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Biomedical subjects

K S Eyres

Publications and source records attributed to K S Eyres.

At least 19 recordsLinked to original sources

Detecting fractures of the scaphoid: the value of comparative X-rays of the uninjured wrist.

Pain or tenderness in the anatomical snuff-box following trauma suggests an injury to the scaphoid or surrounding soft tissues. It is often difficult to make a definite diagnosis since normal bone markings across the scaphoid can be misinterpreted as a fracture. To clarify whether a fracture is present or not, an X-ray of the uninjured scaphoid is taken in a comparable position to the most suspicious view. If bone markings are similar on both views, then a fracture can be excluded. Conversely, if the bone markings differ, then suspicion of a fracture may be confirmed. In combination with the clinical features, a more accurate diagnosis can be made and unnecessary out-patient and X-ray reviews can be avoided.

Adolescent

Osteoporotic fractures: an unusual presentation of haemochromatosis.

The association of haemochromatosis and osteoporosis is well established, but it is unclear whether this is due to iron overload, hypogonadism, liver disease, or diabetes mellitus. We describe a young eugonadal male patient with osteoporotic fractures as a presenting feature of haemochromatosis, suggesting that factors other than hypogonadism contribute to osteoporosis.

Adult

A new paradiscal injection technique for the relief of back spasm after chemonucleolysis.

Back spasm, or spasm of the back muscles, is the commonest adverse reaction encountered after chemonucleolysis. In order to overcome this troublesome complication, the authors present a new 'paradiscal injection technique'. After the injection of chymopapain into the affected disc, the needle is withdrawn to just outside the annulus. Bupivacaine is injected into the paradiscal 'space' which acts upon the paravertebral muscles. Eighty consecutive patients have been treated by chemonucleolysis with paradiscal injection for pain relief. All patients were discharged the same day or the following day and no immediate complications occurred. When reviewed 3 weeks later, only three (3.8%) patients complained of back pain (which was different in character to that present before the injection or was exacerbated by the injection). Pain persisted in the same patients until 6 months after the injection but was negligible. None of the remaining patients had developed back pain as a result of chymopapain. The authors suggest that the addition of paradiscal injection of bupivicaine after cymopapain injection can reduce the incidence of spasm of the back muscles. This technique is a major contribution to increasing the efficacy of chemonucleolysis for the treatment of herniated lumbar disc.

Adult

Drivers' elbow: a cause of ulnar neuropathy.

The ulnar nerve is vulnerable to compression and vibration injury in drivers who have the shoulder abducted and elbow flexed with the arm lying against the lower edge of the window. Three cases of ulnar neuropathy at the elbow are described in vehicle drivers.

Adult

Upper limb fractures in rugby in Huddersfield 1986-1990.

Most injuries sustained by rugby players affect the soft tissues, and fracture is relatively uncommon. Whereas the lower limb is most affected in footballers, the upper limb tends to be injured in rugby players. Thirty consecutive fractures and ten dislocations affecting the upper limb, sustained by 35 rugby players, are reported.

Adult

Internal fixation of closed tibial fractures for the management of sports injuries.

From 1985 to 1988, 90 closed tibial fractures were prospectively studied to assess the morbidity of such injuries to sports people and how this can be influenced by treatment regimens. All fractures were sustained during rugby or football matches. After random selection, 45 fractures were openly reduced and internally fixed (group A), and 45 fractures were manipulated under general anaesthesia and a long-leg plaster applied (group B). For patients in group A, below-knee plasters were used for 3 to 4 weeks, with immediate weight-bearing when tolerated. A total of 44 (98%) tibiae united clinically and radiologically within 14-18 weeks. Within 4 months of surgery 28 (62%) patients had returned to work and were able to play again by the following season. By 6 months 17 (38%) patients had resumed normal activities. In group B, only 24 (53%) tibiae united in a mean time of 16 weeks (range 12-40 weeks). Six (13%) patients required bone grafting for non-union, and one patient subsequently developed osteomyelitis. Only ten (22%) patients were back to work and playing sport again within 6 months of initial injury. It is concluded that internal fixation of closed tibial fractures as a primary procedure following low velocity sports injuries can be safely performed. It leads to a faster return to normal activities with fewer complications than does conservative treatment in plaster using contemporary methods.

Adolescent

Anterior dislocation of the restrained shoulder: a seat-belt injury.

The reduction in morbidity and mortality since the enforcement of seat-belt usage is well documented. Complications from the belt are also reported and the authors present anterior dislocation of the restrained shoulder, an injury not previously described. The mechanism of injury is explained and a change to the present standard of restraints is suggested.

Accidents, Traffic

The use of a tourniquet when plating tibial fractures.

Sixty closed fractures of the tibia were treated by open reduction and internal fixation with plates and screws. Half the operations were performed with a thigh tourniquet and half without. In the tourniquet group, there were six cases with erythema and induration of the wound; in the other group there were no such complications. Despite negative bacterial cultures, superficial infection of the inflamed wounds was suspected. It is suggested that a tourniquet may predispose tissues to infection, and its use is not recommended during operations for internal fixation of the tibia.

Adult

Trigger thumb in children: results of surgical correction.

Stenosing tenosynovitis of the thumb, or trigger thumb, is relatively uncommon in children. The surgical correction of trigger thumb in 15 children is described to illustrate the clinical features of this condition. The literature is reviewed in order to alert the orthopaedic surgeon to the natural history of triggering digits in childhood.

Child

Spontaneous rupture of liver due to cholangitis.

Spontaneous rupture of the liver is rare in the Western world and most cases are associated with primary or metastatic tumours. Spontaneous rupture of the intrahepatic biliary tree is not well documented and only two reports have been found in the literature. The authors describe a further case due to ascending cholangitis but presenting with biliary peritonitis. The literature is reviewed and the diagnostic problems discussed.

Cholangitis

Management problems of coincident traumatic diaphragmatic hernia and myocardial infarction.

A 32 year old man suffered a traffic accident, and was admitted to the Emergency Department with closed left-sided chest injury. Subsequent standard procedures revealed a traumatic rupture of the diaphragm and resulting hernia. The surgical treatment of these lesions was without complications. Postoperative monitoring showed a persistent elevation of the ST segment, which was considered to be due to the original trauma. After 14 days the patient was discharged, but at a precautionary follow-up two months later coronary angiography revealed severe ischaemic disease and ventricular aneurysm. The diagnostic and management problems of cases such as this are discussed. It is concluded that one should not be tempted by the youth or apparent good health of the patient to take short-cuts at any stage.

Accidents, Traffic