Matthew B Dobbs

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (122)379.96 Total impact

  • Justin S Yang · Matthew B Dobbs
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    ABSTRACT: The most common historical treatment method for congenital vertical talus is extensive soft-tissue release surgery. A minimally invasive treatment approach that relies primarily on serial cast correction was introduced almost ten years ago, with promising early results. The purpose of this study was to assess the long-term outcome of patients with congenital vertical talus managed with the minimally invasive technique and compare them with a cohort treated with extensive soft-tissue release surgery. The records of twenty-seven consecutive patients with vertical talus (forty-two feet) were retrospectively reviewed at a mean of seven years (range, five to 11.3 years) after initial correction was achieved. The minimally invasive method was used to treat sixteen patients (twenty-four feet), and extensive soft-tissue release surgery was used to treat eleven patients (eighteen feet). Patient demographics, ankle range of motion, the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire, and radiographic measurements were analyzed. At the latest follow-up, the mean range of motion of patients treated with the minimally invasive method was 42.4° compared with 12.7° for patients treated with extensive surgery (p < 0.0001). The PODCI normative pain and global function scores were superior in the minimally invasive treatment group compared with the extensive soft-tissue release group. Greater correction of hindfoot valgus (anteroposterior talar axis-first metatarsal base angle) was achieved in the minimally invasive treatment group compared with the extensive surgery group (40.1° versus 27.9°, p = 0.03), although all other radiographic values were similar between the two groups (p > 0.1 for all). Subgroup analysis of patients with isolated vertical talus also showed superior range of motion and PODCI normative global function scores in the minimally invasive group. The minimally invasive treatment method for vertical talus resulted in better long-term ankle range of motion and pain scores compared with extensive soft-tissue release surgery. Longer-term studies are necessary to determine whether the improved outcomes are maintained into adulthood and whether the superior outcome is related to reduced scarring. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
    The Journal of Bone and Joint Surgery 08/2015; 97(16):1354-65. DOI:10.2106/JBJS.N.01002 · 4.31 Impact Factor
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    ABSTRACT: Patients ask two main questions when considering an orthopaedic reconstruction: (1) Does it work? And (2) will it last? We have devoted a great deal of space on the Editorial and Spotlight pages of Clinical Orthopaedics and Related Research® to the question of efficacy, and we have considered its importance in many areas.How big of a difference is a patient likely to detect [5]?Have we overlooked women as we design laboratory and clinical research studies [7]?And what is the difference between efficacy and safety[6]?By comparison, the question of durability may have gotten short shrift. For decades now, our specialty—and our Journal—have relied on the now-ubiquitous Kaplan-Meier method of estimating survivorship [4]. This approach is superior to crude survivorship calculations since the Kaplan-Meier estimator adjusts for patients whose status cannot be determined because they have not failed as of the end of the study, or because they have been lost to followup. Two generations (or mor ...
    Clinical Orthopaedics and Related Research 02/2015; 473(4). DOI:10.1007/s11999-015-4182-4 · 2.88 Impact Factor
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    ABSTRACT: Idiopathic scoliosis occurs in 3% of individuals and has an unknown etiology. The objective of this study was to identify rare variants that contribute to the etiology of idiopathic scoliosis, using exome sequencing in a multigenerational family with idiopathic scoliosis. Exome sequencing was completed for three members of this multigenerational family with idiopathic scoliosis, resulting in the identification of a variant in the HSPG2 gene as a potential contributor to the phenotype. The HSPG2 gene was sequenced in a separate cohort of 100 unrelated individuals affected with idiopathic scoliosis, and was also examined in an independent idiopathic scoliosis population. The exome sequencing and subsequent bioinformatics filtering resulted in 16 potentially damaging and rare coding variants. One of these variants, p.Asn786Ser, is located in the HSPG2 gene. The variant p.Asn786Ser is also over-represented in a larger cohort of idiopathic scoliosis cases compared to a control population (p=0.024). Furthermore, we identified additional rare HSPG2 variants that are predicted to be damaging in two independent cohorts of individuals with idiopathic scoliosis. The HSPG2 gene encodes for a ubiquitous multifunctional protein within the extracellular matrix in which loss of function mutation are known to result in a musculoskeletal phenotype in both mouse and humans. Based on these results, we conclude that rare variants in the HSPG2 gene potentially contribute to the idiopathic scoliosis phenotype in a subset of patients with idiopathic scoliosis. Further studies must be completed to confirm the effect of the HSPG2 gene on the idiopathic scoliosis phenotype. Copyright © 2014 Author et al.
    G3-Genes Genomes Genetics 12/2014; 5(2). DOI:10.1534/g3.114.015669 · 2.51 Impact Factor
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    ABSTRACT: Clubfoot treatment commonly fails and often results in impaired quality of life. An understanding of the soft-tissue abnormalities associated with both treatment-responsive and treatment-resistant clubfoot is important to improving the diagnosis of clubfoot, the prognosis for patients, and treatment.
    The Journal of Bone and Joint Surgery 08/2014; 96(15):1249-1256. DOI:10.2106/JBJS.M.01257 · 4.31 Impact Factor
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    ABSTRACT: Adolescent idiopathic scoliosis (AIS) is a complex genetic disorder that causes spinal deformity in approximately 3% of the population. Candidate gene, linkage, and genome-wide association studies have sought to identify genetic variation that predisposes individuals to AIS, but the genetic basis remains unclear. Copy number variants are associated with several isolated skeletal phenotypes, but their role in AIS, to our knowledge, has not been assessed. We determined the frequency of recurrent copy number rearrangements, chromosome aneuploidy, and rare copy number variants in patients with AIS. Between January 2010 and August 2014, we evaluated 150 patients with isolated AIS and spinal curvatures measuring 10A degrees or greater, and 148 agreed to participate. Genomic copy number analysis was performed on patients and 1079 control subjects using the Affymetrix(A (R)) Genome-wide Human SNP Array 6.0. After removing poor quality samples, 143 (97%) patients with AIS were evaluated for copy number variation. We identified a duplication of chromosome 1q21.1 in 2.1% (N = 3/143) of patients with AIS, which was enriched compared with 0.09% (N = 1/1079) of control subjects (p = 0.0057) and 0.07% (N = 6/8329) of a large published control cohort (p = 0.0004). Other notable findings include trisomy X, which was identified in 1.8% (N = 2/114) of female patients with AIS, and rearrangements of chromosome 15q11.2 and 16p11.2 that previously have been associated with spinal phenotypes. Finally, we report rare copy number variants that will be useful in future studies investigating candidate genes for AIS. Copy number variation and chromosomal aneuploidy may contribute to the pathogenesis of adolescent idiopathic scoliosis. Chromosomal microarray may reveal clinically useful abnormalities in some patients with AIS.
    Clinical Orthopaedics and Related Research 07/2014; 472(10). DOI:10.1007/s11999-014-3766-8 · 2.88 Impact Factor
  • Laurene A Sweet · Lindsey M Oʼneill · Matthew B Dobbs
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    ABSTRACT: The purpose of this report is to explore assessment and serial casting intervention for painful rigid flatfoot deformities with vertical talus in an adolescent girl with hereditary spastic paraplegia who was nonambulatory. The participant's right foot underwent 2 phases of casting with correction first toward hindfoot inversion and then dorsiflexion. Because of a vertical talus, her left foot required an intermediate casting toward plantar flexion, inversion, and forefoot adduction prior to casting toward dorsiflexion. The patient improved despite the underlying progressive neuromuscular disorder. Pain ameliorated and she returned to supported standing and transfers. Spasticity decreased bilaterally and the flexibility of her foot deformities improved to allow orthotic fabrication in subtalar neutral. Results were maintained at 12 and 16 months. Individualized multiphase serial casting requires further investigation with patients such as those with hereditary spastic paraplegia.
    Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association 06/2014; 26(2):253-64. DOI:10.1097/PEP.0000000000000023 · 1.29 Impact Factor
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    ABSTRACT: Adolescent idiopathic scoliosis (AIS) causes spinal deformity in 3% of children. Despite a strong genetic basis, few genes have been associated with AIS and the pathogenesis remains poorly understood. In a genome-wide rare variant burden analysis using exome sequence data, we identified fibrillin-1 (FBN1) as the most significantly associated gene with AIS. Based on these results, FBN1 and a related gene, fibrillin-2 (FBN2), were sequenced in a total of 852 AIS cases and 669 controls. In individuals of European ancestry, rare variants in FBN1 and FBN2 were enriched in severely affected AIS cases (7.6%) compared with in-house controls (2.4%) (OR = 3.5, P = 5.46 × 10−4) and Exome Sequencing Project controls (2.3%) (OR = 3.5, P = 1.48 × 10−6). Scoliosis severity in AIS cases was associated with FBN1 and FBN2 rare variants (P = 0.0012) and replicated in an independent Han Chinese cohort (P = 0.0376), suggesting that rare variants may be useful as predictors of curve progression. Clinical evaluations revealed that the majority of AIS cases with rare FBN1 variants do not meet diagnostic criteria for Marfan syndrome, though variants are associated with tall stature (P = 0.0035) and upregulation of the transforming growth factor beta pathway. Overall, these results expand our definition of fibrillin-related disorders to include AIS and open up new strategies for diagnosing and treating severe AIS.
    Human Molecular Genetics 05/2014; 23(19). DOI:10.1093/hmg/ddu224 · 6.68 Impact Factor
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    ABSTRACT: Adolescent idiopathic scoliosis (AIS) is a common rotational deformity of the spine that presents in children worldwide, yet its etiology is poorly understood. Recent genome-wide association studies (GWAS) have identified a few candidate risk loci. One locus near the chromosome 10q24.31 LBX1 gene (OMIM #604255) was originally identified by a GWAS of Japanese subjects and replicated in additional Asian populations. To extend this result, and to create larger AIS cohorts for the purpose of large-scale meta-analyses in multiple ethnicities, we formed a collaborative group called the International Consortium for Scoliosis Genetics (ICSG). Here, we report the first ICSG study, a meta-analysis of the LBX1 locus in six Asian and three non-Asian cohorts. We find significant evidence for association of this locus with AIS susceptibility in all nine cohorts. Results for seven cohorts containing both genders yielded P=1.22×10-43 for rs11190870, and P=2.94×10-48 for females in all nine cohorts. Comparing the regional haplotype structures for three populations, we refined the boundaries of association to a ∼25 kb block encompassing the LBX1 gene. The LBX1 protein, a homeobox transcription factor that is orthologous to the Drosophila ladybird late gene, is involved in proper migration of muscle precursor cells, specification of cardiac neural crest cells, and neuronal determination in developing neural tubes. Our results firmly establish the LBX1 region as the first major susceptibility locus for AIS in Asian and non-Hispanic white groups, and provide a platform for larger studies in additional ancestral groups.
    Journal of Medical Genetics 04/2014; DOI:10.1136/jmedgenet-2013-102067 · 5.64 Impact Factor
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    ABSTRACT: Clubfoot is a common congenital birth defect with complex inheritance patterns. Currently, the genetic and morphological basis of clubfoot is poorly understood. To identify genetic risk factors associated with clubfoot, we performed a genome-wide association study of common genetic variants. The DNA of 396 isolated clubfoot patients and 1000 controls of European descent was genotyped for >600 000 single nucleotide polymorphisms (SNP) using the Affymetrix 6.0 array. Replication was performed with an independent cohort of 370 isolated clubfoot cases and 363 controls of European descent. Strongest evidence for an association of clubfoot was found with an intergenic SNP on chromosome 12q24.31 between NCOR2 and ZNF664 (rs7969148, OR=0.58, p=1.25×10(-5)) that was significant on replication (combined OR=0.63, p=1.90×10(-7)). Additional suggestive SNPs were identified near FOXN3, SORCS1 and MMP7/TMEM123 that also confirmed on replication. Our study suggests a potential role for common genetic variation in several genes that have not previously been implicated in clubfoot pathogenesis.
    Journal of Medical Genetics 03/2014; 51(5). DOI:10.1136/jmedgenet-2014-102303 · 5.64 Impact Factor
  • Clinical Orthopaedics and Related Research 11/2013; 472(2). DOI:10.1007/s11999-013-3397-5 · 2.88 Impact Factor
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    Clinical Orthopaedics and Related Research 09/2013; 471(11). DOI:10.1007/s11999-013-3279-x · 2.88 Impact Factor
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    ABSTRACT: Background The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. Methods We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation. Patients in the bracing group were instructed to wear the brace at least 18 hours per day. The primary outcomes were curve progression to 50 degrees or more (treatment failure) and skeletal maturity without this degree of curve progression (treatment success). ResultsThe trial was stopped early owing to the efficacy of bracing. In an analysis that included both the randomized and preference cohorts, the rate of treatment success was 72% after bracing, as compared with 48% after observation (propensity-score-adjusted odds ratio for treatment success, 1.93; 95% confidence interval [CI], 1.08 to 3.46). In the intention-to-treat analysis, the rate of treatment success was 75% among patients randomly assigned to bracing, as compared with 42% among those randomly assigned to observation (odds ratio, 4.11; 95% CI, 1.85 to 9.16). There was a significant positive association between hours of brace wear and rate of treatment success (P<0.001). Conclusions Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and others; BRAIST number, NCT00448448.)
    New England Journal of Medicine 09/2013; 369(16). DOI:10.1056/NEJMoa1307337 · 54.42 Impact Factor
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    ABSTRACT: Study Design. Descriptive.Objective. To describe the design and development of BrAIST.Summary of Background Data. Bracing has remained the standard of care for the non-operative treatment of adolescent idiopathic scoliosis (AIS) since the introduction of the Milwaukee brace in the late 1940s, but it has never been subjected to a rigorous evaluation of either its efficacy or its effectiveness. The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) was designed to address the primary question: Do braces (specifically a thoracolumbosacral orthosis, or TLSO) lower the risk of curve progression to a surgical threshold (≥50 degrees) in patients with AIS relative to watchful waiting alone?Methods. The authors describe the rationale for BRAIST, including the limitations of the current literature evaluating bracing for AIS. Second, the authors describe the preliminary work, including the preparation of the NIH clinical trials planning grant. Lastly, the authors describe the trial design in detail.Results. BrAIST was conducted in 25 sites in North America. Subjects were treated either with a TLSO or watchful waiting and followed every six months until they reached skeletal maturity or the surgical threshold of 50 degrees Cobb angle.Conclusions. Clinical decision making will be improved by translation of the BrAIST results into evidence-based prognosis and estimates of how the prognosis, specifically the risk of progressing to surgery, may be altered by the use of bracing.
    Spine 09/2013; 38. DOI:10.1097/01.brs.0000435048.23726.3e · 2.45 Impact Factor
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    ABSTRACT: Myosin binding protein C1 (MYBPC1) is an abundant skeletal muscle protein that is expressed predominantly in slow twitch muscle fibers. Human MYBPC1 mutations are associated with distal arthrogryposis type 1 and lethal congenital contracture syndrome (LCCS4). Because MYBPC1 function is incompletely understood, the mechanism by which human mutations result in contractures is unknown. Here, we demonstrate using antisense morpholino knockdown, that mybpc1 is required for embryonic motor activity and survival in a zebrafish model of arthrogryposis. Mybpc1 morphant embryos have severe body curvature, cardiac edema, impaired motor excitation and are delayed in hatching. Myofibril organization is selectively impaired in slow skeletal muscle and sarcomere numbers are greatly reduced in mybpc1 knockdown embryos although electron microscopy reveals normal sarcomere structure. To evaluate the effects of human distal arthrogryposis mutations, mybpc1 mRNAs containing the corresponding human W236R and Y856H MYBPC1 mutations were injected into embryos. Dominant-negative effects of theses mutations were suggested by the resultant mild bent body curvature, decreased motor activity, as well as impaired overall survival compared to overexpression of wild-type RNA. These results demonstrate a critical role for mybpc1 in slow skeletal muscle development and establish zebrafish as a tractable model of human distal arthrogryposis.
    Human Molecular Genetics 07/2013; 22. DOI:10.1093/hmg/ddt344 · 6.68 Impact Factor
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    ABSTRACT: The authors’ current experience in the surgical treatment strategy of stable slipped capital femoral epiphysis deformities was reviewed. From this, a treatment algorithm was developed that could be utilized as a guide in the evaluation and treatment of future patients with slipped capital femoral epiphysis. The clinical parameters of patients’ histories of symptoms, physical examinations, and radiographic assessments of slip severity were used in formulating the algorithm. The intent was to prepare a comprehensive algorithm providing necessary alternate treatment pathways for the variable slip deformity in accordance with the surgical experience/expertise of the treating surgeon.
    Journal of Pediatric Orthopaedics 01/2013; 33:S103-S111. DOI:10.1097/BPO.0b013e31829774d6 · 1.43 Impact Factor
  • Matthew B Dobbs
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    ABSTRACT: This CORR Insights™ is a commentary on the article ''Can a Triple Pelvic Osteotomy for Adult Symptomatic Hip Dysplasia Provide Relief of Symptoms for 25 Years?" By van Stralen and colleagues available at DOI 10.1007/s11999-012-2701-0 .
    Clinical Orthopaedics and Related Research 12/2012; 471(2). DOI:10.1007/s11999-012-2702-z · 2.88 Impact Factor
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    ABSTRACT: Talipes equinovarus is one of the most common congenital musculoskeletal anomalies and has a worldwide incidence of 1 in 1000 births. A genetic predisposition to talipes equinovarus is evidenced by the high concordance rate in twin studies and the increased risk to first-degree relatives. Despite the frequency of isolated talipes equinovarus and the strong evidence of a genetic basis for the disorder, few causative genes have been identified. To identify rare and/or recurrent copy number variants, we performed a genome-wide screen for deletions and duplications in 413 isolated talipes equinovarus patients using the Affymetrix 6.0 array. Segregation analysis within families and gene expression in mouse E12.5 limb buds were used to determine the significance of copy number variants. We identified 74 rare, gene-containing copy number variants that were present in talipes equinovarus probands and not present in 759 controls or in the Database of Genomic Variants. The overall frequency of copy number variants was similar between talipes equinovarus patients compared with controls. Twelve rare copy number variants segregate with talipes equinovarus in multiplex pedigrees, and contain the developmentally expressed transcription factors and transcriptional regulators PITX1, TBX4, HOXC13, UTX, CHD (chromodomain protein)1, and RIPPLY2. Although our results do not support a major role for recurrent copy number variations in the etiology of isolated talipes equinovarus, they do suggest a role for genes involved in early embryonic patterning in some families that can now be tested with large-scale sequencing methods.European Journal of Human Genetics advance online publication, 15 August 2012; doi:10.1038/ejhg.2012.177.
    European journal of human genetics: EJHG 08/2012; 21(4). DOI:10.1038/ejhg.2012.177 · 4.23 Impact Factor
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    ABSTRACT: Adolescent idiopathic scoliosis occurs between two and ten times more frequently in females than in males. The exact cause of this sex discrepancy is unknown, but it may represent a difference in susceptibility to the deformity. If this difference is attributable to genetic factors, then males with adolescent idiopathic scoliosis would need to inherit a greater number of susceptibility genes compared with females to develop the deformity. Males would also be more likely to transmit the disease to their children and to have siblings with adolescent idiopathic scoliosis. Such a phenomenon is known as the Carter effect, and the presence of such an effect would support a multifactorial threshold model of inheritance. One hundred and forty multiplex families in which more than one individual was affected with adolescent idiopathic scoliosis were studied. These families contained 1616 individuals, including 474 individuals with adolescent idiopathic scoliosis and 1142 unaffected relatives. The rates of transmission from the 122 affected mothers and from the twenty-eight affected fathers were calculated, and the prevalence among siblings was determined in the nuclear families of affected individuals. The prevalence of adolescent idiopathic scoliosis in these multiplex families was lowest in sons of affected mothers (36%, thirty-eight of 105) and highest in daughters of affected fathers (85%, twenty-two of twenty-six). Affected fathers transmitted adolescent idiopathic scoliosis to 80% (thirty-seven) of forty-six children, whereas affected mothers transmitted it to 56% (133) of 239 children (p < 0.001). Siblings of affected males also had a significantly higher prevalence of adolescent idiopathic scoliosis (55%, sixty-one of 110) compared with siblings of affected females (45%, 206 of 462) (p = 0.04). This study demonstrates the presence of the Carter effect in adolescent idiopathic scoliosis. This pattern can be explained by polygenic inheritance of adolescent idiopathic scoliosis, with a greater genetic load required for males to be affected.
    The Journal of Bone and Joint Surgery 08/2012; 94(16):1485-91. DOI:10.2106/JBJS.K.01450 · 4.31 Impact Factor
  • Ornusa Chalayon · Amelia Adams · Matthew B Dobbs
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    ABSTRACT: Traditional extensive soft-tissue release for the treatment of congenital vertical talus is associated with a myriad of complications. A minimally invasive approach has recently been introduced with good short-term results in patients with isolated vertical talus. The purpose of the present study was to evaluate the effectiveness of this approach for the treatment of rigid vertical talus associated with neuromuscular and/or genetic syndromes. Fifteen consecutive patients (twenty-five feet) with non-isolated congenital vertical talus were retrospectively reviewed at a minimum of two years following treatment with serial casting followed by limited surgery. The surgery consisted of percutaneous Achilles tenotomy in all feet and either pin fixation of the talonavicular joint through a small medial incision to ensure joint reduction and accurate pin placement (five feet) or selective capsulotomies of the talonavicular joint and the anterior aspect of the subtalar joint (twenty feet). Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic data at the time of the latest follow-up were compared with age-matched normative values. Initial correction was obtained in all cases. The mean number of casts required was five. Mean ankle dorsiflexion was 22° and mean plantar flexion was 25° at the time of the latest follow-up. Recurrence was noted in three patients (five feet), all of whom had had initial subluxation of the calcaneocuboid joint. All radiographic parameters measured at the time of the latest follow-up had improved significantly (p < 0.0001) compared with the values before treatment, and the mean values of the measured angles did not differ significantly from age-matched normal values. Serial manipulation and casting followed by limited surgery, consisting of percutaneous tenotomy of the Achilles tendon and a small medial incision to either palpate the talonavicular joint or perform capsulotomies of the talonavicular joint and the anterior aspect of the subtalar joint to ensure accurate reduction and pin fixation, result in excellent short-term correction of the deformity while preserving subtalar and ankle motion in patients with rigid congenital vertical talus associated with neuromuscular and/or genetic syndromes.
    The Journal of Bone and Joint Surgery 06/2012; 94(11):e73. DOI:10.2106/JBJS.K.00164 · 4.31 Impact Factor
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    ABSTRACT: Over the last 40 years, anatomic reduction with plate stabilization has become the standard in adult patients with diaphyseal fractures of the radius and ulna. When operative fixation has been indicated in skeletally immature patients with these fractures, a variety of techniques have been reported, with intramedullary fixation becoming increasingly accepted. There is currently significant variability in the treatment of adolescents with forearm fractures. The purpose of this study was to investigate the clinical and radiographic outcomes in the adolescent population after intramedullary fixation of both bone forearm fractures. A retrospective review identified 32 patients 12-18 years of age who had undergone intramedullary fixation of both forearm bones in the past 20 years at our institution. Galeazzi, Monteggia, radial head, and distal metaphyseal fractures were excluded. Radiographic evaluation was performed to determine union and postoperative radial bow. Clinical follow-up was carried out for postoperative complications and range of motion of the wrist, forearm, and elbow. The mean age of the patients was 14.1 years. A total of 19 fractures were closed injuries, nine were grade 1, three were grade 2, and one fracture was a grade 3b. Of the patients, 15.6% had limited postoperative range of motion. All patients in the older age group, 15-18 years of age, had a normal range of motion. A decrease in radial bow was not associated with limitation in motion. There was a 98% union rate, and all unions occurred by 7.5 months. Only three major complications occurred, two refractures and one ulnar hardware migration, and subsequent radius nonunion occurred in the one grade 3b injury. Flexible intramedullary nailing of both bone forearm fractures provides reliable bony union and excellent postoperative clinical results in adolescents. Level of evidence, IV.
    Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 03/2012; 21(5):482-8. DOI:10.1097/BPB.0b013e3283528db5 · 0.66 Impact Factor

Publication Stats

2k Citations
379.96 Total Impact Points


  • 2002–2015
    • Washington University in St. Louis
      • Department of Orthopaedic Surgery
      San Luis, Missouri, United States
  • 2002–2013
    • Shriners Hospitals for Children
      Tampa, Florida, United States
  • 2000–2013
    • University of Iowa
      • Department of Orthopaedics and Rehabilitation
      Iowa City, IA, United States
  • 1999–2001
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States