Thursday, March 19, 1998
Stuart Weinstein, MD, will receive the Orthopaedic Research and Education Foundation (OREF) Clinical Research award today for his long-term studies on the natural history of orthopaedic conditions from the time they were discovered in children until those children became adults. The award will be presented during Opening Ceremonies today at 3:45 p.m. in the La Louisianne Ballroom.
Dr. Weinstein's team from the University of Iowa Hospitals and Clinics also evaluated the results of surgical treatment provided to children with spinal, hip and foot disorders to determine whether they were in better physical condition as adults with the treatment than if they had not been treated. "The results of these studies provide orthopaedic surgeons with fundamental knowledge necessary to make intelligent treatment decisions, ultimately resulting in improved patient care," reported Dr. Weinstein, Ponseti Professor of Orthopaedic Surgery.
With a stable population base and good recordkeeping, Dr. Weinstein's team was able to locate hundreds of patients who were first diagnosed more than 30 years ago. In the Scheuermann's kyphosis group, 67 patients were evaluated at an average of 32 years after they were first diagnosed with the round back spinal disorder. These patients had more intense back pain, jobs with lower activity requirements, and less ability to rotate their trunks than did a control group of 34 patients who were matched for age and gender, reported Dr. Weinstein. However, the patients with Scheuermann's did not show any more signs of self-consciousness, need for pain medicine or limitations in daily activities due to back pain than did the control group subjects. While the patients with Scheuermann's kyphosis "may have some functional limitations, the limitations do not cause major interference with their lives," reported Dr. Weinstein.
In a study of 194 patients who had been diagnosed with adolescent idiopathic scoliosis between 1932 and 1948, the Iowa team found that the patients with curvature of the spine had more backache than the general population, but the disorder did not cause significant limitations in vital capacity. In another study involving l02 scoliosis patients who were followed for an average of 40.5 years, the medical investigators documented that 68 percent of the patients' spinal curves progressed after they matured. "Curves that measured between 50 and 75 degrees at maturity, particularly thoracic curves, progressed the most," said Dr. Weinstein.
The third part of the scoliosis study concerned 54 patients who had 64 curves and were followed for 40 years. "The analysis confirmed the radiographic factors identified at skeletal maturity that lead to curve progression apply to the skeletally immature patient as well," he said. The Iowa team's long-term results of Milwaukee Brace Treatment for progressive adolescent idiopathic scoliosis "questions the effectiveness of brace treatment for this condition."
In a pioneering study on persons with congenital hip dysplasia and dislocation, Dr. Weinstein's team has analyzed normal growth and the structure and development of the hip joint in some patients over a 40-year period. They reviewed the records of 119 patients with 152 congenitally dislocated hips who were treated by closed reduction between 1931 and 1969. They found that "the younger the patient at reduction the better were all clinical and radiographic results and the lower the incidence of subluxation, degenerative joint disease and proximal femoral growth disturbance," reported Dr. Weinstein.
The team also analyzed the records of 76 patients whose DDH was
diagnosed late and who required surgery to reduce their dislocations.
With an average 10-year follow-up, the surgeons documented that
the acetabulum can continue to develop for several years after
the corrective surgery. "If DDH goes undetected or is diagnosed
late, normal hip joint growth and development are impaired,"
he said. "With increasing age at detection, especially
beyond six months of age, the obstacles to concentric reductions,
both intra-articular and extra articular, become increasingly
difficult to overcome." Through the long-term studies, they
documented the high degree of variation that occurs in patients
whose dislocations were treated late from a slight functional
disability to severe degenerative disease.
|1998 Academy News Mar.19 Index C|