November 2011
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46 Reads
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7 Citations
The Journal of Bone and Joint Surgery
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November 2011
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46 Reads
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7 Citations
The Journal of Bone and Joint Surgery
January 2008
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23 Reads
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12 Citations
Journal of Pediatric Orthopaedics
Short upper extremity amputation stumps are difficult to fit with an appropriate-level prosthesis. Fitting at a more proximal level generally results in decreased function. Options in the past have included stump and prosthetic modification, both of which provide limited improvement in function. Anecdotal reports of lengthening short amputation stumps have been published. This article reviews our experience with lengthening short upper extremity amputation stumps in children. All patients who underwent an upper extremity stump lengthening at Shriners Hospital Los Angeles with at least 1-year follow-up were included. Charts and radiographs were retrospectively reviewed and prosthetic use preoperatively and postoperatively, complications, and additional procedures were documented. Stump length was measured on radiographs as the length between the proximal flexion crease and the tip of the bone. Eleven patients with 14 amputation stumps underwent lengthening. Mean stump length increase was 264% (4 cm). Nine patients desired prosthetic fitting; all except 1 were able to be fit with an appropriate-level prosthesis. Two of the 9 patients reported only using the prosthesis on rare occasions. The 2 remaining patients underwent lengthening to improve function but did not desire a prosthesis preoperatively. Lengthening is a viable but controversial option for very short upper extremity amputation stumps and may result in better function and/or more appropriate prosthetic fitting. Complications and additional procedures are common. Soft tissue coverage seems to be the main limiting factor to lengthening.
July 2005
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63 Reads
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22 Citations
Journal of Pediatric Orthopaedics
Patients with short lower-extremity amputation stumps exhibit poor prosthetic fit and inefficient gait. Often they are fit at the next-higher prosthetic level, increasing energy consumption. This study aimed to characterize the risk/benefit ratio of stump lengthening with planar external fixators. All patients lengthened for functionally short amputation stumps were reviewed. Outcome measures included changes in prosthetic use, soft tissue problems, qualitative gait analysis, and surgical complications. Patients averaged 15.1 years of age at surgery, with 4.1 years of follow-up. The average lengthening index was 9.2 mm/mo. Femoral lengthenings obtained more length (8.7 vs. 6.9 cm). After treatment, prosthetic skin-related complications decreased and qualitative gait parameters improved. Most (85%) wore a standard prosthesis for their amputation level after surgery, whereas none could before. There were 1.4 complications per patient, all successfully surgically treated. Lengthening is time-consuming and associated with frequent complications but results in improved gait and energy consumption.
September 2003
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10 Reads
The Spine Journal
July 2003
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31 Reads
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3 Citations
JPO Journal of Prosthetics and Orthotics
Lengthening of short amputation stumps has become an accepted, though uncommon, treatment for amputees. The time taken to lengthen the bone and wait until it has become sufficiently strong to remove the external fixator takes many months, during which time the patient is without a functional prosthesis. We describe the need and process of fabricating a temporary prosthesis, which is worn around the fixator to enhance the rehabilitation process in a patient who underwent lengthening of his short transtibial stump.
May 2003
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28 Reads
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22 Citations
Spine
A retrospective review was performed. To evaluate the results of autogenous tibial strut grafts for anterior fusions in children with severe kyphosis and kyphoscoliosis regarding maintenance of correction, clinical outcome, graft fractures, and donor-site morbidity. Anterior strut grafts harvested from the iliac crest, rib, and fibula often are used to treat severe kyphosis and kyphoscoliosis. Several studies in the literature have observed graft failures, loss of correction, or donor-site morbidity when these grafts have been used. Autogenous tibial strut grafts provide some theoretical advantages with minimal donor-site morbidity. This review included 15 patients with severe kyphosis/kyphoscoliosis who underwent anterior spinal fusion with autogenous tibial strut grafts. Among these patients, 13 underwent staged or simultaneous posterior fusions, and 4 underwent cord decompression for myelopathy. An average of seven levels (range, 3-13) were fused anteriorly. Preoperative, postoperative, and latest follow-up radiographs were evaluated for graft incorporation, fracture, hardware failure, and spinal alignment. Patients were examined at the latest follow-up visit, and charts were reviewed to assess neurologic status, back pain, alignment, complications, and donor-site problems. All the patients were available for clinical examination. The mean follow-up period was 3.9 years (range, 2-8 years). The mean kyphosis measured 89 degrees before surgery, 62 degrees after surgery, and 66 degrees at the most recent follow-up assessment. In patients with kyphoscoliosis, the mean coronal curve measured 64 degrees before surgery, 42 degrees after surgery, and 46 degrees at the latest follow-up assessment. Apparent fusion was observed in all cases with no graft fractures. One patient reported mild donor-site discomfort. Autogenous tibial strut grafts provide physical advantages over commonly used iliac crest, rib, and fibula grafts. The tibia provides dense cortical bone with ample length and mechanical strength, although the actual strength of each strut was not measured directly. In this study, adequate correction was maintained throughout an average follow-up period of 3.9 years, and solid fusion was obtained in all cases. The results indicate that this technique offers a reliable means of providing anterior support in the management of severe kyphosis with virtually no donor-site morbidity. Although the number of patients in this review was limited, the authors believe that anterior autogenous tibial struts are an excellent alternative for the treatment of severe kyphosis and kyphoscoliosis.
April 2003
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11 Reads
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9 Citations
Spine
Study Design. A retrospective review was performed. Objective. To evaluate the results of autogenous tibial strut grafts for anterior fusions in children with severe kyphosis and kyphoscoliosis regarding maintenance of correction, clinical outcome, graft fractures, and donor-site morbidity. Summary and Background Data. Anterior strut grafts harvested from the iliac crest, rib, and fibula often are used to treat severe kyphosis and kyphoscoliosis. Several studies in the literature have observed graft failures, loss of correction, or donor-site morbidity when these grafts have been used. Autogenous tibial strut grafts provide some theoretical advantages with minimal donor-site morbidity. Methods. This review included 15 patients with severe kyphosis/kyphoscoliosis who underwent anterior spinal fusion with autogenous tibial strut grafts. Among these patients, 13 underwent staged or simultaneous posterior fusions, and 4 underwent cord decompression for myelopathy. An average of seven levels ( range, 3-13) were fused anteriorly. Preoperative, postoperative, and latest follow-up radiographs were evaluated for graft incorporation, fracture, hardware failure, and spinal alignment. Patients were examined at the latest follow-up visit, and charts were reviewed to assess neurologic status, back pain, alignment, complications, and donor-site problems. Results. All the patients were available for clinical examination. The mean follow-up period was 3.9 years ( range, 2-8 years). The mean kyphosis measured 89degrees before surgery, 62degrees after surgery, and 66degrees at the most recent follow-up assessment. In patients with kyphoscoliosis, the mean coronal curve measured 64degrees before surgery, 42degrees after surgery, and 46degrees at the latest follow-up assessment. Apparent fusion was observed in all cases with no graft fractures. One patient reported mild donor-site discomfort. Conclusions. Autogenous tibial strut grafts provide physical advantages over commonly used iliac crest, rib, and fibula grafts. The tibia provides dense cortical bone with ample length and mechanical strength, although the actual strength of each strut was not measured directly. In this study, adequate correction was maintained throughout an average follow-up period of 3.9 years, and solid fusion was obtained in all cases. The results indicate that this technique offers a reliable means of providing anterior support in the management of severe kyphosis with virtually no donor-site morbidity. Although the number of patients in this review was limited, the authors believe that anterior autogenous tibial struts are an excellent alternative for the treatment of severe kyphosis and kyphoscoliosis.
July 2001
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18 Reads
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13 Citations
Journal of Pediatric Orthopaedics
Because the cross-sectional shape of the long bones of patients with osteogenesis imperfecta is often elliptical, the use of preoperative radiographs to determine intramedullary rod diameter in these patients undergoing osteotomy may be misleading. To investigate this, the authors correlated the narrowest inner bone diameter (NID) on preoperative radiographs to the rod diameter (RD) on postoperative radiographs. The authors evaluated 79 bones in 27 patients undergoing primary osteotomy with intramedullary fixation. Only 5% of the bones had an equal NID and RD, with 81% of bones having a smaller RD than the measured NID. Although a positive correlation was found between RD and NID (correlation coefficient 0.76), measurement of the NID on preoperative radiographs did not provide a good prediction of the actual RD used in this series of children with osteogenesis imperfecta.
July 1998
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12 Reads
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18 Citations
Journal of Pediatric Orthopaedics
This investigation was undertaken to determine the value of a routine radiological consultation on all examinations taken during the course of evaluation and treatment of children with elective orthopedic problems. Shriners Hospital in Los Angeles treats children with chronic orthopedic problems. All radiographs are ordered by an orthopedic surgeon. Currently all plain examinations are also read and reported by a pediatric radiologist. The study was a retrospective chart review. Three hundred nineteen radiographic examinations (6.7% of the total performed in calendar year 1995) were reviewed. The orthopedic surgeons documented the results of their readings in 69% of the cases, while the radiology staff documented 92% of the studies. The data do not show evidence of significant misinterpretations in the readings by the orthopedic surgeons. Therefore routine radiological consultation for all examinations is unnecessary in that specific setting. If a policy change were instituted, it would represent a major saving in health-care costs.
March 1998
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5 Reads
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53 Citations
The Journal of Bone and Joint Surgery
The need for long-term follow-up studies in the evaluation of medical care is not unique to the field of orthopaedic surgery. Medical treatment is continuously changing, and there is pressure from many sources to make it more effective and cost-efficient. The impact that these factors will have on the lives of patients cannot be determined without investigative outcome studies. In order for those data to be meaningful, every reasonable effort should be made to obtain information on all patients in a study. Longitudinal studies require continued contact and evaluation of patients for many years after the administration of treatment. When planning a clinical study, the investigator should include the expense of locating patients in the estimates of the study costs, regardless of whether the study is prospective.
... Cancellous and cortico-cancellous bone is most frequently harvested from the ilium, while the fibula and ribs are common sources of vascularised and non-vascularised strut grafts. The use of tibial strut grafts has been reported less frequently12345. Donor site morbidity and complications following the harvesting of bone from the iliac crest and the fibula have been well documented67891011121314. ...
April 2003
Spine
... The concept of CHW-driven screening using mobile technology has been successfully employed in ophthalmology, dermatology, and orthopedics. [18][19][20][21] CHWs are generally available and can act as an intermediary between children in rural settings and the advanced healthcare personnel (such as audiologists and otolaryngologists) that are otherwise scarce in LMICs. [22][23][24] Using these intermediaries allows for the scalability of these programs as their initial screening process allows for selective referrals, thereby reducing the burden upon the more scarce specialized hearing healthcare professionals. ...
November 2011
The Journal of Bone and Joint Surgery
... Our patients were treated as children and many are now adults living in different geographic areas who have had changes in phone numbers, making it difficult to establish contact despite extensive efforts, including detailed Internet searches. 38,39 Second, we did not report radiographic outcomes. As discussed earlier, multiple studies have shown that nonoperative treatment can lead to asymptomatic radiographic nonunion. ...
March 1998
The Journal of Bone and Joint Surgery
... Treatment options for congenital synostosis of the knee include observation, 5 amputation, 10 supracondylar extension osteotomy of the femur, 6,11 and realignment through the fusion mass. 7 We present 8 patients (13 knees) with congenital synostosis of the knee and review their clinical features, approaches for surgery and the radiographic and clinical results of our treatment approach for this rare condition. ...
January 1996
Journal of Pediatric Orthopaedics
... An anteroposterior picture of the hips in a neutral position is routinely acquired and evaluated during DHD screening. Assessing the relationship among the radiolucent femoral head, bone metaphysis, and acetabulum is crucial [12][13][14]. ...
March 1997
Journal of Pediatric Orthopaedics
... Additionally, there are concerns about bone fragility and the effect of orthodontic forces and trauma on the jaws during extractions and surgical intervention. However, favourable post-osteotomy healing has been reported in a case of PD [37]. Nevertheless, it is recommended that minimum force be used during dental procedures. ...
September 1997
Clinical Orthopaedics and Related Research
... Surgery should not be carried out in cases of asymptomatic tumors, as the risk of surgery-related complications is higher than tumor-related ones [4]. In a study done by Wirganowicz et al., they described the surgical risk for the elective excision of 285 osteochondroma; they found the complication rate to be 12.5%, among which the most common was neurapraxia, followed by arterial laceration, compartment syndrome, and fibula fracture [26]. [11]. ...
July 1997
Journal of Pediatric Orthopaedics
... Consequently, interpretation and quantification of patient CT scans contribute to the diagnosis and treatment plan, and it is therefore an essential component in managing care of the patient. Several other groups have evaluated the benefit of dual interpretations of radiological results [7][8][9][10][11][12][13]. In one group of studies, a dual interpretation of the radiological findings were repeatedly found to have no impact on patient care as there were no significant differences between the attending physician's interpretation of these images compared with that of the radiologist [10][11][12][13]. ...
July 1998
Journal of Pediatric Orthopaedics
... Within the surgical group, procedures are carried out to correct bone deformities, where the planned fracture of the bone is carried out to align it. According to medical management, a telescopic nail counteracts the incidence of fractures and supports the bone [5][6][7][8]. ...
July 2001
Journal of Pediatric Orthopaedics
... Osteomalacia, vertebral tumour erosion, dystrophic bone tissue, and cupped vertebral body can promote the rapid progression of the spinal deformity. Thus, bone augmentation is frequently needed to promote spinal fusion in the presence of dystrophic features [11,17,18]. There are no previous reports on the surgical correction of CK in paediatric patients with NF-1 associated with anterior tibial strut graft. ...
May 2003
Spine