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Biomedical subjects

B F Morrey

Publications and source records attributed to B F Morrey.

At least 19 recordsLinked to original sources
PubMed1992

Origin of the medial ulnar collateral ligament.

The anatomic features of the origin of the anterior medial collateral ligament of the elbow were studied in 10 cadaver elbows to determine the percentage of the medial epicondyle that can be removed without violating the ligament, and whether or not this ligament attaches to the condyle as well as to the epicondyle. In all specimens the anterior medial collateral ligament originated exclusively from the anteroinferior surface of medial epicondyle and had no attachment to the condyle. Only 20% of the width of the medial epicondyle in the coronal plane can be removed without violating a portion of the origin of the anterior medial collateral ligament, an essential stabilizer of the elbow. Excision of the entire epicondyle for ulnar neuropathy would completely detach this ligament from its origin and might therefore potentiate instability. Since the ligament originates on the anteroinferior surface of the epicondyle, more bone can be removed with less violation of the anterior medial collateral ligament origin if the plane of the osteotomy lies between the sagittal and coronal planes.

Cadaver↗
PubMed1992

Total knee arthroplasty in patients with prior ipsilateral hip fusion.

Sixteen total knee arthroplasties performed between 1977 and 1985 in 13 patients with prior ipsilateral hip arthrodesis or ankylosis were studied to determine the preferred sequence and long-term follow-up of procedures in this clinical setting. Twelve of 16 underwent fusion takedown and total hip arthroplasty prior to knee replacement. The average age at total knee arthroplasty was 52.7 years and the average time from hip fusion to total knee arthroplasty was 36.3 years. Mean follow-up after total knee arthroplasty was 5.5 years (range, 2.3 to 10 years). The Hospital for Special Surgery knee score increased from a mean of 31.8 preoperatively to 72.2 after surgery. In patients who had conversion of the hip fusion prior to knee replacement, knee scores were 28 before and 72.5 after both procedures. Patients who retained their hip fusion had mean scores of 43.5 and 72.1, respectively. None of the knees has been removed and 14 of 16 had no pain at last follow-up. One had mild pain and one had moderate pain attributed to pes anserine bursitis. Although the numbers are small, this experience reveals that takedown of the fusion with total hip arthroplasty is an effective technique before performing the knee replacement. Though successful in some instances, the experience is too small to show that if hip fusion is in good position, knee replacement without fusion takedown is acceptable.

Adolescent↗
PubMed1992

Complications with revision of the femoral component of total hip arthroplasty. Comparison between cemented and uncemented techniques.

The intraoperative and early postoperative complications of femoral component revision surgery in a group of 94 treated with a cemented femoral implant and 91 treated with a specific (Bias, Zimmer International, Warsaw, IN) uncemented femoral implant were assessed. Follow-up of at least 2 years for both groups was obtained, averaging 4.5 years and 3.2 years, respectively. The Harris hip score was 45 and 81 before and after the cemented revision and 42 and 84 for the uncemented procedure. The overall complication rate was 41% and 34%, respectively, which is not statistically different. The major differences consist of radiographic evidence of probable loosening in 53% of the cemented population and at least 2 mm of subsidence in 45% of the uncemented group. Fracture occurred in 3% and 18%, respectively, and caused failure in one with cemented and three with uncemented revisions. The reoperation rate was 15% and 12%, respectively. In these patient populations, uncemented femoral revision was a satisfactory technique, having a complication rate comparable to and radiographic features more favorable than what was present with the cemented revision procedure. Long-term follow-up is necessary to determine more fully the role of uncemented implants for femoral component revision.

Cementation↗
PubMed1992

Venous thromboembolism associated with hip and knee arthroplasty: current prophylactic practices and outcomes.

Joint registry and hospital data bases for 5,024 total hip and total knee arthroplasties done between 1986 and 1988 at the Mayo Clinic were used to study prophylactic measures and frequency of symptomatic deep venous thrombosis and pulmonary embolism. In virtually all patients, graduated compression stockings were used, with or without another type of prophylaxis. Only 44 of 3,115 patients who underwent hip arthroplasty (1.4%) and 32 of 1,909 patients who underwent knee arthroplasty (1.7%) had definite or probable deep venous thrombosis or pulmonary embolism. Death definitely or possibly attributable to pulmonary embolism occurred in 11 patients who underwent hip arthroplasty (0.35%) and 1 patient who underwent knee arthroplasty (0.05%). Although patients with a history of deep venous thrombosis or pulmonary embolism were more likely to receive warfarin than were patients without such a history, the relative risk of symptomatic deep venous thrombosis or pulmonary embolism in patients who underwent hip arthroplasty and received warfarin postoperatively was approximately half that in patients who received other types of prophylaxis. The risk of death from pulmonary embolism was similarly diminished in the group that received warfarin. The lower rates of these complications in the patients who received warfarin support the prophylactic use of this agent after total hip arthroplasty.

Aspirin↗
PubMed1992

Kinematics of semi-constrained total elbow arthroplasty.

We used 11 cadaver elbows and a three-dimensional electromagnetic tracking device to record elbow movements before and after implantation of a 'loose-hinged' elbow prosthesis (modified Coonrad). During simulated active motion there was a maximum of 2.7 degrees (+/- 1.5 degrees) varus/valgus laxity in the cadaver joints. This increased slightly after total elbow arthroplasty to 3.8 degrees (+/- 1.4 degrees). These values are lower than those recorded for the cadaver joints and for the prostheses at the limits of their varus/valgus displacements, indicating that both behave as 'semi-constrained' joints under physiological conditions. They suggest that the muscles absorb some of the forces and moments that in a constrained prosthesis would be transferred to the prosthesis-bone interface.

Biomechanical Phenomena↗
PubMed1992

Primary degenerative arthritis of the elbow. Treatment by ulnohumeral arthroplasty.

Degenerative arthritis of the elbow is a poorly recognised condition, usually seen in a middle-aged man with an occupation or activity which involves the repetitive use of his dominant arm. Flexion contracture and pain at terminal extension are common presenting features. Fifteen patients were reviewed at a mean of 33 months after debridement by ulnohumeral arthroplasty. Fourteen had good relief of pain, elbow extension had improved by an average of 11 degrees and elbow flexion by 10 degrees. On an objective scale 12 of the 15 patients had good or excellent results and 13 (87%) felt that they were improved by the operation.

Adult↗
PubMed1992

Classification and treatment of coronoid process fractures.

Fractures of the coronoid process are rare as isolated injuries and usually are associated with significant, sometimes devastating trauma to the elbow. The classification system based on the degree of involvement has proven helpful to estimate prognosis and to help guide treatment. Severe fractures are generally associated with instability and portend a poor prognosis. Treatment by distraction, external fixation, and early motion has been encouraging.

Adolescent↗
PubMed1992

Posttraumatic stiffness: distraction arthroplasty.

Loss of motion after elbow trauma is a common complication. At times, the limitation of motion may significantly impair function. Options to improve posttraumatic motion by surgery depend on whether the joint surface has been severely involved (intrinsic vs extrinsic contracture). Increasing experience with the surgical release of the posttraumatic stiff elbow has been enhanced by the use of distraction with or without interposition arthroplasty. Current experience suggests that approximately 85% of patients will be satisfactorily treated with surgical intervention.

Arthroplasty↗
PubMed1992

Revision of ankle arthrodesis with external fixation for non-union.

We evaluated the cases of twenty-six patients (twenty-six ankles) who had had revision of an ankle arthrodesis with external fixation for a nonunion, to determine the reasons for the failure of the previous arthrodesis. Eighteen patients had had supplemental bone-grafting in addition to the external fixation. The failure of the previous arthrodesis was related to inadequate fixation technique in seven patients and to technical problems in two patients; in the other seventeen patients at least one risk factor was identified. We also determined the functional results of the revision operation with external fixation for all patients. The average duration of follow-up was five years (range, two to ten years) in the twenty-two patients who did not have a reoperation for a persistent nonunion. The results were excellent in eleven patients, good in five, fair in four, and poor in six. The over-all rate of union was twenty (77 per cent) of twenty-six, comparable with that after primary arthrodesis; however, supplemental bone-grafting is usually necessary. In the current series, rigid fixation, precise apposition of bone and alignment of the foot, and early treatment of perioperative infection gave satisfactory results.

Adult↗
PubMed1992

Ligamentous reconstruction for posterolateral rotatory instability of the elbow.

Eleven consecutively seen patients who had posterolateral rotatory instability of the elbow joint were managed operatively. The radial collateral-ligament complex was advanced and imbricated in three of them. In seven patients, the ulnar band of the radial collateral ligament (the lateral ulnar collateral ligament) was reconstructed with the palmaris longus tendon and in two of the seven, the reconstruction was augmented with a prosthetic ligament. The ligament was reconstructed with the lateral one-third of the triceps fascia in the remaining patient. Stability was obtained in ten patients, and seven patients had an excellent functional result. There was one failure in one of the patients in whom the ulnar band of the radial collateral ligament had been reconstructed with the palmaris longus tendon and augmented with a prosthetic ligament.

Adolescent↗
PubMed1992

Operative correction of an unstable total hip arthroplasty.

We reviewed the results of reoperation in ninety-five patients who had acute subluxation (ten patients) or dislocation (eighty-five patients) of the hip after conventional cemented total hip-replacement arthroplasty. Postoperatively, fifty-eight patients (61 per cent) had no subsequent dislocation or subluxation. Seven of thirty-seven patients who had had recurrent dislocation had occasional subluxation during follow-up. Of the remaining thirty patients in whom instability persisted after the reoperation, twenty-eight had at least one dislocation, and nine had bothersome subluxation. Ten of these thirty-seven patients had another operation for the persistent instability. The causes of instability were classified as malrotation of the component, disruption of the trochanteric-abduction mechanism, impingement, or multiple and unknown, and appropriate treatment was provided. The component was revised in forty-five patients, revision and advancement of the trochanteric component was done in twenty-five patients, and impinging bone or cement was removed from six patients; a combination of these procedures was done in nineteen patients. Over-all, fifty-eight procedures (61 per cent) were successful (no additional subluxations or dislocations). We concluded that the results of operative treatment for an unstable total hip replacement can be optimized when a precise determination of the cause of the instability is made and appropriate measures are applied.

Adult↗
PubMed1992

Radio-ulnar dissociation. A review of twenty cases.

The results of treatment were reviewed for twenty patients who had sustained concomitant injuries of the lateral compartment of the radiohumeral joint and the ipsilateral distal radio-ulnar joint. The ages of the patients ranged from eight to seventy-four years (average, thirty-five years) and the duration of follow-up ranged from four months to twenty-seven years (average, 113 months). In fifteen patients, the injury of the wrist was diagnosed after a mean delay of seven years and eleven months (range, one month to twenty-six years). In all fifteen, the radial head injury was treated by excision, either initially or after some delay. After excision of the radial head, all fifteen patients complained of severe pain at the distal radio-ulnar joint. The results, on the basis of elbow and wrist scores of fair or better without complications, were satisfactory in only three patients. In the remaining five patients, in whom the injuries of both the elbow and the wrist had been identified at the initial evaluation, the radial head was either preserved or replaced. The results, on the basis of elbow and wrist scores of fair or better, were graded as satisfactory in four of these patients. Our data show that any injury to the lateral side of the elbow should prompt a careful evaluation of the ipsilateral distal radio-ulnar joint for associated instability.

Adolescent↗
PubMed1992

Compensatory motion in the upper extremity after elbow arthrodesis.

Ten healthy male subjects were asked to complete a series of tasks that represent normal elbow function. They were then fitted with a custom adjustable brace that simulated elbow arthrodesis at 50 degrees, 70 degrees, 90 degrees, and 110 degrees flexion and asked to repeat the tasks. The 3 Space Isotrak system was used to measure shoulder motion; a triaxial wrist goniometer was used to measure wrist compensation; and all subjects were videotaped to qualitatively observe other compensatory motion. Unlike other joints, elbow arthrodesis at any angle results in a significant impairment, since the adjacent shoulder and wrist joints cannot compensate to allow completion of activities.

Activities of Daily Living↗
PubMed1992

Instability after total hip arthroplasty.

The most statistically significant risk factors for hip dislocations following total hip arthroplasty include prior hip surgery, trochanteric nonunion, and posterior surgical approach. Reoperation is required in only about one third of those patients who sustained dislocations. The most reliable surgical procedure is reorientation of the retroverted acetabular component. Care should be exercised to define the precise cause of the instability to plan the surgery that best addresses this particular problem.

Hip Dislocation↗
PubMed1992

Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow.

Fifty-four patients in whom a total of fifty-eight semiconstrained modified Coonrad elbow implants had been inserted for rheumatoid arthritis were followed for a mean of 3.8 years (range, two to eight years). At the latest follow-up, there was little or no pain in fifty-three elbows (91 per cent). The arc of motion was from an average point in flexion of 20 degrees to an average point in flexion of 129 degrees, representing an average increase of 12 degrees of extension and 11 degrees of flexion. The average arc of pronation was 78 degrees, an increase of 14 degrees, and the average arc of supination was 77 degrees, an increase of 18 degrees. An additional ten patients who had had insertion of ten modified Coonrad implants during the same period were followed for less than two years but were included in the assessment of complications. Fifteen (22 per cent) of the sixty-eight elbows had a complication: four, infection; eight, acute or delayed condylar or ulnar fracture; and one each, ulnar neuritis, avulsion of the triceps, and fracture of the implant. Radiographic evaluation was performed for fifty-four of the fifty-eight elbows; the other four were excluded from this evaluation because of infection. A satisfactory radiographic appearance of the cement--its extent and the absence of skip areas--was noted for all of the ulnar components and for fifty-one (94 per cent) of the humeral components. No patient had radiographic evidence of a loose implant. A reoperation was performed in six elbows (10 per cent of the fifty-eight; 9 per cent of the sixty-eight): four were done for infection; one, for insufficiency of the triceps; and one, for a fractured ulnar component. Of the fifty-eight elbows, forty (69 per cent) had an excellent result; thirteen (22 per cent), a good result; four (7 per cent), a fair result; and one, a poor result.

Arthritis, Rheumatoid↗
PubMed1992

Elbow subluxation and dislocation. A spectrum of instability.

After sequential releases of the ligaments and capsules of 13 fresh autopsy specimen elbows, external rotation and valgus moments with axial forces resulted in posterior dislocations in 12 of the 13 with the anterior medical collateral ligament (AMCL) intact. Kinematic displacements measured with a three-dimensional electromagnetic tracking device showed that dislocation involved posterolateral rotation of 34 degrees-50 degrees and 5 degrees-23 degrees valgus at about 80 degrees flexion. Dislocation is the final of three sequential stages of elbow instability resulting from posterolateral rotation, with soft-tissue disruption progressing from lateral to medial. In each stage, the pathoanatomy correlated with the pattern and degree of instability. Testing for valgus stability of the elbow during simulated active flexion revealed no significant increase (-0.3 degrees-2.4 degrees) in valgus laxity after reduction compared with the intact specimens (p greater than 0.05, beta = 0.1, delta = 2.5 degrees). In no case did the digitized AMCL origin-to-insertion distance increase beyond normal during the dislocation (p less than 0.01). The mechanism of dislocation during a fall on the outstretched hand would involve the body "rotating internally" on the elbow, which experiences an external rotation/valgus moment as it flexes. Posterior dislocations should therefore be reduced in supination. If valgus stability in pronation is demonstrated, the AMCL can be assumed to be intact, and rehabilitation in a hinged cast-brace with the elbow in full pronation can be commenced immediately.

Autopsy↗
PubMed1992

Intersegmental elbow joint load during pushup.

Intersegmental loading pattern on the elbow joint during a push-up exercise was investigated. Electromagnetic motion sensors and a piezoelectric force plate were used to simultaneously record upper extremity motion and forces on nine healthy male subjects during push-ups in six different hand positions. Peak axial forces exerted on the elbow joint averaged 45 percent of the body weight. Peak torque to produce elbow flexion was 2305.9 N-cm, or 56 percent of maximal isometric extensor torque. The results of this analysis give insight to the biomechanics of a normal elbow and to its load carrying capacity.

Adult↗