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Biomedical subjects

J R Andrews

Publications and source records attributed to J R Andrews.

At least 19 recordsLinked to original sources

Elbow arthroscopy.

Elbow arthroscopy has made rapid advances in recent years. The improvement in the arthroscopic technique, as well as the development of technically advanced equipment, has made elbow arthroscopy very attractive to orthopaedic surgeons. It is important to realize that elbow arthroscopy is a modality that should be respected. This demanding procedure requires keen awareness of the elbow's anatomy and the technical arthroscopic approach to the elbow joint. With this careful approach in mind, the orthopaedist will find that elbow arthroscopy can be a valuable tool.

Arthroscopy

The wrist: field evaluation and treatment.

A poorly diagnosed and treated wrist injury could become a career-ending injury. Optimal treatment begins on the playing field, not the operative field. A careful, thorough field evaluation is mandatory to ensure prompt recognition of a potentially debilitating injury. Suspected fractures or ligamentous disruption require immediate referral to a physician for definitive early treatment. When the trainer and physician work as a team, early diagnosis, treatment, and rehabilitation of wrist injuries can be instituted to reach the goal of maintaining functional healthy wrists for future athletic endeavors.

Athletic Injuries

The hand: field evaluation and treatment.

A careful field evaluation is mandatory to ensure prompt recognition of a potentially debilitating hand injury. The major responsibility of the examination is to rule out any possible serious injury prior to returning the athlete to competition. This article deals with both on-the-field evaluation and recognition and sideline management of injuries to the hand.

Athletic Injuries

Bicondylar tibial plateau fracture complicated by compartment syndrome.

Compartment syndrome complicating tibial shaft fractures is a well-documented entity. However, the complication of compartment syndrome after tibial plateau fracture as described in this paper is relatively rare because of dissipation of tissue pressures into the knee-joint compartments. A thorough surgical decompression of all four compartments with continuous postoperative monitoring of compartment pressures was accomplished before the patient's fracture was stabilized. This strategy of delayed reconstruction of the tibial plateau worked well in this patient.

Bone Plates

Lesions of the posterior compartment of the elbow.

This article examines the diagnosis and treatment of lesions of the posterior compartment of the elbow, along with the anatomy and biomechanics of the elbow of the throwing athlete. An indepth evaluation of specific lesions and a detailed description of elbow arthroscopy are also presented.

Adolescent

Labral tears in throwing and racquet sports.

Throwing and overhead racquet motion is stressful activity that places great physical demands on the athlete's shoulder. This article focuses on glenoid labral tears as a consequence of this dynamic activity. These labral lesions may be present as an isolated entity or may be in association with glenohumeral instability.

Arthroscopy

Arthroscopic management of the throwing athlete's shoulder: indications, techniques, and results.

This article briefly describes the various pathologic lesions seen in the throwing athlete's shoulder. The pathologic conditions discussed include primary and secondary impingement, tensile lesions of the rotator cuff and biceps-labral complex, glenohumeral laxity, labral tears, and AC joint injuries. Mechanism of injury, indications, and arthroscopic management of these lesions are discussed.

Acromioclavicular Joint

The profile view of the acromion.

A previously undescribed roentgenographic view shows the acromion in "profile." A sagittal view of the acromion outlines its bony architecture, specifically, the subacromial portion. This view is clinically useful in the perioperative evaluation of patients with impingement syndrome and can be especially revealing in some cases of persistent symptomatic impingement following previous acromioplasty. The view also provides an excellent perspective for roentgenographic examination of os acromiale. It is reproducible and relatively easy to obtain. The acromion is but one component of the subacromial arch, but this view is a valuable additional diagnostic tool to be used in evaluating the sometimes perplexing problem of impingement syndrome.

Acromion

Selective management of anterior abdominal stab wounds.

A policy of selective management of anterior abdominal stab wounds was evaluated in 333 consecutive patients. Laparotomy was performed based upon initial clinical assessment in 165 patients. There were six deaths (3.6%), major complications in 23 patients (14%), and 28 negative laparotomies (17%). Eighteen patients developed indications for laparotomy after 10.7 +/- 2.2 hours of observation. There were no deaths, major complications in two patients (11%), and four negative laparotomies (22%). One hundred fifty patients were observed and discharged after 1.8 +/- 0.1 days. Sensitivity, specificity, and positive and negative predictive values for initial clinical evaluation were 91%, 85%, 92%, and 83%, respectively. Length of hospitalization in the initially operated and in the delayed group was 9.5 +/- 0.6 and 10.6 +/- 2.6 days (NS), respectively. Most serious intra-abdominal injuries will declare themselves on initial clinical assessment. The remainder are less severe injuries and these patients can be safely observed without undue sequelae due to delay. The use of clinical assessment alone to prompt laparotomy is also cost effective based on analysis of hospital days for initial illness. No procedures are necessary to define penetration.

Abdominal Injuries

High school football injuries: evaluation.

An epidemiologic survey of the literature on high school football injuries revealed methodologic problems. These numerator-denominator inconsistencies and other confounding factors are discussed. The authors suggest a more reliable system of reporting these parameters to further reduce the risk of high school football injuries.

Adolescent

High school football injuries: identifying the risk factors.

This epidemiologic survey of the literature on the factors contributing to the high number of high school football injuries consolidates the current information on the characteristics and risk factors associated with these injuries. To reduce the incidence of knee sprains and strains, the most common injuries to this population, the following preventive recommendations are presented: 1) optimum maintenance of playing fields; 2) use of the soccer-style shoe; 3) noncontact and controlled activities in practice sessions; and 4) increased vigilance over technique during injury-prone preseason practices. The authors conclude that more research into factors such as exposure time and activity at injury will further reduce the risk to the high school football player.

Adolescent

Shoulder and elbow injuries in the young athlete.

The skeletally immature athlete sustains upper extremity injuries unique to the epiphyseal plate, articular cartilage, musculotendinous units, and specific to the sport itself. Specific shoulder and elbow conditions can be predicted based on the biomechanics of the sport and age of the patient. In the young athlete, recognition of these unique injury patterns with early activity modification and treatment can prevent permanent deformity and functional disability.

Adolescent

Avulsion fractures involving the cruciate ligaments.

The evaluation of a child with an acute knee injury is difficult. The injury may be an avulsion fracture involving either of the cruciate ligaments; a common cause is a cycling accident. The amount of fragment displacement dictates the management. Minimal displacement can be treated with immobilization in flexion. Larger displacement requires internal fixation, which can be accomplished arthroscopically. Rehabilitation must be early and aggressive.

Bicycling

The role of arthroscopic surgery in the evaluation of acute traumatic hemarthrosis of the knee.

Eighty patients presented for evaluation with an acute traumatic hemarthrosis of the knee and negligible instability on clinical examination. All had an examination under general anesthesia followed by arthroscopy. Anatomical lesions were demonstrated in 71 of 80 knees (89%) including anterior cruciate ligament (ACL) disruption in 50 (62%). Twenty-nine of 50 patients (58%) with arthroscopically-demonstrated ACL injuries had associated meniscal tears. Fifteen (19%) demonstrated isolated meniscal tears and nine (11%) osteochondral fractures not detected by conventional roentgenograms. The frequent occurrence of injuries to other joint structures in conjunction with ACL injuries was remarkable. An acute traumatic hemarthrosis of the knee often masks significant lesions. Arthroscopy aids the orthopedic surgeon in determining the full extent of the intraarticular damage.

Adolescent

Arthroscopy of the ankle.

This article describes the surgical technique of arthroscopy of the ankle and the indications for its use. In addition to describing the common anterolateral and anteromedial arthroscopic portals, a discussion is also given regarding portal anatomy of ankle arthroscopy and the various neurovascular structures that lie in close proximity to the arthroscopic portals. Arthroscopy of the ankle has a definite role in the management of certain lesions of the ankle, such as loose bodies, or osteochondral or chondral defects of the talus. Ankle arthroscopy is a technically demanding surgical procedure and great attention to detail is required to perform this procedure in a safe and reproducible fashion.

Ankle Joint

Shoulder arthroscopy in the throwing athlete: perspectives and prognosis.

The efficacy of arthroscopy of the shoulder has been demonstrated as both a diagnostic and an operative tool. The throwing athlete has benefited greatly from this procedure. Intra-articular pathology resulting from throwing motion overuse can be visualized and treated, with relatively little morbidity and a rapid rehabilitation phase.

Arthroscopy