Biomedical subjects
Publications and source records attributed to D I Rowley.
A method of treating Freiberg's disease of the metatarsal head by shortening the metatarsal bone is described. This operation has been performed in 15 patients (16 feet). Excellent relief of pain was obtained, although most patients had persistent stiffness of the metatarsophalangeal joint.
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The relationship between hindfoot deformity and forefoot pressure was assessed in 28 rheumatoid patients who had undergone forefoot reconstruction four years previously. Patients with valgus hindfoot deformities tended to have high forefoot pressures whereas those with a normal hindfoot recorded normal pressures on the dynamic pedobarograph. All patients with residual forefoot pain recorded abnormal forefoot pressures. We believe that orthotic control of hindfoot deformities should be considered for those patients who require forefoot surgery as a combination of surgical and orthotic management may offer the best chance of success.
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A simple traction system which facilitates closed intramedullary nailing of the tibia is described. The system is easy to erect and uses equipment which is readily available in most operating theatres.
Three patients who underwent acetabular augmentation according to the technique of Olerud and Karlström are presented. In all 3 the procedure was a failure. The factors involved in recurrent dislocation of the prosthetic hip and the reason for the failure of this technique are discussed.
The Kates et al. metatarsal head resection arthroplasty has been modified and evaluated clinically and objectively using a dynamic pedobarograph in 35 adult rheumatoid arthritis patients. Preoperatively, all patients complained of severe forefoot pain, but only 70% recorded abnormal plantar pressure measurements. After a mean follow-up time of 36 months, 91% of the patients were satisfied with the result following surgery. Forty-two feet were pain-free, 16 feet still painful but less than preoperatively, and two feet worse. Thirteen of the 18 painful feet recorded abnormal pressure, but 16 additional feet with normal pressures were symptomatic. The clinical and pedobarographic results show that, in the majority of patients, the Kates et al. forefoot arthroplasty relieves pain, improves mobility, effectively decreases high abnormal plantar pressures, and should be considered when conservative methods of treatment have failed.
Three point fixation to stabilise joints using a rigid orthosis is relatively simple. When movement is required in a single plane, a hinge can be incorporated preventing superfluous movement and consequent loss of stability and function. Alternatively the Reciprocating Gait Orthosis (RGO) which utilises a system of Bowden cables with a HKAFO to provide reciprocal flexion and extension forces at the hip joint may be used. Free standing is achieved in the RGO by trunk and arm movements, the cable tension effectively "locking" the hips in neutral. Force transfer through the cables also produces reciprocal gait. The upper limbs acting through external supports provide the initiating force, producing truncal extension and subsequent hip extension of the stance leg. The resulting flexion of the swing leg produces a forward step. Currently 40 patients have been fitted with the orthosis in Salford, of whom 22 are Spina Bifida patients (aged 3-34 years). Most have Thoraco-lumbar or upper Lumbar lesions. The device has performed well with 1 episode of "knee clash" and 3 patients have had structural failures. Functional walking has been achieved with the orthosis.
To assess the results of forefoot arthroplasty, dynamic and static foot pressure studies have been made of the rheumatoid foot in both a prospective study group of 60 feet and in a retrospective study group of 18 feet. Significant reductions of pressure in the forefoot were found. Problems associated with the first and fifth metatarsals were considered.
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The preliminary results are presented from a study in which 85 serious tibial fractures were treated with external skeletal fixation. In group I patients were treated with highly rigid fixation. In group II the same fixation was used but axial micromovement was applied across the fracture site for 30 min per day, starting 1-3 weeks after injury and continuing until partial weight-bearing, which leads to self-induced movement. The overall mean time to independent weight-bearing was longer in group I than group II (p = 0.02); delayed union occurred in more group I patients. Objective measurement of fracture stiffness was made by means of strain gauges placed on the fixation frame for 49 fractures treated consecutively. The time to reach stiffness levels equivalent to clinical union was significantly longer in group I than in group II. The fractures in the treatment groups were of comparable severity. It seems that the fracture healing process is susceptible to small changes in mechanical environment.