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Biomedical subjects

R R Richards

Publications and source records attributed to R R Richards.

At least 73 records · Page 4Linked to original sources
PubMed1986

Internal fixation of a capitellar fracture using Herbert screws. A case report.

Fractures of the capitellum can involve a significant portion of the articular surface, rendering the elbow joint unstable. In this situation it is desirable to reduce and internally fix the capitellar fragment, because this restores the articular surface and augments joint stability. A 35-year-old woman sustained a posterolateral dislocation of the left elbow associated with a capitellar fracture. Fixation of the capitellar fragment with Herbert screws stabilized the joint, allowed anatomic reduction, and gave good fixation. Active motion was possible at three weeks. When the patient was evaluated at one year, the fracture had united and there was no evidence of avascular necrosis.

Adult↗
PubMed1986

Bilateral nontraumatic anterior acromioclavicular joint dislocation. A case report.

An incidental finding of bilateral nontraumatic anterior acromioclavicular joint dislocation was made in a 14-year-old boy with spastic hemiparesis. Acromial processes were dislocated anterior to the distal clavicles, with characteristic radiographic findings. The dislocation is termed "anterior" because the clavicle is anatomically more proximal than the acromion. Anterior acromioclavicular joint dislocation usually is associated with significant trauma. There was no history of trauma in this case. Localized laxity of the acromioclavicular and coracoclavicular ligaments was the presumed cause of this condition, because there was no visible osseous abnormality. Since the patient was asymptomatic, no treatment was indicated.

Acromioclavicular Joint↗
PubMed1986

The surgical and rehabilitation management of vascular injury to the hand.

To be truly successful, a revascularized or replanted hand must not only survive but also function. Survival can be achieved by microvascular surgery, but function depends on integration between the initial surgery and subsequent rehabilitation. In this context, the surgical repair of a vascular injury is seen as the first step in the rehabilitation of the hand.

Adult↗
PubMed1986

Fatal fat embolism during cemented total knee arthroplasty: a case report.

Evidence is accumulating that embolization of bone marrow contents to the lungs can cause the hypotension, hypoxemia, cardiac arrest and death reported after total hip arthroplasty and that the embolism results from high intramedullary pressures exerted during implantation of the prosthesis. The authors describe such an occurrence in an 80-year-old man who had a cemented long-stem total knee prosthesis inserted. Autopsy revealed numerous pulmonary fat emboli that were distributed predominantly in arterioles and capillaries. The possibility of pulmonary fat microembolism occurring during cemented total knee arthroplasty should be recognized, particularly when prostheses with long intramedullary stems are used. Preventive or prophylactic measures that should be considered to avoid fat embolism during implantation include venting the intramedullary canal and meticulous lavage to clear away intramedullary debris. Increasing the inspired oxygen concentration as the prosthesis is inserted and monitoring of cardiopulmonary status to avoid simultaneous hypotension and hypoxemia may help to prevent the cardiopulmonary changes associated with pulmonary fat microembolism.

Aged↗
PubMed1985

Chemically induced vasospasm: the effect of ischemia, vessel occlusion, and adrenergic blockade.

Vasospasm in revascularized tissue can compromise tissue perfusion even though the microsurgical anastomoses remain patent. Circulating catecholamine stimulates peripheral vasoconstriction. Chemical vasospasm was induced by the intraarterial administration of norepinephrine to denervated rat hind limbs. Heel pad blood flow was assessed by laser-Doppler velocimetry. Mean blood flow was 463 +/- 106 in the denervated leg and 337 +/- 50 in the opposite (intact) leg (p less than 0.01). Flow in the denervated leg decreased 78 percent (463 +/- 106 to 100 +/- 23) within 5 minutes of norepinephrine administration and did not return to normal for 30 minutes. Norepinephrine administration in the presence of 1 and 3 hours of ischemia decreased flow at 5 minutes to 6.6 and 6.0 percent of normal, respectively (31 +/- 14, 28 +/- 14, control 100 +/- 23; p less than 0.001). Administration of intraarterial norepinephrine distal to a femoral artery occluded for 1 and 5 minutes reduced flow following clamp release to 11.2 and 7.1 percent of normal 5 minutes after clamp release (52 +/- 9, 33 +/- 7, control 100 +/- 23; p less than 0.001). Comparison of the 1-minute and 5-minute groups to each other showed a significant flow decrease in the 5-minute group (p less than 0.007). This indicates that the observed decrease in flow was related both to the presence of a vessel occlusion and to the length of the occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Shoulder arthrodesis for the treatment of brachial plexus palsy.

In 14 adult patients with brachial plexus injuries, shoulder arthrodesis was completed in a position of 30 degrees abduction, 30 degrees flexion, and 30 degrees internal rotation. Abduction was measured by the position of the arm in relation to the side of the body with the scapula in the anatomic position. Internal fixation was used in each case. Six patients had had Steindler procedures. Three patients with complete paralysis were treated by above-elbow amputation. All shoulders fused. Mean follow-up time was 32 months. All patients noted that shoulder fusion had improved the function of their extremities. Minimum shoulder motion was 60 degrees abduction and 50 degrees flexion. Three procedures failed because of continued pain that was not relieved by surgery. One patient with an elbow flexion contracture disliked the combination of shoulder and elbow flexion. Seven patients required plate removal. Only one of the three patients who had had above-elbow amputation became a good prosthetic user. Shoulder arthrodesis is a reliable procedure that improves function in adult patients with brachial plexus palsy.

Adult↗
PubMed1985

Anterior cruciate reconstruction using the MacIntosh lateral-substitution over-the-top repair.

We reviewed the results of a MacIntosh lateral-substitution over-the-top repair for chronic anterior cruciate-ligament insufficiency in thirty-four patients. This technique is a combined intra-articular and extra-articular repair using a strip of the tensor fasciae latae that is based at Gerdy's tubercle. We describe the operative procedure in detail. The patients were evaluated for both subjective and objective improvement. The average length of follow-up was thirty-seven months (range, twenty-four to fifty-nine months). Thirty-one patients (91 per cent) had a good or excellent result and in three patients (9 per cent) the result was rated as a failure. Ninety-seven per cent returned to their preoperative level of activity. There were no significant complications. We recommend this repair as a sound and effective method of treating chronic anterior cruciate-ligament insufficiency in the young to middle-aged symptomatic patient.

Adolescent↗
PubMed1984

Spontaneous retrocarpal radial artery thrombosis: a report of two cases.

Two patients with spontaneous retrocarpal radial artery thrombosis are reported. Both patients had numbness and cold intolerance of the thumb and index finger and one patient had splinter hemorrhages. Angiography revealed identical occlusions of the radial artery over a 2.5 cm segment dorsal to the wrist. Both patients had complete palmar arches. Flow from the ulnar artery was sufficient to prevent frank necrosis of the thumb but not to prevent ischemic symptoms. Both patients were successfully treated by resection of the area of thrombosis and interpositional vein grafting by use of microsurgical techniques. Symptoms resolved after operation in both cases. Follow-up examinations 3 months and 5 1/2 years later revealed continued graft patency.

Adult↗
PubMed1984

Infra-isthmal fractures of the femur: a review of 82 cases.

Eighty-two infra-isthmal fractures of the femur were reviewed in order to develop a fracture classification, to determine the results of treatment, and to define the best treatment methods for certain specific fracture patterns. Type I (transverse or short oblique) fractures were seen in 36 patients (mean age, 33 years). They had a 25% complication rate when treated by open reduction, and a high malunion rate when treated by closed means. Type II (spiral or long oblique) fractures were generally caused by falls, and were seen in 36 patients (mean age, 56 years). Most patients treated by operation had an unsatisfactory result. Malunion was seen in 29% of the patients treated by closed means. The remaining ten patients had either severely comminuted (Type III), or pathological (Type IV) fractures. Intramedullary nail fixation should be used wherever possible in these fractures since many of the complications in the operative group were related to rigid plate fixation. Closed treatment resulted in an unacceptably high incidence of malunion in this study, particularly in Type I fractures. Conventional methods of internal fixation were not successful in dealing with Type II fracture, and alternative methods are proposed.

Adolescent↗
PubMed1984

Metacarpal reconstruction with free autogenous cartilage and bone following tumor resection. A case report.

A 26-year-old woman with a giant cell tumor of the metacarpal bone of the index finger was treated by en bloc resection and metacarpal reconstruction. A free autogenous iliac crest bone graft was used to reconstruct the metacarpal and a free autogenous costal cartilage graft was used to resurface the metacarpophalangeal joint. The bone graft was transfixed with a plate. The patient developed 12 degrees-62 degrees motion at the metacarpophalangeal joint and has maintained a stable joint space for 30 months. Viable hyaline cartilage was present when a biopsy procedure was performed on the joint at five months. The bone graft rapidly incorporated. There has been no evidence of tumor recurrence.

Adult↗
PubMed1984

Fracture of a calcaneonavicular bar: a complication of tarsal coalition. A case report.

Fracture through a calcaneonavicular bar occurred in a 17-year-old boy with bilateral tarsal coalitions. In spite of successful union of the fracture, symptoms persisted, and talonavicular fusion eventually became necessary. The long-term disability that followed was related not to the fracture but to associated peroneal muscle spasm and secondary degenerative change in the midtarsal joints. Talonavicular arthrodesis was insufficient to relieve the pain that resulted from walking on uneven ground; triple arthrodesis may be indicated.

Adolescent↗
PubMed1981

Evidence for expression of Ly-6.2 on non-bone marrow-derived cells in kidney, skin and connective tissues.

Mouse alloantigen Ly-6.2 is detectable in various non-lymphoid tissues such as kidney, but it is not clear whether or not this expression is due to bone-marrow derived passenger leukocytes. To determine whether non-marrow derived cells express Ly-6.2, we examined the expression of this antigen in kidney and on isolated connective tissue and epidermal cells. Studies in radiation chimeras demonstrated that the kidney did not become Ly-6.2 positive when negative animals were reconstituted with positive marrow. Thus, passenger leukocytes cannot account for the renal expression of Ly-6.2, indicating that most of this antigen is on non-marrow-derived (parenchymal) cells in kidney. Various isolated cell types--fibroblasts, osteocytes, chondrocytes and skin epidermal cells--were found to be Ly-6.2 positive. Indeed, absorption and cytotoxicity results suggested that the amount of Ly-6.2 on fibroblasts exceeded the amount of an H-2 antigen on these cells. Comparison of fibroblasts to lymphocytes indicated that fibroblasts had 13--60 times more Ly-6.2 than spleen cells and three times more than PHA blasts. The results indicate that the Ly-6.2 detected in non-lymphoid tissues is predominantly on the parenchymal or connective tissue elements of those tissues.

Animals↗
PubMedDate not supplied

Treatment of locked posterior fracture-dislocations of the shoulder by total shoulder arthroplasty.

Total shoulder arthroplasty is indicated in the treatment of locked posterior fracture-dislocations of the shoulder where there is extensive damage to the articular surfaces of the humerus and glenoid. This report reviews the surgical technique, postoperative rehabilitation program, and functional results of seven shoulders in five patients who had locked posterior dislocations of the shoulder. Activities involving overhead positioning of the arm and heavy lifting continued to be challenging for this group of patients. The American Shoulder and Elbow Surgeons' Shoulder Score improved from 20.1 before surgery to 55.6 after surgery (p = 0.018). The extrication of the posteriorly dislocated humeral head may be difficult from an anterior deltopectoral approach. The authors describe the use of a secondary posterior incision facilitating the extrication of the humeral head. In this series total shoulder arthroplasty reliably decreased the patients' level of pain, improved their range of motion, and significantly improved their level of function.

Adult↗
PubMedDate not supplied

Assessing the reliability and responsiveness of 5 shoulder questionnaires.

The purpose of this study was to compare the test-retest reliability and responsiveness of 5 different shoulder questionnaires in a sample of patients with shoulder pain. Ninety-nine patients completed the following shoulder questionnaires on 2 occasions: Subjective Shoulder Rating Scale, Simple Shoulder Test, Modified-American Shoulder and Elbow Surgeons Form, Shoulder Severity Index, and the Shoulder Pain and Disability Index. The Short Form-36 was also included. Test-retest reliability was assessed with intraclass correlation coefficients. Standardized response means were calculated to assess responsiveness. This procedure was done on 33 subjects who underwent rotator cuff surgery or total shoulder arthroplasty and who believed that they had improved between testings. All questionnaires had acceptable reliability (coefficients > 0.75) except the Subjective Shoulder Rating Scale (coefficient = 0.71) and were more responsive (0.65 < Standardized response mean < 1.23) than the Short Form-36 (0.08 < Standardized response mean < 0.43) except for pain (0.91). In this longitudinal study a direct comparison of 5 shoulder questionnaires was carried out. We found the Subjective Shoulder Rating Scale to have lower reliability and responsiveness. The other 4 questionnaires including 1 developed to measure whole extremity function (Modified American Shoulder and Elbow Surgeons Form) rather than the shoulder only were comparable with good reliability and responsiveness. The results indicate that the shoulder questionnaires were more sensitive to change in patients with shoulder pain than the generic questionnaire (Short Form-36), and both types of questionnaires should be used in outcome evaluations.

Activities of Daily Living↗
PubMedDate not supplied

Functional outcome after the L'Episcopo procedure.

A study was undertaken to assess functional outcome in 11 patients undergoing latissimus dorsi and teres major transfer (L'Episcopo procedure) for external rotation deficient shoulders. The mean age was 37 years (range 18 to 48 years). All of the patients had adult-onset brachial plexus injuries. The mean time for injury to operation was 32 months. Patients were evaluated by questionnaire, measurement of the range of motion, strength testing, and an overhead work simulation. Of the patients studied, 10 of the 11 patients were working (8 returned to their preinjury employment). The cumulative postoperative mean activities of daily living score was 20 (maximum possible 33) compared with 14 before surgery. No complications occurred. Ten patients reported confidence in the limb and believed the procedure was worthwhile. Mean active external rotation of the shoulder at 0 degrees and 90 degrees elevation was 28 degrees (range 15 degrees to 55 degrees and 36 degrees (range 0 degrees to 90 degrees), respectively. Postoperative external rotation strength was 0.32 that of the control side with the arm at the side. Seven of the nine patients tested were able to complete the Valpor overhead work simulation. The L'Episcopo muscle-tendon transfer reliably improves functional outcome in the late functional reconstruction of adult-onset brachial plexus lesions.

Adult↗
PubMedDate not supplied

The effect of comorbidity and duration of nonunion on outcome after surgical treatment for nonunion of the humerus.

The purpose of our study was to assess the effect of comorbidity and duration of nonunion on the general health status and joint-specific outcome of a group of patients treated for nonunion of the humeral shaft. We identified 25 consecutive patients with nonunion of the humeral shaft, all treated with compression plating and bone grafting. Twenty-one patients returned for a comprehensive assessment including completion of the SF 36 Health Status Survey and determination of the Constant shoulder and Morrey elbow scores. Thirteen patients had > or = 1 comorbid conditions. Eleven patients had a nonunion of > 8 months' duration, and 10 had a nonunion of < 8 months' duration. Follow-up at a mean of 42 months (range 12 to 99 months) revealed that all nonunions united an average of 5 months after surgery. The mean Morrey elbow score was 94, Constant shoulder score 82, and "global" SF 36 score 59.4. The physical portion of the SF 36 score correlated well with the Constant and Morrey scores (p = 0.047 and p = 0.027, respectively). The presence of comorbid factors had a significant negative effect on the SF 36 scores (p = 0.001) but no effect on joint-specific Morrey or Constant scores. The duration of nonunion had no effect on SF 36 or joint-specific scores. Although the reliability of the SF 36 is illustrated by the close correlation between its "physical function" portion and standard (joint-specific) outcome measures, comorbidity has a significant negative effect on overall scores. This must be considered when such tools are used for assessment of orthopaedic intervention.

Bone Plates↗
PubMedDate not supplied

A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons.

The American Shoulder and Elbow Surgeons have adopted a standardized form for assessment of the elbow. This form was developed by the Research Committee of the American Shoulder and Elbow Surgeons and subsequently adopted by the membership. The patient self-evaluation section contains visual analog scales for pain and a series of questions relating to function of the extremity. The responses to the questions are scored on a 4-point ordinal scale. The physician assessment section has 4 parts: motion, stability, strength, and physical findings. It is hoped that adoption of this method of data collection will stimulate multicenter studies and improve communication between professionals who assess and treat patients with elbow disorders.

Activities of Daily Living↗