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Biomedical subjects

M A Tonkin

Publications and source records attributed to M A Tonkin.

At least 37 records · Page 2Linked to original sources
PubMed1995

Sesamoid arthrodesis for hyperextension of the thumb metacarpophalangeal joint.

Forty-two sesamoid arthrodeses performed since 1986 were reviewed. Thirty-seven cases were considered successful. Hypertension recurred in 3 of the 20 procedures performed for cerebral palsy and 1 of the 21 performed in association with basal joint arthroplasty for arthritic conditions. The single post trauma case was successful. Flexion was preserved. Prevention of hyperextension of the metacarpophalangeal joint assists in reducing metacarpal adduction in cerebral palsy and has a stabilizing effect in basal joint arthroplasty.

Adolescent↗
PubMed1995

Long-term results following digital flexor tenosynovectomy in rheumatoid arthritis.

A retrospective review of flexor tenosynovectomy for rheumatoid flexor tenosynovitis in the palm and digit was performed. Fifteen patients (61 fingers) were reviewed for at least 1 year (average, 4 years) after surgery. An average of 2.2 cm improvement in active flexion (pulp to distal palmar crease) was observed. A significant difference in preoperative and postoperative results was found. Sixty-seven percent of digits were classified as having excellent or good results, 21% fair results, and 12% poor results. The clinical recurrence rate was 31% and the reoperation rate was 15%. Only minimal complications from the extended surgical approach were observed. Debulking the fibro-osseous canal by excising a slip of flexor digitorum superficialis was associated with a reduction in the recurrence and reoperation rates.

Adult↗
PubMed1995

An approach to the management of radial longitudinal deficiency.

This paper describes an approach to the management of radial longitudinal deficiency. Early treatment includes manipulation and splintage prior to realignment of the carpus on the forearm. Twelve patients are presented in which a comparison is made between centralisation and radialisation surgical techniques. Preoperative distraction allowed radialisation without excision of a part of the carpus in five out of six patients. In contrast, centralisation with carpal excision was necessary in 5 out of 6 patients not treated by preoperative distraction. It remains to be seen whether radialisation is a superior procedure to centralisation in the longer term. However, radialisation in theory allows greater protection for the distal ulnar physis, maintains maximal length, and allows optimal wrist motion. Late treatment of radial longitudinal deficiency includes techniques of bone lengthening and correction of radial deviation deformity. Three cases are presented in which the Ilizarov technique was used to lengthen the forearm and to correct deformity. The complications of forearm lengthening are high but these techniques do allow significant correction of deformity.

Bone Lengthening↗
PubMed1994

Wild platypus attack in the antipodes. A case report.

The platypus (ornithorhynchus anatinus) is a furry duck-billed mammal that inhabits the waterways of eastern Australia. The male may reach 60 cm in length with a 20 cm beaver-like tail. We report the case of an American naturalist stung whilst trying to study the male in the wild. This resulted in an intense local reaction. Warning signs should therefore be erected at air and sea ports warning tourists of the dangers of these venomous Australians.

Adult↗
PubMed1994

Wrist arthrodesis using a sliding radial graft and plate fixation.

In a retrospective study, the results of 18 wrist fusions with a radial sliding graft and a dynamic compression plate are reviewed. All 18 fusions united, with an average position of 16 degrees of extension and 7 degrees of ulnar deviation. Wrist strength and stability and diminished pain allowed improved function. However, decreased maneuverability impaired function for some activities.

Adolescent↗
PubMed1992

The chauffeur's fracture: simple or complex?

14 chauffeur's-type fractures were treated by open reduction and internal fixation, mainly with Herbert screws. At average follow-up of 18 months, all had good or excellent functional results. The presence of an associated carpal injury in four cases indicates that the mechanism of injury may not be one of simple "backfire" and that a radial styloid fracture may represent the first stage of a more complex pattern.

Adult↗
PubMed1992

The sequelae of osteomyelitis of the proximal ulna occurring in early childhood.

Three patients presented with upper limb problems caused by the loss of the proximal ulnar shaft due to osteomyelitis which occurred in early childhood. The three patients had several features in common: instability of the elbow, dislocation of the radial head and shortness and bowing of the forearm, but hand and wrist function were largely unaffected. One patient had evidence of impaired function of the posterior interosseous nerve, presumably a traction injury. The treatment of these problems is discussed. In one patient, a child who had a functioning ulno-humeral joint, successful reconstruction of the ulna using a vascularised fibular graft was possible.

Adolescent↗
PubMed1992

Lateral band translocation for swan-neck deformity.

Lateral band translocation involves transfer of the dorsally subluxed radial lateral band to the palmar aspect of the joint where it is maintained by a sling created between the flexor superficialis tendon and the palmar plate. Thirty fingers with swan-neck deformity of differing causes and a preoperative hyperextension deformity averaging 16 degrees were treated. After operation all swan-neck deformities were corrected and the average flexion contracture was 11 degrees. The range of preoperative flexion was either regained or improved. There were no recurrences and no complications. This relatively simple procedure is an effective treatment of swan-neck deformity and an attractive alternative to previously described procedures.

Female↗
PubMed1991

Spontaneous rupture of the flexor carpi radialis tendon.

Three cases of closed rupture of the flexor carpi radialis tendon associated with scapho-trapezio-trapezoidal arthritis are reported. Carpal tunnel surgery preceded all three ruptures. Local steroid injection preceded two ruptures. Long-term disability was minimal.

Aged↗
PubMed1991

Acute calcific tendinitis in the hand and wrist.

Three cases of acute calcific tendinitis in the hand and wrist are described. The frequent misdiagnosis of this condition is discussed in the light of these cases and a review of the literature.

Acute Disease↗
PubMed1991

The Herbert screw for the treatment of scaphoid fractures.

Forty-nine patients with fifty fractures of the scaphoid were reviewed more than six months after surgical treatment using the Herbert bone screw. Twenty-nine patients (mainly those with delayed union and non-union) also had bone grafts. The mean period of follow-up was 18.3 months. In 47 patients (94%) the fracture had definitely or probably united. The three patients whose fractures did not unite had proximal pole fractures with pre-existing avascular necrosis and osteoarthritis. Immediate post-operative mobilisation was possible in thirty patients. Wrist function as measured by grip strength and range of motion was excellent or good in most patients. Twenty patients had proximal pole fractures and their results are analysed separately.

Adolescent↗
PubMed1990

Palmar cutaneous branch of the median nerve.

The palmar cutaneous branch of the median nerve was dissected in 25 fresh cadavers. The origin from the median nerve, the course, termination, and variability of the palmar cutaneous nerve are described in relation to two reference lines. In no case did a branch of the palmar cutaneous nerve extend ulnar to the axial line of the ring finger. The planning of incisions around the palmar aspect of the palm and wrist should be based on this anatomical knowledge.

Female↗
PubMed1990

Vascularized fibular osteocutaneous graft: surgical technique and clinical study.

This paper presents a detailed description of the dissection of the vascularized fibular osteocutaneous graft. The fibular graft is vascularized by the peroneal artery. A cutaneous vessel takes origin from the peroneal artery within 2 cm of the fibular midpoint in more than 90% of legs. The reliability of this vessel allows a skin island to be transferred with bone, to act as a monitor of vascularity and provide for skin loss. Ten clinical cases confirmed the reliability of the surgical dissection when centred at the midpoint of the fibula.

Adolescent↗
PubMed1990

Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon.

We reviewed 21 patients with 22 ruptures of the extensor pollicis longus at a mean of 5.3 years after transfer of the extensor indicis proprius tendon. Of these, 19 with 21 transfers described the result as good, and two as fair. The mean deficit of extension between the operated and unoperated thumbs was 1.4 cm, and the mean flexion deficit 0.6 cm. Pressure gauge measurements showed that the strength of the transfer was 51% of that of the uninjured extensor. The two fair results had an extensor lag of over 1.5 cm. Independent extension of the index was maintained in all patients, none having a discernible lag, but the strength of index extension was reduced to 49% of that of the normal finger. There was no evidence of functional loss. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon is a simple and reliable procedure with few complications. It gives satisfactory long-term extension of the thumb.

Adult↗
PubMed1990

The eye and the hand: a clinical review.

The visual system is highly susceptible to involvement in many systemic disorders. Disorders of tissues common to the eye and the hand, such as vascular, connective and neural, may have striking clinical signs in both. Thus signs in the hand may provide useful diagnostic clues in the assessment of disorders of the visual system. The hand may even be causative in traumatic or infective eye diseases. This review provides a schema for a suitable hand examination and documents the eye and hand features of various common and uncommon disorders. The importance to the ophthalmologist of a careful hand examination is emphasised.

Eye Diseases↗
PubMed1989

The posterior interosseous artery free flap.

A case is reported in which retrograde flow in the posterior interosseous artery did not perfuse the posterior interosseous artery flap, which was subsequently transferred as a free tissue transfer based on the proximal posterior interosseous vessels.

Adult↗