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Biomedical subjects

W D Kealey

Publications and source records attributed to W D Kealey.

9 recordsLinked to original sources
PubMed2004

Arthrodiastasis in Perthes' disease. Preliminary results.

We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes' disease. We carried out a prospective trial in boys over the age of eight years and girls over seven years at the time of the onset of symptoms. The patients had minimal epiphyseal collapse and were compared with a conventionally treated, consecutive, historical control group. Arthrodiastasis was applied for approximately four months. The primary outcome measure was the extent of epiphyseal collapse at the end of the fragmentation phase. One of the 15 treated hips and nine of the 30 control hips showed a loss of height of 50% or more of the lateral epiphyseal column on the anteroposterior radiographs (Herring grade-C classification). On a Lauenstein view, one of the treated hips and 19 of the control hips showed at least a loss of height of 50% of the anterior epiphyseal column. The complications of arthrodiastasis included pin-site infection in most hips, transient joint stiffness in two, and breakage of a pin in two. The final outcome will be known when all the patients and the control group reach skeletal maturity.

Adolescent↗
PubMed2001

Percutaneous pin fixation of intercondylar fractures in young children.

T-condylar fractures of the distal humerus are very rare in children. When they do occur they tend to affect those approaching skeletal maturity. Most agree that the undisplaced fracture can be managed conservatively. With increasing displacement and comminution the opinions tend to differ. As an alternative to open reduction and internal fixation we report the use of closed reduction and percutaneous pin fixation for displaced and comminuted T-condylar fractures in a series of three young children. In addition to the classical medial and lateral column fixation we report the use of a transcondylar wire to stabilise the distal fragments and discuss the use of intra-operative arthrography in low supracondylar fractures to exclude a missed intercondylar extension on plain xrays. Although small this series represents the largest series of children less than eight years of age.

Accidental Falls↗
PubMed2000

Implant failure in tibial nailing.

Between 1991 and 1995 five hundred and twenty tibial diaphyseal fractures were treated with intramedullary nailing in Northern Ireland. We retrospectively reviewed three hundred and thirty eight patients in three out of the four fracture units in Northern Ireland. Within this group there were three hundred and forty fractures and we identified twenty five episodes of implant failure. This group of patients had a higher percentage of open injuries with a higher degree of comminution and had been treated with smaller diameter nails when compared with the group of patients, who had no implant failure. Failure occurred most frequently at the transverse proximal locking screw when a single screw was used. Fractures in the distal third of the tibia had a higher incidence of nail breakage. We would recommend early elective dynamisation and the use of statically locked larger diameter nails, especially in comminuted or distal third fractures.

Adult↗
PubMed2000

Deprivation, urbanisation and Perthes' disease in Northern Ireland.

It has been suggested that Perthes' disease is more prevalent in urban areas, and that the risk increases with deprivation. We present the findings of a preliminary analysis of Perthes' disease in Northern Ireland, which is shown to have one of the highest national annual rates of incidence in the world (11.6 per 100000). Of the 313 children diagnosed over a seven-year period, 311 were allocated to the enumeration districts of the 1991 census, thus allowing the incidence to be calculated using both spatial and non-spatial aggregation. The cases were grouped according to the size of the settlement from highly urbanised to open countryside and by level of area deprivation. While the incidence of Perthes' disease was found to be associated with indicators of the level of deprivation for areas, there was no evidence to suggest that there was an increased risk in urban areas; the highest rate was found in the most deprived rural category.

Adolescent↗
PubMed2000

The role of coagulation abnormalities in the development of Perthes' disease.

Recent reports have suggested an association between Perthes' disease and an underlying thrombophilic or hypofibrinolytic tendency. In Northern Ireland there is a high incidence of Perthes' disease (11.7 per 100,000 or 1 in 607 children) in a stable paediatric population. We reviewed 139 children with Perthes' disease and compared them with a control group of 220 aged- and gender-matched healthy primary schoolchildren with similar racial and ethnic backgrounds. There were no significant deficiencies of antithrombotic factors protein C, protein S, antithrombin III or resistance to activated protein C. A total of 53 (38.1%) of the children with Perthes' disease had a prolonged activated partial thromboplastin time (>38) compared with 13 (5.9%) of the control group (p < 0.001). Our findings have shown that using standard assays, thrombophilia secondary to antithrombotic factor deficiency or resistance to activated protein does not appear to be an aetiological factor for Perthes' disease. The cause of the prolonged activated partial thromboplastin time, usually associated with a clotting factor deficiency, is under further investigation.

Antithrombin III↗
PubMedDate not supplied

Transection of the pancreatic head following blunt abdominal trauma.

Pancreatic trauma is rare, with a reported incidence of 0.4 per 100,000. Transection of the pancreas is extremely rare and usually involves the body region. An unusual case of pancreatic trauma, with complete transection through the pancreatic head, is described.

Adult↗