Biomedical subjects

S J Mubarak

Publications and source records attributed to S J Mubarak.

At least 73 records · Page 4Linked to original sources

PubMedDate not supplied

Congenital coxa vara: computed tomographic analysis of femoral retroversion and the triangular metaphyseal fragment.

Three patients with congenital coxa vara studied with two- and three-dimensional computed tomographic (2DCT and 3DCT) methods are reported. In all cases, the femoral retroversion was documented and subsequently corrected by proximal femoral osteotomy. In two patients with isolated coxa vara, the physeal-femoral neck angle was decreased as seen in slipped capital femoral epiphysis in adolescents. Our studies suggest that the triangular metaphyseal fragment reflects a Salter-Harris type II separation pattern through the defective femoral neck. The epiphysis and attached triangular fragment slip from the normal superoanterior portion of the neck in an inferior-posterior direction. The treating surgeon should be aware of the often marked femoral retroversion component present in severe congenital coxa vara. This knowledge allows surgical planning for corrective osteotomies that will better normalize hip mechanics. A combination of marked valgus and flexion with internal rotation of the distal fragment are required to fully correct the deformity.

Acetabulum↗

PubMedDate not supplied

Home traction in the management of congenital dislocation of the hips.

A total of 14 patients with congenital dislocation of the hip have used our home traction frame and program over a 2-year period. The newly designed frame is made of polyvinyl chloride tubing and consists of two parts: a Bradford frame and a roller base. The frame is lightweight, portable, and inexpensive to make. Traction can be maintained for 3 weeks at home, with a significant cost savings of more than $5,000/child. In our patients, there have been no cases of avascular necrosis of the hip or neurovascular problems to the legs. There is decreased psychological stress to the child and family when the care can be provided at home.

Child, Preschool↗

PubMedDate not supplied

Halo application in the infant.

The technique for halo application in very young children is described, with case presentations of three children aged less than 2 years who underwent successful cervical fusion with halo immobilization. Our multiple pin technique for very small children diverges significantly from previously accepted recommendations. With multiple pins, significantly less torque is required to provide stability, allowing a greater range of pin placement sites in areas where the infant skull might otherwise be considered too thin. This technique of halo application provides a safe and effective method of cervical immobilization for infants.

Braces↗

PubMedDate not supplied

Tibial physeal closure and genu recurvatum after femoral fracture: occurrence without a tibial traction pin.

Two cases of premature closure of the anterior portion of the proximal tibial physis with associated genu recurvatum deformity in adolescent males who had sustained a closed femur fracture are reported. In both cases, physeal closure occurred without use of a proximal tibial traction pin. In one patient, treatment included distal femoral pin traction; the other patient was treated with skin traction followed by spica cast. We believe that development of recurvatum of the tibia after femoral fracture in children is not necessarily iatrogenic and related to a tibial traction pin, but instead may result from physeal injury incurred at the time of the original trauma.

Child↗

PubMedDate not supplied

Percutaneous muscle biopsy in the diagnosis of neuromuscular disease.

Open biopsy of affected muscle is traditionally used to obtain tissue samples for histologic, histochemical, and biochemical analysis in patients with suspected myopathies. Percutaneous muscle biopsy offers certain advantages over the open technique: it can be performed in an outpatient clinic or as day surgery, usually with a local anesthetic for children greater than 12 years of age, and thus is less costly, more efficient, and less risky. There is also a significant difference in the residual scar. We reviewed the charts of 379 children and adults who had undergone percutaneous muscle biopsy to determine the usefulness of this alternative technique. The analysis could be accurately performed even though the muscle tissue was not at resting length and not oriented in any particular manner, and in nearly all patients sufficient tissue could be obtained for analysis without open biopsy.

Adolescent↗

PubMedDate not supplied

Proximal hamstring lengthening in the sitting cerebral palsy patient.

We retrospectively studied 62 nonambulatory children with spastic quadriplegic cerebral palsy who underwent proximal hamstring lengthening to improve hip and spine positioning. Preoperatively, all had hamstring contracture, with difficulty sitting due to hip extensor thrust and increased kyphosis. Thirty-five patients with follow-up greater than or equal to 2 years were studied using a modified Reimer scale to assess sitting ability. Sitting ability improved significantly (p less than 0.01) postoperatively, along with popliteal angle (p less than 0.001) and straight leg raising (p less than 0.001). Proximal hamstring lengthening is effective in treating severe hamstring contractures in the wheelchair-bound child with cerebral palsy.

Adolescent↗

PubMedDate not supplied

Metatarsal epiphyseal bracket: treatment by central physiolysis.

Longitudinal epiphyseal bracket (LEB) is a rare ossification anomaly in which an epiphysis brackets the diaphysis of a phalanx, metacarpal, or metatarsal. This abnormal epiphysis tethers longitudinal growth, resulting in a shortened and oval-shaped bone. Four patients with five LEBs were treated by central physiolysis and followed for a mean of 6 years. The patients had significant hallux varus deformity. Three patients had duplicated great toes, and two had tibia hemimelia significant enough to require epiphysiodesis as they neared adolescence. Resection of the LEB allowed the proximal and distal epiphysis to resume untethered growth. Silastic or methyl methacrylate was placed over the resected physis to prevent bony rebridging. The associated hallux varus deformity was corrected by capsulorrhaphy and K-wire fixation. In all patients, the metatarsal resumed longitudinal growth and correction of the hallux varus was maintained.

Child↗

PubMedDate not supplied

Spinal fusion in Duchenne muscular dystrophy--fixation and fusion to the sacropelvis?

Twenty-two wheelchair-bound patients with Duchenne muscular dystrophy (DMD) underwent Luque segmental instrumentation and fusion. Twelve patients were instrumented to the sacropelvis, and 10 were instrumented to L5. Mean preoperative and postoperative curves were nearly identical in both groups. The mild degree of trunk shift and pelvic obliquity was similar between the two groups. The recommendation for operation in such patients should be made when their curve is > 20 degrees and if their forced vital capacity is > 40%. If treatment is initiated early, Luque instrumentation and fusion from high thoracic (T2 or T3) to the fifth lumbar vertebra should be sufficient.

Adolescent↗

PubMedDate not supplied

Evaluation of CT scans and 3-D reformatted images for quantitative assessment of the hip.

Hip measurements using three-dimensional (3-D) images and computed tomography (CT) scans were evaluated. The 3-D measurements proved more accurate than CT measurements of femoral and acetabular anteversion. Additionally, accurate 3-D measurements (> 99%) of the femoral neck-shaft angle were provided. Acetabular anteversion determinations by CT scans were systematically decreased as pelvic flexion increased, whereas accuracy was > 96% with 3-D images. The 3-D software allows image rotation in all three reference planes, which minimizes positional errors. A case study is provided to exemplify the shortcomings of conventional imaging techniques and the utility of the quantitative 3-D protocol.

Cadaver↗

PubMedDate not supplied

Quantitative analysis of hip dysplasia in cerebral palsy: a study of radiographs and 3-D reformatted images.

Cerebral palsy patients (31 hips) were evaluated using radiographic and three-dimensional (3-D) images to quantify hip anatomy. The 3-D images overcome distortions caused by joint contractures. Changes were more pronounced in the non-ambulators and characterized by shallow sockets with increased neck-shaft angles. These hips tended to subluxate in a posterior-superior direction and most had defects in the femoral heads. Ambulators had increased femoral anterversion but other hip parameters tended to improve with age. The 3-D measures of roof steepness and socket depth were found to correlate strongly with radiographic parameters of subluxation.

Acetabulum↗

PubMedDate not supplied

"Isolated" traumatic radial-head dislocation.

A delay in diagnosis of a traumatic radial-head dislocation in the absence of a concurrent ulnar fracture is common. Published reports of this injury imply an isolated injury to the radius without involvement of the ulna. This hypothesis is challenged by a retrospective study of all cases over an 8-year period that demonstrates an identifiable injury to the ulna in every case. A new radiographic sign, the "ulnar bow sign," is described to assist in the proper recognition of this injury pattern. A radial-head dislocation or subluxation should be suspected if the posterior border of the ulna on a true lateral radiograph deviates > 0.01 mm from a straight line.

Child↗

PubMedDate not supplied

Lateral condylar fracture of the humerus following posttraumatic cubitus varus.

Posttraumatic cubitus varus is widely regarded as just a cosmetic deformity. Six cases of lateral condylar fracture of the humerus in children with preexisting cubitus varus due to prior elbow fracture are presented. Five occurred following malunited extension-type supracondylar fractures of the humerus; the other occurred following a lateral condylar fracture complicated by lateral overgrowth. All cases were treated by anatomic reduction (two closed, four open) and percutaneous pinning of the lateral condylar fracture. Three of the six cases subsequently underwent supracondylar osteotomy of the distal humerus to correct the underlying varus malalignment. Biomechanical analysis suggests that both the torsional moment and the shear force generated across the capitellar physis by a routine fall are increased by varus malalignment. Posttraumatic cubitus varus may predispose a child to subsequent lateral condylar fracture and should be viewed as more than just a cosmetic deformity.

Bone Nails↗

PubMedDate not supplied

Financial aspects of femoral shaft fracture treatment in children and adolescents.

The billing records of 58 children and adolescents with femoral shaft fractures treated during 1990 were analyzed. The treatment groups included early spica casting, skin traction, skeletal traction, home traction, and intramedullary rodding. The medical charges included both the hospital and physician (orthopedist, radiologist, and anesthesiologist) components. The total charges were lowest for the early spica group ($5,494) and highest for the skeletal traction and intramedullary rodding groups ($21,093 and $21,359, respectively). Both skin traction and home Neufeld traction were associated with significant savings over in-hospital skeletal traction and intramedullary rodding. With the continually rising cost of health care, it is the responsibility of the physician to know the charges for various treatment options.

Adolescent↗

PubMedDate not supplied

Single-incision combination biopsy (muscle and nerve) in the diagnosis of neuromuscular disease in children.

The diagnosis of specific neuromuscular diseases in infants and children is often suspected clinically and confirmed histologically by muscle biopsy. In relatively few cases, the differential diagnosis includes hereditary or acquired peripheral neuropathies, and nerve biopsy is required for diagnosis. Historically, children who needed both muscle and nerve biopsies have had two separate incisions at the thigh (muscle) and ankle (nerve) to obtain the specimens. A procedure has been developed that employs a single incision on the posterior aspect of the calf, which allows for simultaneous muscle (soleus or peroneals) and nerve (sural) biopsies. A retrospective study of 22 patients who underwent single-incision combination biopsy was performed. Age at time of biopsy ranged from 2 months to 14 years. Adequate specimens for histologic analysis were obtained in all but one case. Histologic diagnoses were made in 32% of the muscle biopsies and 29% of the nerve biopsies. Mean follow-up after biopsy was 3 years 6 months. Potentially significant complications of nerve biopsy were not seen in this cohort. Single-incision combination biopsy is the preferred technique when simultaneous muscle and nerve biopsies are required. Knowledge of the location of the sural nerve in the calf is essential. This technique is relatively less invasive than separate muscle and nerve biopsies, allows for the harvest of adequate muscle and nerve specimens, is minimally morbid, and can be performed on very young infants.

Adolescent↗

PubMedDate not supplied

Ultrasonography and developmental dysplasia of the hip: a cost-benefit analysis of three delivery systems.

The role of ultrasound (US) in the diagnosis and management of infants with developmental dysplasia of the hips (DDH) is becoming widely accepted. In our community, there exist three delivery systems for US-DDH: the radiology based, the combined radiology/orthopaedic based, and the orthopaedic office based. This study reviewed the costs and benefits of each delivery system and found that once expertise had been gained and start-up costs were met, the orthopaedic office-based system was the most convenient, efficient, and cost effective for the patient/family and treating physicians. This mirrors the experience of cardiologists, obstetricians, and family practitioners, fields in which the utility of office-based ultrasonography is widely recognized and has become the standard.

Cost-Benefit Analysis↗

PubMedDate not supplied

The use of modified Neufeld's skeletal traction in children and adolescents.

A modified form of Neufeld's skeletal traction is described. This technique is a useful method of treating children and adolescents with femoral or pelvic fractures. The advantage over standard femoral skeletal traction is early mobilization of the patient to a sitting position. Additionally, the patient can be placed in this form of traction at home, allowing earlier discharge from the hospital.

Adolescent↗

PubMedDate not supplied

Acute exertional superficial posterior compartment syndrome.

This case report of an acute exertional compartment syndrome involving predominantly the superficial posterior compartment emphasizes several important facts: (1) The subacute recurring syndromes, if left untreated, may develop into an acute syndrome. (2) The diagnostic findings separating the acute syndrome from the chronic forms are marked pain with passive stretch of the involved muscles, paresis, and sensory deficit.8,12,15, (3) In the acute form, immediate fasciotomy is mandatory and often results in full recovery. (4) All four major compartments of the leg are susceptible to chronic or acute compartment syndromes initiated by exertion. These compartments can be decompressed as necessary through a limited skin incision as recently reported.11 (5) The need for an easily obtainable and reproducible method for measuring intracompartment pressures (e.g., the wick catheter technique) is indicated.

Acute Disease↗

PubMedDate not supplied

The medial tibial stress syndrome. A cause of shin splints.

The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

Adolescent↗