Biomedical subjects

R Gillespie

Publications and source records attributed to R Gillespie.

64 records · Page 4Linked to original sources

PubMedDate not supplied

Management of myelomeningocele kyphosis in the older child by kyphectomy and segmental spinal instrumentation.

Kyphosis in the myelomeningocele patient population causes significant problems such as skin breakdown, recurrent infection, and decreased function. Kyphectomy has proved to be a satisfactory means of correcting the deformity, but postoperative stabilization to prevent recurrence of deformity continues to be a problem. Twelve patients with myelomeningocele kyphosis, measuring an average of 124 degrees, were managed by posterior kyphectomy and segmental spinal instrumentation. After operation, the curves measured an average of 32.8 degrees. With a follow-up period, 6-57 months, only one patient lost correction. The loss of correction was secondary to rod failure. Straight midline incision, ignoring previous incisions, can be used to approach the spine without risk of increased wound complications. Adequate immediate stable correction can be achieved by kyphectomy and segmental spinal instrumentation with anterior fixation to the pelvis that thus allows the patient to proceed more quickly to an improved functional level.

Adolescent↗

PubMedDate not supplied

Soft tissue recurrence of chondromyxoid fibroma.

A 12-year-old girl presented with an isolated soft tissue recurrence of chondromyxoid fibroma after two previous excisions of tumor from the proximal tibia. Chondromyxoid fibroma is a rare benign tumor of bone. We present this case report of isolated soft tissue recurrence to emphasize a rarely reported complication of surgical extirpation.

Bone Neoplasms↗

PubMedDate not supplied

Patellar instability in juvenile amputees.

Forty-three ipsilateral knees in 41 juvenile amputees were studied for determination of the extent and severity of patellar instability. The amputation was performed for trauma in 13 patients and congenital anomalies in 28 patients. Eleven patients had instability, and three had patellofemoral pain. All symptomatic patients had patella alta, lateral subluxation, and hypoplastic patellae on radiographs. Of the asymptomatic patients, 68% had patella alta, and 35% had hypoplasia. Amputees with patella alta had more below-knee amputations and had worn prostheses longer. It is hypothesized that the pressure of the prosthesis on the patellar tendon may lead to patella alta and predispose to instability.

Adolescent↗

PubMedDate not supplied

Long-term follow-up of infantile hip sepsis.

Nine hips in eight patients were available at a mean follow-up of 31.5 years for participation in a retrospective functional and radiographic analysis for the purpose of examining the late effects of infantile septic hip arthritis in a group untouched by reconstructive hip surgery. Results suggest that reconstructive efforts following hip joint sepsis designed for relocation of an inadequate femoral head for persistent dislocation or for transference of the greater trochanteric epiphysis into the acetabulum may not yield results comparable to nonoperative treatment.

Arthritis, Infectious↗

PubMedDate not supplied

Usefulness and accuracy of arthrography in management of lateral humeral condyle fractures in children.

The value of arthrography in children's fractures is well established, but the accuracy of this technique has not been reported. We assessed the usefulness of arthrography by performing this test on a series of lateral humeral condyle fractures and, when possible, compared the arthrographic findings with the findings at operation to assess the accuracy of the test. Twenty-four consecutive patients were evaluated, and 13 patients underwent both arthrography and open reduction. We conclude that arthrography is a useful and accurate test when performed on children with lateral humeral condyle fractures and have provided guidelines for its use in managing this problem.

Arthrography↗

PubMedDate not supplied

Late sequelae of septic arthritis of the hip in infancy and childhood.

We report a multicenter long-term follow-up study of patients with septic arthritis of the hip during infancy or childhood. Group I ("infantile") consisted of patients with onset before age 3 months, and Group II ("childhood") consisted of patients in whom onset occurred after age 3 months. Patients were specifically examined for this review. Generally, patients at follow-up had poor anatomic appearance radiographically and scored poorly on the Harris rating system. However, pain and activity restriction were minimal. Patients who were not treated operatively tended to function better than patients who underwent operative reconstruction.

Adolescent↗

PubMedDate not supplied

Chronic repetitive unrecognized flexion injury of the cervical spine (high jumper's neck).

Unrecognized flexion injuries of the cervical spine may lead to late instability and neurologic damage. These hidden flexion injuries may be from acute or chronic traumatic episodes. Cervical spine instability was seen in an amateur high jumper as a result of chronic repetitive flexion loading of her cervical spine due to incorrect landing technique. The instability from these types of flexion injuries is generally unrecognized on a routine lateral radiograph. The presence of slight anterior subluxation, simple compression fractures, or subtle kyphotic angulation at one cervical level should alert the physician to this diagnosis. Flexion extension views are useful to demonstrate this instability. Occupations and sports which involve repetitive flexion stress to the cervical spine are at risk for this type of late instability. Therefore, in high jumping careful attention to safe techniques of landing is of utmost importance.

Adolescent↗

PubMedDate not supplied

Isolated limb perfusion.

Growing concern over the rising incidence of malignant melanoma has brought about a need for information on this disorder and the treatment available. Isolated limb perfusion is a relatively new technique used in only a few hospitals. An increased knowledge base will lead to a better understanding of the nursing care required and to a more in-depth care plan.

Chemotherapy, Cancer, Regional Perfusion↗

PubMedDate not supplied

Salmonella pelvic osteomyelitis in normal children: report of two cases and a review of the literature.

We report two cases of salmonella osteomyelitis isolated to the pelvis in white adolescents aged 12 and 16 years. No underlying medical condition predisposed these children to salmonella osteomyelitis, and the clinical course was prolonged before definitive diagnosis. The key to diagnosis and the localization of the site of the pathologic condition was made from radionuclide studies performed 2-3 weeks from the onset of symptoms. Clinicians should be aware of isolated salmonella osteomyelitis of the pelvis in normal children, especially when imaging studies are normal at initial presentation. Technetium-labeled bone scans may be normal < or = 2 weeks from the onset of symptoms. Definitive diagnostic testing should include a gallium scan and computed tomography scan when technetium bone scans are negative. Treatment with antibiotics alone is successful.

Adolescent↗

PubMedDate not supplied

Orthopedic management of osteopetrosis: results of a survey and review of the literature.

Osteopetrosis or Albers-Schonberg disease is a rare hereditary disorder of osteoclast function in which resorption of bone is diminished, resulting in abnormally dense bones. The condition is known to occur in at least four recognizable clinical patterns, each of which is variable. The optimal treatment of fractures and of bone deformity in these patients has not previously been made clear. To determine appropriate orthopedic management of the condition, we conducted a survey of the membership of the Pediatric Orthopedic Society of North America. The combined experience of 57 surgeons who treated 79 patients with osteopetrosis was compiled. Four femoral neck fractures treated by closed reduction and internal fixation had a satisfactory result, but three treated nonoperatively developed varus and required osteotomy. A total of 20 hips was treated for coxa vara by various means, none of which was free of complications. Valgus osteotomy, when used as the primary treatment for coxa vara, was the most consistently satisfactory procedure, whereas in situ pinning failed in two of three hips. Fourteen subtrochanteric fractures and 31 other fractures of the femur were treated. Good results were reported with traction or casting or both in the majority of those fractures. Twenty-nine tibia fractures were treated successfully, the majority by nonoperative means. Upper extremity fractures healed well with closed reduction and casting. Vertebral fractures, spondylolysis, and back pain were most frequently treated without surgery.

Adolescent↗