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Biomedical subjects

N C Carroll

Publications and source records attributed to N C Carroll.

48 records · Page 3Linked to original sources
PubMedDate not supplied

Hip stability and ambulatory status in myelomeningocele.

Fifty-three hips in 32 patients with myelomeningocele and innervation to the quadriceps were surgically stabilized. In most cases, all the surgical procedures necessary to achieve stability were performed at the same time. Preoperatively, 92.5% of the hips were either subluxated or dislocated; the rest were dysplastic. At the time of review, an average of 4 years 1 month following surgery, 83% of the hips were stable. Of the children, 78% were community ambulators. Ambulatory status was found to be adversely affected by subsequent development of spinal deformity, hip flexion deformity, or lordosis and by age. Children with myelodysplasia who have strong quadriceps and stable neurological status can therefore have surgical stabilization of their hips with good results.

Child↗
PubMedDate not supplied

Clubfoot analysis with three-dimensional computer modeling.

Which way are the bones rotated in a clubfoot? This question has long been debated by clubfoot surgeons. Opinions have been based on observations from surgery, radiographs, and autopsies. These methods all have pitfalls and are subject to misinterpretation. We used three-dimensional computer modeling to analyze histologic sections of a newborn clubfoot and a newborn normal foot. Relative to the bimalleolar axis in the axial plane, the normal talus demonstrated 5 degrees of internal rotation of its body and 25 degrees internal rotation of its neck. The clubfoot talus showed 14 degrees of external rotation of its body and 45 degrees of internal rotation of its neck. The calcaneus was externally rotated 5 degrees in the normal foot and internally rotated 22 degrees in the clubfoot.

Calcaneus↗
PubMedDate not supplied

Femoral shaft fractures in children treated with early spica cast.

We retrospectively reviewed 51 patients aged 3-11 years with femoral shaft fractures selected for treatment with early spica cast immobilization. Shortening greater than 20 mm was the most common complication, occurring in 22 (43%) of the 51 patients. Factors associated with unacceptable shortening were shortening at the time of spica cast application greater than 10 mm, shortening greater than 20 mm at initial examination, and increasing age. Achieving less than 1 cm shortening at the time of cast application and close follow-up during the first 2 weeks after cast application are advised in order to achieve an acceptable final outcome.

Casts, Surgical↗
PubMedDate not supplied

Analysis of the components of residual deformity in clubfeet presenting for reoperation.

We reviewed the records and radiographs of 125 children with 159 clubfeet reoperated for residual deformity after operative repair (210 reoperations). We concluded that residual forefoot adduction and supination were the most common persistent deformities (present in 95% of the feet) and that these deformities resulted from undercorrection at the time of primary operation. Although not then apparent, the persistent deformities became more evident with growth, and additional treatment became necessary. Undercorrection resulted from not releasing the calcaneocuboid joint and plantar fascia and failure to recognize residual forefoot adduction on the interoperative radiographs at primary operation.

Adolescent↗
PubMedDate not supplied

Longitudinal tendon splitting: a simple technique.

Orthopaedic surgeons are frequently confronted with the problem of joint contractures and the need for tendon lengthening. We describe a simple reproducible technique for longitudinal splitting of a tendon. We use this method for Z-lengthenings and split tendon transfers and recommend its use to other surgeons.

Child, Preschool↗
PubMedDate not supplied

Diastasis of the tibiofibular mortise, hypoplasia of the tibia, and clubfoot, in a neonate with cleft hand and cardiac anomalies. A case report.

In a newborn girl diastasis of the distal tibiofibula joint was associated with cleft hand deformity, and cardiac anomalies. While at least 3 cases of congenital distal tibiofibular diastasis have been reported previously, this patient seems to be the first to have had hand and cardiac defects. The diastasis is believed to be secondary to tibial hypoplasia. The initial presentation was that of an apparent clubfoot deformity and emphasizes the point that roentgenograms of all equinovarus deformities in the newborn should be mandatory.

Abnormalities, Multiple↗
PubMedDate not supplied

Femoral varus derotation osteotomy with or without acetabuloplasty for unstable hips in cerebral palsy.

We reviewed 39 children with cerebral palsy who had surgery for hip subluxation or dislocation. Of 55 treated hips, 31 had a varus derotation osteotomy alone, and 24 had a combination of varus derotation osteotomy and an acetabular procedure. There was no significant difference in the ages of the two groups. There was no difference in the preoperative acetabular indices of the two groups, but the average percentage of preoperative uncoverage of the femoral head was 56% in the group with varus derotation osteotomy and 63% in the group with combined varus derotation osteotomy with an acetabular procedure. The incidence of resubluxation or redislocation (24%) after varus derotation osteotomy alone was higher than that after varus derotation osteotomy with an acetabular procedure (13%). The incidence of postoperative hip instability was higher in the patients who had preoperative uncoverage of the femoral head ranging from 70 to 100%. This was in comparison with the patients who had preoperative uncoverage of the femoral head ranging from 30 to 70%. These results suggest that a combination of varus derotation osteotomy and an acetabular procedure decreases the incidence of resubluxation or redislocation, and that unstable hips with > 70% uncoverage of the femoral head should undergo the combined procedure.

Acetabulum↗