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Biomedical subjects

Peter M Stevens

Publications and source records attributed to Peter M Stevens.

7 recordsLinked to original sources
PubMed2005

Should full-length standing anteroposterior radiographs replace the scanogram for measurement of limb length discrepancy?

The orthoroentgenogram, commonly known as the 'scanogram', continues to be the most widely used imaging technique for measuring limb length discrepancy (LLD). This study reviews other methods of measuring LLD including full-length standing anteroposterior radiographs, computed tomography/digital localization image, and microdose digital scanography. We present seven cases that demonstrate the pitfalls of scanograms as compared with full-length standing anteroposterior radiographs. Illustrative cases provide the rationale for the clinician managing LLD on a regular basis to utilize full-length standing anteroposterior radiographs as the instrument that will provide the most clinically relevant information.

Female↗
PubMed2004

Chronic Monteggia fractures in children: outcome after treatment with the Bell-Tawse procedure.

Late recognition of Monteggia fracture-dislocations of the elbow continues to pose a treatment challenge. The 15 children in our series with such chronic injuries were all treated with the modified Bell-Tawse annular ligament reconstruction. At an average follow-up of 30 months, all regained flexion-extension arcs in the functional range and no nerve palsies were noted. Some loss of pronation and supination was common, but none had activity restrictions or functional deficits. Four children had recurrent, asymptomatic radial head subluxation; measuring 3-4 mm in the anterior direction. We recommend that late annular ligament reconstruction be considered for most chronic Monteggia fractures to improve long-term function and prevent the need for late excision of the painful, chronically dislocated radial head.

Bone Wires↗
PubMedDate not supplied

Gait analysis of stapling for genu valgum.

Many authors have advocated stapling or epiphysiodesis of the distal medial femur as a means of correcting genu valgum. However, in the literature, aside from clinical improvement (appearance, pain, function), objective evidence of kinetic and kinematic improvement is lacking. Therefore, the authors undertook a prospective gait analysis evaluation of a series of patients treated for genu valgum, comparing pre- and postsurgical measurements to document the benefits of normalizing the mechanical axis. These results indicate that after surgery knee and hip angles and knee moments were returned to within the normal range for a similarly aged control group.

Adolescent↗
PubMedDate not supplied

Surgical correction of miserable malalignment syndrome.

Anterior knee pain is one of the more frustrating problems that orthopaedic surgeons treat. This study investigates the results of surgical correction of miserable malalignment syndrome associated with significant patellofemoral pain. The authors identified and retrospectively reviewed 14 consecutive patients with 27 limbs associated with excessive femoral anteversion, excessive tibial outward rotation, and patellofemoral pain. All of the patients were initially reviewed by the senior author and subsequently treated by ipsilateral outward femoral osteotomy and inward tibial osteotomy. All of the patients had failed nonoperative treatment. No persistent complications were seen. Subjectively and clinically, all of the patients were reviewed at an average of 5.2 (range 2.0-12) years after surgery. All of the patients reported full satisfaction with their surgery and outcomes. Most of the current literature discusses alignment in association with patellofemoral pain in the form of the extensor mechanism alignment. When evaluating patients with patellofemoral pain, it is imperative to assess the rotational profiles of the femur and tibia. The authors recommend that rotational osteotomies be performed in patients with patellofemoral pain and associated excessive femoral and tibial torsion, otherwise known as miserable malalignment syndrome.

Adolescent↗
PubMedDate not supplied

Hemiepiphysiodesis for posttraumatic tibial valgus.

Posttraumatic tibial valgus is a recognized complication of proximal tibial metaphyseal fractures in children. There is no consensus regarding management of this malalignment; approaches range from repeated osteotomy to therapeutic nihilism. The authors present 12 patients with an average age at fracture of 4 years 11 months, each of whom who was successfully managed by temporary hemiepiphysiodesis. An additional patient (age 33 years) is included to illustrate the potential long-term outcome of "benign neglect."Using staples or, more recently, a 2-hole plate for guided growth, we have demonstrated correction of posttraumatic tibial valgus by all criteria; including mechanical axis deviation, lateral tibial metaphyseal-diaphyseal angle, tibiofemoral angle, and tibial length. We conclude that hemiepiphysiodesis is a safe and effective method of treatment with a high degree of patient/parent satisfaction. There have been no permanent growth arrests.

Bone Plates↗
PubMedDate not supplied

Hypophosphatemic rickets: the role of hemiepiphysiodesis.

Despite early medical intervention, children with hypophosphatemic rickets often have progressive deformities in the lower extremities. With the forces imparted by gravity and weight bearing, varus or valgus deformities that might otherwise have been physiological are likely to progress, causing gait disturbance and pain. Proper medical management is important and may theoretically slow or prevent the progression of varus or valgus, but is ineffective at correcting deformity once established. We have reviewed the literature and gathered a series of 10 patients, most of whom underwent hemiepiphysiodesis. We are presenting the rationale for, and the results of, that surgery, in an effort to define the role of this minimally invasive procedure.

Adolescent↗