Biomedical subjects

G I Bain

Publications and source records attributed to G I Bain.

26 records · Page 2Linked to original sources

PubMed1995

In-vitro strength of flexor-tendon repairs.

OBJECTIVE: To compare the standard Tajima technique for flexor-tendon repair of the hand with three new techniques with respect to strength and technical ease of the repair and bulk at the repair site. DESIGN: A randomized analysis of human cadaver flexor digitorum superficialis tendon repairs. SETTING: A musculoskeletal research laboratory at a university-affiliated health centre. MATERIAL: Thirty-nine fresh-frozen cadaveric flexor digitorum superficialis tendons from index, long and ring fingers harvested and divided transversely. The tendons were randomly allocated for repair by the current standard technique or one of three new techniques. INTERVENTIONS: The standard Tajima (modified Kessler) technique, and the Halsted, Savage or Silfverskiold technique. MAIN OUTCOME MEASURES: The time to perform each repair, the cross-sectional dimension and the load to failure of the tendon repairs. RESULTS: The Savage repair tolerated the highest loads, followed by the Halsted, Silfverskiold and Tajima repairs. The Silfverskiold technique was the least time-consuming to perform, followed by the Tajima, Halsted and Savage repairs. All of the techniques increased the cross-sectional dimensions of the tendon: the Silfverskiold repair by at least 50% and the Savage repair by over 100%. Although none of the techniques tested performed ideally, all three new techniques provided greater initial static strength than the standard Tajima method. CONCLUSION: Further in-vitro and in-vivo studies of these new techniques of flexor-tendon repair of the hand are necessary to optimize the treatment of these injuries.

Biomechanical Phenomena↗

PubMed1995

The midline posterior elbow incision. An anatomical appraisal.

The formation of a painful neuroma after operations on the medial or lateral sides of the elbow is a common problem. Our aim was to determine the relationship of the cutaneous nerves to the three usual skin incisions around the elbow. In 18 freshly frozen cadaver arms we made three standard 16 cm incisions in the skin medially, laterally, and posteriorly and explored them using loupe magnification. The number of nerves crossing each incision was determined by gross observation and their diameter measured by electronic microcallipers. In ten arms, biopsies of the nerves in each incision were sent for histological examination. We found significantly more cutaneous nerves crossing the medial and lateral incisions than the posterior. The diameter of the nerves crossing the posterior incision was significantly smaller than those crossing the lateral incision. Cutaneous nerves are at considerable risk of injury when medial or lateral incisions are used to approach the elbow, but the posterior approach carries less hazard. The routine use of the posterior incision may reduce the incidence of symptomatic paraesthesia and the formation of a painful neuroma after operation.

Analysis of Variance↗

PubMed1995

The role of arthroscopy in arthritis. "Ectomy" procedures.

Advances in arthroscopic techniques and instrumentation have enabled the surgeon to extend the therapeutic possibilities of wrist arthroscopy. The introduction of suction punches and smaller, lighter motorized resectors and burrs have facilitated the arthroscopic removal of bone and soft tissue. Arthroscopy provides the surgeon with a magnified view of all intra-articular structures, including those areas difficult to access via an arthrotomy. With the new instrumentation and the excellent views, bone and soft tissues can be resected with precision. Now the wrist arthroscopist can effectively perform a synovectomy; debride a torn TFC, chondral defects, and osteoarthritis; remove loose bodies; and resect the distal ulna and carpal bones. The surgeon should follow the anatomic principles that have been developed for open surgical procedures. Arthroscopic surgery is minimally invasive, hence patients rehabilitate quickly with fewer complications. "Ectomy" surgery of the wrist requires a higher level of skill from the surgeon but, when mastered, provided considerable benefit to the patient.

Arthritis↗

PubMedDate not supplied

Arthroscopic capsular release for contracture of the wrist: a new technique.

SUMMARY: Stiffness of the wrist can occur following trauma or surgery. In some patients, loss of motion may be refractory to conservative treatment and operative treatment may thus be indicated. The authors report the results and technique of arthroscopic capsular release of the wrist. A cadaveric study was performed to assess the safety of arthroscopic capsular release. Arthroscopic capsular release was performed on 2 patients with limited wrist mobility. The average distance from the radiocarpal joint capsule to the neurovascular structures were 6.9 mm to the median nerve, 6.7 mm to the ulnar nerve and 5.2 mm to the radial artery. At 6 months follow-up, the average range of motion had improved from 17 degrees flexion and 10 degrees extension to 47 degrees flexion and 50 degrees extension. The average grip strength had improved from 13 to 31 kg. Pain measured on a visual analogue score (0-10) had improved from 1.5 to 1.0. There were no complications. Arthroscopic capsular release of the wrist is a safe and minimally invasive technique that provides good improvement to range of motion.

Adult↗

PubMedDate not supplied

The dynamic elbow suspension splint.

Elevation of the upper extremity after elbow surgery has rarely been advocated and can be difficult to achieve. Usually the extremity is elevated with the elbow at 90 degrees of flexion, so that swelling from the hand drains to the elbow but the elbow remains dependent. Excessive swelling causes discomfort and compromised wound healing, makes early mobilization difficult, and predisposes to joint contracture. We report on a dynamic elbow suspension splint, which is analogous to the Thomas splint used for femoral shaft fractures. The arm is held in full extension with an above-elbow plaster slab and is secured to the Thomas splint with skin traction. The splint is suspended on a Balkan frame at an angle of 60 degrees. We prefer to use the new Zimmer Thomas splint, because it is radiolucent and has self-adhesive sheep-skin supports that can be simply applied. It allows the patient to mobilize in bed and is well tolerated by patients and nursing staff. The dynamic elbow suspension splint is a useful adjunct after complex elbow surgery or trauma, because it reduces swelling and maintains the elbow in extension.

Elbow Joint↗

PubMedDate not supplied

Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: an anatomic study.

Twelve right shoulders in fresh cadavers were dissected to determine the relation of the axillary nerve to the shoulder capsule and glenoid. Needles transfixed the nerve to the capsule and into the shoulder joint. Arthroscopy was performed to determine the location of the needles on the glenoid clock. The needles were then removed and the position of the shoulder changed to determine the effect on the position of the axillary nerve. The axillary nerve was held to the shoulder capsule with loose areolar tissue in the zone between 5 and 7 o'clock and was close to the glenoid in the neutral position, in extension, and in internal rotation. With shoulder abduction, external rotation, and perpendicular traction, the capsule became taut and the axillary nerve moved away from the glenoid. Abduction, external rotation, and perpendicular traction increase the zone of safety during arthroscopic anteroinferior capsulotomy adjacent to the glenoid between the 5 and 7 o'clock positions.

Aged↗

PubMedDate not supplied

Abduction strength following intramedullary nailing of the femur.

OBJECTIVES: To assess hip abductor function, strength and complaints following insertion of a femoral intramedullary nail. DESIGN: Retrospective clinical review. SETTING: Department of Orthopaedics, Adelaide Women's and Children's Hospital, Adelaide. Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia. PATIENTS: 1. 32 of 37 patients who had an intramedullary nail inserted for an isolated femoral shaft fracture at the Royal Adelaide Hospital between 1987 and 1990. 2. 14 of 18 patients who had closed femoral shortening for leg length discrepancy, at the Adelaide Women's and Children's Hospital between 1985 and 1987. Patients with pathology involving the abductor mechanism were excluded. 3. 40 asymptomatic controls. INTERVENTION: Intramedullary fixation for femoral shaft fractures or as part of closed femoral shortening. All procedures were performed on a traction table via a gluteal splitting approach with reamed nails. MAIN OUTCOME MEASUREMENTS: Complaints included, pain, stiffness, limp and diminished walking distance. Examination of abductor function and measurement of abductor strength. Radiological assessment at followup. RESULTS: Complaints included trochanteric pain (40%, 40%), thigh pain (10%, 8%) and limp (13%, 42%) in the femoral fracture and closed femoral shortening groups respectively. There was significant difference in the abduction strength (p < 0.01) and abduction ratio (p < 0.01) between the control and each treatment group. Abductor weakness correlated (r = 0.30) with the incidence of complaints. CONCLUSION: Pain, limp and weakness are common following insertion of a femoral intramedullary nail. Agluteal retracting approach may minimize abductor weakness.

Adult↗

PubMedDate not supplied

Repair of distal biceps tendon rupture: a new technique using the Endobutton.

The authors describe a technique with a single anterior incision and fixation with an internal button, the Endobutton. The procedure is performed through a 5-cm transverse skin incision, and the tendon is sutured to the Endobutton with 2 number 5 Ethibond sutures. Surgical repair in the depths of the muscular forearm is not required, because the tendon is simply sutured external to the wound. The Endobutton delivers and locks the tendon into a hole in the radial tuberosity. The Endobutton technique was used in 12 patients who were allowed early active mobilization. All were satisfied, returned to activities, and regained grade 5 strength. Average flexion was from 5 degrees to 146 degrees with 81 degrees supination and 80 degrees pronation. No neurovascular complications or synostosis occurred. In cadaveric studies the average distance from the biceps tendon were ulnar artery 6 mm, median nerve 12 mm, and posterior interosseous nerve 18 mm. The average distance from the posterior interosseous nerve to a Steinman pin advanced through the proximal radius was 14 mm. This technique is a safe and effective method of repair of distal biceps tendon avulsion that allows active mobilization with minimal risk of complication.

Adult↗