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C S Phillips

Publications and source records attributed to C S Phillips.

9 recordsLinked to original sources
PubMed1999

Occipitocervical neutral position. Possible surgical implications.

STUDY DESIGN: The study defines the occipitocervical neutral position using cervical radiographs from 30 subjects. OBJECTIVE: To identify reproducible radiographic measures of the occipitocervical neutral position that can be used during surgery to optimize fusion position. SUMMARY OF BACKGROUND DATA: When performing rigid internal fixation of the occiput to the cervical spine, the ability to determine that the occiput is in a neutral position in relation to the cervical spine is important. Currently, no objective radiographic measures for the occipitocervical neutral position exist. METHODS: Thirty flexion, extension, and neutral lateral cervical spine radiographs radiographs interpreted as normal by an experienced radiologist were studied. The occipitocervical angle and occipitocervical distance were defined and calculated. Two investigators, an orthopedic resident and an experienced orthopedic spine surgeon, measured the occipitocervical angle and occipitocervical distance independently on all radiographs in a blinded manner. Correlation coefficients were obtained to determine interobserver reliability. RESULTS: The mean occipitocervical angles were 24.2 degrees, 44.0 degrees, and 57.2 degrees in flexion, neutral, and extension, respectively. The mean occipitocervical distances were 21.5 mm in neutral, 28.0 mm in flexion, and 14.8 mm in extension. The differences in the occipitocervical angle and occipitocervical distance in neutral, flexion, and extension were statistically significant (P < 0.05 and < 0.001, respectively). There were no significant interobserver differences in any of the measurements. CONCLUSIONS: The radiographic measures of the occipitocervical neutral position reported in this study are reliable, repeatable, and simple to determine on routine lateral radiographs. These measurements should be a valuable intra-operative tool for achieving occipitocervical fusion in appropriate alignment.

Adult↗
PubMed1996

Tensile strength of flexor tendon repairs in a dynamic cadaver model.

Twenty-six fresh-frozen cadaver hands (78 tendons) underwent sharp zone II profundus tendon transection and repair with Bunnell, Kessler, Kessler with circumferential epitenon, or epitenon-alone sutures. Suture assignment was randomized, and core sutures were placed either palmarly or dorsally (also randomized) within the flexor tendon. Ten trials of each suture type and placement were performed. Flexion of the repaired digit at a constant excursion rate was performed up to tendon rupture. In all cases, dorsally placed sutures provided significantly more tensile strength than palmarly placed sutures. In light of the previous evidence that tendon viability is dependent on diffusion and not dependent on the vascular supply, we believe that a dorsally placed core suture and circumferential epitenon repair for zone II profundus repairs should be considered because of their increased strength. All future testing of tendon repairs should be performed in an anatomic "curvilinear" model because it simulates the specific biomechanical conditions that are unique to the flexing digit.

Cadaver↗
PubMed1996

Biomechanical changes of cadaveric finger flexion: the effect of wrist position and of the transverse carpal ligament and palmar and forearm fasciae.

This study was designed to investigate whether the position of the wrist or sectioning of the transverse carpal ligament (TCL), as well as the palmar fascia and forearm fascia, modifies the biomechanical behavior of the finger flexion, as defined by changes of excursion, load (force), and work of the flexor tendons. The parameters were measured in fresh-frozen cadaver hands with the wrist in 30 degree extension, neutral, and 30 degree flexion, before and after division of the TCL. Having the wrist in extension improved excursion efficiency, whereas flexing the wrist produced the opposite effect, with a 16% decrease in excursion efficiency after division of the TCL. Change in excursion efficiency between the intact and cut TCL was 8% in the flexed position, 5% in the neutral position, and 0.3% in the extended position. Change in load efficiency between intact and cut TCL was 11% in the flexed position, 6% in the neutral position, and 0% in the extended position. Change in the work efficiency between intact and cut TCL groups was noted most with the wrist in the flexed position (13%), compared to a small change (3%) in neutral wrist position and no change in wrist extension. A significant decrease in the excursion efficiency of the flexor tendons was demonstrated when the wrist was in the flexed position. Any increase in the excursion of the flexor tendons could clinically result in decreased grip strength when the wrist is flexed. Furthermore, the effects of TCL division were not significant when wrist position was in extension.

Biomechanical Phenomena↗
PubMed1995

The flexor synovial sheath anatomy of the little finger: a macroscopic study.

Anatomy texts describe the flexor synovial sheath of the little finger as extending proximally into the palm to join with the ulnar bursa in 80% of cases. Based on this, one would expect frequent extension of little finger flexor synovial sheath infections into the forearm. Methylene blue injection followed by open tenogram was used to define the anatomy of the flexor synovial sheath of the little finger in 60 cadaver hands. In 27 hands, the flexor synovial sheath extended proximally from the bony profundus tendon insertion to terminate at the palmar aponeurosis pulley. A stricture of varying length separated the flexor synovial sheath from the more proximal ulnar bursa. In 19 hands, the flexor synovial sheath was continuous with the ulnar bursa, conforming to the conventional textbook description. In 14 hands, the flexor synovial sheath stopped at the proximal border of the A1 pulley. An inconsistent defect from 1 to 10 mm was noted. The clinical implications of these findings suggest that many little finger flexor synovial sheath infections, when caught early and after careful physical examination, need only be managed by drainage at the distal palmar level.

Cadaver↗
PubMed1988

Current and future delegation of pharmacy activities to technicians in Tennessee.

Pharmacists in charge of community and institutional pharmacies in Tennessee were surveyed to identify which activities they currently delegate to technicians and which activities they might consider delegating in the future. Survey questionnaires were mailed to all pharmacists-in-charge registered with the board of pharmacy. Respondents were asked to indicate which of 38 listed pharmacy activities were currently delegated to technicians and which currently undelegated activities would be delegated in the future if legal and policy barriers were removed and if technician training programs were available. Respondents also ranked six types of technician training programs in order of preference and were asked whether they thought technicians should receive official recognition through certification or licensure. A total of 947 questionnaires were returned, for a response rate of 62%. Of the 24 activities that were delegated by significantly different numbers of pharmacists in community and institutional settings, 23 were delegated more frequently by institutional pharmacists. Activities related to drug therapy were delegated least frequently by either group, although community pharmacists delegated the task of recommending nonprescription drugs more often than did institutional pharmacists. If barriers were removed and training programs were available, more pharmacists would delegate activities to technicians than currently do. Most respondents preferred a formal, in-house training program for technicians; more than 65% of pharmacists favored certification of technicians. Pharmacists in Tennessee currently delegate a number of activities to technicians, and more pharmacists would do so if barriers toward technician use were removed and if more trained technicians were available.

Pharmacies↗