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Biomedical subjects

R M Letts

Publications and source records attributed to R M Letts.

At least 37 records · Page 2Linked to original sources
PubMed1977

Lawnmower injuries in children.

Over an 8-year period 31 children in the Winnipeg area were admitted to hospital with lawnmower injuries. The accidents were always preventable and were caused by patient or parent carelessness. The wounds were severe, often resulting in amputation of a portion of an extremity. Infection was common; prophylaxis with a broad-spectrum antibiotic and human antitetanus globulin is recommended. Radiography, débridement of the wound with thorough exploration under general anesthesia, and defatting and reapplication of degloved skin should be done initially, then the wound should be reinspected and redressed at 2 to 3 days, and finally closed or skin grafted at 6 to 8 days. Children must be educated about the dangers of lawnmowers and prevented from riding on tractor mowers. The grass catcher should be used and the path cleared of missiles. Hand controls should be mounted on the mower's handle and the blade should be kept sharp so that the machine's speed can be reduced.

Accidents↗
PubMed1977

Orthopaedic treatment of hemangiomatous hypertrophy of the lower extremity.

The triad of varicose veins, hypertrophy of soft tissue and bone, and cutaneous hemangiomas (The Klippel-Trenaunay syndrome) often results in major malformations. A review of eleven children treated for this condition showed that the overgrowth of the limb was a major problem in management. In three patients the altered hemodynamics resulted in cardiac complications. Venous stripping, excision of the arteriovenous fistulae, and radiation therapy should be avoided.

Amputation, Surgical↗
PubMed1977

Delayed paresis following spinal fusion with Harrington instrumentation.

Immediate postoperative paresis following spinal fusion for scoliosis is uncommon. This neurological disaster can occur either within hours or days after surgical correction of the curvature. Paresis of the right lower extremity occurred on the third postoperative day in a 15-year-old boy who underwent spinal fusion for a pseudarthrosis of a previous fusion and in whom a Harrington rod was inserted for stability but not correction. The rod was removed within four hours of recognition of the paresis; within 18 months the child made an almost complete recovery of all motor function; slight residual weakness of the anterior dorsiflexors of the foot still remain.

Adolescent↗
PubMed1976

Gunshot wounds of the extremities in children.

A ten-year review of gunshot trauma in Manitoba was prompted by an increasing incidence in gunshot trauma in children. Of 54 children treated from 1964 through 1973 60% sustained injury to one or more extremities. Fifteen children sustained long bone fractures, usually complete and often comminuted. All fractures united and there was only one instance of osteomyelitis. The major complication in gunshot wounds to the skeletally immature was limb length inequality secondary to epiphyseal plate injuries. This complication occurred in nine children. In three children there was in epiphyseal growth disturbance, even though the missile did not appear to pass through the plate but only in close proximity to it. Joint contractures secondary to skin loss and resulting subsequent skin contracture were also common. The amount of debridement required following gunshot trauma in children appears to be somewhat less than is recommended for similar injuries sustained by adults in time of war.

Adolescent↗
PubMed1976

Clinical telemetry of EMG and temporal information during gait.

Multichannel telemetry has formed an integral part of the clinical assessment of children's walking problems. EMG signals and temporal information from foot switches are transmitted from a small belt-pack unit which provides almost complete freedom of movement for the child. Although patients with various crippling diseases have been studied, the investigation of problems resulting from cerebral palsy has been most valuable clinically. The effects of orthopaedic surgery to release or transfer muscles can be asssessed more positively and the causes of some unexplained gait patterns can be investigated more thoroughly.

Cerebral Palsy↗
PubMed1976

Mobility aids for the paraplegic child.

Paraplegic children derive many benefits from upright bracing during their growing years. Physiological advantages include the prevention of joint contractures, decreased osteoporosis, prevention of urinary tract infections, increased cardiopulmonary tolerance, and the development of trunk and head control. The quality of life is enhanced because the child has increased self-esteem and participates in group activities with greater independence. Two new devices, the stand-up wheelchair and the shuttlebug, have been employed with success in the Winnipeg Child Paraplegic Program.

Braces↗
PubMed1976

The upper limb-cardiovascular syndrome, (Holt-Oram syndrome).

Two families recently studied demonstrate the variability of expression of upper limb-cardiovascular syndrome. Four other patients with upper limb and cardiac anomalies and no significant family history may represent spontaneous mutations or examples impenetrance in antecedent generations, rather than phenocopies of the syndrome. Children under the care of the orthopedist for congenital anomalies of the upper limb should have a complete cardiac assessment.

Abnormalities, Multiple↗
PubMed1975

The child and the snowmobile.

From November 1970 through March 1975, 41 children in Manitoba required hospitalization for treatment of injuries sustained in snowmobile accidents. The commonest injuries were fractures of a leg. In general, the injuries were severe, and in many instances the fractures were unusualy and uncommonly seen in children. Most often the child had been driving the snowmobile and all injuries were a result of driver error or misadventure; none was due to malfunction of the snowmobile. Recommendations to minimize the number and severity of snowmobiling injuries in children include an education program for both adults and their children, use of lightweight cowling to protect the legs, incorporation of a governor on the throttle to prevent excessive speeds, and use of a restraint for children travelling as passengers on the snowmobile. Children should always wear tight clothing when around snowmobiles.

Accident Prevention↗
PubMed1975

Locomotion studies as an aid in clinical assessment of childhood gait.

A clinical locomotion laboratory has been developed to provide quantitative information in the management of gait disorders. The biomedical engineering development of this system identified two major clinical constraints: (a) the need for instrumentation that would not alter the natural gait of the patient and (b) the need for data-processing techniques that would permit analysis and correlation of the large volume of electromyographic (EMg) and kinematic information. The net result has been a unit that incorporates a multichannel telemetry system to capture the EMG and foot-switch information and a television computer system to handle the kinematic information. Gait studies on children with hemiparesis, muscular dystrophy and cerebral palsy have yielded quantitative EMG and kinematic information on the pathomechanics of ambulation in these disorders. Because the information obtained is quantitative, an accurate measure of improvement (or lack of it) after treatment can be documented. Therefore, the locomotion laboratory may have an important role in the preoperative and postoperative evaluation of children whose abnormal gait may require surgical corrective procedures or rehabilitative treatment including the use of prostheses or orthoses.

Adolescent↗
PubMed1975

Technetium bone scanning as an aid in the diagnosis of atypical acute osteomyelitis in children.

Technetium bone scanning is a simple, safe and accurate method for the diagnosis of acute osteomyelitis in children whose presenting clinical findings are atypical of bone infection. Bone scanning was effective in the localization of the exact site of osteomyelitis, thus facilitating needle aspiration as well as subsequent surgical decompression. Tehcnetium bone scanning is a diagnostic technique for determining bone infection in children who are unable to communicate adequately or in those whose signs have been modified by previous inadequate antibacterial therapy.

Acute Disease↗
PubMed1975

Special devices as aids in the management of child self-mutilation in the Lesch-Nyhan syndrome.

The Lesch-Nyhan syndrome is a rare inborn error of purine metabolism associated with hyperuricacidemia, mental retardation, and an insatiable urge for self-mutilation, especially of the extremities. Insensitivity to pain and severe muscle spasms create very difficult management problems, especially for children being cared for at home. Fortunately this syndrome is rare (1 per 380,000 live births). Four known patients are under treatment in Manitoba, of which two brothers are the subject of this study. In general, the medical management of these patients has been unsuccessful, especially in controlling self-mutilation. It therefore was decided to manage these children by the use of mechanical aids. Through the utilization of custom-designed seating devices control of the self-mutilation has been obtained, reducing the burden of family care. It is now possible for the children to attend regular school on a half-day basis. They are also able to engage in community activities without the fear that a mishap will occur when not under the vigilance of the immediate family.

Adolescent↗
PubMed1975

Preoperative skeletal traction in scoliosis.

To determine the role of preoperative traction in the treatment of spinal curves, ten patients with curves averaging 81 degrees by the Cobb measurement were studied. Each patient was treated in traction by means of a halo or skull tongs and femoral pins for two to three weeks prior to the surgical correction of the scoliosis with instrumentation. Weights were added to the traction apparatus, 1.8 kilograms a day, to a maximum of 18.1 kilograms. Pretraction supine roentgenograms were compared with supine roentgenograms made at three-day intervals throughout the traction period. Preoperative traction resulted in an average improvement of the curves of 34 degrees, or 41 per cent of the initial curve. Most of the correction was obtained within the first week of traction. Further correction during surgery with Harrington instrumentation yielded 13.5 degrees on the average (16 per cent) so that combined correction averaged 47 degrees, or 57 per cent.

Adolescent↗
PubMed1975

Treatment of acute osteomyelitis in children by closed-tube irrigation: a reassessment.

The addition of closed-tube irrigation to incision and drainage in the treatment of children with acute osteomyelitis has been found to be associated with: (a) a rate of technical complications of 60%, the most common complications being leaking and plugging of the tube; (b) a 30% rate of superinfection at the site of the wound, the most common organism being Pseudomonas; and (c) an average postoperative hospital stay of 30 days compared with only 16 days for the patients treated by incision and drainage alone. Suction-irrigation in the treatment of acute osteomyelitis in children does not appear to be essential for successful management, and introduces added risks of superinfection and technical complications.

Acute Disease↗
PubMed1974

The role of special devices in the management of the handicapped child.

With continued improvements in neonatal care many infants with severe neuromuscular disease are now being salvaged. To achieve independence in ambulation as well as in activities of daily living, such children often require considerable assistance from many allied disciplines. Because each handicapped child is unique in his particular requirements, specially designed and manufactured aids are often indicated. A multidiscipline Special Devices Clinic has been established to fulfil this need.

Activities of Daily Living↗
PubMed1973

The vacuum splint: an aid in emergency splinting of fractures.

The vacuum splint has been shown to be a simple, safe and effective method of emergency splinting of fractured extremities. The splint is simply constructed from clear vinyl sheeting and contains 2-mm. expanded polystyrene balls. Evacuation of air causes the splint to become rigid, thereby providing stability and immobilization of the limb. The splint is radiolucent, containing no obstructive metal components that would interfere with the radiographic appearance of the injured limb. The ease of application of this splint makes it especially effective for the emergency splinting of fractures in children.

Arm Injuries↗