Biomedical subjects
Publications and source records attributed to H K Graham.
We made a prospective study of angulated radial neck fractures in children reduced by leverage with a percutaneous Kirschner wire. Of 36 consecutive cases with angulation of more than 30 degrees reduction was successful in 33. We obtained an excellent or good final result in 31 (94%).
Alterations in serum calcium fractions after trauma may be of clinical importance. For investigation of this problem, serum calcium fractions were studied prospectively in 42 patients with severe musculoskeletal injuries. The severity of trauma was assessed with the Apache II severity of disease classification system. Serum ionized calcium, total calcium, pH, albumin, and arterial blood gases were measured daily for the first five days after admission. The fat embolism syndrome developed in eight patients; they were more severely injured than the others, and they had significantly lower levels of serum ionized calcium for all five days of the study. There was a strong negative correlation between the Apache II score and serum ionized calcium. Ionized hypocalcemia has a strong association with development of the complications of severe musculoskeletal trauma, such as the fat embolism syndrome.
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Fifteen independent observers of three levels of experience (consultant staff, fellows, residents) assessed 40 radiographs of children presenting with Perthes' disease using the Catterall and the Salter-Thompson grading systems. Each observer was supplied with descriptions and illustrations of the classifications and each hip was grouped by both systems by each observer. The results were statistically analysed using 'kappa' statistics. The level of interobserver agreement was higher for the Salter-Thompson system and correlated with the level of experience of the observer. Both systems can give acceptable levels of interobserver agreement, but the Salter-Thompson grouping is simpler and easier to apply in the earlier stages of the disease when treatment must be decided, and has a higher degree of reproducibility amongst more experienced observers.
Calcium homeostasis is altered by strenuous physical exercise. The mechanism is unclear. Our study was designed to investigate this relationship, particularly any associated changes in the calcium regulating hormones. Six subjects carried out a strenuous exercise programme for 10 min on a bicycle ergometer. Blood samples were analysed for ionized calcium, total calcium, calcitonin and pH. Plasma parathormone was assayed using a new and very sensitive N-terminal assay. Serum ionized calcium was significantly elevated by exercise at 50% of maximum aerobic capacity (VO2 max). The rise persisted until the late recovery phase, when it fell significantly below resting levels. Plasma parathormone levels were initially depressed by moderate exercise (50% VO2 max.) but were significantly elevated during and immediately after severe exercise. Our results suggest that exercise stimulates the hormonal, osteolytic influences acting on the skeleton, with increases in plasma parathormone and mobilisation of calcium stores. These changes may provide a supply of raw material allowing the osteogenic mechanical forces initiated by exercise to produce a positive skeletal balance. In view of the possible relevance of these findings to the understanding and management of osteoporosis we feel that this area merits further study.
For equinus deformity in spastic hemiplegia, correction by the White slide technique has been studied in a group of 35 patients followed up for 14 to 20 years. It is a simple, effective method of lengthening the calcaneal tendon, and is free from significant complications with an acceptable rate of recurrent deformity. The majority of patients achieved a heel-toe gait.
The cases of 230 patients who had a displaced extension-type supracondylar fracture of the humerus were reviewed retrospectively. The results of treatment by four different methods were assessed clinically and compared. The mean length of follow-up was 4.6 years (range, one to nine years). The highest percentages of excellent results were achieved by percutaneous Kirschner-wire fixation (78 per cent), skeletal traction (67 per cent), and open reduction with internal fixation (67 per cent). Closed reduction and application of a cast was associated with a significantly lower percentage of early and late complications, including Volkmann ischemic contracture and cubitus varus. It is recommended that treatment with a cast be reserved for undisplaced fractures only. Percutaneous Kirschner-wire fixation is advocated as the method of choice for the majority of displaced fractures.
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Ninety-eight children with severely displaced supracondylar fractures of the humerus were treated by straight lateral traction. After a mean follow-up period of 3.5 years there were 90 satisfactory and only eight unsatisfactory results. Cubitus varus was present in only four children, which compares favourably with the results of operative treatment. The indications for straight lateral traction, and the advantages of this method, are discussed.
A case of locked hypersupination of the distal radio-ulnar joint is described in which the ulnar displacement was purely rotational rather than volar. The mechanism of injury is discussed in the light of cadaveric dissections which reproduced the injury.
Between 1970 and 1981, 64 patients underwent 77 tibial osteotomies for degenerate diseases of the knee at the Withers Orthopaedic Centre in Belfast. Records on 11 patients (12 knees) were either missing or inadequate, leaving 53 patients who underwent 65 tibial osteotomies for study. There were 23 males and 30 females, ranging in age from 23 to 75 years (mean 59.8 years). The predominant diagnosis was osteoarthrosis and the indication for operation in all cases was pain. With a follow-up of from two to ten years (mean 4.8 years), 39 knees were assessed as good, 15 as fair (improved, but still symptomatic), and 11 as failures. Patients with valgus deformity did worse than those with varus deformity. The importance of adequate pre-operative assessment is stressed, the operation itself is outlined, and the end result is seen to correlate closely with the degree of correction obtained.
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