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Biomedical subjects

M Letts

Publications and source records attributed to M Letts.

At least 55 records · Page 3Linked to original sources
PubMed1985

Monteggia fracture-dislocations in children.

Thirty-three Monteggia fracture-dislocations occurring in patients aged 2 to 15 years were reviewed. A follow-up of 2 to 7 years in 25 patients revealed that 88% had good to excellent results and 12% had results which were fair or poor. Closed reduction was successful in 24 of 28 cases and appeared to be very effective. Open reduction was required only for older children or when treatment was begun late. A mild hyperextension deformity at the elbow noted on follow-up of patients with anterior dislocation of the radial head seemed to support the theory that the injury is caused by hyperextension. A new classification of Monteggia fracture-dislocations in children is proposed.

Adolescent↗
PubMed1984

The windblown hip syndrome in total body cerebral palsy.

Windblown hips in patients with cerebral palsy are difficult to treat and predispose to poor, unstable sitting. In an attempt to identify the temporal sequence between dislocation of the hip, scoliosis, and pelvic obliquity, an in-depth clinical and radiological review of 22 teenage children was undertaken. The most common temporal sequence was dislocation of the hip, followed by pelvic obliquity, and finally scoliosis. It is recommended that the hip be closely monitored in infancy and that an aggressive treatment approach be undertaken if hip subluxation occurs. This is greatly facilitated by a good orthotic, therapy, and seating program to maintain the hips in the correct position. The maintenance of hip stability will facilitate seating as well as minimize the effects of the windblown hip syndrome.

Adolescent↗
PubMed1983

Puppetry and doll play as an adjunct to pediatric orthopaedics.

The loss of a considerable segment of body tissue is often psychologically more traumatic than is the actual surgery to the unprepared child. In an attempt to improve the preparation of the child for ablative surgery, as well as to facilitate the pre- and postoperative management of the pediatric patient and family, we have developed a system of doll play and puppetry to educate and prepare children for this type of surgery. Guilt feelings are minimized, an outlet for hostility is provided, and the ever present fear of the unknown is confronted and dealt with in a manner acceptable to the child. The nonthreatening role of this technique also helps alleviate parental fears and concerns. Our experience with this technique has confirmed its usefulness in the preoperative psychological preparation of young children facing amputation or major musculoskeletal procedures.

Body Image↗
PubMedDate not supplied

Thoracic outlet syndrome in children.

Thoracic outlet syndrome, although uncommon in children, may be precipitated during rapid growth in adolescence, especially in association with a cervical rib. Four children exhibited the aching, tiredness in the limb, and occasional paresthesia in adolescence. Two had a cervical rib requiring removal, after which the symptoms disappeared. The other two were treated nonoperatively with shoulder-strengthening exercises and avoidance of posturing that elicited the symptoms. It is proposed that in a child, the anatomy of the thoracic outlet is constantly changing with growth and development of the structures that form the thoracic outlet, as well as those that traverse the outlet itself. A conservative approach to these symptoms is warranted in the first instance to allow further growth and remodeling of the thoracic outlet, which may be sufficient to accommodate the nerve roots and brachial plexus and alleviate the symptoms. Excision of the cervical rib in the presence of increasing and chronic symptoms can be quit beneficial.

Adolescent↗
PubMedDate not supplied

The orthopaedic manifestations of Pelizaeus-Merzbacher disease in children.

Pelizaeus-Merzbacher disease (PMD) is a degenerative leukodystrophy of the central nervous system resulting in progressive spasticity and neurologic deterioration. Seitelberger (13) divided this rare disease into six types. Five patients with the type 1 and two patients with the type II form of PMD have been treated at the Children's Hospital of Eastern Ontario. Our study sought to identify the orthopaedic manifestations of PMD and to develop a common orthopaedic profile for these patients. All children with types I and II PMD developed spastic quadriparesis, truncal hypotonia, thoracolumbar scoliosis, soft-tissue contractures of the adductors and hamstrings, osteopenia, bilateral coxa valga, and associated hip dislocation.

Bone Diseases, Metabolic↗
PubMedDate not supplied

Atrial and venous thrombosis secondary to septic arthritis of the sacroiliac joint in a child with hereditary protein C deficiency.

Septic arthritis and osteomyelitis in children is seldom accompanied by calf vein thrombosis and rarely by atrial thrombosis. We report the case of an 11-year, 5-month-old boy with septic arthritis and osteomyelitis of the sacroiliac region who developed deep venous thrombosis, in addition to life-threatening right atrial thrombosis. After an intensive hematologic investigation, a hereditary protein C deficiency was revealed. The association of venous thrombosis with septic arthritis or osteomyelitis should raise the possibility of the presence of protein C deficiency.

Arthritis, Infectious↗
PubMedDate not supplied

An analysis of an air-ambulance program for children.

Air-ambulance services are extremely expensive to operate and maintain. The value of their existence has been questioned in this era of rationalization and downsizing. We examined the cost, safety, flight crew composition, types of trauma, and effectiveness of our air-ambulance program at the Children's Hospital of Eastern Ontario (CHEO) over a 3-year period, 1994-1997. During this time, 392 children were aeroevacuated to CHEO, 113 surgical (29%), 136 medical (35%), and 143 neonates (36%). Of the surgical cases, 43% were transferred for orthopaedic trauma, the commonest being fractured femur, 23% for general surgical cases, most common being thoracoabdominal trauma, and 22% for neurosurgical reasons, most commonly basilar skull fractures. The average response time (time from which the call was received to the time when the helicopter reached the patient site) for all of the cases was 46 min. The average travel time (time from departure of patient site to arrival at CHEO) for these same cases was 25.59 min. The air-ambulance program for children in the Ottawa-Carleton Eastern Ontario areas, was found to be safe, effective, and allowed earlier specialized medical care to be provided.

Air Ambulances↗
PubMedDate not supplied

The adolescent pilon fracture: management and outcome.

Pilon fractures in the adolescent are complicated by the presence of the adjacent physis. These fractures usually result from high-energy trauma, frequently associated with soft-tissue trauma, further potentiating treatment difficulties. Although rare, such fractures are associated with a high complication rate, including physeal arrest. It was the objective of this review to increase awareness of this fracture pattern in the adolescent, to determine the types of complications in this difficult group, and to develop a treatment plan to improve the outcome of treatment. Seven children, with a total of eight pilon fractures were treated at a major pediatric tertiary referral center over the past 10 years. The average age of the children was 15 years 10 months (range, 13 years 6 months to 17 years 7 months). The average length of follow-up was 16 months (range, 3 months and 3 years 10 months). There were three Reudi type II equivalent fractures and two Reudi type III equivalent injuries. Three fractures did not fit the Reudi classification system as there was an associated ankle dislocation. All fractures were treated with open reduction and internal fixation. There were two cases of posttraumatic osteoarthritis and one physeal arrest. Results were good to excellent in 63% of cases. A new classification system for pediatric pilon fractures has been proposed.

Adolescent↗
PubMedDate not supplied

Fracture of the pars interarticularis in adolescent athletes: a clinical-biomechanical analysis.

Stress fracture of the pars interarticularis is an increasing cause of disability in highly competitive adolescent athletes. We have documented this lesion in 14 adolescent athletes engaged in repetitive training and competition exercises involving flexion/extension of the lumbar spine. An in vivo spinal muscle torque study in 11 normal adolescent girls also revealed mean torque values of 22.6 Nm for left lateral flexion and 27.4 Nm for hyperextension. The most common sports resulting in this lesion were gymnastics and hockey. In four patients the lesion was bilateral, and in 10 it was unilateral. Five of the unilateral lesions went on to heal with immobilization in a thoracolumbar spinal orthoses; however, none of the four bilateral lesions or the remaining five unilateral lesions healed in spite of 3 months of immobilization.

Adolescent↗
PubMedDate not supplied

Gait kinematics in below-knee child amputees: a force plate analysis.

A complete gait analysis was performed on six children with below-knee amputations to determine the kinematics and kinetics of amputee gait in children. A relatively new method of analysis--the inverse dynamic relationship--was used to determine the joint moments in the sagittal plane of the joints in the intact limb and the remaining portion of the amputated limb. The joint moments in the sagittal plane of the intact limb in the child amputee were found to be normal or below normal during level walking. From this study, it was concluded that providing a child amputee has a good prosthetic fit, there will be no increased forces across the joints of the intact or amputated limb and consequently no predisposition to premature degenerative arthritis.

Adolescent↗
PubMedDate not supplied

The prevention of recurrent fractures of the lower extremities in severe osteogenesis imperfecta using vacuum pants: a preliminary report in four patients.

Severe osteogenesis imperfecta results in frequent fracturing of lower extremity bones when the child assumes upright weightbearing. To prevent such breakage and to provide simple, comfortable standing, a special "vacuum pant" orthosis was designed and assessed in four patients. Not only has this enabled the family to help their children stand up safely and comfortably, but the frequency of fracturing has diminished. Bone densitometry studies of the tibia revealed an increase in both the mineral content (0.39 to 0.70 g/cm) and the bone density (0.44 g/cm2) above that expected for growth alone in one patient. The "vacuum pant" orthosis is a useful addition to the treatment program of the severe osteogenesis imperfecta child.

Child↗
PubMedDate not supplied

Hematocolpos as a cause of back pain in premenarchal adolescents.

Persistent low back pain in children demands thorough investigation. An unusual cause of such discomfort is hematocolpos secondary to imperforate hymen in premenarchal girls. Experience with four patients whose initial primary symptom was low back pain has been documented. All had large pelvic masses with greater than 400 ml of old blood being drained at hymenotomy in all patients. Irritation of the sacral plexus or nerve roots is postulated as a mechanism for the referred back pain. Hematocolpos should be included in the differential diagnosis of prepubertal girls who have low back pain.

Adolescent↗
PubMedDate not supplied

Soft Boston orthosis in management of neuromuscular scoliosis: a preliminary report.

Collapsing neuromuscular spinal curvature is extremely difficult to manage with standard rigid orthoses owing to skin breakdown and patient intolerance. Experience with a new, more malleable type of spinal brace (the "soft Boston orthosis") has been very rewarding in 55 children with neuromuscular scoliosis with an average curvature of 42 degrees. Patient tolerance was improved in 38%, patient handling was facilitated in 68%, and postural positioning was enhanced in 79%. Although improvement in the scoliosis averaged only 15 degrees, the major advantage of this orthosis was a marked improvement in sitting stability in 80% of patients.

Activities of Daily Living↗
PubMedDate not supplied

Long-term effects of neonatal bone and joint infection on adjacent growth plates.

Review of children with physeal damage from neonatal infection other than the hip at Winnipeg Children's Hospital showed that six patients had residual growth interference from adjacent infection in the bone or joint. Several of the infections involved multiple joints, with growth plate arrest occurring in the distal femoral growth plate in four, in the proximal humerus in four, in the proximal femur in two, in the distal radius in one, and in the distal humerus in one. Although the initial infection was frequently believed to be successfully treated in the neonate, the clinical effect of these infections on the growth plate was not fully appreciated in five of the infants until the children reached a mean age of 9 years. Because growth abnormalities in physeal bars may not be clinically evident for several years after the initial infection has been treated, we recommend that children with bone and joint infections occurring in the first month of life be followed to skeletal maturity, observing the adjacent physis for late tethering.

Arthritis, Infectious↗
PubMedDate not supplied

Unicameral bone cyst of the calcaneus in children.

The calcaneus is an uncommon site for a unicameral bone cyst. However, because of the concentration of forces through the heel, such cysts are usually symptomatic and require treatment. Because of the lack of attention paid to calcaneal unicameral bone cysts, as well as the controversy concerning their appropriate treatment and ultimate outcome, a retrospective study of our experience was undertaken. Over a 15-year period, we treated six children with calcaneal unicameral bone cysts. The diagnosis was confirmed pathologically at the time of treatment for all six. The most common presenting complaint was heel pain upon weight-bearing, secondary to microfracturing of the cyst. Although conservative treatment, which entailed casting and sponge fillers in the shoes, was attempted for most patients, none responded to this form of management. One child had three separate injections of methylprednisolone acetate without any radiographic or clinical change in the cyst, which ultimately required curettage and bone grafting. Bone grafting with either autogenous or allograft bone was successful in eradicating the cyst in all six patients, with no symptoms of recurrence at an average follow-up of 4 years. No resultant treatment complications were encountered. Unicameral bone cysts of the calcaneus, when symptomatic, respond well to curettage and bone grafting, and this type of treatment is recommended.

Adolescent↗