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Biomedical subjects

A G Rothwell

Publications and source records attributed to A G Rothwell.

At least 19 recordsLinked to original sources
PubMed2000

Iliopsoas haemophiliac pseudotumours with bowel fistulation.

Two cases of iliopsoas haemophilic pseudotumours are presented. In one patient a fistula developed between a pseudotumour and the large bowel. This resulted in an abscess involving the pseudotumour and adjacent tissues. It resolved after 5 years of therapy involving percutaneous drainage and closure of the fistula. The second patient had a massive pseudotumour that had obstructed both ureters. Later he suffered a fatal mixed Gram negative septicaemia probably related to erosion into the colon.

Abscess↗
PubMed1999

Development of the New Zealand Joint Register.

In 1997, to mark 30 years of joint arthroplasty in New Zealand, the New Zealand Orthopaedic Association agreed to establish a national hip and knee register, to be based in the Department of Orthopaedic Surgery at Christchurch Hospital. This paper details the steps in the development of the Register, the problems encountered and their solutions, and the trial process involved before the national implementation of the data collection process in 42 hospitals throughout New Zealand in April of 1999. The whole process took seventeen months and the special features are the enthusiastic and voluntary involvement of nursing staff and the inclusion of patient generated outcomes data. However, it will be at least five years before there is sufficient data for any meaningful analysis.

Arthroplasty, Replacement, Hip↗
PubMed1998

Intrasound vibration in the early diagnosis of scaphoid fracture.

A prospective trial was designed to assess the sensitivity and specificity of intrasound vibration for the early detection of scaphoid fracture. We replicated the method described by Finkenburg et al. (J Hand Surg 1993;18A:4-7) in an attempt to corroborate their results. We found the test to be 73% sensitive and 51% specific. Because the test was not 100% sensitive, as claimed by Finkenburg et al., we discontinued the use of this device in our hospital.

Binomial Distribution↗
PubMed1997

Hand function following Silastic arthroplasty of the metacarpophalangeal joints in the rheumatoid hand.

Twenty-one consecutive rheumatoid patients (23 hands, 92 joints) who underwent Silastic metacarpophalangeal joint arthroplasty between 1989 and 1993 had the 33-task Baltimore quantitative upper extremity function test prior to surgery and then repeated at intervals from 6 weeks to 1 year for all 23 hands and 3 to 4 years for 14 of the hands. In addition all hands had goniometer measurement of active range of finger joint motion and ulnar drift at each assessment. The average preoperative score was 71 improving rapidly to 89 at 6 weeks, to 91 at 1 year and 92 at 3 to 4 years. Most improvement occurred in functions requiring pinch span or hook grip and could be attributed largely to correction of ulnar drift and the change of metacarpophalangeal arc of motion. These results confirm that the Silastic metacarpophalangeal joint arthroplasty significantly improves hand function and that the improvement is maintained over a 3- to 4-year period.

Adult↗
PubMed1996

Sauvé-Kapandji procedure for disorders of the distal radioulnar joint: a simplified technique.

A simplified technique of the Sauvé-Kapandji (SK) procedure for disorders of the distal radioulnar joint (DRUJ) is described. The DRUJ is transfixed by a screw but is not formally exposed and fused, the periosteum of the distal ulna is not excised, and the pronator quadratus is not advanced into the pseudarthrosis. Stability of the ulna shaft is obtained by suturing the sheath of the extensor carpi ulnaris (ECU) and periosteum as a single layer firmly over the ulnar stump and pseudarthrosis. The operating time averages 20 minutes. Review of 28 wrists demonstrated relief of pain in 27; 80 degrees or greater of pronation and supination in 19 and 20, respectively; fusion of the DRUJ in 18; and ulnar carpal shift in 3. The main complications were related to screw placement and length and prominence of the ECU tendon. The simplified SK procedure reliably relieves pain and restores movement at the DRUJ.

Adult↗
PubMed1992

Upper-limb surgery for tetraplegia.

We reviewed the results of reconstruction of 97 upper limbs in a consecutive series of 57 tetraplegic patients, treated from 1982 to 1990. Of these, 49 had functional and eight had cosmetic reconstructions. The principal functional objectives were to provide active elbow extension, hook grip, and key pinch. Elbow extension was provided in 34 limbs, using deltoid-to-triceps transfer. Hook grip was provided in 58 limbs, mostly using extensor carpi radialis longus to flexor pollicis longus transfer, and key pinch in 68, mostly using brachioradialis to flexor pollicis longus transfer. Many other procedures were employed. At an average follow-up of 37 months, 70% had good or excellent subjective results, and objective measurements of function compared favourably with other series. Revisions were required for 11 active transfers and three tenodeses, while complications included rupture of anastomoses and problems with thumb interphalangeal joint stabilisation and wound healing. We report a reliable clinical method for differentiating between the activity of extensor carpi radialis longus and brevis and describe a successful new split flexor pollicis longus tenodesis for stabilising the thumb interphalangeal joint. Bilateral simultaneous surgery gave generally better results than did unilateral surgery.

Activities of Daily Living↗
PubMed1990

Synovium transplantation onto the cartilage denuded patellar groove of the sheep knee joint.

A macroscopic and histologic study has been made on the changes during a 2-year period in a free composite graft of synovium subsynovial fat and periosteum taken from the medial femoral condyle and placed on the cartilage denuded patellar groove of the knee joint in skeletally mature sheep. The results have been compared to a control group which had the same surgical management except that the graft was discarded. The study demonstrated that following "take" and revascularization, the composite graft had converted to a single layer of vascular fibroblastic tissue by 6 weeks and over the ensuing year this had been largely replaced by fibrocartilage of variable differentiation. However, over the next year much of this fibrocartilage would appear to have undergone either redifferentiation into disorganized fibrochondroid tissue or developed secondary degenerative changes. By contrast, the control specimens had profound resorption of the bone plate followed by patchy resurfacing with tissue ranging from a very loose fibrous connective tissue to well differentiated fibrocartilage. The latter had gradually increased in amount of over the 2-year period, but secondary degenerative changes had also developed as in the grafted group. Despite some of the drawbacks, particularly the magnitude of the patello-femoral compression force, the technique has now been refined into a reliable animal model for the study of different parameters either in the graft or the graft environment in the hope that a way can be found to increase the life span of the metaplastic cartilage.

Animals↗
PubMed1983

Reactions of thigh tissues of sheep to blunt trauma.

Severe damage to the deep musculature of the thigh was caused by standardized crushing injuries applied to muscle overlying the femora of anesthetized sheep. The injuries caused an acute inflammatory response, with the formation of granulation tissue and, later, extensive scarring. Periosteal bone formed in all cases, in some instances resulting in a spike of bone that protruded into the overlying soft tissue. Heterotopic bone formed in 16.6% of the legs of sheep within three weeks to three months after trauma by intramembranous ossification within scar tissue replacing muscle tissue.

Animals↗
PubMed1982

Closed Küntscher nailing for comminuted femoral shaft fractures.

From a series of 190 consecutive fractures of the shaft of the femur treated by closed Küntscher nailing, 32 of the more severely comminuted have been studied to determine whether treatment by closed nailing was justified. Radiological criteria were used to divide them into 19 who were moderately comminuted and 13 grossly so. Twenty-four patients were less than 21 years of age and 19 patients had 40 significant associated injuries. Fifteen fractures were nailed on the day of injury, and complications were few. Nineteen patients had a supplementary cast-brace and all those who had been employed returned to work. Twelve patients had shortening of up to two centimetres and two had three centimetres; four had mild rotational deformities; seven had mild restriction of knee flexion; and two had delayed union. There were no infections. The advantages of this technique include a negligible risk of infection and rapid stabilisation of even grossly comminuted fractures, thus facilitating management of other injuries. The 44 per cent incidence of shortening is counterbalanced by early mobilisation and rapid return of knee function. It is concluded that when proper equipment and expertise are available then closed nailing is the treatment of choice for severely comminuted fractures of the femoral shaft.

Adolescent↗
PubMed1979

The pseudo-boutonniere deformity.

The pseudo-boutonniere deformity is a boutonneire-like deformity resulting from a hyperextension injury to the proximal interphalangeal joint causing tearing of the volar soft tissues. It is seen almost exclusively in the little and ring fingers. The features, pathomechanics and prophylaxis of the condition are described. The treatment is by dynamic splintage and the importance of distinguishing the deformity from the true boutonniere deformity is emphasised.

Athletic Injuries↗
PubMed1978

Repair of the established post traumatic boutonnière deformity.

A technique is described for the repair of the chronic, post traumatic, uncomplicated boutonnière deformity which has given consistently good results. The fundamental steps are: Mobilisation and reefing of the lengthened middle slip; Kirschner wire fixation of the proximal joint in full extension and replacement of the mobilised lateral slips with the distal joint flexed approximately 45 degrees.

Finger Injuries↗
PubMed1978

Closed Küntscher nailing of femoral shaft fractures. A series of 100 consecutive patients.

One hundred and two fractures of the femoral shaft, including eighteen pathological fractures, in 100 patients were internally fixed by closed Küntscher nailing. Sixty-eight fractures resulted from motor vehicle accidents; ten were compound. Seventy-five patients were under the age of thirty years and thirty-four had multiple injuries. Sixty-nine fractures were nailed on the day of the accident and the operative technique is described. Complications during and after operations were few. Fifty-eight patients left hospital within four weeks and 77% of those working returned to work in less than four months. There were no wound or bone infections. The results are discussed and it is concluded that, with the correct equipment and careful attention to detail, closed nailing is a straightforward procedure with few complications. Advantages include the wide range of fractures that can be nailed, the short hospitalisation, the rapid return of function to the knee, the early return to work and the absence of infection.

Adolescent↗