Concomitant discitis and spondylolisthesis at adjacent lumbar vertebrae.
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Blood Sedimentation↗
Biomedical subjects
R T Loder
Publications and source records attributed to R T Loder.
Studies on gene control regions X. The effect of specific adenine-thymine transversions on the lac repressor-lac operator interaction.
Chemical and enzymatic methods were used to synthesize a transition (AT to GC) and a transversion (AT to TA) at a lac operator site known to interact with lac repressor through the thymine 5 methyl group. These operators also contained a poly(dA) . poly(dT) tail 8 to 12 base pairs in length at one end. Results suggest that the steric constraints of lac repressor relative to the position of the 5 methyl group are quite critical. For example a seven fold reduction in stability was observed for the transversion. Results also suggest that the operator spans at least 21 base pairs.
Adenine↗
Hip arthroscopy using a limited anterior exposure: an alternative approach for arthroscopic access.
SUMMARY: Hip arthroscopy is a technically difficult procedure to perform. A limited anterior approach to the joint has made hip arthroscopy technically less difficult in our hands and has enabled us to treat a wide range of hip pathology. Five hip arthroscopies were performed using a modified 4-cm Smith-Petersen anterior approach to the hip exposing the joint capsule as manual traction is applied. The arthroscope is then easily introduced making visualization of the hip joint possible. The 5 hip arthroscopies resulted in either removal of loose bodies or debridement of an osteochondral fragment, synovitis, or cartilaginous debris. There were no complications postoperatively. We believe that hip arthroscopy through a limited anterior approach provides an easy and safe alternative method for arthroscopic access to the hip joint. Importantly, there is a decreased risk of neurovascular trauma and iatrogenic damage to the articular cartilage and acetabular labrum when introducing instruments into the hip joint.
Adolescent↗
Skull thickness and halo-pin placement in children: the effects of race, gender, and laterality.
To study the effects of gender, race, and laterality on skull thickness, we reviewed 41 pairs of head computed tomography (CT) scans, matched for age and sex by race. Thickness was measured at the standard locations for halo pins (anterolateral [AL] and posterolateral [PL]) using bone windows. The average measurements ( +/- 1 SD) were right AL = 2.9 +/- 1.0, left AL = 2.8 +/- 1.0, right PL = 3.2 +/- 1.2, and left PL = 3.6 +/- 1.2 mm (range, 1.2-7.2). There were no statistically significant differences by race or gender. The average thickness increased with age. There was a difference between the right and left PL sites (3.2 +/- 1.1 vs. 3.6 +/- 1.2 mm) but not between the AL sites. Caution in halo application must be applied equally to all children.
Adolescent↗
Role of intentional abuse in children 1 to 5 years old with isolated femoral shaft fractures.
We reviewed 42 children, aged 1-5 years, with isolated femoral shaft fractures to investigate the possible role of intentional injury in these children. Those children with documented motor vehicle accidents or pathologic fractures were excluded. Follow-up from the Department of Social Services regarding the potential for the fractures being inflicted was obtained. The average age of the children was 3.1 +/- 1.2 years; the fracture was spiral in 28. oblique in six, and transverse in eight; history of a fall was present in 34 and absent in eight. The history was considered suspicious for intentional injury in 14 children. In all 42 children, only one fracture was documented to be inflicted; one other child had prior documentation of intentional injury. From this review, the likelihood of intentional injury to the femoral shaft appears to be low; unfortunately, there were no discriminating clinical parameters to help to determine which injuries were intentional. The clinician should continue to have a high index of suspicion and have the circumstances investigated if concern exists regarding the fracture.
Age of Onset↗
Open reduction and internal fixation of forearm fractures in children.
We retrospectively reviewed 16 children younger than 13 years with 17 fractures of the shafts of the radius or ulna or both who had undergone an open reduction-internal fixation (ORIF). ORIF was performed when a closed reduction was deemed unacceptable in 14 radius fractures and for three unstable open fractures of the radius. The average age was 9.4 +/- 2.3 years (range, 5.0-12.5). Of the 14 fractures with an unacceptable closed reduction, soft-tissue interposition was encountered in seven. Fixation was secured by plates and screws, percutaneous Steinmann pins, or intramedullary Steinmann pins. There were no delayed unions or nonunions, no infections, and no neurovascular injuries. The average follow-up was 12.3 months; all 17 fractures had excellent results (forearm rotation loss of < 10 degrees). Our study indicates that excellent results can be expected with no increased risk of complications if the treating physician elects to proceed with an ORIF in a pediatric forearm fracture with proper indications.
Adolescent↗
Lower extremity lawn-mower injuries in children.
Lower extremity lawn-mower injuries in children result in significant morbidity with a significant financial burden to the family and society. We reviewed 24 children with lower extremity lawn-mower injuries; all mothers completed standardized psychologic assessments of their children, and 18 children were interviewed. Fifty percent of the mothers had defensive profiles on the standardized psychologic assessment, suggesting the likelihood of denial or underreporting of the child's psychologic difficulties. Therefore, we found the interview with the child to be a more accurate measure of psychologic distress. Prevention measures aimed at parents must emphasize that a child must not be allowed in a yard that is being mowed with a riding mower.
Accident Prevention↗
Slipped capital femoral epiphysis associated with renal failure osteodystrophy.
A retrospective institutional and literature review of 31 children (20 boys and 11 girls) with 58 renal failure-associated slipped capital femoral epiphyses (RFASCFEs) was performed. The average age at diagnosis of renal failure was 8.9 years, and for RFASCFE 11.5 years, with a linear correlation between these two ages. All patients had secondary hyperparathyroidism at diagnosis of the RFASCFE. The median height and weight were below the 5th percentile. The RFASCFEs were stable and bilateral in 95% of the children. Slip magnitude was mild in 53%, moderate in 8%, and severe in 39%. Avascular necrosis was associated with steroid immunosuppression in children with renal transplants. All children were treated with medical management; surgery was used in an additional 29 hips. If correction of secondary hyperparathyroidism is not achieved within 2 months, RFASCFEs are likely to progress and surgical stabilization is recommended.
Adolescent↗
Slipped capital femoral epiphysis associated with radiation therapy.
We reviewed 32 children with 41 radiation-therapy associated slipped capital femoral epiphyses (RTASCFE). Ten were from the authors' institutions and 22 from the literature. Gender distribution was equal. The age at diagnosis of the malignancy was 4.3 +/- 3.1 years; the amount of radiation was 4,240 +/- 1,445 rads. Children with RTASCFE presented younger (10.4 +/- 3.2 years) than a routine SCFE. The average symptom duration was 5 +/- 6 months. Children with RTASCFE are usually thin (median weight, 10th percentile) in contrast to children with typical SCFE, who are usually obese (<95th percentile). The majority (82%) of the slips were mild, compared to routine SCFEs (approximately 50%); 28% were bilateral. There was a positive linear relationship between the age at presentation of the SCFE and the age at diagnosis of the malignancy; there was a negative linear relationship between the age at presentation of the SCFE and the amount of radiation therapy.
Adolescent↗
The induction of congenital spinal deformities in mice by maternal carbon monoxide exposure.
Carbon monoxide (CO) has been shown to be teratogenic in mice. High altitude hypoxia has also been shown to induce congenital vertebral anomalies in mice. The purpose of this study was to investigate the effect of maternal hypoxia owing to CO exposure and the production of congenital spinal deformities in the offspring. Sixty DBA-1J mice were bred using polygamous timed breeding methods. Pregnant females were exposed to 200, 400, or 600 ppm CO using a custom-designed gas blender system. Seven-hour exposures were performed on day 8.5, 9.5, or 10.5 of the 21-day gestation cycle. The neonates were euthanized at birth; the specimens were fixed, eviscerated, and radiographed. Congenital spinal deformities were observed (wedge, hemi, fused, and missing vertebrae; fused ribs) and were located in all regions of the spine. There was a statistically significant difference in the number of spinal deformities between all groups, with no defects in the controls and a 77% incidence at 600 ppm (p < 0.0001). There was no apparent correlation between the time of exposure and defect location. The most sensitive time of gestation was 9.5 days. We identified an animal model of congenital spinal deformities that compares favorably with the evidence of human congenital spinal deformities in cases of maternal exposure to CO and other gas and chemical fumes.
Animals↗
Factors predictive of immobilization complications in pediatric polytrauma.
OBJECTIVES: To determine in a cohort of children with polytrauma which variables are predictive of the development of complications related to immobilization. DESIGN: A retrospective study of children with polytrauma and at least one major musculoskeletal injury. A stepwise forward logistic regression analysis was used to determine variables predictive of complications related to immobilization. PARTICIPANTS: Ninety-three children with polytrauma were studied; motor vehicle incidents accounted for 80 percent of the injuries. The average age was 8.0 +/- 4.1 years. There were 152 fractures in the ninety-three children. The average Modified Injury Severity Scale (MISS) was 24.5 +/- 13.6. There were thirty-five complications in twenty-two children, and four children died. RESULTS: Two variables were predictive of complications related to immobilization: age and MISS score. Complications related to immobilization were positively associated with being older than seven years of age (p = 0.027; odds ratio = 9.5; 95 percent confidence interval 1.4, 64.9) and having a MISS score greater than forty (p = 0.005; OR = 14.1; 95 percent confidence interval 2.2, 89.1). Timing of surgery showed a trend (p = 0.097) but did not reach statistical significance. CONCLUSIONS: Complications of immobilization in children with polytrauma are associated with age greater than seven years and a MISS score greater than forty. Further study is needed to evaluate the effect of early fracture stabilization. Timing of osteosynthesis showed a trend but did not reach statistical significance in this study.
Abbreviated Injury Scale↗
Fibular transfer for congenital absence of the tibia: a reassessment.
Six children (nine limbs) underwent fibular centralization for complete paraxial tibial hemimelia. The preoperative, intraoperative, and postoperative criteria as described by Brown (J Bone Joint Surg [Am] 1965; 47:695-704) were strictly met. At initial postoperative evaluation, three limbs had active knee extension, and five limbs had minimal flexion contractures. However, at final follow-up, 20-123 months later, all knees had ligamentous instability and poor active range of motion; eight had significant flexion contractures. All were classified as poor results. Based on this series and other reports, it is recommended that knee disarticulation instead of fibular centralization be performed for complete paraxial tibial hemimelia, preferably within the first year of life.
Child, Preschool↗
Orthopedic aspects of Rett syndrome: a multicenter review.
Twenty-three of 36 patients (64%) with Rett syndrome showed orthopedic problems at an average age of 8 years 7 months. Sixteen patients had spinal deformities (45%), six had scoliosis, one had sagittal deformity, and nine had scoliosis with sagittal deformity. Eight patients with scoliosis have shown progression, with two patients requiring surgery. Thirteen patients (36%) exhibited joint contractures; three of them have required surgery. Ten fractures occurred in five patients (14%). Coxa valga was present in all 14 hips. Skeletal ages in four preadolescent patients were normal.
Adolescent↗
Association of congenital vertebral malformations with bladder and cloacal exstrophy.
The radiographs of 28 patients with bladder exstrophy and five with cloacal exstrophy were reviewed at an average age of 8 years 3 months to assess congenital vertebral malformations. Fourteen malformations in 11 patients were noted, including abnormal lumbosacral segmentation in five, congenital scoliosis and kyphosis in four, partial sacral agenesis in three, and interpedicular lumbar widenings in two. These findings are explained by an abnormal embryologic development of the spine and cloaca between 4 and 6 weeks of intrauterine life. We recommend entire spinal radiographs in these patients.
Abnormalities, Multiple↗
Aortic anatomy in children with myelomeningocele and congenital lumbar kyphosis.
Preoperative aortograms were reviewed in six children with thoracic myelomeningocele and lumbar kyphosis at an average age of 25 months. In all children, the abdominal aorta bridged the lumbar kyphosis. In four children, the upper renal poles were close to the spine and were at potential risk during kyphectomy. All children had aortic shortening with an increased variability in origin of the major abdominal aortic branches. Abnormal lumbar arteries were noted in four children.
Aorta↗
Extremity gunshot wounds in children.
A retrospective review of 85 children with extremity gunshot wounds at an average age of 12.3 years showed that 83% were male; there were 10 gunshot and 75 non-shotgun injuries. Thirty-eight children sustained 51 fractures. Seventy-six operations were performed. The average hospital stay was 7.3 days. There were no mortalities, secondary amputations, or progressive neurovascular deficits. There were two wound infections but no cases of chronic osteomyelitis.
Adolescent↗
Late-onset tibia vara.
Fifteen children with late-onset tibia vara were studied. There were seven unilateral and eight bilateral cases. Eleven children were male, four were female and 13 were black; 14 were obese. All had a history of gradually progressive genu varus (average onset 11 years); 12 had preoperative knee pain. The average age at surgery was 12 years, with a preoperative tibiofemoral angle of 14 degree varus. The average follow-up was 4 years 4 months. The average tibiofemoral angle at follow-up was 0 degrees. There were 15 good, two fair, and six poor final results.
Adolescent↗
Orthopaedic aspects of children with infectious (central nervous system) postnatal cerebral palsy.
Twenty-two children (15 girls, 7 boys) with postnatal infectious cerebral palsy were reviewed at an average age of 8 years. Orthopaedic deformities were noted in 82% of all children and involved the upper extremity (41%), spine (45%), hips (68%), knees (32%), and feet and ankles (55%). Both typical and atypical cerebral palsy deformities were noted, often severe. Surgical correction of deformities achieved 77% satisfactory results. Bony procedures did better than soft tissue procedures, especially around the hip.
Cerebral Palsy↗