False aneurysm of the anterior tibial artery following removal of tibial plate.
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Adult↗
Biomedical subjects
R S Majkowski
Publications and source records attributed to R S Majkowski.
The effect of bleeding on the cement-bone interface. An experimental study.
A model was developed to simulate bleeding from cancellous bone at the physiologic pressures and flow rates that can occur during total hip arthroplasty. The consequences of simulated bleeding on the penetration of bone cement into cancellous bone, the shear strength of the cement-bone interface, and the shear strength of bone cement were investigated. In the presence of active bleeding, the shear strength of the cement-bone interface was reduced significantly in 50% of interfaces in which cements of lower viscosity were used. The simulated bleeding did not exert a detrimental effect on the depth of cement penetration.
Animals↗
Bone surface preparation in cemented joint replacement.
We studied the effects of nine techniques of bone surface preparation on cement penetration and shear strength at the cement-bone interface in a standard model of bovine cancellous bone. In unprepared bone the mean penetration was 0.2 mm and the mean shear strength of the interface was 1.9 MPa, less than that of the underlying bone. Brushing with surface irrigation gave mean penetrations of 0.6 to 1.4 mm and mean shear strengths of 1.5 to 9.9 MPa. In 50% of specimens the interface was weaker than the underlying bone. The use of pressurised lavage resulted in mean penetrations of 4.8 to 7.9 mm and mean shear strengths of 26.5 to 36.1 MPa, which were greater than those of the cancellous bone in all specimens. Pressurised lavage was equally effective alone or in combination with brushing, and its efficacy was not altered by using pulsed or continuous jets, or by changing the temperature of the solution from 21 degrees C to 37 degrees C.
Animals↗
Treatment of fixed flexion deformities of the knee in rheumatoid arthritis using the Flowtron intermittent compression stocking.
Thirty established fixed flexion deformities of the knee in 18 rheumatoid arthritis patients were studied prospectively to assess the results of 8 weeks of out-patient treatment using the Flowtron intermittent compression stocking. A 44% mean correction of the fixed flexion deformity was obtained from an initial mean of 29 +/- 1 degrees to 16 +/- 1 degrees (P less than 0.001). More than 85% of this correction was obtained in the first 4 weeks of treatment. There was a significant correlation between the correction obtained and the inflation pressure (P less than 0.05), but the time of daily use (minimum 60 min) was not a significant factor. The modified Stanford Health Assessment Disability Index fell from an initial mean of 2.17 to 2.03 (P less than 0.01).
Ambulatory Care↗
Interlocking nails for femoral fractures: an initial experience.
We report the results of the first 50 femoral interlocking nails used in our city. The operations were performed by 20 different surgeons. The follow-up interval averaged 19 months. Five patients with pathological fractures died during this period and two could not be traced. Forty-three fractures were assessed clinically and radiologically by one of the authors. Malunion and/or shortening occurred in 22 patients. Six patients had varus (greater than 5 degrees), ten patients valgus (greater than 5 degrees) and ten patients had malrotation (greater than 10 degrees). Six patients were shortened (greater than 2 cm). Two cases progressed to non-union (greater than 26 weeks), and one had deep sepsis. We discuss the effect of insertion point, dynamic versus static fixation and the lateral table position on the final results. It is concluded that: 1. The nail should be inserted in line with the axis of the femoral shaft. This point is usually in the piriform fossa. 2. The static mode should be used for most fractures. 3. The lateral table position may result in rotational and valgus malalignment.
Adolescent↗
Postoperative collection and reinfusion of autologous blood in total knee arthroplasty.
A series of 40 patients undergoing primary unilateral total knee arthroplasty were entered into a randomised controlled trial to assess the safety and efficacy of postoperative autologous blood salvage and reinfusion. The mean volume of autologous blood reinfused was 520 ml per patient (51% of the mean total drainage). Homologous blood transfusion was required in only 35% of patients in the study group compared with 95% of patients in the control group (P less than 0.001). The mean volume of homologous blood transfused was 0.9 units per patient in the study group compared with 2.5 units in the control group (P less than 0.001), a saving of 64%.
Aged↗
Excision arthroplasty for hallux valgus in the elderly: a comparison between the Keller and modified Mayo operations.
A retrospective clinical and radiological review of 51 patients (mean age 66 years) was performed to assess the outcome of excision arthroplasty for hallux valgus in an elderly population and to compare the results of the Keller, which is still used frequently in many centers in the United Kingdom, and modified Mayo operations. Although significant correction of the deformity was obtained with both procedures, this was incomplete and the mean residual hallux valgus angle was greater than 20 degrees. Lateral metatarsalgia was present in over 40% of patients. Both procedures provided good pain relief, and considerable narrowing of the forefoot was obtained with the modified Mayo operation. Excision arthroplasty in the elderly should be reserved for the low demand patient with symptomatic degenerative changes in the first MP joint in the absence of lateral metatarsalgia.
Aged↗