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Correction of clubfoot deformity associated with Weber type I tibial hemimelia using the Ponseti method

Chen, Tracy S; Sala, Debra A; Chu, Alice; Chorney, Gail S; Lehman, Wallace B
The clubfoot deformity associated with Weber type I tibial hemimelia, a rare congenital disorder, is rigid and difficult to correct. Surgeons have utilized a variety of treatment methods. Since the 1960s, some adopted the Syme amputation to produce a weightbearing lower limb. Others began to explore alternatives such as the Ilizarov technique, ankle reconstruction, and casting, which salvage the foot but have produced mixed results. The current investigators suggest that the Ponseti method, a minimally invasive technique, can produce a functional weightbearing foot. Two cases were treated with the Ponseti method, including a percutaneous Achilles tenotomy and post-cast bracing. After a minimum of 2-years follow-up, both are ambulatory
PMID: 21162708
ISSN: 1936-9727
CID: 117347

Outcomes analysis after routine removal of implants in healthy pediatric patients

Chu, Alice; Madou, Maura R Z; Sala, Debra A; Chorney, Gail S; Feldman, David S
Routine removal of nonspinal, orthopedic implants from pediatric patients is a debated practice. The purpose of this study was to compare preremoval and postremoval outcome measures in children. Twenty-five patients, mean age 11.6 years, completed a pain scale and the Pediatric Outcomes Data Collection Instrument (PODCI). Many patients scored in the normal range of the PODCI before and after removal. Higher postoperative PODCI scores were found in patients without preoperative pain, and in patients with upper extremity versus lower extremity implants. In summary, routine removal of implants in children was carried out without complications and with some functional benefits.
PMID: 19623086
ISSN: 1060-152x
CID: 566802

Patient survey of weight-bearing and physical activity after in situ pinning for slipped capital femoral epiphysis

Anand, Ashish; Chorney, Gail S
Patients with slipped capital femoral epiphysis(SCFE)are often instructed to use crutches and restrict their activities after surgery. In the retrospective study reported here, we determined actual duration of crutch use and activity restriction in patients with SCFE treated with in situ pinning. Forty-three patients (mean age, 14.1 years) responded to a questionnaire. Four patients (9%) never used crutches, and 29 patients (67%) used crutches for 4 weeks or less. Three patients (7%) never restricted their activity, and 29 patients (67%) had resumed full activities, including sports, by 6 months. None of the patients had any postoperative complications. Although these results suggest that early resumption of activities, which would be beneficial to these typically obese patients, is possible without detrimental effects, further investigation is needed before an algorithm for postoperative rehabilitation can be presented
PMID: 17657318
ISSN: 1078-4519
CID: 73705

Anterior dislocation of the radial head with fractures of the olecranon and radial neck in a young child: a Monteggia equivalent fracture-dislocation variant [Case Report]

Ruchelsman, David E; Klugman, Jeffrey A; Madan, Sanjeev S; Chorney, Gail S
We present a case of a type I Monteggia equivalent lesion in a 7-year-old child consisting of anterior dislocation of the radial head, radial neck fracture, and a fracture of the olecranon without an associated fracture of the ulnar diaphysis or metaphysis. After a review of the literature, we report this fracture pattern as a rare type I Monteggia equivalent fracture-dislocation variant. This report describes delayed surgical treatment and outcome after close follow-up of a rare type I Monteggia equivalent lesion. Diagnostic challenges with and treatment options for pediatric Monteggia equivalent fracture-dislocations are discussed
PMID: 16003205
ISSN: 0890-5339
CID: 90074

The Spine

Chapter by: Chorney, GS
in: Sports Medicine: A Comprehensive Approach by
pp. 498-502
ISBN: 9780323070201
CID: 1843272

Severe mid-cervical kyphosis with cord compression in Larsen's syndrome and diastrophic dysplasia: unrelated syndromes with similar radiologic findings and neurosurgical implications

Forese LL; Berdon WE; Harcke HT; Wagner ML; Lachman R; Chorney GS; Roye DP
Mid-cervical kyphosis in diastrophic dysplasia (DD) with cord compression and weakness has been recognized for the last three decades. A strikingly similar situation exists in Larsen's syndrome (LS), an otherwise unrelated problem of weakness with lay joints and dislocations with typical facies. Forty patients with DD were studied of whom seven had cervical spine kyphosis: one patient had spontaneous correction over the ensuing two decades. Seven patients with LS were studied of whom four had cervical spine changes with cord compression. There was one sudden death among the patients with LS and no cases of spontaneous correction. Muscle weakness in DD and LS should lead to evaluation of cervical spine kyphosis with cord compression. Plain films, CT and recently MRI are useful
PMID: 7596660
ISSN: 0301-0449
CID: 25248

Compressive stress-relaxation behavior of bovine growth plate may be described by the nonlinear biphasic theory

Cohen B; Chorney GS; Phillips DP; Dick HM; Mow VC
The compressive behavior of the bovine distal femoral growth plate was studied in vitro. Strain-rate controlled, compression stress-relaxation experiments were performed on cylindrical bone-growth plate-bone specimens from the interior and periphery of the growth plate. The questions addressed in this study were (a) Can the nonlinear biphasic theory, one with strain-dependent permeability, be used to represent the compressive stress-relaxation behavior of bovine growth plate? (b) How do different assumptions concerning the permeabilities of the chondro-osseous interfaces influence the inferred material properties of the growth plate? and (c) Are there any differences in these properties between the periphery and the interior of the growth plate? Intrinsic biphasic material properties--aggregate modulus (HA), Poisson's ratio (v), and nonlinear strain-dependent permeability coefficients (ko and M)--were calculated from the compression stress-relaxation data with use of a finite element model and a least squares curve-fitting procedure. To verify this constitutive model for the growth plate, an independent set of finite element analyses was performed with use of the determined intrinsic biphasic properties, and comparisons were made between these finite element predictions and two additional sets of experimental data subsequently obtained for the same specimens with use of two slower rates of compression. Excellent agreement was achieved between these finite element predictions and the latter two sets of data. The aggregate modulus was found to be insensitive to the permeability of the chondro-osseous interface. The permeability coefficients were very sensitive to, and the Poisson's ratio was only slightly sensitive to the interface permeability condition. Therefore, the periphery of the growth plate is more compliant and permeable than the interior
PMID: 7983556
ISSN: 0736-0266
CID: 25249

The microstructural tensile properties and biochemical composition of the bovine distal femoral growth plate

Cohen B; Chorney GS; Phillips DP; Dick HM; Buckwalter JA; Ratcliffe A; Mow VC
The tensile properties of distal femoral growth plates from 12-month-old cows were determined on uniformly prepared straight bone-growth plate-bone specimens (7 x 7 mm2 in cross-section) from predetermined anatomical sites on the physis. Each specimen was distracted to failure using a computer-controlled servo-hydraulic testing machine at a strain rate of 0.004 s-1. It was found that the exponential constitutive law, using finite deformation formulation for strain, provides an excellent description of the stress-strain behavior of all the specimens up to the point of failure. The ultimate stress and both tangent moduli (i.e., the toe region tangent modulus and the tangent modulus calculated at 75% of ultimate strain) varied with anatomical site. The anterior region was the strongest, followed by the posterior/lateral. The anterior and posterior/lateral regions were also the stiffest, whereas the posterior/medial and center regions were the weakest and most compliant. The bone-growth plate-bone specimen exhibited a low ultimate strain (13.8% +/- 6%) that did not vary significantly throughout the growth plate. This result suggests that disruption of the physis may occur in vivo even at the lower distractions currently recommended for the clinical chondrodiatasis procedure for leg lengthening. The biochemical composition of the growth plate in the anatomical regions correlated well with the tensile properties. There was a greater collagen content in the regions that were the stiffest and strongest. The gross morphology of the growth plate of the bovine distal femur is also described in this study. There is a regular pattern to the undulations of the physis at several dimensional levels. Histologic findings showed that orientation of the hypertrophic cell columns and transphyseal septa are aligned nearly parallel to the longitudinal axis of the diaphyseal shaft. This column orientation is not affected by the undulation of the primary contour of the physis, which at certain locations may be inclined as much as 60 degrees relative to the diaphyseal axis. The orientation of the hypertrophic cell columns appears to be one of the dominant microstructural features influencing the tensile behavior of the bone-growth plate-bone specimens
PMID: 1740744
ISSN: 0736-0266
CID: 25250

Femoral varus and acetabular osteotomies in cerebral palsy

Roye DP Jr; Chorney GS; Deutsch LE; Mahon JH
Sixty-three patients with cerebral palsy underwent proximal femoral varus derotation osteotomy for 86 subluxing or dislocating hips. Eleven hips underwent concomitant pelvic osteotomy. Adductor tenotomy was performed in all patients. The average preoperative femoral neck shaft angle was 158.2 degrees, with a center edge angle of -2 degrees. Femoral osteotomy effected an average femoral neck shaft angle of 132.2 degrees, with a center edge angle of +8 degrees. A Chiari osteotomy was performed when the acetabular index was greater than 35 degrees. This preoperative acetabular index of 46 degrees improved to 28 degrees postoperatively, and proved to be the most reliable indicator for need of an added pelvic osteotomy
PMID: 2259661
ISSN: 0147-7447
CID: 25251