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W Angus Wallace

Publications and source records attributed to W Angus Wallace.

12 recordsLinked to original sources
PubMed2005

Reconstruction of the deltoid and acromion after failed acromionectomy.

UNLABELLED: Ten patients who had reconstruction of the acromion and deltoid in a painful dysfunctional shoulder after an acromionectomy were reviewed with respect to pain, range of motion, strength, patients' satisfaction, and complications. There were four total acromionectomies, five subtotal acromionectomies, and one partial acromionectomy. The retracted deltoid and defect of the bony acromion were reconstructed with a composite graft consisting of tricortical iliac bone with fascia lata. At an average followup of 58 months, the mean active forward flexion improved from 53 degrees to 122 degrees. All patients reported considerable relief of pain and three had no pain; however, the patients who had a supplementary cuff repair had poor results. The average UCLA score of the patients improved from 6.6 to 26.3. The score of the patients with intact rotator cuffs improved from 7.0 to 32.0, whereas patients who had rotator cuff tears had scores that improved from 6.2 to 20.4. Our clinical results suggest that reconstruction of the acromion and deltoid using an iliac bone graft and fascia in failed acromionectomy can lead to relief of pain and the improvement of shoulder function. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series-no, or historical control group).

Acromion↗
PubMed2004

Multinational survey of osteoporotic fracture management.

Osteoporosis is characterized by a decreased bone mass and an increased bone fragility and susceptibility to fracture. Patients with a fragility fracture at any site have an increased risk of sustaining future fractures. Orthopedic surgeons manage most of these fractures and are often the only physician seen by the patient. Mounting evidence that orthopedic surgeons are not well attuned to osteoporosis led the Bone and Joint Decade (BJD) and the International Osteoporosis Foundation (IOF) to survey 3,422 orthopedic surgeons in France, Germany, Italy, Spain, the United Kingdom, and New Zealand. The majority of the respondents in all countries had the opinion that the orthopedic surgeon should identify and initiate the assessment of osteoporosis in patients with fragility fractures. Heterogeneous practice pattern exist in different countries; however, identification and treatment of the osteoporotic patient seems to be insufficient in many areas: half of the orthopedic surgeons surveyed received little or no training in osteoporosis. Only approximately one in four orthopedic surgeons in France, the UK and New Zealand regarded themselves as knowledgeable about treatment modalities. Less than one-fifth of the orthopedic surgeons arranged for a surgically treated patient with a fragility fracture to have a bone mineral density (BMD) test. Twenty percent said that they never refer a patient after a fragility fracture for BMD. Only half of the orthopedic surgeons in southern Europe know about the importance of some external risk factors for hip fractures (cataracts, poor lighting, pathway obstacles, poor balance). In summary, this survey clearly indicates that many orthopedic surgeons still neglect to identify, assess and treat patients with fragility fractures for osteoporosis. More educational opportunities need to be offered to orthopedic surgeons through articles, web-based learning and educational seminars. Development of a simple clinical pathway from evidence-based guidelines is an important step to ensure that optimal care is provided for patients with fragility fractures.

Attitude of Health Personnel↗
PubMed2002

Double-blind comparison study of two doses of botulinum toxin A injected into calf muscles in children with hemiplegic cerebral palsy.

Despite several trials showing reductions in tone and improvements in gait, the relation between botulinum toxin A (BTX-A) dose and response has rarely been investigated. A double-blind randomized comparison of two doses of BTX-A in children with spastic hemiplegic cerebral palsy (n=48, mean age 7 years 6 months, range 3 to 15 years) was undertaken. The two doses selected were representative of the lower and the higher doses used in clinical practice (24 units/kg body weight and 8 units/kg body weight). Using gait analysis we evaluated hip, knee, and ankle joint kinetics and sagittal kinematics throughout the gait cycle. Gastrocnemius muscle length was calculated at each visit using the method described by Eames and used as our primary outcome measure. Our secondary outcome variable was maximum ankle angle measured during stance and swing phases. In summary, we found that there were indications that 24 units/kg body weight was more effective and lasted longer than 8 units/kg. Analysis in terms of absolute dose suggested that the dose-response correlation was non-linear, and that the optimal range lay between 200 and 500 units BTX-A (Dysport).

Adolescent↗
PubMed2002

Comparing injuries of spin bowling with fast bowling in young cricketers.

OBJECTIVE: To compare the incidence and anatomic distribution of injuries sustained in spin and fast bowling in young cricketers. DESIGN: A prospective cohort study. Physical characteristics and retrospective data (sporting involvement and previous injuries) from young cricketers were recorded. The cohort of young cricketers was divided according to style of bowling into a group of spin bowlers and a group of fast bowlers. Data from the spin bowler group was compared with the data from the fast bowler group to assess whether these groups were matched. A prospective study of injuries sustained by the bowlers was then undertaken. Data regarding cricket played and injuries sustained were collected by telephone questionnaire every 6 weeks for 6 months from each bowler. SETTING: Bowlers were recruited from young cricketers training at Centers of Excellence of 3 "First Class" Counties in England in January 1998. PARTICIPANTS: There were 42 spin bowlers and 70 fast bowlers. The mean age was 14.9 years (range 9 to 21 years). MAIN OUTCOME MEASURES: Injuries caused by bowling and interfering with bowling are included in incidence data. The number of deliveries bowled in matches and practice is used as the denominator for the reported incidence. RESULTS: Telephone follow-up was achieved when planned on 98.2% of occasions. There were 29 injuries meeting the criteria above. The incidence of injury in spin bowlers was 0.066 per 1,000 balls and 0.165 per 1,000 balls in fast bowlers (p = 0.097 Wilcoxon rank sum test). The incidence of injury (per 1,000 balls) at various anatomic sites in fast bowling was knee 0.057, ankle 0.043, low back 0.029, and shoulder 0.007. In spin bowlers, the site incidence was shoulder 0.055 and low back 0.011. The percentage with injuries at ankle, knee, and shoulder was significantly different (95% confidence intervals) for fast and spin bowlers. A significant difference was not found for lower back injuries. CONCLUSIONS: Incidence of injuries in fast bowling is greater than in spin bowling (but this was not a significant difference within the limits of this study). Low back injuries in fast bowlers have been the subject of published research. However, injuries in spin bowling have not previously been described, and this study indicates that shoulder injuries in wrist spinners merit further study.

Adolescent↗
PubMedDate not supplied

Heterotopic ossification after primary shoulder arthroplasty.

We have assessed the incidence of heterotopic ossification (HO) after primary shoulder joint replacement in 126 shoulders; 58 patients had hemiarthroplasty, and 68 had total shoulder joint replacement. HO developed to a minor extent in 15% of patients (19/126). There was no statistical difference between hemiarthroplasty or total shoulder replacement or between male and female patients. Patients with cuff tear arthropathy were the only group with an increased risk (36.4% [4/11]) of having HO develop. In patients with osteoarthritis, fractures, or rheumatoid arthritis, HO occurred in less than 14.5% (15/115). Nonsteroidal anti-inflammatory drugs (NSAIDs) did not appear to have any effect on HO as in hip replacement, as HO developed in 15.15% of patients having NSAIDs postoperatively and in 15.05% of patients without NSAIDs. Prophylaxis of HO with NSAIDs seems only to be indicated in patients with cuff tear arthropathy.

Adult↗
PubMedDate not supplied

Scapulothoracic fusion for painful winging of the scapula in nondystrophic patients.

A modified technique of scapulothoracic fusion was used in 6 patients who did not have muscular dystrophy and who were later evaluated clinically. The cause of the painful winging of the scapula was traumatic disruption of the trapezius and the accessory nerve in 3 patients, injury to the brachial plexus in 2, and Sprengel's deformity in 1. To obtain fusion, double wires were passed around each of 4 ribs. A Rush pin was then contoured to fit the curvature of the scapula, and the wires were passed through the scapula and tied over the Rush pin with bone graft. The mean age of the patients was 30 years (range, 22-39 years), with a mean follow-up of 49 months. The mean increase in elevation was 18 degrees with significant pain relief. The medium-term results showed that this operation was successful in achieving stability of the scapula while improving pain and function in patients without facioscapulohumeral dystrophy.

Adult↗
PubMedDate not supplied

One-stage arthroplasty of the ipsilateral shoulder and elbow.

Twenty 1-stage ipsilateral shoulder and elbow joint replacements were performed in 17 patients from 1988 to 1998 in the Nottingham Shoulder and Elbow Unit, Nottingham, England. There were 12 women and 5 men with a mean age at operation of 57 years. All 17 patients had rheumatoid arthritis. The indication for performing the 2 joint replacements in 1 stage was severe symptomatic involvement of both joints. The shoulder was replaced first, with the patient being repositioned and redraped for the elbow replacement. The follow-up averaged 5 years 2 months (range, 23 months to 13 years 8 months). All patients had significant pain relief and improvement in function, and 12 of the 15 patients reviewed would have been prepared to have the same procedure on the other side, if it became necessary (in 3, this had been done). The procedure offers major advantages because the number of anesthetics is reduced, it is more cost-effective, and it facilitates functional rehabilitation.

Adult↗