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Biomedical subjects

B F Morrey

Publications and source records attributed to B F Morrey.

At least 145 records · Page 8Linked to original sources
PubMed1992

Revision of ankle arthrodesis with external fixation for non-union.

We evaluated the cases of twenty-six patients (twenty-six ankles) who had had revision of an ankle arthrodesis with external fixation for a nonunion, to determine the reasons for the failure of the previous arthrodesis. Eighteen patients had had supplemental bone-grafting in addition to the external fixation. The failure of the previous arthrodesis was related to inadequate fixation technique in seven patients and to technical problems in two patients; in the other seventeen patients at least one risk factor was identified. We also determined the functional results of the revision operation with external fixation for all patients. The average duration of follow-up was five years (range, two to ten years) in the twenty-two patients who did not have a reoperation for a persistent nonunion. The results were excellent in eleven patients, good in five, fair in four, and poor in six. The over-all rate of union was twenty (77 per cent) of twenty-six, comparable with that after primary arthrodesis; however, supplemental bone-grafting is usually necessary. In the current series, rigid fixation, precise apposition of bone and alignment of the foot, and early treatment of perioperative infection gave satisfactory results.

Adult↗
PubMed1992

Ligamentous reconstruction for posterolateral rotatory instability of the elbow.

Eleven consecutively seen patients who had posterolateral rotatory instability of the elbow joint were managed operatively. The radial collateral-ligament complex was advanced and imbricated in three of them. In seven patients, the ulnar band of the radial collateral ligament (the lateral ulnar collateral ligament) was reconstructed with the palmaris longus tendon and in two of the seven, the reconstruction was augmented with a prosthetic ligament. The ligament was reconstructed with the lateral one-third of the triceps fascia in the remaining patient. Stability was obtained in ten patients, and seven patients had an excellent functional result. There was one failure in one of the patients in whom the ulnar band of the radial collateral ligament had been reconstructed with the palmaris longus tendon and augmented with a prosthetic ligament.

Adolescent↗
PubMed1992

Operative correction of an unstable total hip arthroplasty.

We reviewed the results of reoperation in ninety-five patients who had acute subluxation (ten patients) or dislocation (eighty-five patients) of the hip after conventional cemented total hip-replacement arthroplasty. Postoperatively, fifty-eight patients (61 per cent) had no subsequent dislocation or subluxation. Seven of thirty-seven patients who had had recurrent dislocation had occasional subluxation during follow-up. Of the remaining thirty patients in whom instability persisted after the reoperation, twenty-eight had at least one dislocation, and nine had bothersome subluxation. Ten of these thirty-seven patients had another operation for the persistent instability. The causes of instability were classified as malrotation of the component, disruption of the trochanteric-abduction mechanism, impingement, or multiple and unknown, and appropriate treatment was provided. The component was revised in forty-five patients, revision and advancement of the trochanteric component was done in twenty-five patients, and impinging bone or cement was removed from six patients; a combination of these procedures was done in nineteen patients. Over-all, fifty-eight procedures (61 per cent) were successful (no additional subluxations or dislocations). We concluded that the results of operative treatment for an unstable total hip replacement can be optimized when a precise determination of the cause of the instability is made and appropriate measures are applied.

Adult↗
PubMed1992

Radio-ulnar dissociation. A review of twenty cases.

The results of treatment were reviewed for twenty patients who had sustained concomitant injuries of the lateral compartment of the radiohumeral joint and the ipsilateral distal radio-ulnar joint. The ages of the patients ranged from eight to seventy-four years (average, thirty-five years) and the duration of follow-up ranged from four months to twenty-seven years (average, 113 months). In fifteen patients, the injury of the wrist was diagnosed after a mean delay of seven years and eleven months (range, one month to twenty-six years). In all fifteen, the radial head injury was treated by excision, either initially or after some delay. After excision of the radial head, all fifteen patients complained of severe pain at the distal radio-ulnar joint. The results, on the basis of elbow and wrist scores of fair or better without complications, were satisfactory in only three patients. In the remaining five patients, in whom the injuries of both the elbow and the wrist had been identified at the initial evaluation, the radial head was either preserved or replaced. The results, on the basis of elbow and wrist scores of fair or better, were graded as satisfactory in four of these patients. Our data show that any injury to the lateral side of the elbow should prompt a careful evaluation of the ipsilateral distal radio-ulnar joint for associated instability.

Adolescent↗
PubMed1992

Compensatory motion in the upper extremity after elbow arthrodesis.

Ten healthy male subjects were asked to complete a series of tasks that represent normal elbow function. They were then fitted with a custom adjustable brace that simulated elbow arthrodesis at 50 degrees, 70 degrees, 90 degrees, and 110 degrees flexion and asked to repeat the tasks. The 3 Space Isotrak system was used to measure shoulder motion; a triaxial wrist goniometer was used to measure wrist compensation; and all subjects were videotaped to qualitatively observe other compensatory motion. Unlike other joints, elbow arthrodesis at any angle results in a significant impairment, since the adjacent shoulder and wrist joints cannot compensate to allow completion of activities.

Activities of Daily Living↗
PubMed1992

Instability after total hip arthroplasty.

The most statistically significant risk factors for hip dislocations following total hip arthroplasty include prior hip surgery, trochanteric nonunion, and posterior surgical approach. Reoperation is required in only about one third of those patients who sustained dislocations. The most reliable surgical procedure is reorientation of the retroverted acetabular component. Care should be exercised to define the precise cause of the instability to plan the surgery that best addresses this particular problem.

Hip Dislocation↗
PubMed1992

Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow.

Fifty-four patients in whom a total of fifty-eight semiconstrained modified Coonrad elbow implants had been inserted for rheumatoid arthritis were followed for a mean of 3.8 years (range, two to eight years). At the latest follow-up, there was little or no pain in fifty-three elbows (91 per cent). The arc of motion was from an average point in flexion of 20 degrees to an average point in flexion of 129 degrees, representing an average increase of 12 degrees of extension and 11 degrees of flexion. The average arc of pronation was 78 degrees, an increase of 14 degrees, and the average arc of supination was 77 degrees, an increase of 18 degrees. An additional ten patients who had had insertion of ten modified Coonrad implants during the same period were followed for less than two years but were included in the assessment of complications. Fifteen (22 per cent) of the sixty-eight elbows had a complication: four, infection; eight, acute or delayed condylar or ulnar fracture; and one each, ulnar neuritis, avulsion of the triceps, and fracture of the implant. Radiographic evaluation was performed for fifty-four of the fifty-eight elbows; the other four were excluded from this evaluation because of infection. A satisfactory radiographic appearance of the cement--its extent and the absence of skip areas--was noted for all of the ulnar components and for fifty-one (94 per cent) of the humeral components. No patient had radiographic evidence of a loose implant. A reoperation was performed in six elbows (10 per cent of the fifty-eight; 9 per cent of the sixty-eight): four were done for infection; one, for insufficiency of the triceps; and one, for a fractured ulnar component. Of the fifty-eight elbows, forty (69 per cent) had an excellent result; thirteen (22 per cent), a good result; four (7 per cent), a fair result; and one, a poor result.

Arthritis, Rheumatoid↗
PubMed1992

Elbow subluxation and dislocation. A spectrum of instability.

After sequential releases of the ligaments and capsules of 13 fresh autopsy specimen elbows, external rotation and valgus moments with axial forces resulted in posterior dislocations in 12 of the 13 with the anterior medical collateral ligament (AMCL) intact. Kinematic displacements measured with a three-dimensional electromagnetic tracking device showed that dislocation involved posterolateral rotation of 34 degrees-50 degrees and 5 degrees-23 degrees valgus at about 80 degrees flexion. Dislocation is the final of three sequential stages of elbow instability resulting from posterolateral rotation, with soft-tissue disruption progressing from lateral to medial. In each stage, the pathoanatomy correlated with the pattern and degree of instability. Testing for valgus stability of the elbow during simulated active flexion revealed no significant increase (-0.3 degrees-2.4 degrees) in valgus laxity after reduction compared with the intact specimens (p greater than 0.05, beta = 0.1, delta = 2.5 degrees). In no case did the digitized AMCL origin-to-insertion distance increase beyond normal during the dislocation (p less than 0.01). The mechanism of dislocation during a fall on the outstretched hand would involve the body "rotating internally" on the elbow, which experiences an external rotation/valgus moment as it flexes. Posterior dislocations should therefore be reduced in supination. If valgus stability in pronation is demonstrated, the AMCL can be assumed to be intact, and rehabilitation in a hinged cast-brace with the elbow in full pronation can be commenced immediately.

Autopsy↗
PubMed1992

Intersegmental elbow joint load during pushup.

Intersegmental loading pattern on the elbow joint during a push-up exercise was investigated. Electromagnetic motion sensors and a piezoelectric force plate were used to simultaneously record upper extremity motion and forces on nine healthy male subjects during push-ups in six different hand positions. Peak axial forces exerted on the elbow joint averaged 45 percent of the body weight. Peak torque to produce elbow flexion was 2305.9 N-cm, or 56 percent of maximal isometric extensor torque. The results of this analysis give insight to the biomechanics of a normal elbow and to its load carrying capacity.

Adult↗
PubMed1992

Arthroscopy of the elbow. Diagnostic and therapeutic benefits and hazards.

We analyzed the results of seventy-one arthroscopies of the elbow in seventy patients who had been followed for an average of thirty-four months, in order to evaluate the risks and benefits of the procedure. Thirty-four arthroscopies were done for diagnostic purposes, fifteen were done for treatment, and twenty-two were done for both diagnosis and treatment. Overall, fifty-one (73 per cent) of the seventy patients benefited in some way. There were diagnostic benefits in thirty-six (64 per cent) of the fifty-six elbows in which diagnosis was an indication for the procedure, and there were therapeutic benefits in thirty (70 per cent) of the forty-three elbows in which treatment was intended or was performed although not planned. The procedure was of benefit in only eighteen (75 per cent) of the twenty-four elbows that had loose bodies, but it was successful in all elbows in which the loose bodies were not secondary to some other condition, including arthrosis. The procedure was also successful in all four elbows in which the loose bodies had been due to osteochondritis dissecans. In twelve (80 per cent) of the fifteen patients who had débridement (removal of flaps or loose fragments of articular cartilage) and in one of the two in whom a synovectomy had been performed, the treatment was successful. Seven (10 per cent) of the seventy patients had complications, none of which were major. Three patients (4 per cent) had a transient radial-nerve palsy after intra-articular injection of local anesthetic; four others had persistent drainage and negative cultures, but the drainage resolved with antibiotic therapy. In one of the four patients, a permanent flexion contracture of 15 degrees developed, and 10 degrees of flexion was lost.

Adult↗
PubMed1991

Orthopedics.

Explore the source record for details and available documents.

Humans↗
PubMed1991

Three-dimensional kinematics of glenohumeral elevation.

To help resolve longstanding uncertainties about kinematics of the shoulder, we studied three-dimensional glenohumeral joint motion during arm elevation. A magnetic tracking system was used to monitor the three-dimensional orientation of the humerus with respect to the scapula. Appropriate coordinate transformations were then performed for the calculation of glenohumeral joint rotation based on the defined Eulerian angle. The effects of the plane of elevation and the humeral rotation on the magnitude of arm elevation were documented. The maximum humeral elevation at the glenohumeral joint took place in a plane anterior to the scapular plane. Maximum elevation in all planes anterior to the scapular plane required external axial rotation of the humerus. Conversely, internal axial rotation was necessary for maximum elevation posterior to the scapular plane. Quantifying the obligatory axial rotation explains the relationship of internal and external rotation with maximum elevation.

Biomechanical Phenomena↗
PubMed1991

Total replacement for post-traumatic arthritis of the elbow.

Fifty-three of 55 consecutive elbow replacements for post-traumatic arthritis were followed for a minimum of two years (mean 6.3, range 2 to 14.4). The patients presented difficult management problems, having undergone an average of two previous operations per joint; 22 joints had suffered prior complications; 18 had less than 50 degrees of flexion and six were flail. One of three versions of the Coonrad prosthesis was employed in all. During the follow-up period, 10 patients underwent 14 revision procedures for aseptic loosening; 38 elbows are currently without progressive radiolucent lines. In two patients an elbow had to be resected, one for deep infection and the other for bone resorption following a foreign-body reaction to titanium. The current design of the Coonrad prosthesis offers a reliable option for the treatment of post-traumatic arthritis but should be used only in carefully selected patients over the age of 60 years.

Adult↗
PubMed1991

The cubital tunnel and ulnar neuropathy.

The anatomy of the cubital tunnel and its relationship to ulnar nerve compression is not well documented. In 27 cadaver elbows the proximal edge of the roof of the cubital tunnel was formed by a fibrous band that we call the cubital tunnel retinaculum (CTR). The band is about 4 mm wide, extending from the medial epicondyle to the olecranon, and perpendicular to the flexor carpi ulnaris aponeurosis. Variations in the CTR were classified into four types. In type 0 (n = 1) the CTR was absent. In type Ia (n = 17), the retinaculum was lax in extension and taut in full flexion. In type Ib (n = 6) it was tight in positions short of full flexion (90 degrees to 120 degrees). In type II (n = 3) it was replaced by a muscle, the anconeus epitrochlearis. The CTR appears to be a remnant of the anconeus epitrochlearis muscle and its function is to hold the ulnar nerve in position. Variations in the anatomy of the CTR may explain certain types of ulnar neuropathy. Its absence (type 0 CTR) permits ulnar nerve displacement. Type Ia is normal and does not cause ulnar neuropathy. Type Ib can cause dynamic nerve compression with elbow flexion. Type II may be associated with static compression due to the bulk of the anconeus epitrochlearis muscle.

Biomechanical Phenomena↗
PubMed1991

The elbow.

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Adult↗
PubMed1991

Partial rupture of the distal biceps tendon.

Rupture of the distal biceps tendon is a relatively uncommon injury. Roentgenograms often demonstrate osseous changes at the radial tuberosity consistent with the degenerative tendon changes seen at the time of surgical repair. Partial rupture of the distal biceps tendon exhibits features similar to that of complete disruption, including acute antecubital pain, weakness of elbow flexion, and forearm supination, and differs only in that the biceps tendon is still palpable in teh partial rupture. The clinical presentation, surgical confirmation, and treatment of this condition seems not to have been reported previously in the literature.

Adult↗
PubMed1991

Biomechanical study of ligaments around the elbow joint.

The ligamentous contribution to elbow joint stability is a product of morphology and biologic parameters of each of the collateral ligaments. Better understanding of these characteristics is of paramount importance for successful ligament reconstruction in the surgery for joint replacement and traumatic injury. Two experiments were performed. In the first, the arc of elbow flexion where the individual ligament was either taut or slack was measured; in the second, the structural properties of each collateral ligament were determined by using bone-ligament-bone preparations. The anterior medial collateral ligament (AMCL) and radial collateral ligament (RCL) were taut throughout most of the entire arc of flexion. The posterior medial collateral ligament (PMCL) was taut only when the elbow was in a flexed position. Among the collateral ligaments, the AMCL was the strongest and stiffest with an average failure load of 260 N. The palmaris longus tendon, the most frequently used graft for elbow ligament reconstruction, was similar in strength (357 N).

Biomechanical Phenomena↗