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Biomedical subjects

M L Clayton

Publications and source records attributed to M L Clayton.

At least 37 records · Page 2Linked to original sources
PubMed1987

Activity, air boots, and aspirin as thromboembolism prophylaxis in knee arthroplasty. A multiple regimen approach.

In this prospective study 90 patients underwent 100 total knee replacements. Each patient walked and practiced rehabilitation exercises one day preoperatively and the morning of surgery. The contralateral calf was intermittently pumped during surgery followed by bilateral pulsatile calf compression postoperatively. Aspirin was administered in the recovery room and continued 600 mg twice a day until discharge. Early activity and ambulation postoperatively were expected. Routine deep venous thrombosis screening tests were not performed. No physiologically significant postoperative venous thrombosis on any of these patients were observed. A Doppler test was performed on eight patients, venogram on two patients, and V/Q lung scan on two patients in whom a thromboembolic disease problem was clinically suspected. All of these tests were negative except for one V/Q scan.

Adult↗
PubMed1986

Arterial anatomy of the triangular fibrocartilage of the wrist and its surgical significance.

This vascular injection study of the triangular fibrocartilage (TFC) was carried out in 12 fresh cadaver arms--eight adults and four infants--with Ward's blue latex. The TFC receives its blood supply from (1) the ulnar artery through its palmar and dorsal radiocarpal branches, (2) the dorsal branch of the anterior interosseous artery, and (3) the palmar branch of the anterior interosseous artery. These vessels are arranged in a radial fashion in relation to the fibrocartilage. Histologic sections of the TFC reveal vascularity in the outer 15% to 20% of the disc, and the rest is avascular. On the basis of these findings, we feel that tears of the TFC in its vascular zone have the potential to heal if repaired and those in the central avascular zone do not have this potential.

Adult↗
PubMed1986

Volz total wrist arthroplasty in rheumatoid arthritis: a long-term review.

The results of 30 Volz total wrist arthroplasties in 23 patients with stage III or stage IV rheumatoid arthritis were reviewed 36 to 106 months after the operation (average 69 months). Sixty percent were rated good or excellent, 27% were rated fair, and 13% were rated poor. Good or excellent results were achieved in 77% with single-prong metacarpal components, but in only 47% of the double-prong group. Wrist imbalance was the primary cause of poorer results with the double-prong metacarpal component. Pain relief and patient satisfaction were achieved in 86% of the cases. Typical radiologic patterns of deterioration were resorption of bone under the collar of the radial component (79%, average 3.7 mm) and metacarpal component loosening (24%). Most patients with component loosening had little or no discomfort. Complications occurred in 12 cases but affected the final outcome in only three patients.

Adult↗
PubMed1986

Correction of alignment deformities during total knee arthroplasties: staged soft-tissue releases.

Preoperative evaluation consists of a series of radiographs and a careful analysis of the gait in order to estimate the amount of bone resection and soft-tissue release needed for successful arthroplasty. Graduated, surgical soft-tissue releases were used for realigning arthritic knees during arthroplasty. Medial, lateral, anterior, and posterior releases provide step-by-step correction for realigning markedly deformed joints. The procedure prevents "over-releasing" leading to ligamentous instability. At surgery the mechanical axis of the limb was used for knee realignment by use of a towel clip over the hip joint and palpation of the malleoli at the ankle; the center of the hip, knee, and ankle should be in a straight line. Elimination of abnormal moment (the tendency to produce motion about the normal axis) at the knee with weight-bearing was the goal for realignment. Proper alignment is the key to success and longevity in knee arthroplasty. Soft-tissue releases should be used with any type of instrumentation the surgeon desires. The patella must also be realigned.

Aged↗
PubMed1985

Bilateral traumatic dislocations of Volz total wrist arthroplasties: a case report.

Bilateral traumatic dislocations of Volz total wrist arthroplasties in a patient with rheumatoid arthritis occurred 7 years after the initial surgical procedures. Treatment consisted of closed manipulation and reduction of both wrists followed by temporary splinting. Good function was restored in both wrists without operative intervention. No fractures or loosening at the bone cement interface was encountered.

Arthritis, Rheumatoid↗
PubMed1985

Synovectomy of the hand and wrist.

Synovectomy of tendons gives excellent results with rare recurrence. This is because the local environment is altered from a closed space into a decompressed area of healthy fat. The synovium can invade and destroy tendon, cartilage or bone when in a closed space and under pressure. Unfortunately, the environment can not be so altered in a joint. Joint synovectomy, however, is the only procedure available to prolong function of the patient's own joint (and relieve pain) for an "X" amount of time, which depends upon the course of the generalized disease. After two to three years, the result of a synovectomy is dependent upon the course of the general disease activity and not the surgery. It is absolutely necessary that general medical treatment be carried on before, during, and after surgery, as the surgery is only one incident, often dramatic, in total care of the patient. Chemical synovectomy of the hand has been shown to have variable results with only short-term gains being noted. Surgical synovectomy is indicated when synovitis persists in spite of adequate medical management and there is pain and early correctible deformities. Besides removing the synovium, it is necessary to reconstruct the capsular support and correct alignment. Flexor tenosynovitis in the fingers should be treated with decompression of the digital sheath, not incising the pulley system due to the possibility of accentuating the forces causing ulnar drift. Dorsal tenosynovitis in the wrist is treated by tenosynovectomy, synovectomy, resection of the distal ulna, reconstruction of the ulnar side of the wrist and transposition of the dorsal carpal ligament beneath the extensor tendons.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗
PubMed1984

Rupture of the triceps tendon with olecranon bursitis. A case report with a new method of repair.

Rupture of the triceps tendon is rare, and no previous report of its association with olecranon bursitis was found in the literature. A previously healthy 72-year-old man fell from a stationary bicycle and was examined by his family physician. Calcification over the olecranon area with an intact triceps tendon was revealed. Two months later the patient presented with triceps rupture and weakness of elbow extension with olecranon bursitis. Grossly, the pathologic lesion consisted of synovial frond proliferation and invasion of the cut end of a tendon. A "collar stud-shaped" bursa was found in front of and behind the triceps tendon and across a 3-cm gap in the tendon. The advancement was completed by splitting the tendon in partial thickness proximal to the cut end. The flap was turned down and anchored to the olecranon through drill holes. The end result was good return of function. Patients with chronic olecranon bursa problems should be carefully examined for triceps function. The gap in the tendon can be treated by mobilizing the tendon in the manner described.

Aged↗
PubMed1983

Extensor tendon rupture over the metacarpal heads.

Rupture of the extensor tendons is common in longstanding rheumatoid arthritis of the hand. The tendons commonly involved are those of the ring and little fingers and the common site of rupture is over the dorsal ulna and distal edge of the extensor retinaculum. We are reporting two cases of extensor tendon rupture over the metacarpal head of the middle finger due to prominent osteophytes.

Adult↗
PubMed1983

Compression arthrodesis of the thumb.

A retrospective study of all patients who had undergone thumb arthrodeses at the Denver Orthopedic Clinic since 1972 was undertaken to determine the incidence of satisfactory results with the Micks External Compression Fixator. Sixty-six patients underwent 82 metacarpophalangeal or interphalangeal arthrodeses that resulted in bony fusion in 81 cases. Indications for surgery included pain, instability, and collapse-type thumb deformity. Complications in the 81 successful cases included three that required a second procedure, one for nonunion and two for loss of position. There were eight cases of pin track drainage that cleared with removal of the device and did not adversely influence the outcome. Joints arthrodesed with external compression formed bony union in approximately half the time required for bony unions with Kirschner wire fixation. The fused position of either metacarpophalangeal or interphalangeal joints did not influence patient satisfaction, and all patients were satisfied with their surgery and demonstrated satisfactory use of the thumb.

Adolescent↗
PubMed1983

Dorsal wrist synovectomy in rheumatoid arthritis--a long-term study.

Dorsal wrist synovectomy, tenosynovectomy of the extensor tendons, excision of the distal ulna, ulnar-side stabilization of the wrist, and placement of the extensor retinaculum underneath the extensor tendons is an effective procedure in wrists with rheumatoid arthritis. Twenty-seven patients who had surgery on 38 wrists were followed for 5 to 14 years, with an average of 7.4 years. There were 25 female and two male patients with an average age of 54 years. Over 95% had excellent pain relief. There was significant reduction of wrist motion, but the arc of motion was within a functional range. Subsequent tendon rupture was minimal and even tendons found to be thinned out at the time of surgery remained intact. There was no recurrence of synovitis. Carpal measurements were done by using the pisiform bone as a reference point. The carpal height was maintained in 70% of the wrists. Carpal translocation occurred in 44% of the wrists. Three patients required wrist arthrodesis, and five, arthroplasty. Carpal collapse and translocation could not be predicted by preoperative x-rays. Progressive carpal collapse was associated with increasing ulnar deviation of fingers. Progression of carpal collapse and ulnar translocation occurred in a linear fashion with the years of follow-up.

Arthritis, Rheumatoid↗
PubMed1983

Surgery of the rheumatoid foot.

The typical rheumatoid foot deformity is that of hallux valgus, bunion, hammer claw toes with contracted dorsal soft tissue, depressed metatarsal heads and associated painful callosities and corns both under metatarsal heads and on dorsal surfaces of cocked-up lesser toes. Deformity and pain will be amendable with surgery if patients are selected properly and correct surgery is performed to achieve a pain free weight-bearing foot.

Adult↗
PubMed1982

Prosthetic arthroplasties of the shoulder.

Twenty-two Neer shoulder arthroplasties were performed in rheumatoid and osteoarthritic patients and followed for a minimum of two years, with an average of four years, seven months. In addition to the Neer humeral prosthesis, eight had Neer glenoid components and seven had a subacromial spacer inserted. Two years postoperation, 11 patients had no pain and eight had only mild discomfort. Shoulder function improved more than 100% compared with the preoperative ratings while the range of motion increased relatively little. There was one failure. Although the hemiarthroplasty group scored similarly to the total shoulder group, total shoulder arthroplasty is preferred because of possible further glenoid deterioration. A subacromial spacer is used if the rotator cuff cannot be repaired. The Neer shoulder prosthesis is recommended for the relief of rheumatoid or osteoarthritic shoulder pain.

Adult↗
PubMed1982

Patellar complications after total condylar arthroplasty.

The incidence of complications in the initial three years' experience with total knee arthroplasty and patellar replacement was 9%. Of the total knee arthroplasties perforated in the last three years, neither fracture nor subluxation of the patella has occurred. A prosthesis with right and left femoral components and slight lateral (physiologic) slanting of the patellar groove is recommended. Lateral release is done only if absolutely necessary and is performed at a considerable distance from the patella to preserve blood supply. Excess bone removal from the patella is avoided. The fat pad is preserved in all cases. Patients who have undergone a patellectomy had a definitely weak knee. Treatment by simple immobilization failed to produce an excellent functional result.

Aged↗