Failure of cementless hip replacements.
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Adult↗
Biomedical subjects
P A Hutton
Publications and source records attributed to P A Hutton.
The timing of amputation for lower limb trauma.
We reviewed 35 patients who had an amputation following the failure of treatment for severe lower limb trauma. Seven of the amputations were for ischaemia, within one month of injury; 13 were between one month and one year for infection complicating loss of wound cover in un-united fractures; and 15 were later than one year after injury, mainly for infected non-union. The latter group of patients had had an average of 12 operations and 50 months of treatment, including eight months in hospital. We used a new limb injury score based on damage to the individual tissue elements; this indicated that, even in the absence of neurovascular injury, the presence of severe damage to skin, bone and muscle, with wound contamination, particularly in the lower tibia, had a poor prognosis. We therefore recommend, to avoid multiple operations, with prolonged hospitalisation and suffering, that these patients should have early independent review by orthopaedic and plastic surgeons with the aim of establishing an accurate prognosis for the salvage of a useful limb.
Adolescent↗
Injection-induced contractures of the quadriceps in childhood. A comparison of proximal release and distal quadricepsplasty.
Thirty-two contractures of the quadriceps induced by injection in 17 children have been reviewed. The average age at presentation was 3 years 4 months. All the children had suffered a severe illness within the first few weeks of life and all had received intramuscular injections into the thigh. Three methods of treatment were used: conservative, distal quadricepsplasty, and proximal release. At follow-up none of the patients treated by proximal release had an extension lag, which was present in 70% of those treated by distal quadricepsplasty. Apart from one case with slight improvement in the range of knee flexion, conservative treatment, at best, could only prevent further loss. The clinical presentation and management is described, and the advantages of proximal release are discussed.
Child↗
The behaviour pattern of the scoliosis associated with osteoid osteoma or osteoblastoma of the spine.
The behaviour pattern of the scoliosis associated with osteoid osteoma or osteoblastoma of the spine is described. In patients presenting with symptoms at or around skeletal maturity, the scoliosis is postural. Excision of the lesion ensures complete resolution of the curve. In the growing child, however, an initial postural scoliosis may develop vertebral rotation with structural characteristics. The magnitude of the curve and the associated vertebral rotation is dependent on the time interval between the onset of symptoms and the surgical treatment. Although removal of the lesion usually results in regression of the curve, a prolonged delay in treatment may result in a progressive structural scoliosis. A possible mechanism for the behaviour of the scoliosis is discussed.
Adolescent↗
Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment.
The clinical presentation and treatment of 18 cases of osteoid osteoma or osteoblastoma of the spine are described, with an average follow-up of 4.2 years (range three months to 11.5 years). The average delay between the onset of symptoms and definitive diagnosis was 19 months. All patients presented with marked spinal stiffness and a painful scoliosis. The lesion was situated in the pedicle in the 15 patients with involvement of the thoracolumbar spine. A surgical approach allowing direct access to the pedicle without entering the spinal canal or jeopardising spinal stability is described. Surgical treatment afforded immediate relief of pain and an early return of full spinal mobility.
Adolescent↗
Quality assurance in hospital medicine: a report.
The Austin Division of Medicine Quality Assurance Programme evaluates the quality of care through reviews of admissions, discharges, deaths, and of outpatient attendances, and through special topic surveys and reviews prepared by providers of care from inside and outside the Division. The main focus of the programme is on the technical quality of medical services although the personal dimension is also discussed. The evaluation of quality of care creates pressures for improvement, primarily through continuing education and by increased administrative awareness of clinical priorities.
Adult↗
Depot penicillin as prophylaxis in accidental wounds.
A series of 285 patients attending an accident and emergency department with wounds which required suturing was divided at random into two equal groups. The first group received a single dose of depot penicillin at the time of suture and the second group received no antibiotic cover. The incidence of subsequent wound infections was not significantly reduced in patients who received penicillin.
Accidents↗