Dennis S Weiner

Computed tomography in the measurement of femoral anteversion.

A new technique using computed tomography for measuring femoral anteversion is presented, with advantages over prior techniques. Computed tomography allows the visual portrayal of the cervical axis to be superimposed upon the diacondylar axis for direct goniometric measurement of the anteversion angle. Beyond its accuracy, the procedure requires no complicated positioning framework and can be done in a brief span of time.

Acute Slipped Capital Femoral Epiphysis

The experience at University Hospitals of Cleveland and Childrens Hospital of Akron with fifty cases of acute slipped capital femoral epiphysis is reviewed. In forty-seven hips treated by manipulative reduction and epiphyseodesis, pin fixation, or both, seven cases of avascular necrosis occurred (15 per cent). In nineteen hips treated by manipulative reduction, epiphyseodesis, and plaster immobilization, one case of avascular necrosis occurred (5 per cent), and seventeen (90 per cent) satisfactory functional results were obtained. In sixteen hips treated by manipulative reduction and pin fixation, three cases of avascular necrosis occurred (25 per cent), and twelve (75 per cent) satisfactory functional results were obtained. No case of avascular necrosis occurred in eight patients treated by manipulative reduction within twenty-four hours of the onset of acute symptoms. No case of avascular necrosis occurred in a female patient.

Treatment of osteoid osteoma by computed tomography guided excision in the pediatric patient

An osteoid osteoma is a benign lesion that can occur in any bone. Controversy exists regarding treatment of this condition. This study demonstrates that the nidus of an osteoid osteoma can be disrupted and removed by use of the CORB biopsy system guided by computed tomography (CT) scan. Of nine patients followed for an average of 42.5 months (range 18-76 months), seven have had complete resolution of their pain after this procedure. The technique failed in two patients, who each required two separate en bloc excisions with bone grafting to resolve each lesion. CT-directed CORB appears to be useful in localization and removal of the nidus of an osteoid osteoma.

The characterization of "transient synovitis of the hip" in children.

A 30-year retrospective review of 497 cases of transient synovitis of the hip involving 475 children allowed full characterization of the syndrome. Femoral head measurements of 118 patients at follow-up of 6 months showed no significant dimensional changes. Three cases of Legg-Calvé-Perthes disease (2.5%) were found in follow-up, as well as a case of osteoid osteoma of the femoral neck and two cases of juvenile rheumatoid arthritis. Recurrent synovitis with a benign prognosis occurred in 19 patients. In spite of a generally anticipated good prognosis in the vast majority of cases, radiographic assessment at 6 months after the initial episode is recommended.

Calcaneal fractures in children. An evaluation of the nature of the injury in 56 children.

The traditional view of calcaneal fractures in children is that this injury and its consequences are generally less severe than its adult counterpart. The validity of this conception and other ways in which childrens fractures differ were examined by a retrospective review of childrens injuries. The fracture patterns encountered in children 15 years of age or older resembled those of adults. Intra-articular Type 5 fractures were predominant. Children 14 years of age or younger had predominantly extra-articular fracture patterns, a possible reflection of less frequent mechanisms of vertical compression loading in children and their ability to absorb compression loading. Extra-articular and intra-articular Type 4 fractures were characteristically nondisplaced injuries, with normal calcaneal articulations being preserved in all cases. Unrecognized calcaneal fractures were frequent, reflecting both the difficulty of detecting minimal osseous injury and the benign nature of the unrecognized fracture. Associated fractures of the extremities, twice as frequent in children as adults, and axial skeletal injuries, half as frequent as in adults, should not be overlooked. The prognosis for a normally functioning calcaneus without the presence of post-traumatic arthrosis should be expected in most cases due to the nature of the fracture in children.

Correlation of Risser sign and bone age determination in adolescent idiopathic scoliosis

At the present, there appears to be a lack of unanimity in the choice of whether the Risser sign (iliac apophysis maturation) or determination of skeletal maturation by bone age roentgenograms is the more accurate indicator of maturity in adolescent idiopathic scoliosis. In an effort to clarify this issue, the authors correlated data from 111 patients to determine the relationship between accuracy of Risser sign and bone age determinations performed during similar chronologic intervals. Data from bone age determinations were then correlated with Risser sign data, and a regression line statistical determination was made. The iliac crest apophysis maturation was statistically significantly (p < 0.01) correlated with data retrieved by skeletal age assessment.

The chondroepitrochlearis muscle

The chondroepitrochlearis is a rare muscle anomaly of the pectoral region in the human. The anomaly is an abnormal musculotendinous unit that is found to originate from the pectoralis major and inserts onto the medial epicondyle of the humerus. This muscle, at times, can be associated with the muscular arch of the axilla and can not be mistaken for the rare coracobrachialis longus. The authors are reporting a 2-week-old infant of normal gestational age with this exceedingly rare anomaly and the only known reported successful surgical release of this muscle with return to normal functional status and cosmetic improvement.

NEONATAL FRACTURE-SEPARATION OF THE DISTAL HUMERAL CHONDROEPIPHYSIS: A CASE REPORT

A recent experience with a most unusual case of birth injury at Akron Childrens Hospital Medical Center has prompted this report in an effort to emphasize the rarity of the lesion, the difficulty in both roentgenographic and clinical scrutiny, the mechanics of the injury, and the unusual direction of displacement. Injury to an unossified epiphysis always demands a high index of suspicion; we stress this fact in our report. In this case marked instability at the separation site necessitated open reduction, although closed reduction and immobilization generally have been successful in other reported cases. The authors present a hypothesis about the mechanism of the injury within the birth canal.

Radical one-stage posteromedial release for the resistant clubfoot.

A large proportion of congenital talipes equinovarus is resistant to correction by nonoperative means. The authors reviewed 54 feet which required surgical intervention, and the operative management utilized was a radical one-stage posteromedial release. Application of plastic surgical techniques has obviated problems of skin healing. Comparable to results reported by others, a good-to-excellent functional and cosmetic result can be expected in 90% of the cases. Careful attention to a well-designed postoperative regimen will frequently obviate the need for additional surgery.

THE MANAGEMENT OF 'DEVELOPMENTAL FEMORAL ANTEVERSION': SHAM OR SCIENCE?

A retrospective clinical review of 1,260 consecutive cases of intoeing arising from hip rotation has provided conclusive evidence as to the natural history by spontaneous resolution at the time of skeletal maturation. A concomitant review of 200 randomly selected teenagers failed to provide a single case of manifest intoeing of clinical importance. The conclusion is drawn that treatment other than watchful waiting is unnecessary.