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Biomedical subjects

M J Cross

Publications and source records attributed to M J Cross.

At least 55 records · Page 3Linked to original sources

Avulsion of the ischial apophysis. The case for open reduction and internal fixation.

We report three cases of avulsion of the ischial tuberosity with marked chronic disability after delay in diagnosis and non-union of the fracture. All were treated by open reduction and internal fixation with return to full function, allowing in one case, athletic performances of Olympic standard. We also report one patient with an acute apophyseal avulsion treated by early reduction and internal fixation with restoration of full function.

Adolescent↗

The longitudinal development of a rehabilitation agency: an integrated rehabilitation service delivery model.

Health care services in the late 1980's are undergoing drastic changes. Similarly the laws, insurance regulations, etc. are changing so rapidly that the health care system appears to be having a difficult time keeping up with the ever changing needs of the consumers (that is, the patients). Diagnosis Related Groups (DRGs) have resulted in decreased hospital stays for patients with subacute and chronic conditions, and therefore patients are being care for in outpatient rehabilitation agencies, and/or outpatient clinics associated with hospitals. In short, a patient cannot stay in the hospital unless he or she is acutely ill or in need of surgery. Outpatient care is gradually becoming more important since patients who would have still been in the hospital several years ago, are now released to go home, with an order to receive outpatient therapy at the local rehabilitation agency. Currently there is no model available for starting an outpatient rehabilitation agency, and as a result health care professionals interested in starting such a facility have no guidelines or methodology for establishing a private rehabilitation practice.

Health Facility Planning↗

Sensory effects of pulling or vibrating exposed tendons in man.

The role of muscle receptors in proprioception has been demonstrated in a variety of ways (for review see McCloskey, 1978) but is still doubted by some. One simple but critical experiment has produced conflicting results: when a tendon of a conscious subject is exposed at operation under local anaesthesia, and pulled so as to stretch its muscle while the joint at which the muscle acts is held still, the subject is claimed by some to perceive nothing (Gelfan and Carter, 1967; Moberg, 1972), while others claim that the subject feels that the joint seems to move (Matthews and Simmonds, 1974). In the present study 4 patients were studied while undergoing surgery at the wrist or hand under local anaesthesia, and a more extensive study was carried out in the laboratory on the exposed, transected tendon of extensor hallucis longus of one of the authors (D.I.McC.). All 4 patients and the experimental subject detected stretches imposed on their muscles, and reported them as rotations of the joint or joints to which those muscles attach. In all cases the movements reported were in the direction of joint rotation that would normally stretch the muscle tested. In the experimental subject it was shown that stretches were detected with comparable acuity to that demonstrable for the detection of movements imposed on the intact toe. Also, the subject was able to detect, as joint movements, sinusoidal stretches of less than 1 mm imposed on the tendon at 1 or 5 Hz. The experimental subject experienced illusory movements of plantar flexion of the big toe when longitudinal vibration at 100 Hz, 20 to 100 microns amplitude was applied. These were sometimes partly masked by spread of the vibration through the foot. These vibration-induced illusions correspond to those reported by Goodwin et al. (1972) for transverse vibration applied through the skin. The subject could maintain a constant tension through the tendon in a contraction in which his effort was held constant. If, during such an effort, a downward movement was imposed on the toe to which the tendon normally connects, or the skin on the bottom of the toe was scratched, achieved tension fell.

Adult↗

Cysts and "pseudocysts" of the menisci of the knee joint.

A series of 636 consecutive knee arthrotomies was subjected to a prospective study, including the incidence, clinical presentation, and operative findings of meniscal cysts and associated pathological conditions. The clinical differential diagnosis was studied in detail, and from this, the importance of a specific clinical sign indicating a torn lateral meniscus was realized. This sign was termed a "pseudocyst". It was concluded that meniscectomy was the operation of choice and not simple cyst removal, and that the high incidence of associated meniscal tears and other less frequent joint pathological conditions justified a standardized approach designed to assess the meniscus and other intraarticular structures, rather than a simple incision over the joint-line swelling.

Adult↗

Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments.

Based on the clinical and operative findings in sixty-eight knees with acute tears of the medial compartment and cruciate ligaments, a standardized terminology and classification of knee ligament instability is presented. With an intact posterior cruciate ligament, anteromedial, anterolateral, or posterolateral rotatory instability may occur, but not true posteromedial rotatory instability. With the posterior cruciate ligament ruptured, straight anterior, posterior, medial, or lateral instability may be found.

Humans↗

Classification of knee ligament instabilities. Part II. The lateral compartment.

Lateral instability of the knee is less frequent but more disabling than medial instability of a comparable amount. At the same time the diagnostic tests for lateral instability are more subtle and more frequently misinterpreted. Posterolateral rotatory subluxation is demonstrated by an apparently positive posterior drawer test with the tibia in neutral rotation or by the external rotation-recurvatum test with the knee in extension. Anterolateral rotatory subluxation is present when the anterior drawer test with the tibia in neutral rotation demonstrates that the lateral tibial condyle appears to become more prominent or that both condyles appear to become equally prominent.

Knee Injuries↗

The injured knee.

Explore the source record for details and available documents.

Exercise Therapy↗

"Silent" transverse patellar fracture following anterior cruciate ligament reconstruction.

Patellar fracture is a rare but specific complication of anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. When this complication occurs, early internal fixation is recommended and need not compromise the outcome. We report 2 cases of displaced transverse patellar fracture occurring after reconstruction but which were not diagnosed and presented with late sequelae.

Adult↗

The patella index as a guide to the understanding and diagnosis of patellofemoral instability.

An analysis of 1004 X-rays has demonstrated that the medial patella facet is significantly smaller in patients with patellofemoral instability. There is no such significant difference in the width of the whole patella. Therefore the longitudinal ridge separating the smaller medial facet from the larger lateral facet must be closer to the medial patella border. As this ridge articulates with the groove between the femoral condyles, its medial position is accounted for by the patella being more laterally positioned in patients with patellofemoral instability.

Bone Diseases↗

Reconstruction of mid-substance anterior cruciate rupture in adolescents with open physes.

Five cases of anterior cruciate ligament reconstruction, performed for symptomatic episodes of giving way or during surgery for associated injury, were carried out in preepiphyseal closure adolescents (ages 12-15 years), utilising a strip of iliotibial band placed over the top of the lateral femoral condyle in a MacIntosh type repair, and avoiding drilling through epiphyseal plates. At a mean follow-up of 4.4 years, all five were symptomatically satisfactory and all five patients had returned to their preinjury level of sports activity. Although objective assessment revealed that increased laxity, when compared to the normal leg anterior laxity measured by the KT-1000, was within normal limits in four of five patients. Only one patient, who had had a fracture of the contralateral femur, had any leg length discrepancy.

Adolescent↗

The meniscal "pseudocyst." A clinical sign of a torn meniscus.

We report a study of 636 patients requiring knee surgery, all of whom underwent detailed preoperative assessment. Fifty-eight patients had a clinical sign of a lump on the joint line when the knee was examined at 45 degrees of flexion, which has been thought to indicate a meniscal cyst. Of these 58 patients, however, only 30 patients had a meniscal cyst demonstrated at surgery. The remaining 28 patients had a meniscal tear without a cyst. In these 28 cases, the clinical sign of a lump protruding from the joint line was termed a "pseudocyst." This new clinical sign is important because of its frequency of occurrence and the complete correlation with meniscal tears requiring surgical intervention.

Adult↗