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Biomedical subjects

H R Chissell

Publications and source records attributed to H R Chissell.

8 recordsLinked to original sources
PubMed1998

Biodegradable rods in adult osteochondritis dissecans of the knee.

Symptomatic osteochondritis dissecans of the knee in skeletally mature patients does not follow a predictable natural history and there has been a trend toward internal fixation of the unstable fragment(s) where possible. Biodegradable implants are enticing for intraarticular use: implant removal is unnecessary and its degradation potentially allows a gradual shift of loading stress to the fracture site. Nine patients with a mean age of 18.6 years (range, 14-23 years) deemed skeletally mature by plain film radiography underwent internal fixation of fragments by 2-mm self reinforced polylactic rods. Six procedures were completed arthroscopically and three required arthrotomy. All fragments were of the medial femoral condyle. The procedure was tolerated well although three patients had early postoperative serosanguinous effusions develop that did not recur after one aspiration. At a mean followup of 33 months (range, 24-54 months), eight fragments radiographically were united whereas one remained ununited at 26 months, accounting for the one poor result in this series. Seven patients had good to excellent results according to Hughston's criteria and were satisfied with the procedure. One of these seven patients had a spontaneous effusion develop at 5 months that did not recur after aspiration and intraarticular steroid injection. Severe, unremitting synovitis did not occur in any patient. Internal fixation of osteochondritis dissecans of the knee with biodegradable polylactic rods provided satisfactory control of symptoms in the short term and resulted in radiographically stable lesions in eight of nine patients. These rods may be suited best for fragmented lesions with intact articular cartilage as an adjunct to drilling.

Absorbable Implants↗
PubMed1996

Behavior of sutures used in anterior cruciate ligament reconstructive surgery.

This study was performed to determine the material properties of sutures commonly used in orthopedic surgery in order to allow selection of the most appropriate one for securing a hamstring or quadriceps tendon graft in anterior cruciate ligament (ACL) reconstruction. Three suture materials (number 5 Ticron, number 5 Ethibond, and 5 mm Mersilene tape) were tested. The ultimate tensile load (UTL) with and without a knot, modulus of elasticity, effect of conditioning on the behavior of the suture, and plastic deformation were determined for each suture. Prior conditioning significantly improved the plastic deformation characteristics of all three sutures. Mersilene possessed the highest UTL both with and without knots, and its plastic deformation was significantly lower than that of Ticron or Ethibond. We feel that these characteristics make it the best suture for use in securing hamstring or tendon grafts in ACL surgery. Because of the high UTL achieved by Mersilene tape in the knotted surgical loop construct (nearly 500 N), it may be possible to achieve fixation integrity approaching that of interference fixation with bone blocks.

Anterior Cruciate Ligament↗
PubMed1995

Urinary tract infection and hip fracture.

A routine audit revealed that in 25 per cent of patients with proximal femoral fracture, hospital stay was complicated by urinary tract infection (UTI). A prospective study was undertaken to investigate the relationship of UTI to fracture type, timing of surgery and the effect of perioperative antibiotics. Eighty-eight patients were investigated over a 4-month period with urine specimens obtained at time of operation and 48 h from operation. Of the patients, all female, 12.5 per cent had positive urine cultures at the time of operation. Of all patients, 42 per cent had positive urine cultures 48 h after operation. Females with intra-capsular fractures were more likely to have positive cultures both pre- and post-operatively (P < 0.005). Age (P < 0.05) and operative delay beyond 48 h (P < 0.05) were also found to predispose to infection. All patients except one who had urinary infection at the time of surgery had post-operative urine infection with the same organism. Present audit methods have significantly under estimated the presence of UTI in these patients. Fracture type and operative delay would appear to be the most significant determinants of a positive urine culture 48 h after operation. Prophylactic antibiotics appear to be ineffective in eradicating pre-existing or preventing early post-operative infection.

Adult↗
PubMed1995

The influence of a diastasis screw on the outcome of Weber type-C ankle fractures.

We performed a retrospective study of the factors affecting the outcome of Weber type-C ankle fractures in 43 patients reviewed at two to nine years after injury. We determined the functional result in relation to the use of a diastasis screw, the accuracy of reduction, the presence of tibiotalar dislocation, and of injury to the medial side of the ankle by medial malleolar fracture or deltoid ligament rupture. We assessed the use of a diastasis screw as appropriate or inappropriate on the basis of an anatomical study performed by Boden et al (1989). The diastasis screw was used unnecessarily in 19 of the 31 patients so treated, but this did not appear to affect the final functional result. The worse functional results were in ankles dislocated at the initial injury, and in those with medial malleolar fractures as opposed to those with deltoid ligament ruptures. The best results were after accurate reduction of the fibula and the syndesmosis, and greater increase in the width of the syndesmosis was associated with a worse result. Our results suggest that an increase of more than 1.5 mm in syndesmosis width is unacceptable. We recommend that when the deltoid ligament is ruptured, a diastasis screw should be used if the fibular fracture is more than 3.5 cm above the top of the syndesmosis. When a medial malleolar fracture has been rigidly repaired a diastasis screw is required if the fibular fracture is more than 15 cm above the syndesmosis.

Ankle Injuries↗
PubMed1994

MRI of the knee: its cost-effective use in a district general hospital.

In the first year of magnetic resonance imaging (MRI) scanning of the knee in the East Berkshire Health District, 175 patients were scanned and 79 of these subsequently had an arthroscopy performed. We found that MRI accurately demonstrated the pathology present in the knee, particularly for meniscal lesions, although it was less accurate for anterior cruciate and cartilage lesions. The relative costs of MRI scanning, arthroscopy and conservative treatment are compared. On the basis of this analysis we have worked out a protocol for the cost-effective use of MRI in imaging the knee. This protocol has reduced the number of arthroscopies performed, allowing us to expend resources on patients who would definitely benefit from arthroscopic surgery.

Arthroscopy↗
PubMed1993

External fixator pin placement in the forearm: how safe is it? An anatomical study.

An anatomical study was undertaken using cadaveric forearms to identify the best technique and angle of pin placement for external fixator pins. We have found that inserting pins through stab incisions risks transfixion of the underlying structures and leads to an increased morbidity. We conclude that inserting pins under direct vision is much safer and that the optimum angle of pin insertion is in the coronal plane, parallel to the plane of the metacarpals.

Bone Nails↗
PubMed1993

Syme's amputation: a neglected procedure.

Over a 9-year period nine patients underwent Syme's amputation, one patient undergoing a staged bilateral procedure. Six of the ten amputations were carried out for the complications of peripheral vascular disease, including one with Buerger's disease who had bilateral amputations. Three patients had amputations for infected diabetic gangrene and one amputation was performed as a result of trauma. Five patients had previously undergone surgery to improve their peripheral circulation. Two patients required a subsequent below knee amputation. The indications for and technique of Syme's amputation are discussed.

Adult↗