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Biomedical subjects

Bernard F Morrey

Publications and source records attributed to Bernard F Morrey.

46 records · Page 3Linked to original sources
PubMed2002

Dislocation after revision total hip arthroplasty : an analysis of risk factors and treatment options.

BACKGROUND: Dislocation is a leading and underemphasized cause of failure in revision total hip arthroplasty. Although this fact is generally well recognized, we are aware of no detailed assessments of this problem to date. Our purpose therefore was to evaluate the risk factors leading to instability after revision as well as the expected outcome of various treatment strategies. METHODS: Data were obtained from 1548 revision arthroplasties in 1405 patients who were followed for a minimum of two years (range, 2.0 to 16.4 years; mean, 8.1 years) or until dislocation occurred. Revisions specifically performed because of instability were excluded from the analysis. Risk factors were recorded along with treatment strategies and their success. The statistical relevance of both sets of variables was calculated. RESULTS: A dislocation occurred after 115 (7.4%) of 1548 revision hip arthroplasties. The use of an elevated rim liner was associated with significant decreases (p < 0.05) in dislocation following revision of femoral and acetabular components. The presence of trochanteric nonunion was a significant risk factor for subsequent dislocation (p < 0.001). Revisions with 32-mm and 28-mm-diameter femoral heads were both more stable than was revision with a 22-mm-diameter head (p < 0.05 for each). Surgery was the initial treatment for twelve of the 115 dislocations. Six of the twelve hips had no further instability. Of the 103 postoperative dislocations initially managed nonoperatively, only thirty-six did not redislocate. Thirty-eight of the sixty-seven hips that had an additional dislocation after closed treatment had repeat surgery for treatment of the instability. Only eleven of the thirty-eight hips were stable at one year after surgery. Overall, at the time of the final assessment, sixty-five (57%) of the 115 hips were stable, forty-one (36%) remained unstable, and the status of nine (8%) was unknown. CONCLUSIONS: The risk factors for instability after a total hip revision are not the same as those after a primary procedure. The extent of the soft-tissue dissection is probably the most important variable since head size and trochanteric nonunion are related to "soft-tissue tension." Modular acetabular components with an elevated rim help to stabilize a hip undergoing a revision procedure.

Age Distribution↗
PubMed2002

Anconeus arthroplasty: a new technique for reconstruction of the radiocapitellar and/or proximal radioulnar joint.

BACKGROUND: Management of posttraumatic radiocapitellar and/or proximal radioulnar joint dysfunction and pain is a challenging problem, often with more than one pathological feature, and to date there are no consistently reliable solutions. The unreliability of prosthetic replacement prompted us to develop an anconeus arthroplasty wherein the anconeus muscle is rotated into the radiocapitellar and/or proximal radioulnar joint. METHODS: Three interposition options were assessed in our laboratory and were employed clinically: interposition at the radiocapitellar joint (Type I), interposition at the radiocapitellar and proximal radioulnar joints (Type II), and proximal radioulnar interposition (wrap) (Type III). The clinical outcomes in fourteen patients who had been treated with one of the three types of anconeus interposition arthroplasty were reviewed at least two years (mean, 6.1 years) postoperatively. RESULTS: Anatomic dissection of twenty-five specimens revealed that all three applications were possible. Of the fourteen patients, twelve (all six with a Type-I interposition, three of the five with a Type-II interposition, and all three with a Type-III interposition) had a satisfactory overall subjective result. The Mayo Elbow Performance Score averaged 63 points before the surgery and 89 points after it. CONCLUSIONS: Anconeus interpositional arthroplasty offers a reasonable likelihood of improved subjective and objective function in patients with the challenging problem of radiocapitellar and/or proximal radioulnar joint dysfunction and pain after trauma, even when there is Essex-Lopresti axial instability.

Adult↗
PubMed1998

Contribution of capsuloligamentous structures to passive static inferior glenohumeral stability.

OBJECTIVE: This study attempted to determine the relative stabilizing effect of the capsuloligamentous structures to inferior humeral displacement. DESIGN: This was an in vitro study, utilizing cadaveric shoulder specimens. BACKGROUND: Inferior glenohumeral instability has come under increasingly close scrutiny in the literature in recent years, yet a description of the precise pathoanatomy is still lacking. METHODS: Thirteen shoulder specimens were cleaned of soft tissue superficial to the vented joint capsule. The position of the humeral head relative to the glenoid was determined. The humeri were subjected to an inferior load. Static position recordings were obtained for each specimen: (1) with the humerus adducted and abducted, (2) before and after sectioning the superior and inferior capsuloligamentous structures. These recordings were analyzed. RESULTS: In adduction, the humeral head migrated inferiorly as the capsuloligamentous structures were sectioned, but no capsuloligamentous structure was seen to be most important. In abduction, when the inferior capsuloligamentous structures were sectioned first, the humeral head migrated inferiorly (P<0.001). When the superior structures were sectioned first, the humeral head position did not significantly change. CONCLUSIONS: In this experimental model, the inferior capsuloligamentous structures are the primary inferior stabilizers of the abducted shoulder. The primary stabilizers of the adducted shoulder remain unclear.

Journal Article↗
PubMedDate not supplied

Medial oblique compression fracture of the coronoid process of the ulna.

The most widely recognized coronoid fractures have been described as occurring in the coronal plane according to the amount of process detached from the ulna. Over the last few years, we have recognized that the coronoid fracture is a much more complex injury than originally thought. This report calls attention to an oblique, medial compression fracture of the coronoid, a fracture so subtle as to be missed by routine assessment but sometimes associated with joint subluxation or dislocation. The currently accepted classification system based on a simple fracture pattern in the coronal plane may be too simplistic to characterize fractures of the coronoid fully.

Accidental Falls↗
PubMedDate not supplied

Stability of the elbow: osseous constraints.

The elbow is considered a complex joint, and thus the elements contributing to stability of the elbow are no less intricate. The soft-tissue and articular surfaces that provide stability to the elbow share the capacity as a function of joint position and loading configuration. The issue of soft-tissue constraints is dealt with elsewhere in this volume, and the focus of this discussion is that of the articular contributions. In this context, the radial head is defined as a secondary stabilizer to resist valgus force. The coronoid is clearly the most important articular stabilizer of this joint.

Biomechanical Phenomena↗
PubMedDate not supplied

Use of osteochondral bone graft in coronoid fractures.

Results of the treatment of the deficient coronoid and chronic elbow instability have not been reported. The purpose of this study was to analyze the results of structural bone graft for reconstruction of the coronoid process. Structural bone graft was used to reconstruct the coronoid process of 6 patients. All injuries were of the terrible triad: fracture of the coronoid, radial head fracture, and collateral ligament disruption. All cases had persistent posterior subluxation averaging 6 months (range, 1-13 months before reconstruction. Patient charts, surgical records, and radiographs were reviewed. All patients were contacted at a mean of 64 months after treatment to answer a specific set of questions to determine the Mayo Elbow Performance score. In 1 patient, radiographs showed complete resorption of the graft and severe osteoarthritis of the elbow at 54 months after surgery (case 4). The Mayo Elbow Performance score showed 1 excellent, 2 good, 1 fair, and 2 poor results. Structural bone graft may be a useful option for a deficient coronoid process and an unstable elbow, but the outcome is unpredictable.

Adult↗
PubMedDate not supplied

Neuropathic elbow arthropathy: a review of six cases.

Neuropathic arthropathy, also known as Charcot arthropathy, of the elbow joint is a rare and progressive joint disorder with little available information in the literature. Presentation and treatment data on 6 patients with this pathology are reviewed. In addition, outcome data are presented on all 6 patients at a mean follow-up of 51 months. Three of these patients had undergone surgical procedures for the treatment of their pathology. At the time of their latest follow-up, 2 patients had died but reported good pain relief and functional range of motion before their deaths. At a mean follow-up of 63 months, the remaining 4 patients also had minimal pain. Of these 4 patients, 3 reported moderate to gross instability in their elbows. Nevertheless, all 4 patients had good functional use of their arms with a mean Mayo Elbow Performance Score of 91. Our data suggest that surgical treatment of appropriate patients does not necessarily preclude a successful outcome. However, surgical treatment was also associated with an unpredictable course and a high rate of complications. Therefore, most patients with this pathology should be treated with nonoperative methods, and routine surgical intervention should be avoided.

Adolescent↗
PubMedDate not supplied

Fracture and nonunion of the olecranon in total elbow arthroplasty.

BACKGROUND: While fracture and nonunion of the olecranon have been reported in patients undergoing total elbow arthroplasty, little information exists about the management and outcome of these cases. METHODS: Twenty-four patients (twenty-five elbows) were studied; fifteen (sixteen elbows) with rheumatoid arthritis and nine with post-traumatic elbow disorders. Twenty-three of the twenty-five elbows presented with an olecranon fracture or nonunion prior to the reported arthroplasty. During arthroplasty the olecranon fragment was initially treated by tension band in sixteen elbows, excision in four, suture fixation in two and three with stable fibrous union were left alone. RESULTS: At an average follow-up of 66 months (range, 18 to 242), there were twelve excellent, nine good, three fair and one poor results. The mean pre-operative Mayo Elbow Performance Score improved from 42 (range, 20 to 62) points pre-operatively to 86 (range, 50 to 100) points post-operatively (p < 0.001). Of the eighteen patients undergoing an attempt at union, nine (50%) obtained osseous union, eight (45%) developed a stable fibrous union and one patient underwent subsequent excision of the fragment due a superficial infection (5%). Fifteen of twenty-one could extend the hand above the head against gravity. CONCLUSION: A functional arc of motion and satisfactory clinical outcome can be achieved with osseous or a stable fibrous nonunion.

Adult↗
PubMedDate not supplied

Kinematics and functional characteristics of the Pritchard ERS unlinked total elbow arthroplasty.

This study examined the kinematic characteristics of the Pritchard ERS elbow-resurfacing system, with special attention paid to the effects of the radial head component. The kinematics between the ulna and humerus were assessed in 6 human cadaveric specimens by an electromagnetic tracking system throughout a full flexion/extension range of motion. The elbows were studied under 2 loading conditions, in 3 orientations (neutral, varus, and valgus), and under 4 surgical conditions. The varus/valgus and internal/external rotation laxities were used to assess the condition differences. Specifically, the maximum laxities throughout the extension motion were compared, as were the laxities at 40 degrees, 75 degrees, and 110 degrees of flexion. Both the varus/valgus and internal/external rotation laxities of the ulnohumeral joint increased after total elbow arthroplasty (TEA) implantation, with and without a radial head. This increase was most evident in the extension portion of the arc of motion. At 40 degrees of flexion, the varus/valgus laxity of the intact elbow was 4 degrees +/- 2 degrees versus 11 degrees +/- 8 degrees for a TEA with a radial head and 22 degrees +/- 11 degrees for a TEA without a radial head while the elbow was being subjected to compressive loads via the biceps, brachialis, and triceps. The kinematic data demonstrate a consistent increase in laxity with the Pritchard ERS TEA. They also indicate that a radial head component is necessary for optimal tracking and stability of the ERS arthroplasty.

Arthroplasty↗