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Biomedical subjects

R S Bryan

Publications and source records attributed to R S Bryan.

At least 19 recordsLinked to original sources
PubMed1991

Total replacement for post-traumatic arthritis of the elbow.

Fifty-three of 55 consecutive elbow replacements for post-traumatic arthritis were followed for a minimum of two years (mean 6.3, range 2 to 14.4). The patients presented difficult management problems, having undergone an average of two previous operations per joint; 22 joints had suffered prior complications; 18 had less than 50 degrees of flexion and six were flail. One of three versions of the Coonrad prosthesis was employed in all. During the follow-up period, 10 patients underwent 14 revision procedures for aseptic loosening; 38 elbows are currently without progressive radiolucent lines. In two patients an elbow had to be resected, one for deep infection and the other for bone resorption following a foreign-body reaction to titanium. The current design of the Coonrad prosthesis offers a reliable option for the treatment of post-traumatic arthritis but should be used only in carefully selected patients over the age of 60 years.

Adult↗
PubMed1979

Mechanical cornpicker hand injuries.

The mechanical cornpicker causes tearing anse injuries from 1962 to 1975 were studied with regard to mechanism and extent ohe time of injury in 36% of hands, and in 73% of the remainder following treatmophylaxis, and antibiotics, and 73% hands required some form of delayed surgical treatment. Antibiotics did not appear to be helpful. Eighty-nine ps the most common cause given for farmers for their injuries. Excluding four pr permanently disabled patients, the average length of disability was 135 days. Eighty-nine per cent of patients experienced some permanent impairment of hand function. The mechanical cornpicker is described, and the importance of its proper use and physician's emphasis on accident prevention as well as treatment are stressed.

Adolescent↗
PubMed1979

Arthrodesis of the knee following failed total knee arthroplasty.

In forty-five patients, who had an arthrodesis because of failed total knee arthroplasty, the cause was infection in forty, instability in two, failure of the prosthesis in two, and loosening in one. The arthrodesis succeeded in twenty-nine (81%) of thirty-six patients who had had a minimally or partially constrained arthroplasty and in five (56%) of nine who had had a hinge-type prosthesis inserted. The reasons for failure were severe bone loss, persistent sepsis, and loss of bone apposition after manipulation. The technique of arthrodesis did not seem to influence the final result. External fixation most commonly had to be used because of the infections and the device was kept in place for an average of ten weeks, after which immobilization in a cast was used until the arthrodesis healed.

Adult↗
PubMed1979

Total joint arthroplasty. The elbow.

The first total elbow arthroplasty at the Mayo Clinic was performed in 1972, and it provided markedly superior results compared with previously performed procedures for elbow arthritis. However, a high revision rate (14%), due mainly to loosening (75%), tempered early enthusiasm for the procedure. Prospects for improved design and surgical technique based on our clinical experience and biomechanical data are encouraging. For the present, however, more limited procedures are recommended, and the total elbow arthroplasty is reserved for only a relatively few patients for whom there are no other viable surgical options.

Arthritis↗
PubMed1978

Osteochondritis dissecans of the knee with loose fragments. Treatment by replacement and fixation with readily removed pins.

We reviewed six patients with a five to fifteen-year follow-up and a seventh with shorter follow-up who underwent replacement and fixation with easily removable pins of large osteocartilaginous fragments resulting from osteochondritis dissecans. Excellent or good results were achieved in all but one patient. Preparation of the fragments to fit into their vascularized beds prior to internal fixation is advisable, and in some cases the bed should be partially filled with cancellous bone before the fragments are replaced. Immobilization is prescribed until the pins are removed three to six weeks after surgery. Weightbearing is delayed until there is roentgenographic evidence of beginning union of the fragment to the underlying bone.

Adolescent↗
PubMed1977

Total replacement of the elbow joint.

Total replacement of the elbow joint has been performed on 86 elbows at the Mayo Clinic, all but 15 in patients with rheumatoid arthritis. The Mayo design, which replaces both radiohumeral and humeroulnar joints, was used in 41 elbows, almost all in rheumatoid patients, with 71% good results. The Coonrad hinge with polyethylene bushings was used in 34 elbows; it was successful in 64% of rheumatoid patients, but failed in 46% of posttraumatic patients with bone loss. Previous designs have failed because of humeral loosening. Total elbow replacement is a technique still to be perfected in medical centers before general release.

Arthritis, Rheumatoid↗
PubMed1977

The Moberg deltoid-triceps replacement and key-pinch operations in quadriplegia: preliminary experiences.

The use of the tendons of the lateral four extensors of the toes in order to transfer the pull of the posterior deltoid to extend the elbow is successful in the OCu:2 quadriplegic patient. The Moberg operation for key pinch in its various modifications also improves the function of these patients and is well received by them. The necessity for prolonged protecton (three months) and for simplicity in surgical procedures in these patients is illustrated in seven patients.

Adolescent↗
PubMed1977

Wide-track polycentric total knee arthroplasty: one year follow-up study.

The use of a peritoneal catheter enhances diagnosis using arthroscopy by affording a clear visibility of the knee joint. The accuracy in diagnosis is significantly enhanced using this method of irrigation. No better method of irrigation is available for cases of acute knee joint injuries.

Adult↗
PubMed1976

Review and analysis of silicone-rubber metacarpophalangeal implants.

A series of 530 consecutive arthroplasties using silicone-rubber implants in 119 patients was reviewed. Clinical and roentgenographic evaluations were completed on sixty patients and 254 implants, with an average follow-up of two and a half years; the remaining fifty-nine patients were evaluated by questionnaire. All but three patients had rheumatoid disease, usually with severe deformity, and many of the patients underwent other procedures on the upper extremity; these procedures often precluded early motion after the arthroplasties. Three prostheses (0.6 per cent) were removed because of infection, and reoperation was required in 2.4 per cent of the joints. Detailed clinical follow-up of 254 prostheses revealed the following: for Swanson prosthesis-average motion 38 degrees, fracture rate 26.2 per cent, and recurrence of clinical deformity 11.3 per cent; for Neibauer prostheses-average motion 35 degrees, fracture rate 38.2 per cent, and recurrence of clinical deformity 44.1 per cent. It should be noted that use of early implant types and some variations from the designer's recommended rehabilitation protocols were features of this series.

Adolescent↗
PubMed1976

Ultrasound evaluation of the popliteal space. Comparison with arthrography and physical examination.

Ultrasound scanning techniques were used to examine the popliteal space in 102 knees. In 30 of 34 knees in which arthrograms were also obtained, the information obtained from both tests was the same. In two instances in which there were different results, the presence of palpable popliteal cysts was confirmed by ultrasound scans but not by arthrography, and in two other cases, small asymptomatic cysts were seen on arthrograms but not on ultrasound scans. In the 68 other knees, ultrasound scans were helpful in the differential diagnosis of popliteal cysts, popliteal artery aneurysms, thrombophlebitis, and a solid poplitieal mass. The results indicate that ultrasound scanning is a valuable, rapid, safe, accurate technique in evaluating patients with symptoms or findings related to the popliteal space.

Aneurysm↗
PubMed1976

Polycentric total knee arthroplasty. A two-year follow-up study.

Polycentric total knee arthroplasty provided significant relief of pain in 86 per cent of 500 knees. The independence and activity levels of the patients increased dramatically. The frequency of major complications as reflected by reoperation was 10 per cent in this series. There was a 2.8 per cent deep infection rate. One-third of the infected knees were salvaged and two-thirds required arthrodesis. Loosening of a component was noted in 2.4 per cent. After operation the average range of motion was from 6 to 101 degrees of flexion, for a range of 95 degrees; this was a 5-degree increase over average preoperative motion. Ninety-six per cent of the patients expressed satisfaction with the surgical result.

Adult↗
PubMed1976

A statistical evaluation of polycentric total knee arthroplasties.

Four hundred nineteen knees in 299 patients were examined preoperatively and at two years after polycentric total knee surgery. One hundred forty-three knees were in 109 patients with osteoarthritis. Two hundred seventy-six knees were in 190 patients with rheumatoid arthritis. Pain decreased significantly, use of aids decreased significantly, and distance walked increased significantly in both groups. Rheumatoid patients did not fare as well as osteoarthritics in the use of aids and distance walked. Osteoarthritic knees had proportionately more implant settling, implant loosening and reoperations than did rheumatoid arthritic knees.

Arthritis, Rheumatoid↗
PubMed1975

Total knee arthroplasty after septic arthritis.

Total knee arthroplastie were performed as salvage procedures in 1- patients with irreversible knee destruction secondary to bacterial arthritis. All now have functioning knees that are pain-free and average 85 degrees of motion. None has evidence of clinical infection at present. These patients are not yet regarded as cured. They may remain at risk for the development of late reinfections. This procedure is not advocated as the operation of choice for patients with knee joint destruction secondary to bacterial arthritis. We emphasize the risk involved and the necessity for obtaining the informed consent of the patient before proceeding with total knee arthroplasty when there has been previous infection.

Aged↗
PubMed1975

Unicompartmental polycentric knee arthroplasty: description and preliminary results.

Unicompartmental polycentric knee arthoplasty is a procedure that we have performed in relatively few patients whose disease has not been suitable for conventional reconstruction or for total knee replacement. Preoperative and postoperative evaluations and operative technique differ little from that previously published for total knee arthroplasty. One-year follow-up of 14 knees (13 patients) reveals no major complications. These early results encourage further trial of the procedure in selected patients. Unicompartmental arthroplasty is reserved for conditions affecting predominantly one side of the joint. More specific indications are clearly defined and pertain to patients who have osteoarthritis unsuitable for valgus upper tibial osteotomy, condylar fracture and necrosis, and failure of osteotomy and tibial plateau prosthesis.

Aged↗