Papers by Sanjeev Sabharwal
The Journal of bone and joint surgery. American volume, 2009
It is well recognized that the alignment of the lower limb changes during early childhood. The hi... more It is well recognized that the alignment of the lower limb changes during early childhood. The hip-knee-ankle angle is often referred to as the mechanical femoral-tibial angle and is measured on a full-length radiograph of the lower extremity. While several authors have independently reported consistent reference values for the hip-knee-ankle angle in adults, such values have not been well documented for children. The purpose of our study was to establish reference values for the hip-knee-ankle angle and assess the relationship between it and the anatomic femoral-tibial angle in children.
The Journal of bone and joint surgery. American volume, 2009
It is well recognized that the alignment of the lower limb changes during early childhood. The hi... more It is well recognized that the alignment of the lower limb changes during early childhood. The hip-knee-ankle angle is often referred to as the mechanical femoral-tibial angle and is measured on a full-length radiograph of the lower extremity. While several authors have independently reported consistent reference values for the hip-knee-ankle angle in adults, such values have not been well documented for children. The purpose of our study was to establish reference values for the hip-knee-ankle angle and assess the relationship between it and the anatomic femoral-tibial angle in children.
The Journal of Bone and …, 2006
Background: Although a scanogram is commonly used to measure limb-length discrepancy, there are s... more Background: Although a scanogram is commonly used to measure limb-length discrepancy, there are several potential pitfalls associated with this imaging technique. The purpose of the present study was to evaluate the results obtained with use of a full-length standing ...
The Journal of Bone and Joint Surgery ( …, 2007
Children with Blount disease tend to be heavier than their peers; however, the relationship betwe... more Children with Blount disease tend to be heavier than their peers; however, the relationship between the magnitude of obesity and the severity of limb deformities in Blount disease has not been well studied. A retrospective review of the preoperative medical records and radiographs of patients with previously untreated Blount disease was conducted. Demographic information including gender, ethnicity, the age when deformity was first noted, the age at the examination, and the body mass index was recorded. Frontal and sagittal plane deformities were analyzed by one examiner using full-length standing radiographs. The association of body mass index with various demographic and deformity parameters was then analyzed. Over an eight-year period, forty-five patients with sixty-five limbs affected by Blount disease were identified. Seventeen children (twenty-seven limbs) had early-onset Blount disease, and twenty-eight children (thirty-eight limbs) had late-onset disease. Fifteen of the children with early-onset disease and twenty-six of those with late-onset disease were overweight. There was no significant relationship between body mass index and gender, ethnicity, or laterality. The children with early-onset disease tended to have a lower body mass index but a greater magnitude of radiographic deformities compared with the children with late-onset disease. Greater varus malalignment (r = 0.74, p < 0.0001) and tibial procurvatum (r = -0.79, p = 0.002) were noted with an increasing body mass index in the early-onset, but not the late-onset, group of patients. Irrespective of the age at onset, the correlation of body mass index with frontal and sagittal plane deformities was stronger in extremely obese children (body mass index of > or =40). There is a significant relationship between the magnitude of obesity and biplanar radiographic deformities in children with the early-onset form of Blount disease and in those with a body mass index of > or =40. These clinical findings are consistent with the literature concerning the effect of compressive forces on growth at the proximal tibial physis. Prognostic Level II.
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2007
Journal of Orthopaedic Trauma, 2005
Given the constraints of a short metaphyseal fragment and adjacent growth plates, there are limit... more Given the constraints of a short metaphyseal fragment and adjacent growth plates, there are limited options for operative fixation of metadiaphyseal fractures of the femur in children. This article outlines the surgical technique and reports early results of metadiaphyseal pediatric femur fractures treated with an Ilizarov external fixator by a single surgeon. Ten skeletally immature males with 5 proximal and 5 distal metadiaphyseal femur fractures underwent closed reduction and application of an Ilizarov external fixator. Time in the fixator averaged 138 (range, 104-180) days. At a mean follow-up of 26 months, there were no cases of loss of reduction, refracture, malalignment, leg length inequality, or loss of knee and hip mobility. Although superficial pin tract infections were common, no patient developed deep infection or required premature pin removal. One patient developed a transient foot drop after external fixation for a distal metadiaphyseal fracture, which recovered after revision of the pin construct. A low profile Ilizarov fixator can be effective in the management of certain metadiaphyseal pediatric femur fractures that may be difficult to manage by traditional methods.
Journal of Spinal Disorders Techniques, 2006
There is little awareness among surgeons of the potential for noninvasive mechanical ventilation ... more There is little awareness among surgeons of the potential for noninvasive mechanical ventilation as an alternative to prolonged endotracheal intubation or tracheostomy for patients with neuromuscular scoliosis and ventilatory failure. These methods have not been reported for the perioperative management of scoliosis correction in patients with an inability to sustain their alveolar ventilation. Five children with flaccid scoliosis secondary to muscular dystrophy or spinal muscular atrophy who had very high pulmonary risk were preoperatively trained in the use of noninvasive intermittent positive-pressure ventilation (IPPV) and mechanically assisted coughing prior to spinal fusion. All patients were extubated by the third postoperative day to noninvasive IPPV despite continuous ventilator dependence. No patient developed any postoperative pulmonary complications or required a tracheotomy. It is critical for the orthopedic surgeon to be aware of these noninvasive options to tracheotomy to decrease the tendency to avoid surgery for these otherwise high-risk surgical patients.
American Journal of Orthopedics, May 1, 2006
Limb Lengthening and Reconstruction Surgery Case Atlas, 2015
Limb Lengthening and Reconstruction Surgery Case Atlas, 2015
Journal of Pediatric Orthopaedics B, 2016
Children with underlying metabolic bone diseases, such as osteogenesis imperfecta and spastic cer... more Children with underlying metabolic bone diseases, such as osteogenesis imperfecta and spastic cerebral palsy, pose a challenge in the treatment of femoral shaft fractures. We performed flexible intramedullary nailing with supplemental monolateral external fixation in a subgroup of such patients. The external fixator assists in controlling angulation and rotation at the fracture site, and avoids the need for supplemental casting with its associated problems such as skin breakdown and difficulty with personal hygiene. We describe the surgical technique, pitfalls, and outcomes in a series of four patients with underlying osteopenia treated with external fixator-augmented flexible nailing for femoral shaft fractures.
Limb Lengthening and Reconstruction Surgery Case Atlas, 2014
Clinical Orthopaedics and Related Research®, 2015
Limb Lengthening and Reconstruction Surgery Case Atlas, 2014
Limb Lengthening and Reconstruction Surgery Case Atlas, 2014
Limb Lengthening and Reconstruction Surgery Case Atlas, 2015
The Journal of bone and joint surgery. American volume, Jan 7, 2015
Clinical orthopaedics and related research, 2014
Journal of pediatric orthopedics
Patients with limb length discrepancy (LLD) often have associated angular deformities requiring a... more Patients with limb length discrepancy (LLD) often have associated angular deformities requiring a standing full-length radiograph of the lower limb in addition to a scanogram. The purpose of our study was to determine the intraobserver and interobserver reliability of measuring LLD with both techniques, using computed radiography. The LLD was measured on 70 supine scanograms and standing anteroposterior radiographs of the lower extremity by 5 blinded observers on 2 separate occasions. Intraclass correlation coefficient (ICC) and mean absolute difference (in millimeters) was calculated to assess intraobserver and interobserver reliability and found to be excellent for both radiographic techniques. Intraobserver ICC and mean absolute difference was 0.975 to 0.995 and 1.5 to 2.6 mm for scanogram and 0.939 to 0.996 and 1.5 to 4.6 mm for the standing radiograph, respectively. Repeated measurements for both radiographic studies were within 5 mm of the first measurement greater than 90% an...
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Papers by Sanjeev Sabharwal