Biomedical subjects

B F Morrey

Publications and source records attributed to B F Morrey.

At least 199 records · Page 11Linked to original sources

PubMed1986

Results of delayed excision of the radial head after fracture.

Twenty-one patients had a delayed excision of a previously fractured radial head (range, one month to more than twenty years). There were four Mason type-II and seventeen Mason type-III fractures. Five fractures had been associated with a concomitant dislocation of the elbow and four, with an ulnar fracture. All of the patients were evaluated for pain, motion, strength, stability, and function by personal interview, examination, and testing in an upper-extremity-biomechanics laboratory. The average length of follow-up was fifteen years (range, three to thirty-two years). Postoperatively, pain was less severe in 76 per cent of the patients and motion was improved in both flexion and rotation in 81 per cent. An objective functional index showed that 77 per cent of the patients had a good or excellent result while 23 per cent had a fair or poor result. This study demonstrates the effectiveness of delayed excision after failure of closed management of fractures of the radial head. Thus, some justification is offered for the initial closed treatment of these fractures, with delayed excision of the radial head to be considered as needed.

Adolescent↗

PubMed1986

The effect of partial removal of proximal ulna on elbow constraint.

Accepted clinical practice allows the resection of up to 80% of the olecranon in comminuted fractures. Although this procedure is well-established, its effect on the static stability of the ulnohumeral joint has not been studied. An experiment was designed to study the amount of the greater sigmoid fossa of the ulna that can be removed before significant static ulnohumeral instability may occur. In eight fresh specimens, tested both in extension and at 90 degrees of flexion, changes in constraint were studied in four displacement, two torsional, and two axial modes. The constraint of the ulnohumeral joint appeared linearly proportional to the area of remaining articulation and was not provided solely by the distal 25%. The proximal portion of the olecranon has a greater effect on joint constraint than is generally appreciated.

Biomechanical Phenomena↗

PubMed1986

Arthroscopy of the elbow.

Elbow arthroscopy is a valuable adjunctive means to diagnose difficult elbow problems and is a relatively atraumatic means to remove loose bodies. It is also helpful with the patient in whom the objective findings do not coincide with persistent and significant subjective complaints. However, the use of elbow arthroscopy in a routine fashion is to be avoided, and the procedure should have limited indications at this time. Ideally it should be done primarily only by those experienced in the technique of arthroscopy who possess a significant knowledge of elbow anatomy and pathology.

Arthroscopy↗

PubMed1986

Applied anatomy and biomechanics of the elbow joint.

A clear understanding of the unique anatomic features of the elbow joint aids in a more full appreciation of the biomechanical aspects of this joint. This knowledge may, it is hoped, be translated into a broader understanding of the scientific basis of the management of elbow problems.

Biomechanical Phenomena↗

PubMed1985

Elbow joint contact study: comparison of techniques.

Elucidation of the contact areas between joint surfaces is important to both prosthetic design and the understanding of degeneration of articular cartilage. Numerous experimental methods are available to study joint contact, including cartilage staining, joint space casting, and pressure sensitive film techniques. This study attempts to compare the ability of each experimental technique to determine elbow joint contact. The silicone casting technique appears to be the best method to study joint contact area. The effects of magnitude and orientation of applied forces on the elbow joint contact patterns are studied.

Coloring Agents↗

PubMed1985

Ankle instability: comparison of primary repair and delayed reconstruction after long-term follow-up study.

Twenty-five consecutive primary ligament repairs and 40 delayed reconstructions for lateral collateral ankle ligament injuries were studied. Response to a questionnaire provided a 94% subjective evaluation at a mean of 9.5 years after surgery; 97% of patients were satisfied with the surgical result. Clinical examination, stress radiography, and biomechanical gait analysis studies were performed on 39 patients at four years or more after surgery (mean, 9.6 years). In 14% of those with ligament repair and 41% of those with reconstructive procedures, mean residual talar tilt with stress testing was 3.2 degrees and 5.2 degrees, respectively. Gait studies did not demonstrate a consistent abnormal gait pattern, even with side slope walking, and did not correlate with the talar tilt values. There was no significant measurable difference between the results of repair and reconstruction. Thus, most severe Grade III sprains can be managed nonoperatively, and if late residual instability occurs, a reconstructive procedure can be offered with confidence that the result will be equivalent subjectively and roughly comparable objectively to that of the immediate repair.

Adolescent↗

PubMed1985

Rupture of the distal tendon of the biceps brachii. A biomechanical study.

In biomechanical studies on ten patients who had had a rupture of the distal tendon of the biceps brachii, we compared the results of immediate anatomical reattachment, delayed reattachment, and conservative treatment. When the tendon was simply attached to the brachialis muscle (one patient), there was nearly normal strength in elbow flexion but about 50 per cent loss of forearm supination. Late reinsertion (one patient) improved strength of both flexion and supination, but not to normal. Immediate reattachment (four patients) restored normal strength in flexion and supination at one year but not at four months (one patient). With conservative treatment (three patients) there was a mean loss of 40 per cent of supination strength and variable loss of flexion strength, averaging 30 per cent. These data suggest that immediate surgical reinsertion of the biceps tendon into the radial tuberosity, compared with other modes of treatment, restores more strength of flexion and supination.

Adult↗

PubMed1985

Functional anatomy of the ligaments of the elbow.

Dissections of 10 fresh cadaver specimens revealed an important insertion of the posterior portion of the lateral collateral ligament to the ulna at the crista supinatoris. The humeral origin of the medial ligament attachments was found to lie posterior to the axis of elbow flexion; in this position a cam effect is created so that ligament tension varies with elbow flexion. The three-dimensional distance between the origin and the insertion of the anterior portion of the medial collateral ligament was found to increase slightly from extension to approximately 60 degrees of flexion; thereafter, it remained nearly constant. The distance of the posterior portion increased by about 9 mm from 60 degrees to 120 degrees of flexion. The flexion axis was shown to pass through the origin of the lateral collateral ligament, so the length of this structure was not changed during elbow flexion.

Aged↗

PubMed1984

Carrying angle of the human elbow joint.

Previous elbow kinematic studies have created some controversy because of conflicting and contradictory results. The lack of consistent results may be traced to the limitations and definitions of the specific measurement techniques, as well as individual variations in the specimens. To resolve this issue, a rigorous theoretical analysis of elbow kinematics was performed based on available anatomic and geometric data of the skeleton with consideration of anthropometric variations. Three definitions have been adopted previously for the measurement of the carrying angle of the elbow joint. The relationships of these three definitions of the carrying angle as a function of the elbow joint flexion angle were evaluated. Clinically, the dynamic change of carrying angle may have little practical significance. However, the variation is reflected in differences in design criteria of the resurfacing and semiconstrained elbow replacement implants.

Anthropometry↗

PubMed1984

Ankle instability: current concepts, diagnosis, and treatment.

Our approach to the problem of ankle sprains and instability is reviewed. After diagnostic evaluation (including stress roentgenography, arthrography, or tenography if necessary), most of our patients are treated either by taping if they have a grade 1 or 2 sprain or by casting if they have a grade 3 disruption. If the injury should progress to chronic instability despite this treatment regimen, which is an unusual occurrence, satisfactory reconstructive procedures are available. Indications for acute primary repair are limited.

Ankle Injuries↗

PubMed1984

Determination of muscle and joint forces: a new technique to solve the indeterminate problem.

Analytic determination of muscle force across human joints encounters an indeterminate problem. A new optimization approach, based on minimizing the upper bound of muscle stress, is introduced to obtain a unique solution. Mathematical and physiological justification of this new approach distinguishes it from previously described methods. A complex joint, the elbow, was studied. The results of muscle forces in resisting the elbow flexion moment were obtained and compared with electromyographic observation, as well as with solution from other optimizing techniques. The resultant humero-ulnar joint forces at various elbow joint positions are calculated. In normal daily activities, resultant joint forces of 0.3-0.5 times body weight are commonly encountered.

Biomechanical Phenomena↗

PubMed1984

Respiratory arrest following posteriorly displaced odontoid fractures. Case reports and review of the literature.

Posterior displacement of the odontoid after fracture occurs much less frequently than does anterior displacement. Experience with four patients suggests that anatomic reduction may not be possible and prolonged attempts to gain reduction are not advisable. Those cases should be managed with early application of a halo vest. A rotating frame should be avoided. The potential for respiratory arrest, at least in the older individual, is great and can be precipitated even by a change of position in the process of turning on the rotating frame. The mechanism of the respiratory failure is obscure.

Accidents, Home↗

PubMed1984

Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty.

The effects of anterolateral, transtrochanteric, and posterior surgical approaches for total hip arthroplasty on heterotopic bone formation were studied in 507 consecutive patients with osteoarthritis or avascular necrosis who had not had previous hip surgery. Range of motion, degree of pain, and satisfaction were compared. Although the lowest incidence of ectopic ossification occurred after the posterior approach, there were no statistically significant differences among the three approaches. Extensive ectopic bone, involving more than half the distance between the trochanter and acetabulum, occurred in 29% after anterolateral, 28% after lateral transtrochanteric, and 22% after posterior approaches. Motion was most affected by the lateral approach, whereas relief of pain and general satisfaction were slightly better with the posterior approach. Multivariate statistical analysis suggests that the difference in results (p less than 0.05) with the posterior approach is primarily due to a relatively lower incidence of severe grades of heterotopic bone.

Adult↗

PubMed1984

Management of the infected total joint arthroplasty.

Infection is the most severe complication of total joint arthroplasty. Prompt recognition and correct management, as well as prophylaxis against infection, are essential to minimize morbidity and maximize function. In this article, the etiology and diagnosis of prosthetic infection and the management of infected total arthroplasties of the hip, knee, ankle, shoulder, elbow, and wrist are discussed.

Anti-Bacterial Agents↗

PubMed1984

Reliability of isometric strength testing. Temporal factors and strength variation.

Isometric strength measurements of grip, pronation, supination, and elbow extension and flexion on dominant and nondominant sides were made on 40 normal subjects (age range, 40-70 years) to investigate the variability of isometric strength at different times of the day. Statistically significant differences were found in certain pronation, supination, and grip comparisons. No statistically significant difference was found in extension and flexion. Although significant, the absolute change in strength at different times of the day was small and showed no consistent trend. On the basis of these data, it appears that this variation can probably not be routinely detected in the normal clinical setting. However, the study further defines the reliability of isometric strength testing and should be considered in further attempts at more accurate measurement of elbow function. The small variations of strength, approximately 5%, that can be measured universally with sensitive testing equipment, are clinically relevant. However, when attempting to determine an impairment state in order not to place too much importance on small differences, care should be exercised in interpreting strength measurements. This investigation demonstrates how the application of sophisticated biomechanical techniques may be employed to provide useful objective information in the difficult clinical area of disability assessment. Disability judgments may be made more accurate as more is learned of the normal variables influencing objective measurement.

Adult↗

PubMed1983

Infection after total elbow arthroplasty.

Deep sepsis occurred after fourteen (9 per cent) of 156 elbow-replacement procedures in 140 patients. This high frequency of infection was attributed to several factors. First, the patients were drawn from a population that was at high risk of infection, because rheumatoid arthritis and post-traumatic arthritis were the indications for arthroplasty. Second, many of the patients had had prior surgery, which significantly (p less than 0.02) increased the risk of sepsis in those with rheumatoid arthritis. Third, some patients had surgery after the arthroplasty, which also seemed to predispose to deep infection (p less than 0.05). In one patient the elbow was salvaged by early débridement, and in two others reimplantation of a total joint replacement was successful after removal of the first prosthesis and control of the infection. Resection arthroplasty was required to arrest the infection in ten patients, eight of whom had a satisfactory result. The high incidence of this significant complication attests to the hazardous nature of the elbow-replacement procedure and should warn orthopaedic surgeons to be cautious when recommending this form of treatment.

Adult↗

PubMed1983

Musculoskeletal infection with nongonococcal neisseria species not associated with meningitis.

Five patients with type III musculoskeletal infection from nongonococcal Neisseria species were examined during a 13-month period. The initial clinical diagnosis was incorrect in all cases. Synovial fluid analysis and Gram's stain were not helpful, and the correct diagnosis was made only after culture reports were available. The patients responded well to antibiotic treatment, but two patients with underlying rheumatoid arthritis required surgical debridement. All patients were asymptomatic, with resolution of their infection at follow-up evaluation. An early correct diagnosis is mandatory and Neisseria infection should be considered in patients with pre-existing joint disease.

Adolescent↗

PubMed1982

Surgical excision for anterior-process fractures of the calcaneus.

Most fractures of the anterior process of the calcaneus are successfully treated with cast immobilization. Eighteen of the twenty-five patients in this study were so treated successfully, although their symptoms persisted for variable periods after removal of the cast. Seven of the twenty-five patients had excision of the fracture fragment, two of whom were not relieved of their symptoms after excision. Both of these patients had had a missed diagnosis and no prior treatment of a fracture that had gone on to non-union. This suggests that the correct initial diagnosis and treatment are important, particularly if the fracture fragment is large, and that early excision of the fragment is usually not necessary or advisable.

Adolescent↗