Biomedical subjects

Gordon Bannister

Publications and source records attributed to Gordon Bannister.

6 recordsLinked to original sources

PubMed2006

Early death following primary total hip arthroplasty: 1,727 procedures with mechanical thrombo-prophylaxis.

BACKGROUND: The aims of this study were to quantify the risk and identify the causes of early postoperative mortality after total hip arthroplasty. This would help clinicians address preventable causes of death and help in accurate counseling and consenting of patients. METHODS: We determined the death rate at 90 days in an unselected consecutive series of 1,727 primary total hip arthroplasties where patients had not routinely received chemothromboprophylaxis. RESULTS: The mortality at 90 days was 17/1,727 (1%). The 90-day mortality was 0.2% in patients under 70 years of age, 1.3% in patients between 70 and 80, and 2.5% in those over 80. 7 patients died from ischemic heart disease, 4 died following cerebrovascular events, and 2 from pulmonary embolism. 4 patients died from non-vascular causes. Of the vascular deaths, ischemic heart disease outnumbered cerebrovascular events which, in turn, outnumbered pulmonary embolism (7 vs. 4 vs. 2). INTERPRETATION: Strategies aimed at reducing deaths should address all vascular causes, not just pulmonary embolism. Our findings can be used to inform patients as to the risk of early death after total hip arthroplasty.

Age Factors↗

PubMed2005

Do Kirschner wires maintain reduction of displaced Colles' fractures?

Fifty-three patients underwent closed reduction and longitudinal k-wiring of displaced Colles' fractures and were reviewed after a mean of 26 months. Radiographs taken at the time of injury, after reduction and k-wiring, and at fracture union were compared for radial shortening and dorsal angulation. Manipulation significantly improved fracture position (P<0.001). Dorsal angulation was successfully corrected by manipulation in 98%, and this position was maintained to fracture union in all cases. Seventy-three percentage of fractures manipulated for radial shortening >2 mm were adequately reduced, but 41% of these fractures subsequently lost position to malunite. In this group of patients, the mean radial shortening between reduction and fracture union was 1.6 mm. This did not correlate with Frykman Class or radial shortening at injury. Closed reduction and k-wire stabilisation is an attractive technique because it is relatively non-invasive compared with plating or external fixation. However, a degree of radial shortening between reduction and fracture union must be anticipated. Fractures reduced inadequately to allow for this loss of radial length, are more likely to malunite. This may compromise functional outcome.

Adolescent↗

PubMed2005

Which Colles' fractures should be manipulated?

Ninety-two patients with displaced Colles' fractures were followed prospectively after manipulation under regional anaesthesia. Radiographs were taken before and after manipulation and after 3 months when a functional assessment was also made. A correlation was sought between outcome and radiological measurements. Final radial shortening of 3mm or more was associated with a significantly worse functional outcome after 3 months (P < 0.001). Where the initial radial shortening was 3 mm or more, the probability of malunion was 65% whereas with less than 3mm, the probability of malunion was 28% (P < 0.001). With 5 mm or more of radial shortening at presentation, the probability of malunion was 73% (P < 0.01). The decision to manipulate remains a matter of judgement but a high failure rate renders simple manipulation and plaster cast fixation a poor treatment option in fractures with 5mm or more of radial shortening at presentation.

Colles' Fracture↗

PubMed2004

Effect of autologous salvaged blood on postoperative natural killer cell precursor frequency.

BACKGROUND: Immunosuppression after major surgery increases the risk of infections. Natural killer cells play a pivotal part in defence against infection. We aimed to investigate the immunomodulatory effects of different types of postoperative blood transfusion by use of a new assay for measuring the frequency of peripheral blood natural killer precursor cells (NKpf assay). METHODS: We measured the natural killer cell precursor (NKp) frequency before and 5 days after surgery in 120 patients undergoing joint replacement surgery. The patients were assigned to one of five groups according to the type of transfusion received: non-transfused (n=32), allogeneic non-leukodepleted blood (eight), allogeneic leukodepleted blood (30), autologous predeposited blood (ten), and autologous salvaged blood collected within the first 24 h after surgery (40). We also measured interferon gamma and interleukin 10 concentrations before and after surgery. FINDINGS: The mean postoperative NKp frequency for all patients was lower than the preoperative values, except in patients receiving autologous salvaged blood, which was higher than all other groups (p<0.0001). Postoperative NKp frequencies for patients receiving allogeneic or autologous predeposited blood responded similarly (p=0.99), but these patients had lower NKp frequencies than did the non-transfused group (p<0.0001). Postoperative interferon gamma concentrations were higher in the autologous salvaged blood group (p<0.0001) than in other groups, which did not differ from each other. Interleukin 10 concentrations were similar across all groups (p=0.49). INTERPRETATION: Immunosuppression associated with surgery and blood loss was reflected in a reduced frequency of NKp and decreased interferon gamma. This immunosuppression was reversed by transfusion of autologous salvaged blood, suggesting that this fluid contained immunostimulants.

Adjuvants, Immunologic↗

PubMed2004

Cemented bipolar hemiarthroplasty for displaced intracapsular fracture in the mobile active elderly patient.

Fifty-three patients who were independently mobile outside their home at the time of a displaced intracapsular fractured neck of femur were reviewed at a mean follow-up of 32 months after treatment with a cemented bipolar hemiarthroplasty. Forty-four had no or mild pain. Eleven of the sixteen able to walk 1 mile before fracture were able to do so at review, once significant co-morbidity was excluded. There were no dislocations. Two had been revised, one for technical failure. These results are significantly better than would be expected with conventional hemiarthroplasty in this group of patients. They are comparable with results of total hip replacement (THR) but without the risk of dislocation. Patients able to walk 1 mile before fracture regained their pre-fracture mobility significantly better than those able to walk 500 yards. We suggest that ability to walk 1 mile should define the mobile active elderly for future studies and in guiding treatment.

Activities of Daily Living↗

PubMed2002

Collarless polished tapered stem: clinical and radiological follow-up over 5 years.

The clinical and radiologic outcome of a cemented, polished, tapered stem (CPT), implanted using contemporary cementing techniques in 108 consecutive operated hips in 100 patients (68 women and 32 men, aged 19 to 83 years at the time of surgery [mean, 65 years]) was assessed after >5 years. The Harris hip scores were good or excellent in 96% of the patients. Stem subsidence measured by the computer-assisted method described by Braud and Freeman was at a mean rate of 0.44 mm/y, 1.08 mm during the first year, and stabilizing to a mean total of 2.18 mm at >5 years. Subsidence was related inversely to the completeness of the cement mantle but did not correlate with the clinical or radiologic outcome. This study confirms that collarless, polished, tapered stems subside within the cement mantle but without loosening and that the CPT performs at least as well as the Exeter stem.

Aged↗