Biomedical subjects
Publications and source records attributed to T A Andrew.
Twenty-two patients with a total of 23 fractures of the olecranon were reviewed after an average period of 26 months (range 5-96 months). All fractures were either comminuted, transverse or oblique fractures with separation of the fragments and all were treated without operation by early active mobilization within 10 days of fracture. Results compare favourably with cases treated by operation.
The long-term results of 134 screw-and-graft fusions of the lumbar spine for treatment of chronic low-back pain with or without acute sciatic nerve symptoms were observed for over 16 years. Clinically, the results were excellent or good in 80% of patients at a mean review interval of nine years. There were no differences in success rates between single-level L4/5 and lumbosacral fusion or two-level fusions. Ninety-seven percent of patients returned to their previous occupation within six months. Screw-and-graft fusion is recommended as an effective method of treatment in management of selected cases of intractable low back pain.
The first 400 patients having cementless isoelastic total hip arthroplasties with a polyacetyl femoral component stem were assessed by independent observers with a minimum review time of two years. Six percent of the patients had died at the time of review; these were mainly elderly patients with subcapital fractures. Ninety-seven percent of the surviving patients appeared for a complete clinical and radiological review. Ninety-two percent of these patients considered that they had a good result following surgery. Six patients (1.6%) developed infection, and three patients (0.8%) required revision procedures, two for femoral loosening and one for recurrent dislocation. Two (0.5%) acetabular components were loose, one of which was associated with infection. In the initial part of the series with narrow-diameter, second-generation femoral components, some had subsided and tilted into varus, but with improved instrumentation and availability of wider diameter femoral components, this problem has been overcome. In order to obtain a more secure mechanical fixation of the femoral component in the medullary canal and to increase implant-bone interface, the third-generation femoral components were used in the latter 48 cases of the series, and clinical and radiological results were excellent with corresponding reduction in the recommended period of gait support. No component had broken. Femoral fractures incurred during surgery by dislocation or impaction had all healed with routine management. These early results are encouraging, but the effectiveness of this prosthesis must be determined by longer follow-up data.
In a five- to 12-year follow-up survey of 179 sequential cementless Ring metal-on-metal total hip arthroplasties, 55 (31%) of the patients were found to have died as a result of nonorthopedic conditions. Analysis of the records demonstrated that 20% of these patients had had poor results attributable to pain. Of the remaining 124 patients, 116 (94%) attended for full clinical and radiologic review yielding a total of 154 hips. Using Ring's classification, 75 hips were judged to have excellent or good results. Forty-one hips were graded as fair or poor as a result of pain, and an additional 15 hips were revised for symptomatic loosening. There were five cases of Brooker Grade IV periarticular ossification, four cases of gross metal reaction requiring prosthetic removal, and two cases of infection. There was considerable variation in the radiographic appearance of the hips, and at times radiographic changes were inconsistent with clinical symptoms. Eleven of the revised hips were converted to longer and larger-diameter uncemented Ring femoral components. Nine of these yielded only fair or poor results at the time of review, whereas both cases in which the femoral component was cemented were associated with good results.
Nine cases of subtrochanteric fracture are reviewed following 300 fixations of subcapital fractures with Garden screws. In six cases technical operative errors were considered to contribute to the fracture. It is stressed that adequate reduction and suitably placed crossed Garden screws are demanding requirements and that every attempt should be made to avoid making extra holes with guidewires. In two technically satisfactory cases the low position of the lower Garden screw-hole in the femur probably predisposed to the subtrochanteric fracture. A computerized two-dimensional finite analysis confirmed smaller magnitudes of stress at a more proximally positioned lower Garden screw, and in patients at risk, particularly those with a valgus femoral neck or valgus reduction, it is suggested that if this method of internal fixation is to be used, the screws should be crossed less obliquely, with the lower screw more proximally positioned in the femur.
Eighty-seven feet have been reviewed after arthrodesis of the first metatarsophalangeal joint stabilised by chromic catgut. Radiological union was present in 90% of patients at the mean review time of six years. Twenty-four patients had significant metatarsalgia before operation and only two failed to improve afterwards. Excellent or good subjective results were reported in 94% of patients at review. Chromic catgut is advocated as a simple and effective method of stabilising an arthrodesis of the first metatarsophalangeal joint.
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We review four generations of a short statured family in whom 12 members have osteochondritis dissecans (O.D.) affecting the knees, elbow, or both, and other minor anomalies of bony development are recorded. Four of the family, unaffected by O.D., exhibit idiopathic scoliosis.
The behaviour and fate of allogenic skin transplanted to rabbit deciduomata was investigated and compared with orthotopic and subcutaneous allografts. Allografts implanted in the decidua of non-sensitized hosts were alive and showed no evidence of immunological rejection 14 days after grafting. The surrounding decidual tissue showed no infiltration by lymphocytes. Allografts in the myometrium of nonsensitized hosts demonstrated immunological rejection as early as 7 days post grafting. Orthotopic allografts on non-sensitized hosts were rejected between 7 and 8 days. Allografts implanted in the decidua of pre-sensitized hosts were alive and histologically healthy 6 days after grafting but showed minimal survival at 8 days. Since rejected grafts were not usually infiltrated with lymphocytes it was concluded that humoral antibody, in the absence of a cell mediated effect, may have procured the destruction of grafts. Subcutaneous allografts in pre-sensitized hosts were rejected between 4 and 6 days after grafting and demonstrated a classical second set type of immunological reaction. The significance of these results was discussed and it as suggested that the decidua, possibly because of its structure, may serve to restrict invasion of its substance by maternal immunocompetent cells thus contributing to the immunologically privileged nature of pregnancy.
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Ther were over 1000 fatal motorcycle accidents in Britain during 1976, which cost the taxpayer over pounds 40 million. There has been a 50 per cent increase in the number of motocyclists treated at Newcastle General Hospital Casualty Department over the past six months. Most accidents occur with young inexperienced male drivers, making elementary driving errors. Suggestions for positive prevention of motorcycle accidents are made. Of paramount importance is the need for consideration of compulsory formal training and enactment of the motorcycle lighting-up law.
Three cases of 'idiopathic pneumoperitoneum' following injury are reviewed. Two cases occurred several days after initial injury and were associated with post-traumatic pneumothorax and artificial respiration. It is likely that artificial respiration induced pneumoperitoneum in these cases. The third case of pneumoperitoneum occurred one hour after initial injury and was associated with bilateral pneumothoraces and pneumopericardium. Congenital abnormalities and tension pneumothorax were thought to account for this case of 'idiopathic pneumoperitoneum'.
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As a contribution to the problem of the immunological privilege of the fetus it was decided to investigate the fate of yolk sac grafts in mice. Ten-day post-coitum mouse visceral yolk sac was transplanted to a dermal tunnel in the flank of isogeneic animals. In this site the yolk sac was capable of surviving for at least 15 days past the normal duration of pregnancy. Yolk sac was transplanted to a similar site in allogeneic animals and was found to be destroyed by an immunological reaction within 13 days. Orthotopic skin grafts between the same strains of mice used in the yolk sac transplantation were rejected in first-set fashion within 13 days. A limited series of host animals, previously sensitized by visceral yolk sac, rejected orthotopic skin grafts in second-set fashion. These findings indicate that the cells of the visceral yolk sac in the mouse contain transplantation antigens. Possible reasons why such antigens do not lead to fetal rejection during pregnancy are considered.
Three patients with primary subacute epiphyseal osteomyelitis are reviewed. All had a history of minor trauma and complained of pain and limp; none was systemically ill. Plain radiographs demonstrated a well-defined lytic lesion in the epiphysis. One case occurred in the distal tibial epiphysis from which pneumococci were isolated; this appears not to have been described previously. Patients were treated with flucloxacillin and two without operative intervention; all recovered completely. Follow-up radiographs at 2-5 years demonstrated healing of the lesions with no evidence of damage to the epiphysis or the joint. There have been 10 previously reported cases in the literature, all treated by antibiotics and curettage. Based on this experience we believe that administration of appropriate antibiotics and immobilisation of the affected limb are sufficient treatment for some children presenting with this condition.