Children's Orthopaedics Research Articles

Orthopaedic Management of Neuromuscular Disorders

Drawing mostly from his own practice and experience as a recognized expert in the field of children's orthopedics, Dr Drennan has written a most comprehensive, interesting, and instructive book. Although packed with information for the enthusiast, it is still comfortably brief (306 pages) in this age of the inflated text. Reviewing it was like making personal grand rounds with an experienced and skilled clinician-surgeon, and I found the occasion gratifying with much to stimulate and encourage the practitioner who elects to manage this group of difficult The book is aimed at bridging the growing gap between medical understanding and the increasing inadequacies of medicine to deliver the appropriate quality of care to patients with neuromuscular disorders. It is directed to the orthopaedist, neurologist, pediatrician and family practitioner, as well as to the allied medical personnel who are involved in this care system. The statutory (and somewhat cursory) introductory section

Book Reviews

Book reviewed in this article:The Easter Seal Guide to Children's Orthopaedics: Prevention, Screening and Problem Solving By Mercer Rang Mark HofferNeurology of the Newborn By Joseph J. Volpe J. K. BrownProgress in Perinatal Neurology (Vol. I) Edited By Rowena Korobkin and Chrisian Guilleminault L. M. S. DubowitzNeurologic Infections in Children, 2nd. Edn. By William E. Bell and William F. McCormick John WilsonAn Introduction to Paediatric Neurology By Gwilym Hosking Diane SmythThe Development of Movement Control and Co‐ordination Edited By J. A. Scott Kelso and Jane E. Clark L. RosenbloomNeurology: Continuing Education Review, 3rd. Edn. By James H. Halsey, JR. Martin BellmanAmniotic Fluid and its Clinical Significance Edited By Merton Sandler R. D. H. BoydObstetrics Pocket Consultant By G. M. Stirrat L. I. ZanderProspective Longitudinal Research Edited By S. A. Mednick and A. E. Baert Harvey Goldstein

Posterior Tibial Tendon Transfer

At Rancho Los Amigos Hospital on the Children's Orthopedic Service, 43 patients underwent anterior transfer of the posterior tibial tendon through the interosseous membrane between 1969 and 1979. This included 74 procedures for the following diagnoses: Duchenne muscular dystrophy, club-foot, cerebrospastic disease (cerebral palsy and head injury), Charcot-Marie-Tooth disease, scapuloperoneal dystrophy, and peroneal palsy. The purpose of this paper is to present the 54 of these transfers that have a minimum 2 year follow-up were performed with a uniform surgical technique, and had uniform postoperative management. This series is analyzed and compared with a review of the literature in order to set down guidelines for the use of the procedure. The analysis reveals that the patient with Duchenne muscular dystrophy who has decreasing gait function or brace fitting problems is the ideal candidate for the procedure with 26 of 28 satisfactory results. Gait electromyography was critical to the selection of the cerebrospastic patient for the transfer with those patients demonstrating swing-phase function of the posterior tibialis muscle yielding the best results. Finally, posterior tibial tendon transfer is generally not indicated in congenital clubfoot with six unsatisfactory results in 10 procedures, and the procedure should not be done in Charcot-Marie-Tooth disease as part of staged treatment that includes a possible future hindfoot stabilization.

Improved survival in children with osteosarcoma following resection of pulmonary metastases

Despite the effectiveness of improved chemotherapy and radiotherapy, surgical resection of all gross metatastic disease from the lung appears to improve the survival of children with osteosarcoma. At Children's Orthopedic Hospital and Medical Center (COHMC), from 1952 through 1980, 55 patients were treated for osteosarcoma. Twenty-eight of these patients (4 with active disease) were surviving in January 1981. Six patients had pulmonary metastases at diagnosis and 28 patients developed pulmonary metastases after diagnosis. From 1964 through 1980, 17 patients had 34 thoracotomies for resection of metastases. Seven of these 17 patients (41%) are surviving and remain free of disease. The disease was often bilateral, and in most patients more than one thoracotomy was required to erradicate recurrent disease. No patient who developed pulmonary metastases from osteosarcoma survived without surgical resection of all gross disease. An aggressive surgical approach to the treatment of osteosarcoma metastatic to the lung in children appears worthwhile.

INCREASING THE USEFULNESS OF RADIONUCLIDE RENAL STUDIES IN PEDIATRIC PATIENTS

Departments of Pediatrics and Radiology, Children's Orthopedic Hospital and Medical Center, Seattle, Washington.

Clinical Trends in Orthopaedics

This is the report of 39 leading orthopedic surgeons, hand surgeons, and basic scientists celebrating the 62nd Annual Alumni Meeting of the Hospital for Special Surgery in 1980. There are three sections on fracture healing, two on hand replantation, three on new radiological techniques, two on children's orthopedics, three on musculoskeletal tumors, four on biomechanics, four on the knee, three on arthroplasty, four on the spine, and three on basic sciences. Most of the articles are well written, well organized, and thoroughly documented. The sections on electrically induced osteogenesis, fracture bracing, intervention radiology, gait analysis, and knee ligament reconstruction are all classics and alone justify the price of the text. Unfortunately, as with any compendium involving many authors, the quality is uneven. The diagrams are excellent, but many of the photographs did not reproduce well. This is especially true of those involving hand surgical and arthroscopy procedures. Some of the

Congenital Distal Femoral Focal Deficiency

An 8-year-old Chinese boy with congenital leg length discrepancy is believed to be the first reported case of unequivocal distal femoral focal deficiency. A pseudarthrosis is present between the normal appearing distal femoral epiphysis and the lower end of the femoral diaphysis. The patient's family history is negative for congenital limb deficiency, psuedarthrosis and neurofibromatosis. There is no history of trauma or infection. Congenital lack of distal femoral physis in this case is analogous to Aitken's Classification Type B proximal femoral focal deficiency.

The prognostic significance of the triradiate cartilage in suppurative arthritis of the hip in infancy and early childhood.

The Journal of Bone and Joint Surgery. British volumeVol. 63-B, No. 2 ArticlesFree AccessThe prognostic significance of the triradiate cartilage in suppurative arthritis of the hip in infancy and early childhoodS Wientroub, GC Lloyd-Roberts, M FraserS WientroubSearch for more papers by this author, GC Lloyd-RobertsSearch for more papers by this author, M FraserSearch for more papers by this authorPublished Online:1 May 1981https://doi.org/10.1302/0301-620X.63B2.7217140AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByReferencesCase Reports: Treatment of Traumatic Triradiate Cartilage Epiphysiodesis: What is the Role of Bridge Resection?15 May 2013 | Clinical Orthopaedics and Related Research®, Vol. 471, No. 11Septic Arthritis of the Neonatal Hip: Acute Management and Late ReconstructionJournal of the American Academy of Orthopaedic Surgeons, Vol. 21, No. 10Infection4 October 2011Extra capsular extrusion of femoral capital epiphysis – an unusual presentation of sequelae of septic arthritis of hipJournal of Pediatric Orthopaedics B, Vol. 20, No. 6Osteochondroplasty of the femoral head in hip reconstruction for type II late sequelae of septic arthritis: a preliminary reportHazem Mossad El-Tayeby1 December 2008 | Journal of Children's Orthopaedics, Vol. 2, No. 6Acetabular Dome Retroversion: Radiological Appearance, Incidence and Relevance24 January 2018 | HIP International, Vol. 16, No. 3Pathomorphologic Characteristics of Posttraumatic Acetabular DysplasiaJournal of Orthopaedic Trauma, Vol. 14, No. 7BibliographyInfectionNeonatal and Infantile Septic ArthritisPelvis: Triradiate Cartilage Vol. 63-B, No. 2 Metrics Downloaded 97 times History Published online 1 May 1981 Published in print 1 May 1981 InformationCopyright © 1981, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Tap Water Burns in Handicapped Children

The original tap water burn series included three handicapped children, but the extent of their special risk of injury was not appreciated or emphasized.1 When I (K.W.F.) presented that burn series to the medical staff at Children's Orthopedic Hospital and Medical Center, my colleagues in the handicapped children's clinic suggested the possible increased risk to their patients because of their anesthesia and motor dysfunction. In September 1978, we sent letters to the 730 families of those clinic patients informing them that tap water can cause severe burns and that their children might be at a greater risk of injury. We suggested that they set back their water heater thermostats to 49 to 54 C (120 to 130 F).

Esophageal atresia and tracheoesophageal fistula: Review of thirteen years’ experience

A review of the treatment of esophageal atresia (EA) was undertaken to examine current methods of management and to ascertain the influence of prematurity and associated medical defects on survival. One hundred patients with EA presented at The Children's Orthopedic Hospital and Medical Center, Seattle, between 1967 and 1979. Eighty-two percent had a blind proximal esophageal pouch and distal tracheoesophageal fistula (TEF). Ninety-two patients were initially treated by gastrostomy. Fifty-nine patients were born at term and had no major medical problems. They underwent either primary or delayed (up to 1 week) repair of the esophagus. The survival rate was 93% and surgical mortality was 3%. Twenty-two patients born prematurely or having major medical problems underwent a staged repair. Survival in the staged group was 55% with a surgical mortality of 27%. Overall survival for the entire series was 79% (79/100). The use of air rather than contrast material for the radiographic diagnosis of EA was associated with fewer subsequent pulmonary abnormalities. There was an 18% incidence of minor anastomotic leaks, regardless of technique. The route of approach (transpleural, retropleural) did not influence mortality or morbidity in this series. There were more than three times as many significant strictures among patients who had double-layer anastomoses (18%) as among those who had single-layer repairs (5%). The surgical treatment of infants with EA has reached a level in which associated illness, anomalies, or prematurity are now the most significant determinants of survival.

An interdisciplinary teacher education program

In 1975 the faculty of the University of Washington School of Dentistry, in conjunction with the College of Education and the affiliated Children's Orthopedic Hospital and Medical Center, developed a 36-month formal teacher education program in combination with joint specialty training in pedodontics and orthodontics. The program goal was to produce a professional dental educator/administrator who could function primarily in the teaching and practice of child and adolescent comprehensive care. After four years and three graduates, the faculty terminated this program. This paper outlines the rationale and structure of the original program and discusses the reasons for its termination.

Cystic cerebellar astrocytomas in childhood

Thirty-nine patients with low grade cystic cerebellar astrocytomas were treated at the University of Washington and Children's Orthopedic Hospital in Seattle, Washington, between 1955 and 1977; 29 were treated with partial or complete resection alone, and 10 received radiation therapy after various types of surgical procedures. With a mean follow-up time of 7 years, the survival rate for patients who had complete resections of their primary disease was 100%. The relapse-free survival rate was 82%. The relapse-free survival rate for patients treated primarily with partial resection alone was 36%. Postoperative irradiation after partial resection for both primary and recurrent disease resulted in a relapse-free survival rate of 83%. If complete tumor excision is not possible, postoperative radiation therapy is recommended following partial resection.

The spectrum of the DiGeorge syndrome

Clinical and autopsy data on 25 patients with DiGeorge syndrome and its variants are presented. Congenital heart disease was the most common presenting complaint; 15 patients came to medical attention in the first 48 hours of life because of cyanosis, cardiac murmurs, or tachycardia and tachypnea. Two unusual anomalies, interrupted aortic arch or truncus arteriosus, were seen in 17 patients. Clinically documented hypocalcemia associated with seizures was seen in ten patients, with a median age at onset of eight days. Fifteen of our 25 patients died at less than one month of age. Most of the patients surviving the first month of life developed purulent rhinitis, maculopapular rashes, failure to thrive, and developmental delay. Sixteen patients had major congenital anomalies not localized to the anterior neck and thorax; these anomalies included arhinencephaly, cleft lip, palate, or uvula, diaphragmatic abnormalities, hydronephrosis, malrotation of the gut and imperforate anus. The 24 autopsied cases constitute 0.7% of the 3,469 sequential postmortem studies done in the period 1950--1975 at The Children's Orthopedic Hospital and Medical Center.

Cardiac surgery under age two years: A review

To assess the current status and risks of both open and closed cardiac procedures for congenital heart disease in patients under the age of 2 years, we reviewed all cardiac catheterizations and cardiac operations done from January, 1974, through December, 1977, at The Children's Orthopedic Hospital and Medical Center in Seattle, Washington. In this interval 370 patients under 2 years of age were catheterized. Eighty open procedures were performed in patients under 2 years of age, with seven hospital deaths. One hundred twenty-four closed heart procedures were performed on children under the age of 2 years, with eight deaths, for a hospital mortality rate of 6.5 percent. This review of consecutive cases over a 4 year period suggests that the judicious application of palliation or open repair using current techniques can lead to an overall mortality rate of between 6 and 7 percent for both open and closed heart procedures in children under 2 years of age. Since all deaths except one in the open-heart group occurred in patients with the most complex multiple defects, it seems reasonable to suggest that improved intraoperative and postoperative techniques have lowered the time for repair of straightforward congenital heart defects to under 2 years of age.

Autotransfusion for surgery: A comeback?

Replacement of blood loss during surgery with the patient's own blood—certainly not a new idea— currently is attracting increased attention from anesthesiologists and surgeons. Why the second look? First, autotransfusion gives the patient the best blood product he can use: his own. Second, use of autologous blood reduces demand on local and national blood reserves. Several reports on intraoperative autotransfusion were presented at the recent Chicago meeting of the American Society of Anesthesiologists. Eric Furman, MB, BCh, of the Department of Anesthesiology, Children's Orthopedic Hospital and Medical Center and the University of Washington School of Medicine, Seattle, employs the hemodilution technique of autotransfusion. A predetermined amount of blood is withdrawn from the patient at the time of surgery and replaced with an electrolyte solution. When surgery is completed, the blood is returned. An intravenously administered diuretic promotes the elimination of the electrolyte solution. The procedure is indicated, Furman states, in

RESPIRATORY FAILURE IN CHILDHOOD STATUS ASTHMATICUS

Children's Orthopedic Hospital and Medical Center and Division of Allergy, School of Medicine, University of Washington, Seattle, Washington

Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management.

Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management.

A double-blind evaluation of the use of nebulized metaproterenol and isoproterenol in hospitalized asthmatic children and adolescents

This study compared two beta-adrenergic agents in the treatment of severe asthma of children and adolescents. Thirty patients admitted to Children's Orthopedic Hospital and Medical Center with acute asthma were treated with either isoproterenol 0.05% (iso) or metaproterenol 0.5% (meta) nebulized in physiologic saline and delivered with O 2 in addition to intravenous hydration, aminophylline, and corticosteroids. Vital signs, blood gases, and pulmonary function were monitored frequently. No adverse reactions to the study drugs were encountered. Pulse rates increased similarly after treatments with both drugs. Patients treated with meta had somewhat higher rates than those treated with iso. Diastolic blood pressure decreased significantly from admission in the meta group compared to the iso group. For FVC and FEV 1, the meta group had greater percentage increases from admission than the iso group at all times, with the difference being significant (p < 0.05) at 1 and 12 hr. The same trend occurred for FEF 25%–75%. Though iso seemed to cause greater increases in flow immediately after administrations, these changes were transient compared to improvement caused by meta. Thus, meta seemed to be more effective than iso in reversing bronchospasm as measured by certain pulmonary function parameters.

Children's Orthopaedics—Practical Problems

Children's Orthopaedics—Practical Problems

An approach to children's foot orthopedics.

An approach to children's foot orthopedics.