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Biomedical subjects

R T Loder

Publications and source records attributed to R T Loder.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Narrow window of bone age in children with slipped capital femoral epiphyses.

Pelvis radiographs of 30 children with slipped capital femoral epiphyses (SCFE) were reviewed by four readers to determine the skeletal age. The average chronologic age for girls was 12.1 +/- 1.0 years and that for boys was 14.4 +/- 1.3 years; the average pelvic bone age was 13.2 +/- 0.6 for girls and 15.1 +/- 0.6 years for boys. The chronologic age range was 98 months, and skeletal age range was only 50 months. Pelvis bone age was advanced in the youngest children, normal in most children, and mildly delayed in older children. We conclude that there is a uniform skeletal age or "narrow window" during which epiphyseal slipping occurs, regardless of the child's chronologic age.

Adolescent↗
PubMedDate not supplied

Aneurysmal bone cysts in young children.

We reviewed seven young children (< or = 10 years) with aneurysmal bone cysts. There were four girls and three boys. Six had involvement of the long bones and one had involvement of the clavicle. The average age was 5.5 years (range 2.9-10.6 years). Initial treatment was curettage and bone grafting. There were recurrences in five of the seven children (71%). This represented 100% of children with radiographically aggressive or active lesions. The recurrences appeared rapidly, at an average of 8 months from the first procedure. The mitotic index of the initial lesion did not correlate with that of the recurrent lesion. Surgical management of the recurrences must be handled individually, but repeat curettage and grafting is only recommended when surgical resection is not possible. This high rate of recurrence in radiographically aggressive or active aneurysmal bone cysts in young children should be considered when planning treatment, and in the preoperative counseling of parents.

Bone Cysts, Aneurysmal↗
PubMedDate not supplied

Biomechanical analysis of single- versus double-screw fixation in slipped capital femoral epiphysis at physiological load levels.

Slipped capital femoral epiphyses in 12 pairs of bovine femora were pinned with a single screw on one side and two screws on the other. The specimens were subjected to physiological shear loads across the epiphysis (100 cycles at 1.1 Hz; 400 N for slow walking, and 900 N for fast walking). The rates of creep were decreased 23% with double screws compared to single screws at slow walking, and 30% at fast walking; this was not statistically significant. Single-screw fixation in slipped epiphyses is thus recommended, because the small gains in resistance to cyclic creep at physiological loading were not statistically different, and did not offset the increased risks of complications with multiple screws.

Animals↗
PubMedDate not supplied

The psychosocial characteristics of children with fractures.

We examined the psychosocial characteristics of 52 children with fractures. The parents completed questionnaires regarding injury circumstances, family functioning, home environment, and child behavior. Established psychosocial questionnaires were used: the McMaster Family Assessment Device (family environment), the Conners Parent Symptom Questionnaire, and Achenback Child Behavior Checklist (child behavior). Parent's perception of family functioning fell within the average range. The children exhibited a significantly high degree of social competence problems as well as behavioral difficulties. These behavioral difficulties included conduct disorder features, psychosomatic complaints, and impulsive/hyperactive behavior. To the extent that these variables constitute risk factors unique to children with fractures, prevention strategies can be designed to decrease the incidence of pediatric fractures.

Child↗
PubMedDate not supplied

Bone age determination in children with Legg-Calvé-Perthes disease: a comparison of two methods.

In 100 children (17 girls, 83 boys) with Legg-Calvé-Perthes disease, the average chronological age, pelvis bone age, and hand-wrist bone age were significantly different for the girls (8.2, 6.9, and 7.0 years, respectively; p < 0.05) and the boys (8.2, 7.4, and 5.9 years, respectively; p < 0.05). For the girls, the chronological age was greater than the pelvis bone age and the hand-wrist bone age (p < 0.05); there was no difference between the pelvis and hand-wrist bone age. For the boys, the chronological age was greater than the pelvis bone age and the hand-wrist bone age (p < 0.05); the pelvis bone age was greater than the hand-wrist bone age and less than the chronological age (p < 0.05). The acromelic growth in Legg-Calvé-Perthes disease may explain why the more proximal pelvis bone age in boys was less delayed than that of the more distal hand-wrist.

Age Determination by Skeleton↗
PubMedDate not supplied

Determination of skeletal age in children with Osgood-Schlatter disease by using radiographs of the knee.

We determined the skeletal age in 26 children (12 girls, 14 boys) with Osgood-Schlatter disease using knee radiographs. The average chronological age was 13.2 +/- 2.2 years, and the average bone age was 13.1 +/- 2.3 years (p > 0.01). All but one of the skeletal ages fell within the normal range. Skeletal maturation in children with Osgood-Schlatter disease is thus normal. With normal skeletal maturation and normal physes histologically (previously shown), it is unlikely that an abnormality of physeal development or structure is the etiology of Osgood-Schlatter disease. Rather, it is most likely a result of tensile stresses on the tibial tuberosity. This is in contrast to slipped capital femoral epiphysis, another common disorder affecting children of the same ages as those with Osgood-Schlatter disease, in which physeal abnormalities and skeletal maturation anomalies do occur.

Adolescent↗
PubMedDate not supplied

Slipped capital femoral epiphysis associated with endocrine disorders.

We reviewed 85 patients with endocrine disorders and slipped capital femoral epiphysis (SCFE). The disorders were hypothyroidism (40%), growth hormone deficiency (25%), and others (35%). The average age at diagnosis of the disorder was 13.2 +/- 6.2 years and 15.3 +/- 5.3 years at diagnosis of the first SCFE. In 53 hips, the bone and chronologic age were both known: 11.6 +/- 3.0 years bone age, 16.5 +/- 6.5 years chronologic age, p < 0.01. The age at presentation of the first SCFE ranged from 7-35 years; only those with hypothyroidism or growth hormone deficiency were < 10 years of age; all patients with other endocrinopathies, when seen first with an SCFE at an atypical age, were > 16 years. The hypothyroid patients usually had the endocrine diagnosis made at presentation of the first SCFE; the growth hormone-deficient children usually had the endocrine diagnosis made before that of the SCFE (p < 0.01). None of those in whom the diagnosis of the endocrine disorder occurred after the diagnosis of the SCFE was hypothyroid or growth hormone deficient. All hypothyroid patients developed the first SCFE before or during hormonal supplementation; 92% with growth hormone deficiency developed the SCFE during or after supplementation (p < 0.01). Because the prevalence of bilaterality was 61% (p < 0.01), prophylactic treatment of the opposite hip should be considered.

Adolescent↗
PubMedDate not supplied

The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis.

To assess the sagittal orientation of the cervical and thoracolumbar spine, 38 adolescents with idiopathic scoliosis were studied. The C7 plumb line and Cobb angles from C2-6, T1-12, and L1-S1 were measured on preoperative films. Lateral radiographs with > 1-year follow-up after surgical correction were available for the same measurements in 28 patients. The preoperative curve from C2-6 was 6 +/- 11 degrees of kyphosis. There was a significant correlation between the loss of thoracic kyphosis and the development of cervical kyphosis for the entire group preoperatively (p = 0.009). Postoperatively, cervical kyphosis increased to 11 +/- 9 degrees at 1-year follow-up (p = 0.05). There was no progression of cervical kyphosis in patients with "thoracic hypokyphosis" (kyphosis < 20 degrees). Cervical kyphosis increased in patients with "normal" thoracic kyphosis (20-40 degrees) and in patients with hyperkyphosis (kyphosis > 40 degrees) after surgery, despite preservation of thoracolumbar sagittal contour. There were no significant differences between the sagittal contour of patients treated with Cotrel-Dubousset or Harrington instrumentation.

Adolescent↗
PubMedDate not supplied

Scoring of pediatric orthopaedic polytrauma: correlations of different injury scoring systems and prognosis for hospital course.

Trauma scoring systems were compared among themselves and to recovery variables in a cohort of 91 pediatric polytrauma patients with orthopaedic injuries. They included the Trauma Score (TS), Revised Trauma Score (RTS), Injury Severity Score (ISS), Modified Abbreviated Injury Severity Scale (MISS), Pediatric Trauma Score (PTS), and TRISS-b survival statistic. Significant correlations between scoring systems and hospital course parameters existed. TRISS-b had the strongest correlation for days in the intensive care unit and total complications (r2 = 0.59, 0.58). PTS correlated poorly with recovery variables when compared to other scoring systems. The TS correlated most strongly with ventilatory days and complications of immobilization (r2 = 0.77, 0.58). The TS should be used early in the assessment of the pediatric polytrauma patient, along with the TRISS-b statistic. If they predict prolonged intensive care unit and ventilatory days and hospital complications, operative fracture management should be strongly considered.

Adolescent↗
PubMedDate not supplied

Clinical characteristics of children with atypical and idiopathic slipped capital femoral epiphysis: description of the age-weight test and implications for further diagnostic investigation.

SUMMARY: Slipped capital femoral epiphyses (SCFEs) can be idiopathic or atypical (associated with renal failure, radiation therapy, and endocrine disorders). The demographics of 433 children (285 idiopathic, 148 atypical) with 612 SCFEs were studied to define predictors of atypical SCFEs. Multiple logistic regression analysis showed that age and weight were predictors. For two patients of equal weight, those younger than 10 or older than 16 years of age were 4.2 times more likely to have an atypical SCFE; for two patients of equal age, those <50th percentile weight were 8.4 times more likely. The age-weight test was defined as negative when age younger than 16 years and weight > or = 50th percentile and positive when beyond these boundaries. The probability of a child with a negative test result having an idiopathic SCFE was 93%, and the probability of a child with a positive test result having an atypical SCFE was 52%. An evaluation of the child's age and weight is useful when considering the cause of an SCFE.

Adolescent↗
PubMedDate not supplied

Effect of femur position on the angular measurement of slipped capital femoral epiphysis.

SUMMARY: A femur model was used to simulate a slipped capital femoral epiphysis (SCFE). Wedges were inserted into a cut in the femoral neck to create SCFEs of 25, 50, and 75 degrees. The effects of femur position on the angular measurement of SCFE were studied by taking radiographs of the SCFE at preselected positions of rotation and abduction, which were ensured by a holding device. The views selected were the cross table lateral (CTL), Billing lateral, and frog lateral (FL) projections. FL views were obtained at 22.5, 45, and 67.5 degrees of abduction. The rotational positions were 20 degrees internal, neutral, and 15, 30, 45, and 60 degrees external. Slip angles were measured from these radiographs. The CTL and FL projections accurately portrayed any severity of an SCFE at all positions except for 45 and 60 degrees of external rotation. The Billing view falsely portrayed a severe SCFE at all positions of rotation. The most accurate representation of an SCFE is seen on either the CTL or FL view when the external rotation of the femur does not exceed 30 degrees.

Anthropometry↗
PubMedDate not supplied

Mouse model for thoracic congenital scoliosis.

SUMMARY: This study sought to produce a dose-response curve for acute and chronic maternal carbon monoxide (CO) exposure versus vertebral anomalies in mouse offspring and to determine the critical day of exposure. In Part I, pregnant CD-1 mice were exposed to an acute dose of CO at 9 days of gestation. A positive dose-response relationship of acute maternal CO exposure and vertebral anomalies in the offspring was produced. In Part II, pregnant females were exposed to chronic CO for the first 11 days of gestation. Chronic exposure to CO did not produce significant vertebral anomalies. In Part III, pregnant females were exposed to an acute dose of 600 ppm of CO at gestation day 8, 9, or 10. Day 9 in this mouse breed is the critical day for maternal exposure to CO. The detected anomalies were predominately in the thoracic spine.

Acute Disease↗
PubMedDate not supplied

Infantile tibia vara.

We studied the applicability of Langenskiöld's classification to a predominantly nonwhite population with infantile tibia vara. Age at presentation was younger than that in previously published studies. Forty-seven tibiae averaging 6 years 7 months of follow-up had 66% good results. Poor results increased in proportion to stage at presentation. Brace treatment for early lesions was only 50% effective. Single tibial osteotomy before 4 years of age gave good results in 85% of tibiae, and multiple osteotomies gave good results between 4 and 8 years of age. One-half of tibiae treated with osteotomy developed recurrent varus. This review documents earlier stages at presentation, a more malignant course, and poorer results than Langenskiöld's series would suggest. We question the accuracy of Langenskiöld's estimate of prognosis when applied to this patient group.

Black People↗
PubMedDate not supplied

Behavioral characteristics of children with Legg-Calvé-Perthes disease.

We explored the behavioral characteristics of 24 children with Perthes' disease. Parents completed standard psychological self-administered questionnaires regarding their child's behavior: the Conners Parent Symptom Questionnaire and the Achenbach Child Behavior Checklist. One third (33%) of the children had abnormally high scores in profiles associated with attention deficit hyperactivity disorder (ADHD) (impulsive, hyperactive, and psychosomatic categories), much higher than the 3-5% incidence of ADHD in the general population. They also tended to have difficulties with school and social interaction skills. Certain epidemiologic characteristics of Perthes' disease (sex ratio, socioeconomic status, geographic location, and associated congenital anomalies) are also similar to those of ADHD, suggesting a correlation between the two disorders.

Child↗
PubMedDate not supplied

Metastatic vertebral disease in children.

We retrospectively reviewed 19 children with osseous vertebral metastases. The average age was 10.9 years at diagnosis of the primary tumor and 11.2 years at diagnosis of metastasis. The location of the multiple metastases was cervical (three), thoracic (14), and lumbar (10). Treatment consisted of chemotherapy (19), radiation therapy (12), and operation (seven). Ten children died at an average of 13 months after diagnosis of the primary tumor; nine are alive at an average of 72 months after diagnosis. All four children treated with chemotherapy, spinal radiation, and laminectomy, and who survived > 2 months, developed deformity. In this particular situation, we encourage consideration of spinal stabilization when it is appropriately coordinated with radiation and chemotherapy.

Adolescent↗
PubMedDate not supplied

The use of helical computed tomographic scan to assess bony physeal bridges.

Coronal and sagittal reformatted images of the physis obtained with the helical computed tomography (CT) scanner were studied in five children. This technique allows tomographic slices at 1.0-mm thickness and can be performed in approximately 20 s. The distal femora were studied in two children, the distal tibia in two children, and the distal radius in one child. In three children, after physeal mapping, bar resections were performed. In all cases, the location and size of the bar was accurately predicted by the map constructed from the helical CT scan. We recommend the helical CT scan to prepare physeal maps to determine the extent and location of physeal bony bars because of excellent bony detail, radiation doses one half to one quarter those of conventional tomography, and the rapidity of scanning, which bypasses the need for sedation.

Adolescent↗
PubMedDate not supplied

Extremity lawn-mower injuries in children: report by the Research Committee of the Pediatric Orthopaedic Society of North America.

In a multicenter study of pediatric lawn-mower injuries (push or riding gas-powered machines), we reviewed 144 children at an average age of injury of 7.0 years; 77% were boys. Most injuries (92 of 104) occurred in the afternoon. The child was the machine operator in 36 cases, a bystander in 84, and a passenger in 21. The average hospital stay was 13.3 days with 2.6 surgeries per child. Amputations occurred in 67 children; 63 were unilateral and four bilateral; the most common level was the toes (63%). Blood transfusions were given to 35 children. Children injured by riding lawn mowers, when compared with those by push lawn mowers, were younger (5.4 vs. 11.0 years), less frequently the operator (15 vs. 60%), had longer hospitalizations (15.0 vs. 8.9 days), and required more surgeries (3.0 vs. 1.6) and blood transfusions (41 vs. 3%). Children with free flaps needed more transfusions (78 vs. 26%), and transfused children were younger (4.6 vs. 8.1 years), more likely to be bystanders (91 vs. 63%), required more surgeries (4.1 vs. 2.0), and were hospitalized longer (21.6 vs. 9.7 days). Soft-tissue infections occurred in eight of 118 and osteomyelitis occurred in six of 117 children. At an average follow-up of 1.9 years, there were 43 satisfactory and 84 unsatisfactory results. When excluding those children with amputations of digits, there were 42 satisfactory and 47 unsatisfactory results. If children younger than 14 years had not been permitted around lawn mowers, approximately 85% of the injuries in this report would have been prevented. Further public dissemination of the following information is needed: (a) children younger than 14 years should not operate lawn mowers, (b) children younger than 14 years should not be in the yard while the lawn is being mowed, and (c) no passengers, regardless of age, should be allowed on riding mowers.

Accidents, Home↗