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Biomedical subjects

J K Stanley

Publications and source records attributed to J K Stanley.

At least 19 recordsLinked to original sources
PubMed2002

Genetic susceptibility in Dupuytren's disease: lack of association of a novel transforming growth factor beta(2) polymorphism in Dupuytren's disease.

The genes involved in the pathogenesis of Dupuytren's disease have yet to be identified. In this study, we tested for an association between Dupuytren's disease (DD) and a novel insertion polymorphism within the 5'-untranslated region (5'-UTR), of the TGFbeta(2) gene. DNA samples from 179 DD patients and 187 ethnically matched controls were examined. There was no statistically significant difference in TGFbeta(2) allele frequency distributions between cases and controls for the TGFbeta(2) polymorphism.

Adult↗
PubMed2001

The value of crossed intrinsic transfer after metacarpophalangeal silastic arthroplasty: a comparative study.

Seventy three hands in patients with rheumatoid arthritis undergoing primary index to small finger metacarpophalangeal joint replacements were studied retrospectively. In twenty eight hands a crossed intrinsic transfer was performed and in forty five hands it was not. A similar splintage and rehabilitation programme was followed in each group. The two treatment groups had similar preoperative ulnar drift (crossed intrinsic transfer group mean 27 degrees, comparative group 29 degrees). At a mean follow up of 50 months the crossed intrinsic transfer group had statistically less ulnar drift (crossed intrinsic transfer group mean 6 degrees, comparative group mean 14 degrees, P=0.01). There were no other significant differences at follow up.

Adult↗
PubMed2001

Revision total elbow replacement using the Souter-Strathclyde prosthesis.

The Souter-Strathclyde prosthesis was used in 52 evisions of total elbow replacements (TERs) between August 1986 and May 1997. Of these, 50, carried out in 45 patients, were prospectively followed for a mean of 53 months (14 to 139). The procedure produced reliable relief of pain, and the range of movement was preserved. There was a considerable incidence of adverse events associated with revision (30%), and 12 further procedures have been required. Nonetheless, a revision is the preferred salvage procedure for failed primary arthroplasty in the absence of sepsis.

Adult↗
PubMed2000

The effect of epidemiologic and intraoperative factors on survival of the standard Souter-Strathclyde total elbow arthroplasty.

Previously published work has revealed an 87% survivorship after 12 years for the standard Souter-Strathclyde total elbow arthroplasty in patients with rheumatoid arthritis. Of the 13% that were revised, 75% were due to loosening of the humeral component. The aim of this research was to identify the specific epidemiologic and intraoperative factors that predisposed to this humeral loosening. Specifically, factors such as age, sex, radiologic staging of the disease, position of the implant in bone, and size of the implant inserted were evaluated. After analysis of 186 cases, we concluded that the position of the humeral component within the humerus is crucial for long-term survivorship. Specifically in the lateral plane, the stem should be aligned in the plane of the humerus and the implant inserted to the correct depth. The articular surface of the implant should lie at the level of the normal trochlea. At the anteroposterior plane, the implant should sit centrally and not be lateralized. We conclude that good surgical technique is crucial to the long-term effectiveness of this implant.

Arthritis, Rheumatoid↗
PubMed2000

Kienböck's disease: conservative management versus radial shortening.

Avascular necrosis of the lunate, first described by Kienbock, can be treated either conservatively or by various surgical procedures. We compared the results of 18 conservatively treated patients, all of whom had stage-2 or stage-3 disease, with those of 15 who underwent a radial shortening procedure. We evaluated pain, range of movement, grip strength and functional disability, and determined the progression of the disease by assessing radiologically carpal height, the width and flattening of the lunate, the radioscaphoid angle, the pattern of the fracture and sclerosis and cysts. The mean follow-up was for 3.6 years (1.5 to 9). Patients treated by radial shortening had less pain and better grip strength than those managed conservatively. In some patients with stage-3 disease treated conservatively there was rapid deterioration to carpal collapse. Although radial shortening did not reverse or prevent carpal collapse, it slowed down the process in patients with stage-3 disease. We recommend a radial shortening procedure for patients with severe pain and radiological signs of progressive carpal collapse.

Activities of Daily Living↗
PubMed1999

Biaxial wrist replacement. Initial results in the rheumatoid patient.

We report a short term review of 26 patients after Biaxial total wrist replacement. The mean follow up was 33.6 months (range, 24-62). All except one patient with psoriatic arthropathy had either seropositive or negative rheumatoid arthritis. A significant improvement in the range of motion was obtained; however, only 14 of 26 achieved a "functional" range. Eighteen obtained an excellent or good result when graded using the Hospital for Special Surgery score. Two radial and three carpal components showed radiolucent lines. Follow-up, however, was too short to determine whether this indicates progressive loosening.

Activities of Daily Living↗
PubMed1999

Blatt's capsulodesis for chronic scapholunate dissociation.

We have reviewed prospectively 44 cases of chronic scapholunate dissociation treated by Blatt's dorsal capsulodesis. The diagnosis was based on clinical and arthroscopic criteria. The minimum follow-up was 2 years. The results were analysed clinically and radiologically. Postoperatively statistically significant reductions in wrist movements and grip strengths were noted. Delay in surgery and presence of compensation claims were also statistically significant factors. Patients with a high column/row index had higher overall good and excellent results. The scapholunate gap, scapholunate angle, carpal height and the type of instability as diagnosed on arthroscopy and cineradiography did not affect the outcome significantly. The scapholunate gap, scapholunate angle and the carpal height did not change significantly after operation.

Adult↗
PubMed1999

The results of ulnar shortening for ulnar impaction syndrome.

From the Centre tfr Hand Twenty-three wrists in 22 patients (mean age, 37 years) with ulnar impaction syndrome were treated by ulnar shortening. The mean ulnar shortening was 2 mm (range, 1-4 mm). At a mean follow-up time of 33 months, 17 patients had obtained good subjective pain relief and 16 were shown to have a good overall outcome using the Wrightington Hospital Wrist Function Evaluation.

Adolescent↗
PubMed1999

A patient-reported comparison of trapeziectomy with Swanson Silastic implant or sling ligament reconstruction.

A retrospective review of two types of operations for carpometacarpal osteoarthritis of the thumb was done for patients operated on between 1991 and 1996. Follow-up ranged from 18 to 90 months (mean 62 months). Fifty-eight Swanson Silastic arthroplasties and 56 sling excision arthoplasties were reviewed. Eight patients with Swanson arthroplasties underwent removal of the implant. Eight patients in the sling excision group required further surgery. These patients were excluded from further analysis. Questionnaires about pain, general satisfaction and function were sent to the other patients and 87 responses were received (sling 45, implant 42). In the implant group significantly better results were obtained for pain at 1 year, carrying a milk bottle and taking a handbrake off a car, and overall function. We conclude that trapeziectomy combined with Swanson implant gives better results in the short term if there are no complications of the operation.

Arthroplasty↗
PubMed1999

Soft tissue surgery in rheumatoid arthritis of the hand.

All surgery in patients with rheumatoid arthritis of the hand involves careful consideration and planning of the soft tissue component of the disease. The planning must include acknowledgment of the patient's functional requirements and surgical requirements. Multiple surgeries are common in patients with rheumatoid disease and must be planned carefully to avoid conflicting postoperative rehabilitation programs. Joint replacement and other surgery are only an adjunct to the soft tissue treatment. The progressive nature of rheumatoid arthritis is not a barrier to early surgery and may prolong the function of the patient. The logical approach to the surgical requirements is discussed and specific soft tissue surgeries are described. Some details of specific surgical techniques also are included.

Arthritis, Rheumatoid↗
PubMed1999

Survivorship and radiological analysis of the standard Souter-Strathclyde total elbow arthroplasty.

We undertook a radiological analysis of 186 standard Souter implants to determine survivorship and to analyse the pattern of failure in those needing revision. The implants had been inserted as a primary procedure in patients with rheumatoid arthritis of the elbow at our hospital over the last 12 years. Taking revision as an endpoint, the survivorship after 12 years was 87%. If, however, revision and loosening, defined as the Hindex value equivalent to demarcation of 1 mm around the whole implant, are also included, the survivorship falls to 80%. Of the 24 implants revised, 18 (75%) were for problems with the humeral component, three (12.5%) with the ulnar component and three (12.5%) for instability. Loosening of the humeral component occurred when the implant extended into the humerus, with the tip moving anteriorly on to the anterior humeral cortex. Our study indicates that loosening can be predicted by the rate of change in this angle of extension of the prosthesis.

Aged↗
PubMed1998

Movement of the scaphoid in the normal wrist.

The radiological images of 30 normal wrists in varying degrees of radial and ulnar deviation were analysed by measuring parameters of flexion and translation of the scaphoid bone. Results demonstrated a linear relationship, indicating that movement is consistently either by flexion of the scaphoid, translation or more commonly a combination of the two. The significance of this is discussed. There did not appear to be any age or sex related differences.

Adult↗
PubMed1998

Early results of a modified Brunelli procedure for scapholunate instability.

Twenty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure. The overall results of this short follow-up study showed that a majority of patients (17 out of 22) had relief of pain. Grip strength recovered well. Postoperative range of motion was reduced in extension and flexion, remained unchanged for radial deviation and improved for ulnar deviation. The radiological appearance of dynamic or static scapholunate instability did not change after the procedure. Most patients (17 out of 22) felt subjective improvement and would have the operation again. A significantly poorer result was seen in those patients with an unresolved medicolegal claim. Although short-term results are encouraging for some patients, the authors feel that more long-term follow-up is needed before recommending the procedure.

Adult↗
PubMed1998

Neuroma of the distal posterior interosseous nerve. A cause of iatrogenic wrist pain.

We describe four women and two men who had persistent wrist pain and reduced function after minor operations on the dorsum, usually for ganglia. They had diffuse pain and paraesthesia over the dorsum of the wrist, thumb, index and middle fingers, which was worse and different from that before operation. They all had temporary relief of symptoms after block of the posterior interosseous nerve with bupivacaine. Later, excision of the terminal branches of the nerve at the wrist cured three patients completely and gave marked improvement in the other three, with no complications. Great care is required at operations on the dorsum of the wrist, but pain from a neuroma can be relieved by local excision.

Adult↗
PubMed1996

Flexor tenosynovectomy and tenolysis in longstanding rheumatoid arthritis.

A total of 43 patients (49 hands; 424 flexor tendons), who had rheumatoid arthritis of more than 15 years duration at the time of surgery, were clinically assessed at a mean follow-up of 5.7 years (range, 1.2-12 years). Pain and inability to flex actively despite a good passive range of motion were the main surgical indications. The results suggest that the patients had excellent sustained pain relief (mean score = 0.9) and were highly satisfied with the outcome of the procedure (mean score = 2.2). 81% had adequate pulp-to-pulp and key pinch. Range of finger motion (total active motion, TAM) was excellent to good in 45% and fair in 22%. Thirty-three per cent were graded as poor and these were found to be multifactorial in origin, with associated significant joint disease, preoperative tendon ruptures, extensive digital surgery, readhesions and combinations of operative procedures which adversely affect the rehabilitation programme. Flexor tenosynovectomy with tenolysis is a useful procedure with a low rate of recurrence.

Adult↗
PubMed1996

A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes.

Fifty preserved cadaver wrist specimens were studied. The anatomy of the distal radioulnar joint is complex, with varying configurations in the transverse and midcoronal planes. There is disparity in the radii of curvature of the sigmoid notch and the ulna-articular surface in the transverse plane, with resultant articular incongruity. Motion at the distal radioulnar joint is, hence, likely to be a combination of sliding and rotation with a small area of true appositional contact. The palmar osteocartilaginous lip of the sigmoid notch, along with the interosseous membrane, may be of importance in distal radioulnar stability. Palmar and dorsal radioulnar ligaments may act as "check-rein" ligaments, especially when seen with the "flat face" (type A) sigmoid notch.

Adult↗
PubMed1995

Late rupture of extensor pollicis longus after wrist arthroscopy.

The first cases of impending rupture of the extensor pollicis longus after wrist arthroscopy are reported and the etiology is compared with extensor pollicis longus ruptures after nondisplaced or minimally displaced Colles fractures. Both cases were treated with extensor indices proprius to extensor pollicis longus transfer with good clinical results.

Adult↗