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Biomedical subjects

G E B Giddins

Publications and source records attributed to G E B Giddins.

9 recordsLinked to original sources
PubMed2006

Outcome following conservative treatment of metacarpophalangeal collateral ligament avulsion fractures of the finger.

Avulsion fractures of the metacarpophalangeal joints are uncommon and there are few reports on their outcome after conservative treatment. We treated seven such patients with fracture fragment sizes between 10% and 25% of the width of the articular surface on the radiograph by early active mobilisation in neighbour strapping. The outcome of treatment was assessed at a mean follow-up of 57 (range 8-94) months. The mean visual analogue pain score was 0.6 (range 0-2) and the mean visual analogue function score was 9 out of 10 (range 6-10). The mean DASH score was 3.1 (range 0-12.5). All but one patient had normal grip strength and a full range of finger movement. We believe that the majority of avulsion fractures of the metacarpophalangeal joint can be managed successfully without surgery.

Adolescent↗
PubMed2005

Development of an in-vivo method of wrist joint motion analysis.

BACKGROUND: A clinically applicable method of plotting wrist joint motion in three-dimensions has not been described. Computer modelling has been used to improve joint arthroplasty elsewhere in the body. We aimed to develop a method of measuring, and modelling, wrist joint motion that could potentially be used to improve the kinematic performance of wrist arthroplasty designs. METHODS: An electromagnetic system was used to record wrist motion in three-dimensions. A small pilot study attempted to assess repeatability. A larger group of volunteers with normal wrists was also studied. An iterative computer model, using a two-axis hinge, was developed. One output from this model, the offset of the two axes of motion, is presented as an example of the possible applications of this method of analysis. FINDINGS: For any one individual, in the pilot study, the offset of the axes calculated was relatively reproducible. Between individuals the difference in the offset of the axes was more marked. In 99 normal sets of data the mean axis offset was 6.8mm (range 28 mm to -21 mm) A positive value represented the radio-ulnar deviation axis placed distal to the flexion-extension axis. INTERPRETATION: The three-dimensional motion plots generated using this method could be used clinically to follow disease progression or recovery following surgery. The computer modelling method described has potential applications, if further refined, to wrist joint arthroplasty design.

Algorithms↗
PubMed2004

'Doctor, when can I drive?': an update on the medico-legal aspects of driving following an injury or operation.

In line with recent changes in UK legislation, we updated our position regarding the determination of fitness to drive. The responsibility for determining the fitness to drive of an individual now rests entirely with the Driving and Vehicle Licensing Agency (DVLA). Previous work on this subject was reviewed, updated published documents were evaluated and a literature search on fitness to drive following an injury or operation was carried out. We should advise our patients to drive once they feel safe, but they should be careful during the earlier stages of rehabilitation. If in any doubt, the driver should contact the DVLA and take advice accordingly from their medical advisors.

Automobile Driving↗
PubMed2004

A kinematic model of the wrist based on maximization of joint contact area.

The wrist is a complex joint and the factors governing its behaviour are poorly understood. A hypothesis that the movement of the carpal bones could be predicted using a minimum energy principle was tested. Carpal bones were dissected from a cadaveric forearm and their shapes were laser-digitized to obtain three-dimensional computer models. A computer program was created to measure contact area between neighbouring articular surfaces and to maximize this quantity by adjusting the six degrees of freedom of the bone models. This procedure was performed for 1.0 degree increments of rotation applied to the capitate bone up to 20 degrees of ulnar and 10 degrees of radial deviation. The model correctly predicted certain aspects of the complex behaviour of the carpal bones. The results for the scaphoid in particular displayed characteristics in common with known behaviour of this bone. During 20 degrees of unlar deviation and 10 degrees of radial deviation, the bone demonstrated 11.3 degrees of extension and 9.4 degrees of flexion respectively. The novelty of the study lay in the fact that the model did not rely upon ligamentous constraints. The results are encouraging, considering the only information used by the algorithm was the shape of the articular surfaces.

Biomechanical Phenomena↗
PubMed2004

A method for measuring vertical forces applied to the upper limb during sit-to-stand.

The aim of this study was to develop a basic measurement system to estimate the vertical loading of the upper limb during the sit-to-stand activity, with a view to increasing the understanding of the loading of the wrist in daily living activities. A chair was adapted and instrumented with strain gauges and position sensors so that the force applied through the upper limbs to the arms of the chair could be calculated. Four aspects of the chair's geometry could be varied. A force plate was positioned on the floor between the legs of the chair to record the corresponding foot loading. Twenty normal subjects (22-56 years, mean 32.7 years) participated in a pilot study in which loading through the upper and lower limbs was recorded for a range of chair geometries. The vertical force transmitted through each upper limb was typically 20-30 per cent of bodyweight. The vertical upper limb load averaged across all subjects showed a small reduction when either the seat height or the height of the chair arms was increased.

Adult↗
PubMed2003

The relationship between the strength of supination of the forearm and rotation of the shoulder.

In children with obstetric brachial plexus palsy (OBPP) who develop an internal rotation deformity of the shoulder, release of subscapularis improves the range of external rotation of the shoulder and the strength of supination of the forearm. We studied the strength of supination in 35 healthy adult volunteers at 45 degrees of both internal and external rotation. The mean and maximum torques were greater in external than internal rotation by 8.7% and 7.5%, respectively. This was highly significant (p < 0.0001). The increased strength of supination in external rotation is probably because the maximum power of biceps, particularly the long head, may be exerted in this position. In children the difference may be even greater due to anatomical differences causing the dramatic increases in the strength of supination after surgery for OBPP. In adults our findings suggest that the supination exercises which are undertaken after injury or surgery to the forearm or wrist should be performed in external rotation.

Adult↗
PubMed2003

Direct access carpal tunnel surgery.

Carpal tunnel syndrome is a common condition and clinical diagnosis is often easily made. A system of direct referral for day-case carpal tunnel surgery was introduced. General practitioners, physicians and surgeons were advised of the service and the criteria for referral, which included female patients with bilateral symptoms and physical signs, and some response to conservative treatment. All patients were reviewed preoperatively by the senior author (GEBG). The service was an alternative to standard outpatient referral. A total of 51 patients was seen. Two were refused surgery. In all those who underwent surgery, the symptoms either resolved or were improved. The service was well received, although some patients felt that they were poorly informed preoperatively. The mean waiting time for surgery was reduced by four months and the patients avoided an outpatient appointment. Direct access day-case carpal tunnel surgery works well by reducing delays and the costs of treatment. Adequate patient information is important to make the best of the service.

Adult↗
PubMed2002

Maintaining wrist function in severe rheumatoid arthritis: a case study of revision Swanson wrist arthroplasty staged via a wrist fusion in rheumatoid arthritis.

We present a case of revision Swanson wrist arthroplasty staged via a wrist fusion in a patient with rheumatoid arthritis. Due to extensive bone loss in the rheumatoid patient, it may not be possible initially to revise a wrist arthroplasty; however after fusion with a bone graft to regain bone stock we have demonstrated that this is possible. It may even be possible to convert such a fusion to a total wrist arthroplasty.

Aged↗