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Biomedical subjects

R N Hensinger

Publications and source records attributed to R N Hensinger.

At least 19 recordsLinked to original sources
PubMed1992

Musculoskeletal aspects of prune-belly syndrome. Description and pathogenesis.

OBJECTIVE: To determine the types and prevalence of musculoskeletal involvement in children with prune-belly syndrome, and to analyze the pathogenesis of the syndrome in relationship to the musculoskeletal deformities. DESIGN: A retrospective review of charts and roentgenograms along with a comprehensive review of 188 cases from the literature. SETTING: Tertiary care children's hospital. PARTICIPANTS: Twelve boys treated between 1975 and 1990. MEASUREMENTS/MAIN RESULTS: The prevalence of musculoskeletal involvement in patients was 45%. The involvement can be congenital (eg, clubfeet, limb deficiencies, teratologic hip dysplasia, and vertebral malformations) or developmental (eg, renal osteodystrophy, scoliosis, and pectus excavatum and/or pectus carinatum). The embryologic characteristics of congenital musculoskeletal problems correlate better with the embryologic theory of the prune-belly syndrome (an aberration of mesenchymal development around 6 weeks of gestation) than with the distal urinary tract obstructive theory. CONCLUSION: Since children with prune-belly syndrome are now living into adulthood, these musculoskeletal aspects will become important regarding potential morbidity.

Adolescent↗
PubMed1992

Osteoid osteoma and osteoblastoma of the spine.

Eleven patients with spinal osteoid osteoma and six patients with spinal osteoblastoma treated between 1975 and 1990 were reviewed to characterize the tumors as they affect the spine and to define the important differences between the two tumors. All patients with cervical osteoid osteoma presented with pain, limited range of motion of the neck, and torticollis. Four osteoblastomas had soft-tissue components in the epidural space, necessitating dissection of the tumor from the dura. No soft-tissue component was found in any of the osteoid osteomas. Our results were similar to a metaanalysis of the clinical, radiographic, and surgical findings of all published cases of spinal osteoid osteoma and osteoblastoma. Important features that have not been emphasized in the literature are the high incidence of torticollis with cervical lesions and the frequent association of epidural invasion with osteoblastoma. Surgeons treating osteoblastoma of the spine should be prepared to dissect tumor from the dura.

Adolescent↗
PubMed1992

Cervical spinal cord injury in children.

We examined 19 children under 10 years of age with cervical spinal cord injury using clinical records and radiographs. The children were divided into two groups: Eight had immediate and complete spinal cord injury, and 11 had incomplete or partial spinal cord injury. Those with complete spinal cord injury were injured in motor vehicle accidents with a proximal spinal cord injury. Eighty-eight percent had cervical spine fractures/instability with a distraction pattern of injury. Half had associated trauma. The mortality rate was 25%, and those who survived showed no neurologic improvement. Most of the children with partial spinal cord injury were injured at birth. Many had no radiographic evidence of cervical fracture. One-quarter had associated trauma. The neurologic improvement averaged 1.9 Frankel grades. Half of both groups required posterior cervical fusion, and there was a significant complication rate. Eight-eight percent developed scoliosis, and 71% developed hip subluxation.

Accidents, Traffic↗
PubMed1992

Softball injuries. Aetiology and prevention.

Over 40 million individuals nationally participate in organised softball leagues, playing an estimated 23 million games per year in the United States. It has also been estimated that softball causes more injuries leading to emergency room visits in the United States than any other sport. Between 1983 and 1989, over 2.6 million injuries were documented through selected emergency rooms throughout the United States. In addition, the potential costs of these injuries can be staggering, therefore, prevention is of utmost importance. Prior to implementation of any preventative measures, the aetiology and distribution of injuries must be ascertained. Softball-related injuries can be grouped into 3 categories: (a) sliding-related injuries--the most common injury scenario; (b) collision-related injuries; and (c) falls sustained by the player. Various preventative approaches have been utilised to reduce the incidence of these recreational sports injuries and the associated health care costs. In regard to sliding-related injuries, breakaway bases have been utilised and have been found to reduce sliding-related injuries by approximately 98%. In reference to collision injuries, deformable walls and padded back stops and field maintenance have been found to prevent the majority of injuries secondary to collisions and falls. In addition, better coaching techniques as well as stretching and conditioning programmes have all been found to benefit players in the prevention of their injuries. As physicians, trainers and individuals involved with sporting activities, it is imperative that we turn and focus our attention on prevention. The cornerstone to diminished injuries and subsequent prevention of an injury is a safer environment for the recreational softball player to participate in.

Athletic Injuries↗
PubMed1991

Fusion of the upper cervical spine in children and adolescents. An analysis of 17 patients.

A retrospective review of 17 immature patients who underwent posterior spinal fusion of C1-C2 or C1-C3 was performed to establish the efficacy of the procedure, to determine the incidence of complications, and to identify those at high risk for complications. All had radiographic C1-C2 instability or dislocation. Etiologies included os odontoideum, fixed rotatory subluxation, atlantoaxial subluxation, type II dens fracture nonunion, and nonunion of a Hangman's fracture. Before surgery, 10 patients were neurologically intact, and seven had neurologic findings. Associated diagnosis included Down's syndrome in three and Ehler-Danhlos in one. Follow-up averaged 25 months. One neurologically intact patient had a C2 radiculopathy that resolved by 1 year. Three patients with Down's syndrome had complications: one with a preoperative Brown-Sequard syndrome had transient worsening in the immediate postoperative period, one with a preoperative myelopathy developed a late recurrence of a severe myelopathy that required odontectomy, and another sustained an intraoperative spinal cord contusion followed by postoperative quadriplegia and death due to respiratory failure. Of seven reporting neurologic symptoms before surgery, two had residual deficit in the late postoperative period. These two represented preventable technical errors. There were two nonunions, one of which required occiput to C2 fusion. In general, posterior spinal fusion of the upper cervical spine was found to be a reliable, safe, and predictable procedure, but extra caution should be employed when considering arthrodesis in patients with ongoing spinal cord compression, fixed dislocations, and inherited ligamentous laxity.

Adolescent↗
PubMed1991

Complications of fusion to the upper cervical spine.

Forty-seven operations for posterior fusion of the upper cervical spine were reviewed for complications. Alarmingly, only 11 patients had an entirely uncomplicated course. Most complications were minor, but there were four nonunions, one requiring reoperation. Although seven patients had increased neurologic deficits after surgery, only one was permanent. There was one death due to technical error. Patients with significant instability, myelopathy, prior failed fusions, or unreducible dislocations are at high risk for perioperative neurologic complications.

Adult↗
PubMed1991

Familial cervical dysplasia.

Nine of twelve family members from three generations were affected by an inherited form of cervical vertebral dysplasia. All of the affected people had an abnormality of the first cervical vertebra. Some also had defects of the axis and caudad to it. The mode of transmission of the disorder is autosomal dominant, with apparently complete penetrance and variable expressivity. Two patients had symptoms. One had a passively correctable tilt of the head, with an associated audible clunk and hypoplasia of the left superior facet of the second cervical vertebra. This patient had no local symptoms, neurological involvement, or muscle spasm. In the other patient, suboccipital pain developed. Radiographs revealed an anterior atlanto-occipital dislocation. The symptoms resolved after reduction and arthrodesis. Because of the apparently complete penetrance of this disorder, physicians caring for patients who have this type of congenital malformation of the cervical spine should consider examination of closely related members of the family. Clinical findings such as tilting of the head, torticollis, or limitation of cervical motion suggest that additional evaluation should be done. The examination should include lateral radiographs of the cervical spine in flexion and extension. Three-dimensional computed-tomography reformatting was helpful in demonstrating the complex cervical anatomy in our patients. Patients who have recognized abnormalities should be followed and should be re-examined whenever local or neurological symptoms develop. A magnetic resonance image of the spine in flexion and extension was valuable for identification of the potentially disastrous situation of impending damage to the cord in patients who had instability and evolving symptoms.

Adult↗
PubMed1991

Congenital anomalies of the cervical spine.

Congenital anomalies of the cervical spine are uncommon. The majority of afflicted individuals are asymptomatic or have only mild restriction of neck motion. If symptoms develop, they are usually due to cervical instability or degenerative osteoarthrosis. Recent information indicates that patients with upper cervical anomalies such as atlantooccipital fusion, anomalies of the odontoid, or the transverse atlantal ligament have a great propensity to develop early instability and neurologic problems secondary to minor traumatic events. If symptoms occurs in the lower cervical spine, it is usually in adult life and due to degenerative arthritis in the hypermobile articulations adjacent to the area of synostosis. The relatively good prognosis of cervical lesions is overshadowed by the "hidden" or unrecognized associated anomalies. There is a high incidence of significant scoliosis, Sprengel's deformity, renal anomalies, deafness, and neurologic malformations. Early recognition and treatment of these problems may be of substantial benefit, sparing the patient further deformity or serious illness.

Adolescent↗
PubMed1990

Cobb angle versus spinous process angle in adolescent idiopathic scoliosis. The relationship of the anterior and posterior deformities.

The standard clinical measurement for adolescent idiopathic scoliosis is the Cobb angle, measured from the end-plates of the end vertebral bodies in a standing radiograph. This measurement of anterior column structures describes the anterior spinal deformity. The posterior spinal deformity can be described by the "spinous process angle," measured from a curve joining the tips of the spinous processes. A computer model, and a radiographic study of Cobb angle, spinous process angle and vertebral rotation show that adolescent idiopathic scoliosis results in larger angulations of the anterior elements than posterior elements. This helps to explain some of the inherent limitations of posterior instrumentation, including Cotrel-Dubousset instrumentation, and of noninvasive posterior surface measurement systems.

Adolescent↗
PubMed1989

The management of rotatory atlanto-axial subluxation in children.

Twenty-three children who were treated for rotatory atlanto-axial subluxation between 1975 and 1986 were retrospectively studied. The success of closed reduction with traction and the length of hospitalization were related to the duration of symptoms before admission. In sixteen of the children, who were seen less than a month after the onset of symptoms, the subluxation reduced either spontaneously or after a short period of traction. Of the seven remaining children, who were seen more than one month after the onset of symptoms, three eventually needed a posterior atlanto-axial arthrodesis. Dynamic computed-tomography scans, with the head rotated maximally to each side, were made for five children, and proved to be an excellent method of documenting the presence of rotatory atlanto-axial subluxation.

Adolescent↗
PubMed1989

Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous.

In ten children who were less than seven years old, an unstable injury of the cervical spine was found to have anterior angulation or translation, or both, on initial lateral radiographs that were made with the child supine on a standard flat backboard. In all ten patients, extension was the proper position for reduction of the injury of the cervical spine. Young children have a large head in comparison with the rest of the body. When a young child is positioned on a standard backboard, the neck may be forced into relative kyphosis. Supine and upright lateral radiographs that were made of seventy-two children who did not have a fracture also demonstrated more relative cervical kyphosis in younger children when they were in the supine position. Calculations from anthropometric data documented disproportionate rates of growth of the head and the chest. The circumference of the head grows logarithmically, but the circumference of the chest grows linearly. This disproportionate growth causes young children to have a relatively large head. When they lie supine, the neck is flexed. To prevent undesirable cervical flexion in young children during emergency transport and radiography, a standard backboard can be modified to provide safer alignment of the cervical spine. This can be accomplished by the use of a recess for the occiput to lower the head or of a double mattress pad to raise the chest.

Age Factors↗
PubMed1987

Arthrography in evaluation of birth injuries of the shoulder.

Birth injuries of the shoulder and proximal humerus of infants can be difficult to evaluate on plain radiographs because of lack of ossification in the proximal humeral epiphysis. We here describe arthrography of the infant shoulder and advocate it as a useful diagnostic procedure in the evaluation of humeral fractures and brachial palsies. Two infants with birth injuries of the shoulder are described. The value of dynamic fluoroscopic evaluation of the injured joint in conjunction with arthrography is illustrated in evaluation of a brachial plexus palsy.

Arthrography↗