Biomedical subjects
Publications and source records attributed to I A Trail.
The mechanical strengths of five techniques of tendon repair have been evaluated using human cadaver tendons. A modified Kessler repair with a peripheral circumferential suture and the method of Becker were found to require the greatest load to produce gapping, but the Becker and Savage repairs withstood the highest load before failure.
The incidence of Dupuytren's disease amongst the residents of two epileptic centres was found to be 12.0% in one and 38.1% in the other. The overall incidence at the second was significantly higher than a control population (16.0%) and this difference was particularly apparent in patients over 50 years old. The distribution of the Dupuytren's disease was found to be very similar to that of non-epileptic patients. At both centres, the disease process was more severe, with an increased incidence of contractures. Drug therapy was not clearly implicated in the aetiology of this condition.
Pisotriquetral arthrosis in young patients is considered rare and the diagnosis may be difficult to distinguish from other ulno-carpal problems. 12 patients under 40 years of age (15 cases) who underwent pisiformectomy were reviewed at a mean of 41 months. Patients with a good history of trauma and a positive response to intra-articular local anaesthetic injection did well. Others with an indefinite history and bilateral symptoms did not do so well. Trispiral tomography is the radiological investigation of choice.
Two in vitro experiments have been done comparing various techniques of tendon repair. These include repairs using an adhesive, 2-butyl cyanoacrylate (Histoacryl), and repairs by the modified Kessler technique, using 4/0 braided polyester and 4/0 stainless steel. Mechanical analysis has shown that by replacing the circumferential suture of a modified Kessler tendon repair with Histoacryl, the tensile strength of the repair and the force needed to produce a gap can be increased by 30% to 40%. This improvement was statistically significant (P < 0.05).
Fifty-six patients with psoriatic arthropathy have been reviewed to asses the extent and severity of their hand involvement. The hand was affected in 84% of cases. Although the distal interphalangeal joints are said to be classically affected, we found the proximal interphalangeal and metacarpophalangeal to be more frequently involved. Many other findings often associated with rheumatoid arthritis (e.g. boutonniere and swan-neck deformities, or tenosynovitis) can be seen in psoriatic arthropathy.
The Matrix seating system is an adaptable orthosis made of interlocking plastic components which can be shaped to fit the needs of the disabled. Twenty-five patients who had used this system for a minimum of 12 months have been assessed clinically. It was found to have several advantages over its rivals particularly in patient and guardian acceptance, versatility and on economic grounds. However, it was found not to prevent deterioration in spinal deformity nor to prevent hip dislocation.
A set of metal clamps cooled by liquid nitrogen were developed to hold the ends of tendons during in vitro tension tests. These were then used to determine the strength of whole human tendons, and human tendons repaired in vitro by sutures or by cyanoacrylate glues with or without suturing. The mean ultimate load of the intact human tendons was 1065 N, and the ultimate stress was 99.02 MN m-2. The repairs gave values of 0.3-2.3% of those of intact human tendon. Tendons were then repaired in vivo by a Kessler suture technique using braided polyester sutures with or without augmentation by a butyl cyanoacrylate glue (Histoacryl). At six months post-repair all tendons were as strong as the unoperated contralateral tendons. The glue augmented sutures were stronger than those not so augmented. A scanning electron micrograph of a tension tested glued tendon showed that it had failed by cohesive failure, i.e. failure of the inter-glue bonds rather than failure at the glue/tendon interface.
The following suture materials have been evaluated for their suitability for use in flexor tendon repairs: 4/0 gauge monofilament and multifilament stainless steel, mono-filament nylon, monofilament polypropylene, monofilament polybutestor, braided polyester, braided polyglycolic acid and a monofilament polyglyconate. These were investigated for their tensile strength (both knotted and unknotted), their extension to failure and knot-holding properties. Stainless steel and monofilament polyglyconate appeared to be the most suitable in that they had high tensile strengths, both knotted and unknotted, and had good knot-holding security. The only disadvantages are that stainless steel is difficult to use and monofilament polyglyconate is absorbable. Polypropylene and braided polyester, although having lower tensile strengths, are reasonable alternatives.
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Two groups of patients with symptomatic Osgood-Schlatter disease were compared over a 4-5 year follow-up period. One group was treated surgically by tibial sequestrectomy and the other group was managed conservatively. Tibial sequestrectomy was found to offer no significant benefit over simple conservative methods of treatment. In addition, a significant complication rate was identified with this procedure.