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Biomedical subjects

N J Goddard

Publications and source records attributed to N J Goddard.

At least 37 records · Page 2Linked to original sources
PubMed1998

Knee pain and the infrapatellar branch of the saphenous nerve.

Pain over the front of the knee is common after surgery or trauma but often a definite diagnosis is difficult to make. Over the past year we have seen five cases in which the pain could be ascribed to damage to a branch of the infrapatellar branch of the saphenous nerve. Two were subsequent to trauma and three to surgical procedures. In all five cases surgical exploration gave symptomatic relief. Eight cadaveric knees were prosected to explore further the anatomy of this nerve in relation to the injuries. Injury to one of these branches should be considered in cases of persistent anterior, anteromedial or anterolateral knee pain or neurological symptoms following surgery or trauma.

Adult↗
PubMed1998

Acute percutaneous scaphoid fixation. A pilot study.

Fractures of the scaphoid are most common in young men; immobilisation in a cast usually means a long period away from work and athletic activities. Early rigid fixation has been shown to promote a rapid functional recovery, but open reduction and internal fixation is technically demanding with the dangers of damage to the radiocarpal ligaments, the scaphotrapezial joint, and the blood supply of the scaphoid. For minimally displaced or undisplaced B1 or B2 fractures, these problems can be overcome by percutaneous fixation. We report our technique and the results of a pilot study in 15 patients. There was no immobilisation; patients were allowed movement soon after operation, but union was obtained in all at a mean of 57 days (38 to 71). The range of movement after union was equal to that of the contralateral limb and grip strength was 98% of the contralateral side at three months. Patients were able to return to sedentary work within four days and to manual work within five weeks. Our initial results show that percutaneous scaphoid fixation for acute fractures is satisfactory and gives rapid functional recovery.

Acute Disease↗
PubMed1997

Carpal tunnel decompression: open vs endoscopic.

Carpal tunnel decompression is a common operation. While most patients report satisfaction there are recognized complications. New endoscopic techniques are claimed to reduce the incidence of these. However, the new techniques are not without complications of their own.

Carpal Tunnel Syndrome↗
PubMed1996

Current techniques in total knee replacement: results of a national survey.

A postal questionnaire was sent to all Fellows of the British Orthopaedic Association to obtain a census of total knee replacement (TKR) preferences in the United Kingdom; 1162 questionnaires were sent and 721 replies received. There were 92 Fellows who had retired or filled in the forms incorrectly, and 32 no longer perform TKR. Thus, 597 responded correctly, giving a 62% response rate. This gives an extrapolated total of 34,677 TKRs being implanted per year in the UK, with an average of 34.3 being performed by each surgeon per year. Only 9% perform more than 90 per year. There were 41 different prostheses in current use among the respondents to our questionnaire, of which five prostheses constituted 61% of the total. Cemented prostheses were used by 95.2%. Resurfacing of the patella was always carried out by 32%, while 19% never resurface it; the most common reason for doing so being patellofemoral arthropathy at operation. Intramedullary alignment was used for the femoral component in 86%, 76% preferred extramedullary alignment for the tibial component. Regarding cementing technique, 43% use pulsatile lavage, 9% used a cement gun, 88% dry the bone and 56% seal the hole made by the femoral alignment device in the femur before cementing. All components were cemented simultaneously by 65% and one at a time by 31%. Metal-backed tibial prostheses are now used by 98% of surgeons, modular tibial components being preferred by 80%. Metal-backed patellar components were used by 13%. An onlay type of patella was preferred by 51%. This survey highlights the great diversity of surgical practice in the UK, which may reflect uncertainty regarding best practice in total knee replacement.

Attitude of Health Personnel↗
PubMed1995

Natural history and treatment of instability of the hip in proximal femoral focal deficiency.

We studied 67 patients with 78 affected femurs to determine the natural history of proximal femoral focal deficiency (PFFD) with respect to hip instability and to establish guidelines for management. Using the classification systems of Aitken and Fixsen and Lloyd-Roberts as applied to a radiograph taken at age 12-15 months, we could accurately predict development of hip instability, defined as formation of a pseudoarthrosis or complete failure of hip development. The pseudoarthrosis occurred either at the cervical or subtrochanteric level of the femur. Cervical instability was difficult to treat operatively, but subtrochanteric instability fused spontaneously in 30% of cases and responded well to operative treatment when necessary. For unilateral failure of hip joint formation, various surgical procedures were used to assist prosthetic fitting, but bilateral cases were treated nonoperatively.

Adolescent↗
PubMed1994

Low-temperature-responsive barley genes have different control mechanisms.

Several low-temperature-responsive (LTR) genes from barley have been shown to have high steady-state transcript levels. Run-on transcription was used to determine the control of expression of these LTR genes. Six of these are shown to be transcriptionally regulated (blt 4/9, blt 101, blt 1015, blt 63, blt 49, blt 410) whilst three are post-transcriptionally regulated (blt 14, blt 411, blt 801). Two transcriptionally regulated genes (blt 4/9 and blt 101) and one post-transcriptionally regulated gene (blt 14) have been used in expression studies. The time course for the appearance and decay of these transcripts is given. Initial appearance and steady-state levels of individual transcripts have different temperature characteristics but no single gene correlates with the cold acclimation response. We suggest that these different response profiles may represent a means of fine-tuning the low-temperature response. One gene, blt 4/9, also accumulated high steady-state levels of transcript in response to drought and a nutrient stress. However, only drought has an acclimating effect on barley plants.

Acclimatization↗
PubMed1994

A simple jig to ease the insertion of distal screws in intramedullary locking nails.

Distal locking of closed intramedullary nails can be time consuming and expose the surgeon to unnecessary increased ionization radiation. A simple jig is described which facilitates the insertion of the second distal locking screw, using the first drill hole as a pilot. This tool reduces the operating and the ionizing radiation exposure time.

Bone Nails↗
PubMed1994

Weight changes after total hip arthroplasty.

A survey is presented that contradicts the often quoted teleologic argument that restricted mobility is the limiting factor in weight reduction in overweight patients needing a total hip arthroplasty. One hundred fifty patients were reviewed at 1 year after arthroplasty. All reported improved mobility, but there was no evidence of a trend toward weight loss. More complications with overweight patients were observed. This is useful information in encouraging overweight people to lose weight prior to hip arthroplasty, and could be extrapolated to other procedures.

Body Mass Index↗
PubMed1994

Current attitudes to cementing techniques in British hip surgery.

Aseptic loosening is the major problem in hip joint replacement. Improved cementing techniques have been shown to improve the long-term survival of implants significantly. To assess the use of modern cementing techniques in British surgeons, a detailed questionnaire was sent to all Fellows of The British Orthopaedic Association (BOA) regarding cement preparation, bone preparation, cementing technique and prostheses used in total hip arthroplasty. Excluding retired fellows, surgeons who use no cement, and those who had filled in forms inadequately, 668 responded, who between them performed 43,680 hip arthroplasties per year. In this survey, 21 different types of hip prostheses were implanted by the surgeons; 48% of hips implanted were Charnley type. Of the surgeons, 46% used Palacos with gentamicin as their cement for both the femur and acetabulum. For the femur, 44% of surgeons remove all cancellous bone, 40% use pulse lavage, 59% use a brush to clear debris, 94% dry the femur, 97% plug the femur, 76% use a cement gun and 70% pressurise the cement. For the acetabulum, 88% of surgeons retain the subchondral bone, 40% use pulse lavage, 100% dry the acetabulum, 22% use hypotensive anaesthesia and 58% pressurise the cement. Overall only 25% of surgeons (26% of hips implanted) use 'modern' cementing techniques. This has implications for the number of arthroplasties that may require early revision.

Acetabulum↗
PubMed1993

Molecular analysis and spatial expression pattern of a low-temperature-specific barley gene, blt101.

A cDNA clone of the previously unreported low-temperature-induced gene blt101 was isolated after a differential screen of a cDNA library prepared from low-temperature (6 degrees C day/2 degrees C night) grown barley shoot meristems. Southern blot analysis of barley ditelosomic addition lines was used to assign this single-copy gene to the long arm of chromosome 4. Analysis of steady-state levels of blt101 mRNA showed the induction of this transcript in shoot meristems upon transfer of barley (cv. Igri) plants from control (20 degrees C/15 degrees C) to low (6 degrees C/2 degrees C) temperature treatment. Further, the high level of this transcript is maintained at low temperatures but is reduced on transfer from low to control temperatures. The gene is not induced by drought or by foliar application of ABA. Analysis of segregating doubled haploid lines shows that there is no specific association of this gene with either spring/winter growth habit or frost hardiness. Examination of the spatial expression pattern revealed ubiquitous expression of blt101 in low-temperature (6 degrees C/2 degrees C) grown barley shoot meristems, mature leaves and roots.

Abscisic Acid↗
PubMed1992

Failure of acetabular cups influenced by marker wire anchorage.

Failure of an acetabular cup is uncommon and has been attributed to wear or creep, trauma or bony irregularities in the acetabulum. We report ten cases in which fracture of the cup occurred at the site of drill holes used to anchor the marker wire. The role of such indentations as stress raisers has not been previously reported; we suggest that deep indentations or grooves should not be placed in the most highly stressed areas and that the cup thickness should allow for predicted wear rates.

Acetabulum↗
PubMed1990

Atlanto-axial rotatory fixation and fracture of the clavicle. An association and a classification.

Five children with atlanto-axial rotatory fixation (AARF) in association with fractures of the clavicle are described. It is postulated that the rotary fixation is a direct result of the trauma which produces the fracture. The importance of early diagnosis is stressed, since delayed diagnosis may lead to chronic deformity. Early diagnosis depends on awareness of the possibility of AARF, and either fluoroscoping the patient in order to take appropriate spot films or imaging the atlanto-axial joint by CT. A simple classification of AARF is proposed based on distinct radiological features which differentiate subluxation from dislocation.

Atlanto-Axial Joint↗
PubMed1988

Intra-articular fluid pressure and pain in osteoarthritis of the hip.

We investigated the relationship between the pain experienced by 50 patients with osteoarthritis of the hip and the resting intra-articular pressure of the synovial fluid. We found a significant linear correlation between these factors, greater pain being experienced by patients with higher pressures. In 20 cases we showed that the pressure rises in extension and medial rotation and is least in flexion and mid-abduction. These results help to explain the benefits of rotation osteotomy of the hip and of psoas release. They also help explain the natural resting position of the hip in patients with an acute effusion and the fixed deformities associated with late osteoarthritis of the hip.

Adult↗