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Biomedical subjects

A H Alexander

Publications and source records attributed to A H Alexander.

51 records · Page 3Linked to original sources
PubMed1980

Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Long-term follow-up.

Experience with forty-nine patients with surgically treated transchondral fractures of the talar dome seen between 1957 and 1977 at our institution has indicated that surgical treatment yields a good long-term result. Long-term results in twenty-five patients with sufficiently long follow-up (average, sixty-five months) were recorded. Ninety-two per cent of the patients had had a history of severe ankle sprain or fracture and many had had chronic symptoms before the definitive diagnosis was made. The surgical treatment consisted of drilling and curettage followed by non-weight-bearing and early range-of-motion exercises. Twenty-two patients had good or excellent results, two had fair results, and one had a poor result. In eleven patients followed for five to eighteen years, no deterioration in functional capacity was noted; however, improvement in the postoperative status was noted for as long as eighteen months. Even when it was performed for a chronic lesion the operation gave a high percentage of good results, and the long-term results did not differ appreciably from the results eighteen months postoperatively. No other reports were found concerning long-term follow-up of this lesion.

Adolescent↗
PubMedDate not supplied

Bilateral traumatic dislocation of the distal radioulnar joint, ulna dorsal: case report and review of the literature.

Bilateral dislocation of the distal radioulnar joint seems not to have been reported in the literature. This is a report of a 22-year-old man successfully treated with closed reduction and immobilization in long arm casts. Limited forearm rotation and wrist pain after a twisting injury are typical findings. In ulna dorsal dislocation the patient's forearm is locked in pronation. In ulna volar dislocation the wrist appears narrow and the forearm is locked in supination. The mechanism of injury for dorsal dislocations is hyperpronation; for volar dislocations it is hypersupination. Dislocation of the distal radioulnar joint injures the triangular disk and/or fractures the ulnar styloid. Suspicion is important in making the diagnosis. Fifty per cent of unilateral cases reported in the literature were missed initially or were diagnosed late. The acute case is easily treated by closed reduction under local anesthesia and immobilization in a long arm cast. Treatment of the chronic dislocation includes various soft tissue reconstructions or resection of the distal ulna depending on the degree of arthrosis.

Adult↗
PubMedDate not supplied

Analgesia for the reduction of fractures in children: a comparison of nitrous oxide with intramuscular sedation.

A prospective, randomized study was undertaken to compare the effectiveness of nitrous oxide with intramuscular sedation (meperidine and promethazine) in providing analgesia and amnesia during the reduction and treatment of children's fractures in an outpatient clinic setting. Fifteen patients received a 50:50 mixture of nitrous oxide and oxygen, and 15 received intramuscular injection. The two groups were similar in regard to gender distribution, age, and fracture types. Pain response was recorded using the Children's Hospital of Eastern Ontario (Canada) Pain Scale (CHEOPS) at the time of fracture reduction and 30 min postreduction. At the first follow-up visit a questionnaire regarding the patient's memory and subjective experience of the fracture reduction was answered. Data between the two groups were compared using the Mann-Whitney test. The CHEOPS scores, and the memory and subjective experience of the fracture reduction were similar between the two groups. Time in the outpatient department averaged 83 min for the intramuscular group and 30 min for the nitrous oxide group (p < 0.01). All of the nitrous oxide patients stated they would use nitrous oxide again, whereas only eight of 15 intramuscular patients stated they would try intramuscular sedation again. Nitrous oxide is as effective as intramuscular sedation in providing analgesia and amnesia in the treatment of children's fractures while having a more rapid onset and a shorter recovery period with greater patient acceptance.

Adolescent↗
PubMedDate not supplied

Does memory constrain utilization of top-down information in spoken word recognition? Evidence from normal aging.

Young and elderly adults heard recorded words that had been computer-edited from connected speech so as to be heard in isolation from their linguistic surround. Word identification was tested for words in isolation and when heard with increasing amounts of linguistic context that had either preceded or followed them in their original utterances. Although the elderly subjects were poorer in identifying the words in isolation compared to young adults, both age groups showed similar increases in correct word identification as increasing amounts of prior context were presented. By contrast, context that followed the target words was less effective for the elderly subjects than it was for the young. It is argued that a memory trace of the unclear stimulus must be maintained for effective utilization of following context in a retrospective analysis. The elderly subjects' relative inability to utilize following context implicates an age-related memory deficit operating at the sentence level.

Adolescent↗
PubMedDate not supplied

The Elmslie-Trillat procedure: evaluation in patellar dislocation and subluxation.

The Elmslie-Trillat procedure for correction of patello-femoral malalignment was evaluated in 27 knees in 22 patients with an average followup of 42 months (minimum of 24 months). Preoperative and postoperative pain and activity levels were recorded for all knees. The quadriceps angle was recorded in 22 knees preoperatively and in 19 knees postoperatively. Good or excellent results were obtained in 81% overall and in 91% of those knees with patella alta. The postoperative quadriceps angle (Q-angle) correlated with the result. Correction of 10 degrees or less was always associated with a good or excellent result. In contrast, all patients with a fair or poor result had Q-angles at 15 degrees or greater. The preoperative Q-angle did not correlate with the eventual result. We concluded that inadequate medial displacement of the anterior tibial tuberosity may lead to unsatisfactory results and that this may be avoided by intraoperative measurement of the Q-angle; that significant distal advancement of the tibial tuberosity is not required in patella alta; and that correction of the Q-angle to 10 degrees or less correlates with a good or excellent result from the Elmslie-Trillat procedure for treatment of patella subluxation and dislocation.

Adolescent↗
PubMedDate not supplied

The natural history of conservatively treated partial anterior cruciate ligament tears.

Twenty-five patients with arthroscopically proven partial ACL tears were reviewed. All patients underwent examination under anesthesia and arthroscopy following an acute injury to a previously normal knee. The percentage of tear was estimated during arthroscopy. Postoperatively, patients were treated with early motion and hamstring strengthening. Weightbearing and quadriceps rehabilitation were delayed. A detailed rating of symptoms and function was performed at a minimum of 18 months after injury, using a modification of the AOSSM ACL follow-up form. Neither the estimated percentage of ligament tear, length of followup, nor age at time of injury significantly correlated with clinical score at followup. Thirteen patients underwent partial meniscectomy at the time of original arthroscopy. Their clinical outcome was not different from those without meniscectomy. Two patients (8%) underwent ACL reconstruction 8 and 64 months after injury, respectively. Overall results were judged as excellent (28%), good (32%), fair (24%), and poor (16%). Only 44% were able to resume sports at their preinjury level, and 72% had activity-related symptoms.

Adolescent↗
PubMedDate not supplied

Arthroscopic treatment of transchondral talar dome fractures.

Fifteen cases of transchondral talar dome fractures treated arthroscopically at the Naval Hospital in Oakland, California, were reviewed. Roentgenograms and results from clinical examination were assessed preoperatively and at regular intervals postoperatively. Clinical followup of 18 months was obtained in all cases (range, 18 to 36 months; mean, 26 months). All lesions were treated with arthroscopic excision of fragments with abrasion and/or drilling of the remaining crater. There were nine excellent results, four good, one fair, and one poor. There were no complications. Results of arthroscopic treatment compare favorably to those of open arthrotomy.

Adolescent↗
PubMedDate not supplied

The Bankart repair illustrated in cross-section. Some anatomical considerations.

The Bankart repair for chronic anterior shoulder instability effectively addresses the pathologic components responsible for repeated dislocation or subluxation. However, contrary to popular belief, the Bankart repair does not precisely restore the premorbid anatomy. The capsule is reattached to the boney rim of the anterioinferior glenoid deep to and lateral to the torn cartilagenous labrum, thus excluding the labrum from the joint anteriorly. This was demonstrated by cross-sectional cadaver dissections performed to illustrate this complex surgical anatomy to orthopaedic residents in training. In addition, when correlated with double-contrast computerized axial tomography, we noted five predominant patterns of anatomical lesions which by common use have been collectively termed the "Bankart lesion." These are: 1) the rare "classic" Bankart lesion in which the cartilagenous labrum and capsular origin are torn from the glenoid rim; 2) the capsule stripped from the scapular neck and the labrum detached from the glenoid rim remaining fixed to the overlying capsule; 3) the capsule stripped from the scapular neck and the labrum separated from the glenoid rim, but separately; 4) the labrum abraded away and no longer radiographically detectable; and 5) glenoid rim fracture.

Humans↗
PubMedDate not supplied

Arthroscopic treatment of symptomatic synovial plica of the knee. Long-term followup.

We studied all patients undergoing arthroscopic resection of symptomatic plica without other intraarticular abnormality at our institution from October 1981 to March 1987. To be considered abnormal, plicae had to be thickened and/or fibrotic when viewed arthroscopically. Seventy-six of nearly 2000 patients (4%) who underwent diagnostic arthroscopies met our inclusion criteria. Clinical response after arthroscopic resection was evaluated in 51 patients at an average of 47 months (range, 15 to 77). Excellent or good results were obtained in 57 (75%) of the patients. Eleven patients (14%) had an impingement lesion defined as a localized femoral condylar ridge or groove of the articular surface that impinged upon the plica with increasing flexion. All of these patients had an excellent or good result. Other factors associated with a favorable outcome included a specific preoperative diagnosis localizing symptoms to the medial compartment, onset of pain after a period of increased athletic activity or after a twisting injury, and younger age. Poor prognostic factors included associated chondromalacia and an unclear preoperative diagnosis.

Adult↗
PubMedDate not supplied

Multidirectional shoulder instability. Clinical results of inferior capsular shift in an active-duty population.

We reviewed the results of a capsular shift procedure performed on 10 active-duty patients with an average of 28 months follow-up. Improvement in pain, function, and stability occurred postoperatively in nearly all patients. Loss of total elevation and external rotation were minimal and an average of three spinal segments of internal rotation were lost. Only one patient required further surgery for recurrent instability and all patients except two reported over-all improvement. Dominant shoulders made greater improvements in pain, stability, and functional capacity than nondominant shoulders. Patients with generalized ligamentous laxity had less pain and more posterior instability than those without laxity. A history of an acute traumatic event was predictive of greater improvement in pain and stability. A previous instability repair was indicative of the most postoperative instability and least functional improvement.

Adult↗
PubMedDate not supplied

Return of normal gait patterns after anterior cruciate ligament reconstruction.

Individuals with anterior cruciate ligament deficiency typically do not have quadriceps activity during stance. This aberrant pattern has been termed "quadriceps avoidance" gait. We performed gait analysis during walking on 10 normal controls and 10 subjects 8 to 12 months after they had anterior cruciate ligament reconstruction using autogenous middle third of the patellar tendon. All patients had good subjective and objective results at the time of analysis. Differences in gait between subjects and controls persisted up to 12 months after surgery. Specifically, subjects with anterior cruciate ligament reconstructions demonstrated significant reductions in midstance knee flexion moments (P < 0.01) and tibially directed loading rates (P < 0.05) when compared with controls. However, the subjects had a net external flexion moment throughout most of the stance phase of gait, implying that quadriceps activity was present. After anterior cruciate ligament reconstruction, there is a tendency toward gait normalization, and a quadriceps avoidance mechanism is no longer present.

Anterior Cruciate Ligament↗
PubMedDate not supplied

Open versus closed chain kinetic exercises after anterior cruciate ligament reconstruction. A prospective randomized study.

We conducted a prospective, randomized study of open and closed kinetic chain exercises during accelerated rehabilitation after anterior cruciate ligament reconstruction to determine if closed kinetic chain exercises are safe and if they offer any advantages over conventional rehabilitation. The closed kinetic chain group used a length of elastic tubing, the Sport Cord, to perform weightbearing exercises and the open kinetic chain group used conventional physical therapy equipment. Results are reported with a minimum 1-year followup (mean, 19 months). Pre- and postoperative evaluation included the Lysholm knee function scoring scale, Tegner activity rating scale and KT-1000 arthrometer measurements. Overall, stability was restored in over 90% of the knees. Preoperative patellofemoral pain was reduced significantly; 95% of the patients had a full range of motion. The closed kinetic chain group had lower mean KT-1000 arthrometer side-to-side differences, less patellofemoral pain, was generally more satisfied with the end result, and more often thought they returned to normal daily activities and sports sooner than expected. We concluded that closed kinetic chain exercises are safe and effective and offer some important advantages over open kinetic chain exercises. As a result of this study, we now use the closed kinetic chain protocol exclusively after anterior cruciate ligament reconstruction.

Adolescent↗
PubMedDate not supplied

The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction.

To correlate clinical results after anterior cruciate ligament reconstruction with tunnel placement measured radiographically, we prospectively studied 128 patients who had arthroscopically assisted bone-patellar tendon-bone reconstructions. Patients with bilateral anterior cruciate ligament reconstructions, other significant knee ligament injuries, or those undergoing chondroplasty or meniscal repairs were excluded, leaving 42 patients. The relationship between radiographic tunnel position and clinical results was determined using the Lysholm score, KT-1000 arthrometer testing, the Tegner activity level, and the pivot shift and Lachman tests. Clinical results correlated positively with posterior femoral tunnel placement on lateral radiographs and negatively with excessive anterior tibial tunnel placement. Specifically, when femoral tunnels were placed at least 60% posterior along Blumensaat's line and tibial tunnels were at least 20% posterior along the tibial plateau, 69% of patients had good or excellent Lysholm scores and 79% had KT-1000 arthrometer maximum manual side-to-side differences of 3 mm or less. When the above criteria were not met, 50% of patients had good or excellent Lysholm scores and 22% had KT-1000 arthrometer maximum manual side-to-side differences of 3 mm or less. This close correlation indicates that satisfactory radiographic tunnel position influences outcome after anterior cruciate ligament reconstruction.

Adolescent↗