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Biomedical subjects

M M McQueen

Publications and source records attributed to M M McQueen.

At least 19 recordsLinked to original sources
PubMed2006

Prediction of instability in distal radial fractures.

BACKGROUND: Effective methods of treating an unstable distal radial fracture are described in the literature, but there is no reliable method of identifying an unstable fracture in time to initiate appropriate treatment. The purposes of this study were to identify the predictors of fracture instability and to construct a method of prospectively predicting the radiographic outcome. METHODS: Data on approximately 4000 distal radial fractures were prospectively recorded over a 5.5-year period. The database was validated by reexamining a sample of it. Demographic data on the patients and mode of injury, as well as the fracture classification and measurements, were recorded at the time of presentation. Outcome measures consisted of radiographic measurements made at one week and six weeks and assessment of carpal alignment at six weeks. Univariate and multiple logistic regression analyses were performed to identify the significance of the data obtained at presentation in the prediction of early and late instability as well as the risk of malunion and carpal malalignment. RESULTS: The predictors of early and late instability and malunion differed according to the displacement of the fracture at presentation. Patient age, metaphyseal comminution of the fracture, and ulnar variance were the most consistent predictors of radiographic outcome. Dorsal angulation was not found to be significant in the prediction of radiographic outcome for displaced fractures. The degree to which the patient was independent was predictive of malunion in minimally displaced and displaced fractures. Formulas that are predictive of each of the seven radiographic outcome measurements were constructed. CONCLUSIONS: The study succeeded in identifying the factors that are prognostic of the radiographic outcome for distal radial fractures. Formulas to predict the radiographic outcome were constructed as the independent prognostic significance of these factors was quantified. These formulas can be used to inform the surgeon's decision about the nature of primary treatment of fractures of the distal aspect of the radius. However, they must be validated by further studies before they are used to impact the management of distal radial fractures. LEVEL OF EVIDENCE: Prognostic Level I.

Carpal Bones↗
PubMed2004

Acute compartment syndrome in the absence of fracture.

OBJECTIVES: To determine if there are differences in demographics, referral patterns, and operative findings between patients with and without a fracture who develop an acute compartment syndrome. DESIGN: Retrospective cohort. SETTING: Orthopaedic trauma unit, university teaching hospital. METHODS: This study examines 164 cases of acute compartment syndrome over an 8-year period. Of these, 13 patients had a diagnosis of crush syndrome and are excluded from this study. The remaining 38 cases with no fracture form the basis for this study. MAIN OUTCOME MEASURES: Patient demographics, referral patterns, and operative findings were compared for the "fracture" and "no fracture" groups. RESULTS: Patients who had acute compartment syndrome in the absence of fracture were older (P < 0.05) and had significantly more comorbidities (P < 0.001) than those with a fracture. Cases without a fracture had a significantly greater mean delay to fasciotomy of 12.4 hours (P < 0.05) compared to those with a fracture. At fasciotomy, 20% of patients without a fracture had muscle necrosis requiring debridement compared to 8% for patients with a fracture (P < 0.05). CONCLUSIONS: This study demonstrates that muscle necrosis is more commonly found in acute compartment syndrome in the absence of a fracture than in those with a fracture. Referral of swollen limbs without fracture for an orthopaedic opinion should not be delayed.

Acute Disease↗
PubMed2003

Ulnar procedures for post-traumatic disorders of the distal radioulnar joint.

Post-traumatic abnormality of the distal radioulnar joint (DRUJ) still presents a therapeutic challenge to orthopaedic surgeons. The most common difficulty is a failure to diagnose these injuries early, resulting in chronic post-traumatic disorders of the DRUJ. The main aim of therapy is to avoid adverse sequelae. This is of particular importance in malunion of the distal radius, the most common cause for post-traumatic disorders of the DRUJ. Distal radial malunion can be avoided by early appropriate treatment and the need for subsequent ulnar procedures reduced. Ulnar procedures for post-traumatic disorders of the DRUJ are intended to improve function and to decrease pain. Many methods to improve post-traumatic DRUJ function have been described. This article reviews the current state of the art in dealing with post-traumatic disorders of the distal radioulnar joint and presents algorithms to help in decision making.

Chronic Disease↗
PubMed2003

The epidemiology of multifocal upper limb fractures.

AIM: The aim of this study is to identify the epidemiology of multifocal upper limb fractures and define any commonly occurring patterns. PATIENTS: Patients included were those over the age of 13 years who presented to one orthopaedic trauma unit, in an eight-year period, and who sustained a multifocal upper limb fracture. RESULTS: There were 83 patients with 171 multifocal upper limb fractures. Mean age 60 years; range 13 to 92 years. 78 patients had bifocal fractures and 5 had trifocal. The most common pairing of fourteen different combinations was distal radius and proximal humerus. All but nine patients had involvement of the proximal humerus or distal radius. The most common injuries were the two-part proximal humerus fracture, the simple intra-articular olecranon fracture and the extra-articular fracture of the distal radius with metaphyseal comminution. CONCLUSION: This study has shown that multifocal fractures of the upper limb are most likely to occur in the middle aged to elderly women who have had a fall from standing height. As previously demonstrated osteopenic fractures are increasing in incidence in developed countries, where the population is ageing, which implies that the incidence of multifocal fractures of the upper limb is likely to increase.

Adolescent↗
PubMed2002

Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment.

We present a retrospective study of 125 patients with an impacted valgus fracture (B1.1) of the proximal humerus. This fracture rarely occurs in young patients and is much more common in elderly fit subjects. All patients were documented prospectively and followed for one year. None was treated surgically. At one year, 80.6% of the patients had a good or excellent result, the quality of which depended on the age of the patient and the degree of displacement of the fracture. Mean outcome scores based on these two parameters are presented. A comparison with data from other studies suggests that operative fixation of these fractures is not necessary.

Adult↗
PubMed2002

Refractures in patients at least forty-five years old. a prospective analysis of twenty-two thousand and sixty patients.

BACKGROUND: Individuals who sustain a low-energy fracture are at increased risk of sustaining a subsequent low-energy fracture. The incidence of these refractures may be reduced by secondary preventative measures, although justifying such interventions and evaluating their impact is difficult without substantive evidence of the severity of the refracture risk. The aim of this study was to quantify the risk of sustaining another fracture following a low-energy fracture compared with the risk in an age and sex-matched reference population. METHODS: During the twelve-year period between January 1988 and December 1999, all inpatient and outpatient fracture-treatment events were prospectively audited in a trauma unit that is the sole source of fracture treatment for a well-defined local catchment population. During this time, 22,060 patients at least forty-five years of age who had sustained a total of 22,494 low-energy fractures of the hip, wrist, proximal part of the humerus, or ankle were identified. All refracture events were linked to the index fracture in the database during the twelve-year period. The incidence of refracture in the cohort of patients who had sustained a previous fracture was divided by the "background" incidence of index fractures within the same local population to obtain the relative risk of refracture. Person-years at-risk methodology was used to control for the effect of the expected increase in mortality with advancing age. RESULTS: Within the cohort, 2913 patients (13.2%) subsequently sustained a total of 3024 refractures during the twelve-year period. Patients with a previous low-energy fracture had a relative risk of 3.89 of sustaining a subsequent low-energy fracture. The relative risk was significantly increased for both sexes, but it was greater for men (relative risk = 5.55) than it was for women (relative risk = 2.94). The relative risk was 5.23 in the youngest age cohort (patients between forty-five and forty-nine years of age), and it decreased with increasing age to 1.20 in the oldest cohort (patients at least eighty-five years of age). CONCLUSIONS: Individuals who sustain a low-energy fracture between the ages of forty-five and eighty-four years have an increased relative risk of sustaining another low-energy fracture. This increased risk was greater when the index fracture occurred earlier in life; the risk decreased with advancing age. Secondary preventative measures designed to reduce the risk of refracture following a low-energy fracture are likely to have a greater impact on younger individuals.

Age Factors↗
PubMed2001

Mallet deformity in sport.

During a four month period 851 patients presented to the Edinburgh Orthopaedic Trauma Unit with an acute sporting injury. Eighteen (2%) patients had either a soft tissue or bony mallet deformity. Six different sports were identified with rugby accounting for eight of the 18 mallet deformities. All patients were treated with splintage. Fourteen patients returned questionnaires regarding subjective digit function following treatment and nine patients claimed excellent function. The average splinting time for this group was 6 weeks and sports were avoided for an average of 5 weeks. Mallet deformity accounts for a minority of sporting injuries, but excellent functional outcome can be achieved with splintage and avoidance of the causative sport while splinted.

Adolescent↗
PubMed2001

The epidemiology of proximal humeral fractures.

We present a 5-year prospective study of the epidemiology of 1,027 proximal humeral fractures. These fractures, which tend to occur in fit elderly persons, have a unipolar age distribution and the highest age-specific incidence occurs in women between 80 and 89 years of age. The commonest was the B1.1 impacted valgus fracture, found in one-fifth of the cases in this series, a type that is not included in the Neer classification. We used both Neer and AO classifications. The AO classification proved to be more comprehensive because in the Neer classification, half of the fractures are minimally displaced and almost nine-tenths fall into only three categories. In the AO classification, the B1.1, A2.2, A3.2 and A1.2 sub-groups comprise over half of all proximal humeral fractures, while the AO type C fractures occur in only 6%. We suggest that the literature does not adequately reflect the spectrum of proximal humeral fractures.

Activities of Daily Living↗
PubMed2001

Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur.

OBJECTIVES: To compare the surgical complications and functional outcome of the Gamma nail intramedullary fixation device versus the Richards sliding hip screw and plate device in intertrochanteric femoral fractures. DESIGN: A prospective, randomised controlled clinical trial with observer blinding. SETTING: A regional teaching hospital in the United Kingdom. PATIENTS: All patients admitted from the local population with intertrochanteric fractured femurs were included. There were 400 patients entered into the study and 399 followed-up to one year or death. INTERVENTION: The devices were assigned by randomization to either a short-type Gamma nail (203 patients) or a Richard's-type sliding hip screw and plate (197 patients). MAIN OUTCOME MEASUREMENTS: The main surgical outcome measurements were fixation failure and reoperation. A functional outcome of pain, mobility status, and range of movement were assessed until one year. RESULTS: The requirement for revision in the Gamma nail group was twelve (6%); for Richard's group, eight (4%). This was not statistically different (p = 0.29; odds ratio, 1.48 [0.59-3.7]). A subcapital femoral fracture occurred in the Richard's group. Femoral shaft fractures occurred with four in the Gamma nail group (2%) and none in the Richard's group (p = 0.13). Three required revision to another implant. Lag-screw cut-out occurred in eight patients in the gamma nail group (4%) and four in the Richard's group (2%). This was not statistically significant (p = 0.37; odds ratio, 2.29 [0.6-9.0]). The development of other postoperative complications was the same in both groups. There was no difference between the two groups in terms of early or long-term functional status at one year. CONCLUSIONS: The use of an intramedullary device in the treatment of intertrochanteric femoral fractures is still associated with a higher but nonsignificant risk of postoperative complications. Routine use of the Gamma nail in this type of fracture cannot be recommended over the current standard treatment of dynamic hip screw and plate.

Adult↗
PubMed2001

The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient.

We have undertaken a five-year prospective study of 126 translated two-part fractures of the proximal humerus and present an analysis of the epidemiology and of the factors which affect outcome in elderly patients. The fracture has a unimodal age distribution and rarely affects adults under the age of 50 years. Analysis showed that patients with two-part translated fractures of the surgical neck tended to be independent and relatively fit, despite the fact that their mean age was 72 years. Outcome was determined by the age of each patient and the degree of translation on the initial anteroposterior radiograph. Surgery did not improve the outcome, regardless of the degree of translation.

Activities of Daily Living↗
PubMed2000

Long-term sequelae of fasciotomy wounds.

A retrospective study of patients admitted to an Orthopaedic Trauma Unit over an 8-year period requiring fasciotomies, of either upper or lower limb, to reduce the risk of compartment syndrome was performed. Sixty patients were studied, of which 49 had an underlying fracture. The long-term morbidity of the wounds was studied. Ongoing symptoms such as pain related to the wound occurred in six patients (10%) and altered sensation within the margins of the wound occurred in 46 patients (77%). Examination revealed 24 patients (40%) with dry scaly skin, 20 patients (33%) with pruritus, 18 patients (30%) with discoloured wounds, 15 patients (25%) with swollen limbs, 16 patients (26%) with tethered scars, eight patients (13%) with recurrent ulceration, eight patients (13%) with muscle herniation and four patients (7%) with tethered tendons. The appearance of the scars affected patients such that 14 (23%) kept the wound covered, 17 (28%) changed hobbies and seven (12%) changed occupation. This study reveals a significant morbidity associated with fasciotomy wounds. In light of these findings, further consideration should be given to techniques that reduce both the symptoms and examination findings mentioned above and the aesthetic insult to the affected limb.

Adolescent↗
PubMed2000

Acute compartment syndrome. Who is at risk?

We have analysed associated factors in 164 patients with acute compartment syndrome whom we treated over an eight-year period. In 69% there was an associated fracture, about half of which were of the tibial shaft. Most patients were men, usually under 35 years of age. Acute compartment syndrome of the forearm, with associated fracture of the distal end of the radius, was again seen most commonly in young men. Injury to soft tissues, without fracture, was the second most common cause of the syndrome and one-tenth of the patients had a bleeding disorder or were taking anticoagulant drugs. We found that young patients, especially men, were at risk of acute compartment syndrome after injury. When treating such injured patients, the diagnosis should be made early, utilising measurements of tissue pressure.

Acute Disease↗
PubMed2000

Analysis of muscle function in the lower limb after fracture of the diaphysis of the tibia in adults.

We examined the recovery of power in the muscles of the lower limb after fracture of the tibial diaphysis, using a Biodex dynamometer. Recovery in all muscle groups was rapid for 15 to 20 weeks following fracture after which it slowed. Two weeks after fracture the knee flexors and extensors have about 40% of normal power, which rises to 75% to 85% after one year. The dorsiflexors and plantar flexors of the ankle and the invertors and evertors of the subtalar joint are much weaker two weeks after injury, but at one year their mean power is more than that of the knee flexors and extensors. Our findings showed that age, the mode of injury, fracture morphology, the presence of an open wound and the Tscherne grade of closed fractures correlated with muscle power. It is age, however, which mainly determines muscle recovery after fracture of the tibial diaphysis.

Adolescent↗
PubMed2000

The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius.

The capacity for physiotherapy to improve the outcome after fracture of the distal radius is unproven. We carried out a randomised controlled trial on 96 patients, comparing conventional physiotherapy with a regime of home exercises. The function of the upper limb was assessed at the time of removal of the plaster cast and at three and six months after injury. Factors which may predict poor outcome in these patients were sought. Grip strength and hand function did not significantly differ between the two groups. Flexion and extension of the wrist were the only movements to improve with physiotherapy at six months (p = 0.001). Predictors of poor functional outcome were malunion and impaired function before the fracture. These patients presented with pain, decreased rotation of the forearm and low functional scores at six weeks. Our study has shown that home exercises are adequate rehabilitation after uncomplicated fracture of the distal radius, and routine referral for a course of physiotherapy should be discouraged. The role of physiotherapy in patients at high risk of a poor outcome requires further investigation.

Aged↗
PubMed1999

Fractures of the tibia. Can their outcome be predicted?

We have carried out a prospective study to determine whether the basic descriptive criteria and classifications of diaphyseal fractures of the tibia determine prognosis, as is widely believed. A number of systems which are readily available were used, with outcome being determined by standard measurements including fracture union, the need for secondary surgery and the incidence of infection. Many validated functional outcomes were also used. The Tscherne classification of closed fractures proved to be slightly more predictive of outcome than the others, but our findings indicate that such systems have little predictive value.

Adult↗