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Biomedical subjects

B F Morrey

Publications and source records attributed to B F Morrey.

At least 235 records · Page 13Linked to original sources
PubMed1977

Diphtheroid osteomyelitis.

Isolates of either Corynebacterium diphtheriae or Propionibacterium acnes from osteomyelitis are not necessarily contaminants, as shown by the cases of three patients who had bone and joint infections in which these organisms were pathogenic (one in pure culture and two in mixed cultures). Previous operation or other factors that compromise host resistance create the setting for these opportunistic organisms. Penicillin with or without streptomycin is the treatment of choice, but if penicillin or streptomycin cannot be used then the cephalosporins, clindamycin, and erythromycin are acceptable alternatives (depending on susceptibility studies). In general, the prognosis is good.

Aged↗
PubMed1977

Hematogenous osteomyelitis of the clavicle in children.

Recognition of acute hematogenous osteomyelitis of the clavicle can be difficult. The condition may even to confused with fracture or malignancy. Treatment with parenteral antibiotics must be continuous for at least three weeks. If there is evidence of abscess formation, incision and drainage is indicated. If surgery is performed, a thorough debridement or partial resection may be required to prevent recurrence. If inadequately treated, the process becomes chronic. Resection of involved portion of the clavicle has been effective in the chornic stage of the disease. In the young child the resected segment often regenerates and the clavicle completely reconstitutes itself.

Acute Disease↗
PubMed1976

Recurrent anterior dislocation of the shoulder. Long-term follow-up of the Putti-Platt and Bankart procedures.

Follow-up of 176 patients among 223 who underwent 232 repairs for recurrent shoulder dislocation (average follow-up, 10.2 years) revealed a recurrence rate of 11%. Among the twenty with recurrence, important factors were youth, athletic activity, inadequate immobilization, a history of contralateral dislocation, and a family history of shoulder dislocation. Redislocation occurred two years or more after operation in seven of the twenty patients with recurrence. Surgical repair permitted good function without significant pain in most cases.

Adolescent↗
PubMed1976

Suppurative arthritis of the hip in children.

Of thirty-seven children treated at the Mayo Clinic for suppurative arthritis of the hip and followed for at least one year (average, 8.3 years), nineteen had a satisfactory result and eighteen, an unsatisfactory result. An analysis of the records of the thirty-seven children revealed the following: (1) duration of symptoms was the most important prognostic feature, there being no unsatisfactory results if treatment was instituted less than four days after onset of symptoms; (2) fourteen of sixteen patients with associated osteomyelitis and six of eight with so-called penicillin-resistant Staphylococcus aureus had unsatisfactory results; (3) if symptoms had been present for more than ten days or if there was osteomyelitis, at least two weeks of parenteral antibiotics with arthrotomy and continuous irrigation offered the best prognosis; and (4) the prognosis has improved in recent years, possibly due to a move vigorous policy of early arthrotomy.

Adolescent↗
PubMed1976

Passive motion of the elbow joint.

A previously unreported method of measuring three-dimensional motion of joints, applied to two elbows obtained post mortem, showed that during flexion there is a continuous and linear change in the carrying angle, the forearm going into varus angulation as elbow flexion progresses. In addition, internal axial rotation of the forearm occurs near the beginning and external axial rotation, toward the end of flexion. With the elbow extended, the ulna shows little tendency to deviate laterally or to rotate axially during pronation and supination. The axis of rotation during elbow flexion lies approximately at the center of the trochlea.

Biomechanical Phenomena↗
PubMed1975

Septic arthritis in children.

When septic arthritis involves the hip, the prognosis is much worse than with any other joint. Approximately 50 per cent of the results were unsatisfactory with hip involvement compared to 12 per cent unsatisfactory results with involvement of the other joints. The erythrocyte sedimentation rate is a much more helpful diagnostic test than the leukocyte count or differential cell count. The most important prognostic factors are the duration of symptoms prior to treatment, a penicillinase-producing organism (penicillin-resistant) as the etiologic agent, and evidence of associated metaphyseal osteomyelitis. Early decompression and cleansing of the joint by aspiration or arthrotomy are essential for a good result. Long-term parenteral antibiotic therapy improves the prognosis when osteomyelitis is an assoicated feature. Arthrotomy with continuous irrigation appears to be more effective in decreasing long-term residual effects than arthrotomy alone. Almost all secondary surgical procedures are directed toward correcting the sequelae of septic arthritis of the hip.

Adolescent↗
PubMed1975

Hematogenous pyogenic osteomyelitis in children.

Early diagnosis of acute hematogenous osteomyelitis is difficult. The diagnosis can be positively established only by isolation of the organism from bone or by histologic confirmation. The diagnosis should always be suspected when clinical signs are suggestive. In these cases aspirated material should be obtained for culture and the patient should be treated with antibiotics and observed closely. If the clinical response is good and no bone destruction occurs, surgical intervention may not be necessary. If the clinical response is not satisfactory or if bone destruction occurs, surgical treatment should be carried out to drain the area and to identify the etiologic organism. When osteomyelitis is associated with joint involvement, the prognosis is poor, and our data show no obvious improvement even with long-term antibiotic therapy. The key is prevention by early recognition and treatment. If culture fails to isolate a pathogenic organism, the prognosis appears to be good. Overall, in recent years the prognosis of hematogenous osteomyelitis has continued to improve, probably as a result of early detection and better antibiotic therapy.

Adolescent↗
PubMedDate not supplied

An in vitro biomechanical study of a hinged external fixator applied to an unstable elbow.

Details of the mechanical properties of hinged external fixators are essential to use the fixator properly in the clinical setting. A hinged external fixator (Dynamic Joint Distractor 2) was attached to the lateral side of 7 cadaveric elbows. Cantilever lateral bending tests were performed at 3 flexion angles in varus and valgus directions. Varied states of joint contact and axial loading were studied. Stiffness of the construct was calculated with uniaxial loading. Stiffness decreased with increased elbow flexion. Gap creation made the system less stiff. Axial loading made the system stiffer, especially in valgus testing. Stiffness in varus was approximately 4 times that in valgus. Lateral fixator application with half pins is most effective for protecting against varus-producing forces. When using the external fixator for unstable elbows, attention should be paid to the status of the articular surfaces and the integrity of the ligaments, and this should also be noted for elbow position during rehabilitation.

Aged↗
PubMedDate not supplied

Biomechanical analysis of tension band fixation for olecranon fracture treatment.

This study assessed the strength of various tension band fixation methods with wire and cable applied to simulated olecranon fractures to compare stability and potential failure or complications between the two. Transverse olecranon fractures were simulated by osteotomy. The fracture was anatomically reduced, and various tension band fixation techniques were applied with monofilament wire or multifilament cable. With a material testing machine load displacement curves were obtained and statistical relevance determined by analysis of variance. Two loading modes were tested: loading on the posterior surface of olecranon to simulate triceps pull and loading on the anterior olecranon tip to recreate a potential compressive loading on the fragment during the resistive flexion. All fixation methods were more resistant to posterior loading than to an anterior load. Individual comparative analysis for various loading conditions concluded that tension band fixation is more resilient to tensile forces exerted by the triceps than compressive forces on the anterior olecranon tip. Neither wire passage anterior to the K-wires nor the multifilament cable provided statistically significant increased stability.

Biomechanical Phenomena↗
PubMedDate not supplied

Shoulder muscle moment arms during horizontal flexion and elevation.

The instantaneous muscle moment arms of 10 shoulder muscles including the three portions of the deltoid and the rotator cuff and scapulohumeral muscle groups during four specified glenohumeral motions were calculated. Moment arm values were derived from a plot of tendon excursion versus glenohumeral joint rotation angle during horizontal flexion along the 90 degrees elevation plane and elevation in the sagittal, scapular, and coronal planes. The deltoid had the largest moment arm in elevation. The anterior deltoid has a larger moment arm in the anterior planes, whereas the midportion is greater in the scapular and coronal planes. The muscles with the largest depressor (adductor) moment arms are the pectoralis major, latissimus dorsi, and teres major. Contrary to the findings of other investigators, the supraspinatus and infraspinatus have a smaller potential elevation torque in the scapular plane than has been previously reported. Furthermore the subscapularis may potentially be a more important elevator in the scapular plane than either the supraspinatus or infraspinatus, especially in the latter phases of motion. The pectoralis major has the largest horizontal flexion moment arm with the humerus elevated 90 degrees, whereas the posterior deltoid and infraspinatus have the largest horizontal extension moment arms in this plane.

Adult↗
PubMedDate not supplied

Reduction of triceps muscle force after shortening of the distal humerus: a computational model.

Bone deficiency resulting in shortening of the distal humerus may occur after fractures, treatment of nonunions, or revision of total elbow arthroplasty. A biomechanical model of the triceps muscle and tendon was used to investigate the effect of distal humeral shortening on triceps force production. The analysis indicated that shortening of the distal humerus primarily influences the media head of the triceps, which contributes most to elbow extension strength in extended elbow positions. In a posture of 30 degrees elbow flexion, shortening the distal humerus by 1, 2, and 3 cm reduced the extension strength by 17%, 40%, and 63%, respectively. At 90 degrees of flexion, strength was reduced by 11%, 15%, and 21%, respectively. This result suggests that shortening the humerus by 1 cm may be well tolerated, but shortening by 2 or more cm may cause a significant reduction in triceps force. This would be particularly important in patients requiring terminal extension strength for weight bearing.

Arm↗
PubMedDate not supplied

Surgical treatment of aseptic olecranon bursitis.

Most cases of aseptic olecranon bursitis respond to conservative treatment, yet some will develop a chronic bursitis with sufficient symptoms to warrant surgery. Over a 10-year period 21 cases of aseptic olecranon bursitis were treated surgically at our institution. Surveillance was a minimum of 2 years and averaged 5.2 years. The procedure provided complete and long-term relief in only 40% (two of five) of patients with rheumatoid arthritis, whereas 94% (15 of 16) of the patients without rheumatoid arthritis did well (p = 0.028, Fisher's Exact test). No patients had deep infection or draining wounds. Properly performed surgical treatment of aseptic olecranon bursitis appears to offer long-lasting symptomatic relief to patients without rheumatoid arthritis.

Adolescent↗
PubMedDate not supplied

Mechanical environment associated with rotator cuff tears.

A simplified 2-dimensional finite element model was used to investigate the stress environment in the supraspinatus tendon. The extrafibrillar matrix and collagen fiber were modeled with fiber-reinforced composite elements. The stress was evaluated at humeroscapular elevation angles of 0 degree, 30 degrees, and 60 degrees. Two acromion conditions were simulated. In the first set of conditions there was no subacromial impingement. In the second set there was subacromial impingement of the bursal side. Impingement was simulated by producing a 1-mm indentation on the bursal surface, an indentation similar to the type of impingement associated with deltoid contraction. The results demonstrated that subacromial impingement generates high stress concentrations in and around the critical zone. Such high stress could initiate a tear; tears that result from stress point to an extrinsic mechanism. However, we found that high stress and potential tears caused by impingement may occur on the bursal side, the articular side, or within the tendon. This result is unaccounted for by traditional mechanical models in which only bursal-sided partial tears are initiated by subacromial impingement.

Aged↗
PubMedDate not supplied

Stress analyses of glenoid components in total shoulder arthroplasty.

Finite element analysis was used to characterize the local stresses at the bone-implant interface of 2 different types of glenoid components presently used in unconstrained total shoulder arthroplasty. A series of 2-dimensional finite-element meshes was developed to model the glenoid in 2 mutually perpendicular planes with and without implanted components. One of the implants modeled was a cemented all-polyethylene component, and the second was an uncemented metal-backed component. A variety of parameters were studied including the resultant loading direction (concentric versus eccentric), keel geometry, subchondral bone integrity, and cement mantle size. Results of the analyses show that the cemented all-polyethylene design demonstrated an overall stress pattern that was closer to that of the intact glenoid. When the effects of concentric and eccentric loading conditions were compared, the overall stress magnitudes in the subchondral bone were found to be much lower with the uncemented metal-backed component than with its cemented all-polyethylene counterpart. This finding suggests that some degree of stress shielding may be associated with the metal-backed component. In addition, under both the concentric and eccentric loading conditions, extremely high stress regions were found within the polyethylene near the polyethylene-metal interface of the uncemented metal-backed component.

Arthroplasty, Replacement↗
PubMedDate not supplied

Semiconstrained total elbow arthroplasty in the context of treated previous infection.

Previous infection has been considered a strict contraindication to implantation or reimplantation of an elbow prosthesis. The purpose of this study was to investigate whether these patients can in fact be successfully treated with a prosthetic arthroplasty given previous treatment of the infection. Ten consecutive prosthetic arthroplasties performed in patients with documented infections in the elbow were retrospectively reviewed. Seven of the patients had infectious complications of total elbow arthroplasties that led to resection. Two patients had previous infections from septic joints and 1 from open reduction internal fixation. The median interval of time from infection treatment to final implant was 45 months (3.8 years). All arthroplasties were performed by the same surgeon with a modified Coonrad-Morrey, semiconstrained prosthesis. Patients were monitored for clinical signs of infection including radiographic and serologic studies and clinical evaluation based on the Mayo Elbow Performance Score. Mean surveillance was 4 years (range 2.8 to 5.4 years). Eight of the 10 cases have not shown signs of infection at the latest assessment. Two have had recurrent infections. The time interval from the original infection to latest implantation did not correlate with infection recurrence. Among those 8 without recurrent infection, 7 had excellent and 1 had satisfactory results according to the Mayo Elbow Performance Score. The recurrent infections were rated as failures. The average score was 32 before and 81 after surgery. The average pain score was 15 before surgery, and the average postoperative pain score was 40. Salvage of previously infected elbows with prosthetic arthroplasty can provide excellent results in a significant proportion of patients. Although the procedure offers superior functional outcomes compared with the alternative treatment options, it is technically demanding.

Aged↗