PubMed Health⌕ Search

Biomedical subjects

Andrew D Toms

Publications and source records attributed to Andrew D Toms.

4 recordsLinked to original sources

Stereolithographic models for biomechanical testing.

Variable properties and limited availability are pitfalls in using cadaveric bones for implant stability tests. Artificial bones avoid these, but tailoring them to specific studies may be difficult. Stereolithography (SLA) techniques produce tailor-made bones with realistic geometries, but their lower Young's modulus might affect outcomes. We investigated whether implant stability and cortical strains with SLA made bones match those with stiffer artificial bones and, if not, whether a thicker cortex to compensate the lower modulus gives a better match. Tibial trays were cemented in place and cyclically loaded while determining cortical strain and tray migration. Permanent and cyclic migration of trays in both types of SLA model (range: 13-28 and 58-85 mum) was within the range of those in composite models (range: 4-62 and 51-105 microm). Strains more distally were approximately inversely proportional to the material stiffness and cortical thickness of the tibiae. We conclude this first study provides a strong indication for SLA tibiae as a valid model for the biomechanical assessment of new techniques in knee surgery and compare favourably with previously utilised models.

Bone Cements↗

Percutaneous plating of distal tibial fractures.

We studied 20 patients (mean age 47.9+/-3.9, range 25-85 years) undergoing percutaneous plating of the distal tibia for 43A or 43C fractures in the period 1999-2002. Bony and functional results were classified into four categories ranging from excellent to poor. Union was achieved in all but one patient. Seven patients had angular deformities between 7 and 10 degrees, but none of these patients required further operations. No patient had a leg-length discrepancy greater than 1 cm. Thirteen patients had excellent and good bone results, and none used walking aids. Seven patients reported stiffness of the operated ankle. This reported use of percutaneous techniques in the management of fractures of the distal tibial metaphysis is preliminary. However, the functional results and the lack of soft tissue complications are encouraging.

Adult↗

Impaction bone-grafting in revision joint replacement surgery.

The standard graft material for impaction bone-grafting is fresh-frozen femoral head allograft morselized to a particle size as large as is practical to ensure stability and allow new bone formation. The graft must be sufficiently compacted to provide immediate mechanical stability; this requires containment of the graft and substantial impaction energy. Diaphyseal bone fracture and excessive implant migration are the most common complications of the operation. Impaction bone-grafting in revision total hip replacement has produced good medium-term results on both the acetabular and the femoral side. The use of compacted morselized bone graft is a relatively new technique in revision knee surgery and requires longer-term follow-up with larger numbers of patients to assess its value.

Arthroplasty, Replacement, Hip↗