Biomedical subjects

David Healey

Publications and source records attributed to David Healey.

3 recordsLinked to original sources

PubMed2002

Simultaneous fracture of every cervical vertebra: a case study.

STUDY DESIGN: The case of a 14-year-old boy who sustained simultaneous fractures of every cervical vertebra in a high-energy snowmobile accident is reported. OBJECTIVE: To describe a case of multiple cervical spine fractures and their management. SUMMARY OF BACKGROUND DATA: Injuries from all-terrain vehicles and off-road vehicles, including snowmobiles, are increasing in severity and frequency. The reported case illustrates a result of high-impact loading in which the driver struck his head after being thrown from a snowmobile at high speed. METHODS: The 14-year-old boy in the reported case fractured C1-C7, but had no neurologic sequelae. RESULTS: The fractures were treated with a halo vest after traction and reduction of the displaced odontoid fracture. All the fractures healed with no residual cervical instability. CONCLUSIONS: This case report is the first to describe a patient of any age who sustained simultaneous fractures of every cervical vertebra. Treatment with a halo vest was successful in protecting the cervical spine until healing was complete.

Accidents↗

PubMed2002

Evidence-based practice in dentistry.

The importance of evidence in teaching and in support of clinical decisions is well established in health care, including dentistry. Defence of clinical decisions increasingly requires reliable data or evidence to support the stance taken. Assistance in finding the best evidence comes from a variety of sources, including computerised databases, journals, continuing education meetings, and study clubs. The randomised controlled trial heads the hierarchy of research designs on which evaluation of evidence is based; anecdotally based evidence and individual case studies are the least preferred study designs. Evaluation of a study requires a number of questions to be asked to determine how the study was performed, and whether it applies to a clinical situation. These questions relate to how the study was carried out, whether controls were used, were the results likely to be valid, and was statistical and clinical significance present. Quackery, pressure from consumers, and legal considerations have contributed to an increase in the importance of evidence-based practice. The benefits, however, of evidence-based practice are that treatment decisions are easier to justify, especially when there is a complaint or a dento-legal issue, and the personal satisfaction that patients are being offered the best treatment.

Decision Support Techniques↗

PubMed2002

Cervical spine instability in children with Goldenhar's syndrome.

OBJECTIVE: To study the vertebral involvement of the cervical spine, in particular the stability of C1-C2, in children with proven Goldenhar's syndrome. DESIGN: A case review. SETTING: The Children's Hospital of Eastern Ontario, Ottawa. PATIENTS: Eight children who had a minimum of 2 out of 3 Goldenhar criteria plus other strong associations with the syndrome and for whom detailed radiographic spinal assessment, including flexion-extension views of the cervical spine and computed tomography of the congenital anomalies, were available. OUTCOME MEASURES: Radiographic findings. RESULTS: Seven children demonstrated cervical spine anomalies. Of particular concern was the high incidence of C1-C2 instability in 3 children, 2 of whom required occiput to C2 fusion. The presence of hemivertebrae and failures of segmentation were most common and resulted in thoracic scoliosis, leading to spinal fusion in 2 children. CONCLUSIONS: In patients with Goldenhar's syndrome the cervical spines must be monitored carefully for C1-C2 subluxation before any proposed surgery for other malformations associated with the syndrome, so that any instability can be identified to avoid cord impingement during a general anesthetic.

Adolescent↗