Voluntary (normal) versus obligatory (cerebral palsy) toe-walking in children: a kinematic, kinetic, and electromyographic analysis.

Surgical management of toe-walking gait in children with cerebral palsy currently favors simultaneous, multilevel soft-tissue and bony interventions. Formulation of such a surgical plan is based on our ability to determine which of the gait deviations present are primary and which are secondary or compensatory. To evaluate this issue further, 32 normal children, walking normally and voluntarily toe-walking, were compared to 15 children with cerebral palsy walking in an obligatory toe-walking gait pattern.

Objective assessment of dyskinesia in children with cerebral palsy.

The clinical classification of children with cerebral palsy is limited by multiple factors. Distinguishing between spasticity and dyskinesia is critical, because the outcome after standard orthopaedic and neurosurgical interventions is less predictable in children with cerebral palsy who have a significant dyskinetic component. This study applied computer-based analysis of gait to assess objectively the presence of significant dyskinesia in children with cerebral palsy.

Kinematic and kinetic analysis of running in children with cerebral palsy.

Computer-based analysis of gait was used to study walking and running in 19 children with spastic-diplegic cerebral palsy (CP) and 15 healthy control children. Temporospatial parameters, kinematic and kinetic data were compared and contrasted between groups for both types of gait. The majority of children with diplegic CP, who are independent ambulators, are able to run.

Proximal tibiofibular bifurcation synostosis for the management of longitudinal deficiency of the tibia.

Three adults with severe longitudinal deficiency of the tibia (LDT), in which an unossified proximal tibial anlage was present, who had been treated with proximal tibiofibular bifurcation synostosis (PTFBS) in early childhood, were evaluated between 20 and 31 years after the index procedure. All three were found to be functioning well as below-the-knee (BK) amputees. Mediolateral stability and anteroposterior instability of the knee were present in all cases.

Characterization of the muscarinic receptor subtype(s) mediating contraction of the guinea-pig lung strip and inhibition of acetylcholine release in the guinea-pig trachea with the selective muscarinic receptor antagonist tripitramine.

1. The muscarinic receptor subtypes mediating contraction of the guinea-pig lung strip and inhibition of the release of acetylcholine from cholinergic vagus nerve endings in the guinea-pig trachea in vitro have previously been characterized as M2-like, i.e.

Skin surface pressure beneath an above-the-knee cast: plaster casts compared with fiberglass casts.

Complications related to immobilization in a cast after an injury or an operation may be related to the materials used for the cast or to the techniques of application, or to both. To evaluate the widely held clinical opinion that the use of a fiberglass cast is dangerous and inappropriate when subsequent swelling of the extremity is anticipated, we studied the skin surface pressures that were generated beneath above-the-knee casts made with different materials and applied with different techniques. A prosthetic model of the lower extremity was designed with an expandable calf compartment to simulate swelling after an injury or an operation.

Dislocating medial triceps and ulnar neuropathy in three generations of one family.

Variations in the medial triceps in conjunction with bilateral ulnar neuropathy have been identified in three generations of one family also possessing the phenotype of Waardenburg syndrome (a rare autosomal-dominant disorder with clinical features including cochlear deafness, dystopia canthorum, and pigmentation problems). To our knowledge, no other inherited condition with triceps anomalies has been reported. Study of this family provided insight into the relationship between dislocating medial triceps and ulnar neuropathy and demonstrated that a broad spectrum of clinical presentations exists-from being completely asymptomatic to producing symptomatic snapping and ulnar neuropathy.

Surgical management of ankle valgus in children: use of a transphyseal medial malleolar screw.

Valgus deformity of the ankle in children is associated with a wide variety of clinical conditions. A retrospective review was performed of 17 children (29 involved extremities) with ankle valgus deformity who had been managed by use of a percutaneously placed, transphyseal medial malleolar screw. Median age at the time of surgery was 11 years, 2 months.

Pediatric knee. Clinical assessment and common disorders.

Knee pain and injury are commonly seen in children and adolescents. A comprehensive evaluation of the knee is built on an appreciation of the anatomy, biomechanics, and pathophysiology of common disorders. This article considers these issues and describes a sequential technique for physical examination of the knee.

A dynamic biomechanical analysis of the etiology of adolescent tibia vara.

Biomechanical overload of the proximal tibial physis due to static varus alignment and excessive body weight has been implicated in the etiology of infantile tibia vara. Whether a similar pathophysiologic process applies to adolescent tibia vara is controversial, with poor consensus concerning the nature and significance of static knee alignment early in the course of the disease. This study examines the hypothesis that dynamic gait deviations to compensate for increased thigh girth associated with obesity (fat-thigh gait) could result in increased loading of the medial compartment of the knee during the gait cycle.

Longitudinal deficiency of the fibula. Operative treatment.

We reviewed the results of early amputation and prosthetic fitting in twenty-five children (thirty-one extremities) who had longitudinal deficiency of the fibula and were managed between 1977 and 1992. The median age at the time of the initial operation was thirteen months (range, eight months to nine years and eight months). The median duration of follow-up was eight years and ten months (range, two years and six months to sixteen years and eleven months).

Operative treatment of bone overgrowth in children who have an acquired or congenital amputation.

Fifty-three children who were less than thirteen years old were followed for a median of seven years and ten months (range, two years and nine months to fourteen years and six months) after operative treatment for overgrowth of the tibia or humerus after amputation. During the thirty-one years in which these children were managed, three operative techniques were used in successive periods. Thus, the fifty-three children could be divided into three groups: thirty-one who had had a resection and revision, nine in whom the bone had been capped with a synthetic device, and thirteen in whom the bone had been capped with an autogenous tricortical bone graft from the iliac crest.

Ultrasonography and developmental dysplasia of the hip: a cost-benefit analysis of three delivery systems.

The role of ultrasound (US) in the diagnosis and management of infants with developmental dysplasia of the hips (DDH) is becoming widely accepted. In our community, there exist three delivery systems for US-DDH: the radiology based, the combined radiology/orthopaedic based, and the orthopaedic office based. This study reviewed the costs and benefits of each delivery system and found that once expertise had been gained and start-up costs were met, the orthopaedic office-based system was the most convenient, efficient, and cost effective for the patient/family and treating physicians.

[Reaction of a young boy in early latency to the sudden death of his newborn brother].

Surprisingly little has been written on the impact of the death of a baby on an older sibling. This paper describes how a narcissistically vulnerable latency boy grappled, in the course of his psychotherapy, with the painful loss of his baby brother. Emotional and cognitive aspects of his early confrontation with the reality of death are considered.

Radiosensitivity of testicular cells in the fetal mouse.

The effects of prenatal X irradiation on postnatal development of the CBA/P mouse testis was studied. At days 14, 15 and 18 post coitus pregnant female mice were exposed to single doses of X rays ranging from 0.25-1.

Single-incision combination biopsy (muscle and nerve) in the diagnosis of neuromuscular disease in children.

The diagnosis of specific neuromuscular diseases in infants and children is often suspected clinically and confirmed histologically by muscle biopsy. In relatively few cases, the differential diagnosis includes hereditary or acquired peripheral neuropathies, and nerve biopsy is required for diagnosis. Historically, children who needed both muscle and nerve biopsies have had two separate incisions at the thigh (muscle) and ankle (nerve) to obtain the specimens.

Radiosensitivity of testicular cells in the prepubertal mouse.

The effects of total-body X irradiation on the prepubertal testis of the CBA/P mouse have been studied. At either day 14 or day 29 post partum male mice were exposed to single doses of X rays ranging from 1.5-6.

Lateral condylar fracture of the humerus following posttraumatic cubitus varus.

Posttraumatic cubitus varus is widely regarded as just a cosmetic deformity. Six cases of lateral condylar fracture of the humerus in children with preexisting cubitus varus due to prior elbow fracture are presented. Five occurred following malunited extension-type supracondylar fractures of the humerus; the other occurred following a lateral condylar fracture complicated by lateral overgrowth.

Rotational deformity and remodeling after fracture of the femur in children.

The remodeling potential of angular deformities in the coronal and sagittal planes in children is widely appreciated, and has been studied extensively. The short-term clinical consequences and remodeling potential of torsional deformity after fracture of the femur are less well understood. Computerized axial tomography (CT) was used to identify and follow children with torsional malunion after standard treatment (traction/spica cast) of a closed femur fracture.

Significance of the confusion test in cerebral palsy.

The confusion test examines ankle dorsiflexion in patients with cerebral palsy. Orthopedists have related this test to swing-phase activity of the tibialis anterior, and have used it as a prerequisite for tendon transfer. To determine the validity of this assumption, ankle dorsiflexion was tested in 47 normal children.

Postnatal development of testicular cell populations in mice.

The postnatal development of body and testis weight and the size of the testicular cell populations were studied in CBA mice up to day 52 post partum. The body weight increased from 1.3 g at day 1 to 22.

Subcutaneous granuloma annulare: recognition and treatment.

Subcutaneous granuloma annulare (SGA) is a benign inflammatory disorder that occurs in children. The profiles of 12 children with SGA who were diagnosed and treated at our institution were reviewed. The patients presented with a rapidly growing, painless soft-tissue mass of the extremities or scalp.

Differential effects of fractionated X irradiation on mouse spermatogonial stem cells.

The response of spermatogonial stem cells to fractionated X irradiation was studied in the various stages of the spermatogenic cycle of the CBA mouse. Fractionated doses of 2 + 2, 1 + 3, and 3 + 1 Gy with a 24-h interval between the doses were compared with a single dose of 4 Gy. The numbers of undifferentiated spermatogonia present 10 days after (the second) irradiation were taken as a measure of stem cell survival.