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Biomedical subjects

F R Howell

Publications and source records attributed to F R Howell.

13 recordsLinked to original sources
PubMed2004

Reducing lateral skin flap numbness after total knee arthroplasty.

One hundred and thirteen knees were assessed for lateral skin flap numbness, 5-227 weeks following IB2 total knee arthroplasty. The final 53 had the numb area measured. To define the anatomy of the cutaneous nerves we dissected four cadaveric knees. Eighty-six percent of patients had a numb area on objective assessment but only 60% had subjective numbness, 62% of which had improved. Patients had a larger numb area if they were aware of a numb patch, had a scar over 22 cm long or were less than 25 weeks following surgery. We conclude that not all patients will get lateral skin flap numbness and improvement occurs with time. The area of numbness can be reduced by using a shorter proximal incision, which preserves branches of the medial and intermediate cutaneous nerves of thigh.

Adult↗
PubMed2003

Counting health care: is there aF in CE?

The consultant episode is widely used by health economists as a measure of delivery of care. The clinical notes of 174 consecutive patients undergoing elective orthopaedic procedures were reviewed. Just over half of the cases (89/174, 51%) were patients referred by their general practitioner, but under half of the available operating time (47%) was expended on these patients, the remainder being on patients already within the system. Under standard NHS accounting, these latter patients are not registered as new consultant referrals and, thus, the episodes of patient care of which their operation is a part, do not constitute finished consultant episodes. Our view is that the episode of care is an inappropriate measure of health care delivery applied to orthopaedic surgery in general.

Episode of Care↗
PubMed2002

Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly.

We report a randomised, prospective study comparing a standard sliding hip screw and the intramedullary hip screw for the treatment of unstable intertrochanteric fractures in the elderly. One hundred and two patients were randomised on admission to two treatment groups. Fifty-two patients were treated with a compression hip screw (CHS), and fifty had intramedullary fixation with an intramedullary hip screw (IMHS). Patients were followed for 1 year and had a clinical and radiological review at 3, 6 and 12 months. The mean duration of operation and fluoroscopy screening time was significantly greater for insertion of the intramedullary hip screw. There was no difference between the groups with regard to transfusion requirements or time to mobilise after surgery. There were two technical complications in the CHS group and three in the IMHS group. There was no significant difference between the two groups in radiological or functional outcome at 12 months. It remains to be shown whether the theoretical advantages of intramedullary fixation of extracapsular hip fractures bring a significant improvement in eventual outcome.

Aged↗
PubMed2000

Plugging the intramedullary canal of the femur in total knee arthroplasty: reduction in postoperative blood loss.

A prospective, randomized trial comparing postoperative drainage was carried out in 120 consecutive knees undergoing total knee arthroplasties divided into 2 groups. In one (55 knees), the entry point for the femoral intramedullary rod was left open. In the other (65 knees), the entry point was closed by an autologous bone plug. The mean drainage after 24 hours and the total drainage were lower when the femoral canal was plugged (800 vs 960 mL and 925 vs 1,165 mL). The bone plug always united, and no loose bodies were seen 6 months after operation. We conclude that the femoral intramedullary guide hole should be plugged with autologous bone because this technique results in a small but significant reduction in early blood loss without countervailing disadvantages.

Adult↗
PubMed1998

The protective effect of a cut-resistant glove liner. A prospective, randomised trial.

We performed a prospective, randomised study comparing the rates of glove perforation using double latex gloving with or without a disposable protective glove liner (Paraderm) on 118 patients undergoing primary or revision arthroplasty of the hip or knee by one surgeon (FRH). The patients were randomly allocated into two groups: in group 1 an inner and outer pair of latex gloves were worn as double gloves and in group 2 the glove liner was worn between the two latex gloves. There was glove perforation in at least one outer glove in 99 operations (84%). The operating surgeon was aware of the perforation in 21 of these. There were 22 perforations of the inner glove. Group 1 had a significantly higher perforation rate per operation (p < 0.05) than group 2. Our findings show that protective glove liners significantly reduce the rate of perforation of the inner glove during hip and knee arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed1992

Growth beyond skeletal maturity.

Serial measurements of standing and sitting height of children show that growth continues beyond the age of skeletal maturity when judged by the fusion of the epiphyses of the hand and wrist. Most of this increase occurs in the sitting height, largely reflecting spinal growth, and may account for the known progression potential of idiopathic scoliosis beyond the attainment of skeletal maturity.

Adolescent↗
PubMed1989

The deformity of idiopathic scoliosis made visible by computer graphics.

We present a method of visualising spinal deformities in three dimensions using conventional radiographs and computer graphics. The shape of the spinal column can be determined from the anteroposterior and lateral radiographs and displayed in any projection. In patients with adolescent idiopathic scoliosis, the fundamental lesion, an abnormal lordosis, can be demonstrated without the need for additional views. The method is applicable to other spinal deformities and may help to elucidate their three-dimensional shape.

Adolescent↗
PubMed1989

The three-dimensional anatomy of the proximal femur in Perthes' disease.

A new method of recording the three-dimensional anatomy of the proximal femur from a single anteroposterior radiograph is described. This technique shows that in Perthes' disease the femoral head and neck are in significant anteversion and true varus. This anatomical configuration may be important in the pathogenesis and treatment of this disorder.

Child↗
PubMed1988

V-Y advancement of the inferiorly based rectus abdominis musculocutaneous flap.

We describe two cases in which a rectus abdominis musculocutaneous flap was used to reconstruct an ipsilateral groin defect by V to Y advancement. Cadaveric studies undertaken to investigate the likely versatility of this flap showed that it may be advanced to midthigh level. This range can be increased by division of the inguinal ligament and by partial reflection of the rectus abdominis muscle from the skin island. The operative technique and the merits and disadvantages of the flap are discussed. This variation is a useful alternative. It has a considerable excursion potential and may be cosmetically more acceptable than other transposition flaps.

Abdominal Muscles↗