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Biomedical subjects

J E Robb

Publications and source records attributed to J E Robb.

11 recordsLinked to original sources

The value of internal fixation and radiotherapy in the management of upper and lower limb bone metastases.

Fifty-four consecutive patients underwent 61 orthopaedic operations for metastatic bone disease affecting the upper and lower limbs. These patients were subsequently managed using a consistent postoperative radiotherapy (RT) policy. There were 27 prophylactic internal fixations and 34 internal fixations of pathological fractures. There was a marked difference in survival between these groups. The median postoperative survival of the prophylactic (P) group was 15 months whereas that of the fracture (F) group was 2 months (P less than 0.0001). Ninety-three per cent of the P group and 59% of the F group were able to be discharged home following treatment. Subsequent local fracture requiring further surgical intervention occurred in 11% of the P group and in none of the F group. Seventy-eight per cent of the P group and 62% of the F group did not suffer any further sequelae at the operation site until the time of death or last follow-up. Patient mobility following surgery and RT for metastatic lesions occurring in the lower limb was significantly improved in both the P group (P less than 0.05) and in the F group (P less than 0.0001) such that 91% and 58%, respectively, of these patients were subsequently able to walk.

Adult

Reliability of the acetabular teardrop as a landmark.

This study investigated the effect of tilt and observer reliability on radiographic measurements of the position of a prosthetic acetabular cup in seven dry bone pelves using the teardrop as a landmark. Coronal or sagittal tilt of more than five degrees was easily recognisable and there was effectively no observer variation in the measurements up to this limit. In addition, 90 out of 100 randomly selected antero-posterior pelvic radiographs from an outpatient department were not significantly rotated and 93 demonstrated a clearly defined teardrop. Measurements about the teardrop on routine radiographs are therefore sufficiently accurate to allow assessment of prosthetic position.

Acetabulum

Double dislocations of digits.

We report eight patients who sustained simultaneous dislocations of two joints in a digit. The little finger was involved in five patients.

Adult

Biomechanical effects of rockers on walking in a plaster cast.

Rockers are applied to lower limb casts to assist walking but there is little information on their biomechanical effects. The performances of 10 commercially available rockers were compared. They were applied to a below-knee cast worn by a normal subject who was also tested walking in the cast alone. Gait analysis was used to evaluate kinematic and kinetic data. The design of rocker had no effect upon the kinematics of walking. However, using new criteria for kinetic assessment of rocker function (tibial floor angular velocity and centre of pressure progression), most designs had a deleterious effect on the biomechanics of gait. Only two rockers approached the ideal kinetic criteria.

Biomechanical Phenomena

The termination of flexor tendon sheaths.

Fifty-five preserved cadaver digits were injected to show the termination of the flexor tendon sheath. The angle between the termination of the sheath and the most proximal dorsal and ventral bony points of the distal phalanx was measured. Using this concept of angles, a clinical guide to the region containing the sheath is given.

Finger Joint

Treatment of congenital pseudarthrosis of the tibia by the Ilizarov method.

Three cases of congenital pseudarthrosis were treated by the Ilizarov method. Consolidation was obtained by 3.5 months in three patients who had undergone several previous surgical procedures. Although the length of follow-up was short (maximum 3.5 years), consolidation occurred more quickly than by traditional methods. This technique also permitted both simultaneous correction of axial malalignment and leg lengthening. We think that this method has a place as a salvage procedure except where the distal fragment is very thin or dystrophic.

Bone Lengthening

Ankle-foot orthosis function in low-level myelomeningocele.

Six children with low-level myelomeningocele underwent gait analysis. All showed excessive ankle dorsiflexion and knee flexion when walking barefoot. A rigid thermoplastic ankle-foot orthosis (AFO) improved gait by preventing ankle dorsiflexion and reducing knee flexion. Biomechanically, the AFO caused a reduction in external knee moment by aligning the knee with the ground reaction force. Small changes in the foot-shank angle of the orthosis had profound effects on knee mechanics. Knee hyperextension could be controlled by a rocker sole. Kinetic gait analysis permits understanding of the biomechanical effects of orthoses.

Biomechanical Phenomena