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Biomedical subjects

A F Brooker

Publications and source records attributed to A F Brooker.

At least 19 recordsLinked to original sources
PubMed1997

Observer variation in the detection of acetabular bone deficiencies.

To determine observer variation in the detection of acetabular bone deficiencies, 42 pairs of frontal (AP) and lateral hip radiographs and CT studies for total hip arthroplasty patients obtained within an average of 4 weeks of each other were reviewed separately by five radiologists and one orthopedic surgeon. Interobserver variations were calculated for each individual reading the films using kappa values. The individual film readings were then compared with a consensus reading of the CT data. When separate observers were analyzed, agreement on plain film readings was slight to fair (av. kappa = 0.1440 +/- 0.1047). The individual observers were not able to give readings which were very consistent with the CT consensus reading, resulting in a low sensitivity (65%) and specificity (74%) for acetabular defect classification with plain radiographs. The identification of acetabular bone defects from the AP and lateral views of the hip is highly subjective and variable from observer to observer.

Acetabulum↗
PubMed1992

Intramedullary nailing of tibial nonunions.

Fifteen tibial nonunions, ranging nine months to 19 years after original injury, were treated with the Brooker intramedullary nail (IMN). The average number of previous failed surgeries was two. The fracture location ranged from several centimeters below the tubercle to 3 cm above the plafond. Twelve of 15 had bone grafting, and all 15 had fibular osteotomy at the time of the IMN procedure. Thirteen of 15 were reamed, and 11 of 15 were nailed open. Patients required an average of five postoperative days in the hospital, and 14 of 15 tibial nonunions healed uneventfully at an average of eight months after the IMN procedure. Weight bearing in a removable patellar-tendon-bearing (PTB) brace was encouraged in most cases by two to four weeks postoperative. One nonunion patent, traumatically refractured after rod removal, was treated at another hospital with dynamic compression plating and iliac crest bone graft; the fracture healed three months later but was considered an IMN treatment failure. There were no other significant complications. The IMN procedure encourages early return to function and reliably promotes union in even the most challenging and complex of tibial healing problems.

Adult↗
PubMed1992

Excision of heterotopic bone followed by irradiation after total hip arthroplasty.

Twelve patients who had had a total hip arthroplasty had extensive excision of heterotopic bone, followed by prompt, low-dose irradiation, between 1983 and 1990. Volumes of as much as 900 milliliters of heterotopic bone tissue were resected. Of these patients, eleven had excellent relief of pain, and all twelve gained an average of 45 degrees of flexion and 25 degrees of abduction. Two patients had a recurrence of heterotopic bone (Brooker et al. class II); however, only one of these patients was symptomatic and had a result that was considered a failure.

Combined Modality Therapy↗
PubMed1989

Enhanced computed tomographic techniques for the evaluation of total hip arthroplasty.

Computed tomography (CT) has revolutionized the evaluation of musculoskeletal pathology. Until recently, however, CT of the postoperative orthopaedic patient has been severely limited by its inability to provide useful information in the vicinity of acetabular and femoral implants. Typically the hardware produces extensive artifacts that can markedly degrade the whole image. Methods are now available to reduce the metal artifact. Following hip arthroplasty, these methods have been used to plan for revision arthroplasty and to evaluate the contralateral side for avascular necrosis.

Evaluation Studies as Topic↗
PubMed1989

Nonunion of acetabular fractures: evaluation with interactive multiplanar CT.

Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool (copyright and trademark of the Body CT Imaging Laboratory, Department of Radiology, The Johns Hopkins Medical Institutions) that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.

Acetabulum↗
PubMed1989

Advanced three-dimensional evaluation of acetabular trauma: volumetric image processing.

Volumetric image processing is a new approach to generating simulated three-dimensional images from transaxial CT data. The major advantages compared to conventional surface-rendering 3D technique include: preservation of every pixel of CT data for increased accuracy of rendered image; tissue layer translucency allowing appreciation of multiple tissue layers on each image; simulation of real-time rotation in varying axes for optimal appreciation of abnormalities; and a high-speed, high-capacity computer setup which generates high-quality images rapidly, giving the system sufficient flexibility for these complicated functions while remaining user friendly and fast.

Accidents, Traffic↗
PubMed1989

Total replacement of the hip for avascular necrosis in sickle cell disease.

Total hip replacement was performed in 27 hips of patients who had sickle cell anaemia with avascular necrosis of the femoral head. The disease was bilateral in 11 patients. Considerable medical problems were encountered although most of the patients had exchange transfusion before surgery (86%), which prevented postoperative sickle cell crises in all but two cases. At the primary operation hard sclerotic bone was seen in nine femora with complete obliteration of the femoral canal. There were four femoral fractures, three following perforation of the shaft due to this hard bone. There was a very high morbidity due to loosening in both cemented and uncemented prostheses. With a rate of 59% over a cumulative 5.5 year period, revision was being performed at an average of only 43 months. Surgeons should be aware of these problems.

Adult↗
PubMed1988

Brooker-Wills nails in treatment of infra-isthmal injuries of the femur.

Forty-four consecutive infra-isthmal fractures of the femur were treated with the Brooker-Wills locking nail system. Choice of this device was based on the desire to use a closed nailing system that provides improved fixation of the distal femur. Forty-three of 44 fractures healed. Complications of the device included some difficulty with instrumentation and deployment of the fins early in the series. Three femurs were 1 cm shorter than the opposite side and one was 2 cm shorter. There were no device failures. It is concluded that this completely closed locking nail system provided reliable results and few complications.

Adolescent↗
PubMed1988

Fractures of the sacrum and sacroiliac joint: evaluation by computerized tomography with multiplanar reconstruction.

Conventional roentgenographic views of the pelvis provide inadequate assessment of complex bony trauma. Computerized tomography (CT) allows simpler patient positioning, more reliable detection of subtle fractures, better characterization of complex fractures, and detection of associated soft tissue and joint space abnormalities. The addition of multiplanar reconstructions (MPR) provides a better understanding of the pathoanatomy. The sacrum and the sacroiliac joint, traditionally problematic to image, are particularly well defined by CT/MPR. Subtle diastasis and intra-articular fragments are more reliably detected when the transaxial image is supplemented by coronal reconstructions. The degree of comminution and direction of fragment displacement are also best defined by coronal and sagittal formatting. Surgeons often find this protocol useful in preoperative assessment of extent and stability of fractures, and in planning conservative or surgical management.

Adult↗
PubMed1988

Fracture nonunion: CT assessment with multiplanar reconstruction.

Nineteen patients with suspected or possible fracture nonunion underwent computed tomography (CT) with multiplanar reconstruction (MPR). Each case represented a difficult problem in fracture management in which clinical and conventional radiographic examinations had failed to provide a definitive diagnosis. CT with MPR demonstrated nonunion in 13 of 19 cases by delineating the lack of bone bridging across the fracture site in multiple planes. Variable amounts bridging were detected in six cases, indicating partial healing or delayed union. Evaluation of fracture healing with MPR was possible despite remaining metal hardware (ten cases), multiple operations (15 cases), or bone grafting (five cases). CT with MPR aided surgical planning and affected treatment options by providing a more detailed assessment of malalignment and angular deformities, the magnitude of the gap in bone, and the integrity of the adjacent weight-bearing joints in multiple projections. It is an important new modality for evaluating fracture nonunion.

Adult↗
PubMed1987

Multiplanar computed tomography: a multidimensional tool for evaluation and treatment of acetabular fractures.

Fractures of the acetabulum present a formidable diagnostic and therapeutic challenge. Improved management has decreased the mortality associated with these injuries. Prolonged survival of the severely injured has raised the associated morbidity. To improve diagnosis and treatment in these patients, computed tomography with multiplanar reconstructions has been utilized in the pre- and post-operative period in 30 patients. This refinement provides a precise, accurate, and reproducible method of establishing the diagnostic data base. Consequently it is possible to better define the pathoanatomy, make decisions as to the best technique for intervention, and facilitate execution of these techniques by improved preoperative planning and postintervention assessment. It is concluded that computed tomography with multiplanar reconstructions optimizes the ability to manage these injuries.

Acetabulum↗
PubMed1987

Three-dimensional imaging of acetabular trauma.

Computed tomography (CT) scanning is widely used in evaluation of acetabular fractures. Three-dimensional (3D) images of the pelvis can be created from CT scan data. This article reports two studies, each employing one type of 3D imaging in acetabular trauma cases. The first was a study of 21 patients utilizing surface-rendered 3D images, the second, a study of 19 patients using volume-rendered 3D images. Both types of 3D images were clinically helpful and can be used in lieu of conventional plain films as a supplement to CT examination. Advantages of volume-rendered images are described.

Acetabulum↗
PubMed1987

Volumetric rendering techniques: applications for three-dimensional imaging of the hip.

Volumetric rendering is a new approach to three-dimensional (3D) imaging that overcomes many of the drawbacks of currently available surface-rendering systems. Its application on the Pixar Imaging System in two cases of acetabular fracture was assessed to illustrate the features of the technique. The fast-computing architecture and large memory of this system allow rapid generation of a series of high-quality 3D images in each plane of rotation (x or spinal axis, z or somersaulting axis) that can be viewed as independent static images or as an animated real-time video loop. Editing to remove the normal contralateral hemipelvis enhances appreciation of acetabular abnormalities. Every pixel of computed tomographic data is preserved, allowing representation of both soft tissue and bone as translucent overlap. The presentation of data also allows detection of subtle abnormalities and features and minimizes the artifact generation common in surface-rendered images.

Computers↗
PubMed1987

Nonunion of the humeral shaft.

Retrospective review of records of 26 patients with nonunion of the humeral shaft revealed several factors frequently associated with the development of nonunion. The fractures were transverse and short oblique and treated per primam with hanging casts or open reduction. Surgical fixation was unstable. The types of nonunion were atrophic in 19 patients, hypertrophic in five patients, and synovial pseudarthrosis in two patients. Twenty-four of 26 nonunions (92%) treated with bone grafts and rigid internal fixation healed in an average of 5.6 months. Overall, 47 surgical procedures, including prior procedures, were performed on these 26 nonunions. The average number of operations per patient was 1.8. Successful platings produced immobilization, consisting of an average of 6.8 points of cortical fixation above the nonunion and 7.1 cortices below. Rigid fixation was not obtained in the unsuccessful procedures. Unsuccessful platings were noted to have unstable fixation, with an average of 2.7 points of cortical fixation above the nonunion and 3.0 cortices below. Bone grafting was performed in only 55% of the unsuccessful platings. Optimal treatment of nonunions of the humeral shaft consists of resecting atrophic nonunions, shortening the bones, drilling sclerotic areas, and apposing bleeding diaphyseal surfaces; open reduction with internal fixation with a broad compression plate, including at least six points of cortical fixation above and below the nonunion; compression of the nonunion by means of interfragmentary lag screws, prestressing of the plate, dynamic compression by the plate, or direct compression by the external compression device; and autogeneic cancellous iliac bone grafts.

Adolescent↗
PubMed1986

Multiplanar (MPR) imaging of the hip.

Multiplanar CT expands the ability of the radiologist to define the extent of disease, to suggest appropriate surgery, and to offer a probable prognosis.

Acetabulum↗