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Biomedical subjects

J E Nicholl

Publications and source records attributed to J E Nicholl.

12 recordsLinked to original sources
PubMed2006

The gap after trapeziectomy: a prospective study.

Thirteen patients with basal joint arthritis of the thumb were treated by simple trapeziectomy. All patients underwent radiological assessment pre-operatively and at 2, 4 and 12 weeks after surgery. Special standardised views were taken to assess changes in the 'trapezial gap'. Collapse of this was noticed up to 4 weeks following surgery but no significant change occurred thereafter. In respect of this collapse, prolonging immobilisation after 4 weeks is probably unnecessary.

Aged↗
PubMed2004

Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular vicryl suture: a prospective randomised trial.

PURPOSE: To compare 2 methods of wound closure-metallic staples or 3-0 undyed vicryl-according to postoperative wound complication rates. METHODS: Patients who underwent surgery for proximal femoral fractures were randomised to have wound closure with metallic staples or with subcuticular vicryl suture. Wounds were regularly examined postoperatively and only those with positive wound swabs were regarded as wound infections. RESULTS: Five infections and one superficial wound dehiscence occurred in the patients who had wound closure with metallic staples. The complication rate was significantly higher for this group compared with the group who had wound closure with subcuticular vicryl suture (p<0.025). CONCLUSION: Superficial wound complication rates are higher for wounds closed with metallic staples compared to wounds closed with subcuticular vicryl.

Aged↗
PubMed2000

Degenerative changes at the scaphotrapezial joint following Herbert screw insertion: a radiographic study comparing patients with scaphoid fracture and primary hand arthritis.

One method of Herbert screw insertion is to mobilize the scaphotrapezial joint and insert the screw through the articular surface of the distal scaphoid. Because of concern that this might predispose to osteoarthritis in the scaphotrapezial joint, we have investigated joint space width and the presence of osteophytes adjacent to the scaphotrapezial joint using high definition macroradiography.Twenty-eight patients with symptomatic primary osteoarthritis of their hands, 23 with a scaphoid fracture successfully treated conservatively and 18 treated with a Herbert screw were studied. The patients with primary osteoarthritis of their hands had more narrowing of the scaphotrapezial joint compared with the other two groups, but patients treated with a Herbert screw had a significantly higher incidence of osteophytosis on the distal scaphoid than the other two groups. With Herbert screw fixation, osteophytosis on the distal scaphoid may cause impingement and pain, and be a predictor of further degenerative joint changes.

Adult↗
PubMed2000

A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition.

Forty-three patients were randomly allocated to undergo either trapeziectomy alone (control) or with a ligament reconstruction and tendon interposition (LRTI) using an abductor pollicis longus tendon slip. The patients were reviewed at a median 13 (range, 7-29) months after surgery. The demographic characteristics, severity of disease and pre-operative clinical measurements of the two study groups were indistinguishable but LRTI lengthened the operation by approximately 15 minutes. Both groups expressed equal satisfaction with the operation and there were no significant differences between the two treatment groups. Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb and the addition of a ligament reconstruction was not shown to confer any additional benefit.

Carpal Bones↗
PubMed1999

The tourniquet in total knee arthroplasty. A prospective, randomised study.

We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis. We conclude that the use of a tourniquet is safe and that current practice can be continued.

Aged↗
PubMed1999

Acetabular augmentation for the treatment of unstable total hip arthroplasties.

Twenty-eight unstable total hip arthroplasties were treated with an acetabular augmentation wedge. Of the hips, 23 have had no further dislocations at a mean follow-up of 26 months. Five patients continued to dislocate and have needed further surgery. To our knowledge this is the largest reported series of acetabular augmentation with as good results as those of the most successful reported series of this technique, and a success rate comparable to other methods of treating recurrent dislocation. Careful patient selection, and using a thin augmentation wedge to avoid impingement, are important to the success of a technique which is a useful option in the management of recurrent dislocation.

Acetabulum↗
PubMed1996

Relative optic cup depth assessments using three stereo photograph viewing methods.

PURPOSE: A consistent stereoscopic (stereo) effect in disc photographs is important to be certain that apparent depth changes are real and are not the result of artifact caused by a variable stereo angle. The purpose of this study is to compare the accuracy of relative depth assessments using three different stereo photo viewing methods. METHODS: We evaluated the ability of 12 observers to arrange sets of simultaneous stereo photographs (Nidek 3-Dx split-frame slides, Lentec transparencies) and sequential stereo photographs (Zeiss full-frame slides) according to apparent cup depth. Observer arrangements of each set of 10 photographs were compared to a "reference standard" sequence determined from cup depth measurements made by the Imagenet optic nerve analyzer. RESULTS: The median number of sequence errors (n = 6) made by all examiners in arranging the Nidek 3-Dx simultaneous stereo slides was significantly lower than the median number of errors (n = 12) with the Zeiss sequential stereo slides. CONCLUSIONS: Simultaneous stereo slides provide significantly more interobserver consistency for judgements of cup depth than sequential stereo slides.

Analysis of Variance↗
PubMed1996

Anterior compartment syndrome after revision hip arthroplasty.

We report a case of anterior compartment syndrome in the ipsilateral leg after a revision total hip arthroplasty. Possible causes include post-ischaemic swelling after occlusion of the vessels during prolonged surgery and vigorous repetitive stretching of the muscles of the anterior compartment from the intraoperative use of electrical calf stimulators. Epidural infusions for postoperative analgesia may mask symptoms, but when there is clinical suspicion, we recommend measurement of the compartment pressures and early fasciotomy.

Acute Disease↗
PubMed1995

Pattern of scaphoid fracture union detected by macroradiography.

Stereoscopic macroradiography was used to study the pattern of union of scaphoid fractures. Of 21 patients who had partial union of a scaphoid fracture, 13 united on the ulnar side and five on the radial side only. In three it was on both sides but delayed in the centre. Where there was initial union on the ulnar side, all progressed to complete union, including two patients with displaced fractures. Four out of five patients with initial union on the radial side had displaced fractures, and three of these went on to non-union. We conclude that in those patients with partial union of a scaphoid fracture, if union is seen on the ulnar side, the fracture is likely to unite completely, whereas if there is partial union on the radial side, there is a high risk of non-union.

Adolescent↗