Biomedical subjects

S L Filan

Publications and source records attributed to S L Filan.

8 recordsLinked to original sources

PubMed2005

Long term follow-up of composite non-vascularized toe phalanx transfers for aphalangia.

The results of 21 non-vascularized toe phalanx transfers in 13 patients were reviewed radiologically with respect to function, physeal patency, growth and donor site morbidity at a mean follow-up of 7.4 (range 2.9-13.6) years. Physeal patency was maintained in 4 of 18 surviving transfers. The length of the transferred phalanx averaged 75% of the contralateral comparable toe phalanx and 44% of the contralateral digit proximal phalanx. Most patients had good or simple use of the hand with active joint motion. There was universal shortening of the donor toe with hypoplasia of the middle and distal phalanges. This review suggests that transfer of a non-vascularized toe phalanx provides a reliable but limited means for increasing length of a digit, stabilizing soft tissue "nubbins" and improving function. Longer follow-up has shown more modest gains in growth than in some previous reports.

Epiphyses↗

PubMed2002

The role of biofilm formation in percutaneous Kirschner-wire fixation of radial fractures.

This study examines the formation of bacterial biofilms on percutaneous wires used for fracture fixation. Twelve control (clinically uninfected) wires and ten infected wires were collected and examined using broth culture and scanning electron microscopy. Three of the 12 control wires grew Staphylococcus spp. with very low bacterial counts in their percutaneous portions. In the clinically infected wires, six wires in four subjects had positive cultures in their percutaneous portions and four of these also had positive cultures in their deep portions with much higher bacterial counts than the controls. In two patients (four wires) treated with antibiotics, cultures were negative except for the percutaneous portion of one wire. Scanning electron microscopy did not reveal bacterial biofilm formation, but biological deposit without bacteria was noted on most wires. During the 6 weeks of fracture fixation, some bacterial colonization of wires occurred, but bacteria did not form biofilms which may increase bacterial resistance to systemic antibiotics, cause implant loosening and act as a source of late infection.

Biofilms↗

PubMed1999

Proximal scaphoid nonunion-osteosynthesis.

Proximal pole fractures of the scaphoid have a high incidence of nonunion and avascular necrosis. Because of their poor prognosis, the treatment of these fractures remains controversial. 102 patients with symptomatic nonunion of the proximal pole were treated by simple osteosynthesis, using retrograde screw fixation through a direct dorsal approach to the scaphoid. Fracture preparation and bone grafting were kept to a minimum, in order to preserve as much bone stock as possible, and to avoid damage to the already compromised vascularity of the proximal fragment. No postoperative splinting was used and most patients were able to return to their normal work within a few weeks of surgery. 69 patients were followed-up at an average of 34 months. 59 (85%) were asymptomatic, and had regained excellent wrist function, in spite of the fact that sound radiological union was present in only 50% of these. Union was often slow (3 to 36 months) and appeared to be related to the vascularity of the bone fragments. However, even when bone union was incomplete, the fracture remained stable, with no loss of fixation. The ten patients with unsatisfactory results had all developed late avascular necrosis of the proximal pole, requiring salvage surgery. Stable internal fixation of proximal pole nonunion leads to rapid symptomatic improvement in the majority of cases and sets the scene for revascularisation and healing. Even when union is incomplete the scaphoid remains intact, thus preserving excellent wrist function and, at the same time, offering the best possible long term prognosis.

Adolescent↗

PubMed1998

Vein implantation for treatment of painful cutaneous neuromas. A preliminary report.

Based on the theory that recurrent neuroma formation can be prevented if the cut nerve end is implanted into the lumen of a vein, 14 patients have been treated by neuroma excision followed by proximal vein implantation over the last 5 years. Thirteen patients reported dramatic pain relief following surgery, and this was sustained in all but one case. Both failures were re-explored, when it was found that the nerve had pulled out of the vein, leading to recurrent neuroma formation. Both cases were revised successfully using the same technique. With a mean follow-up of 15 months, 11 patients remain symptom-free, whilst three have minor residual symptoms which are not severe enough to require further surgery.

Adult↗

PubMed1997

The hand and the eye.

A variety of systemic diseases may affect both the hand and eye, leading to profound sensory and functional deficits. The aetiology of some of the most common conditions is reviewed, with an explanation of their manifestations in the hand and eye. Recognition of the association between a hand condition and ocular pathology may aid in diagnosis of a systemic disorder or allow early detection and prevention of ocular disease and loss of vision.

Blindness↗

PubMed1996

The effect of workers' or third-party compensation on return to work after hand surgery.

OBJECTIVES: To investigate the role of compensation in recovery from scaphoid internal fixation. DESIGN: Retrospective review of patients who had had scaphoid internal fixations performed by one surgeon between 1 September 1981 and 31 December 1994 with a minimum follow-up of six months. SETTING: Private practice of a specialist hand surgeon. PATIENTS: 202 patients who attended for the minimum of six months' follow-up, and for whom accurate details of return-to-work time were available. INTERVENTION: Internal fixation of scaphoid fractures using the Herbert bone screw without postoperative immobilisation. MAIN OUTCOME MEASURES: Return-to-work time and compensation status. RESULTS: Overall, patients receiving compensation took more than twice as long as privately insured individuals to return to work after scaphoid internal fixation (7.3 v. 3.3 weeks). There was no difference for clerical workers, but for manual workers compensable individuals took significantly longer (P < 0.001) to return to work. Compensation status did not affect bony union, postoperative wrist function, pain or patient satisfaction. CONCLUSIONS: Compensation encourages a slower return to work after surgery. The current compensation system could save millions of dollars each year by incorporating incentives to return to work without sacrificing good surgical results.

Adult↗

PubMed1996

Herbert screw fixation of scaphoid fractures.

We reviewed the records of 431 patients who had open reduction and internal fixation of the scaphoid performed by one surgeon (TJH) over a 13-year period. The Herbert bone screw provided adequate internal fixation without the use of plaster immobilisation, promoting a rapid functional recovery. On average, patients returned to work 4.7 weeks after surgery and wrist function was significantly improved, even when the fracture failed to unite. Healing rates for acute fractures were better than those reported for plaster immobilisation and were independent of fracture location. In the case of established nonunions, healing depended on the stage and location of the fracture, but the progress of arthritis was halted and carpal collapse significantly improved. Internal fixation of the scaphoid using the Herbert bone screw, although technically demanding, has few complications and appears to offer significant advantages over other methods of treatment.

Acute Disease↗

PubMed1995

Avascular necrosis of the proximal scaphoid after fracture union.

We report four cases of late avascular necrosis (AVN) of the proximal part of the scaphoid following apparent healing of acute scaphoid fractures. One patient had been treated conservatively, by plaster immobilization, and the other three had undergone internal fixation of their acute fractures. The onset of symptoms associated with AVN varied, being as late as 2 years in one patient. Late AVN following healing of a scaphoid fracture does not appear to have been previously recognized, perhaps due to the fact that patients are seldom followed up for long enough. We feel that this condition is in many ways analogous to late AVN following femoral neck fractures and as such is a special complication related to the fact that both bones are intracapsular and have a precarious blood supply.

Adult↗