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Biomedical subjects

G D Sundararaj

Publications and source records attributed to G D Sundararaj.

17 recordsLinked to original sources
PubMed2004

External fixators in haemophilia.

External fixators (EF) are not commonly used for patients with haemophilia. We describe the use of EF (Ilizarov, AO- uni- and bi-planar fixators and Charnley clamp) in nine patients (mean age: 19.2 years; range: 9-37) with haemophilia for the following indications - arthrodesis of infected joints, treatment of open fractures and osteoclasis. EF required an average of nine skin punctures [range: 4-17 were maintained for a period of 15 weeks (range: 8-29.5), without regular factor replacement, till bone healing was adequate and were removed with a single dose of factor infusion]. The mean preoperative factor level achieved was 85% (range: 64-102%). Much lower levels were subsequently maintained till wound healing. The average total factor consumption was 430 IU kg(-1) (range: 240-870), administered over a period of 17 days (range: 9-44). There were no major complications related to EF except in a patient who developed inhibitors. In conclusion, EF can be used safely in haemophilic patients who do not have inhibitors and does not require prolonged factor replacement.

Adolescent↗
PubMed2003

Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine.

We present a prospective study of patients with tuberculosis of the dorsal, dorsolumbar and lumbar spine after combined anterior (radical debridement and anterior fusion) and posterior (instrumentation and fusion) surgery. The object was to study the progress of interbody union, the extent of correction of the kyphosis and its maintenance with early mobilisation, and the incidence of graft and implant-related problems. The American Spinal Injury Association (ASIA) score was used to assess the neurological status. The mean preoperative vertebral loss was highest (0.96) in the dorsal spine. The maximum correction of the kyphosis in the dorsolumbar spine was 17.8 degrees. Loss of correction was maximal in the lumbosacral spine at 13.7 degrees. All patients had firm anterior fusion at a mean of five months. The incidence of infection was 3.9% and of graft-related problems 6.5%. We conclude that adjuvant posterior stabilisation allows early mobilisation and rehabilitation. Graft-related problems were fewer and the progression and maintenance of correction of the kyphosis were better than with anterior surgery alone. There is no additional risk relating to the use of an implant either posteriorly or anteriorly even when large quantities of pus are present.

Adolescent↗
PubMed1994

Total innominatectomy for chondrosarcoma innominate.

Internal hemipelvectomy or innominatectomy is a preferred alternative to hindquarter amputation for malignant tumours of the pelvis. Various segments of the pelvis have been removed surgically leaving the lower limb with residual segments of the pelvis in treatment of such tumours. We herewith present a case of total innominatectomy, i.e. dis-articulation at the pubic symphysis and sacroiliac joint for surgical clearance and treatment of a chondrosarcoma of the Innominate bone. The tumour extended from just in front of the sacroiliac joint to the ischium and warranted such a complete resection.

Adult↗
PubMed1993

Multicentric giant cell tumour of bone--a report of two cases.

Two cases of metachronous multicentric giant cell tumour of bone are reported. One patient had tumours in the tibia and the femur, the second tumour appearing five years after the first. The other patient developed tumours in the tibia and the radius, the second tumour appearing two years and nine months after the first. The metachronous tumours, in both cases, were clinically and radiologically more aggressive than the initial tumours. Treatment with curettage and bone grafting proved to be ineffective for these tumours and en-bloc excision was required for cure.

Adult↗
PubMed1992

Opponensplasty by extensor indicis and flexor digitorum superficialis tendon transfer.

From 1977 to 1988, 166 patients with median nerve paralysis of varied aetiology underwent opponensplasty. In 50 of these the extensor indicis was used, and in 116 the flexor digitorum superficialis of the ring finger. An analysis of these hands showed that the EI opponensplasty was best in supple hands and FDS opponensplasty was more suitable for less pliable hands. There were fewer complications seen after FDS opponensplasty if the detachment of the donor tendon was done through a volar oblique incision rather than the conventional lateral incision.

Adolescent↗
PubMed1991

Extensor indicis proprius opponensplasty.

An analysis of 39 patients (40 hands) who underwent an extensor indicis proprius opponensplasty was carried out. Of these, 29 hands had simultaneous adjuvant surgery to correct other deformities. The mean follow-up period was 33.8 months. Excellent or good results were seen in 87.5%, fair in 10% and poor in 2.4% hands.

Adolescent↗
PubMed1985

Pattern of contracture and recovery following ischaemia of the upper limb.

196 cases of Volkmann's Ischaemic Contracture of the upper limb with well-established ischaemia are presented. In all cases tight external circumferential splintage was the primary factor. 59.2% of these patients had been initially treated by "bone setters". 54.6% had fractures of the forearm; supracondylar fracture of the humerus was seen in 10.7% and 17.9% had no evidence of bone or joint injury. Different patterns of ischaemic contractures are recognised and the severity of the contracture is found to be related to the extent of paralysis. Sensory recovery occurs in a proximodistal direction even following total ischaemia and degeneration of the nerve. Motor recovery, however, does not seem to take place. Sensory recovery in the forearm proceeds rapidly in the first six months; thereafter it is less significant. However, the sensory recovery in the hand is significant only after more than twelve months. Since sensory recovery occurs even after total ischaemic degeneration of the nerve it is postulated that such nerves recover and regenerate in course of time.

Adolescent↗
PubMed1985

Management of Volkmann's ischaemic contracture of the upper limb.

One hundred and ninety six cases of Volkmann's ischaemic contracture in the upper limb were studied for their pattern of contracture and recovery (Sundararaj and Mani 1985). Mild, moderate and severe forms of contracture have been described (Tsuge 1975; Sundararaj and Mani 1985). The management of 102 of these cases has been studied and discussed here.

Arm↗
PubMed1984

Interphalangeal joint stiffness following claw hand reconstruction.

Conventional immobilisation following surgery for claw hand reconstruction necessitates altogether more than six weeks of post-operative physiotherapy. Two to four weeks of physiotherapy was required for re-education of the transferred tendons and an additional period of physiotherapy was needed to overcome the interphalangeal joint stiffness seen in all hands--even those with no pre-operative I.P. stiffness. Fifty hands with no pre-operative I.P. stiffness were immobilised post-operatively following claw hand correction by three different techniques, (Conventional technique 20 hands; Modification type 1, 10 hands and Modification type 2, 20 hands). Modification type 1 produced unsatisfactory results. Modification type 2 however, resulted in near total absence of I.P. stiffness with no additional physiotherapy required to overcome the minimal stiffness, without interfering with the results of reconstructive surgery. Type 2 immobilisation was achieved by a volar plaster slab extending from just below the elbow to the finger tips with circumferential plaster up to just beyond the metacarpophalangeal joints. Modification type 2 is recommended.

Casts, Surgical↗
PubMed1984

Surgical reconstruction of the hand with triple nerve palsy.

Simultaneous paralysis of the ulnar, median and radial nerves is seen in about 1% of hands with nerve involvement in Hansen's disease. Forty such cases were treated between 1955 and 1976; 35 of these have been followed up. In two hands there was a high radial, median and ulnar palsy and these left no scope for reconstruction. The other 33 cases which underwent two-stage reconstructive surgery are presented here. The first stage consisted of restoring active extension of the wrist, fingers and thumb: for this purpose the ideal muscles for transfer are pronator teres, flexor carpi radialis and palmaris longus respectively, and muscle power exceeding Grade 3 (on the MRC classification) was achieved in 89%, 96%, and 100% of these individual transfers. Arthrodesis of the wrist is not recommended when suitable muscles are available for transfer. The second stage of reconstruction attempts to restore intrinsic function of the fingers and opposition of the thumb; the sublimis is ideal for both purposes and satisfactory restoration of function was achieved in 89% and 85% of cases respectively. Ten of the 18 hands in which all five tendons were transferred had good or excellent results.

Adolescent↗
PubMed1983

A comparative study of EFMT and sublimis transfer operations in the claw hand.

Two hundred cases each of EFMT and sublimis transfer operations performed for correction of claw hand deformity following Hansen's disease were studied and the results compared. The cases were selected by systematic sampling. The incidences of reclawing in the index, long, and ring fingers were found to be more in the EFMT series. Also the postoperative intrinsic plus deformity was seen more often in the ring and little fingers in the EFMT series. The occurrence of a sublimis minus deformity following removal of the sublimis tendon is recognized and described. Both operative procedures produced 95% satisfactory results.

Hand Deformities, Acquired↗