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Biomedical subjects

M B Coventry

Publications and source records attributed to M B Coventry.

At least 37 records · Page 2Linked to original sources
PubMed1983

Neurogenic arthropathy and recurring fractures with subclinical inherited neuropathy.

Some patients with radiologic findings of neurogenic arthropathy or multiple fractures do not exhibit overt neurologic signs. Results of nerve conduction velocity, computer-assisted sensory examination, periosteal nociception, and morphometric and graded teased-fiber evaluation of cutaneous nerves allowed us to recognize a mild neuropathic abnormality. Neurogenic arthropathy and subclinical neuropathy were also found in relatives. In three kinships, the underlying disorder was probably hereditary sensory neuropathy type 1 and in several others, it was recessively inherited sensory neuropathy. These arthropathies were often painful, and overt loss of superficial and deep pain sensation was not a prominent or necessary condition. An interplay of multiple factors including insensitivity, trauma, obesity, activity, abuse, personality, mental subnormality, and metabolic joint and bone disease are probably involved in the development of the bony lesions and thus provide further evidence that environmental factors affect expression of human mutant genes for inherited neuropathy.

Adolescent↗
PubMed1981

The use of radiation to discourage ectopic bone. A nine-year study in surgery about the hip.

Patients who had total hip arthroplasty were categorized according to the risk of development of ectopic bone. Radiation therapy was administered after operation to those considered to be at high risk of formation of ectopic bone. The dosage used was 2,000 rads given in ten fractions (875 rets). Forty-eight hips in forty-two patients were treated from 1970 to 1977. Massive formation of ectopic bone did not occur in any hip when the radiation was given relatively early after operation. Thus, we believe that radiation aids in the prevention of formation of ectopic bone. Radiation was found to be of doubtful value, however, hence the ectopic bone was visible on radiography.

Adult↗
PubMed1981

Fracture of the femoral component after total hip replacement. An analysis of fifty-eight cases.

Clinical, radiographic, biomechanical, and metallurgical data from fifty-eight patients with a fractured stem of the femoral component of a total hip replacement (thirty-seven Charnley, sixteen Müller, three Trapezoidal-28, and two Bechol prostheses) were analyzed, as well as the cases of twenty-seven control patients with matching clinical and radiographic data who had a Charnley prosthesis but no fracture of the stem. Radiographic data in the form of defined measurements were classified into discrete variables for statistical analysis. These radiographic variables, along with clinical variables, were rated by linear discriminant analysis and a fracture risk index (the sum of the rating scores or regressive coefficient) was derived for each patient. Using this index, two zones (of index values) were defined: one for the patients at risk for fracture and the other for those not at risk for fracture according to the discriminative scale. All patients in both the fracture group and the non-fracture group were separated successfully into one of these two zones, except for one patient with a metallurgical defect of the prosthesis and a stem in marked valgus orientation. Based on the values of the risk index. the zone for those at risk for fracture and the zone for those not at risk were each divided into three regions - questionable, marginal, and positive - to give more weight to the contributions of clinical, biomechanical, and material factors in the prediction of fractures of prosthetic stems. The mechanisms causing stem fracture that seemed to involve multiple variables of different origins were identified and an attempt was made to rank these groups of variables as causes of stem failures. A risk index developed in this way could be useful in predicting the possibility of fracture or loosening of a prosthetic stem after total hip replacement.

Adult↗
PubMed1981

Treatment of nonunion of the greater trochanter.

Nonunion of the greater trochanter is an uncommon problem. Even when it occurs, many hips are sufficiently functional to obviate surgical intervention. When symptoms are significant and surgery appears necessary, firm fixation of the trochanter to an adequate bony bed is essential to achieve union. Pseudarthrosis at the site of nonunion must be excised down to viable bone, and near-perfect apposition to the femur must be achieved. Wiring must be performed carefully, the goals being adequate containment and firm fixation. Abduction stresses after surgery should be controlled; the security achieved at the time of reattachment is the only guide to the kind and degree of protection required. Although results in patients treated with early ambulation were not significantly different from those in patients with abduction splints or casts, the latter patients had been carefully selected; in certain cases, therefore, patients should receive prolonged treatment by abduction.

Aged↗
PubMed1980

Stress fractures after total knee arthroplasty.

Fifteen patients sustained fractures of the tibia after geometric and polycentric total knee arthroplasty. The mean follow-up after arthroplasty was 45.1 months. The chief causes for the stress fractures were axial malalignment and improper component orientation. All fifteen patients experienced loosening of the prosthesis and required revision arthroplasty for a satisfactory result. Revision at the time of diagnosis of the fracture did not adversely affect fracture healing.

Aged↗
PubMed1979

Arthrodesis of the knee following failed total knee arthroplasty.

In forty-five patients, who had an arthrodesis because of failed total knee arthroplasty, the cause was infection in forty, instability in two, failure of the prosthesis in two, and loosening in one. The arthrodesis succeeded in twenty-nine (81%) of thirty-six patients who had had a minimally or partially constrained arthroplasty and in five (56%) of nine who had had a hinge-type prosthesis inserted. The reasons for failure were severe bone loss, persistent sepsis, and loss of bone apposition after manipulation. The technique of arthrodesis did not seem to influence the final result. External fixation most commonly had to be used because of the infections and the device was kept in place for an average of ten weeks, after which immobilization in a cast was used until the arthrodesis healed.

Adult↗
PubMed1977

Deep wound sepsis following total hip arthroplasty.

After follow-ups ranging from two to five years on all but four (five hips) of 2,694 patients who had 3,215 total hip arthroplasties, deep wound infection had been demonstrated in forty-two hips (1.3 per cent). The infections among the 3,210 hips appeared during the immediate postoperative period or as long as five years after surgery. All operations were performed in conventional operating rooms. Previous operations, prolonged operating time, positive culture at operation, and unrecognized preoperative sepsis were related to the development of deep infection. In only eight of the forty-one patients (forty-two hips) was salvage of the prosthetic arthroplasty possible. The deaths of tree patients were directly attributable to the infection or its treatment.

Adult↗
PubMed1976

Peripheral neuropathies associated with total hip arthroplasty.

The clinical and electromyographic findings in fourteen patients in whom peripheral nerve damage developed after total hip arthroplasty were reviewed (an incidence of 0.7 per cent in 2,012 procedures). In addition, a prospective study of the clinical, electromyographic, and nerve-conduction findings before and after arthroplasty was performed on twenty-eight patients who had thirty total hip arthroplasties. In the prospective study many patients showed evidence of mild nerve damage, most likely due to operative trauma. Peroneal neuropathies at the knee did not occur in either study. Nerve damage was more frequent in women, but no other predisposing factor could be identified. The prognosis for most patients with severe nerve injuries after total hip arthroplasty is good.

Arthroplasty↗