Biomedical subjects

G J McLauchlan

Publications and source records attributed to G J McLauchlan.

12 recordsLinked to original sources

PubMed2006

Reducing incision length or intensifying rehabilitation: what makes the difference to length of stay in total hip replacement in a UK setting?

Minimal-incision surgery for hip arthroplasty and intensive post-op physiotherapy have both been shown to allow early mobilisation and to reduce hospital stay. Forty-five patients undergoing primary total hip arthroplasty using a standard posterior approach were compared with 51 patients using a minimal incision. In both groups, physiotherapy involved either a routine or intensive regime. Patients were matched in age, sex and body mass index. There was no significant difference in blood loss, post-operative stay and change in Oxford hip scores at one year between the mini- and standard-incision groups. There was a significant difference (P=0.003) in length of stay between routine- and intensive-physiotherapy groups (11.4 vs. 7.9 days). The dislocation rate was higher in the mini-incision group. This study suggests that in a standard UK setting, intensive physiotherapy can significantly decrease in-patient stay, but reducing the incision length does not.

Aged↗

PubMed2006

Outcome assessment in the elderly after total hip arthroplasty.

An analysis of the Short-Form 36 (SF-36) and Oxford Hip questionnaires, were used to assess 2 randomized groups, by either mail or interview, at a minimum 10-year follow up after total hip arthroplasty. Ninety-nine patients (median age 77 years) were reviewed at a median 11 years after total hip arthroplasty. There was a 91% response rate to participation in the study. There was no significant difference between the groups for missing values. The mode of administration did not affect the mean Oxford scores (P > .1), but significant differences were noted in SF-36 health scales Role Emotional and Role Physical (P = .01). Analysis of other demographic variables revealed unexpectedly that comorbidity affected the Pain score in the Oxford questionnaire (P = .002) and that age had no effect on scores obtained in either questionnaire (P > .05). The uses of both general health and disease-specific questionnaires complement each other in the assessment of such groups. The SF-36 and Oxford questionnaires give a more accurate reflection of health status when self-completed while accepting higher missing values in an elderly population.

Aged↗

PubMed2002

Sacral and iliac articular cartilage thickness and cellularity: relationship to subchondral bone end-plate thickness and cancellous bone density.

OBJECTIVES: To measure the thickness and cellularity of adult human sacral and iliac articular cartilages and the thickness and density of the subchondral bones. METHODS: The right sacroiliac joints of 15 adult patients were examined post-mortem. HOME (Highly Optimized Microscope Environment) microscopy was used to measure articular cartilage and subchondral bone end-plate thickness. Conventional morphometric techniques were employed to estimate cartilage cellularity and cancellous bone density. RESULTS: Sacral articular cartilage was thicker than iliac (1.81 vs 0.80 mm, P<0.001). Iliac cartilage cell density in all zones was higher than sacral. The overall mean was 31.19 x 10(-3) vs. 23.23 x 10(-3)/mm(3), P<0.001. Superficial zones contained more cells than middle and deep zones but there were large differences between the cell numbers of the middle and deep zones of both sacral and iliac cartilages. Iliac subchondral bone end-plates were thicker than sacral (0.36 vs 0.23 mm, P<0.001). The thickness of these plates was related inversely to that of the overlying articular cartilages. Iliac subchondral cancellous bone was twice as dense as sacral (22.07 vs. 12.05%, P<0.001), a ratio recognized anteriorly, centrally and posteriorly. CONCLUSIONS: Adult human sacral cartilage is thick and of low cell density. It rests upon a thin bone end-plate supported by porous, cancellous bone. Iliac cartilage and bone display the converse proportions. The identification of these variables may assist understanding of normal sacroiliac joint function and the interpretation of tissue changes in the spondylarthropathies.

Adult↗

PubMed2002

Management of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomised controlled trial.

In a prospective, randomised controlled trial, 68 children who had a completely displaced metaphyseal fracture of the distal radius were treated either by manipulation (MUA) and application of an above-elbow cast alone or by the additional insertion of a percutaneous Kirschner (K-) wire. Full radiological follow-up to union was obtained in 65 children and 56 returned for clinical evaluation three months after injury. Maintenance of reduction was significantly better in the K-wire group and fewer follow-up radiographs were required. There was no significant difference in the clinical outcome measured three months after injury. Seven of 33 patients in the MUA group had to undergo a second procedure because of an unacceptable position compared with none of the 35 in the K-wire group (chi-squared test, p < 0.01). One patient in the K-wire group required exploration for recovery of a migrated wire. We conclude that the use of a percutaneous K-wire to augment the reduction of the fracture in children who have a completely displaced metaphyseal fracture of the distal radius is a safe and reliable way of maintaining alignment of the fracture.

Adolescent↗

PubMed2001

Interventions for treating acute and chronic Achilles tendinitis.

BACKGROUND: Achilles tendinitis is one of the most common of all sports injuries. There is no consensus on treatment. OBJECTIVES: To assess the effectiveness of various treatment interventions for acute and chronic Achilles tendinitis in adults. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group specialised register (December 2000), Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2000), MEDLINE (1966 to December 2000), EMBASE (1980 to 2001 wk 04), CINAHL (1982 to December 2000), and reference lists of identified trials were searched. SELECTION CRITERIA: Randomised or quasi-randomised trials of treatment interventions for acute and chronic Achilles tendinitis in adults. Studies focusing on pathological tendinitis were excluded. Excluded were those trials that compared different dosages of the same drug or drugs within the same class of drugs, for example different non-steroidal anti-inflammatory drugs (NSAIDs). DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed trial quality, by use of a ten item check list, and extracted data. Requests were sent for separate data for Achilles tendinitis patients in studies within trials of mixed patient populations. Where possible, quantitative analysis and limited pooling of data were undertaken. MAIN RESULTS: Nine trials, involving 697 patients, met the inclusion criteria of the review. Methodological quality was adequate in most of the trials with regards to blinding but the assessment of outcome was incomplete and short-term. There was weak but not robust evidence from three trials of a modest benefit of NSAIDs for the alleviation of acute symptoms. There was some weak evidence of no difference compared with no treatment of low dose heparin, heel pads, topical laser therapy and peritendonous steroid injection, but this could not be fully evaluated from the reports of four trials. The results of an experimental preparation of a calf-derived deproteinized haemodialysate, Actovegin, were promising but the severity of patient symptoms was questionable in the single small trial testing this comparison. The results of a comparison of glycosaminoglycan sulfate with a NSAID were inconclusive. REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate for the treatment of acute or chronic Achilles tendinitis. Further research is warranted.

Achilles Tendon↗

PubMed1999

Extension of the elbow and supracondylar fractures in children.

We tested the hypothesis that children who sustain a supracondylar fracture have a greater range of elbow hyperextension than those with a fracture of the distal radius. Three observers made 358 measurements in 183 children (114 boys and 69 girls). There were 119 fractures of the distal radius and 64 supracondylar fractures. Initially, the group with a supracondylar fracture appeared to have extension 1.7 degrees greater than that of the group with fracture of the distal radius. On average, there was a maximum variation of 3 degrees between observers. After allowing for age, gender and observer, there was no significant difference between the groups. Our study had greater than 80% power to detect a difference in hyperextension of 2 degrees at the 5% level with the above observer variability. When age and gender are taken into account, any variation in the amount of hyperextension at the elbow is not sufficient to explain the occurrence of a supracondylar fracture.

Adolescent↗

PubMed1999

Assessment of an electronic mailing list for orthopaedic and trauma surgery.

Medical electronic mailing lists have grown rapidly with the evolution of the Internet. The purpose of this paper was to assess the content and academic quality and of an electronic mail discussion list "Orthopod" dedicated to research in orthopaedic and trauma surgery. A retrospective analysis was undertaken of four months of web-based archive of communication through the Orthopod mailing list http:(/)/www.mailbase.ac.uk/lists/Orthopod. At the end of this study period there were 505 members of the Orthopod list. The main outcome measures of this paper were number of messages, type of messages, number of contributors, designation of contributor and number of topics referenced. On average 276 messages were posted each month. The mean number of messages per contributor per month only varied between 2.3 and 2.5. On average 54% of message threads contained at least one reference. At least 77% of the patient history and general threads had input from senior orthopaedic staff. The quantity of information on the Internet need not be a substitute for quality in orthopaedic and trauma surgery mailing lists. The Orthopod Electronic mail discussion list is another medium for the circulation of good quality surgical information. Orthopod provides a unique international electronic forum list for trauma and orthopaedic surgeons worldwide.

Humans↗

PubMed1998

Epidemiology of fractures in 15,000 adults: the influence of age and gender.

We report a prospective study of the incidence of fractures in the adult population of Edinburgh, related to age and gender. Over a two-year period, 15,293 adults, 7428 males and 7865 females, sustained a fracture, and 5208 (34.0%) required admission. Between 15 and 49 years of age, males were 2.9 times more likely to sustain a fracture than females (95% CI 2.7 to 3.1). Over the age of 60 years, females were 2.3 times more likely to sustain a fracture than males (95% CI 2.1 to 2.4). There were three main peaks of fracture distribution: the first was in young adult males, the second was in elderly patients of both genders, mainly in metaphyseal bone such as the proximal femur, although diaphyseal fractures also showed an increase in incidence. The third increase in the incidence of fractures, especially of the wrist, was seen to start at 40 years of age in women. Our study has also shown that 'osteoporotic' fractures became evident in women earlier than expected, and that they were not entirely a postmenopausal phenomenon.

Adolescent↗

PubMed1997

Results of an operative policy in the treatment of periprosthetic femoral fracture.

OBJECTIVE: To determine the clinical outcome of patients with periprosthetic femoral fractures treated operatively. DESIGN: Retrospective analysis from 1986 to 1993. SETTING: Edinburgh Orthopaedic Trauma Unit, Edinburgh, Scotland. PATIENTS: Forty-five patients identified from a computer database as being admitted to the Edinburgh Orthopaedic Trauma Unit with periprosthetic femoral fractures. MAIN OUTCOME MEASURES: Clinical outcome grade (good, fair, poor) dependent on integrity of fixation, refracture rate, and ability to perform activities of daily living analyzed against age, type of fracture, prosthetic alignment, loosening, and method of fixation. RESULTS: Type I fractures were more common in uncemented or loosely cemented prostheses, whereas type II fractures occurred predominantly in securely cemented prostheses. Type I fractures treated by revision had the poorest results. Outcome in type II fractures was equally good whether treated by internal fixation or by revision. Age, loosening, and prosthetic alignment did not influence outcome. The mortality rate in this series was 20%. CONCLUSIONS: If a prosthesis is loose, it should be revised, or treatment varies with fracture and prosthetic type. In type I fractures, an uncemented stem may be revised to a cemented one; however, a securely cemented prosthesis probably is better when fixed internally. Type II fractures should be fixed internally because there is less operative insult. Type III fractures probably are not related to the prosthesis and should be fixed internally according to normal practice. The results of an operative policy compare well with the results of conservative management and avoid the problems of long-term immobilization.

Adult↗

PubMed1995

Return to work after laparoscopic cholecystectomy.

To assess whether the introduction of laparoscopic cholecystectomy has led to a change in attitude regarding the resumption of normal activities after operation, the views of 407 general practitioners (GPs) and 532 patients were analysed. Although 99 per cent of GPs thought that laparoscopic cholecystectomy represented an improvement on the open operation, 55 per cent advised significant restrictions in the postoperative period. For the 231 patients in employment who had an uncomplicated laparoscopic procedure the mean time of return to work was 3.3 weeks. Although 47 per cent of patients returned to work within 2 weeks, 19 per cent took more than 4 weeks. The self-employed returned significantly earlier than employees. Education through better communication among hospital, general practitioners and patients is required if prevailing attitudes towards the length of convalescence after laparoscopic cholecystectomy are to change.

Attitude of Health Personnel↗

PubMed1995

Outcome of patients with abdominal sepsis treated in an intensive care unit.

A group of 125 patients with abdominal sepsis admitted to the intensive therapy unit between January 1990 and June 1993 were reviewed to determine outcome. Mean(s.d.) age was 66(12) years and admission Acute Physiology And Chronic Health Evaluation (APACHE) II score 23(9). The hospital mortality rate was 63 per cent. Factors associated with mortality included age, APACHE II score, occurrence of septic shock, chronic ill health, female sex, sepsis of upper gastrointestinal origin and failure to clear the source of sepsis (all P < 0.05). Delay to surgery, anastomotic leakage and presence of malignancy did not influence survival significantly. Quality of life (measured by the World Health Organization performance score) at 15 months after discharge showed 24 of 32 survivors to be independent, ambulatory and capable of self care. No patient survived to become completely disabled. The factors associated with survival did not predict subsequent quality of life. Accurately defining the characteristics of this heterogeneous group of patients is a prerequisite for improved treatment, patient selection and research.

APACHE↗

PubMed1995

Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing.

We reviewed 63 patients with fractures of the distal tibial metaphysis, with or without minimally displaced extension into the ankle joint. The fractures had been caused by two distinct mechanisms, either a direct bending force or a twisting injury. This influenced the pattern of the fracture and its time to union. All fractures were managed by statically locked intramedullary nailing, with some modifications of the procedure used for diaphyseal fractures. There were few intra-operative complications. At a mean of 46 months, all but five patients had a satisfactory functional outcome. The poor outcomes were associated with either technical error or the presence of other injuries. We conclude that closed intramedullary nailing is a safe and effective method of managing these fractures.

Adolescent↗