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Primary Psoas Pyomyositis Presenting as Subluxation of the Hip: A Case Report. JBJS case connector Gamble, J. G. ; 6 (1): e21
Abstract

An eight-year-old girl presented with a septic subluxation of the right hip secondary to spontaneous drainage of a psoas pyomyositis. The course of the infection was protracted, and the symptoms were mild relative to the magnitude of the psoas abscess and the volume of purulence in the hip that caused subluxation of the femoral head. At the time of surgical drainage, the hip capsule directly communicated with the psoas abscess along the course of the iliopsoas tendon sheath. Methicillin-sensitive Staphylococcus aureus (MSSA) was the microorganism that was isolated from the abscess and from the hip joint.Drainage of the psoas abscess and septic arthritis coupled with antibiotic treatment eliminated the infection, and the child returned to normal activities. At the five-year follow-up, she was asymptomatic, but the subtle changes in the sphericity of the femoral head as well as the slight joint-space narrowing may be associated with problems in the future.

View details for PubMedID 29252727
Painful Ununited Fracture of the Posterior Process of the Talus in an Adolescent Dancer: A Case Report. JBJS case connector Kao, H. K., Gamble, J. G. ; 4 (4): e92
Abstract

Fractures of the talus in children and adolescents are uncommon and generally involve the body or neck of the talus. We present a thirteen-year-old dancer with an ununited fracture of the posterior process of the talus that was initially thought to be a painful os trigonum.This injury was confused with a painful os trigonum. We found that the size of the fragment, the extent to which the fracture line undercut the tibial plafond, and the findings on magnetic resonance imaging were helpful in clarifying the diagnosis of the fracture.

View details for PubMedID 29252760
Remodeling of Sagittal Plane Malunion After Pediatric Supracondylar Humerus Fractures. Journal of pediatric orthopedics Gamble, J. G., Vorhies, J. S. 2020
Abstract

Pediatric supracondylar humeral fractures (SCHFs) can heal in hyperextension malunion after casting or surgical treatment. Here the authors present quantitative evidence concerning the ability of children to remodel sagittal plane malunion. Their null hypothesis was that like varus and valgus malunion, children have little capacity to remodel sagittal plane malunion after SCHFs.The authors performed a prospective longitudinal radiographic study of 41 children, aged 22 to 126 months, who were registered during the study interval. They calculated the percent displacement of the center of the capitellum behind the anterior humeral line (AHL) as the distance of the midpoint of the capitellum from the AHL, divided by the diameter of the capitellum, multiplied by 100. Longitudinal measurements were made using the embedded software on our institution's digital radiographic system. The primary outcome focus was the percent displacement of the center of the capitellum relative to AHL on the initial and on the latest radiograph.The average initial displacement (hyperextension) of the capitellum behind the AHL for all patients was 61% (range, 23% to 134%). At an average follow-up of 21 months, 24 children (60%) had remodeled 100% the sagittal plane malunion, 12 children (30%) had remodeled such that the AHL passed through the central third of the capitellum, and 5 children (10%) had minimal or no remodeling.The authors rejected their null hypothesis. Children do have the capacity to remodel radiographically measurable sagittal plane malunion of SCHFs. Children younger than 5 years of age can remodel 100% displacement of the center of the capitellum, whereas those over 8 years of age have minimal remodeling capacity.

View details for DOI 10.1097/BPO.0000000000001623

View details for PubMedID 32604347
Fracture of the Supracondylar Process in a Child: A Case Report and Review of the Literature. JBJS case connector Gamble, J. G., Krygier, J. E. 2019
Abstract

CASE: A 5-year-9-month-old boy sustained a fracture of the supracondylar process of the distal humerus. The fracture healed with cast immobilization and with no neurovascular complications. Magnetic resonance imaging showed the medial nerve and the brachial artery to be located under the ligament of Struthers that extended from the supracondylar process to the medial epicondyle.CONCLUSIONS: Fracture of the supracondylar process of the humerus in children is rare and easy to misdiagnose, but once discovered, the fracture can be treated successfully with cast immobilization and without compromise to the neurovascular structures passing under the ligament of Struthers.

View details for DOI 10.2106/JBJS.CC.18.00396

View details for PubMedID 31633496
Transepiphyseal (Type VII) Ankle Fracture Versus Os Subfibulare in Pediatric Ankle Injuries JOURNAL OF PEDIATRIC ORTHOPAEDICS Sugi, M. T., Tileston, K., Krygier, J. E., Gamble, J. 2018; 38 (10): E593?E596
View details for DOI 10.1097/BPO.0000000000001246

View details for Web of Science ID 000447699100017
Trans-metaphyseal Screws Placed in Children: An Argument for Monitoring and Potentially Removing the Implants. Journal of pediatric orthopedics Gamble, J. G., Zino, C., Imrie, M. N., Young, J. L. 2018
Abstract

BACKGROUND: Surgeons frequently use trans-metaphyseal screws in children to achieve osteosynthesis after fractures or stability after reconstructive osteotomies. Screws that were initially inserted below the cortex of bone can become prominent and symptomatic due to the process of funnelization that narrows the wide metaphysis to the diameter of the thinner diaphysis.METHODS: Case series presentation of 11 children who presented with screw prominence after the cutback process range in age from 19 to 169 months. We used the screws as radiographic markers to quantitate the amount of bone "cutback" or lost during the process of funnelization.RESULTS: The average length of screw protrusion beyond the edge of the bone when symptomatic was 8.7mm (range, 3.3 to 14.3mm). Time from implantation to the last radiograph averaged 40 months (range, 19 to 84mo). The average loss of bone width at the time of presentation was 21% (range, 7% to 36%).CONCLUSIONS: These cases suggest that orthopaedic surgeons should consider monitoring children after implantation of trans-metaphyseal screws and informing parents and patients about the possibility of screw prominence necessitating removal due to the process of metaphyseal funnelization.LEVEL OF EVIDENCE: Level IV.

View details for DOI 10.1097/BPO.0000000000001280

View details for PubMedID 30379707
Transepiphyseal (Type VII) Ankle Fracture Versus Os Subfibulare in Pediatric Ankle Injuries. Journal of pediatric orthopedics Sugi, M. T., Tileston, K., Krygier, J. E., Gamble, J. 2018
Abstract

BACKGROUND: Pediatric ankle injuries are common, giving rise to 17% of all physeal injuries. An os subfibulare in a child with an ankle sprain may be confused with a type VII transepiphyseal fracture. Here, we evaluate the clinical and radiographic features of type VII transepiphyseal fractures to those of os subfibulare presenting with acute ankle trauma with the hypothesis that radiographs are necessary for final diagnosis and neither clinical history nor examination would be diagnostic.METHODS: We performed an internal review board-approved, retrospective chart review of patients identified with a traumatic os subfibulare or type VII ankle fracture over an 18-month period. Charts were reviewed for demographics, mechanism, and clinical findings on initial presentation. Radiographic measurements of the distal fibular fragment as well as epiphysis were made on presenting ankle series radiographs.RESULTS: A total of 23 patients were identified. Eleven patients had a traumatic type VII ankle fracture and 12 had trauma associated with an os subfibulare on initial radiographs. The history and clinical presentations were similar and were nondiagnostic. The ratio of the width of the fibula at its largest point on the anterior posterior view to the width of the fibular fragment was significantly larger in the type VII ankle fractures (P=0.05). All os subfibulare were located within the inferior third of the epiphysis, whereas all type VII fractures were either at the equator or within the middle third of the fibular epiphysis.CONCLUSIONS: Radiographs, not clinical presentation, can differentiate an os subfibulare from a type VII transepiphyseal fracture. Children with type VII fractures have a long, irregular fracture line within the middle third of the distal fibular epiphysis. Those with an ankle sprain and os subfibulare have a smooth-edged ossicle of relatively short length located within the inferior pole of the epiphysis. Furthermore, the radiographic width of the fragment in the type VII fractures is significantly larger in width than the os subfibulare.LEVEL OF EVIDENCE: Level II.

View details for PubMedID 30199459
Clinical motion analyses over eight consecutive years in a child with crouch gait: a case report. Journal of medical case reports Butler, E. E., Steele, K. M., Torburn, L., Gamble, J. G., Rose, J. 2016; 10: 157-?
Abstract

This case report provides a unique look at the progression of crouch gait in a child with cerebral palsy over an 8-year time period, through annual physical examinations, three-dimensional gait analyses, and evaluation of postural balance. Our patient received regular botulinum toxin-A injections, casting, and physical therapy but no surgical interventions.A white American boy with spastic diplegic cerebral palsy was evaluated annually by clinical motion analyses, including physical examination, joint kinematics, electromyography, energy expenditure, and standing postural balance tests, from 6 to 13 years of age. These analyses revealed that the biomechanical factors contributing to our patient's crouch gait were weak plantar flexors, short and spastic hamstrings, moderately short hip flexors, and external rotation of the tibiae. Despite annual recommendations for surgical lengthening of the hamstrings, the family opted for non-surgical treatment through botulinum toxin-A injections, casting, and exercise. Our patient's crouch gait improved between ages 6 and 9, then worsened at age 10, concurrent with his greatest body mass index, increased plantar flexor weakness, increased standing postural sway, slowest normalized walking speed, and greatest walking energy expenditure. Although our patient's maximum knee extension in stance improved by 14 degrees at 13 years of age compared to 6 years of age, peak knee flexion in swing declined, his ankles became more dorsiflexed, his hips became more internally rotated, and his tibiae became more externally rotated. From 6 to 9 years of age, our patient's minimum stance-phase knee flexion varied in an inverse relationship with his body mass index; from 10 to 13 years of age, changes in his minimum stance-phase knee flexion paralleled changes in his body mass index.The motor deficits of weakness, spasticity, shortened muscle-tendon lengths, and impaired selective motor control were highlighted by our patient's clinical motion analyses. Overall, our patient's crouch gait improved mildly with aggressive non-operative management and a supportive family dedicated to regular home exercise. The annual clinical motion analyses identified changes in motor deficits that were associated with changes in the child's walking pattern, suggesting that these analyses can serve to track the progression of children with spastic cerebral palsy.

View details for DOI 10.1186/s13256-016-0920-9

View details for PubMedID 27301473
Endoscopic-assisted epiphysiodesis: technique and 20-year experience. Journal of pediatric orthopedics. Part B Ledesma, J. B., Wang, T., Desmond, E., Imrie, M., Gamble, J. G., Rinsky, L. A. 2016; 25 (1): 24-30
Abstract

The aim of the study was to describe the endoscopic-assisted epiphysiodesis technique and review our 20-year experience with it. A retrospective review of 44 patients who underwent proximal tibia and/or distal femur endoscopic-assisted epiphysiodesis was carried out. Only patients who had preoperative and postoperative scanograms with clinical follow-up of at least 6 months were included. The mean length of follow-up was 36.8 months. All patients had radiographic evidence of physeal fusion within 6-12 months from the index procedure. No patient required revision surgery. Endoscopic-assisted epiphysiodesis is safe, effective, and achieves predictable physeal fusion. Advantages over current techniques include reduced radiation exposure and lack of requirement for hardware placement.

View details for DOI 10.1097/BPB.0000000000000230

View details for PubMedID 26462167
Leg Constriction by Electronic Security Bracelets That Are Obscured by a Pavlik Harness: A Report of Two Cases. JBJS case connector Gamble, J. G., Krygier, J. E. 2013; 3 (2 Suppl 2): 1?3
View details for PubMedID 29252236
King Tutankhamun's Family and Demise JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Gamble, J. G. 2010; 303 (24): 2472
View details for DOI 10.1001/jama.2010.820

View details for Web of Science ID 000279010900015
King Tutankhamun's Family and Demise: King Tut's Clubfoot Journal American Medical Association Gamble JG 2010; 303 (24): 2472
Cole Porter's orthopaedic odyssey. The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha Gamble, J. G. 2007; 70 (1): 20-26
View details for PubMedID 17357749
Hip adductor injury in competitive swimmers AMERICAN JOURNAL OF SPORTS MEDICINE Grote, K., Lincoln, T. L., Gamble, J. G. 2004; 32 (1): 104-108
Abstract

The authors conducted a survey of 296 competitive swimmers to assess the incidence and importance of interfering groin pain in breaststroke swimmers.Breaststroke swimmers were more likely to have current groin pain (6.92%) than individual medley swimmers who did not compete in pure breaststroke events (0, P = 0.015). Breaststroke swimmers (42.7%) were also more likely than individual medley swimmers (21.5%, P = 0.000622) or nonbreaststroke, nonindividual medley swimmers (5.8%, P = 0.00000311) to have been unable to train breaststroke in practice during the past year due to groin injury.Results indicate that breaststroke swimmers are at significant risk of groin injury, groin injury is positively correlated with increased magnitude of breaststroke training, and groin injury may prevent participation in practices and competitions.

View details for DOI 10.1177/0363546503258905

View details for PubMedID 14754731
Frida Kahlo: her art and her orthopedics. The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha Gamble, J. G. 2002; 65 (3): 4-12
View details for PubMedID 12298406
Postural balance in children with cerebral palsy DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., Wolff, D. R., Jones, V. K., Bloch, D. A., Oehlert, J. W., Gamble, J. G. 2002; 44 (1): 58-63
Abstract

Postural control deficits have been suggested to be a major component of gait disorders in cerebral palsy (CP). Standing balance was investigated in 23 ambulatory children and adolescents with spastic diplegic CP, ages 5 to 18 years, and compared with values of 92 children without disability, ages 5 to 18 years, while they stood on a force plate with eyes open or eyes closed. The measurements included center of pressure calculations of path length per second, average radial displacement, mean frequency of sway, and Brownian random motion measures of the short-term diffusion coefficient, and the long-term scaling exponent. In the majority of children with CP (14 of 23) all standing balance values were normal. However, approximately one-third of the children with CP (eight of 23) had abnormal values in at least two of the six center of pressure measures. Thus, mean values for path length, average radial displacement, and diffusion coefficient were higher for participants with CP compared with control individuals with eyes open and closed (p<0.05). Mean values for frequency of sway and the long-term scaling exponent were lower for participants with CP compared with control participants (p<0.05). Increased average radial displacement was the most common (nine of 23) postural control deficit. There was no increase in abnormal values with eyes closed compared with eyes open for participants with CP, indicating that most participants with CP had normal dependence on visual feedback to maintain balance. Identification of those children with impaired standing balance can delineate factors that contribute to the patient's gait disorder and help to guide treatment.

View details for Web of Science ID 000173138000009

View details for PubMedID 11811652
A working visit to a developing country. The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha Gamble, J. G. 2000; 63 (4): 22-24
View details for PubMedID 11216352
Dressed to kill: the mid-nineteenth century crinoline craze. The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha Gamble, J. G. 2000; 63 (1): 16-21
View details for PubMedID 10752348
Electromyographic differentiation of diplegic cerebral palsy from idiopathic toe walking: Involuntary coactivation of the quadriceps and gastrocnemius JOURNAL OF PEDIATRIC ORTHOPAEDICS Rose, J., Martin, J. G., Torburn, L., Rinsky, L. A., Gamble, J. G. 1999; 19 (5): 677-682
Abstract

Clinical differentiation of patients with mild diplegic cerebral palsy (CP) and idiopathic toe walking (ITW) can be difficult. However, an involuntary extensor pattern may be a distinguishing sign. The purpose of this study was to determine if selected gait parameters or patterns of electromyogram (EMG) timing of quadriceps, gastrocnemius, and tibialis anterior during knee extension while sitting can distinguish between these patients. The hypothesis was that EMG testing for selective control of the quadriceps and gastrocnemius could differentiate patients with diplegic CP from normal controls and from patients with ITW. We evaluated 10 control, eight CP, and eight ITW subjects. Measurements included walking speed, energy expenditure index (EEI), ankle position during stance, and EMG of the quadriceps, gastrocnemius, and tibialis anterior during gait and during knee extension while sitting. Dynamic EMG timing during gait showed significant differences in the mean onset of the gastrocnemius between subjects with CP and ITW, but there was considerable overlap. More consistent differences were found during active and active-resisted knee extension while sitting. Mean values for gastrocnemius EMG timing recorded as a percentage of duration of quadriceps EMG while sitting were 0 and 0.4% for controls, 0 and 3.9% for ITW subjects, and 84.3% and 93.4% for CP subjects. Patterns of EMG timing of the quadriceps and gastrocnemius during knee extension while sitting can help to differentiate patients with mild diplegic CP from those with ITW.

View details for Web of Science ID 000082295100025

View details for PubMedID 10488875
Analysis of radiographic measurements as prognostic indicators of treatment success in patients with developmental dysplasia of the hip JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B Rosen, A., Gamble, J. G., Vallier, H., Bloch, D., Smith, L., Rinsky, L. A. 1999; 8 (2): 118-121
Abstract

Measurements were taken and statistically analyzed from the initial radiographs, the 1-year follow-up radiographs, and the most recent radiographs of 81 patients (103 hips) to determine which measurements could predict the success of treatment. The average follow-up was 49 months (range, 12-139 months), and the average age of the patients at the last follow-up was 65 months (range, 15-190 months). Analysis of the data showed that the measurement with statistically significant predictive value was the Tonnis grade of dislocation determined from the initial radiograph. A single unit increase in the Tonnis grade was associated with a doubling of the odds of failure in patients treated with a Pavlik harness (P < 0.04, odds ratio = 2.2) or a closed reduction (odds ratio = 2.0).

View details for Web of Science ID 000081887100011

View details for PubMedID 10218173
Death by spontaneous combustion: Charles Dickens and the strange case of Mr. Krook. The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha Gamble, J. G. 1999; 62 (2): 11-15
View details for PubMedID 10414129
Evaluation and treatment of pes cavus in spina bifida 2nd International Symposium on Spina Bifida Gamble, J. G. SPRINGER-VERLAG TOKYO. 1999: 378?381
View details for Web of Science ID 000165072800073
A social history of people with physical disabilities, including spina bifida 2nd International Symposium on Spina Bifida Gamble, J. G. SPRINGER-VERLAG TOKYO. 1999: 275?288
View details for Web of Science ID 000165072800050
Charles Dickens gets a lesson in sensitivity: Mrs. Jane Seymour Hill's reaction to David Copperfield. The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha Gamble, J. G. 1998; 61 (3): 8-12
View details for PubMedID 9731451
Postural balance measurements for children and adolescents JOURNAL OF ORTHOPAEDIC RESEARCH Wolff, D. R., Rose, J., Jones, V. K., Bloch, D. A., Oehlert, J. W., Gamble, J. G. 1998; 16 (2): 271-275
Abstract

Measurements of standing balance were determined for 92 children and adolescents, 5-18 years old, while they stood on a force plate with eyes open or eyes closed. The measurements included center-of-pressure calculations for path length per second, average radial displacement, anterior-posterior and mediolateral amplitudes, area per second, mean frequency of sway, Brownian random motion measure of short-term diffusion coefficient, and long-term scaling exponent. All balance parameters improved from youngest to oldest subjects, and the parameters improved when measured with the subjects' eyes open compared with closed. The mean values for data from three trials varied by only 5% when compared with the mean values from 10 trials. Data from this study suggest that force-plate center-of-pressure data can be used to determine differences in standing balance between children and adolescents of different ages and those with movement and balance abnormalities.

View details for PubMedID 9621902
Charles Dickens: his quaint little "person of the house," and the English disease. The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha Gamble, J. G. 1996; 59 (4): 24-28
View details for PubMedID 9130856
Effectiveness of ice packs in reducing skin temperature under casts CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Metzman, L., Gamble, J. G., Rinsky, L. A. 1996: 217-221
Abstract

Skin temperature lowering effects were measured after application of crushed ice packs to the surface of synthetic and plaster casts. The skin temperature of legs in synthetic casts decreased an average of 10.4 degrees C (range, 8.3 degrees-12.6 degrees) to a minimum temperature of 19.7 degrees C (range, 16.2 degrees-21.8 degrees), and the temperature of legs in plaster casts decreased an average of 11 degrees C to a minimum of 18.7 degrees C (range, 13 degrees-22.8 degrees). It took an average of 56 minutes (range, 40-80 minutes) for the legs in synthetic casts and 63.8 minutes (range, 26-116 minutes) for the legs in plaster casts to reach the minimum temperature. Cryotherapy is used clinically with the intention of lowering skin temperature and presumably decreasing the pain and swelling of a patient's injured extremity. The presence of a synthetic or a plaster cast does not eliminate the lowering effects of skin temperature when crushed ice packs are applied to the surface of the casts.

View details for Web of Science ID A1996VG55100029

View details for PubMedID 8804296
Loss of elbow and wrist motion in hemophilia CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Gamble, J. G., Vallier, H., Rossi, M., Glader, B. 1996: 94-101
Abstract

The longitudinal changes in elbow and wrist motion for 48 patients with hemophilia were reviewed to determine the effect of recurrent hemarthroses. The average age of the patients at the time of followup was 23 years 9 months. The average duration of followup was 10.8 years. The patients were divided into 3 age groups: younger than age 15 years (14 patients), age 15 to 25 years (11 patients), and older than age 25 years (23 patients). For patients older than age 25 years, pronation, supination, elbow flexion and extension, wrist flexion and extension, and ulnar deviation were significantly decreased relative to patients younger than age 15 years. Pronation was the first motion to show a significant change, decreasing by 19% in patients age 15 to 25 years and by 31% in patients older than age 25 years. Loss of elbow extension showed the greatest change. In cases of severe hemophilic arthropathy of the elbow, synovectomy and radial head excision decreased elbow pain and bleeding episodes and improved supination and pronation.

View details for PubMedID 8653985
Erroneous interpretation of magnetic resonance images of a fracture of the first rib with non-union. Two case reports. journal of bone and joint surgery. American volume Gamble, J. G., Comstock, C., Rinsky, L. A. 1995; 77 (12): 1883-1887
View details for PubMedID 8550657
Erroneous interpretation of magnetic resonance images of a fracture of the first rib with non-union - Two case reports JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Gamble, J. G., Comstock, C., Rinsky, L. A. 1995; 77A (12): 1883-1887
View details for Web of Science ID A1995TL78100013
GASTROINTESTINAL PROBLEMS IN PATIENTS WHO HAVE TYPE-III OSTEOGENESIS IMPERFECTA JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Lee, J. H., Gamble, J. G., Moore, R. E., Rinsky, L. A. 1995; 77 (9): 1352-1356
Abstract

We performed a study of forty-three patients who had type-III osteogenesis imperfecta. Our purpose was to determine the frequency and severity of abdominal problems and the relationship between these problems and pelvic deformity. Twelve patients had had recurrent episodes of abdominal pain. Eleven of them had a history of chronic constipation, and five had been treated for fecal impaction. Radiographs had been made for ten of these patients, and eight of them had radiographic evidence of pelvic deformity with severe acetabular protrusion. Chronic constipation and recurrent abdominal pain are more frequent in patients who have osteogenesis imperfecta and acetabular protrusion than in those who do not have protrusion. These patients may benefit from early attention to a bowel program and referral to a gastrointestinal specialist.

View details for PubMedID 7673285
MUSCLE PATHOLOGY AND CLINICAL MEASURES OF DISABILITY IN CHILDREN WITH CEREBRAL-PALSY JOURNAL OF ORTHOPAEDIC RESEARCH Rose, J., Haskell, W. L., Gamble, J. G., Hamilton, R. L., Brown, D. A., Rinsky, L. 1994; 12 (6): 758-768
Abstract

We performed a histologic and morphometric study of spastic muscle from 10 children with diplegic cerebral palsy, comparing muscle structure with the gait parameters of energy expenditure index and dynamic electromyography. Variations in fiber area within and between fiber types were increased significantly in children with cerebral palsy. In each of the control subjects, the combined coefficient of variation for type-1 and type-2 fiber area was less than 25% and the average was 17%; in the subjects with cerebral palsy, the combined coefficient of variation was more than 25% and the average was 36% (p < or = 0.004). The average difference between the mean area of type-1 and type-2 fibers was 26.7 +/- 18.9% for subjects with cerebral palsy and 4.2 +/- 2.4% for control subjects (p < or = 0.004). There was a 67% predominance of one fiber type in the subjects with cerebral palsy compared with a 55% predominance in the control subjects (p < or = 0.03). The difference between the total area of type-1 and type-2 fibers was 57% in the subjects with cerebral palsy and 17% in the control subjects (p < or = 0.002). There was a significant correlation between the combined coefficient of variation of fiber area and the energy expenditure index (r = 0.77, p < or = 0.03). The difference between the mean area of type-1 and type-2 fibers correlated with prolongation of electromyographic activity (r = 0.69, p < or = 0.05). No abnormalities in fiber ultrastructure were found in the subjects with cerebral palsy. Children with cerebral palsy had abnormal variation in the size of muscle fibers and altered distribution of fiber types. The values for variation in fiber area correlated with the energy expenditure index and with prolongation of electromyographic activity during walking.

View details for Web of Science ID A1994PW53900002

View details for PubMedID 7983551
The relevance of John Dewey's philosophy to graduate medical education. The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha Gamble, J. G. 1994; 57 (2): 16-19
View details for PubMedID 8022869
A COMPARISON OF OXYGEN PULSE AND RESPIRATORY EXCHANGE RATIO IN CEREBRAL-PALSIED AND NONDISABLED CHILDREN ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Rose, J., Haskell, W. L., Gamble, J. G. 1993; 74 (7): 702-705
Abstract

Energy expended while walking is increased for children with cerebral palsy compared to nondisabled children. This study compared oxygen uptake, oxygen pulse, and the respiratory exchange ratio (RER) in children with cerebral palsy and nondisabled children walking on a treadmill. Resting oxygen uptake and oxygen pulse values were not different in the two groups. At a given walking speed, oxygen uptake, oxygen pulse, and RER were higher for subjects with cerebral palsy. At a given level of submaximal oxygen uptake, oxygen pulse and RER values were not different in subjects with cerebral palsy compared to nondisabled children. It was concluded that the cardiorespiratory response to walking at submaximal level of work is not significantly different for children with cerebral palsy.

View details for Web of Science ID A1993LM07900006

View details for PubMedID 8328890
CASE REPORT-764 - DIAGNOSIS - PRIMARY LYMPHOMA OF BONE, LARGE CELL, B-PHENOTYPE, WITH ARTICULAR INVOLVEMENT SKELETAL RADIOLOGY Beatty, P. T., BJORKENGREN, A. G., Moore, S. G., Gelb, A. B., Gamble, J. G. 1992; 21 (8): 559-561
View details for Web of Science ID A1992KA97100014

View details for PubMedID 1465654
TRANSVERSE CERVICOPERTROCHANTERIC HIP FRACTURE JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G., LETTICE, J., SMITH, J. T., Rinsky, L. A. 1991; 11 (6): 779-782
Abstract

A 3-year-old boy sustained a previously undescribed transverse hip fracture that involved the cervical, cervicotrochanteric, and intertrochanteric regions. The fracture was successfully treated with skeletal traction for 4 weeks using a Steinmann pin placed through the distal femoral metaphysis followed by spica cast immobilization. The 3-year follow-up examination demonstrated satisfactory growth and remodeling of the proximal femur with no evidence of osteonecrosis, premature physeal closure, or coxa vara.

View details for Web of Science ID A1991GM56700016

View details for PubMedID 1960206
THE ENERGY-EXPENDITURE INDEX - A METHOD TO QUANTITATE AND COMPARE WALKING ENERGY-EXPENDITURE FOR CHILDREN AND ADOLESCENTS JOURNAL OF PEDIATRIC ORTHOPAEDICS Rose, J., Gamble, J. G., Lee, J., LEE, R., Haskell, W. L. 1991; 11 (5): 571-578
Abstract

We used heart rate and walking speed to calculate an energy expenditure index (EEI), the ratio of heart rate per meter walked, for 102 normal subjects, age 6-18 years. Heart rate was measured at self-selected slow, comfortable, and fast walking speeds on the floor and on a motor-driven treadmill. At slow walking speeds (37 +/- 10 m/min) the EEI was elevated (0.71 +/- 0.32 beats/m), indicating poor economy. At comfortable speeds (70 +/- 11 m/min) the EEI values decreased to the maximum economy (0.47 +/- 0.13 beats/m). At fast speeds (101 +/- 13 m/min), the EEI increased (0.61 +/- 0.17 beats/m), indicating poor economy relative to comfortable speeds. A graph of the EEI versus walking speed provides a way to evaluate and compare energy expenditure in a clinical setting.

View details for PubMedID 1918341
SIMPLE METHOD OF DOCUMENTING METATARSUS ADDUCTUS JOURNAL OF PEDIATRIC ORTHOPAEDICS SMITH, J. T., BLECK, E. E., Gamble, J. G., Rinsky, L. A., Pena, T. 1991; 11 (5): 679-680
Abstract

A simple, accurate, and inexpensive method of documenting metatarsus adductus involves taking photocopies of the foot in the weightbearing position. Subsequently, treatment progress can be assessed objectively by reviewing serial photocopies. Some caution is urged because the strength of the glass copying surface of photocopying machines is unknown.

View details for Web of Science ID A1991GD03600023

View details for PubMedID 1918361
Arthropathy of the ankle in hemophilia. journal of bone and joint surgery. American volume Gamble, J. G., BELLAH, J., Rinsky, L. A., Glader, B. 1991; 73 (7): 1008-1015
Abstract

Seventy-five patients who had hemophilia were followed clinically and roentgenographically to assess the prevalence of hemarthrosis and the prevalence and severity of arthropathy of the ankle. The mean age of the patients at the time of follow-up was twenty-two years and seven months. The patients were divided into four age-groups: less than ten years (eleven patients), ten to nineteen years (twenty-one patients), twenty to thirty years (twenty-four patients), and more than thirty years (nineteen patients). Intra-articular bleeding occurred more frequently in the joints of the lower extremities than in the joints of the upper extremities. During the second decade of life, hemarthroses occurred more often in the ankle than in the knee. A history of recurrent bleeding into the ankle joint, chronic synovitis, and overgrowth of the medial portion of the distal tibial epiphysis was associated with an early onset of arthropathy. In older patients, compression arthrodesis of the ankle joint was helpful in eliminating pain, recurrent bleeding, and equinus deformity.

View details for PubMedID 1908466
ARTHROPATHY OF THE ANKLE IN HEMOPHILIA JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Gamble, J. G., BELLAH, J., Rinsky, L. A., Glader, B. 1991; 73A (7): 1008-1015
Abstract

Seventy-five patients who had hemophilia were followed clinically and roentgenographically to assess the prevalence of hemarthrosis and the prevalence and severity of arthropathy of the ankle. The mean age of the patients at the time of follow-up was twenty-two years and seven months. The patients were divided into four age-groups: less than ten years (eleven patients), ten to nineteen years (twenty-one patients), twenty to thirty years (twenty-four patients), and more than thirty years (nineteen patients). Intra-articular bleeding occurred more frequently in the joints of the lower extremities than in the joints of the upper extremities. During the second decade of life, hemarthroses occurred more often in the ankle than in the knee. A history of recurrent bleeding into the ankle joint, chronic synovitis, and overgrowth of the medial portion of the distal tibial epiphysis was associated with an early onset of arthropathy. In older patients, compression arthrodesis of the ankle joint was helpful in eliminating pain, recurrent bleeding, and equinus deformity.

View details for Web of Science ID A1991GC97300007
INVESTIGATING WHETHER EDUCATION OF RESIDENTS IN A GROUP-PRACTICE INCREASES THE LENGTH OF THE OUTPATIENT VISIT ACADEMIC MEDICINE Gamble, J. G., LEE, R. 1991; 66 (8): 492-493
Abstract

This prospective study, carried out over an eight-week period in 1990, compared the amount of time required for 468 outpatients in an academic group practice (pediatric orthopedics) to be evaluated by an attending surgeon working with a resident with the time required for 216 patients in the same practice to be evaluated by the attending surgeon only. On the average, 24.2 minutes were added when a resident was involved: 12.6 of these for the resident's examination of the patient and the remaining 11.6 for the resident's discussion of the case with the attending surgeon. These findings suggest that the education process builds in a time cost not only for the patient but for the attending surgeon, who has less time to see additional outpatients than does a private practitioner or a physician in a health maintenance organization.

View details for Web of Science ID A1991GB27700021

View details for PubMedID 1883439
RECOMMENDATIONS ON THE BONDING OF PHYSICIANS TO MEDICAL INSTITUTIONS PERSPECTIVES IN BIOLOGY AND MEDICINE Gamble, J. G. 1991; 34 (2): 226-228
View details for Web of Science ID A1991EX26500007

View details for PubMedID 2023798
SIMULTANEOUS CORRECTION OF PELVIC OBLIQUITY, FRONTAL PLANE, AND SAGITTAL PLANE DEFORMITIES IN NEUROMUSCULAR SCOLIOSIS USING A UNIT ROD WITH SEGMENTAL SUBLAMINAR WIRES - A PRELIMINARY-REPORT JOURNAL OF PEDIATRIC ORTHOPAEDICS Maloney, W. J., Rinsky, L. A., Gamble, J. G. 1990; 10 (6): 742-749
Abstract

Ten patients with neuromuscular scoliosis and pelvic obliquity had segmental spinal instrumentation using a unit Luque rod with sublaminar wires and fixation into the pelvis. Nine of the 10 patients also had anterior spinal fusion without instrumentation before the posterior procedure. Average preoperative pelvic obliquity was 42 degrees which was corrected to 6 degrees (82% correction). Average preoperative scoliosis was 92 degrees, which was corrected to 16 degrees (81% correction). Complications included a wound hematoma in one patient and a superficial wound dehiscence in another. There have been no pseudarthroses or hardware failures to date. Excellent correction of the pelvic obliquity and the spinal curve in neuromuscular scoliosis can be obtained with use of a unit rod and without use of anterior instrumentation.

View details for Web of Science ID A1990EF61000007

View details for PubMedID 2250058
GLUCOSAMINIDASE, GALACTOSAMINIDASE, AND GLUCURONIDASE IN THE GROWTH PLATE JOURNAL OF ORTHOPAEDIC RESEARCH Gamble, J. G., HAIMSON, R., Smith, R. L. 1990; 8 (5): 764-768
Abstract

The activities of glucosaminidase, galactosaminidase, and glucuronidase were determined in fractions of bovine growth plate cartilage. Glucosaminidase and galactosaminidase activities were lowest in the area corresponding to the reserve cartilage and increased from the upper to the lower portions of the hypertrophic zones of the growth plate, reaching a maximum in the calcifying cartilage. Glucuronidase activity showed a distinct spike of activity in the calcifying cartilage. The spatial distribution of these activities suggests a role in calcification and in the dissolution of the extracellular matrix at the chondro-osseous junction of the growth plate.

View details for Web of Science ID A1990DU81900017

View details for PubMedID 2388115
ENERGY-EXPENDITURE INDEX OF WALKING FOR NORMAL-CHILDREN AND FOR CHILDREN WITH CEREBRAL-PALSY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., Gamble, J. G., Burgos, A., Medeiros, J., Haskell, W. L. 1990; 32 (4): 333-340
Abstract

Energy expenditure indices (EEI) based on oxygen uptake and heart rate were used to compare the economy of walking at various speeds by normal and cerebral-palsied children. At low walking speeds, EEI values were high, indicating poor economy. At higher speeds the EEI values decreased until a range of maximum economy was reached. For normal children who were capable of walking beyond this range at higher speeds, the EEI increased again. This pattern was noted for both oxygen-uptake and heart-rate indices. Mean EEI values based on oxygen uptake and heart rate for normal children were significantly lower and occurred at faster walking speeds than values for children with cerebral palsy. EEI based on either oxygen uptake or heart rate can be used clinically to provide objective information to help evaluate the influence on gait function of surgical intervention, ambulatory aids or orthotics.

View details for Web of Science ID A1990CV23200008

View details for PubMedID 2332124
ESTABLISHED HIP DISLOCATIONS IN CHILDREN WITH CEREBRAL-PALSY CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Gamble, J. G., Rinsky, L. A., BLECK, E. E. 1990: 90-99
Abstract

Hip dislocation in children with cerebral palsy is caused by a combination of factors, including spastic muscle imbalance, persistent fetal femoral geometry, acetabular dysplasia, and flexion-adduction contracture. The incidence of dislocation correlates with the severity of the spasticity, and the prevalence is close to 50% in neurologically immature, spastic quadriplegic children. Successful hip reductions improve muscular balance, provide satisfactory reduction of the femoral head, and establish good pelvic coverage. In 31 occurrences of established hip dislocation in 24 patients, the most successful operations used a combined procedure consisting of soft-tissue release, open reduction, femoral varus derotation and shortening osteotomy, and pelvic osteotomy.

View details for Web of Science ID A1990CX27900012

View details for PubMedID 2180606
ENERGY-COST OF WALKING IN NORMAL-CHILDREN AND IN THOSE WITH CEREBRAL-PALSY - COMPARISON OF HEART-RATE AND OXYGEN-UPTAKE JOURNAL OF PEDIATRIC ORTHOPAEDICS Rose, J., Gamble, J. G., Medeiros, J., Burgos, A., Haskell, W. L. 1989; 9 (3): 276-279
Abstract

The rate of oxygen uptake can be used to assess energy expenditure during walking, but the necessary instrumentation is cumbersome, expensive, and usually unavailable in the clinical setting. Heart rate is an easily measured parameter, but its use as an index of energy expenditure in children has not been validated previously. We found that the relationship between oxygen uptake and heart rate was linear throughout a wide range of walking speeds for both children with cerebral palsy and normal children. There was no significant difference between the slope or the gamma-intercept of the lines for the two groups. These findings validate the use of heart rate as an index of energy expenditure for normal children and for children with cerebral palsy.

View details for Web of Science ID A1989U380200004

View details for PubMedID 2723046
Trapeziometacarpal abnormalities in Ehlers-Danlos syndrome. journal of hand surgery Gamble, J. G., Mochizuki, C., Rinsky, L. A. 1989; 14 (1): 89-94
Abstract

We studied 24 patients with Ehlers-Danlos syndrome with particular attention to the thumb and the trapeziometacarpal joint. The 11 males and 13 females had a mean age of 15.9 years. Symptomatic complaints included pinch, grip and twisting weakness; measurements showed dominant hand strength deficits of 71% for tip pinch, 55% for palmar pinch, 46% for key pinch, and 70% for grip. All finger joint ranges of motion were increased. Sixty-six percent of all the patients had trapeziometacarpal subluxation; 29% had dislocation. Sixteen percent had radiographic evidence of arthritis. Early occupational therapy evaluation and education can help these patients better understand and adapt to their limitations.

View details for PubMedID 2786020
TRAPEZIOMETACARPAL ABNORMALITIES IN EHLERS-DANLOS SYNDROME JOURNAL OF HAND SURGERY-AMERICAN VOLUME Gamble, J. G., Mochizuki, C., Rinsky, L. A. 1989; 14A (1): 89-94
View details for Web of Science ID A1989R777900013
COMPLICATIONS OF INTRAMEDULLARY RODS IN OSTEOGENESIS IMPERFECTA - BAILEY-DUBOW RODS VERSUS NONELONGATING RODS JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G., Strudwick, W. J., Rinsky, L. A., BLECK, E. E. 1988; 8 (6): 645-649
Abstract

Twenty-nine patients with osteogenesis imperfecta underwent 108 intramedullary roddings with 42 Bailey-Dubow rods and 66 nonelongating rods. The average age at insertion of the first rod was 5 years; average follow-up was 3.1 years (range 1-9 years). The overall complication rate was 60%-69% for Bailey-Dubow rods and 55% for nonelongating rods. Forty-seven percent of bones receiving rods required reoperation. Nonelongating rods had a 29% reoperation rate and a 24% replacement rate; Bailey-Dubow rods had a 19% reoperation rate and a 12% replacement rate.

View details for Web of Science ID A1988Q655600003

View details for PubMedID 3056970
Orthopaedic aspects of central core disease. journal of bone and joint surgery. American volume Gamble, J. G., Rinsky, L. A., Lee, J. H. 1988; 70 (7): 1061-1066
Abstract

We studied the cases of fifteen patients who had central core disease, a non-progressive congenital myopathy that is usually inherited as an autosomal dominant trait. As infants, the patients had poor muscle tone and developmental delay, and as adolescents and adults, they had varying degrees of proximal muscle weakness and tended to use the Gower maneuver. The most common musculoskeletal problems were dislocation or subluxation of the hip, pes planus, and hypermobility of the joints. The most serious orthopaedic problems were in the hips: ten patients had a total of nine dislocations and six subluxations, nine being present at birth and six developing later. Only nine hips were stable after the initial treatment, and there was a propensity for hip-joint contractures. Scoliosis and patellar instability were also seen. Although patients who have central core disease have been reported to be at increased risk for malignant hyperthermia, this did not occur in our patients.

View details for PubMedID 3403575
ORTHOPEDIC ASPECTS OF CENTRAL CORE DISEASE JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Gamble, J. G., Rinsky, L. A., Lee, J. H. 1988; 70A (7): 1061-1066
Abstract

We studied the cases of fifteen patients who had central core disease, a non-progressive congenital myopathy that is usually inherited as an autosomal dominant trait. As infants, the patients had poor muscle tone and developmental delay, and as adolescents and adults, they had varying degrees of proximal muscle weakness and tended to use the Gower maneuver. The most common musculoskeletal problems were dislocation or subluxation of the hip, pes planus, and hypermobility of the joints. The most serious orthopaedic problems were in the hips: ten patients had a total of nine dislocations and six subluxations, nine being present at birth and six developing later. Only nine hips were stable after the initial treatment, and there was a propensity for hip-joint contractures. Scoliosis and patellar instability were also seen. Although patients who have central core disease have been reported to be at increased risk for malignant hyperthermia, this did not occur in our patients.

View details for Web of Science ID A1988P831300015
KINGELLA-KINGAE INFECTION IN HEALTHY-CHILDREN JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G., Rinsky, L. A. 1988; 8 (4): 445-449
Abstract

Kingella kingae is a gram-negative occasional, but normal, inhabitant of the nasopharynx. We present two new cases of this infection that occurred in previously healthy children, and compare and contrast them to other cases reported in the literature. K. kingae osteomyelitis generally has an insidious, subacute onset, whereas septic arthritis has an acute presentation. To date, all strains of K. kingae have been sensitive to penicillin, and no residual damage has been reported following osteomyelitis or septic arthritis, except that residual disk space narrowing did occur after K. kingae discitis.

View details for Web of Science ID A1988N916200012

View details for PubMedID 3292580
Non-union of fractures in children who have osteogenesis imperfecta. journal of bone and joint surgery. American volume Gamble, J. G., Rinsky, L. A., STRUDWICK, J., BLECK, E. E. 1988; 70 (3): 439-443
Abstract

Although a fracture rarely fails to unite in a healthy child, non-union is not a rare occurrence in a child who has osteogenesis imperfecta. We identified twelve non-unions in ten patients from a population of fifty-two patients who had osteogenesis imperfecta. The average age of these patients when the diagnosis of non-union was made nine years, and the average age at the time of treatment was 12.5 years. All of the patients had had a decrease in functional ability as a result of the non-union. There were five femoral, four humeral, one radial, one ulnar, and one pubic non-union. Five of the non-unions were hypertrophic, and seven were atrophic. Eight of the nine ununited fractures that were operated on healed after excision of the non-union, intramedullary nailing, and bone-grafting. Three of the non-unions (in two patients) were not operated on, and the one patient in whom surgery failed had an amputation. Non-union was frequently associated with repeated fractures at a progressively deforming site.

View details for PubMedID 3346270
NON-UNION OF FRACTURES IN CHILDREN WHO HAVE OSTEOGENESIS IMPERFECTA JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Gamble, J. G., Rinsky, L. A., STRUDWICK, J., BLECK, E. E. 1988; 70A (3): 439-443
View details for Web of Science ID A1988M630300018
ADOLESCENT IDIOPATHIC SCOLIOSIS WESTERN JOURNAL OF MEDICINE Rinsky, L. A., Gamble, J. G. 1988; 148 (2): 182-191
Abstract

Adolescent idiopathic scoliosis is the single most common form of spinal deformity seen in orthopedic practice. Our knowledge about the epidemiology, etiology, natural history, and treatment has recently increased dramatically. The incidence of small curves is rather high (2% of the population), whereas severe curves are much less common (<0.1%), but we cannot always predict which curve will progress. Abnormalities of the neuromuscular system and of calcium metabolism, and certain growth, genetic, and mechanical factors may all play roles in the pathogenesis of the disorder. The physiologic secondary effects of severe scoliosis relate to restrictive lung disease, but most patients do not have a deformity great enough to affect their cardiorespiratory function. The psychological and social effects of scoliosis are significant for patients but difficult to quantitate. For most patients with moderate scoliosis-that is, more than 25 to 30 degrees-treatment with an underarm brace or electrical stimulation is adequate to "control" progression of the curve. Surgical fusion allows actual correction of the curve but is indicated in only a small percentage of patients-usually those with more than 50 degrees of deformity.

View details for Web of Science ID A1988M118200005

View details for PubMedID 3279708
BACK PAIN AND SPINAL DEFORMITY IN CYSTIC-FIBROSIS AMERICAN JOURNAL OF DISEASES OF CHILDREN Rose, J., Gamble, J., Schultz, A., LEWISTON, N. 1987; 141 (12): 1313-1316
Abstract

Back pain is a common complaint of individuals with cystic fibrosis (CF). We studied back pain in our patient population in three ways: a questionnaire, an orthopedic evaluation, and a survey of chest roentgenograms. Forty-seven patients with CF reported back pain as compared with seven controls. Patients with CF showed decreased muscle strength and mobility in the trunk, chest, and shoulders. The incidence of structural kyphosis was only 8.7%, but many had vertebral wedging. Much of the back pain may be due to postural abnormalities or to vertebral wedging, not fixed structural kyphosis.

View details for Web of Science ID A1987L008900035

View details for PubMedID 2961252
HIP MOTION CHANGES IN HEMOPHILIA JOURNAL OF PEDIATRIC ORTHOPAEDICS Goodman, S., Gamble, J. G., Dilley, M. 1987; 7 (6): 664-666
Abstract

We reviewed early and late motion changes of the hip in 102 hemophiliacs with a mean follow-up of 7 years. Sixty patients (59%) had at least one hip bleed. Sixty-four hips in 49 patients demonstrated at least a 15 degree change in range of motion (ROM) at some time. At final review, only 34 of these 64 hips (53%) lost motion. Patients whose hips lost motion were just as likely to report hip bleeds as those who lost no motion. Twenty hips examined within 2 months of bleeding lost significant motion, but most motion returned within a year. The relationship between hip girdle bleeding and ROM remains obscure.

View details for PubMedID 3429650
SYMPTOMATIC DORSAL DEFECT OF THE PATELLA IN A RUNNER AMERICAN JOURNAL OF SPORTS MEDICINE Gamble, J. G. 1986; 14 (5): 425-427
Abstract

The dorsal defect of the patella is a benign lesion characteristically located in the superolateral corner of the patella. The microscopic pathology shows fibrous tissue, reactive woven bone, and stringy, eosinophilic, extracellular debris. Although the lesion is usually asymptomatic, the juxtaarticular location in the patella can provoke symptoms in the athlete. Excision of the lesion and cancellous bone graft of the defect resolved the problem in a competitive adolescent runner.

View details for Web of Science ID A1986E558400017

View details for PubMedID 3777323
THE SYMPHYSIS PUBIS - ANATOMIC AND PATHOLOGICAL CONSIDERATIONS CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Gamble, J. G., Simmons, S. C., Freedman, M. 1986: 261-272
Abstract

The symphysis pubis is a nonsynovial amphiarthrodial joint that is situated at the confluence of the two pubic bones. A thick intrapubic fibrocartilaginous disc is sandwiched between thin layers of hyaline cartilage. The inferior pubic ligament provides most of the joint's stability. Anatomic sections demonstrate a symphysis by the end of the second month of gestation. Thick cartilaginous end-plates are present at birth but become thin by the time of skeletal maturity. Congenital diseases resulting in failure of symphysis formation include exstrophy of the bladder and cleidocranial dysostosis. Both pyogenic and tuberculous infectious diseases involve the symphysis. Metabolic disease, such as renal osteodystrophy, produces widening, while ochronosis results in calcific deposits in the symphysis. Inflammatory disease, such as ankylosing spondylitis, results in bony fusion of the symphysis. Osteitis pubis, the most common inflammatory disease, is treated with anti-inflammatory medication and rest. Degenerative joint disease of the symphysis, which can cause groin pain, results from instability or from abnormal pelvic mechanics. As is the case with most joints, the symphysis serves as a barrier to tumor invasion. The patterns of trauma include diastasis, straddle fracture, intraarticular fracture and overlapping dislocation, and combinations of injuries.

View details for Web of Science ID A1986A261400033

View details for PubMedID 3955988
CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS - A DISTINCT CLINICAL ENTITY JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G., Rinsky, L. A. 1986; 6 (5): 579-584
Abstract

We reviewed the cases of five children with the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) and compared and contrasted them to 11 cases of subacute osteomyelitis. Significant differences were found between these two groups in the number of cases with positive biopsy cultures, number of clinical episodes, and number of bones involved. In CRMO, cultures are negative, and recurrent clinical episodes involve different bones at different times. The data indicate that CRMO is a distinct clinical entity, different from subacute osteomyelitis; it is a benign, self-limiting inflammatory disease of bone, and no chronic problems have occurred as a result of CRMO. Restraint in antibiotic treatment and in performing repeated biopsies is indicated in CRMO.

View details for Web of Science ID A1986D802800010

View details for PubMedID 3760168
COMBINED OCCIPITOATLANTOAXIAL HYPERMOBILITY WITH ANTERIOR AND POSTERIOR ARCH DEFECTS OF THE ATLAS IN PIERRE-ROBIN SYNDROME JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G., Rinsky, L. A. 1985; 5 (4): 475-478
Abstract

Combined occipitoatlantoaxial instability of the cervical spine occurred in a 8-year-3-month old boy with Pierre-Robin syndrome. He also had failure of ossification of both the anterior and posterior arches of the atlas. An in situ fusion from the occiput to C2 restored cervical spine stability. This case is discussed in relation to other hypermobility and instability syndromes of the cervical spine.

View details for Web of Science ID A1985ALA9400018

View details for PubMedID 4019764
HYPERVITAMINOSIS-A IN A CHILD FROM MEGADOSING JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G., IP, S. C. 1985; 5 (2): 219-221
Abstract

Hypervitaminosis A developed in a 2-year-9-month-old boy after his mother gave him 6,338 IU/kg/day vitamin A for 5 months. The clinical features included irritability, xerosis of the skin and mucous membranes, pruritus, bone pain, and loss of ambulation. The bone scan showed involvement of more bones than was apparent on the roentgenograms. A prompt diagnosis depended on an accurate history of excessive vitamin intake, and the serum vitamin A level confirmed the diagnosis.

View details for Web of Science ID A1985AEL0100021

View details for PubMedID 3988928
COXA MAGNA FOLLOWING SURGICAL-TREATMENT OF CONGENITAL HIP DISLOCATION JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G., Mochizuki, C., BLECK, E. E., Rinsky, L. A. 1985; 5 (5): 528-533
Abstract

We studied coxa magna after operative treatment of congenital dislocation of the hip, including incidence, relationship to treatment, and influence of coxa magna on the acetabulum. Coxa magna was defined as a femoral head with a horizontal diameter at least 15% greater than the symmetrical position on the opposite side. Coxa magna developed in 16 hips (33%). The mean increase was 20.9% (range 15-30%). Three factors correlated with coxa magna: femoral osteotomy (100%), open reduction (75%), and operation at a younger age (mean 15.6 vs. 35.8 months). Four of the 16 hips developed coxa magna following Type 1 avascular necrosis; no other growth deformities appeared. At follow-up, the acetabular indices and the center edge angles were not statistically different between the coxa magna and the control groups. One must avoid confusing coxa magna with hip subluxation or inadequate reduction, of which the latter requires appropriate treatment. Coxa magna gives a good hip if a concentric, congruous reduction is obtained, providing the acetabulum has enough growth potential for remodeling.

View details for Web of Science ID A1985APK9600004

View details for PubMedID 4044810
SEGMENTAL INSTRUMENTATION WITHOUT FUSION IN CHILDREN WITH PROGRESSIVE SCOLIOSIS JOURNAL OF PEDIATRIC ORTHOPAEDICS Rinsky, L. A., Gamble, J. G., BLECK, E. E. 1985; 5 (6): 687-690
Abstract

Nine young children had segmental spinal stabilization without fusion for progressive scoliosis. External bracing was not used. There were no immediate complications, but at a mean follow-up of 28 months, the mean loss of correction was 32% and only four patients maintained the initial correction. The mean interval spinal growth was only 0.8 cm. Rods failed in three patients, requiring revision and fusion. Thus, the early results of this technique are discouraging.

View details for Web of Science ID A1985AVD8800011

View details for PubMedID 4066943
ACETABULAR OSTEOMYELITIS IN CHILDREN CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Gamble, J. G., Rinsky, L. A., BLECK, E. E. 1984: 71-74
Abstract

The clinical, laboratory, and roentgenographic features of acetabular osteomyelitis were present in a 20-month-old boy and a five-year-old girl. The clinical and laboratory parameters were similar in extracapsular acetabular osteomyelitis and septic arthritis of the hip. A secondary effusion was evident in roentgenograms in both conditions. Acetabular osteomyelitis responded to selected intravenous antibiotic therapy. Septic arthritis of the hip required immediate surgical drainage as well as appropriate antibiotic coverage.

View details for Web of Science ID A1984SW27700012

View details for PubMedID 6723163
ENZYMATIC ADAPTATION IN LIGAMENTS DURING IMMOBILIZATION AMERICAN JOURNAL OF SPORTS MEDICINE Gamble, J. G., Edwards, C. C., MAX, S. R. 1984; 12 (3): 221-228
Abstract

Ligaments are a composite of fibroblasts and collagen in a proteoglycan matrix. Seventy-five percent of the organic solid is collagen and 23% is proteoglycan. Fibroblasts are responsible for the overall composition of the ligament, that is the synthesis and the degradation of macromolecular components. Like muscle and bone, ligaments are dynamic, undergoing hypertrophy with exercise and atrophy with immobilization. This paper reviews the structure and composition of ligaments and discusses the cellular events responsible for atrophy of ligaments with immobilization. As an experimental model, one knee of New Zealand White rabbits was immobilized with a pin. After 2, 4, and 8 weeks of immobility, the medial collateral ligaments were isolated and enzyme analysis was performed. Gross and microscopic changes were apparent after 2 weeks. As for enzyme changes, lactic dehydrogenase and malic dehydrogenase decreased in activity. The lysosomal hydrolases responsible for glycosaminoglycan degradation increased in activity, suggesting that enzymatic adaptations mediate the physical and chemical changes in the ligament. The cells switch from an anabolic synthetic state to a catabolic, degradative state during immobility. It would seem from the biochemical viewpoint that, whenever possible, cast-bracing and functional splints may be preferable to rigid plasters in many sports-related ligamentous injuries.

View details for Web of Science ID A1984SR85100011

View details for PubMedID 6742306
PROXIMAL TIBIOFIBULAR SYNOSTOSIS JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G. 1984; 4 (2): 243-245
Abstract

A case of proximal tibiofibular synostosis with a 10-year follow-up is presented. The lesion was documented roentgenographically when the patient was 3 years of age and when she became symptomatic at 13 years of age after vigorous running. The symptoms were successfully treated with custom-molded shoe orthotics.

View details for Web of Science ID A1984SE64000014

View details for PubMedID 6699166
RESECTION ARTHROPLASTY OF THE HIP IN PARALYTIC DISLOCATIONS DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Kalen, V., Gamble, J. G. 1984; 26 (3): 341-346
Abstract

The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

View details for Web of Science ID A1984ST83900008

View details for PubMedID 6376226
HIP DISEASE IN HUTCHINSON-GILFORD PROGERIA SYNDROME JOURNAL OF PEDIATRIC ORTHOPAEDICS Gamble, J. G. 1984; 4 (5): 585-589
Abstract

Two cases of Hutchinson-Gilford progeria syndrome are presented with a focus on hip disease. A severe coxa valga is the first abnormality. The femoral head becomes increasingly uncovered as the acetabulum becomes more dysplastic. The center edge angle decreases, the acetabular index increases, and the medial wall of the acetabulum widens. Hip pain, subluxation, and eventually dislocation are the sequelae of these changes. Late osteotomy is unpredictable; thus the best therapeutic regimen is early osteotomy (age 4-6 years) and a regular exercise program to maintain muscle strength and range of motion.

View details for Web of Science ID A1984TK98000013

View details for PubMedID 6490880
BILATERAL SCAPHOID FRACTURES IN A CHILD CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Gamble, J. G., Simmons, S. C. 1982: 125-128
View details for Web of Science ID A1982ND01200021

View details for PubMedID 7067206
PSEUDOMONAS INFECTION OF THE SYMPHYSIS PUBIS IN A HEROIN USER - A CASE-REPORT ORTHOPEDICS Gamble, J. G., DHANDA, A. M., Edwards, C. C., Young, J. D. 1980; 3 (12): 1212-1214
Abstract

This article reports a case of Pseudomonas aeruginosa infection of the symphysis pubis in a heroin user. Cultures showed the organism to be sensitive to gentamicin, and cure was effected after the use of intravenous gentamicin therapy and operative curetting of joint debris and affected bone. The patient remained asymptomatic at the nine-month followup.

View details for Web of Science ID A1980KW41700005

View details for PubMedID 24823091
RESPONSE OF MITOCHONDRIAL-ENZYMES TO DECREASED MUSCULAR-ACTIVITY AMERICAN JOURNAL OF PHYSIOLOGY RIFENBER, D. H., Gamble, J. G., MAX, S. R. 1973; 225 (6): 1295-1299
View details for Web of Science ID A1973R581900008

View details for PubMedID 4357326

James Gamble

Professor of Orthopaedic Surgery at the Stanford University Medical Center

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