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Biomedical subjects

B F Morrey

Publications and source records attributed to B F Morrey.

At least 217 records · Page 12Linked to original sources
PubMed1982

Extensive posterior exposure of the elbow. A triceps-sparing approach.

Difficulty with triceps avulsion or loss of continuity after total elbow arthroplasty has prompted the development of a modified posterior approach to the elbow joint. The characteristic feature of this approach is that the triceps mechanism is reflected from medial to lateral in continuity with the forearm fascia and the olecranon and ulnar periosteum. A variant of the technique reflects the extensor mechanism from lateral to medial. The ulnar collateral ligament may be released from the humerus to provide more exposure, but the ligament must then be securely reattached. This approach, which provides extensive exposure to the elbow joint, has been employed in 49 consecutive total elbow arthroplasties and results show no loss of triceps function and no significant weakness. The approach has proved useful for treatment of intra-articular fractures of the distal end of the humerus and with synovectomy in the rheumatoid arthritic patient.

Elbow Joint↗
PubMed1982

Epidemiologic features of humeral fractures.

Five hundred sixty-four Rochester, Minnesota, residents had a total of 586 humeral fractures during the period from 1965 to 1974. Of these, 47% involved the proximal humerus, and 20% the humeral shaft, and 33% the distal humerus. The incidence of humeral fractures associated with severe trauma was relatively higher among children and young adults, and distal humeral fractures predominated. Among the elderly, however, proximal humeral fractures associated with moderate trauma were most common and were responsible for the excess humeral fracture incidence rates among women and the dramatic increase in rates with age for both sexes. Rochester incidence rates for all three humeral fracture sites were substantially greater than those previously reported from the United Kingdom, although the proximal humeral fracture incidence was very similar to that in Malmo, Sweden. The Rochester rates appear to be the best available for use in determining the costs and benefits of efforts to prevent these and other aging or osteoporosis-related fractures in the United States.

Adolescent↗
PubMed1982

Complications of total elbow arthroplasty.

The need for revision surgery for loosening exceeds 25% with tightly constrained prostheses but is much less with the semiconstrained designs. Resurfacing prostheses may be unstable if not adequately balanced by static and dynamic soft-tissue constraints. Infection is excessive (4%-9%), but resection arthroplasty is a reasonably good salvage procedure. Implant failure is rare. The ulnar nerve is subject to transient (10%) or, occasionally, partial dysfunction. Routine anterior translocation has been beneficial, but there is considerable variation in technique in this regard. Triceps insufficiency can be virtually eliminated with the Kocher lateral-to-medial or the Bryan lateral-to-medial triceps-sparing approach. Fractures of the ulna usually can be treated by cast application, but humeral fractures may require revision surgery because of component loosening. Some complications are decreasing in frequency, whereas others are becoming more widely appreciated. The procedure remains a challenging one, and is one that should be performed by those who are experienced in elbow surgery and who have a detailed knowledge of the numerous potential pitfalls.

Elbow Joint↗
PubMed1982

Dislocations after total hip arthroplasty.

During the ten-year period ending in 1978, 10,500 conventional total hip arthroplasties were performed at the Mayo Clinic; dislocation developed after 331 (3.2 per cent) of these procedures. Cross correlations of the data were performed using multivariate analysis. This analysis showed that previous surgery on the hip was the most significant of the factors predisposing to dislocation, the incidence doubling from 2.4 per cent (in hips without previous surgery) to 4.8 per cent (in hips with previous surgery) (p less than 0.001). The dislocation rate was 2.3 per cent after an anterolateral approach and 5.8 per cent after a posterior approach (p less than 0.01). The size of the head of the femoral component was not a strongly influential factor. The incidence of dislocation was 17.6 per cent in the hips that had osteotomy and avulsion of the greater trochanter, compared with 2.8 per cent in those in which the trochanteric osteotomy united (p less than 0.001). Reoperation for instability of the hip was performed in a third of the patients, but in 31 per cent of the patients whose hip was reoperated on the instability persisted after the revision.

Adolescent↗
PubMed1981

Silastic prosthetic replacement for the radial head.

Seventeen patients had a Silastic prosthesis for the radial head inserted following fracture of that structure. Follow-up averaged 6.7 years. Nine of the seventeen patients had had an associated dislocation of the elbow or a Monteggia fracture. Six patients received the implant at the time of the treatment for the fracture and all six were doing well, although the implant had failed radiographically in three of the six. There were five failures among the other eleven patients; four of the five had the prosthesis removed. On the basis of these data, we concluded that the indications for use of the Silastic radial-head prosthesis after fracture are extremely limited, and its routine use cannot be justified.

Adult↗
PubMed1981

A biomechanical study of normal functional elbow motion.

UNLABELLED: We studied thirty-three normal patients, eighteen women and fifteen men, for normal motion and the amount of elbow motion required for fifteen activities of daily living. The amounts of elbow flexion and forearm rotation (pronation and supination) were measured simultaneously by means of an electrogoniometer. Activities of dressing and hygiene require elbow positioning from about 140 degrees of flexion needed to reach the occiput to 15 degrees of flexion required to tie a shoe. Most of these activities are performed with the forearm in zero to 50 degrees of supination. Other activities of daily living (such as eating, using a telephone, or opening a door) are accomplished with arcs of motion of varying magnitudes. Most of the activities of daily living that were studied in this project can be accomplished with 100 degrees of elbow flexion (from 30 to 130 degrees) and 100 degrees of forearm rotation (50 degrees of pronation and 50 degrees of supination). CLINICAL RELEVANCE: These data, not previously recorded, may be used to provide an objective basis for the determination of disability impairment, to determine the optimum position for elbow splinting or arthrodesis, and to assist in the design of elbow prostheses. The motion needed to perform essential daily activities is obtainable with a successful total elbow arthroplasty.

Activities of Daily Living↗
PubMed1981

Total elbow arthroplasty. A five-year experience at the Mayo Clinic.

During the five years from 1973 through 1977, eighty Mayo and Coonrad total elbow arthroplasties were performed in seventy-two patients at the Mayo Clinic. Follow-up after at least two years (average, four years) revealed that the results were good in 60 per cent, fair in 16 per cent, and poor in 24 per cent. Pain was a major symptom in 80 per cent of the elbows preoperatively but in only 3 per cent postoperatively. At follow-up, motion had increased: extension-flexion by 10 degrees (average range, 29 to 131 degrees of flexion) and forearm rotation by 26 degrees (average range, 61 degrees of pronation to 59 degrees of supination). Excluding eleven prostheses with loosening for which revision was necessary, there were forty-four complications (55 per cent) after eighty procedures. Of these forty-four complications, eleven were ulnar neuropathies (two permanent and nine transient); four were wound-healing problems; ten, significant triceps weakness; eleven, intraoperative fractures of the medial or lateral supracondylar bone column; seven, deep infections; and one was an ulnar fracture. Although the complication rate was very high, most of the complications occurred during the early years of the study. Follow-up revealed twenty-nine elbows with radiolucency around the components: in twenty-five about the humeral and in four about the ulnar component. Revisions were performed in nineteen (24 per cent) of the eighty elbows: in eleven because of loosening, in seven because of deep infection, and in one because of ankylosis. Intraoperative supracondylar fracture and defective cementing of the prosthesis were important factors contributing to prosthetic loosening. When the arthroplasty was successful, the relief of pain was dramatic, stability was excellent, and the range of motion was superior to that provided by any other procedure currently available.

Arthritis↗
PubMed1980

Electrogoniometer for the measurement of human elbow joint rotation.

Since the electrogoniometric method has been justified for the measurement of lower extremity joint motion, a similar device is developed for the measurement of elbow joint and forearm rotations. In this design, the axis of forearm rotation coincides with the anatomical axis which eliminates the cross talk existing in the regular triaxial goniometer. Although the axis of abduction-adduction is still offset from the elbow joint, special linkage arrangement was used to obtain equivalent motion. Experimental method was used to validate the accuracy of the device and model simulation was performed to emphasize the importance of accurate placement of the instrument on test subjects. Application of the present apparatus to normal subjects was studied to illustrate the range of elbow motion required in performing normal activities of daily living. This device is currently used in the functional evaluation of patients with elbow and forearm problems.

Activities of Daily Living↗
PubMed1980

Complications and long-term results of ankle arthrodeses following trauma.

A review of sixty patients who had undergone ankle fusion for post-traumatic arthritis revealed that thirty-five (58 per cent) had the procedure performed within the first year after injury. A total of forty-eight complications occurred in twenty-nine (48 per cent) of the patients. Frequent complication were infection (23 per cent), non-union (23 per cent), inadequate surgical alignment or early loss of position (15 per cent), malunion (12 per cent), and delayed union (7 per cent). The lateral transfibular approach had the highest incidence of complications, and a two-incision approach using the Charnley compression apparatus was the procedure with the fewest complications. Forty-one patients were followed for an average of 7.5 years after operation. Of these, thirty-four (83 per cent) were satisfied with the procedure. Examination of thirty of the forty-one patients at an average of 7.3 years after surgery revealed virtually no subtalar motion but motion of 13 degrees at Chopart's joint. With shoes, patients had a near-normal gait. The roentgenograms revealed a minimum amount of degenerative arthritis at Chopart's joint, which may worsen with time. Varus or valgus angulation of the hind part of the foot was associated with a greater degree of symptoms in the subtalar area as well as the middle of the foot. The neutral position in varus-valgus angulation as well as dorsiflexion-plantar flexion was the optimum position for both men and women. The results of the procedure did not deteriorate with time.

Adult↗
PubMed1979

Hyperbaric oxygen and chronic osteomyelitis.

Forty patients with chronic osteomyelitis were treated with hyperbaric oxygen as an adjunct to surgical therapy and antibiotics and followed for an average of 2 years with a recurrence rate of 15%. The mechanism of action of hyperbaric oxygen in osteomyelitis is probably an indirect one of improving local vascularity and potentiating phagocytosis. Many of these patients represent a refractory group with poor prognosis due to the etiology of the infection, site of involvement, and duration of infection prior to treatment. The recurrence rate following this mode of treatment seems to be primarily related to inadequate surgical management. There was no definite correlation between the site of the infection of pathologic organism and recurrence. Although this is a preliminary report, the results are encouraging. Hyperbaric oxygen may be indicated as an adjunct to good surgical and medical management, particularly in patients with refractory chronic osteomyelitis and in whom ablative surgery is under consideration as the only other means of controlling the infection.

Adolescent↗
PubMed1979

Total joint arthroplasty. The elbow.

The first total elbow arthroplasty at the Mayo Clinic was performed in 1972, and it provided markedly superior results compared with previously performed procedures for elbow arthritis. However, a high revision rate (14%), due mainly to loosening (75%), tempered early enthusiasm for the procedure. Prospects for improved design and surgical technique based on our clinical experience and biomechanical data are encouraging. For the present, however, more limited procedures are recommended, and the total elbow arthroplasty is reserved for only a relatively few patients for whom there are no other viable surgical options.

Arthritis↗
PubMed1979

Total joint arthroplasty. The role of biomechanics.

The role of biomechanics is intricately involved in total joint replacement from its inception to its clinical use. By integrating knowledge of joint function and material properties, the artificial joint is designed and tested. After clinical use, the joint function is again studied and failure modes are defined. Biomechanics is the single most important discipline that can be employed to study the cause of failure in order to improve design and technique. This will increase the reliability of, and decrease the incidence of failure associated with, total joint replacement.

Arthroplasty↗
PubMed1979

Biomechanical study of the elbow following excision of the radial head.

The extent of proximal migration of the radius in thirteen patients who had had the radial head excised for fracture was 1.9 millimeters. After an average of twenty years there was minimum loss of motion of the elbow and forearm but strength was moderately decreased. The patients often had degenerative arthritis at the elbow that generally was not severe but correlated with the amount of pain. It correlated poorly with the severity of arthritis, loss of strength, motion, or pain. Over-all, the patients did well following resection of the radial head and there was no deterioration of results with time. An instrumented method for functional evaluation provided an objective and sensitive quantitative means to assess the need for and effectiveness of reconstructive procedure.

Adult↗
PubMed1978

Stress fractures.

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Adolescent↗
PubMed1978

Hematogenous osteomyelitis at uncommon sites in children.

The diagnosis of hematogenic osteomyelitis is often delayed in children if it involves uncommon sites such as the pelvis, clavicle, or calcaneus. Although parenterally administered antibiotics may control the disease process in the acute stage, abscess formation requires incision and drainage. Staphylococcus aureus was the most common organism in this series, and it usually was penicillin resistnat. When the condition is diagnosed early and is properly treated with at least 3 weeks of antibiotic therapy and judicious surgical intervention, recurrences are rare and morbidity is minimal.

Adolescent↗