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Biomedical subjects

N C Carroll

Publications and source records attributed to N C Carroll.

At least 37 records · Page 2Linked to original sources
PubMed1990

Van Nes rotationplasty with segmental limb resection.

Segmental limb resection is becoming a practical alternative to limb ablation in tumor surgery. The addition of Van Nes rotationplasty to provide a pseudo knee joint has been found to be a practical, functional addition facilitating prosthesis use. This procedure has now been used successfully in 21 children with malignant neoplasms, with few complications. The surgical technique, as outlined, produces significantly improved functional results over an above-knee amputation or hip disarticulation.

Adolescent↗
PubMed1988

Three-dimensional computerized reconstruction of histologic serial sections for orthopedic research.

New programs in image processing and computer graphics can now render three-dimensional images from serial tissue slices. Although neuroanatomists have used these techniques most intensively, there are exciting applications of this methodology in orthopedic research and investigative embryology. Three-dimensional reconstructions of histologic sections from newborn clubfeet have been used to determine the rotational alignment of the hindfoot bones. Similar studies could be undertaken to improve understanding of the normal and pathologic perinatal development of the spine, hip, and hand.

Computer Graphics↗
PubMed1987

Assessment and management of the lower extremity in myelodysplasia.

The goal in managing the lower extremity in a child with spina bifida is to achieve a pattern of development as near normal as possible. Lower limb deformities are produced by muscle imbalance, weight-bearing, and the postural effects of gravity. At any point in time, the management of the lower extremities will depend on the child's general development. Lower limb paralysis, hydrocephalus, bladder infections, hydromyelia, and Arnold Chiari malformation, all contribute to developmental delay. A child's potential for mobility varies with the severity of the motor and sensory deficit. Surgery is done to correct deformity, provide joint stability, and improve joint mobility. The results of surgery will be compromised if the child is not neurologically stable, or if appropriate therapy and orthotic care are not available. Muscle imbalance produces the problem of deformity and instability of the hip. Deformity must be corrected if the child is to assume an upright posture. Instability is of concern only in those children with a strong quadriceps muscle. Hip surgery for instability should be limited to one procedure, which must achieve a stable concentric reduction and balance the muscle forces about the hip. The common deformities seen at the knee are recurvatum, knee flexion contractures, and genu valgum. Most knee deformities can be corrected by soft tissue procedures. Well-designed orthoses rocker sole shoes, and appropriate gait training help prevent knee deformities. The goal in managing foot deformities is to achieve a plantigrade foot with stable skin. Whenever there is a problem with sensation, concentrated pressure in one area of a deformed foot will lead to skin breakdown. Surgical procedures must completely correct deformity and restore muscle imbalance. After surgery, meticulous orthotic care is required to prevent skin breakdown and avoid loss of correction. The orthopedist has a significant role in helping a child with spina bifida to achieve a pattern of development as near normal as possible. He or she must work in concert with a team of professionals and realize that orthopedic surgery is but an incident in the habilitative program. This rather chatty narrative is based on spina bifida care experience, in Sheffield, Toronto, and Chicago.

Adolescent↗
PubMed1987

Congenital clubfoot: pathoanatomy and treatment.

A better understanding of the pathoanatomy of clubfoot, meticulous attention to detail during surgery, and orthotic maintenance of correction to facilitate remodeling should make it possible to improve the results of treatment.

Casts, Surgical↗
PubMed1982

Cerebral palsy associated with maple syrup urine disease.

Maple syrup urine disease (MSUD) is a rare heritable enzyme defect associated with mental retardation. A diet deficient in the branched-chain amino acids is essential for survival. Patients with MSUD are at risk of ketoacidotic metabolic crises brought on by catabolic states, including simple infection or fasting. Delayed diagnosis and therapy can predispose these patients to loss of the gag reflex, lethargy, seizures, and feeding problems. Ultimately, this may result in aspiration and respiratory arrest, which, in turn, can cause cerebral palsy. Of seven cases of MSUD reviewed at The Hospital for Sick Children, two developed spastic diplegic cerebral palsy because of these sequelae. These two patients are similar to other patients with cerebral palsy. Despite special diet, healing of surgical wounds and fractures in patients with MSUD is normal. Simple precautions allow uncomplicated surgery and recovery, even though catabolic states can easily trigger acute ketoacidotic metabolic crises in these patients. The patients with MSUD discussed did not have an increased risk of infection.

Cerebral Palsy↗
PubMed1982

The role of arthroscopy in children.

The records for 156 consecutive arthroscopic examinations in children with knee complaints were reviewed. Diagnostic accuracy was based on subsequent arthrotomy and the clinical course in the absence of arthrotomy. All arthroscopies were performed by one person (NCC) between 1975 and 1979. Children under 12 years (most of them aged 6-11 years) accounted for 43 of the patients. The arthroscopic diagnoses were classified into three categories: very useful, useful, and not useful. Arthroscopy was found to be very useful in 30% of children in both age groups, those under and those over 12 years. In all these patients, unnecessary arthrotomies were avoided. Most (63%) of the arthroscopies were found to be useful, since they provided additional findings and biopsies. Only in 5% of cases did the arthroscopy fail to add any information. There were no complications from the procedure. Arthroscopy is an effective diagnostic tool that can be used safely in children.

Adolescent↗
PubMed1981

Juvenile osteochondritis dissecans of the knee: etiology.

Of 73 patients in whom 122 lesions of osteochondritis dissecans of the knee developed, nearly half had multiple lesions and 30% were of short stature. Endogenous and exogenous traumas play a minor role in the etiology of this disorder. Over half of the children with a history of trauma had bilateral and symmetrical lesions. Constitutional factors, such as hereditary predisposition, endocrine dysfunction, collagen and epiphyseal abnormalities, are frequently associated with juvenile osteochondritis dissecans of the knee.

Adolescent↗
PubMed1981

Experimental observations on the effects of leg lengthening by the Wagner Method.

A proximal tibial epiphysiodesis was successfully performed on the right hind legs of 23 young lambs, producing an average shortening of 12% of the total length of the tibia. A lengthener was attached to stainless steel pins which were then tapped into the shortened tibia prior to osteotomy. In 16 of the 23 animals it was possible to lengthen the shortened bone at a rate of 0.5 mm twice daily until the discrepancy was corrected. The gait was normal in most of the animals, all had full knee motion with no thigh atrophy, and 16 had limited hock (ankle) joint motion. Lengthening of the tibia by more than 11% consistently produced muscle changes in the leg and cartilage damage in the hock (ankle) joint. Any malalignment of the tibial fragments during lengthening intensified these changes.

Animals↗
PubMed1979

Volkmann's contracture in children: aetiology and prevention.

A review was conducted of the records of fifty-five children who were admitted to the Hospital for Sick Children in Toronto between 1955 and 1975 with a diagnosis of Volkmann's contracture in fifty-eight limbs. Ten patients had been transferred to this hospital with established ischaemia after Bryant's traction for a fractured femur; all had a very poor outcome. Thirteen other cases of Volkmann's contracture affecting the superficial posterior compartment had been treated with a fixed Thomas' splint and a Bradford frame after fractures of the femoral shaft. Supracondylar fractures of the elbow resulting in Volkmann's contracture frequently had both an arterial injury and a compartment syndrome. Most of the fifty-five children reviewed here had not had early appropriate treatment. For the past twenty-one years the frequency of Volkmann's contracture has not declined in spite of many published reports on the compartment syndrome, and the hazards of supracondylar fractures and of Bryant's traction.

Adolescent↗
PubMed1979

Familial osteochondritis dissecans of the knee.

The autosomal dominant pattern of osteochondritis dissecans and association with mild dwarfism were observed during a study of 4 generations of one family. Twelve of 31 family members had proven osteochondritis dissecans and 8 others appeared to have or (now deceased) have had it; 10 of these 20 patients were of short stature (less than 5%). At the onset, children under 11 years of age had bilateral irregularities of ossification. Three of the 11 adolescents (13-19 years) had osteochondritis dissecans with development of the condition from irregularities of ossification that could be traced in the roentgenograph of one. Two of the 3 surviving adults now in their sixth or seventh decade have osteoarthritis (one moderate, one severe). The younger adults, now in the 20's and 40's, have minimal knee sysmptoms.

Adolescent↗
PubMed1978

The pathoanatomy of congenital clubfoot.

Patients with resistant clubfeet were reviewed in their second and third decades. For comparison, normal embryological and fetal feet, untreated clubfeet, a recurrent clubfoot, and an amputated foot were dissected. In no child with a resistant clubfoot was the bone architecture normal. In untreated and recurrent clubfeet we found the lateral malleolus to be directed posteriorly, the head of the talus pointed laterally, and the navicular subluxated medially toward the medial malleolus. An operative technique to restore normal alignment of the talus in the ankle mortice, of the navicular and talus, and of the talus and os calcis is described.

Adult↗