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Biomedical subjects

G R Barrett

Publications and source records attributed to G R Barrett.

36 records · Page 2Linked to original sources
PubMed1983

Foam bones. Experimental teaching aid.

The teaching of surgical anatomy is an important aspect of an orthopedic training program. The fabrication of polyurethane bones by the authors' staff has proved to be a simple, inexpensive, and rapid means of duplicating bones, permitting the orthopedic surgeons to experiment with new surgical techniques as well as to teach surgical skills. Polyurethane bones may be purchased commercially but are much less costly and more instructive when made by staff members.

Audiovisual Aids↗
PubMed1981

Pantalar arthrodesis: a long-term follow-up.

Eighty-three pantalar arthrodeses in 69 patients performed at the Shriners Hospital for Crippled Children, Greenville, South Carolina, between 1941 and 1977 were evaluated. Follow-up was from 1 to 33 years. Diagnoses included poliomyelitis, myelodysplasia, arthrogryposis, clubfeet, and extremity or spinal cord trauma. Methods of fusion were one-stage pantalar arthrodesis, two-stage triple ankle fusion, one-stage completion of prior tarsal fusion, and one-stage denudation of the talus. Pantalar arthrodesis is successful in the paralytic sensitive foot with a stable knee and there is no greater incidence of nonunion in the one-stage (Hunt-Thompson) procedure than in the two-stage procedure. Complications and failure of fusion are common in the insensitive foot.

Ankle Joint↗
PubMedDate not supplied

Clinical results of meniscus repair in patients 40 years and older.

The critical role that the meniscus plays in the knee along with the advantages of preserving as much of the meniscus as possible have both been well documented. Whenever possible, meniscus repair has become the procedure of choice for treatment of meniscal tears. However, some researchers have reported less favorable results in older patients. To determine the results of meniscus repair in older patients, patients 40 years and older who underwent arthroscopically assisted meniscus repair were prospectively followed up. Thirty-seven patients were included in the study, all of which had a minimum 2-year follow-up (average, 26.5 months). The average age of the patients at the time of the repair was 44.2 years (range, 40 to 52 years); 26 were males and 11 were females. There were 19 left knees and 18 right knees included in the study. Twenty-two patients had associated anterior cruciate ligament reconstructions. Physical examination at follow-up included swelling, joint line tenderness, locking, and McMurray testing and radiographs. Five of 37 menisci repaired (13.5%) were symptomatic at latest follow-up. All of these patients had joint line tenderness and two had a positive McMurray test. Three of these patients had repeat arthroscopy confirming that the meniscus had not healed. Because of the small number of patients with symptoms at follow-up, the authors feel that meniscus repair in patients 40 years and older is an effective treatment for peripherally located meniscus tears. With 86.5% of the patients having good clinical results, these findings are comparable with other studies with a younger population and signify that repair of peripheral tears is indicated in this age group especially in conjunction with anterior cruciate ligament reconstruction. The findings suggest that the location and meniscal tear, rather than the age of the patient, determine the potential for successful repair.

Adult↗
PubMedDate not supplied

Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women.

Reconstruction of the anterior cruciate ligament using a hamstring tendon autograft has often been recommended for female athletes. We compared the results of acute, isolated, intraarticular anterior cruciate ligament reconstructions using quadruple-looped hamstring autografts in 39 female and 26 male patients. All reconstructions were performed by the same surgeon using a similar surgical technique and the same postoperative management. In each case, patients had Endobutton femoral fixation and either post or button fixation for the tibial side. The average follow-up was 40.9 months for women and 39.0 months for men. Objective analysis of results included examination for the presence of effusion and crepitus, Lachman and pivot shift testing, and KT-1000 arthrometer testing for side-to-side differences. Subjective analysis consisted of a 15-item visual analog scale completed by patients postoperatively, and pre- and postoperative Tegner and Lysholm scores. The clinical failure rate was 23% (9 of 39) for the female patients and 4% (1 of 26) for the male patients, which was statistically significant. There was also a trend toward increased laxity in female patients. Subjectively, the women also reported a higher frequency and intensity of pain. Based on Tegner activity levels, more of the men returned to their preinjury level of activity than did the women. When compared with the male patients, female patients had a significantly higher failure rate after reconstruction.

Adolescent↗
PubMedDate not supplied

Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. A prospective analysis of 575 tears.

We used our database to evaluate the locations of meniscal tears associated with anterior cruciate ligament injuries. Five hundred seventy-five meniscal tears were seen in 476 patients. Each tear was categorized prospectively according to the side (medial/lateral), the radial zone of the tear, and the circumferential zone of the tear. The different tear locations were then compared for the medial and lateral menisci and evaluated for statistical significance. We found a nearly equal number of tears on the medial (305) and lateral (270) sides. A significantly greater number of tears on the medial side as compared with the lateral side were posterior (99.4% versus 87.8%) and peripheral (75.4% versus 44.1%). Peripheral posterior horn tears of the medial meniscus were the most common type of tear (230 of 575, 40%) by a statistically significant amount.

Adolescent↗
PubMedDate not supplied

Correction of abduction. Deformity of the small finger caused by avulsion of the insertion of the third volar interosseous muscle.

Wartenberg described the clinical sign of the abducted extended small finger that can result from ulnar nerve palsy. When this sign occurs in ulnar nerve palsy, it is a result of imbalance created by paralysis of the third volar interosseous muscle allowing the extensor digiti minimi to abduct the small finger as the finger is extended. If the third volar interosseous muscle is traumatically avulsed at its insertion and the ulnar nerve is intact, the abductor digiti minimi manus is an additional deforming force.

Adult↗
PubMedDate not supplied

A multicenter study on the results of anterior cruciate ligament reconstruction using a Dacron ligament prosthesis in "salvage" cases.

A multicenter study is presented on 80 patients who underwent ACL reconstruction using a Dacron (E.I. Du Pont de Nemours and Co., Wilmington, DE) ligament prosthesis. Patient selection was based on a history of a failed autologous reconstruction and/or primary repair of the ACL. These selection criteria are unique and have not been previously reported in the literature. The frequency of prior intraarticular ACL surgery was 1.24 procedures per patient and 1.68 when combined with prior extraarticular reconstructions. Forty-one patients had a mean followup of 28 months (24 to 42 months). The mean followup for all of the patients was 21 months. The graft was augmented with autologous tissue in 59 cases and used as a pure prosthesis in the rest. Functionally, the mean Lysholm score improved from 40 to 81 points. The percentage of a combined excellent/good Lysholm rating increased from 6% to 60%. The Tegner activity rating level improved from 2 to 4. The percentage of a negative Lachman sign, anterior drawer, and pivot shift was approximately 75% at followup. There was no significant difference between the results of augmentation and nonaugmentation cases, indicating that the graft acts as a permanent prosthesis rather than as a scaffold or stint. The patients showed a significant improvement considering their preoperative global instability.

Adult↗
PubMedDate not supplied

The Dacron ligament prosthesis in anterior cruciate ligament reconstruction. A four-year review.

We studied 40 patients who underwent reconstruction for chronic anterior cruciate ligament deficiency with a Dacron ligament prosthesis using a modified MacIntosh over-the-top technique, augmented with iliotibial band. Thirty patients had undergone at least 1 prior surgical procedure on the affected knee, but only 7 patients had previous anterior cruciate ligament reconstruction. All patients were followed for a mean of 47.5 months. The results at final followup demonstrated an average side-to-side arthrometer difference of 1.0 mm. The Lysholm score improved from 65 preoperatively to 89 at the end of the review; the Tegner activity level score improved from 3 to 5. Objectively, 75% of the patients had a negative Lachman test result and 95.1% of the subjects had negative or trace pivot shift results at review. Mild knee pain was still present with day-to-day activity in 87.7% of the patients. Complications occurred in 27.5% of patients, including five who had implant ruptures and two who had their grafts removed. Synovitis was a significant problem. Based on our failure criteria, 47.5% (19) of the subjects had failed results. In this study, radiologic evidence of tracer separation greater than 1 cm was a criterion of failure. With inclusion of tracer separation, the failure rate increased to 60.0% (24). Multiple previous surgeries of any type had an adverse effect on results. Damage to secondary stabilizers in these cases increased failure rate. Based on the high complication and failure rates, and relatively poor end result in this retrospective review, we cannot recommend this procedure.

Adolescent↗
PubMedDate not supplied

Deltoid and syndesmosis ligament injury of the ankle without fracture.

Ankle diastasis without fracture is a rare injury with few examples reported. We report on four male patients, aged 16 to 18 years, who sustained this injury playing football. Swelling and tenderness over both the deltoid and syndesmosis ligaments are the most common physical findings. Plain ankle radiographs demonstrated lateral talus subluxation in three patients, and a stress radiograph demonstrated subluxation of the talus in one patient. Treatment consisted of reduction and fixation of the syndesmosis with a screw followed by 6 weeks of cast immobilization. Using the scale developed by Edwards and DeLee, three patients had excellent results and one had a good result. Diagnosis of tears of the deltoid and syndesmosis ligaments without fracture requires a high index of suspicion on the physician's part. In patients whose mortise is more than 1 mm subluxated, reduction and screw fixation will produce good results.

Adolescent↗
PubMedDate not supplied

Early season anterior cruciate ligament tears. A treatment dilemma.

An anterior cruciate ligament tear before or early in an athlete's season presents a treatment dilemma: surgically repair the ligament and end the season, or use rehabilitative exercises and bracing to quickly return the athlete to play. We conducted a prospective study of 43 athletes (44 acute tears) over 44 months to determine criteria for early return to play and if an early return is safe. All patients had an acute injury in a previously normal knee, a positive Lachman test, and KT-1000 arthrometry indicating ligament abnormalities. Magnetic resonance imaging of each injured knee showed an interior cruciate ligament tear but no meniscal tear. Thirty patients (31 tears) returned to play with rehabilitation and a brace at an average of 5.7 weeks after injury: Only 12 patients returned to their sports without recurrent buckling of their injured knees; 18 patients (19 knees) had recurrent buckling during play. Thirteen patients could not return to play. Patients were observed until they 1) had ligament reconstruction (29 patients, 29 tears), 2) gave up their sports because of instability but did not elect surgery (3 patients), or 3) returned to play in a brace and declined surgery (11 patients, 12 tears). All who elected reconstruction experienced recurrent knee buckling. We found 23 meniscal tears (17 knees) in the 29 patients undergoing reconstruction.

Anterior Cruciate Ligament↗
PubMedDate not supplied

Endoscopic anterior cruciate ligament reconstruction. Endobutton/button--a method of endoscopic fixation.

1. Reconstruction of the anterior cruciate ligament may be accomplished in many ways using a variety of autologous as well as allograft tissue. 2. A method of fixation uses an Endobutton for femoral fixation and a 19 mm Hewson Ligament Button for the tibial fixation of the graft. 3. This method of fixation will permit the surgeon to choose the graft best suited to the patient's needs while allowing endoscopic reconstruction of the anterior cruciate ligament, regardless of the choice of graft. Fixation of the graft need no longer be a variable in anterior cruciate ligament reconstruction.

Anterior Cruciate Ligament Injuries↗