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Biomedical subjects

W H Bunch

Publications and source records attributed to W H Bunch.

At least 37 records · Page 2Linked to original sources
PubMed1986

The candidate's view of the orthopaedic residency selection process.

Two hundred and seventy-nine applicants for an orthopaedic residency who participated in the 1985 match program returned a questionnaire that was designed to evaluate the candidate's impression of the process of selecting a residency. The respondents requested information from an average of thirty-three programs and applied to an average of twenty-two programs. The candidates who participated in the match each ranked an average of 7.5 orthopaedic residency programs. The candidates assigned a high ranking to programs in which the morale of the staff was high and the faculty was committed to teaching. Low morale, poor treatment by people at the institution, an inadequate commitment to teaching, a disorganized day of interviews, and a program in transition were the major reasons for not ranking a program. We concluded that the process is run for the convenience of the programs, with little regard to the problems that are faced by the applicants.

Choice Behavior↗
PubMed1985

Posterior fusion for idiopathic scoliosis.

A posterior fusion is the standard operative approach that will allow the orthopaedic surgeon to treat most scoliosis satisfactorily. The extent of fusion should be determined by the type and extent of the curve. All spines should not be fused from T4 to L4. The management of the blood loss has evolved to a very controlled situation, with the reasonable goal that no patient should be sensitized to homologous blood. Instrumentation systems provide good correction and stability to assist in providing a solid fusion. There are advantages and disadvantages to each instrumentation system, and the trade-offs should be considered for each patient. Finally, what our patients want more than anything else from these operations is safety, and we should strive to provide that for them.

Adolescent↗
PubMed1985

Patient preferences in surgery for scoliosis.

To assess individual preferences for a method of scoliosis surgery, we surveyed 224 teen-age patients, their parents, orthopaedic surgeons, and other health professionals. Rather than asking the respondents directly for the relative importance that they would assign to the four possible outcomes, we employed conjoint analysis, a preference measurement technique that is widely used in marketing and psychology. In conjoint analysis, respondents explicitly trade off the relative desirability of certain aspects of the outcome of scoliosis surgery--for example, between greater degree of curve correction or greater risk of reoperation. This study indicated that risk of nerve damage had the highest relative importance to the respondents, followed by risk of reoperation, curve correction, and aftercare, in that order. This ranking was found in all five groups of respondents.

Adolescent↗
PubMed1984

Dermatomal somatosensory evoked potentials: their use in lumbar radiculopathy.

The accurate diagnosis of lumbar radiculopathy secondary to intervertebral disc herniation or spinal stenosis remains a significant problem. Studies have stressed that misdiagnosis of root entrapment significantly contributes to the incidence of failed back syndrome. In an attempt to aid the proper selection of surgical candidates, dermatomal somatosensory evoked potentials ( DSSEP ) have been used in conjunction with standard diagnostic techniques to evaluate our patients. The advantage of this technique lies in the root specificity. The authors studied the DSSEP using two methods. In Method 1, using myelograms as the standard, the accuracy was 85.7%. In Method II, using surgical outcome as the standard, the accuracy was 87.5%. As a result, the authors have found the noninvasive, relatively inexpensive DSSEP to be a useful adjunct in the selection of patients undergoing lumbar spine surgery.

Afferent Pathways↗
PubMed1984

Iliopsoas transfers in children with myelomeningocele.

Thirty-two paralytic hips in seventeen children with myelomeningocele and a neural deficit at the fourth lumbar level were treated with iliopsoas transfers. Four to fourteen years later, all of the hips were reduced and nineteen had a center-edge angle of more than 25 degrees. This result was more consistent in the hips of the ten patients who had had a combined varus osteotomy and transfer. All but three of the transferred muscles were active: twenty-one had abduction and fifteen had extension against gravity. We concluded that the procedure has value, but that it does not produce a normal hip.

Adolescent↗
PubMed1983

Pitfalls in the assessment of skeletal immaturity: an anthropologic case study.

Nonoperative treatment protocols in adolescent scoliosis require that growth is still occurring. The open iliac apophyses and vertebral ring apophyses are usually considered evidence that growth remains. Studies of adolescent skeletons are not consistent with this view, and one such example is presented. Of clinical importance is that determinant of immaturity should be based on the secondary sexual characteristics, not roentgenographic shadows.

Adolescent↗
PubMed1983

Pattern of closure of the proximal femoral and tibial epiphyses in man.

Review of 25 proximal femora and 10 proximal tibiae of adolescent skeletons at the time of plate union reveals a distinct pattern of closure. The proximal femur initiates union superiorly with closure proceeding inferiorly. Closure of the tibia occurs along the anteromedial border and spreads posteriorly. No exceptions to these patterns were encountered. A knowledge of the pattern of plate union is useful when assessing fracture geometry in the injured adolescent and in trying to understand disorders of plate closure.

Adolescent↗
PubMed1981

Orthopedic and rehabilitation aspects of eosinophilic granuloma.

Eosinophilic granuloma in children occurs in descending frequency in the skull, femur, ribs, pelvis, and spine. The varying degrees of radiographic diagnostic certainty indicate that biopsy is frequently required for diagnosis. The orthopedist should extend his involvement in such patients from the biopsy to prevention of deformity during the subsequent treatment and healing of the lesion.

Biopsy↗
PubMed1979

Dermatomal somatosensory evoked potentials in children with myelomeningocele.

Evoked responses were obtained from electrical stimulation of dermatomes representing individual lumbar and sacral roots. Normal ranges of latency have been established for adults, but have not been extended to children at this time. DSSEPs can be utilized, however, to sequentially follow lumbo-sacral cord function in individual children at risk of progressive myelopathy.

Adolescent↗
PubMed1978

Osteogenesis imperfecta in one of twins. Case report.

The is a report of a 5-year-old girl with osteogenesis imperfecta, an uncommon abnormality considered to encompass several distinct disorders and biochemically classified as a connective tissue disease. Affected individuals, in the more severe form of the disease, often die in utero or shortly thereafter secondary to birth trauma. The patient was one of dizygotic twins discordant for osteogenesis imperfecta tarda inherited as an autosomal dominant trait.

Adolescent↗
PubMed1978

Legg-Perthes disease in children less than four years old.

In children with Legg-Perthes disease who were less than four years old, better results were seen after treatment by recumbency and abduction bracing than with no treatment. All results were better in children having mild epiphyseal involvement (Catterall Groups I and II) than in those with more extensive disease.

Age Factors↗
PubMed1977

Kyphosis in the paralytic spine.

The paralytic spine without supplementary support is unstable and susceptible to axial collapse. The biomechanical factors responsible for spinal stability should be considered in any treatment regimen for paralytic spines. If posterior fusion is elected as the treatment, kyphosis must be corrected so that the eccentric loading and kyphotic bending moment is very small. When this is done, posterior fusion alone is adequate to give spinal stability and increased function to the individual.

Adolescent↗