Biomedical subjects

A J Vicar

Publications and source records attributed to A J Vicar.

3 recordsLinked to original sources

PubMed1988

Proximal interphalangeal joint dislocations without fractures.

Injuries to the proximal interphalangeal joint are extremely common. An understanding of the complex anatomy of this joint is essential for diagnosis and treatment of proximal interphalangeal joint sprains and dislocations. Lateral injuries are among the commonest injuries in the hand. These are often stable after reduction, requiring only closed treatment. Occasionally, however, the collateral ligament can be trapped in the joint and require open reduction. Dorsal dislocations represent the most common dislocation in the hand. These, too, are usually stable after reduction and can be treated by closed methods. On occasion, however, these dislocations will be open or irreducible by closed means, requiring surgical intervention and repair of damaged structures. Complex rotary dislocations are exactly that: complex. An exact understanding of the damaged structures and causes of irreducibility frequently makes this an injury often requiring open reduction and selective repair of damaged soft tissue structures. Fortunately, prompt diagnosis, reduction, and institution of appropriate treatment can usually afford the patient good function after these injuries. It must be noted that stiffness is more common than instability, and active range-of-motion exercises instituted at the proper time are essential. These joints will often remain permanently thicker after injury in spite of optimal care, and tenderness and soreness with use may persist for 6 to 12 months.

Adolescent↗

PubMed1986

Surgical management of the rheumatoid wrist--fusion or arthroplasty.

Forty-eight patients with 33 wrist fusions and 37 silicone wrist arthroplasties were reviewed and compared. Of those who had arthrodesis 97% showed a good or excellent result. Follow-up time averaged 82 months. All patients had a decrease in pain. Most patients had stronger wrists but complained of decreased dexterity. There were no pseudarthroses. The complication rate was 18%. Of patients in the arthroplasty group, 78% had a good or excellent result. Follow-up time averaged 51 months. Most patients in the arthroplasty group had improved dexterity and adequate wrist strength. Average flexion/extension was 32 degrees/29 degrees. The complication rate was 25%, which included four revisions. Of patients who had arthroplasties, 14% had bone resorption about the stem, and 11% of the patients with arthroplasties had x-ray evidence of settling. Factors that did not influence the result of the arthroplasty were patient age, duration of disease before surgery, finger extensor tendon rupture, preoperative motion, and hand dominance. Factors that were associated with failure and/or a fair result in arthroplasty patients were the use of ambulatory aids, the older and narrower prosthetic design, dislocated wrist preoperatively, and the chronic use of steroids.

Adult↗

PubMed1984

A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary total hip arthroplasty.

For evaluation of both the anterolateral and posterior approaches to total hip arthroplasty as alternatives to the transtrochanteric approach, 269 replacement procedures in 237 patients were reviewed. Follow-up periods ranged from 24 to 71 months (average, 38.2 months). The anterolateral approach was used in 91 hips, the transtrochanteric approach in 136, and the posterior approach in 42. Dislocation was four times more common (p less than .05) in the posterior approach (9.5%) than in the other two (2.2% each). Seven of the nine dislocations occurred in patients older than 65 years of age, and all four dislocations in the posterior approach group occurred in patients over 65. Heterotrophic bone was three times more common (p less than .10) in posterior and transtrochanteric approaches than in the anterolateral approach. Trochanteric bursitis was twice as common (p less than .05) in the transtrochanteric approach than in the other two. Roentgenographic evaluation of femoral component positioning, width of medial calcar cement, and acetabular cup orientation showed no significant differences between the three surgical approaches. It is apparent that the anterolateral surgical approach (modified Watson-Jones) provides a satisfactory alternative to trochanteric osteotomy in the elderly patient who requires total hip arthroplasty.

Adolescent↗