Biomedical subjects
Publications and source records attributed to S R Bollen.
We report a case of intra-articular calcification involving the knee joint secondary to primary hyperparathyroidism. This caused significant disability to the patient and following excision of the calcified mass the patients knee function returned to normal. This feature of hyperparathyroidism has not been previously reported.
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We report the design of a surgical instrument that facilitates the harvest of the autologous patellar tendon in anterior cruciate ligament (ACL) reconstruction. The advantage of this jig is that it is a simple, self-centring device resulting in a reproducible and consistent autograft. Its use also minimises the potential risks of donor site morbidity such as patellar fracture and tendon rupture. We briefly describe our technique and discuss its advantages.
One hundred and seventeen consecutive patients with 119 anterior cruciate deficient knees presenting to a knee clinic were studied to analyse an apparent poor diagnosis rate by referring doctors. The diagnosis had been made by the original treating physician in only 9.8 per cent of cases. Thirty per cent of the patients had been seen by an orthopaedic consultant without the diagnosis being made. Thirty-six patients had undergone 51 invasive investigations, including arthroscopy, without the diagnosis being made. This was despite 90 per cent of patients having a typical history and all having unequivocal physical signs. The average delay in diagnosis was 21 months.
Ankle fractures requiring either manipulation under anaesthetic or open reduction and internal fixation can lead to prolonged morbidity. This prospective study investigates the possible relationship between obesity and the severity of ankle fractures following low velocity injuries. The body mass index (BMI) of patients with displaced malleolar fractures was compared with that of patients with undisplaced malleolar fractures. A BMI of 18 to 25 kg/m2 is considered to be the 'desirable' range for both men and women. Fractures considered 'severe' were those associated with disruption of the ankle joint, with more than one malleolar fragment, and requiring manipulation under anaesthesia or open reduction and internal fixation. The mean BMI of patients with displaced fractures (28.25 kg/m2) was significantly higher than that (24.58 kg/m2) of those with undisplaced fractures (P = 0.0001). Obesity is associated with increased severity of ankle fractures following low velocity injuries.
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Radiographs of the hands of 36 rock climbers were compared with radiographs of the hands of controls matched for age and sex. Subchondral cysts were present in the hands of 17 climbers and only two controls. Osteophytes or bony spurs were present in 14 climbers but not in any of the controls, and the only two cases of frank osteoarthrosis were in the hands of climbers. Cortical thickness of the proximal and middle phalanges was significantly greater in the hands of climbers (P = < 0.01). Pronounced 'scalloping' of the necks of the proximal phalanges was only seen in climbers, and is due to thickening of the attachment of the distal end of the fibrous A2 pulley of the flexor sheath.
One hundred and eight patients having undergone arthroscopic anterior cruciate replacement and having had continuous passive motion (CPM) as part of their immediate post-operative regime were prospectively compared with 108 patients having an identical operative procedure but not receiving CPM. All patients were operated on by the same surgeon, and the two groups were well matched for age, weight and associated injuries and procedures. Those not receiving CPM required significantly less analgesia (P = 0.0001), had less blood loss measured in the drains (P = 0.001) and had a shorter hospital stay (P = 0.0001). At review 6 months after surgery, there was no significant difference between the two groups in the range of movement of the operated leg compared to the normal leg.
The performance of competition climbers in laboratory-based tests of pinch and whole hand grip strength and endurance was compared to that of non-climbers of the same age, sex and physique. Climbers performed significantly better, indicating higher stresses acting in the flexor mechanism, possibly predisposing injury. Attempts were made to correlate the performance in the tests to climbing achievement, measured by current technical climbing standards. Although pinch grip strength increased with the length of climbing experience, there was no evidence that strength in the hands alone guarantees success in competition climbing.
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Injury to the A2 pulley of the flexor sheath, resulting in bow-stringing of the flexor tendons, would appear to be fairly common in rock climbers performing at the present limits of difficulty. A typical case is described.
All 67 of the competitors at the first British Open climbing competition were examined for signs of previous or present hand injury. The most important clinical findings were that 26 per cent of the climbers had signs of previous injury to the A2 pulley of the ring finger, and that fixed flexion deformity of the proximal interphalangeal joints of the fingers was present in 24 per cent.
Rockclimbing is now a popular sport and its standards have undergone a revolution in the past 10 years. Improvements in protection techniques and the quality of climbing equipment mean that the old problems of broken bones have been replaced by a new set of soft tissue problems. These include the impingement syndrome at the shoulder, lateral and medial epicondylitis and brachialis tendinitis at the elbow, and fixed flexion deformity and A2 pulley injury of the fingers.
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Rock climbing is an increasingly popular sport. Its standards of difficulty have undergone a revolution in the past ten years. Regular training is now almost mandatory for the aspiring climber, but little has been published about the patterns of soft tissue injury to which climbers are susceptible. This paper aims to identify some of the common injuries that may be encountered, some of which do not appear to be associated with other sports.
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Five cases of anterior cruciate ligament reconstruction, performed for symptomatic episodes of giving way or during surgery for associated injury, were carried out in preepiphyseal closure adolescents (ages 12-15 years), utilising a strip of iliotibial band placed over the top of the lateral femoral condyle in a MacIntosh type repair, and avoiding drilling through epiphyseal plates. At a mean follow-up of 4.4 years, all five were symptomatically satisfactory and all five patients had returned to their preinjury level of sports activity. Although objective assessment revealed that increased laxity, when compared to the normal leg anterior laxity measured by the KT-1000, was within normal limits in four of five patients. Only one patient, who had had a fracture of the contralateral femur, had any leg length discrepancy.
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