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Biomedical subjects

R T Loder

Publications and source records attributed to R T Loder.

At least 37 records · Page 2Linked to original sources
PubMed1995

Variability in Cobb angle measurements in children with congenital scoliosis.

The variability in measurement of angles in congenital scoliosis is not known, but it is postulated that it is larger than that in adolescent idiopathic scoliosis due to skeletal immaturity, incomplete ossification, and anomalous development of the end-vertebrae. To determine this variability, we selected 54 radiographs of adequate quality showing 67 scoliotic curves from children with congenital scoliosis. The end-vertebrae were preselected. Each curve was measured by the Cobb method on two separate occasions by six different observers, using the same goniometer and marker. The intraobserver variability was +/- 9.6 degrees and the interobserver variability +/- 11.8 degrees. If 'significant progression' is to be used as a criterion for surgical fusion in congenital scoliosis, there should be at least a 23 degrees increase, the entire range of the interobserver variability, in the curvature to ensure that the perceived increase is not due to variability in measurement.

Analysis of Variance↗
PubMed1993

Applicability of the Greulich and Pyle skeletal age standards to black and white children of today.

OBJECTIVE: The Greulich and Pyle skeletal age atlas was derived from white children of upper socioeconomic level during the 1930s. To our knowledge, the Greulich and Pyle standards have not been reassessed for both black and white children; it was the purpose of this study to reassess the applicability of these standards to today's children. DESIGN: A "blinded" review of hand roentgenograms taken for the evaluation of trauma was performed. Age of the subjects was evenly distributed between 0 and 18 years. The roentgenograms were scored for bone age by five individuals from different disciplines and levels of training. The difference between the median bone age and the child's chronologic age was calculated for each roentgenogram and stratified into four age groups: early childhood (0 to 4 years), middle childhood (4 to 8 years), late childhood (8 to 13 years), and adolescence (13 to 18 years). SETTING: The roentgenograms were obtained from four hospital emergency rooms in the Lake Erie basin area, the same geographic area from which the Greulich and Pyle standards originated. PATIENTS: There were 841 children: 452 boys and 389 girls, 461 black and 380 white children. RESULTS: The bone ages and chronologic ages were similar for white girls of all ages. Black girls were skeletally advanced by 0.4 to 0.7 year (P < .001), except during middle childhood. White boys were skeletally delayed during middle childhood by 0.9 year (P < .001) and during late childhood by 0.4 year (P < .01), but they were advanced during the adolescent years by 0.5 year (P < .01). Black boys showed no difference except for the adolescent group, which was skeletally advanced by 0.4 year (P < .02). CONCLUSIONS: The Greulich and Pyle atlas is not applicable to all children today, especially black girls. We should be aware of this information when making clinical decisions requiring accurate bone ages.

Adolescent↗
PubMed1993

Influence of pelvic osteotomy on birth canal size.

Six pelvic osteotomies (Salter, Sutherland, Steel, Tönnis, Chiari, and periacetabular) were performed on the right hemipelvis of adult female pelvic plastic models. Each pelvis underwent conventional X-ray and computed tomographic digital pelvimetry before and after osteotomy. The change in the anteroposterior and transverse dimensions at the inlet, midpelvis, and outlet were calculated. None of the osteotomies significantly decreased the inlet. The Salter and Sutherland osteotomies decreased the midpelvis to borderline low. The Salter, Sutherland, and Steel osteotomies significantly decreased the pelvic outlet. These changes correlated closely with those in living patients. Much of this decrease is nullified when the osteotomy is performed prior to the pubertal growth spurt.

Adult↗
PubMed1993

Musculoskeletal involvement in children with gastroschisis and omphalocele.

A review of 58 children with gastroschisis and 8 children with omphalocele showed 14 musculoskeletal problems in 11 children. These problems consisted of limb deformities in 6 children, spinal deformities in 4 children, and osteopenia in 3 children, with 1 of the osteopenic children developing pathological fractures. About one third (5/14) of the problems were arthrogrypotic in nature. The remainder were mild digital deformities, developmental or spondylodysplastic scolioses, and, rarely, congenital spinal deformities.

Abdominal Muscles↗
PubMed1993

Acute slipped capital femoral epiphysis: the importance of physeal stability.

To test the traditional classification system of slipped capital femoral epiphysis, we evaluated the presenting symptoms and radiographs of fifty-four patients and reclassified the slipped epiphyses as unstable or stable, rather than acute, chronic, or acute-on-chronic. Slips were considered to be unstable when the patient had such severe pain that weight-bearing was not possible even with crutches. Slips were considered to be stable when the patient could bear weight, with or without crutches. We reviewed the records on fifty-five hips in which the slip would have been classified as acute because the duration of symptoms was less than three weeks; thirty of these were unstable and twenty-five were stable. All slips were treated with internal fixation. A reduction occurred in twenty-six of the unstable hips and in two of the stable hips. Fourteen (47 per cent) of the thirty unstable hips and twenty-four (96 per cent) of the twenty-five stable hips had a satisfactory result. Avascular necrosis developed in fourteen (47 per cent) of the unstable hips and in none of the stable hips. We were not able to demonstrate an association between early reduction and the development of avascular necrosis.

Acute Disease↗
PubMed1993

The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan.

The records of 224 children who had a slipped capital femoral epiphysis and who had no underlying metabolic or endocrine disorder were studied retrospectively to investigate the epidemiology of bilateral slipped capital femoral epiphysis. Eighty-two (37 per cent) of the 224 children (fifty-one boys and thirty-one girls) had a bilateral slip. Sixty-four of these children were black and eighteen were white. The age at the time of the diagnosis of the first slip was 13 +/- 1.7 years (mean and standard deviation), the duration of the symptoms was 5 +/- 5.0 months, and the angle of the slip was 26 +/- 16 degrees. Obese children were younger at the time of the diagnosis of the first slip (12 +/- 1.6 compared with 13 +/- 1.6 years for the children who were not obese, p = 0.001). The diagnosis of a slipped capital femoral epiphysis was made simultaneously in both hips in forty-one children and sequentially in forty-one children. Compared with the children in whom both hips were diagnosed simultaneously, the children in whom the hips were diagnosed sequentially had had a shorter duration of the symptoms before the diagnosis of the first slip (3 +/- 2.4 compared with 7 +/- 5.9 months, p = 0.0003), were younger at the time of the diagnosis of the first slip (12 +/- 1.9 compared with 13 +/- 1.2 years, p = 0.001), and tended to be more obese (p = 0.025). In 88 per cent of the patients who had sequential slips, the second slip was diagnosed within eighteen months after the diagnosis of the first slip.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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

Postoperative migration of the adductor tendon after posterior adductor transfer in children with cerebral palsy.

The adductor longus tendon was tagged with metallic markers after posterior adductor transfer in 17 children (33 hips) with cerebral palsy: 10 had spastic diplegia and seven had spastic quadriplegia. The average age at operation was 5 years 3 months, time of postoperative immobilization 5.7 weeks and average follow-up 1 year 7 months. In 19 hips the tendon remained attached to the ischium, in 11 hips it pulled away from the ischium and in three hips the result was equivocal. The incidence of detachment was higher among diplegic children than quadriplegic children.

Adolescent↗
PubMed1992

Slipped capital femoral epiphysis in black children.

We reviewed 74 black children with 97 slipped capital femoral epiphyses (SCFEs) with an average follow-up of 3.7 years. There were 24 bilateral, 22 right, and 27 left SCFEs. The average age at operation was 12 years 6 months. The average slip severity was 28 degrees with 61 mild, 21 moderate, and 14 severe slips. Group I slips (54) were treated with multiple pins, and group II slips (43) were treated with a single central screw. Satisfactory results were achieved in 74% of the group I and 91% of the group II slips, with only three cases of chondrolysis. We conclude that single central screw fixation of SCFE in black children can lead to excellent results with a low incidence of chondrolysis.

Adolescent↗
PubMed1991

Fracture patterns in battered children.

We reviewed cases of 75 battered children with fractures over a 2-year period. The average age was 16 months; 57% were boys. There were 154 fractures (2.0 per child); 77% were acute and 23% were old. The most common fracture occurred in the skull (32%) and the most common long bone fracture occurred in the tibia (16%). The most common long bone fracture pattern was transverse (41%); corner fractures accounted for 28% of long bone fractures. An isolated acute fracture was the orthopaedic injury in 65% of the children, whereas multiple fractures in various stages of healing were present in only 13% of children.

Battered Child Syndrome↗
PubMed1991

Spinal cord monitoring in patients with nonidiopathic spinal deformities using somatosensory evoked potentials.

Seventy-nine somatosensory evoked potentials were intraoperatively recorded in 52 patients undergoing spinal surgery for nonidiopathic spinal deformities. There were 37 true-negative, 28 true-positive (a significant change in the somatosensory evoked potential related to the surgical process), and 14 false-positive (a significant change in the somatosensory evoked potential not related to a surgical event) readings. There were, however, no postoperative neurologic deficits with any of the true-positive readings and no false negatives. Spinal and subcortical somatosensory evoked potentials gave few false-positive readings. True-positive somatosensory evoked potentials occurred in 44% of the patients with neuromuscular deformities, 17% with congenital deformities, 45% with Luque instrumentation, 22% with Harrington instrumentation, and none with fusion in situ. Fifty percent of the true positives occurred while the sublaminar wires were tightened. The predictive accuracy of intraoperative spinal cord monitoring in this patient population is not high, but the sensitivity to potentially harmful surgical events is high.

Child↗
PubMed1990

Seasonal variation of slipped capital femoral epiphysis.

To correlate the season of the year with the prevalence of slipped capital femoral epiphysis, we reviewed the cases of 177 patients who had 243 slips during an eleven-year period. We assessed the month when the patient was seen and the implied time of onset of the slip and found a statistically significant variation for both. The average time of onset was mid-June, with a standard deviation of 2.5 months, and was not significantly different for race, sex, or laterality. We attributed the increased incidence of slipped capital femoral epiphysis during the summer to increased physical activity in that season.

Adolescent↗
PubMed1988

A surface ultrastructure study of ganglia and digital mucous cysts.

Three digital mucous cysts and three dorsal wrist ganglia were studied by light and scanning electron microscopy. Both exhibited the same findings, namely a porous network of collagenous fibers forming the wall and a fibrillated inner surface composed of a random arrangement of collagen fibers. An intermittent thin membrane was observed on the inner surface, but no evidence of a cellular lining was apparent. This anatomic study lends support to a shared cause.

Cysts↗
PubMed1988

The influence of diabetes mellitus on the healing of closed fractures.

Thirty-one closed fractures of the lower extremity in diabetics were retrospectively reviewed to determine healing times. There was a prolonged union time overall (163% of expected) and in both insulin and oral hypoglycemic-controlled diabetics (157% and 176% of expected). Displaced fractures showed a prolonged union time, while nondisplaced fractures healed in the normal time period (187% and 96% of expected). Fractures treated by open reduction had a more prolonged healing time than those treated by closed reduction (186% and 142% of expected), but this was primarily related to displacement. Sex and age had no effect on union time. The known effects of diabetes mellitus on bone and mineral metabolism in both experimental animals and humans may explain these prolonged union times.

Adult↗
PubMed1987

Pediatric polytrauma: orthopaedic care and hospital course.

Seventy-eight children with multiple trauma who had sustained one major musculoskeletal injury and at least one other major injury were studied. Injury severity was classified by the Modified Injury Severity Scale. There were 137 musculoskeletal injuries; 47 complications occurred in 27 patients. Early osteosynthesis tended to shorten the hospital stay, intensive care unit stay, and length of time ventilatory support was needed. Those patients undergoing immediate surgical stabilization of fractures had fewer complications than those undergoing surgical stabilization after 72 h. Those children with fractures treated by prolonged bed rest and who also had both neural and thoracoabdominal injuries had a higher rate of complications related to immobilization.

Accidents, Traffic↗
PubMed1987

Disarticulation of the knee in children. A functional assessment.

We assessed the functional abilities of six patients who had had disarticulation of nine knees during childhood by analyzing their gait using electrocardiographic telemetry. Those who were more than five years old were further studied by timing them as they ran the fifty-yard (45.7-meter) dash and by testing the strength of the musculature of the hip girdle using a Cybex dynamometer. The physiological cost-index of Butler et al. was used to assess energy consumption. Three patients had had unilateral disarticulation and three had had bilateral disarticulation. Kinematic studies showed persistent bilateral abduction of the hip throughout the gait cycle in all six patients. The flexion-extension arc of the hip was decreased in the three who had had bilateral disarticulation. Increased flexion of the hip was noted on the normal side and decreased flexion, on the affected side in those who had had unilateral disarticulation. Phase reversal of pelvic obliquity was noted in the amputees who had had bilateral disarticulation. The prosthetic knee showed good flexion during the swing phase. All patients showed a mild decrease in the velocity of gait and in the length of step and stride. The patients who had had unilateral disarticulation showed decreased duration of the bilateral stance and single stance phases and increased duration of the swing phase. Those who had had bilateral disarticulation of the knee had a normal distribution of the components of the gait cycle: bilateral stance, single stance, and swing. The physiological cost-index for all six was within the normal range, indicating minimum energy handicap.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗