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March 2015 - present
August 1979 - September 1982
August 1977 - July 1979
Publications
Publications (224)
The energy transition presents a critical juncture for the oil and gas industry. As we navigate toward a more sustainable future, digital oilfield (DOF) technologies play a pivotal role in optimizing operations, reducing environmental impact, and ensuring energy security. This paper aims to explore best practices and lessons learned from two decade...
Background:
The ligamentum teres (LT) is believed to have a number of functions, including a role in hip stability, nociception, proprioception, vascular supply to the femoral head, and synovial fluid circulation. The LT is often excised in the process of performing a medial open reduction (MOR) of the hip. We sought to conduct a retrospective rev...
Evaluation of the etiology of a younger child (age <5) with gait disturbance or refusal to walk is a critical skill for the orthopedic surgeon. The common causes are trauma and infection, which can often be delineated with a detailed history. Prompt diagnosis is critical to distinguish orthopedic emergencies from relatively benign processes and chr...
Case:
Talocalcaneal coalition (TCC) is a common type of coalition, often neglected. This case is of a 10-year-old girl with a painful ankle mass, diagnosed with TCC and a ganglion cyst. Examination revealed stiff subtalar motion, a submalleolar prominence, and well-circumscribed, tender mass at the posteromedial ankle. Treatment options include sh...
Purpose
Asymmetric skin folds (ASFs) have been linked to developmental dysplasia of the hip (DDH) in select studies, leading to their inclusion in paediatric practice guidelines regarding orthopaedic referral for hip evaluation. The purpose of this study was to investigate the utility of isolated ASFs as a screening tool for DDH in a series of pati...
Tarsal coalitions have been reported in the setting of equinovarus foot deformities, but only as rare isolated findings. Failure to recognize this diagnosis may inhibit successful equinovarus correction. Here, we review a series of tarsal coalitions seen in congenital and neuropathic equinovarus deformity at two institutions, to report the breakdow...
Case:
We describe the first reported case of scurvy developing secondary to behavioral traits of Jacobsen syndrome. The diagnosis of scurvy was significantly delayed because bleeding symptoms were initially attributed to baseline thrombocytopenia and platelet dysfunction associated with Jacobsen syndrome and patient's medication. Following vitamin...
Background:
Nonossifying fibroma (NOF) is the most common benign osseous lesion in children; however, our understanding of which lesions progress to a fracture remains unclear. In this study, we seek to formulate a classification system for NOFs to assess for fracture risk and determine what this classification system tells us regarding fracture r...
Purpose
Patients with developmental dysplasia of the hip (DDH) may require a pelvic osteotomy to treat acetabular dysplasia. The Pemberton osteotomy and modified San Diego acetabuloplasty are two options available when surgically treating DDH. The purpose of this study was to compare outcomes following the Pemberton and modified San Diego when trea...
Orthopaedic surgeons rely on history and physical exam findings to help establish any diagnosis. When the orthopaedic surgeon examines a child with painful foot or flatfoot, the patient's gait and motion should be evaluated. A careful evaluation of subtalar motion should be performed with the foot positioned near neutral (plantigrade). In this posi...
* Careful scrutiny of radiographs is important in the assessment of pediatric elbow injuries. Disruption of the radiocapitellar line and an increased bow of the posterior ulnar border are sometimes subtle signs of a Monteggia injury.
* An attempt at closed reduction up to 4 weeks after injury has been cited in the literature as successfully treatin...
Muscle stem cells (MuSCs) contribute to muscle regeneration following injury. In many muscle disorders, the repeated cycles of damage and repair lead to stem cell dysfunction. While telomere attrition may contribute to aberrant stem cell functions, methods to accurately measure telomere length in stem cells from skeletal muscles have not been demon...
Purpose
We aim to retrospectively evaluate patients with non-ossifying fibroma (NOF) of the distal femur by radiographs, CT and MRI, and to provide a theory describing the reasoning for the distal femur NOF’s location and aetiology.
Methods
Charts of patients with NOFs between 2003 and 2014 were retrospectively reviewed. Inclusion criteria encompa...
Abstract
Evaluation of the etiology of a younger child (age <5) with gait disturbance or refusal to walk is a critical skill for the orthopedic surgeon. The common causes are trauma and infection, which can often be delineated with a detailed history. Prompt diagnosis is critical to distinguish orthopedic emergencies from relatively benign process...
Background:
The role of femoral aspiration (FA) in the treatment of septic arthritis of the hip is controversial. The purpose of this study was to determine if FA conducted concomitantly with irrigation and debridement (I&D) of the septic hip aids in microorganism and osteomyelitis identification and alters the treatment plan, or if the risks of t...
Background: The use of a brace has been shown to be an effective treatment for hip dislocation in infants; however, previous studies of such treatment have been single-center or retrospective. The purpose of the current study was to evaluate the success rate for brace use in the treatment of infant hip dislocation in an international, multicenter,...
PurposeNonossifying fibromas (NOFs) present in a characteristic pattern in the distal tibia. Their predilection to this region and etiology remain imprecisely defined. Methods
We performed a retrospective chart review of patients between January 2003 and March 2014 for distal tibial NOFs. We then reviewed radiographs (XRs), computed tomography (CT)...
Purpose:
It has been the observation of the senior author that there is a bony fullness or "double medial malleolus" over the middle facet as a consistent finding with most talocalcaneal coalitions (TCC). To document this observation, we reviewed records and radiographs in 3 patient groups.
Methods:
Part 1: retrospective chart review was complet...
Background:
The natural history of scoliosis in Duchenne muscular dystrophy (DMD) is progressive and debilitating if neglected. The purpose of this study was to evaluate outcomes related to spinal deformity surgery in patients with DMD over a 30-year period.
Methods:
This was a single center retrospective study of all operatively treated scolios...
Background
Most infants with developmental dysplasia of the hip (DDH) are diagnosed within the first 3 months of life. However, late-presenting DDH (defined as a diagnosis after 3 months of age) does occur and often results in more complex treatment and increased long-term complications. Specific risk factors involved in late-presenting DDH are poo...
Introduction:
Posttraumatic pediatric distal tibiofibular synostosis is a rare complication following fracture. This is a retrospective, multicenter case series of synostosis of distal tibiofibular fractures in children. The purpose was to evaluate the incidence and pattern of posttraumatic distal tibiofibular synostosis in children.
Methods:
Of...
History: When a toddler (1-4 years) presents with a recent onset of a limp, the differential diagnosis is primarily between trauma and infection. Often these two entities can be sorted out by a careful history: was there immediate onset of pain following a witnessed injury? If there was a delay in the onset of the limp or pain or history of trauma...
Talocalcaneal coalitions present with complaints of flatfeet, foot or ankle pain after minor injury, or recurrent ankle sprains. Physical examination findings include limited subtalar motion and prominence inferior to the medial malleolus. Use of computed topography (CT) scans is recommended for preoperative planning. Confirmation of resection with...
Dr Marino Ortolani was an Italian pediatrician who developed a test for hip instability in the infant (1936) and then promoted early diagnosis of this condition to the medical community. He studied the pathoanatomy of hip instability in the 1940s. He wrote his textbook in 1948 and in 1952 he produced a movie about the examination and treatment of h...
Background:
Surgical correction of juvenile hallux valgus has a high risk of recurrence and complications. This short-term follow-up study evaluates the radiographic differences between 3 osteotomy types: distal first metatarsal osteotomy, proximal first metatarsal osteotomy, and double first metatarsal osteotomy with regard to ability to achieve...
To provide the best possible care to patients with developmental dysplasia of the hip, it is helpful to understand the normal growth and development of the hip joint; the pathoanatomy, epidemiology, and diagnosis of the condition; and the natural history of a missed diagnosis of dislocation, subluxation, and dysplasia.
C sign is used to alert the physician of the possible presence of talocalcaneal coalition (TCC), so that advanced imaging can be ordered. The purpose of this study was to know the prevalence of the C sign among patients with TCC and its relationship to the presence of a TCC or to hindfoot alignment.
Retrospective reviews of the presence of C sign i...
Intraoperative assessment of talocalcaneal (TC) coalition resection can be challenging, with no reliable plain radiographic view available for evaluation. Therefore, in March of 2011, we began using a CereTom portable CT scanner to assess TC coalition resections intraoperatively. This study evaluates the use of intraoperative CT during surgical res...
The purpose of this study was to describe fractures sustained by children and to analyze the associated costs when a caretaker falls down stairs while holding a child.
Between 2004 and 2012, 16 children who sustained a fracture after a fall down stairs while being carried by a caregiver were identified. Parents/caregivers were interviewed to see ho...
Longitudinal epiphyseal bracket or bracket epiphysis is an uncommon disorder of growth. Alternatively known as a delta phalanx, it is due to an anomalous secondary ossification center that extends longitudinally along the diaphysis. Although rare, longitudinal epiphyseal bracket most commonly manifests in the hands as clinodactyly and in the feet a...
: Premature physeal closure (PPC) is a common complication resulting from the management of a displaced Salter-Harris II (SH II) fracture of the distal tibia. The purpose of this study was to evaluate our institution's treatment approach to assess PPC and complication rates of fractures treated both surgically and nonsurgically.
: We performed a re...
: Adolescent tibial tubercle fractures are uncommon, complex, high-energy injuries. The use of lateral radiographs in isolation to diagnose and treat these injuries is the standard of practice. However, with a single 2-dimensional (2D) view, there may be a risk that the degree of injury can be underestimated. This study was performed to report on t...
: Surgery is indicated in symptomatic flatfoot when conservative treatment fails to relieve the symptoms. Osteotomies appear to be the best choice for these painful feet. The purpose of this study was to compare the clinical and radiographic outcome of the calcaneo-cuboid-cuneiform osteotomies (triple C) and the calcaneal-lengthening osteotomy in t...
Pain isolated to the lateral aspect of the heel can be difficult to diagnose, particularly in the growing child. Peroneal tendinopathy or frank tears of the peroneal tendons secondary to an enlarged peroneal tubercle has been implicated as a potential source of pain in adults. Neither the prevalence of enlarged peroneal tubercles in the pediatric p...
Treatment of displaced Gartland type 3 supracondylar humerus fractures in children may include closed reduction and percutaneous pinning. The pin configuration may be all-lateral entry or cross-pin. Despite the improved stability possible with cross-pinning, there is an inherent iatrogenic risk to the ulnar nerve of about 6%. As medial fixation may...
Physeal fractures of the distal tibia and fibula are common and can be seen at any age, although most are seen in the adolescent. An understanding of the unique anatomy of the skeletally immature ankle in relation to the mechanism of injury will help one understand the injury patterns seen in this population. A thorough clinical exam is critical to...
The purpose of this study was to review outcomes of patients treated for symptomatic talocalcaneal coalition with resection and interposition of fat graft.
A retrospective review was performed on all patients who underwent surgical treatment for symptomatic talocalcaneal coalition over a 13-year period. Ninety-three feet were treated with excision...
Gowers' sign is a screening test for muscle weakness, typically seen in Duchenne muscular dystrophy but also seen in numerous other conditions. The mildest presentations and the variations of Gowers' sign are poorly described in the literature but are important to recognize to help with early diagnosis of a neuromuscular problem.
We therefore (1) d...
![Fig. 1 The six signs and symptoms of compartment syndrome. From [41]](profile/Scott-Mubarak-2/publication/233831065/figure/fig1/AS:601695822295046@1520466871262/The-six-signs-and-symptoms-of-compartment-syndrome-From-41_Q320.jpg)
Pediatric tibial shaft fractures are common injuries encountered by the orthopaedic surgeon. Flexible intramedullary nailing has become popular for pediatric patients with tibial shaft fractures that require operative fixation. The purpose of our study was to evaluate the incidence of, and the risk factors for, compartment syndrome (CS) after flexi...
The goals of cavus foot correction are to obtain a plantigrade foot with the heel in slight valgus position and to hopefully preserve joint motion in both the tarsal and metatarsal joints. The apex of many cavus deformities is near Chopart joint. We are reporting on a new technique involving navicular excision and cuboid osteotomy to correct severe...
Flexible flatfoot is a physiological variation of normality that does not need correction unless it becomes symptomatic. It remains unclear why some flexible flatfeet become symptomatic. Operations for symptomatic flatfoot correct the theoretical deformities with the intent of relieving symptoms. Using radiographic measurements, we analyzed the rel...
Osteomyelitis in the setting of closed fractures is a recognized association in the literature, but to our knowledge, septic arthritis after a closed intra-articular fracture has not yet been reported.
We conducted a retrospective review of 3 cases of septic arthritis after closed intra-articular fractures of the proximal phalanx of the great toe,...
For correction of angular deformity, tension band plating has been proposed as a safe and minimally invasive technique. The purpose of this study was to assess the experiences and report the rate of correction obtained with this procedure in patients with idiopathic genu valgum.
This study was a retrospective review of 47 valgus deformities of the...
Talocalcaneal coalitions can be difficult to detect on plain radiographs, despite obvious clinical findings. The purpose of this study is two-fold: (1) to delineate the benefits of thin-cut computed tomography (CT) and 3D reconstructions and (2) to develop a classification scheme for talocalcaneal coalitions that will provide valuable information f...
To review our incidence of developmental dysplasia of the hip (DDH) in breech infants referred for ultrasound screening and to determine if subsequent follow-up radiographs are necessary in these patients with normal clinical and ultrasound examinations.
A review of the clinical data and imaging studies of all children with the risk factor of breec...
Symptomatic calcaneonavicular coalitions treated with resection and interposition of the extensor digitorum brevis (EDB) muscle often have unpredictable improvement of symptoms. Concerns with regard to skin cosmesis from a bony prominence on the lateral aspect of the foot and inadequate filling of the resection gap potentially causing reossificatio...
The cavovarus foot has been defined as plantar flexion of the first ray. The usual cause is due to a muscle imbalance. The purpose of this study was to report our experience with selective, joint-sparing osteotomies of the foot that address each deformity in the cavovarus foot in a stepwise fashion. Most bony procedures for correction of cavus feet...
To develop a classification system for all proximal tibial fractures in children that accounts for force of injury and fracture patterns.
At our institution, 135 pediatric proximal tibia fractures were treated from 1997 to 2005. Fractures were classified into four groups according to the direction of force of injury: valgus, varus, extension, and f...
The aim of this paper was to review the outcomes of treatment of dislocated but reducible (Ortolani-positive) hips.
A comparative retrospective review was conducted of all patients aged younger than 6 months who presented for treatment of developmental dysplasia of the hip for two 10-year periods. The inclusion criteria consisted of a clinical eval...
The mucopolysaccharidoses (MPS) are a family of lysosomal storage diseases that result in the abnormal accumulation of glycosaminoglycans throughout the body1. There is a broad spectrum in severity of expression of the musculoskeletal and neurological manifestations of these diseases, ranging from an early and obvious presentation, with rapid degen...
Dorsal rotatory subluxation of the navicular, a common sequela of resistant surgically treated clubfeet, presents a challenging treatment problem. This subluxation typically progresses after posteromedial release. Patients develop a cavovarus foot deformity and complain of pain, gait problems, and difficulty with shoe wear. Previous attempts at sof...
Computed tomography (CT) is the current imaging standard for confirming the diagnosis of a calcaneonavicular coalition. The purpose of this study was to evaluate three-dimensional (3D) multi-planar CT images of calcaneonavicular coalitions and adjacent tarsal relationships, compared to controls, in order to obtain an understanding of the 3D anatomy...
The ligamentum teres has primarily been considered as an obstruction to reduction in children with developmental dislocation of the hip (DDH). In the early surgical descriptions of both the medial (Ludloff) approach and the anterior (Salter) approach to the hip, it was generally accepted that the ligamentum teres was an obstruction to reduction and...
Richard von Volkmann (1830-1889), one of the most important surgeons of the 19(th) century, is regarded as one of the fathers of orthopaedic surgery. He was a contemporary of Langenbeck, Esmarch, Lister, Billroth, Kocher, and Trendelenburg. He was head of the Department of Surgery at the University of Halle, Germany (1867-1889). His popularity attr...
A recent study reported a higher incidence of pre-operative ulnar nerve symptoms in patients with flexion-type supracondylar fractures than in those with the more common extension supracondylar fractures and a greater need for open reduction (Kocher in POSNA paper #49 2006). We have encountered a specific pattern of flexion supracondylar fractures...
Focal fibrocartilaginous dysplasia (FFCD) is a benign condition first described in 1985 as a cause of tibia vara. We are reporting on 11 cases. The lesions involved proximal tibia (9 cases), distal femur (1 case), and distal ulna (1 case). We believe that this entity represents a bony anchor preventing natural sliding of the periosteum during growt...
Focal fibrocartilaginous dysplasia (FFCD) is a benign condition first described in 1985 as a cause of tibia vara. We are reporting on 11 cases. The lesions involved proximal tibia (9 cases), distal femur (1 case), and distal ulna (1 case). We believe that this entity represents a bony anchor preventing natural sliding of the periosteum during growt...
Nine pediatric patients (mean age 3.5 yrs) with low energy femur fractures were treated with 90/90 spica casts and developed leg compartment syndromes, Volkmann contracture, and ankle skin loss. These cases are detailed and a proposed mechanism leading to this devastating complication is explained. The authors believe the technique of an initial be...
The distal tibial physis is the second most commonly injured physis in long bones. Recent reports demonstrate a high rate of premature physeal closure (PPC) in Salter-Harris (SH) type I or II fractures of the distal tibia.
At our institution, 137 distal tibial SH type I or II fractures were treated from 1994 to 2002. Reviews were performed on all p...
This study was designed to evaluate the incidence of compartment syndrome (CS) resulting from the treatment of both-bone forearm fractures in children. A retrospective analysis of 285 consecutive children who presented with both-bone forearm fractures was performed. Of 235 closed injuries, 205 were treated with closed reduction and casting; none of...
A thorough knowledge of the normal growth and development of the hip, the causes of abnormal development, and the structural and functional changes that result from developmental hip dysplasia and dislocation provide needed information for treating these conditions. Ultrasonography, newborn screening, and radiographic evaluation are important diagn...
Both nonsurgical and surgical options are available for the treatment of developmental hip dysplasia and dislocation. The advantages, pitfalls, and techniques for using the Pavlik harness should be thoroughly examined before treatment. Other closed and open treatments are aimed at concentric reduction and prevention of residual subluxation and dysp...
The incidence and predictors of premature physeal closure (PPC) after pediatric distal tibial fractures were investigated. PPC was defined as evidence of growth plate disturbance on the injured side compared with the uninjured side. Ninety-two fractures were reviewed with at least 1 year of follow-up, or until physiologic closure of the growth plat...
The incidence and predictors of premature physeal closure (PPC) after pediatric distal tibial fractures were investigated. PPC was defined as evidence of growth plate disturbance on the injured side compared with the uninjured side. Ninety-two fractures were reviewed with at least 1 year of follow-up, or until physiologic closure of the growth plat...
A case series of patients with cerebral palsy treated for spinal deformity using Luque-Galveston instrumentation was retrospectively analyzed.
To analyze the incidence and risk factors for postoperative loss of sagittal plane correction initially obtained with Luque-Galveston instrumentation in patients with cerebral palsy.
The Luque-Galveston inst...
Study Design. A case series of patients with cerebral palsy treated for spinal deformity using Luque-Galveston instrumentation was retrospectively analyzed. Objective. To analyze the incidence and risk factors for postoperative loss of sagittal plane correction initially obtained with Luque-Galveston instrumentation in patients with cerebral palsy....
Because of the high rate of avascular necrosis, Pavlik developed his harness and method of treating developmental dysplasia of the hip in infants. This historical review highlights Pavlik's career from the time he worked with Frejka and then later in his own clinic in Olomouc, Czech Republic (1938). In the 1950s, he wrote five articles on the resul...
AIM: There are different approaches to treat foot deformities in Duchenne muscular dystrophy. Some authors recommend conservative, others only surgical means. The purpose of this study was to compare the outcome of both non-surgical and surgical treatment. METHOD: The records of 91 boys with DMD were retrospectively evaluated. The three treatment g...
There are different approaches to treat foot deformities in Duchenne muscular dystrophy. Some authors recommend conservative, others only surgical means. The purpose of this study was to compare the outcome of both non-surgical and surgical treatment.
The records of 91 boys with DMD were retrospectively evaluated. The three treatment groups studied...
A retrospective comparison of pediatric patients weighing less than 30 kg who underwent thoracoscopic anterior spinal release and fusion for deformity correction. This group was compared to two control groups: patients weighing over 30 kg (thoracoscopic) and patients under 30 kg (open).
To determine the efficacy and safety of thoracoscopic anterior...
Acute compartment syndrome has been widely reported in legs positioned in the lithotomy position for prolonged general surgical, urologic, and gynecologic procedures. The orthopaedic literature also contains reports of this complication in legs positioned on a fracture table in the hemilithotomy position. The purpose of this study was to identify t...
Fractures of the anterior superior iliac spine (ASIS) in adolescents are usually due to avulsion of the sartorius origin from the ASIS; however, the authors here report a second type due to avulsion of the tensor fascia lata origin. Eight patients were identified with ASIS avulsion fractures. Type II sartorius avulsion fracture was due to sprinting...
The purpose of this study was to evaluate the results of a modification of the posterior tibial tendon transfer in Duchenne muscular dystrophy patients with regard to foot deformity and ambulation. The records of 57 patients with Duchenne muscular dystrophy were retrospectively reviewed. Three treatment groups were studied: group 1, those who had s...
We describe six patients aged from 10 to 15 years who, after injury to the distal tibial physis, presented with the following clinical findings: 1) severe pain and swelling of the ankle; 2) hypoaesthesia or anaesthesia in the web space of the great toe; 3) weakness of extensor hallucis longus and extensor digitorum communis; and 4) pain on passive...
We describe six patients aged from 10 to 15 years who, after injury to the distal tibial physis, presented with the following clinical findings: 1) severe pain and swelling of the ankle; 2) hypoaesthesia or anaesthesia in the web space of the great toe; 3) weakness of extensor hallucis longus and extensor digitorum communis; and 4) pain on passive...
The longitudinal epiphyseal bracket is a rare ossification defect of tubular bones in the hand and foot. This deformity contains an abnormal secondary ossification center, which may lead to progressive shortening and angular deformity of involved bones. This article describes the results from early treatment of this deformity before the secondary o...
Iatrogenic synostosis of the tibia and fibula following an operation on the leg in a child has been reported rarely in the literature, and the effects of this complication on future growth, alignment, and function are not known. This is a retrospective case series, from one institution, of crossunions of the distal parts of the tibia and fibula com...
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 s...
Ninety-two patients with cerebral palsy underwent a special type of pericapsular acetabuloplasty designed to correct the hip dysplasia that occurs in cerebral palsy. The osteotomy was performed as part of a combined procedure (including femoral osteotomy and soft-tissue releases). Retrospective analysis was performed on 75 of the children (104 hips...
Valproic acid (VPA) is used in the treatment of seizure disorders often present in patients with cerebral palsy. The charts of 114 patients with cerebral palsy were reviewed to evaluate the effect of VPA on blood loss during spine surgery. Forty-one patients had seizure disorders. Of these, 18 were taking VPA as monotherapy (group III) and the rema...
The purpose of this study was to quantify the gait of subjects receiving two injections of either botulinum A toxin or saline vehicle into the gastrocnemius muscle(s). The study group consisted of cerebral palsy patients who walked with an equinus gait pattern. This study was a randomized, double-blinded, parallel clinical trial of 20 subjects. All...
This retrospective review evaluates the efficacy of standard intramedullary Kirschner wires (K-wires) for the treatment of open or unstable diaphyseal forearm fractures in 32 children with a mean follow-up of 13 months. Thirty-one patients had an excellent result, and one patient had a good result. Average time to bridging cortex was 3 months. Four...
