Biomedical subjects
Publications and source records attributed to M F Macnicol.
A family, of which thirteen members suffered from hereditary onycho-osteodysplasia (HOOD), is presented. Four of the thirteen patients also had foot deformities, and it is postulated that this anomaly may be a true part of the HOOD syndrome, and not just an incidental finding.
Twenty young men with displaced fractures of one or more long bones in the lower limb, but with no evidence of cranial, thoracic or abdominal injury, were studied prospectively. Although all the patients became hypoxaemic, the six who developed signs of respiratory distress (Group 1) were found to have a significantly lower arterial oxygen tension and a significantly higher rate of urinary urea excretion than the remaining 14 patients whose pulmonary function appeared to be clinically normal (Group 2). Circulating fat macroglobules were identified in three cases, only one of whom was in Group 1, and hence the tests for fat embolism were not of prognostic value. Although an immunodeficient state is considered to contribute to the pulmonary insufficiency which occurs after major trauma, convincing evidence of a lymphocyte-suppressive agent was found in only one patient.
The results of subtotal palmar fasciectomy employing an open palm technique have been reviewed. Full correction of the metacarpophalangeal flexion deformity was achieved in the majority of 120 hands which were followed up for between one and nine years after operation, but the results from associated digital dissection were less satisfactory. Leaving the transverse distal palmar wound open lessens many of the hazards inherent in a palmar dissection, and the approach is therefore relatively safe for the less experienced surgeon. Efficient supervision of the hand after surgery is of paramount importance and may influence the outcome as significantly as the operation itself.
The accessory navicular is occasionally the source of pain and local tenderness over the instep. If conservative measures fail, surgical treatment may be required and the results of 62 operations to one or both feet in 47 patients are reported. Twenty-six patients were treated by the Kidner operation, in which the main insertion of the tibialis posterior is re-routed; in the remaining 21 the ossicle was merely excised. Excision was as effective as the Kidner technique, provided that the medial surface of the main navicular bone was contoured to prevent any residual prominence. Both procedures were successful in relieving symptoms in the majority of cases and failures resulted from errors in the selection of patients or in the surgical technique. Correction of any associated flat foot was secondary to growth and maturation of the foot rather than to the operation; hence the Kidner procedure does not confer any particular advantages over simple excision.
Traumatic neuropathies of the common peroneal nerve at the head of the fibula are relatively common, but nerve entrapment at this site is rarely encountered. A 55-year-old man with hemophilia A in whom common peroneal nerve entrapment occurred secondary to a probable muscle hematoma is described.
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Using fresh cadaveric arms, extraneural pressures were recorded along the path of the ulnar nerve at the elbow using a fine silastic cannula. Significant pressure increases occurred when the elbow was flexed beyond a right angle, and concomitant shoulder abduction further raised the pressures recorded at the cubital tunnel and post-condylar groove. Surgical release of the cubital tunnel decreased pressures in the post-condylar groove by approximately 50 per cent when the elbow was fully flexed, whereas clamping the flexor carpi aponeurotic arch significantly increased extraneural pressures in the groove, presumably by preventing accommodative changes in neural relationships.
Over the 10-year period 1969 to 1978, 271 consecutive cases of congenital dislocation of the hip were diagnosed at birth. Standard anteroposterior radiographs of the pelvis were obtained routinely and were analysed retrospectively. The medial gap, a measure of the separation between the proximal femur and the pelvic wall, was found to be significantly increased in cases with unilateral or bilateral dislocation when compared to normal. A medial greater than five millimetres is indicative of femoral head displacement and is of value where the clinical diagnosis is uncertain. The rate of missed dislocation at birth was 0.6 cases per thousand. Treatment with the Malmo splint was the normal routine. The Pavlik harness was applied if splintage was poorly tolerated by the infant, or in the rare instance of limited hip abduction. Failure to maintain reduction by splintage occurred in 3.3 per cent. The incidence of pressure deformities of the femoral head was 2.95 per cent and there was a residual deformity in later childhood of 1.1 per cent. It is presumed that this lesion can be attributed to the effect of splintage and it was notably avoided in the later period of the review when greater mobility of the abducted hips was encouraged.
Twenty-four patients treated for tibial shortening secondary to poliomyelitis were reviewed at least 20 years after operation. All subjects were active and only one expressed doubt about the value of tibial lengthening, considering the period of hospitalisation to have been a significant drawback. Approximately five centimetres were added to the length of the treated tibiae. Only one of the nine patients with lengthening of over five centimetres was able to walk at a rate of more than five kilometres per hour, compared with seven of the remaining 15 whose tibiae had been lengthened five centimetres or less.
The work capacity of 26 women after a Chiari pelvic osteotomy for symptomatic unilateral subluxation of the hip was assessed using two simple exercise tests: the maximal walking speed during a 12-minute test and the time taken to climb stairs. A significant linear decline in walking speed occurred with increasing age, despite the operation, and only one patient over the age of 25 years was able to walk at a normal rate. Compared to the results in a control group of women of similar age the stair climbing time was increased in 54 per cent of the patients and showed a significant negative correlation with the maximal walking speed. Age-adjusted walking speed was closely associated with the degree of pain experienced but there was no relationship between observed function and conventional clinical assessment based on the range of movement and the radiographic appearances of the hip.
In 30 elderly women awaiting hip arthroplasty on account of unilateral osteoarthritis of the hip, walking speed and oxygen consumption were measured during a 12-minute test and the power output was calculated from the stair climbing rate. The results were compared with those for a group of 30 normal women of similar age. An age-related decline in maximal walking speed was observed in both groups. After arthroplasty there was a significant increase in maximal walking speed, particularly among the more disabled patients, with the major gain occurring by three months and a further slight increase by six months. Oxygen consumption returned towards normal values, and both stride length and cadence increased by a comparable degree. Mean power output during stair climbing doubled, and both before and after arthroplasty bore a linear relationship to the maximal walking speed.
Twenty-seven children with progressive infantile idiopathic scoliosis have been reviewed after long-term management. Twenty-two children had single thoracic curves which were diagnosed at an early age and treated in a modified Milwaukee brace until the age of ten years when the spine was corrected and fused. The mean correction after operation was 40 per cent of the initial degree of curvature seen in early childhood before treatment. Solid spinal fusion led to a further moderate loss in correction due to bending of the fusion mass before the spine became stable several years later. Five children had double structural curves and were treated only in a brace. This provided less satisfactory control of these curves but because of the minimal cosmetic deformity, extensive spinal fusion was avoided.
The records of 110 cases of ulnar neuritis in 100 patients have been reviewed an average of 4.4 years after anterior transposition, or release of the aponeurosis. Seventy of the patients were reviewed personally. In over half the cases no precipitating cause was apparent. At operation the nerve was constricted by the flexor carpi ulnaris aponeurosis in fifty cases but in twenty-five no abnormal pathology was found. Recovery was greatest when operation was performed within three months of the onset of symptoms. In those cases where no abnormality was found, and those in which adhesions in the postcondylar groove involved the nerve, simple release was less effective than anterior transposition. It is therefore recommended that release be restricted to patients with a short history and with an obvious aponeurotic constriction unaccompanied by adhesions. Anterior transposition is the operation of choice where no abnormality is seen or where the nerve is dislocated, compressed or tethered proximal to the aponeurosis of flexor carpi ulnaris.
Bilateral fractures of the humeral surgical neck occurred in a 62-year-old woman, subsequently found to have osteomalacia secondary to primary biliary cirrhosis. Treatment was conservative with good result. After an extensive search of the literature, this is believed to be the first reported case of bilateral fractures of the surgical neck of the humeri without associated posterior dislocation. There has also been no previous report of fracture as the presenting symptom of primary biliary cirrhosis.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.