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W A Souter

Publications and source records attributed to W A Souter.

16 recordsLinked to original sources
PubMed1990

Surgery of the rheumatoid elbow.

I suggest that for too long the problem of the rheumatoid elbow, particularly the need for surgical intervention, has been underestimated. Where the latter has been advocated the philosophy has been adopted that synovectomy and debridement with excision of the head of the radius is probably all that is required, or that in the late case excision arthroplasty may yield an adequate result. I suggest that these approaches are no longer tenable. Synovectomy and debridement with or without excision of the head of the radius does indeed retain an extremely valuable place in the management of stage 1, 2, and early stage 3 disease. In the later stages of the disease, however, serious consideration must now be given to total joint replacement, the results of which can be remarkably successful and durable, and the complications from which can now be contained within acceptable limits provided that the operating team is fully experienced. It must also be stressed how necessary it is in the medical or combined clinic to pursue careful clinical and radiological monitoring of the rheumatoid elbow so that signs of dangerous deterioration can be recognised early, and surgery applied at a time when optimal conditions for the particular surgical weapons to be used still exist.

Arthritis, Rheumatoid↗
PubMed1986

Idiopathic hyperphosphatasia with dermal pigmentation. A twenty-year follow-up.

Hyperphosphatasia, or hereditary bone dysplasia with hyperphosphatasaemia, is a rare genetic disorder which is characterised by failure to transform woven into lamellar bone. Clinical, radiological and histological features establish the diagnosis, fractures, deformities, diffuse sclerosis on radiographs and high serum alkaline phosphatase being characteristic. We report the case of a 27-year-old man with follow-up at the same hospital for 20 years. Attempts at treatment with calcitonin and disocium etidronate (EHDP) failed, but stapling of the growth plates at the knee was successfully performed. Transverse "brittle" fractures of the humerus, lower leg and ribs healed normally, but internal fixation and late bone grafting were required for a subtrochanteric stress fracture of the femur at the age of 24 years. At present the patient has no clinical problems and leads a normal life.

Adult↗
PubMed1986

[Planning surgical treatment].

The following should be regarded as prerequisites for successful surgical treatment: careful assessment of the local problem and of the patient as a complete individual; a thorough understanding of the biomechanical implications of the disease and of the operations used in its management; a clear definition of the goals of surgery in both the patient's and the surgeon's minds; and very careful planning with regard to the timing and sequence of operations. Other factors of major importance, especially in multijoint reconstructive programmes, are careful patient selection, the early establishment of good doctor/patient rapport, the support of a highly skilled multidisciplinary team of health professionals, and impeccable supervision of the convalescence, especially at the particularly difficult period for the patient following discharge from hospital. Finally, the hospital team must be prepared to offer a permanent service as a readily available advice bureau for family doctors, patients, and their relatives.

Arthritis, Rheumatoid↗
PubMed1983

The surgical treatment of the rheumatoid shoulder.

Rheumatoid disease of the shoulder may affect not only the gleno-humeral joint but also the other joints of the shoulder girdle complex. Excision arthroplasty of the acromioclavicular and much less commonly of the sternoclavicular joints may be necessary to relieve persistent symptoms. Bursectomyin conjunction with anterior acromioplasty should provide a definitive solution to rheumatoid involvement of the subacromial bursa when this fails to respond to simple aspiration and hydrocortisone injection. Synovectomy has been little employed and perhaps deserves re-appraisal with regard to its role in the management of early cases of glenohumeral disease. Where pain is the predominant presenting symptom and until such time as joint replacement becomes more fully established and reliable double osteotomy may be worth considering as a very simple and in no way irrevocable surgical procedure. Glenoidectomy on the other hand should probably be regarded as obsolete except in cases where total joint replacement will be permanently contra-indicated. Even then arthrodesis may provide a stronger more stable and lasting solution, but before this operation is exhibited, pre-operative investigation must establish that the patient will be able post-operatively to remain independent with regard to routine activities of daily living and in particular perineal toilet. Arthroplasty of the shoulder must still be regarded as being in the developmental if not frankly experimental stage. The results from several sizeable series however are now beginning to show promising results. Moreover the pendulum is tending to swing towards the concept of a minimally constrained joint such as the Neer prosthesis which will mimic anatomical function and minimise the risks of scapular loosening. Careful attention to the soft tissues and very intensive and prolonged post-operative physio-therapy are vital to a successful outcome. It remains to be seen however whether more constrained joints would provide better functional results in the rheumatoid patient with severe bone erosion and rotator cuff destruction. In spite of the problems still to be solved, the author would regard total joint replacement as being the treatment of choice in the markedly eroded gleno-humeral joint presenting with severe pain and limitation of function. Moreover in the event of mechanical failure or infection, it would still seem to be possible to salvage adequate painfree function either by removal of the prosthesis and the creation of a pseudarthrosis or by arthrodesis.

Acromioclavicular Joint↗
PubMed1979

Planning treatment of the rheumatoid hand.

A detailed assessment of the patient as a whole is an essential pre-requisite to the successful planning and execution of surgical treatment of the rheumatoid hand. In particular the decision whether or not to operate must emerge from a careful weighing of the severity of the patient's symptoms, signs and physical disability against the benefits which are likely to accrue from surgical treatment assessed in relation to the patient's own individual requirements. The author presents his personal reflections on the relative merits of the commonly used surgical procedures with reference to their ability to relieve pain, restore function, achieve cosmetic improvement, and prevent further damage, while at the same time carrying minimal risk of further damage to the already impaired function of the hand. Finally, the philosophy which should govern the surgeon - patient relationship during the management of a chronic progressive disease is examined. That it is absolutely essential to establish a sound rapport from early in the surgical programme is strongly emphasised. Some guidelines as to the design of the programme are also provided.

Arthritis, Rheumatoid↗
PubMed1977

Radiation osteitis following irradiation for breast cancer.

Radiographs of the shoulder girdle were examined in 180 women who attended the breast follow-up clinic at the Department of Radiotherapy, Edinburgh. These comprised 52 controls who had been treated by radical mastectomy alone and 128 patients who had received post-operative X-ray therapy. The significance of osteoporosis as a sequel to irradiation is doubtful as it occurred in a substantial proportion of the control cases. Osteitis of severe degree occurred in 13.3% of patients who had been irradiated and was present in a mild form in a further 8.6%. The development of severe osteitis requires an NSD of 1650 rets or more. Estimates of the frequency of radiation osteitis are of no value unless detailed information is also provided about the techniques and quality of radiation.

Aged↗