A chart review. SETTING: The Children's Hospital of Eastern Ontario (CHEO), a pediatric centre with a large referral base. PATIENTS: Forty-one children (18 boys 23 girls, average age 7 years), who had open reduction of irreducible supracondylar fractures at the CHEO over a 10-year period (1985 to 1995). Of these 41 children, 7 were lost to direct follow-up. INTERVENTIONS: After closed reduction of displaced supracondylar fractures of the humerus failed, all patients underwent open reduction and percutaneous fixation in the operating room. Before operation, 6 had no radial pulse, 5 lost their pulse with flexion after reduction and 4 had unstable fracture patterns. MAIN OUTCOME MEASURES: Assessment of elbow range of motion and carrying angle, distal neurovascular status and radiographic measurement of the Baumann angle and the humerocapitellar angle. RESULTS: In 25 children, the humerus was found to have "buttonholed" through the brachialis muscle; 1 had entrapment of the common flexor muscle at its origin and 1 had entrapment of the triceps. In 15 children there was entrapment or tethering of the median nerve and radial nerve or brachial artery, or both, but this was not predictive of preoperative neurovascular deficit, which was recorded in 21 patients (fully recovered). At follow-up, the Baumann angle and the humerocapitellar angle differed by an average of 2 degrees and 5.3 degrees respectively compared with the unaffected arm. Range of motion was satisfactory in 94% of patients, and there was no significant cubitus varus. CONCLUSION: Open reduction of supracondylar fractures is a safe and effective procedure, for which orthopedists should should lower their threshold, given certain appropriate indicators.

Adolescent↗
PubMed1998

Masked rotatory subluxation of the atlas associated with fracture of the clavicle: a clinical and biomechanical analysis.

We report on two children who developed a fixed rotatory subluxation of the atlantoaxial joint due to torticollis being attributed to a fractured clavicle. Appropriate treatment was delayed for weeks to months; only after the fractured clavicle had healed and the torticollis persisted was the problem identified. Persisting rotatory subluxation also predisposes to further anterior displacement of C-1 due to an increased moment arm created by the forward displacement of the center of gravity of the head. The association of atlantoaxial subluxation should always be considered in children presenting with a clavicular fracture and an acute torticollis.

Atlanto-Axial Joint↗
PubMed1998

Synovitis secondary to giardiasis in children.

Giardia lamblia, a gastrointestinal protozoan, is one of the most common disease-causing parasites in the world. Giardiasis is primarily encountered in areas with poor sanitation, but it is also seen in more developed countries. A possible sequela of Giardia infections of the bowel is reactive arthritis or synovitis. Few reports of synovitis secondary to giardiasis exist in the literature. Arthropathy secondary to giardiasis is uncommon, but may be underdiagnosed. In this study, Giardia synovitis was diagnosed in two children at a major children's hospital over a 20-year period. Both were boys, aged 7 years, 6 months and 1 year, 8 months at the time of presentation. The knee was the affected joint in both patients, and both cases were initially misdiagnosed as septic arthritis. The synovitis subsided with treatment of the giardiasis, one with cefuroxime and the other with cefuroxime and metronidazole. The diagnosis of Giardia synovitis should be suspected by the presence of Giardia cysts in the stool, similar symptoms in other family members, a synovial white count under 40,000, and an increase in the eosinophil count. Although uncommon, giardiasis can cause severe synovitis that may be confused with a septic joint.

Animals↗
PubMed1996

Diagnosis and treatment of posterior sternoclavicular joint dislocations in children.

Posterior dislocation of the sternoclavicular joint is uncommon in children, difficult to diagnose, and may be confused with a physical injury of the medial clavicle. We reviewed our experience with posterior dislocations of the medial clavicle over a 10-year period, and found 5 children who had sustained this injury. The computed tomography (CT) scan was found to be the best diagnostic procedure to assess the integrity of the sternoclavicular joint. The cause of the dislocation was most commonly lateral compression of the shoulders sustained during contact sports, particularly football and hockey. Reduction was usually obtained by retraction of the shoulders; for persistent dislocations, a towel clip was used to lift the medial end of the clavicle into its reduced position with the patient under general anesthesia. Reduction was maintained with a figure-of-eight bandage. Any child presenting with pain and swelling in the region of the sternoclavicular joint and no evidence of obvious fracture of the clavicle should have the possibility of dislocation of the sternoclavicular joint investigated with a CT scan.

Adolescent↗
PubMed1995

Parosteal fasciitis in children.

Parosteal fasciitis is a pseudosarcomatous benign lesion of fibrous tissue that has often been confused with malignancy. The purpose of this study was to document the clinical and pathological features of four children with this condition and compare the results with the world literature. The ages of the patients whose cases were reviewed ranged from 9 to 15 years. There were three girls and one boy. All the lesions occurred in the lower extremities, and histologically were characterized by a fibroblastic proliferation with inflammatory cells, diffuse capillary network, and varying quantities of metaplastic bone. All patients were treated by local excision of the lesion. One child had a recurrence of the lesion requiring another surgical removal. A set of clinicopathological criteria has been formulated for the diagnosis of parosteal fasciitis in children. Parosteal fasciitis is uncommon in children but manifests the same clinicopathological features as the adult lesion.

Adolescent↗
PubMed1993

Congenital longitudinal deficiency of the fibula (fibular hemimelia). Parental refusal of amputation.

Fibular hemimelia with significant limb-length inequality is usually best treated with foot ablation and prosthetic fitting. Parents tend to be reluctant to agree to allow their child's foot to be amputated at an early age, especially when the foot is near normal and the limb length is not grossly abnormal. Experience with some families of children with fibular hemimelia who initially refused amputation of the affected limb prompted a retrospective review of the treatment experience with these children. Twenty-four children with 36 affected limbs were treated during the last three decades. Amputation of the foot was performed for 16 limbs in 12 of the 24 patients. The 12 patients whose limbs were not amputated were reviewed in detail. Six of these children were advised to have an amputation, but their families refused to consent. These children were managed by specially designed prostheses to incorporate their foot deformity and limb-length inequality. Four patients required subsequent corrective surgical procedures in an attempt to stabilize the feet or lengthen the limb. To facilitate treatment decisions for both the clinic team as well as the involved families, the authors propose a more practical classification of fibular hemimelia.

Abnormalities, Multiple↗
PubMed1992

The orthopaedic manifestations of the Langer-Giedion syndrome.

Less than 50 cases of Langer-Giedion syndrome (also known as trichorhinophalangeal syndrome with exostoses) have been reported in the English literature since its first description in 1974. Affected individuals have been described as having a bulbous nose, micrognathia, short stature, multiple cartilaginous exostoses, and large, protruding ears. We recently treated a 5-year-old, mentally retarded boy with Langer-Giedion syndrome for symptomatic multiple exostoses involving his proximal tibia and distal femur. This paper will highlight the musculoskeletal abnormalities found in this child and compare them to those of 43 patients reported in the world literature. The comparison reveals a very distinctive pattern of exostosis, demonstrating a primary altered growth pattern in the lower extremities and deformity secondary to marked ligamentous laxity. Orthopaedic surgeons are frequently the first consultants to see these children for their obvious osteochondromata. They must consider the diagnosis of Langer-Giedion syndrome to facilitate the treatment of its other manifestations.

Child↗
PubMed1992

Aneurysmal bone cyst of the upper thoracic spine. An operative approach through a manubrial sternotomy.

Surgical access to T-1 and T-2 vertebral bodies through standard cervical approaches may be difficult and extensive in patients with short necks or high sterna. Adequate exposure of this area can be achieved in children, using a partial manubrial sternotomy and retraction of the manubrial halves. This procedure was successfully performed in a 14-year-old girl whose T-1 vertebra had been completely replaced by a large aneurysmal bone cyst that had produced major paraparesis. A two-stage anteroposterior excision and spinal fusion resulted in complete restoration of neurologic function, eradication of the cyst, and stabilization of the cervicothoracic spine. The limited manubrial split approach to lesions in the T-1 and T-2 vertebrae is recommended.

Adolescent↗
PubMed1991

Hereditary onycho-osteodysplasia (nail-patella syndrome). A three-generation familial study.

Hereditary onycho-osteodysplasia or nail-patella syndrome is an uncommon familial musculoskeletal condition that is primarily seen initially in orthopaedic clinics. This three-generation familial review identifies three affected family members, one of whom demonstrated spondylolisthesis, a condition not previously associated with nail-patella syndrome. All affected family members demonstrated the typical radial nail dysplasias, hypoplastic patellae, iliac horns, and posterior dislocation of the radial heads. Overgrowth of the medial femoral condyles caused valgus deformities of the knees that necessitated orthotic treatment in the youngest affected family member. Although this syndrome has classic common musculoskeletal anomalies, the lumbar spine should also be carefully examined for the presence of spondylolysis and for signs of potential spondylolisthetic development.

Adult↗
PubMed1990

The modified Chopart's amputation.

A modified Chopart's amputation has been designed to overcome the complications of the traditional Chopart's amputation of plantar flexion and skin breakdown over the anterior talus and calcaneus. The modifications are: (1) contouring of the talus and calcaneus; (2) transfer of the anterior and posterior tibialis tendons and the extensor communis and hallucis to the neck of the talus and sustentaculum tali; (3) anterior advancement of the plantar flap; and (4) lengthening of the tendo Achillis. This procedure has been performed in a prospective manner on eight feet in six children. An average 3.5-year follow-up term has not revealed any complications. The modified Chopart's procedure appears to be a functional, useful amputation for children requiring foot ablation secondary to congenital malformations.

Amputation, Surgical↗
PubMed1990

Occipitocervical arthrodesis in children.

A technique for occipitocervical arthrodesis was used in seven patients whose ages ranged from three to thirteen years. The indication for the arthrodesis was occipitocervical instability secondary to various forms of dysplasia. There were no non-unions, and internal fixation was used in only one patient. Six patients were immobilized postoperatively with halo fixation. There was only slight limitation of cervical motion after fusion; we believe that the limitation was due to increased motion in the vertebral segments caudad to the level of fusion. Six patients had full flexion, and only three patients had decreased rotation. We found that, in young patients, occipitocervical arthrodesis by means of the described procedure was both safe and effective.

Adolescent↗
PubMed1988

Computerized ultrasonic digitization in the measurement of spinal curvature.

A major concern in school screening programs as well as in the clinical assessment of spinal curvature has been the frequent radiation exposure required to ascertain curve progression. Various techniques have been developed to identify scoliosis such as the Moire and ISIS techniques, but these are very sophisticated and expensive. The authors have developed a simple procedure of identifying and documenting spinal curvature during the performance of the Adams forward bend test, using an ultrasonic sound probe, four sound receivers, and a micro-computer. The probe is run along the spinous processes emitting an ultrasonic sound, which is picked up by four receivers mounted at the corners of a rectangle above the patient. The signal is fed into a micro-computer and the spinal curvature is plotted out. The magnitude of the curve is calculated by the computer, and the actual curve plus the magnitude is printed in hard copy to be placed in the chart. The reproducibility error and intermeasurer error has been less than 5%. A series of 30 patients with varying magnitudes of scoliosis from 15 degrees to 73 degrees were examined. The results of the ultrasonic digitization were compared with standard scoliosis radiographs of the patient taken the same week. The average curvature measured from the radiographs was 38 degrees, and from the ultrasonic digitization technique, 30 degrees: The forward bend position contributed to smaller curvature measurement, and measurement in the standing position was thought to be a better technique. Ultrasonic digitization as a method of curve measurement is most accurate in curves over 30 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Computer-Assisted↗
PubMed1988

A biomechanical analysis of halo fixation in children.

The use of prolonged halo stabilisation in a child is increasingly indicated for trauma and congenital instability of the cervical spine, but complications of pin fixation in this age group are frequent. We have analysed four aspects of the mechanics of the halo pin: the forces applied by each of six surgeons was shown to vary widely, penetration of the inner table occurred relatively easily, friction at the pin-halo interface influenced forces, and the skull thickness measured by CT scan varied from 1.1 mm to 4.3 mm in children under six years of age. We recommend CT scanning of the skull before elective halo application in young children to ascertain the safest pin sites.

Adolescent↗
PubMed1986

The "floating knee" in children.

The term "floating knee" describes the flail joint resulting from fractures of the shaft or adjacent metaphyseal region of the ipsilateral femur and tibia; we have reviewed 15 children with this combined injury seen at the Winnipeg Children's Hospital. All had been involved in motor vehicle accidents, eight having been struck while cycling; the biomechanics of such an injury have also been studied. Treatment is difficult and the regimes varied. Results were poor when both fractures were treated nonoperatively and we recommend that at least one of the fractures should be rigidly fixed.

Adolescent↗
PubMed1986

Metastatic osteosarcoma and multiple lung resection. A case report.

The existence of pulmonary metastases in patients presenting with osteosarcoma is known to indicate a poor prognosis. Lung resection of solitary lesions is now a standard treatment approach, but with limited successful long-term results. We report the progress of a 16-year-old girl with osteosarcoma of the proximal tibia who underwent 11 lung resections for pulmonary metastases over a two-year period, and who has since then been free of disease for seven years.

Adolescent↗