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Biomedical subjects

A J Johnstone

Publications and source records attributed to A J Johnstone.

At least 19 recordsLinked to original sources
PubMed2006

A complex fracture of the talus following a rugby union line-out.

Fractures of the talus are frequently difficult to treat. The vulnerable blood supply and abundant articular surfaces may lead to long-term problems with avascular necrosis and osteoarthritis. A case of a complex injury to the talus occurring in a rugby union player during a line-out is presented. The laws relating to line-out play disallow "lifting" and "levering" in the line out, but in reality allow "supporting" of the jumper on his shorts, once he has jumped. A further law insists on "lowering" of the supported jumper to the ground as soon as the ball has been won. This unusual injury to the talus clearly demonstrates the potential dangers of the line-out and the necessity that the laws of the game must be strictly adhered to, in order to ensure the safety of the line-out jumper.

Adult↗
PubMed2004

Regional regenerative potential of meniscal cartilage exposed to recombinant insulin-like growth factor-I in vitro.

It is well recognised that meniscal tears situated within the inner, avascular region do not heal. We investigated the potential effect of insulin-like growth factor-I (IGF-I) in promoting regeneration of meniscal tissue in the inner, middle and outer zones of the meniscus. Sheep menisci were harvested and monolayer cell cultures prepared. Various concentrations of IGF-I were used in the presence or absence of 10% fetal calf serum (FCS). We measured the uptake of radioactive thymidine, sulphur, and proline to assess cell proliferation and formation of extracellular matrix (ECM). IGF-I, in the presence or absence of FCS, increased the formation of DNA and ECM in all meniscal zones. However, the response of the cells from the avascular zone was greater than that from the vascular zone. Our findings indicate that fibrochondrocytes cultured from avascular meniscal tissue have the ability to regenerate when exposed to anabolic cytokines such as IGF-I.

Animals↗
PubMed2004

A comparison of the torsional performance of stainless steel and titanium alloy tibial intramedullary nails: a clinically relevant approach.

In recent years there has been a tendency to design and manufacture intramedullary nails from titanium alloy rather than from stainless steel. The aim of this project was to compare the torsional performance of one manufacturers standard stainless steel and titanium alloy tibial intramedullary nails, using their distal locking screw holes and dedicated cross screws to secure each nail distally. A custom built test rig and materials testing machine were used to determine the torsional rigidity of the nails. Theory was used to calculate the torsional rigidity of the central parts of each nail. From the mechanical testing, the mean torsional rigidity of the titanium alloy nail system was 40.9 N m2 while that of the stainless steel nail system was 34.6 N m2, for all distal interlocking screw positions tested. Based on theoretical calculations the torsional rigidity of the central part of the nail was 83 N m2 for the stainless steel nail and 66 N m2 for the titanium alloy nail. This study shows the importance of using the distal locking screw holes and dedicated cross screws to secure intramedullary nails during mechanical testing so that clinically relevant results are obtained about the whole nail system and not just the nail.

Alloys↗
PubMed2002

Design considerations for a wrist implant.

Rheumatoid arthritis and other forms of inflammatory arthritides commonly affect the wrist leading to pain, deformity and a reduced quality of life for the patient. Joint arthroplasty is an attractive solution for improving function while relieving pain, but unfortunately, current designs of wrist arthroplasties have not met with great success. This review paper describes the anatomy and biomechanics of the normal wrist, and reviews the current and past designs of artificial wrist joints. The design considerations for a successful wrist implant are discussed, and it is concluded that future generations of wrist implants should not attempt to recreate the natural wrist, but permit a limited functional range of motion. Different materials and methods of fixation of artificial wrist joints should also be considered to improve implant durability.

Arthritis, Rheumatoid↗
PubMed2002

"Pepper-pot" arthrodesis of the small joints of the hand: our experience in 68 cases.

Sixty-eight small joint arthrodeses were performed in the hand using a new technique. Following removal of the articular cartilage, multiple drill holes are made through the subchondral bone, connecting the medullary canal with the joint space. The final joint position is maintained with an intraosseous wire loop and a Kirschner wire. Union was achieved at a mean of 7 weeks and our results are comparable with those of other series. This technique is easy to perform but is contraindicated if there is extreme joint destruction. Its main advantages are that the position of the fusion can be adjusted as bone-to-bone congruency is maintained through an arc of flexion and the overall length and shape of the digit is preserved.

Adolescent↗
PubMed1999

Coping with the epidemic. The impact of proximal femoral fractures upon the acute orthopaedic services in northeast Scotland.

Increasing health care costs and an aging population have made hip fractures one of the most pressing concerns for developed nations in the latter half of the twentieth century. Using data collected in 1970 and in 1993, the extent of the hip fracture problem in the northeast of Scotland is assessed. The results demonstrate a 101% increase in the number of patients admitted with hip fractures, and an increase in the proportion of patients aged 75 years and over by 158%. Although there has been no change in the number of acute orthopaedic beds in the region, the increase in patient numbers have been managed by approximately halving the in-patient stay through the provision of rural convalescent/rehabilitation beds. Through this approach considerable savings can be made by the health service without reducing the standard of care that is required by the elderly patient later in the post-operative period. In addition, this approach will help focus local community services upon the long-term placement of the patient, in keeping with current government policy.

Age Factors↗
PubMed1996

Skull fractures in children: a population study.

OBJECTIVE: To provide information about children with a skull fracture in the Edinburgh area, since head injury is the single most important traumatic cause of death in children over 1 year of age. METHODS: During the period January 1983 to December 1989, all children in the Edinburgh area under 13 years of age who sustained a skull fracture were identified. Details of the children who died primarily from a head injury, and the total number of children who were admitted to hospital with a head injury not associated with a skull fracture, were also documented. Data were obtained from the General Register Office for Scotland, Edinburgh Fiscal Office records, and Lothian Health Board records. Data on cause of injury and clinical condition were obtained. RESULTS: 3498 children under 13 years of age were admitted to hospital after sustaining a head injury and 27 died primarily as a result of their injuries; 409 children had a skull fracture and 76 of this group had cranial CT scans. Nineteen of the CT scans performed were on children who had been admitted to hospital in a coma, and all had abnormal scan findings. In addition all children with intracerebral haematomas/haemorrhages had been admitted in a coma. Road traffic accidents accounted for the greatest number of deaths (84%), associated injuries, and overall morbidity. CONCLUSIONS: To reduce the incidence of head injuries, and the associated morbidity and mortality, the following are required: identify at risk groups; promote accident prevention; publicise the findings and guidelines concerning childhood head injuries; ensure that all children with head injuries have appropriate investigations and begin treatment as early as possible; establish clinical audit; and set up regional rehabilitation teams.

Accidents, Traffic↗
PubMed1995

Skull fractures in children: altered conscious level is the main indication for urgent CT scanning.

It has been suggested that all children with skull fractures require urgent CT scanning to exclude intracranial injury. Adhering to such a policy could both tax limited scanning facilities and result in unnecessary exposure to radiation. The aim of this study is to assess the level of consciousness in determining the need for urgent CT scanning, and the possible role of the mechanism of injury as a secondary risk factor. We identified 140 children admitted during a 7-year period with a skull fracture after falling outside the home. Thirteen children had a diminished level of consciousness. Scans were performed in nine, and seven of the scans revealed significant intracranial injuries. By comparison, all 127 children with a normal level of consciousness recovered fully. Scanning was performed in only eight of them; seven scans were normal and one revealed a small subarachnoid heamorrhage which did not require active treatment. In addition, all 13 children with a diminished level of consciousness had sustained their injuries by falling from greater than their own standing height. By comparison, none of the children who had sustained their skull fractures by tripping up had a diminished level of consciousness or a significant intracranial injury. We conclude that all children with a diminished level of consciousness need to undergo an urgent CT scan. Children with skull fractures and a normal conscious level may be managed initially by neuroobservations and the clinician may be further reassured if the child's injury resulted from tripping up.

Child↗
PubMed1994

Temporal bone fractures in children: a review of 34 cases.

Head injuries are commonly seen in accident and emergency (A&E) departments and within this group a small proportion will have a temporal bone fracture. Thirty-four such cases were identified from a 7-year period and their case notes were reviewed. The mechanisms of injury included:falls outdoors (15 cases), falls in the home (eight cases), road traffic accidents (RTAs; seven cases), missiles (three cases) and non-accidental injury (one case). In 20 cases the fracture involved more than one cranial bone, and the implications of this with regard to non-accidental injury are discussed. CT scans were carried out in 14 cases and 11 of these showed intracranial haematoma. The criteria for CT scan following head injury in general, and temporal bone fracture in particular are discussed. Outcome measures indicated that those injured as a result of RTAs had the poorest outcome, followed by those who fell outdoors and then those who fell in the home.

Accidental Falls↗
PubMed1992

Liver trauma: a 10-year experience.

The management of 73 patients with liver trauma (58 male, 15 female; mean age 30 (range 6-68) years) presenting from January 1980 to August 1990 is reviewed. There were 29 cases of penetrating injury and 44 of blunt trauma. Seven patients were successfully managed without operation (five with blunt injury) and were discharged after a mean hospital stay of 8 days. Fifty-one cases were classified as simple injuries (grade I or II) and were managed by suture (with or without drainage) or required no intervention, with three deaths. Fifteen cases were classified as complex injuries (grade III or IV) and underwent one or more of the following: perihepatic packing, resectional debridement, hemihepatectomy and hepatotomy with direct suture ligation. Six of these patients died from uncontrolled haemorrhage. The continued use of suture for simple injuries and of resectional debridement and/or packing for complex injuries is supported. Judicious clinical assessment and radiological monitoring may reduce the number of unnecessary laparotomies.

Abdominal Injuries↗
PubMed1992

Case report: duodenal and jejunal strictures treated with balloon dilatation through a duodenostomy.

An 11-year-old girl with duodenal and jejunal strictures considered to be inaccessible for surgery was successfully treated using balloon dilatation under fluoroscopic control via a duodenostomy. This is the first reported paediatric case of small bowel stricture dilatation using a balloon catheter, and it is also the first report of the small bowel being approached for balloon dilatation through a duodenostomy. This case demonstrates another use for balloon dilatation which appears to be a relatively safe and effective form of treatment for short, subacute strictures involving the gastro-intestinal tract.

Catheterization↗
PubMed1992

Primary knee arthroplasty for distal femoral fractures in elderly patients.

We discuss the role of primary knee arthroplasty in supracondylar and intercondylar fractures of the femur in elderly patients with reference to 13 cases. This method of treatment is shown to be effective and to have good results. It is recommended for all type C and some type A supracondylar fractures in old people.

Aged↗
PubMed1991

Primary hepatocellular carcinoma in a patient with breast carcinoma.

We report the case of a patient who presented with a carcinoma of her right breast with ipsilateral axillary lymph node involvement whose staging investigations were otherwise normal. In addition to surgery she received a course of CMF chemotherapy and tamoxifen. Within six months of the diagnosis of breast carcinoma being made, the patient presented as an emergency with widespread intra-abdominal disease from a primary hepatocellular carcinoma. We have not previously witnessed the development of a second primary malignancy in a patient who has already received medication considered to be beneficial in the treatment of both types of malignancy. An extensive literature search has failed to reveal a similar case. The question of immunosuppression secondary to treatment with CMF chemotherapy is raised, and we suggest that perhaps a simple percutaneous biopsy of apparent liver metastases be performed under ultrasound control so as to determine the origin of liver disease in patients with breast carcinoma.

Abdominal Neoplasms↗
PubMed1991

Wound compression pads are of no value after local anaesthetic breast biopsy.

In a randomised study of 120 patients undergoing breast biopsy, wound compression pads did not reduce the frequency of postoperative bruising or haematoma formation, and 12% of the 62 patients having pads had complaints regarding their use. Wound compression pads are of no value after local anaesthetic breast biopsy.

Anesthesia, Local↗