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Biomedical subjects

M W Fidler

Publications and source records attributed to M W Fidler.

34 records · Page 2Linked to original sources
PubMed1985

Pathological fractures of the cervical spine. Palliative surgical treatment.

Eleven patients with metastases in the cervical spine had operations for severe pain due to a pathological fracture which, in eight of the cases, was unstable. Conservative treatment had either failed or was unsuitable. In the first five patients internal fixation with tension band wires and bone grafts was supported by a halo-brace. The method has evolved to the use of posterior instrumentation with laminar wires from two levels above the lesion to two levels below. Stability is increased by the use of bone cement with or without bone autografts applied to one side of the spine. This technique enables the patient to get up within a few days of operation--a great advantage when life expectancy is limited. The operations were successful in all except one case.

Adult↗
PubMed1984

Subclavian artery aneurysm due to costoclavicular compression.

Proximal involvement of the innervation of the arm is a well recognised cause of hand symptoms; a proximal vascular abnormality is rarely responsible. This case report describes such a rare cause, namely, a post-stenotic aneurysm of the subclavian artery due to an abnormal first rib but in the absence of a cervical rib or scalene bands.

Adult↗
PubMed1984

Excision of prolapse of thoracic intervertebral disc. A transthoracic technique.

A new technique for the transthoracic removal of a prolapsed intervertebral disc in the mid or lower thoracic spine is described. Investigations before operation include thoracic myelography, selective spinal angiography and CT scanning. Image intensification is used at operation to check the level of the prolapse. A tunnel in the coronal plane (vertebrotomy) is made through the posterolateral part of the disc and the adjacent vertebral bodies, to reach the spinal canal at the site of the prolapse. This gives good exposure and enables gentle removal of the disc prolapse and any associated osteophytes, under direct vision without need for retraction or pressure on the dura or spinal cord. Spinal stability is not compromised, and the blood supply of the cord is not disturbed. Five consecutive patients are reported, including one in whom the disc prolapse was calcified and had herniated into the spinal cord. All were treated successfully.

Adult↗
PubMed1983

Knee arthrodesis following prosthesis removal. Use of the Wagner apparatus.

Arthrodesis after the removal of a knee prosthesis is often hampered by the small area of contact of the bony surfaces and by pre-existing infection. Conventional systems of external fixation and compression frequently fail to achieve stability but the addition of the Wagner leg-lengthening apparatus applied anteriorly and adjusted to give compression ensures rigid external fixation. Four knees in four patients were treated using this technique; the treatment followed the removal of infected prostheses in three knees and painful fibrous ankylosis after the removal of the prosthesis in the other. All obtained a sound arthrodesis.

Adult↗
PubMed1983

The effect of four types of support on the segmental mobility of the lumbosacral spine.

With the aid of flexion-extension lateral radiographs, we investigated the effect of the canvas corset, the Raney and Baycast jackets, and the Baycast spica on the segmental sagittal mobility of the lumbosacral spine in separate groups of five volunteers each. The canvas corset reduced the mean angular movements at each level to two-thirds of normal. The Raney and Baycast jackets reduced the mean angular movements in the middle of the lumbar spine to approximately one-third of normal. The Baycast spica was the most effective in restricting angular movements below the third lumbar vertebra, and especially at the fourth lumbar-fifth lumbar level and the lumbosacral level.

Adult↗
PubMed1983

Multiple-view scintigraphy for localization of osteoid osteoma.

A circumscript accumulation of 99mTc-MDP in the spine of a patient, presenting with back pain and negative radiographs, was histologically confirmed to be an osteoid osteoma. As radiological procedures failed to localize the lesion, this was accomplished by means of posterior and lateral view bone scintigrams as well as by single photon emission tomography. The role of scintigraphy in patients suspected of having osteoid osteoma and the possibility of localizing the lesion before and during surgical intervention are underlined.

Adult↗
PubMed1981

The GSB knee prosthesis.

In the three years' period 1976-1978, 53 GSB knee prostheses were inserted in 46 patients. The use of this type of prosthesis was mainly indicated for the relief of pain in the presence of severe deformity or ligamentous insufficiency. There were two subsequent arthrodeses, one for infection and one for persistent pain. A follow-up study of 39 prostheses (excluding the two arthrodeses) revealed relief or reduction of pain to an acceptable level in 35 of the 39 knees (90%). The patients, however, were enthusiastic or satisfied with 37 of the 39 knee prostheses available for follow-up (05%). Good alignment and movement were obtained in all knees except one, in which flexion was less than 60 degrees. The most frequent problem was mild to moderate patello-femoral pain in 12 (31%) of the 39 knee-arthroplasties. This can largely be avoided if taken into account when planning the operation.

Follow-Up Studies↗
PubMed1979

Atlanto axial rotatory fixation--a cause of torticollis.

Atlanto-axial rotatory fixation is a rare but important cause of persistent torticollis. The diagnosis is confirmed by careful radiological examination of the atlanto-axial joint, also employing tomography if necessary. Treatment is skull traction in an attempt to improve the position followed by posterior atlanto-axial fusion to prevent further, and potentially disastrous, displacement. Atlanto-axial dislocation or subluxation should be looked for in all cases of acute torticollis, when reduction by traction will most likely be successful and prevent the development of atlanto-axial rotatory fixation and the associated persistent torticollis.

Atlanto-Occipital Joint↗
PubMed1977

The management of secondary neoplastic deposits in long bones by prophylactic internal fixation.

Pathological fracture through a secondary neoplastic deposit is a distressing event. Prevention of such a fracture is clearly of considerable benefit. To determine which secondary deposits are liable to fracture the notes and X-rays of 57 patients with 91 secondary deposits were examined. Fractures are unlikely (2.4%) to develop where the deposit involves less than 50% of the cortex as seen on radiological examination, but 2 out of 3 deposits with over 50% involvement will fracture. As the benefits of internal fixation in those that would otherwise fracture are so great, it is recommended that all deposits involving over 50% of the cortex of a long bone should be treated by prophylactic internal fixation. The results of 26 patients treated by prophylactic internal fixation are summarized. Apart from fracture-prevention, the benefits of such internal fixation were found to be: pain relief, simple operation, rapid postoperative recovery, facilitation of administration of radiotherapy and maintenance of the independance of the patient. The possible effects on local and general tumour spread are not considered to be a contraindication to operation.

Adult↗
PubMed1976

Muscle imbalance in the aetiology of scoliosis.

At the apex of an idiopathic scoliotic curve there is a greater proportion of "slow twitch" muscle fibres in multifidus on the convex as compared to the concave side. To determine whether this represents a primary muscular imbalance relevant to the aetiology of idiopathic scoliosis or merely a secondary change, the lengths of multifidus on opposite sides of the curve were measured. Multifidus is shorter on the convex side. This is consistent with the theory of primary muscular imbalance, in which the more tonically acting muscle with its higher proportion of "slow twitch" fibres contracts and shortens as the deformity is produced. The paradox of multifidus being shorter on the convex rather than on the concave side is explained by consideration of its action.

Adolescent↗
PubMed1975

Myosin ATPase activity in multifidus muscle from cases of lumbar spinal derangement.

Biopsies of lumbar multifidus muscles were obtained at operation on seventeen patients aged from fifteen to fifty-eight with lumbar spinal derangement, and further material was taken from the cadavers of three subjects aged from nineteen to fifty-one. Sections were prepared to show the presence of ATPase activity, so distinguishing Fast from Slow types of muscle fibre. The normal mosiac pattern arising from the intermingling of fibres from Fast and Slow motor units was seen in sections from cadaveric material and from many of the biopsies. With age and limited lumbar flexibility, the Fast fibres became relatively smaller but with increasing variation in size, suggesting a reduced capacity for phasic activity. The presence of positive root signs was associated with a greater proportion of Slow fibres, and in some patients with the occurrence of atrophied Fast fibres, giving rise to differences in the populations of the two fibres in neighbouring fascicles. The results suggest that multifidus adopts an increasingly postural role with advancing age and with disabling lesions of the lumbar spine.

Adenosine Triphosphatases↗