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Biomedical subjects

M A Mowbray

Publications and source records attributed to M A Mowbray.

9 recordsLinked to original sources
PubMed1997

The Mayday distal first metatarsal osteotomy for hallux valgus: a review after the introduction of a new instrument.

We present the short-term follow-up of 55 symptomatic hallux valgus deformities in 38 patients, treated operatively with a modification of the spike distal first metatarsal osteotomy, as described by Gibson and Piggott in 1962. The age range of the patients was 17 to 72 years at the time of surgery. The postoperative follow-up period was 12 to 55 months. Excellent and good clinical and radiographic results were recorded in 96.2% of our patients. Two of the patients (3.8%) were dissatisfied; one of them complained of metatarsalgia after the procedure, and the other had stiffness of the metatarsophalangeal joint and metatarsalgia that had been present before surgery. Three others (5.45%) required revision after early postoperative displacement but were asymptomatic subsequently. We concluded that our technique is an effective method of treating mild hallux valgus deformities with the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal tilting of the distal fragment. Hallux valgus (lateral deviation of the great toe) is not a single disorder, as the name implies, but a complex deformity of the first ray that sometimes may involve the lesser toes. More than 130 procedures exist for the surgical correction of hallux valgus, which means that no treatment is unique. No single operation is effective for all bunions. The objectives of surgical treatment are to reduce pain, to restore articular congruency, and to narrow the forefoot without impairing function, by transferring weight to the lesser metatarsals either by shortening or by dorsal tilting of the first metatarsal. Patient selection is important for a satisfactory outcome after surgery of any kind, and our criteria were age, degree of deformity, presence of arthrosis, and subluxation of the first metatarsophalangeal joint. In this study, we present a new method of treating hallux valgus that has been used at Mayday University Hospital since 1990. The technique was first described at the British Orthopaedic Foot Surgery Society, Liverpool, November 1990, and we now present the short-term follow-up results. The procedure is essentially a modification of the spike osteotomy of the neck of the first metatarsal, as described by Gibson and Piggott. It has the advantages of simplicity, no shortening of the first metatarsal, and no risk of dorsal displacement of the distal fragment.

Adolescent↗
PubMed1995

Histological changes associated with an artificial anterior cruciate ligament.

AIMS: To investigate the histopathological features of the synovial lining of the knee following implantation of an artificial cruciate ligament. METHODS: Eighty two patients underwent anterior cruciate ligament reconstruction for chronic, symptomatic instability of the knee. The cruciate ligament was reconstructed with a scaffold type prosthetic ligament. All patients underwent arthroscopy at the time of cruciate reconstruction and also as a "second look" procedure at a mean 26.5 months later, at which time synovial biopsy specimens were obtained in all cases. RESULTS: The most frequent histological finding was granulomatous synovitis in 48% (39/82) of patients. Particulate polyester debris produced a greater response than carbon fibres. In 24% (20/82), nonspecific inflammation was present and in 28% (23/82) the synovium was considered normal. When the prosthetic ligament was fully covered by soft tissue in-growth, a granulomatous reaction was present in 42% (24/57), irrespective of whether the ligament was partially or totally uncovered. Stabilisation of the joint did not prevent subsequent deterioration in the articular cartilage; other factors such as increasing patient age, interval between injury and reconstruction and altered knee kinematics after reconstruction are probably important. Granulomatous synovitis was not associated with progressive chondral changes. CONCLUSIONS: Although present in 48% of cases, granulomatous synovitis was not shown to have adverse effects on either chondral surface or the prosthetic material of the ligament. Rupture of the implant is caused by mechanical factors and granulomatous synovitis is not responsible for implant failure.

Adolescent↗
PubMed1994

Displaced bucket handle tears of the medial meniscus masking anterior cruciate deficiency.

Traditionally, anterior cruciate ligament (ACL) injuries have been difficult to diagnose in the Casualty Department. Studies have shown that the anterior drawer test has a poor sensitivity both in acute and chronic ACL deficient knees [4, 6, 9]; thus, more emphasis has been placed on the pivot shift and Lachman tests [3]. We report four cases of proven ACL rupture where clinical examination revealed an absent pivot shift and a near normal Lachman test following a displaced bucket handle tear of the medial meniscus. This finding has been reproduced in cadaver studies, and we conclude that if the history strongly suggests an ACL injury and examination reveals a stable knee, then the dual pathology of medial meniscus tear and ACL rupture should be suspected.

Adult↗
PubMed1988

Guidewire centering instrument.

A new instrument for centering the guidewire into the neck of the femur has been designed and clinically tested for 2 years. It enables the surgeon to vary the position of the guidewire relative to the long axis of the neck of the femur and to achieve the desired position in two planes, anteroposterior and lateral. The objective is to reduce operating time and minimize irradiation to patients and staff when using metal implants to fix a fracture of the neck of the femur.

Femoral Neck Fractures↗
PubMed1984

Triaxial electrogoniometric examination of the pivot shift sign for rotatory instability of the knee.

The precise nature of the motion of the knee during a pivot shift is of interest when types of knee instability are correlated with specific injuries. Ten subjects with anterior cruciate ligament injuries and demonstrable pivot shift instabilities were examined with a triaxial electrogoniometer to detect angular motion at the joint during the performance of a pivot shift test. By varying the method of test performance and observing the patterns of motion by eye and in the electrogoniometric data, the pivot shift was shown to be a dominantly translational event during nonstressed knee testing and a dominantly rotational event during stressed knee testing.

Humans↗
PubMed1983

Studies of dynamic ligamentous instability of the knee by electrogoniometric means.

Ligamentous injuries to a knee joint increase the risk of post-traumatic degenerative changes. Successful early diagnosis and treatment of such injuries remains a challenging and controversial task. There are a variety of clinical tests available and some of these are difficult to perform and interpret. These clinical tests are really static in nature and may not reveal the presence of what is essentially a dynamic event. A complete assessment would need to be "dynamic" and by its application during ambulation, incorporate the effects of ground-foot forces, joint motions and muscle activities. At the Ontario Crippled Children's Centre (OCCC) a triaxial electrogoniometer system (extensively modified CARS-UBC) has been used, together with complementary gait laboratory instrumentation, in order to study the knees of 16 male subjects. Ten subjects had knees without evidence of injury and six had a variety of cruciate and menisceal tears. The purpose of the study was to investigate if a subject's knee could be classified as "normal" or "unstable" by using just the data provided by the electrogoniometer during walking trials. These data are difficult to interpret in their time series form because they are multidimensional and in all subjects likely to exhibit subtle stride to stride variations. The method described allows the mapping of this data into an abstract two dimensional co-ordinate system, resulting in a set of trajectories which cluster together for data belonging to the "normal" group. Only two subjects, with grossly unstable knees, were judged different from normal using a level walking test protocol. Some potential reasons for this are discussed.

Electrophysiology↗
PubMed1980

A retrospective review of the healing of fractures of the shaft of the tibia with special reference to the mechanism of injury.

A retrospective review of 500 fractures of the tibia was undertaken. In 316 adults we assessed the influence of various forms of violence on the rate of healing and the incidence of complications in fractures of the shaft of the tibia. Other factors pertinent to fracture healing in the shaft of the tibia were also investigated and their relative importance was assessed.

Accidents, Traffic↗
PubMed1980

Horizontal intra-articular dislocations of the patella: case report and literature review.

This case report describes a horizontal intra-articular dislocation of the right patella in a 57-year-old male. This is an extremely rare injury. Our case is unusual in that previous authors have described this injury as exclusive to adolescents. A mechanism has been suggested for the causation of this injury. Our case does not seem to conform to the mechanism described, in that the patient's knee was locked in extension, not flexion, at the time of injury.

Humans↗