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Biomedical subjects

M R Colville

Publications and source records attributed to M R Colville.

15 recordsLinked to original sources
PubMed1997

Treatment of tibial plateau fractures by limited internal fixation.

Seventy-five adults who sustained 76 tibial plateau fractures were treated according to a prospective protocol using instability in extension as the principal indication for operative fixation. Patients showing instability underwent closed manipulative reduction under fluoroscopic guidance. If significant joint depression persisted after reduction, elevation of the fracture was performed either from below using bone punches through a cortical window or via limited arthrotomy. Iliac crest bone graft was used to buttress depressed fractures. Fixation was then secured using 7-mm cannulated screws with washers or buttress plates and screws. Postoperatively, 58 of 76 knees were managed in a hinged knee brace, allowing the patient early range of motion and protected weightbearing for 8 weeks. Patients who were found to have a stable knee were treated with Bledsoe braces according to the postoperative protocol. In the 75 patients, 18 of the 76 knees were unsuitable for percutaneous screw fixation because of fracture complexity requiring plates, severe open injuries, or inadequate reductions with limited fixation had been done. A minimum followup of 12 months was obtained in 55 patients (range, 12-59 months). All fractures had healed at the time of followup. Eighty-seven percent of the patients at followup had a successful outcome using Rasmussen's criteria. Fourteen of these patients had arthroscopic assisted reduction or evaluation. All seven patients who had poor outcomes had AO Type C3 fracture patterns. Severely depressed or comminuted fractures or fractures with significant metaphyseal diaphyseal extension may not be suitable for this technique and require the addition of an external fixation device or buttress plate to maintain the reduction and allow for early range of motion.

Adolescent↗
PubMed1997

Biomechanical comparison of intramedullary and percutaneous pin fixation for proximal humeral fracture fixation.

OBJECTIVES: The purpose of this study was to investigate the mechanical strength and durability of intramedullary nailing (IM) and percutaneous pinning (PP) for fixation of three-part proximal humeral fractures using a cadaveric model. DESIGN: Three-part surgical neck fractures were created in paired embalmed cadaveric humeri. Fractures were fixed with IM and PP fixation. The fixation stiffness and durability was assessed under cyclic rotational loading (infraspinatus) ramping from 0.1 to 1.25 Newton-meters for 10,000 cycles. The specimen were then torsionally loaded to failure. SETTING: Mechanical testing was performed using a servohydraulic test system (MTS, Minneapolis, MN, U.S.A.). INTERVENTION: PP fixations were accomplished using standard multiplane techniques. IM fixation was attained using an 11.0-millimeter-diameter curved rod interlocked proximally with three splayed 5.0-millimeter cancellous screws and distally with three 3.5-millimeter cortical screws. MAIN OUTCOME MEASUREMENTS: During cyclic loading the reconstruction stiffness, angular migration, and angular displacement per cycle were measured and compared between fixation methods. The ultimate torque at failure, absolute angular migration, and reconstruction stiffness during failure were recorded and compared between fixation methods during destructive testing. RESULTS: The intramedullary device had greater stiffness and less angular displacement of fragments during cyclic loading. When loading the reconstructions to failure, the intramedullary device proved to have greater failure torques, stiffness, energy absorbed, and angular displacement before failure. CONCLUSIONS: This biomechanical study showed that the IM device provided a stronger, more stable, and durable fixation option than did PP fixation for large-fragment multipart proximal humeral fractures with minimal comminution.

Biomechanical Phenomena↗
PubMed1993

Muscle strength testing following surgery for acetabular fractures.

A retrospective clinical analysis was performed on 30 patients who underwent surgery for acetabular fractures. In addition to clinical and radiographic evaluations, muscle strength was tested using an isokinetic dynamometer. Average follow-up time was 21 months. Joint surface and congruency were restored within 3 mm in 29 of 30 cases. The average hip score was 83. Eight patients had an unsatisfactory result. Only 14 patients had a normal gait, while seven patients had a Trendelenburg gait. The overall strength deficit was 27%. This mean strength deficit was highly correlated with the hip-rating score. The greatest loss of strength was in abduction, where the average deficit was 50%. The loss of abduction strength was significantly greater for patients operated on through posterior approaches. Among patients operated on through a Kocher-Langenbeck approach, those with transverse fractures had significantly larger losses of abduction strength than those with posterior wall fractures.

Acetabulum↗
PubMed1993

Meniscal repair.

Explore the source record for details and available documents.

Arthroscopy↗
PubMed1991

Characterizing osteochondral lesions by magnetic resonance imaging.

In a double-blind prospective study, 12 patients with osteochondral lesions of either the knee or talus were studied using magnetic resonance imaging (MRI) prior to arthroscopic treatment. MRI correctly staged 11 of the 12 lesions. We developed a new staging system for osteochondral lesions, which accurately correlates MRI with arthroscopic findings.

Adult↗
PubMed1987

Posteromedial dislocation of the ankle without fracture.

We report the results of treatment in eight patients who had posteromedial dislocation of the ankle without fracture. The ages of seven of the eight patients ranged from twenty-three to thirty-six years. Four patients had increased generalized ligamentous laxity. One-half of the injuries were sustained during athletic competition. The mechanism of injury appeared to be forced inversion of the foot when it was maximally plantar flexed and axially loaded. Five of the eight patients had an open injury, and four of the five patients had an associated injury to the anterolateral neurovascular structures. No patient had an injury to the distal tibiofibular ligaments or to the syndesmosis. The three patients who had a closed dislocation achieved good long-term functional and roentgenographic results after closed reduction and immobilization. The patients who had an open injury that was treated by anatomical repair of the disrupted lateral ligaments at the time of initial débridement also achieved good long-term functional and roentgenographic results. It does not appear to be necessary to repair the deltoid ligament. In one patient who had an open dislocation and in whom the lateral ligaments were not repaired, moderate instability of the ankle resulted and degenerative changes developed in the joint.

Adult↗
PubMedDate not supplied

The systemic and local effects of an intramedullary injection of methylprednisolone acetate in growing rabbits.

Intramedullary injection of methylprednisolone acetate (Depo-Medrol) is successful in the treatment of children with unicameral cysts, but its mechanism of action remains obscure. Using a rabbit model, methylprednisolone was injected into the intramedullary canal of the left proximal tibia. Normal saline was injected into the right proximal tibia as a control. Venous blood samples following injection revealed that corticosteroid was rapidly cleared from bone. Serum methylprednisolone levels rose rapidly, giving a dose-response curve similar to that after an intramuscular injection in humans. Rabbits were killed and analyzed histologically for local changes. There was no fibroblastic proliferation, neovascularization, or other histologic change secondary to injection.

Animals↗
PubMedDate not supplied

The Lenox Hill brace. An evaluation of effectiveness in treating knee instability.

Forty-five patients with documented ACL injuries were examined objectively and subjectively to evaluate the effectiveness of the Lenox Hill brace in treating knee instability. The brace failed to significantly reduce maximal anterior subluxation of the tibia, but did increase resistance to displacement. Rotatory instability was improved an average of one grade by the brace, while varus/valgus laxity was unchanged. Subjectively, patients experienced a significant reduction in episodes of giving way, and athletic performance was improved by the brace in 69% of patients. Increased symptoms of instability correlated positively with greater measured laxity and low resistance to tibial displacement. The brace, while not effective in controlling absolute laxity, significantly reduced symptoms of instability in the nonelite athlete, possibly through increasing relative resistance to subluxation. Overall, 91% of the patients examined were satisfied with the brace and felt it was beneficial for them.

Adult↗
PubMedDate not supplied

Snowboard injuries.

A retrospective survey of 267 snowboarders was undertaken to determine the population at risk and types and mechanisms of injuries sustained in this sport. Snowboarders are young (average age, 21 years), male (greater than 90%), view themselves in average or above average physical condition (96%), and have varied sports interests. One hundred ten injuries that resulted in a physician visit were reported. Ligament sprains, fractures, and contusions were the most frequent types of injury. Fifty percent of all injuries occurred in the lower extremities, with ankle injuries being the most common. Snowboard riders using equipment with increased ankle support seem to be more protected from lower extremity injuries. The lower extremity injuries were concentrated in the forward limb of the snowboarder, where the rider's weight is disproportionately distributed. Differences in the mechanism and spectrum of injury between snowboarding and skiing injuries were noted, including: impact rather than torsion as the major mechanism of injury, a significant lack of thumb injuries, comparative increase in ankle injuries, a decrease in knee injuries, and a higher percentage of upper extremity injuries.

Adolescent↗
PubMedDate not supplied

Strain measurement in lateral ankle ligaments.

We measured strain in the lateral ligaments of 10 human cadaver ankles while moving the ankle joint and applying stress in a variety of ways. We studied the anterior talofibular, calcaneofibular, posterior talofibular, anterior tibiofibular, and posterior tibiofibular ligaments. Strain measurements in the ligaments were recorded continuously while the ankle was moved from dorsiflexion into plantar flexion. We then repeated measurements while applying inversion, eversion, internal rotation, and external rotation forces. Strain in the anterior talofibular ligament increased when the ankle was moved into greater degrees of plantar flexion, internal rotation, and inversion. Strain in the calcaneofibular ligament increased as the talus was dorsiflexed and inverted. These findings support the concept that the anterior talofibular and calcaneofibular ligaments function together at all positions of ankle flexion to provide lateral ankle stability. We measured maximum strain in the posterior talofibular ligament when the ankle was dorsiflexed and externally rotated. The strain in the anterior and posterior tibiofibular ligaments increased when the ankle was dorsiflexed. External rotation increased strain in the anterior tibiofibular ligament and decreased strain in the posterior tibiofibular ligament. Based upon strain measurements in the lateral ankle ligaments in various ankle joint positions, we believe the anterior talofibular ligament is most likely to tear if the ankle is inverted in plantar flexion and internally rotated. Theoretically, the calcaneofibular ligament tears primarily in inversion if the ankle is dorsiflexed; the anterior tibiofibular ligament tears in dorsiflexion, especially if combined with external rotation; and the posterior tibiofibular ligament tears with extreme dorsiflexion.

Adult↗
PubMedDate not supplied

Reconstruction of the lateral ankle ligaments. A biomechanical analysis.

UNLABELLED: The purpose of this study was to perform a biomechanical analysis of several commonly performed operative procedures used to stabilize the lateral ankle. We performed the Evans, Watson-Jones, and Chrisman-Snook procedures on 15 cadaveric ankles and tested the ankles for stability, motion, and isometry of graft placement. The Evans procedure allowed increased anterior displacement, internal rotation, and tilt of the talus when compared to ankles with intact ligaments. Subtalar joint motion was restricted by the Evans procedure. The Watson-Jones procedure controlled internal rotation and anterior displacement of the talus, but was less effective in controlling talar tilt and also restricted subtalar joint motion. The Chrisman-Snook procedure allowed increased internal rotation and anterior displacement of the talus when compared to ankles with intact ligaments. The procedure was effective in limiting talar tilt, but restricted subtalar joint motion. Based on the biomechanical data obtained, we devised a lateral ankle reconstruction with bone tunnels that reproduce the anatomic orientation of both the anterior talofibular and calcaneofibular ligaments. This ankle ligament reconstruction resists anterior displacement, internal rotation, and talar tilt without restricting subtalar joint motion. CLINICAL RELEVANCE: We found considerable mechanical differences among the more commonly performed lateral ankle reconstructions. It is possible to locate bone tunnels and graft placement so that a more anatomic configuration is achieved.

Adult↗
PubMedDate not supplied

The significance of isometer measurements and graft position during anterior cruciate ligament reconstruction.

Intraoperative isometry measurements are commonly performed before bone tunnel drilling during anterior cruciate ligament reconstruction. The relationship between initial isometer measurements and final graft isometry, however, is unclear. We tested 15 cadaveric knees to determine the relationship between isometer readings and final graft isometry. We found that isometer readings may vary widely from final graft isometry because of eccentric placement of the anterior cruciate ligament graft within bone tunnels. Isometer measurements may be used, however, to predict accurate final graft isometry for specific graft positions within the bone tunnels.

Anterior Cruciate Ligament↗
PubMedDate not supplied

Anatomic reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft.

Fifteen patients with recurrent inversion ankle sprains and documented lateral ankle instability were treated with an anatomically oriented ligament reconstruction using a split peroneus brevis tendon graft. This reconstruction is designed to augment repair of the anterior talofibular and calcaneofibular ligaments without restricting subtalar motion. Of the 12 patients available for long-term followup, all were functionally improved, with no recurrences of instability. Stress radiographic examination at followup confirmed that mechanical stability had been restored in all ankles. Eversion strength and subtalar joint motion were maintained after surgery. We recommend this procedure in patients who require augmented reconstruction of the lateral ankle ligaments.

Adolescent↗
PubMedDate not supplied

Surgical treatment of the unstable ankle.

Symptomatic ankle instability will develop in as many as 20% of patients after inversion sprain of the lateral ankle ligaments. Although most patients may be successfully treated with a rehabilitative exercise program and bracing, some will continue to sustain recurrent ankle sprains with activities of daily living, work on uneven terrain, or sports. The anterior talofibular ligament and the calcaneofibular ligament are the primary stabilizers of the lateral ankle, and surgical procedures should be aimed at restoring the normal function of these ligaments. Preoperative stress radiographs should be obtained to determine the degree of laxity and to differentiate between subtalar joint and ankle joint instability. Numerous surgical techniques have been described to correct ankle instability, most with an 80% to 90% success rate. Reconstructions using tendon grafts may restrict normal ankle and subtalar joint motion, depending on the placement of the graft. Direct repair of the anterior talofibular and calcaneofibular ligaments with shortening and reattachment to the fibula has a success rate similar to that for augmented reconstruction and avoids the increased morbidity associated with tendon graft procedures. Patients with severe laxity or with weak or deficient tissue for direct repair may require an augmented reconstruction. Osteotomy may be required in addition to ligament reconstruction in patients with severe ankle or hindfoot varus alignment, in order to prevent failure of the repair. Patients with paralysis or weakness of the peroneal musculature may require a nonanatomic procedure that limits subtalar motion.

Ankle Joint↗