Wallace B Lehman, M.D.

Progression of idiopathic clubfoot correction using the Ponseti method
Chaudhry, Sonia; Chu, Alice; Labar, Amy S; Sala, Debra A; van Bosse, Harold J P; Lehman, Wallace B
2012 Jan;21(1):73-78, Journal of pediatric orthopaedics. Pt. B
The Ponseti technique involves sequential clubfoot correction by abduction, supination, and finally dorsiflexion. Although shown to be effective, correction progression has not been examined. The Dimeglio/Bensahel classification system was used to analyze heel equinus, varus, midfoot rotation, adduction, posterior crease, medial crease, and cavus initially and after each casting. From 2000 to 2008, 123 patients (185 feet) with idiopathic clubfeet, aged below 60 days, without prior treatment were grouped by number of casts required. Successive castings achieved goals of reducing cavus and medial crease first, then gradually correcting midfoot rotation, adduction, and heel varus. Unexpectedly, heel equinus improved simultaneously with midfoot variables, as well as with final casting
— id: 149792, year: 2012, vol: 21, page: 73, stat: Journal Article,

Persistent clubfoot deformity following treatment by the Ponseti method
Chu, Alice; Lehman, Wallace B
2012 Jan;21(1):40-46, Journal of pediatric orthopaedics. Pt. B
The Ponseti method of clubfoot correction is now widely practiced worldwide. Initial correction rates are nearly 100%, but subsequent relapses may occur in up to one-third of patients. Very little has been written by anyone other than Dr Ponseti about the characterization and treatment of recurrent clubfoot deformity following use of the Ponseti method. This review paper is the first one which draws together the current literature on the topic
— id: 145771, year: 2012, vol: 21, page: 40, stat: Journal Article,

Revision clubfoot surgery with calcaneocuboid fusion: Results at long-term follow-up
Lehman W.; Chaudhry S.; Chu A.; Atar D.; Sala D.
2012 ;21(1):97-97, Journal of pediatric orthopaedics. Pt. B
Purpose: Calcaneocuboid fusion has been used to supplement soft tissue revision clubfoot surgery to tether growth of the outer column of the foot. The purpose of the present study was to reevaluate the clinical and radiographic long-term outcomes of 20 patients (27 clubfeet), treated with this procedure, who were previously examined at mean follow-up of 5.5 years. Methods: Ten patients (13 clubfeet) who underwent this procedure from 1991-1994 returned for radiographs and reevaluation by the original surgeon. Results: Patients had a mean age of 24 years (range 23-26) and an average of 18 years follow-up (range 16-19). The procedure was performed at an average age of 7 years (range 5-8). Eleven of thirteen feet (85%) demonstrated radiographic fusion. The two failed fusions occurred unilaterally in bilaterally treated patients. No patient required major additional procedures. Comparison of Hospital for Joint Diseases Functional Rating System results from earlier to current follow-up for all 13 feet demonstrated: (a)significant decline in mean score, 77.8 versus 65.9 (P=0.03), and (b)number of good/excellent ratings went from 85% to 38%. At long-term follow-up: (a) average Foot Ankle Outcomes Questionnaire standardized shoe comfort and core scores were 84.5 (range 25-100) and 85.6 (range 44-100), respectively, and (b)average foot pain was 1.38 (range 0-8) on a scale of 1 to 10. Conclusion: At long-term follow-up, revision clubfoot surgery with calcaneocuboid fusion in patients 5 to 8 years of age produces relatively painless, plantigrade feet with moderate functional outcomes
— id: 147741, year: 2012, vol: 21, page: 97, stat: Journal Article,

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
2010 ;68(4):299-303, Bulletin of the NYU Hospital for Joint Diseases
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
— id: 117347, year: 2010, vol: 68, page: 299, stat: Journal Article,

Clubfoot classification: correlation with Ponseti cast treatment
Chu, Alice; Labar, Amy S; Sala, Debra A; van Bosse, Harold J P; Lehman, Wallace B
2010 Oct-Nov;30(7):695-699, Journal of pediatric orthopedics
BACKGROUND: Many different clubfoot classification systems have been proposed, but no single one is universally accepted. Two frequently cited systems, developed by Dimeglio/Bensahel and Catterall/Pirani, are often used for evaluation purposes in the treatment of idiopathic clubfoot. Our hypothesis was that the initial scores would be positively correlated with the number of casts required for clubfoot correction, indicating to us that the more severe score would require more casts, and therefore truly show the accuracy and usefulness of the scoring system. METHODS: From May 2000 to April 2008, 123 patients (185 feet) with idiopathic clubfeet were treated. All patients were below 60 days of age (mean 15.3 d, range: 2 to 57 d) at the time of their initial evaluation, and had not received prior clubfoot treatment. All cast placements were under the supervision of the same pediatric orthopedic surgeon. Initial correction was achieved in all patients. RESULTS: The mean number of casts required for correction was 5.1 (range: 2 to 8). On the basis of number of casts required, no significant differences were found in final total scores (Dimeglio/Bensahel P=0.14 and Catterall/Pirani P=0.44), indicating a similar level of correction for all feet. The Dimeglio/Bensahel and Catterall/Pirani classification systems were both similarly, poorly correlated with the number of casts needed [Spearman rank correlation coefficients (rs)=0.34 vs. 0.33]. The 2 components with the highest correlations were equinus (rs=0.39) and forefoot adduction (rs=0.35) for the Dimeglio/Bensahel system and coverage of the lateral head of the talus (rs=0.40) and rigid equinus (rs=0.39) for the Catterall/Pirani system. CONCLUSIONS: When using the initial scores, both the Dimeglio/Bensahel and Catterall/Pirani classification systems had a low correlation with the number of Ponseti casts required. Analysis of the individual components revealed variability in the coefficients, with some having low-to-moderate correlation and others having none. There was no difference between the Dimeglio/Bensahel and Catterall/Pirani classification systems when measuring their correlation with the number of Ponseti casts required for clubfoot correction. An improved classification system is needed to predict the length of treatment and, ultimately, the risk of recurrence. LEVEL OF EVIDENCE: Prognostic Level IV
— id: 113663, year: 2010, vol: 30, page: 695, stat: Journal Article,

Congenital tibial dysplasia (congenital pseudoarthrosis of the tibia): an atypical variation
Lehman, Wallace B; Abdelgawad, Amr Atef; Sala, Debra A
2009 Sep;18(5):211-213, Journal of pediatric orthopaedics. Pt. B
— id: 101134, year: 2009, vol: 18, page: 211, stat: Journal Article,

Correction of Arthrogrypotic Clubfoot With a Modified Ponseti Technique
van Bosse, Harold J P; Marangoz, Salih; Lehman, Wallace B; Sala, Debra A
2009 May;467(5):1283-1293, Clinical orthopaedics & related research
Surgical releases for arthrogrypotic clubfeet have high recurrence rates, require further surgery, and result in short, painful feet. We asked whether a modified Ponseti technique could achieve plantigrade, braceable feet. Ten patients (mean age, 16.2 months; range, 3-40 months), with 19 arthrogrypotic clubfeet, underwent an initial percutaneous Achilles tenotomy to unlock the calcaneus from the posterior tibia followed by weekly Ponseti-style casts. A second percutaneous Achilles tenotomy was performed in 53%. Mean number of casts was 7.7 (range, 4-12). From pretreatment to completion of initial series of casts, mean scores of Dimeglio et al. improved from 16 to 5 (ranges, 12-18 and 2-9, respectively), Catterall scores (as modified by Pirani and colleagues) from 4.8 to 0.9 (ranges, 1.5-6.0 and 0.0-2.0), and maximum passive dorsiflexion from -45 degrees (range, -75 degrees to -20 degrees ) to 10 degrees (range, 0 degrees to 40 degrees ). Ankle-foot orthoses maintained correction. At the minimum followup of 13 months (mean, 38.5 months; range, 13-70 months), the mean maximum dorsiflexion was 5 degrees (range, -20 degrees to 20 degrees ), two patients had posterior releases and no patient's ambulatory ability was compromised by foot shape. Arthrogrypotic clubfeet can be corrected without extensive surgery during infancy or early childhood. Limited surgery may be required as the children age
— id: 95821, year: 2009, vol: 467, page: 1283, stat: Journal Article,

Two rare spinal conditions in children
Lehman, Wallace B
2008 Jul;37(7):E120-E120, American journal of orthopedics (Belle Mead, NJ)
— id: 95822, year: 2008, vol: 37, page: E120, stat: Journal Article,

Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up
Abdelgawad, Amr Atef; Lehman, Wallace B; van Bosse, Harold J P; Scher, David M; Sala, Debra A
2007 Mar;16(2):98-105, Journal of pediatric orthopaedics. Pt. B
One hundred and thirty-seven idiopathic clubfeet were treated by the Ponseti technique and followed for at least 2 years. Nine feet (7%) were not corrected with initial casting and required early surgery. Recurrence after correction was related to compliance with bracing. At latest follow-up, two-thirds of those noncompliant with brace had recurrences with one-third of these recurrences requiring more extensive surgery than Achilles tenotomy and anterior tibial tendon transfer while only 14% of those compliant with brace had recurrences with none requiring more than Achilles tenotomy and anterior tibial tendon transfer. Early failures and recurrences constituted about 20% of our 137 feet by 2 years of follow-up. When the Ponseti method was fully followed, including initial casting, compliance with brace and treatment of recurrences by recasting, Achilles tenotomy and/or anterior tibial tendon transfer, our success rate was 93%
— id: 71208, year: 2007, vol: 16, page: 98, stat: Journal Article,

Educating our residents: more important than ever
Lehman, Wallace B
2007 Dec;36(12):E171, E189-, American journal of orthopedics (Belle Mead, NJ)
— id: 95823, year: 2007, vol: 36, page: E171, E189, stat: Journal Article,

Interobserver and intraobserver reliability of radiographic evidence of bone healing at osteotomy sites
Anand, Ashish; Feldman, David S; Patel, Raviraj J; Lehman, Wallace B; van Bosse, Harold J P; Badra, Mohammod I; Sala, Debra A
2006 Jul;15(4):271-272, Journal of pediatric orthopaedics. Pt. B
Plain radiographs are commonly used to evaluate the degree of bone healing after an osteotomy and the application of an external fixator. The purpose of the study was to assess intraobserver and interobserver reliability in determining bone healing, defined as bridging callus across three of four cortices, of osteotomy sites on radiographs. Substantial intraobserver reliability and a high intraobserver percentage agreement were found. Interobserver reliability was moderate and interobserver percentage agreement was less than half for agreement between all involved orthopaedic surgeons. The lower reliability across surgeons suggests that the determination of the extent of the bone healing is subjective
— id: 69239, year: 2006, vol: 15, page: 271, stat: Journal Article,

Accuracy of correction of tibia vara: acute versus gradual correction
Feldman, David S; Madan, Sanjeev S; Ruchelsman, David E; Sala, Debra A; Lehman, Wallace B
2006 Nov-Dec;26(6):794-798, Journal of pediatric orthopedics
The purpose was to assess the accuracy of deformity correction achieved in patients with tibia vara using acute intraoperative correction compared with gradual postoperative correction. Acute correction (AC) group consisted of 14 patients (14 tibiae) with a mean age of 11.4 years and whose tibia vara was corrected acutely and held using an EBI external fixator. Gradual correction (GC) group consisted of 18 patients (18 tibiae) with a mean age of 10.2 years and whose tibia vara was corrected gradually using 6-axis deformity analysis and Taylor Spatial Frame. Deformity measurements were compared preoperatively, postoperatively, and at latest follow-up. At latest follow-up, medial proximal tibial angle deviation from normal was similar for the 2 groups; posterior proximal tibial angle was significantly greater in the AC group (5.6 degrees) than in the GC group (1.9 degrees). Mechanical axis deviation was significantly greater in the AC group (17.1 mm) than in the GC group (3.1 mm). Postoperatively, frequency of accurate translation corrections (achieved translation within 5 mm of preoperative required translation) was significantly greater in the GC group (18/18) than in the AC group (7/14). Frequency of accurate angulation corrections (medial proximal tibial angle within 3 degrees of normal and posterior proximal tibial angle within 5 degrees of normal) was significantly greater in the GC group (17/18) than in the AC group (7/14). For both groups, all tibiae with preoperative internal rotation deformity had accurate rotation correction. Correction of preoperative limb-length inequality was achieved in 5 of the 7 patients in the AC group and 11 of the 11 patients in the GC group. Gradual deformity correction is a more accurate treatment method of tibia vara than acute correction
— id: 69421, year: 2006, vol: 26, page: 794, stat: Journal Article,

Reminder: radiopacities from metal-containing substances
Madan, Sanjeev; Mohaideen, Ahamed; Lehman, Wallace B; Welber, Adam
2005 Oct;34(10):508-509, American journal of orthopedics (Belle Mead, NJ)
A 17-month-old boy with a toed-out left lower extremity was presented for evaluation. Before coming to the doctor, the mother had applied a zinc oxide lotion to treat a simple diaper rash in the groin. The radiologist did not remove the boy's diaper for the radiographic examination and so did not notice the lotion. The first radiograph showed what looked like multiple soft-tissue calcifications in the groin, but the radiopacities had been produced by the zinc oxide. This case serves as a reminder to be aware that metal-containing substances both on and in the body can produce radiopacities
— id: 61855, year: 2005, vol: 34, page: 508, stat: Journal Article,

Use of the foot abduction orthosis following Ponseti casts: is it essential?
Thacker, Mihir M; Scher, David M; Sala, Debra A; van Bosse, Harold J P; Feldman, David S; Lehman, Wallace B
2005 Mar-Apr;25(2):225-228, Journal of pediatric orthopedics
The purpose of this study was to evaluate the need for the use of a foot abduction orthosis (FAO) in the treatment of idiopathic clubfeet using the Ponseti technique. Forty-four idiopathic clubfeet were treated with casting using the Ponseti method followed by FAO application. Compliance was defined as full-time FAO use for 3 months and part-time use subsequently. Noncompliance was failure to fulfill the criteria during the first 9 months after casting. Feet were rated according to the Dimeglio and Pirani scoring systems at initial presentation, at the time of FAO application, and at 6 to 9 months of follow-up. At the time of application, no significant differences in scores were found between the groups. At follow-up, the compliant group's scores were significantly (P < 0.01) better than those of the noncompliant group. From the time of application to follow-up, for the compliant group, the Dimeglio scores improved significantly (P = 0.005). For the noncompliant group, the Dimeglio scores deteriorated significantly (P = 0.001). The feet of patients compliant with FAO use remained better corrected than the feet of those patients who were not compliant. Proper use of FAO is essential for successful application of the Ponseti technique
— id: 56031, year: 2005, vol: 25, page: 225, stat: Journal Article,

Surgical technique for an 'almost' percutaneous triple pelvic osteotomy for femoral head coverage in children 6-14 years of age
Lehman, Wallace B; Mohaideen, Ahamed; Madan, Sanjeev; Atar, Dan; Feldman, David S; Scher, David
2004 Jan;13(1):57-62, Journal of pediatric orthopaedics. Pt. B
A relatively simple triple pelvic osteotomy using two cosmetically small skin incisions can provide excellent coverage of the femoral head. An adductor approach and a bikini approach are used to do the osteotomy. The 'almost' percutaneous pelvic osteotomy successfully increases femoral head coverage in a concentric hip joint. The VCA angle of Lequesne and the center-edge angle of Wiberg both show significant improvement in the coverage of the femoral head. Three-dimensional computed tomography scanograms may provide a more graphic representation before and after surgery. Preoperatively, this is especially useful in evaluating posterior acetabular coverage of the femoral head. The almost percutaneous pelvic osteotomy is another possible triple pelvic osteotomy for procedures for hip dysplasia. It has a relatively low learning curve in comparison with other triple pelvic osteotomies for hip dysplasia in children aged 6-14 years. With careful patient selection, femoral head coverage can be improved with small incisions that are cosmetically acceptable
— id: 55959, year: 2004, vol: 13, page: 57, stat: Journal Article,

Predicting the need for tenotomy in the Ponseti method for correction of clubfeet
Scher, David M; Feldman, David S; van Bosse, Harold J P; Sala, Debra A; Lehman, Wallace B
2004 Jul-Aug;24(4):349-352, Journal of pediatric orthopedics
The purpose of this study was to determine how to predict the need for tenotomy at the initiation of the Ponseti treatment. Fifty clubfeet (35 patients) were prospectively rated according to Pirani and Dimeglio scoring systems. Tenotomies were performed in 36 of 50 feet (72%). Those that underwent tenotomy required significantly more casts (P = 0.005). Of 27 feet with initial Pirani scores > or = 5.0, 85.2% required a tenotomy and 14.8% did not; 94.7% of the Dimeglio Grade IV feet required tenotomies. Following removal of the last cast, there was no significant difference between those that did and did not have a tenotomy. Children with clubfeet who have an initial score of > or = 5.0 by the Pirani system or are rated as Grade IV feet by the Dimeglio system are very likely to need a tenotomy. At the end of casting, feet were equally well corrected whether or not they needed a tenotomy
— id: 46114, year: 2004, vol: 24, page: 349, stat: Journal Article,

Correction of tibia vara with six-axis deformity analysis and the taylor spatial frame
Feldman, David S; Madan, Sanjeev S; Koval, Kenneth J; van Bosse, Harold J P; Bazzi, Jamal; Lehman, Wallace B
2003 May-Jun;23(3):387-391, Journal of pediatric orthopedics
Operative correction for infantile and adolescent tibia vara has been described using both external and internal fixation. Gradual correction using a circular fixator offers the advantage of accurate coronal, sagittal, and axial plane correction without significant soft tissue dissection. This study evaluated the use of six-axis deformity analysis and the Taylor Spatial Frame (TSF) for the correction of tibia vara. Nineteen patients (22 tibias), 6 with infantile and 13 with adolescent tibia vara, underwent correction with TSF. On the basis of mechanical axis correction, 21 of 22 tibias were corrected within 3 degrees of normal. Using Schoenecker's criteria, all patients achieved good results (no pain, <5 degrees difference in tibial-femoral angle from the normal side). Complications included one intractable pin-site infection, two superficial pin-site infections, and one delayed union. Six-axis deformity analysis and TSF provide accurate and safe correction of infantile and adolescent tibia vara
— id: 36161, year: 2003, vol: 23, page: 387, stat: Journal Article,

A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot
Lehman, Wallace B; Mohaideen, Ahamed; Madan, Sanjeev; Scher, David M; Van Bosse, Harold J P; Iannacone, Michelle; Bazzi, Jamal S; Feldman, David S
2003 Mar;12(2):133-140, Journal of pediatric orthopaedics. Pt. B
The Ponseti casting technique is reported to have a high success rate in the treatment of idiopathic clubfoot. Non-operative treatment of clubfoot provides a lower complication rate, less pain, and higher function as the patient ages than operative treatment. To demonstrate serial post-treatment change in clubfeet over time, three clubfoot rating systems were utilized in the current study. Patients compliant with the Ponseti technique and treated before the age of 7 months, had a 92% success rate at an early follow-up after casting was completed. It is not the purpose of this article to analyze the long-term clubfoot treatment result but to establish tools which can be used to judge initial success with the Ponseti technique. Complications are few and minor, limited to equipment used and cast technique
— id: 36162, year: 2003, vol: 12, page: 133, stat: Journal Article,

Congenital clubfoot
Cummings, R Jay; Davidson, Richard S; Armstrong, Peter F; Lehman, Wallace B
2002 ;51:385-400, Instructional course lectures (American Association of Orthopaedic Surgeons)
Although the etiology of congenital clubfoot remains unknown, reproducible pretreatment grading now seems possible. However, the lack of an agreed-on and reproducible posttreatment evaluation system still hinders outcome studies of the treatment of clubfoot. The literature from about 1970 to 1990 contains enthusiastic reports on the correction of congenital clubfoot through extensive surgical release procedures. Over time, we have come to recognize the complications of such surgery, including recurrence, overcorrection, stiffness, and pain (WJ Shaughnessy, MD, P Dechet, MD, HB Kitaoka, MD, Vancouver, BC, Canada, unpublished data, 2000). Perhaps because of these findings, there is a renewed interest in nonsurgical techniques for the correction of congenital clubfoot. Recent studies have documented the effectiveness of the two leading techniques involving serial manipulation and cast treatment. The Ponseti technique appears to be effective and requires only a reasonable amount of time out of the lives of the patient and his or her parents. The technique frequently includes some minimally invasive surgery. The Kite and Lovell technique requires minimally invasive surgery less often but is more time consuming. French investigators and others have introduced new ideas that may reduce the need to immobilize the foot. The French approach requires fairly extensive physical therapy and demands substantial parental time and attention. It is not yet clear that the French technique is more successful in obviating the need for surgery than is expertly applied serial manipulation and cast immobilization. It also has not been proved that the long-term results of the French technique are better than those of serial manipulation and cast immobilization. It is probably that unless the French technique is found to substantially decrease the need for surgery, it will prove to be less cost effective than serial manipulation and cast immobilization. It is likely that a small number of clubfeet will require surgery even after expertly applied nonsurgical treatment. However, it is hoped that such surgery will be less extensive than procedures commonly performed in the recent past
— id: 95824, year: 2002, vol: 51, page: 385, stat: Journal Article,

Congenital clubfoot
Cummings, R Jay; Davidson, Richard S; Armstrong, Peter F; Lehman, Wallace B
2002 Feb;84-A(2):290-308, Journal of bone & joint surgery (American volume)
— id: 95825, year: 2002, vol: 84-A, page: 290, stat: Journal Article,

Percutaneous fixation in clubfoot surgery: a radiographic and gait study
Tareco, Jennifer; Sala, Debra A; Scher, David M; Lehman, Wallace B; Feldman, David S
2002 Apr;11(2):139-142, Journal of pediatric orthopaedics. Pt. B
Twenty patients with Type II clubfeet were evaluated an average of 3.1 years after complete surgical soft tissue release. A pinned group had fixation of the talonavicular and calcaneocuboid joints and a non-pinned group had no fixation. The control group consisted of 10 children without foot ailments. Radiographic measurements of talocalcaneal and talus-first metatarsal angles and frequencies of dorsal and medial navicular subluxation were not different for the two treatment groups. Foot progression angle was not significantly different for the two treatment groups, but was significantly different between all clubfoot patients (3.6 degrees of in-toeing) and the control group (5.0 degrees of out-toeing). Tourniquet time was significantly greater for the pinned than for the non-pinned group, but the duration of surgery was similar. Similar radiographic and gait measurement findings suggest that clubfoot surgery with and without percutaneous fixation have comparable outcomes
— id: 38888, year: 2002, vol: 11, page: 139, stat: Journal Article,

Hip arthrodesis in adolescents using external fixation
Scher DM; Jeong GK; Grant AD; Lehman WB; Feldman DS
2001 Mar-Apr;21(2):194-197, Journal of pediatric orthopedics
Between 1994 and 1998, seven adolescents underwent hip arthrodesis with the use of an external fixator. Mean time of follow-up was 24.0 months after surgery. The duration of fixation and time to fusion were 6.6 months (range, 5-9.5 months) and 8.0 months (range, 5.2-15 months), respectively. At most recent follow-up, there was a significant improvement in the mean modified Harris hip score, in which the maximum score is 91 points after omitting 9 points for hip range of motion and deformity, from 25.7 before surgery to 66.7 after surgery (p < 0.01). The advantages of this procedure include (i) the ease and accuracy of obtaining the proper position for fusion, (ii) the ability to lengthen the affected leg at the same time, (iii) the diminished likelihood of compromising future hip operations, and (iv) the ability to ambulate and bear weight throughout the treatment course. We recommend this method of hip arthrodesis with external fixation for patients with intractable hip pain necessitating this procedure
— id: 26777, year: 2001, vol: 21, page: 194, stat: Journal Article,

Congenital pseudoarthrosis of the tibia [In Process Citation]
Lehman WB; Atar D; Feldman DS; Gordon JC; Grant AD
2000 Apr;9(2):103-107, Journal of pediatric orthopaedics. Pt. B
Congenital pseudoarthrosis of the tibia remains one of the most difficult conditions to treat in orthopedic surgery. Seven cases were treated in our hospital by different methods. Three out of seven patients were healed, two of these refractured. At follow-up, the success rate was 14% (one out of seven cases). It is our recommendation that early primary amputation with an appropriate prosthesis should be considered, and that the final evaluation should not be based on obtaining bone union, but on the level of function of the lower extremity
— id: 11635, year: 2000, vol: 9, page: 103, stat: Journal Article,

Results of complete soft tissue clubfoot release combined with calcaneocuboid fusion in the 4-year to 8-year age group following failed clubfoot release
Lehman WB; Atar D; Bash J; Grant A; Feldman D; Kissin Y; Gutman J; Lindsey J
1999 Jul;8(3):181-186, Journal of pediatric orthopaedics. Pt. B
A subset of postoperative recurrent clubfeet was isolated in a group of patients 4 to 8 years old. Twenty-seven consecutive patients who underwent redo surgery consisting of complete soft tissue clubfoot release combined with a calcaneocuboid fusion were reviewed for this study. Twenty-six feet of 27 feet in 20 patients had a long-term good result, suggesting that this procedure is the one of choice for this age group
— id: 56453, year: 1999, vol: 8, page: 181, stat: Journal Article,

Salter-Harris type III fracture-dislocation of the proximal humerus
Wang P Jr; Koval KJ; Lehman W; Strongwater A; Grant A; Zuckerman JD
1997 Jul;6(3):219-222, Journal of pediatric orthopaedics. Pt. B
Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result
— id: 44574, year: 1997, vol: 6, page: 219, stat: Journal Article,

Chronic fracture-separation of the radial head in a child
Rokito SE; Anticevic D; Strongwater AM; Lehman WB; Grant AD
1995 Jun;9(3):259-262, Journal of orthopaedic trauma
A rare case of a complete fracture-separation of the proximal radial epiphysis is described in a pediatric patient. A further complicating factor is the delay in diagnosis that may worsen prognosis. An emphasis on early detection by physical examination and imaging studies, as well as consideration of treatment options, are presented
— id: 61306, year: 1995, vol: 9, page: 259, stat: Journal Article,

Histological and radiographic determination of the age of physeal closure of the distal femur, proximal tibia, and proximal fibula of the New Zealand white rabbit
Kaweblum M; Aguilar MC; Blancas E; Kaweblum J; Lehman WB; Grant AD; Strongwater AM
1994 Sep;12(5):747-749, Journal of orthopaedic research
A longitudinal study was performed in a series of 124 New Zealand White rabbits to determine the radiographic versus the histologic age of closure of the growth plates of the distal femur, proximal tibia, and proximal fibula. Periodic assessment was made by standard radiographs and histological studies. Histologically, growth plates in the distal femur closed at 19-24 weeks; growth plates in the proximal tibia, at 25-32 weeks; and growth plates in the proximal fibula, at 26-32 weeks. Radiographically, evidence of closure of growth plates in the distal femur occurred at 20-23 weeks; in the proximal tibia, at 22-27 weeks; and in the proximal fibula, at 23-31 weeks. A discrepancy in age between radiographic and histologic closure of the growth plate occurred in 3.6% of the femora, 10.9% of the tibias, and 16% of the fibulas
— id: 61307, year: 1994, vol: 12, page: 747, stat: Journal Article,

Magnetic resonance imaging of pediatric disorders of the ankle and foot
Schoenberg NY; Lehman WB
1994 Feb;2(1):109-122, Magnetic resonance imaging clinics of North America
This article discusses the unique contribution of MR imaging to the evaluation of selected pediatric disorders of the ankle and foot. MR imaging is helping to unravel the complex congenital malformation of talipes equinovarus. It is the study of choice for the examination of intraarticular abnormalities such as Trevor's disease. The MR imaging staging of osteochondritis dissecans and delineation of a tarsal coalition have shown great promise in guiding surgical management of these abnormalities
— id: 22924, year: 1994, vol: 2, page: 109, stat: Journal Article,

OSTEOID OSTEOMA UNDER THE AGE OF 5 YEARS - THE DIFFICULTY OF DIAGNOSIS
KAWEBLUM, M; LEHMAN, WB; BASH, J; STRONGWATER, A; GRANT, AD
1993 NOV ;44(296):218-224, Clinical orthopaedics & related research
Ninety-one cases of histologically confirmed osteoid osteoma were collected during an 11-year period; of them, seven (7.6%) had onset of symptoms while younger than five years of age. Special diagnostic difficulties were found in this specific age group: most cases were misdiagnosed or diagnosed incorrectly. The time between the onset of symptoms and the diagnosis varied from three months to five years. Although pain was present in six patients, in four cases, other concomitant signs and symptoms attracted more attention and led to a misdiagnosis and unnecessary invasive procedures. Gait disturbance (limp) was the second most frequent sign and was always present when the lower extremity was affected. In five cases, initial radiographs were not conclusive. Bone scans were very sensitive and conclusive in three cases where radiographs were atypical. Computerized tomograms always located the tumor
— id: 52173, year: 1993, vol: 44, page: 218, stat: Journal Article,

New method of limb deformities correction in children
Atar D; Lehman WB; Grant AD; Strongwater A; Frankel VH; Posner M; Golyakhovsky V
1992 Nov;68(4):447-469, Bulletin of the New York Academy of Medicine
A new 'bloodless' technique (Ilizarov) was used to correct 36 limb deformities in 29 children. There were six leg length discrepancies, five achondroplasias, four deformed feet, five joint contractures, one rotational deformity of tibia, and in three the apparatus was used as an external fixator after corrective osteotomy. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus 11 cm (40%). Bony union was achieved in two out of five pseudoarthroses. Four deformed feet were fully corrected. Joint contractures were corrected in four out of five. The complication rate is as high as in other methods but with the Ilizarov apparatus, longer segments of bone were lengthened and more complex deformities were treated. Complications lessened as experience was gained
— id: 35487, year: 1992, vol: 68, page: 447, stat: Journal Article,

Revision surgery in clubfeet
Atar D; Lehman WB; Grant AD; Strongwater AM
1992 Oct;(283):223-230, Clinical orthopaedics & related research
The reoperated clubfeet of 29 children aged one to 12 years were reviewed. The surgical procedure most often used in revision surgery was recomplete soft-tissue release alone or combined with plantar release, calcaneocuboid fusion, and capsulotomies of the navicular-first cuneiform-first metatarsal joint. In 27 of 29 feet, acceptable results were achieved. Nineteen were excellent and good results. An algorithm that suggests surgical solutions to a variety of clubfoot deformities in different age groups has been developed, as well as an objective rating system, to evaluate the long-term results of revision surgery of clubfeet
— id: 61308, year: 1992, vol: , page: 223, stat: Journal Article,

The Ilizarov apparatus for treatment of melorheostosis. Case report and review of the literature
Atar D; Lehman WB; Grant AD; Strongwater AM
1992 Aug;(281):163-167, Clinical orthopaedics & related research
Traditional conservative and surgical methods of treatment of melorheostosis, such as manipulations, plaster casts, soft-tissue releases, capsulotomies, and osteotomies cause a high recurrence rate. In a 12-year-old girl, flexion contracture of a knee with limb inequality caused by melorheostosis was corrected successfully with the Ilizarov distraction apparatus
— id: 61309, year: 1992, vol: , page: 163, stat: Journal Article,

Treatment of complex limb deformities in children with the Ilizarov technique
Atar D; Lehman WB; Grant AD; Strongwater A; Frankel V; Golyakhovsky V
1991 Sep;14(9):961-967, Orthopedics (Thorofare NJ)
Twenty-nine children underwent 36 Ilizarov procedures for a variety of limb deformities. We present the results in 11 patients, six with leg length discrepancies and five with achondroplasia, who underwent lengthening procedures using the Ilizarov method. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus length 11 cm (40%). Eleven complications occurred. The most common were pin tract infections (4), joint contractures (2), transient nerve injury (4), premature consolidation (5), and three fractures of the regenerated bone. The complication rate was as high as in other methods, but with the Ilizarov apparatus longer segments of bone were lengthened and more complex deformities were treated. The number of complications were lessened as experience was gained
— id: 35489, year: 1991, vol: 14, page: 961, stat: Journal Article,

Fractional lengthening of the flexor tendons in clubfoot surgery
Atar D; Lehman WB; Grant AD; Strongwater AM
1991 Mar;(264):267-269, Clinical orthopaedics & related research
Massive scarring of the Z-lengthened flexor digitorum and flexor hallucis longus is a constant finding in clubfoot surgery. A method of fractional lengthening of the tendons is described. This method has been proven effective in preventing this complication
— id: 61311, year: 1991, vol: , page: 267, stat: Journal Article,

Ilizarov technique in treatment of congenital hand anomalies. Two case reports
Atar D; Lehman WB; Posner M; Paley D; Green S; Grant AD; Strongwater AM
1991 Dec;(273):268-274, Clinical orthopaedics & related research
An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities
— id: 61310, year: 1991, vol: , page: 268, stat: Journal Article,

Preventing and overcoming equinus contractures during lengthening of the tibia
Lehman WB; Grant AD; Atar D
1991 Oct;22(4):633-641, Orthopedic clinics of North America
The new technique of leg lengthening and deformity correction with different types of external fixators has given the orthopedic surgeon a tool that allows correction of very difficult deformities and leg length discrepancies of the lower extremity. Dissemination of this knowledge has demonstrated that there are many associated problems with these techniques: one of which is resulting equinus deformity after correcting the tibia. The shortened soleus-gastrocnemius-achilles tendon complex is the cause of this deformity. Several techniques are suggested on avoiding this complication and how to correct it once it has occurred
— id: 13870, year: 1991, vol: 22, page: 633, stat: Journal Article,

Intra-operative arthrography in open reduction of congenital hip dislocation
Atar D; Grant AD; Lehman WB; Strongwater AM
1990 May;72(3):526-526, Journal of bone & joint surgery (British volume)
— id: 61315, year: 1990, vol: 72, page: 526, stat: Journal Article,

The use of a tissue expander in club-foot surgery. A case report and review
Atar D; Grant AD; Silver L; Lehman WB; Strongwater AM
1990 Jul;72(4):574-577, Journal of bone & joint surgery (British volume)
Primary skin closure after the surgical correction of severe club-foot may be difficult. We describe the use of a tissue expander to provide sufficient skin, and review some aspects of the use of the method
— id: 61314, year: 1990, vol: 72, page: 574, stat: Journal Article,

Cannulated blade plate for proximal femoral varus osteotomy
Grant AD; Lehman WB; Strongwater AM; Atar D
1990 Oct;(259):111-113, Clinical orthopaedics & related research
Fixation of the osteotomy site in the proximal femur is technically demanding. A new system, which includes cannulated chisels and a cannulated one-piece plate that can be inserted over a guide wire, is suggested. The new system simplifies the procedure and provides stable fixation
— id: 61313, year: 1990, vol: , page: 111, stat: Journal Article,

Re-do clubfoot: surgical approach and long-term results
Lehman WB; Atar D; Grant AD; Strongwater AM
1990 Nov-Dec;66(6):601-617, Bulletin of the New York Academy of Medicine
— id: 61312, year: 1990, vol: 66, page: 601, stat: Journal Article,

Rotational injury of the distal tibial physis
Koval KJ; Lehman WB; Koval RP
1989 Sep;18(9):987-990, Orthopaedic review
Rotational displacement of the distal tibial physis occurred in a 12-year-old boy. A review of the literature indicates that long-term follow-up is necessary to determine whether premature physeal closure will occur
— id: 22116, year: 1989, vol: 18, page: 987, stat: Journal Article,

Treatment of slipped capital femoral epiphysis with a cannulated-screw technique
Koval KJ; Lehman WB; Rose D; Koval RP; Grant A; Strongwater A
1989 Oct;71(9):1370-1377, Journal of bone & joint surgery (American volume)
Sixty patients (eighty hips) who had slipped capital femoral epiphysis were treated by epiphyseodesis with a cannulated-screw technique. Forty-nine patients (sixty-seven hips) were available for follow-up, forty-four (sixty hips) of whom were followed for a minimum of two years. Thirty-five patients (forty-six hips) were followed until the hardware was removed. Of seventy-two hips in which contrast medium was injected, arthrographic results were obtained in three. In these three hips, there was evidence of pre-existing narrowing of the joint space. Four patients (six hips) who did not have evidence of penetration by a screw or guide-wire had evidence of either pre-existing chondrolysis or osteoarthrosis. Chondrolysis did not develop postoperatively in any patient who had no evidence of it preoperatively
— id: 22115, year: 1989, vol: 71, page: 1370, stat: Journal Article,

Operating room guide to cross sectional anatomy of the extremities and pelvis
Lehman, Wallace B.; Thomas, Hugh A
New York : Raven Press ; c1989,
— id: 261, year: 1989, vol: , page: , stat: ,

The anatomical basis for incisions around the foot and ankle in clubfoot surgery
Lehman WB; Silver L; Grant AD; Strongwater AM; Weg O
1987 Fall;47(2):218-227, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute
Skin problems are the cause of a high incidence of recurrent clubfoot problems. With respect to the demonstrated vascular territories (angiosomes) of the ankle and foot, the incisions which seem to be safest are vertical as opposed to transverse, and between angiosomes. The safest of all are the posteromedial incision with an additional vertical lateral incision if necessary, and the posterolateral with an additional medial incision
— id: 61316, year: 1987, vol: 47, page: 218, stat: Journal Article,

Hospital for Joint Diseases' traction system for preliminary treatment of congenital dislocation of the hip
Lehman WB; Grant AD; Nelson J; Robbins H; Milgram J
1983 Feb;3(1):104-107, Journal of pediatric orthopedics
— id: 67371, year: 1983, vol: 3, page: 104, stat: Journal Article,