Biomedical subjects
J V Fowles
Publications and source records attributed to J V Fowles.
Adolescent idiopathic scoliosis.
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Tibial defect due to acute haematogenous osteomyelitis: treatment and results in twenty-one children.
The management of twenty-one children with a defect of the tibial shaft due to acute haematogenous osteomyelitis is described. Half the defects were due to removal of the sequestrum before the involucrum had formed. Only four patients, all under ten years of age, had spontaneous regeneration of the shaft. Eleven children had a posterior tibiofibular graft and six had a transfer of the ipsilateral fibular diaphysis. The results of operation were superior to those of spontaneous regeneration. All the grafts united and the children returned home to lead normal lives. Shortening was only a problem when growth plates or adjacent joints had been damaged. We now leave the sequestrum for up to one year after the onset of infection. If the involucrum fails to form we reconstruct the tibia as soon as possible after sequestrectomy.
Total replacement arthroplasty of elbow in rheumatoid arthritis.
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Osteomyelitis, septic arthritis and cortisone. A problem of mistaken diagnosis.
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Intra-articular injuries of the elbow: pitfalls of diagnosis and treatment.
Poor results in treating fractures and dislocations about the elbow may be avoided if the surgeon is aware of the possible injuries, examines good radiographs of both elbows, and treats the injury promptly and appropriately. A displaced fracture of the lateral or medial condyle of the humerus should be suspected if there is a flake fracture of the adjoining metaphysis; open reduction and internal fixation give better results than closed reduction. A shear fracture of the capitulum humeri can only be seen on a lateral radiograph; excision of the fragment, followed by mobilization, is sufficient for a good functional result. Dislocation of the elbow in a child may avulse the medial epicondyle, which sometimes lodges in the joint; it is essential to recognize this and remove the fragment without delay to avoid early degenerative arthritis. An apparently isolated fracture of the ulna should alert the surgeon to the possibility of a dislocation of the radial head; the dislocation and the fracture must be reduced and stabilized to conserve elbow function.
Observations concerning fractures of the lateral humeral condyle in children.
From an anatomical study and clinical review of fractures of the lateral humeral condyle in children, the following conclusions are drawn. The mechanism of injury is a violent varus force with the elbow in extension, the condyle being avulsed by the lateral ligament and the extensor muscles. If the fracture is incomplete, with an intact hinge of pre-osseous cartilage medially, the fragment will not be displaced. If the fracture is complete the fragment may be displaced, and open reduction with internal fixation is mandatory. The results of open reduction more than three weeks after the fracture are no better than those of no treatment at all, and may kill the lateral condylar fragment by damaging its blood supply. The major problem of a neglected fracture is tardy ulnar nerve palsy; to avoid this, immediate anterior transposition of the nerve is recommended, operation for the fracture itself being of no benefit.
[Osteoarticular tuberculosis: a diagnostic problem].
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Scoliosis and myasthenia gravis. A case report.
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[Treatment of congenital dislocation of the hip by Salter's innominate osteotomy. Study of the first 40 cases operated on at the Orthopedic Institute, Kassar Said, Tunisia].
1) Twenty-nine children aged 18 months to 7 years with 40 congenitally dislocated hips, were treated between 1964 and 1971. Six hips had a closed reduction, 34 had an open reduction and capsulorrhaphy, and all had an innominate osteotomy. 2) Complications of the treatment included 2 joint infections. Of 11 hips which were unstable post-operatively, more than half were due to errors of the operative technique, and 8 required further surgery. Avascular necrosis of the femoral head occured in 3 hips post-operatively, and another 3 showed irregular ossification of the femoral epiphysis. All 6 hips had had an open reduction, and were mainly in older children who had inadequate pre-operative traction. 18 hips were stiff post-operatively ; 17 had had an open reduction ; Seven of eleven were improved by traction and physiotherapy. 3) The average length of follow-up was 4 years. Although only 70 p. 100 of the hips were clinically satisfactory, 92 p. 100 had excellent or good anatomical results as seen on radiographs.
[Methods of presenting an audio-visual text].
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The treatment of idiopathic scoliosis in Tunisia. A review of the first five years.
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Untreated scoliosis in the adult.
Untreated scoliosis affects the quality of life and is a disabling disease in the adult. Most patients can expect back pain, particularly after the age of 30, and one in 4 may be disabled by it. The majority of adults are embarassed by their deformity. Women, in particular, are less likely to marry. Surgical treatment of the adult is difficult and hazardous, and is associated with socioeconomic problems not encountered in the adolescent. Scoliosis should be treated definitively before the end of the period of growth.