Biomedical subjects
M F Macnicol
Publications and source records attributed to M F Macnicol.
Calcaneocuboid malalignment in clubfoot.
In a series of 179 clubfeet treated surgically with a follow-up of 3 to 14 years, the clinical significance of calcaneocuboid malalignment was assessed on the basis of a standardized anteroposterior radiograph. The revision rate was 15% and the clinical requirement for a further soft tissue release was related to the talocalcaneal and calcaneocuboid angles. Calcaneocuboid malalignment does not have an adverse effect on the good prognosis of an otherwise well-corrected foot and does not alter the surgery needed to improve a clearly uncorrected foot. When talocalcaneal correction is doubtful, calcaneocuboid malalignment should tilt the balance toward a revision and is of value when the navicular has yet to ossify. Surgical release of the calcaneocuboid joint is unnecessary, particularly the lateral dissection, provided that the medial and subtalar dissection is complete.
Finger flexion sign for ulnar neuropathy.
We report a diagnostic sign of ulnar neuropathy. Function of the interossei is tested by asking the patient to hold a sheet of paper between the middle and ring fingers, by adducting the fingers while the examiner pulls it firmly away. The metacarpophalangeal joints will flex more on the affected side as the flexor tendons are recruited. This test can easily detect muscle weakness in the early stage of ulnar neuropathy, and is produced by a similar mechanism to that of Froment's sign.
Prognosis in Perthes' disease: a comparison of radiological predictors.
We compared the prognostic value of the Catterall grouping, the Salter-Thompson grading, the arthrographic shape of the femoral head, and the Herring lateral pillar grouping during the fragmentation stage of Perthes' disease in 73 patients with 81 affected hips. Radiographs were available for study from the onset of the disease until skeletal maturity. We used the Stulberg classification to assess outcome. The Herring grade and arthrographic sphericity proved to be the best predictors of final outcome. Combining these two values further increased the predictive value. All but one patient in Herring group A achieved an excellent outcome. In Herring group B, the age of the child and the sphericity of the femoral head influenced the end result. If the child was less than seven years old at the onset of symptoms the prognosis was invariably good and all spherical hips in group B had a good outcome with Stulberg grades 1 or 2. Moderately and severely deformed hips on arthrography resulted in Stulberg 3 and 4 hips. None of the hips in Herring group C had a normal appearance at maturity and the outcome was not significantly influenced by the age at onset or the arthrographic appearance.
Epiphysiodesis using a cannulated tubesaw.
A technique for epiphysiodesis using a cannulated tubesaw has been developed to combine the precision of the original Phemister method with newer percutaneous methods. The approach is unilateral, and requires minimal access. Reinsertion of the removed core of bone reduces haemorrhage from the defect and augments arrest of the growth plate. In 35 patients treated by this method predicted discrepancies of 2 to 4.5 cm were reliably reduced to 0.7 +/- 0.6 cm, with no serious complications. The timing of surgery is critical, and relies upon careful monitoring of the pattern of discrepancy over several years, using clinical and radiographic measurements. Undercorrection of the disparity in three patients was the direct result of late referral.
Fracture of the femur in children.
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Congenital insensitivity to pain: orthopaedic implications.
We report two children in one family with congenital insensitivity to pain, anhidrosis, and mental retardation with behavioural disturbance. Orthopaedic manifestations of this condition include recurrent fractures, osteomyelitis, and neuropathic joints. The differential diagnoses and difficulties in the management of this rare disorder are discussed.
Early results of the Leeds-Keio anterior cruciate ligament replacement.
We report the two- to four-year results following the insertion of the Leeds-Keio prosthetic ligament for chronic anterior cruciate deficiency. Virtually all the 20 patients were less disabled by instability, but objective results were good or excellent in only two-thirds and under anaesthesia the pivot shift sign was still positive in half. Arthroscopic and histological assessment in 16 patients failed to show the development of a functional neoligament, and the common appearance of a synovitic reaction to polyester particles gave concern.
Distal transfer of the greater trochanter.
After congenital dislocation of the hip, Perthes' disease and some other conditions, the femoral neck may be short and the greater trochanter in a relatively proximal position. Distal transfer of the greater trochanter is an effective and relatively simple operation to correct this deformity. We have reviewed 26 patients (27 hips) at a mean follow-up of eight years. Pain relief and improvement in gait were maintained in 74%, and the poor results were largely due to progression of osteoarthritis. We describe a 'gear-stick' sign of trochanteric impingement, which is useful in the pre-operative assessment of patients.
Results of a 25-year screening programme for neonatal hip instability.
From 1962 to 1986, 117,256 neonates were screened for congenital dislocation of the hip (CDH). When the primary physical examination was performed by the junior paediatric staff there was a persistent late diagnosis rate of 0.5 per 1000 live births. When the primary examination was undertaken by experienced orthopaedic personnel (1982 to 1984) the late diagnosis rate fell and fewer infants were splinted.
Idiopathic meralgia paresthetica.
Idiopathic meralgia paresthetica was treated surgically in 14 men and 11 women, the latter group were a decade older on average. Treatment was unsatisfactory if symptoms had been present for longer than 18 months. Reexploration of the nerve was not therapeutic in those cases in which the initial decompression provided no relief. The usual course of the lateral femoral cutaneous nerve is deep to the lateral end of the inguinal ligament but superficial to the sartorius muscle. However, the nerve may overlie the anterior iliac wing or pass between two slips of the inguinal ligament and may also be compressed if it passes deep to or through the sartorius muscle.
The torn anterior cruciate ligament.
The anterior cruciate ligament may be ruptured when the knee is hyperextended, hyperflexed and rotated inwards, or forced into excessive valgus. The functional anatomy of the ligament is described, and reasons for the decompensation of the knee are considered. A brief historical review of ligament repair and reconstruction is presented before outlining the clinical assessment of this common sports injury. Both autogenous and prosthetic surgical reconstruction are considered briefly although the emphasis is still upon conservative management in the majority of these cases. Lastly, a plea is made for the prevention of incidents which may lead to rupture of the ligament.
Acrodysostosis and protrusio acetabuli. An association.
Progressive protrusio acetabuli in a patient with acrodysostosis (peripheral dysostosis Type 12) has not, as far as we know, been reported previously. It is recognised that epiphyseal dysplasias may lead to disturbances of acetabular growth, but generally this results in a shallow socket with associated changes in the proximal femoral epiphysis.
Pulmonary insufficiency after long bone fractures: significant correlation with the catabolic response.
Twelve young men between the ages of 17 and 25 years had their metabolism investigated over the first 5 days after sustaining multiple fractures involving at least one femoral shaft. Five patients developed respiratory distress and three of these required varying periods of ventilatory support. The lowering of arterial oxygen tension following injury was directly proportional to the excretion of urinary urea (a convenient index of protein catabolism). Pulmonary insufficiency was rectilinearly related to the degree of thrombocytopenia. The relationship between hypoxaemia and protein catabolism following long bone fractures has not been reported previously. It is important to appreciate that metabolic alterations are more severe in those patients with overt pulmonary insufficiency and that the metabolic response does not appear to be directly related to the severity of skeletal injury.
The Chiari pelvic osteotomy. A long-term review of clinical and radiographic results.
We have reviewed a series of 94 Chiari pelvic osteotomies carried out from 1966 to 1982. In 83 hips the indication for surgery had been pain, and of these patients 73 (88%) had appreciable relief within one year of operation. The other 11 hips were all in children and were painless; in them the osteotomy had successfully stabilised progressive subluxation of the hip. At review after a mean follow-up of 10 years (range, 2 to 18 years) 68 previously painful hips were reassessed. Although function of the hips had deteriorated slowly with time, four of the seven cases with 18 years' follow-up had good function and only minor symptoms. A detailed analysis of the radiographic changes produced by the Chiari osteotomy was made, using computerised analysis of variance. The beneficial effects of the osteotomy resulted from complex changes, among which the provision of a stable fulcrum for the hip seemed to be the most important.
Hemophilic arthropathy of the upper limb.
Little has been written about the effects of hemophilic arthropathy on the function and radiography of the upper limb. Therefore, 14 moderate and 19 severe hemophiliacs between the ages of 10 and 57 years were examined clinically and radiographically. The extent of the arthropathic changes in the shoulders, elbows, wrists, and hands were classified according to the system proposed by the World Federation of Hemophilia. The severity of the arthropathy increased with the age of the patient and with the number of hemarthroses recorded, although the correlation between these parameters was variable. The elbow joints were the site of recognizable arthropathy in 87% of the cases, with a slight preponderance for the nondominant side. The glenohumeral and wrist joints were affected in a small proportion of patients, although symptoms were rarely experienced. Hemorrhages affecting the hands were uncommon and produced arthropathy infrequently.
Symptomatic calcaneonavicular bars. The results 20 years after surgical excision.
Eleven patients were reviewed an average of 23 years after they had been treated by excision of a symptomatic calcaneonavicular bar in 16 of their feet. Of these feet 69% (11 feet) had a good or excellent result. Of the five failures, three feet had good results after subsequent triple arthrodesis, but two treated by repeated excision of the bar were still unsatisfactory. Beaking of the talus seen before operation correlated with poor results.