Progression of the curve in boys who have idiopathic scoliosis.

The prevalence of curve progression was evaluated in 210 boys who had idiopathic scoliosis. A minimum age of eight years, a deformity of at least 10 degrees, and radiographic follow-up of one year or progression of the curve within the first year of follow-up were the criteria for inclusion in the study. Of the 210 patients, sixty-eight (32 per cent) had progression of 10 degrees or more.

Congenital vertebral displacement.

We defined congenital vertebral displacement as displacement at a single vertebral level that results in an abrupt displacement of the neural canal. We reviewed the data on 642 patients who had congenital vertebral abnormalities and identified ten who had congenital vertebral displacement. There were two patterns of deformity: Type A (eight patients) consisted of displacement in the sagittal plane only, and Type B (two patients), rotatory, transverse, and sagittal displacement.

The pulp plasty: a composite graft for complete syndactyly fingertip separations.

Composite grafts of skin and subcutaneous fat harvested from the glabrous non-weight-bearing areas of the foot were used to graft 34 fingertips after separation of 23 complete syndactyly webs in 13 patients. Simple complete syndactylies accounted for 17% and complex complete syndactylies accounted for 83%; synonychia was encountered in 70%. Follow-up averaged 13.

Combined split anterior tibial-tendon transfer and intramuscular lengthening of the posterior tibial tendon. Results in patients who have a varus deformity of the foot due to spastic cerebral palsy.

Twenty patients who had a varus deformity of the foot secondary to spastic cerebral palsy had twenty-two operations involving combined split anterior tibial-tendon transfer and intramuscular lengthening of the posterior tibial tendon, with and without concomitant lengthening of the Achilles tendon. Preoperatively, all patients had had a dynamic varus deformity of the hindfoot and adduction of the forefoot in both the stance phase and the swing phase of gait. At an average follow-up of 6.

Infantile tibia vara.

Infantile tibia vara is a developmental condition producing progressive varus deformity of the knee in young children. It appears to have a worse prognosis in the predominantly nonwhite population seen with this condition in the United States than previous studies from Scandinavia would suggest. Early roentgenographic diagnosis is critical, since toddlers can have infantile tibia vara at an early stage instead of physiologic genu varum.

Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation.

Interobserver variations for measurements of the Cobb angle on radiographs of patients who had kyphosis were comparable with those on the radiographs of patients who had scoliosis. Four staff orthopaedists and one physical therapist measured eight radiographs that showed scoliosis and twenty that showed kyphosis. The measurements were made on two occasions and in random order.

Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment.

In twenty-five patients, the Pavlik harness failed to obtain or maintain reduction in thirty of thirty-five congenital dislocations of the hip. All of the patients had met the clinical criteria for use of the harness in our institution: they were less than seven months old, the femoral head pointed to the triradiate cartilage on anteroposterior radiographs that were made with the child wearing the harness, and they had no evidence of neuromuscular disease or teratological dislocation. These patients were compared with seventy-one patients (eighty-one dislocations) who had also been treated with the Pavlik harness and in whom a stable reduction was obtained and maintained.

Biomechanical analysis of pedicle screw instrumentation systems in a corpectomy model.

Five different spinal implants, all using pedicle screw attachment to vertebrae, were examined in a one above/one below corpectomy model, to determine 1) the relative stiffness of each construct, 2) the stresses generated in the implant during loading, and 3) the relative fatigue susceptibility of each implant. Results indicated that the relative axial and torsional stiffnesses were similar for all the implants tested (DKS/Zielke, VSP/Steffee, AO Fixator Interne, Luque plate, AO Notched plate). Hence, each of the devices impart approximately the same stability to the spine in this highly unstable model.

In vitro spinal arthrodesis implant mechanical testing protocols.

Mechanical testing protocols and test methods used to evaluate spinal implants have varied widely. Use of different test methods would not present a problem except that multicomponent mechanical systems, such as the spine and spinal implant constructs, yield different mechanical properties when subjected to different test methods. The goal of this article is to outline considerations specific to the mechanical assessment of spinal implants.

Gastrostomy and Nissen fundoplication in neurologically impaired children.

We report our experience with 90 neurologically impaired children treated with gastrostomy and Nissen fundoplication. Malnutrition was the main problem, followed by aspiration, recurrent pneumonia, and vomiting. The symptomatology was caused by swallowing incoordination and gastroesophageal reflux.

Parent involvement in physical therapy: a controversial issue.

Children with physical disabilities are often treated in physical therapy without a parent present, under the assumption that the parent may "interfere" with therapy and/or the child will be too distracted if a parent is present. The effectiveness of a therapy program with parental involvement was compared to a program without parents involved. Results indicate that training with the mother present was as effective as training without the mother.

One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening.

We reviewed the results of primary operative treatment in twenty-five patients (thirty-three hips) who were two years or older and had congenital dislocation of the hip. None of the patients had had previous treatment for the dislocation. Preliminary traction was not used in any patient.

Infantile tibia vara.

We studied the applicability of Langenskiöld's classification to a predominantly nonwhite population with infantile tibia vara. Age at presentation was younger than that in previously published studies. Forty-seven tibiae averaging 6 years 7 months of follow-up had 66% good results.

Disarticulation of the knee in children. A functional assessment.

We assessed the functional abilities of six patients who had had disarticulation of nine knees during childhood by analyzing their gait using electrocardiographic telemetry. Those who were more than five years old were further studied by timing them as they ran the fifty-yard (45.7-meter) dash and by testing the strength of the musculature of the hip girdle using a Cybex dynamometer.