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Biomedical subjects

J L Barrie

Publications and source records attributed to J L Barrie.

16 recordsLinked to original sources
PubMed2004

Improvement in the treatment of stable ankle fractures: an audit based approach.

Stable ankle fracture patients form a distinct, clinically benign group in which functional treatment can be used. An initial retrospective audit of the fracture clinic records of our institution for 1 calendar year demonstrated that recognition and functional treatment of stable ankle fractures was rarely followed. After the introduction of formal departmental evidence-based guidelines, subsequent audits have showed progressive improvements with significant reductions of time spent immobilised in plaster, time spent non-weight bearing and number of routine check radiographs, without compromising patient safety. This study illustrates the value of evidence-based guidelines in maintaining high standards of care over time.

Ankle Injuries↗
PubMed2002

Correction of hammer toe with an extended release of the metatarsophalangeal joint.

Between March 1995 and January 2000 we reviewed retrospectively 84 patients with hammer-toe deformity (99 feet; 179 toes) who had undergone metatarsophalangeal soft-tissue release and proximal interphalangeal arthroplasty. The median follow-up was 28 months. Patients were assessed by the American Orthopaedic Foot and Ankle Society Scores (AOFAS) and reviewed by independent assessors. The median AOFAS score was 83, with 87% of patients having a score of more than 60 points; 83% were satisfied and 17% were dissatisfied with the procedure. Pain at the metatarsophalangeal joint was the commonest cause of dissatisfaction, with 14% having moderate or severe pain. Only 2.5% had instability and 9% had formation of callus. There was no statistical difference for the age and gender of the patients, the number of toes operated on, associated surgery for hallux valgus or length of follow-up. Our study was based on an anatomical model and shows good results with no recurrence of deformity.

Adult↗
PubMed2000

The value of the axial view in assessing calcaneal fractures.

We studied the value of the axial view of the calcaneum in diagnosing fractures. Fifty sets calcaneal radiographs were studied by four senior trauma staff and four orthopeadic trainees on two occasions 2-3 weeks apart. On the first occasion only the lateral view was studied; on the second, both lateral and axial views were studied. The axial view did not improve the sensitivity or specificity of the lateral view alone. Senior staff were more accurate in assessing the radiographs. We suggest that the axial view should not be used routinely in assessing a patient with a possible calcaneal fracture.

Calcaneus↗
PubMed1996

Surgery for unstable hips in cerebral palsy.

We studied 67 patients with 86 unstable hips, all of whom had total-body-involvement cerebral palsy. Sixty-four operations were performed on 53 hips in 39 patients in a sequential radiographically controlled manner. Twenty-five operations were contralateral operations on a previously treated patient or revisions of a previous procedure. Soft-tissue release alone led to recurrence of dislocation or subluxation in many patients and has been abandoned. Combined pelvic and femoral osteotomy and soft-tissue release corrected the migration percentage and center-edge angle better than femoral osteotomy and soft-tissue release alone. Excision of the proximal femur was a useful salvage procedure if the femoral head was eroded.

Cerebral Palsy↗
PubMed1995

Scoliosis and lung function in spinal muscular atrophy.

The notes and radiographs of 43 patients with a confirmed diagnosis of spinal muscular atrophy were reviewed. A significant inverse linear relationship between the severity of scoliosis and the percentage of predicted vital capacity and peak flow was found. The patients who stood had a significantly better lung function than patients who were confined to a wheelchair, and their scoliosis deteriorated significantly more slowly. Sixteen patients underwent surgical spinal stabilisation, 4 with Harrington instrumentation and 12 with segmental spinal instrumentation, at an average age of 12 years and 11 months. The average curve correction achieved was 40%. The decline in lung function seen pre-operatively was not only reversed, but a significant improvement was found at final follow-up.

Adolescent↗
PubMed1992

Quality of data in the Manchester orthopaedic database.

OBJECTIVE: To determine the completeness and accuracy of data in a computerised clinical information system (Manchester orthopaedic database) in comparison with the data available through the Hospital Activity Analysis. DESIGN: Retrospective review of case notes, computer data, and Hospital Activity Analysis data. SETTING: Orthopaedic unit in a district general hospital in Manchester. SUBJECTS: 200 random patient records distributed through the period of use of the computer system (1 October 1988 to 31 March 1990) and 121 records for random admissions between 1 April 1989 and 31 March 1990, 71 of which were included in the previous sample. MAIN OUTCOME MEASURES: Conformity of the computer record key words and Hospital Activity Analysis codes to an ideal key word record and ideal code record drawn up by one investigator from the clinical notes; overall quality (completeness times accuracy). RESULTS: Overall completeness of the data in the orthopaedic database was 62% and the accuracy was 96%. Completeness improved after feedback to doctors on the use of key words in regular audit meetings. Completeness was higher in inpatient than outpatient records (69.9% v 53.7%, p less than 0.001) and when a new key word was required compared with missing and incorrect key words (both p less than 0.001). Completeness was lower when the key word was required of a senior registrar (p less than 0.05). Accuracy was not significantly different. The completeness of Hospital Activity Analysis data was 90.5% and accuracy 69.5%. Thus the overall data quality was similar in both systems. CONCLUSIONS: Even in a system designed for simple and efficient data capture, compliance by users was poor. Accuracy was high, suggesting that users understood the principles of data entry. Completeness of data capture can be improved by providing feedback to users on use of the system and performance. Improvements in future versions of the software should improve performance.

Abstracting and Indexing↗
PubMed1992

Delay in diagnosis of intradural spinal tumors.

Fifty-seven patients with primary intradural spinal tumors operated on in North Manchester and Salford between 1978 and 1988 were reviewed retrospectively. The commonest diagnoses were meningioma and nerve sheath cell tumors (neurilemmomas and neurofibromas). The median delay in diagnosis was 2.5 years (range 3 days to 24 years). Fifty-eight percent were initially referred to orthopaedic surgeons and 95% percent to specialties other than neurosurgery. The commonest presenting symptom was back pain, but later neurologic and urinary symptoms came to predominate. Eighty-eight percent are disease-free at a mean follow-up of 5.7 years. Symptoms were partially or completely relieved in the majority of patients. Delay in diagnosis of these tumors arises from failure to consider the diagnosis in patients with longstanding back pain or neurologic problems.

Diagnostic Errors↗
PubMed1991

A new technique in the management of the ring avulsion injury.

There is universal agreement that microvascular repair is the only way to salvage class II ring avulsion injuries. We report on two patients who sustained this type of injury and were treated successfully by extensive fasciotomy. The circulatory compromise following class II ring injuries deteriorates rapidly due to the tourniquet-like effect by the progressive swelling of the soft tissue envelope. Fasciotomy eliminates this effect and allows adequate inspection of the neurovascular bundles. Microvascular repair is still feasible if considered necessary.

Adult↗