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Biomedical subjects

P Burge

Publications and source records attributed to P Burge.

At least 19 recordsLinked to original sources
PubMed2006

Failure of surgery for scaphoid non-union is associated with smoking.

Scaphoid fractures predominantly affect young men, in whom the UK smoking prevalence approaches 40%. We examined the association between smoking and failure of non-vascularized bone grafting and screw fixation for scaphoid non-union and delayed union in a retrospective cohort study. Adequate follow-up was obtained in 64 of 87 patients treated (74%). Union was defined as the presence of trabecular continuity on at least two films from a four-view radiographic series. Union was achieved in 47 of 64 cases. Seventeen were smokers. Thirteen of the 17 patients with non-union were smokers (relative risk 3.7; 95% CI: 1.3-10.1, p=0.005). Proximal pole fractures, long injury-grafting interval and non-compliance were not more frequent in smokers than non-smokers. Smoking is strongly associated with failure of union after screw fixation and non-vascularized bone grafting of the scaphoid. Smokers should be advised to avoid smoking pre-operatively and during the healing period.

Adult↗
PubMed2004

Pre-osteotomy plate application technique for ulnar shortening.

The self-compressing mode of the AO/ASIF LC-DC plate can be harnessed to close and compress modest osteotomy gaps that are created after provisional application of the plate with two screw holes on either side of the osteotomy. The oblique osteotomy cuts are made through 70% of the bone diameter and the actual osteotomy width is measured. After provisional plate application and removal, the cuts are completed and the plate is re-applied. Eccentric drilling of up to five holes of a 6-hole plate using the 3.5 mm universal drill guide allows closure and compression of osteotomy gaps of up to 4 mm. An interfragmentary screw is placed across the oblique osteotomy through the remaining hole. The technique is simple but requires careful planning and execution.

Biomechanical Phenomena↗
PubMed2001

Localized amyloid deposition in trigger finger.

Trigger finger is due to degeneration and thickening of the proximal portion (A1 pulley) of the flexor tendon sheath, which causes constriction of the flexor tendon. This study reports the presence of localized amyloid deposition in the tendon sheath of 11 of 47 cases (23%) of idiopathic primary trigger finger. Amyloid deposits were only found in patients aged over 46 years old and were present around cells and at sites of mucinous and fibrinoid degeneration which contained highly sulphated glycosaminoglycans. The pathogenic significance of these deposits is uncertain but their small size and presence only in middle-aged and elderly adults suggests that they represent a form of age-associated amyloid deposition.

Adult↗
PubMed2001

Screening for extensor tendon rupture in rheumatoid arthritis.

OBJECTIVE: Surgery can prevent extensor tendon rupture in the rheumatoid wrist but it is difficult to identify patients at risk. Extensor digiti minimi (EDM) usually ruptures first, but rupture may pass unnoticed because extensor digitorum communis (EDC) extends all four fingers simultaneously. We assessed the value of screening for EDM rupture by examining for absent independent extension of the little finger in a hospital rheumatoid arthritis population. METHODS: The EDM test was performed in 550 previously unoperated wrists. Disease activity, joint damage, wrist swelling, tenderness and crepitus were recorded. RESULTS: Unsuspected EDM loss was found in nine of the 550 wrists (1.6%); dorsal synovitis was absent or minimal in eight and ulnar tenderness was absent in six. EDM loss was not associated with activity, severity or duration of disease. CONCLUSIONS: The EDM test is simple and cheap. It may identify patients at risk and permit prophylactic surgery before hand function is lost.

Arthritis, Rheumatoid↗
PubMed2001

Closed cast treatment of scaphoid fractures.

Cast immobilization of the wrist remains the treatment of choice for stable fractures of the waist and distal pole of the scaphoid. Criteria for diagnosis of stability should be stringent; plain radiographs may be misleading. CT may provide more accurate information on displacement. Immobilization of the thumb confers no advantage and restricts function unnecessarily. Evidence to support immobilization of the elbow is weak, but it may be useful for selected fractures. A cast does not protect the carpus from the effects of axial loading, which can produce large angulatory forces at the fracture. A gap or fracture offset of 1 mm or more are indicators of instability with potential for nonunion or malunion; internal fixation should be considered for these fractures. Internal fixation may also be considered routinely for proximal pole fractures, regardless of the degree of displacement, in view of their long healing time and high risk of nonunion after cast treatment.

Casts, Surgical↗
PubMed2000

The role of MRI in the assessment of scaphoid fracture healing: a pilot study.

Twenty-two patients with fracture of the scaphoid treated by cast immobilisation underwent clinical examination, radiography and MR scanning 6 weeks after injury. On clinical and plain radiographic criteria alone, 12 patients were considered sufficiently healed to warrant mobilisation. The remaining 10 patients were considered unhealed and were immobilised for a further period. A musculoskeletal radiologist, blinded to the clinical diagnosis, reviewed the MRI scans. Of the 10 patients considered unhealed, 5 had the MR appearances of a united fracture, based on normal marrow signal across the fracture line on T1-weighted images. Of the 12 patients deemed to have united, union could be confirmed by MRI criteria in only 5, but all 12 were healed at 1 year. The results suggest that MRI can provide additional information in this group of patients. It can confirm bony union in a high proportion of patients deemed clinically non-united. Its use in this context will allow a more rapid mobilisation and return to normal function. The significance of persistent MR signal abnormalities in patients who have clinical and radiographic signs of healing merits further study.

Adult↗
PubMed1999

Genetics of Dupuytren's disease.

The striking variation in prevalence, approaching 30% in individuals over the age of 60 years in Norway, is strong evidence for an inherited susceptibility to Dupuytren's disease. In many pedigrees, inheritance appears to follow the autosomal dominant model. Other modes of inheritance are consistent with the data, however, and it remains unclear whether the many apparently sporadic cases have a genetic basis. The inherited susceptibility may influence tissue's sensitivity to the effects of environmental exposures. High prevalence, late age of onset, and the possibility of nongenetic cases are features of Dupuytren's disease that complicate genetic studies, as can be seen from estimates of relative risk. Identification of susceptibility loci is a worth-while goal as it may throw entirely new light on the nature of Dupuytren's disease and ultimately may open avenues to new treatments.

Age of Onset↗
PubMed1997

Smoking, alcohol and the risk of Dupuytren's contracture.

We investigated the association of Dupuytren's contracture with smoking and with alcohol by a case-control study in which 222 patients having an operation for this condition were matched for age, operation date and gender with control patients having other orthopaedic operations. Fifty of the cases were also each matched with four community controls. Data were collected by postal questionnaire. Dupuytren's contracture needing operation was strongly associated with current cigarette smoking (adjusted odds ratio 2.8 (95% confidence interval (CI) 1.5 to 5.2)). The mean lifetime cigarette consumption was 16.7 pack-years for the cases compared with 12.0 pack-years for the controls (p = 0.016). Dupuytren's contracture was also associated with an Alcohol Use Disorders Test score greater than 7 (adjusted odds ratio 1.9 (95% CI 1.02 to 3.57)). Mean weekly alcohol consumption was 7.3 units for cases and 5.4 units for controls (p = 0.016). The excess risk associated with alcohol did not appear to be due to a confounding effect of smoking, or vice versa. Smoking increases the risk of developing Dupuytren's contracture and may contribute to its prevalence in alcoholics, who tend to smoke heavily.

Alcohol Drinking↗
PubMed1991

Computer-aided localisation of peripheral nerve lesions.

The clinical localisation of peripheral nerve lesions can sometimes be difficult, particularly following injury to the brachial plexus when multiple lesions are often present. In this situation, computers may be of assistance in interpreting the complicated patterns of clinical findings. This paper describes the evaluation of a computer program that uses a simulation model of the consequences of nerve injury, based on a representation of the relevant anatomy. A retrospective study of 26 patients with upper limb nerve lesions was carried out. The computer program compared favourably with three clinicians in interpreting the findings correctly. It is suggested that this approach may be transferable to other applications.

Arm↗
PubMed1991

Deposition of calcium pyrophosphate dihydrate crystals in a soft tissue chondroma.

Calcium pyrophosphate dihydrate (CPPD) crystal deposits were found in an extraarticular chondroma of the soft parts overlying the distal phalanx of the right middle finger. The lesion appeared to arise from the flexor tenosynovium. The pathogenesis of soft tissue chondroma and the relation of cartilage metaplasia to the process of CPPD crystal deposition were investigated.

Aged↗