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Biomedical subjects

N M Clarke

Publications and source records attributed to N M Clarke.

At least 55 records · Page 3Linked to original sources
PubMed1992

Observations on removal of metal implants.

A total of 86 adult patients who underwent routine surgery to remove metal internal fixation devices were studied prospectively. At the time of surgery, 46 patients were symptomatic, but only 27 requested surgery; 59 were admitted for routine surgery on medical advice. There was no correlation between symptoms, the length of time the implant had been in situ or the location of the implant. Good results were achieved in 91 per cent of symptomatic patients and no problems occurred in 95 per cent of asymptomatic cases. Overall there was a 3 per cent complication rate including one refracture, one radial nerve injury and one haematoma. No wound infections occurred. Potential difficulties in the removal of implants and possible risks of retained implants are discussed, relating to refracture, osteopenia, metal toxicity and neoplasia. In conclusion, it may be appropriate to leave asymptomatic implants in situ, except for femoral and tibial diaphyseal plates.

Adolescent↗
PubMed1991

Complications of splintage in congenital dislocation of the hip.

The use of abduction splintage in the treatment of congenital dislocation of the hip has an important morbidity. Six children who developed complications are presented in this paper. Sustained splintage of an unreduced hip, overcorrection of the femoral head displacement, avascular necrosis of the femoral head, full thickness pressure sores, and excessive tibial torsion may occur as a consequence of treatment. Expert supervision of abduction splintage, correct case selection, and regular review are necessary to reduce the incidence of such complications.

Bone Diseases↗
PubMed1990

Comparison of audible sound transmission with ultrasound in screening for congenital dislocation of the hip.

In a comparative study ultrasound and the sound transmission test were used to seek congenital dislocation of the hip in 102 babies referred to a paediatric orthopaedic clinic. The sound transmission test correctly identified all those hips considered normal or dislocated on ultrasound. 17 babies underwent repeated ultrasound examination for hips considered abnormal but not dislocated. 12 improved and 5 required treatment. With a cut-off decibel difference between the hips of 5.8 dB the sound transmission test correctly identified the dislocated hips but did not detect some of the hips that needed treatment. A cut-off of 5.6 dB reduced the likelihood of a false-negative result while maintaining the sensitivity of the test.

Analysis of Variance↗
PubMed1989

Ultrasound screening of hips at risk for CDH. Failure to reduce the incidence of late cases.

Of 4,617 babies born in Coventry in 1986, a total of 448 (9.7%) had either clinical abnormality of the hip or at risk factors for CDH. All were examined by ultrasound, but only 17 required treatment (3.7 per 1,000); in five of these no clinical abnormality had been detected. An additional 81 babies had ultrasound abnormalities but did not require treatment, despite the fact that ultrasound at first showed major hip displacement in 17 of them. Three late cases of CDH have presented among the babies born in 1986, but not examined by ultrasound. This incidence of late CDH is unchanged compared with the previous nine years, although ultrasound had detected covert displacement in a number of hips.

Hip Dislocation, Congenital↗
PubMed1987

The unrestrained coach passenger--an injury complex.

Details are given of the injuries sustained by 16 occupants of a coach that overturned. An injury of the forequarter common to 10 patients is described. An explanation for this injury complex is proposed and its prevention is discussed.

Accidents, Traffic↗
PubMed1986

Breakdancer's thumb--partial rupture of the ulnar collateral ligament with a fracture of the proximal phalanx of the thumb.

Breakdancing is an acrobatic dance that involves spinning on various parts of the body including the head, dorsal spine and hand. Three cases are reported of partial rupture of the ulnar collateral ligament (UCL) of the thumb, associated with a fracture of the base of the proximal phalanx which occurred as a result of torsional forces applied to the abducted and hyperextended thumb. It appears to be a distinct clinical entity. In all cases, open reduction was required and led to excellent functional recovery.

Adolescent↗
PubMed1986

Ossification center of the infant hip: sonographic and radiographic correlation.

A new sonographic technique for evaluating the ossification center of the infant's hip allowed identification of the ossific nucleus before it could be visualized radiographically. With this technique, delay in ossification associated with hip pathology can also be recognized. Proper assessment of the size of the ossific nucleus requires scanning in orthogonal planes. Acoustic shadowing causes the growing ossification center to appear curved and may make the medial acetabulum and triradiate cartilage difficult to identify. Sonographic hip evaluation usually ceases to be reliable in children over 1 year old.

Femur Head↗
PubMed1985

Osteosarcoma after the fourth decade. A clinico-pathological review.

Of 160 cases of osteosarcoma seen over an 18-year period, 18 were over the age of 40 at the time of presentation. The clinical presentation and histology of these cases is reviewed. Delay in referral and incorrect histological diagnoses were frequent. Only 2 cases were associated with Paget's disease.

Adult↗
PubMed1985

Real-time ultrasound in the diagnosis of congenital dislocation and dysplasia of the hip.

A technique of examining the infant hip joint with real-time ultrasound is described. Since the cartilaginous femoral head is clearly imaged by ultrasound, anatomical structures and their relationships can be accurately determined. Dislocated hips are easily detected and subluxations also can be visualized. We report our experience with 131 examinations in 104 patients, comprising 259 single hip studies. Of 83 patients who were previously untreated, there were 178 hip studies with three false-negative and four false-positive ultrasound results. No dislocations were missed. Twenty-seven patients who were already being treated were examined to assess hip location, comprising a total of 81 hip studies. In some cases the patients were examined while in an abduction device, cast, or Pavlik harness. In one case a dislocation was not detected. The method of examination using real-time ultrasound is considered to be reliable, accurate, and a useful adjunct to radiography. The advantages are that it is non-invasive, portable, and involves no exposure to radiation.

Child, Preschool↗
PubMed1984

Coxa plana--the fate of the physis.

Eighty patients who had unilateral coxa plana and who had been treated conservatively were followed to a mean age of sixteen and one-quarter years, and their cases were reviewed for radiographic evidence of a disturbance of the femoral capital growth plate. This physeal involvement was inferred by the presence of one or more of five findings: premature physeal closure, overgrowth of the greater trochanter, change in physeal shape, lateral protrusion of the capital nucleus, and medial bowing of the femoral neck. Premature physeal closure, which was more common in the girls than in the boys, occurred in 25 per cent of the affected femoral heads, and 90 per cent of the patients showed some interference with normal physeal growth in the affected femoral head. A direct correlation was found between the severity of the physeal involvement and the ultimate deformity of the femoral head. The possible causes of interference with physeal growth and damage are discussed.

Bone Diseases, Developmental↗
PubMed1984

Examination of the infant hip with real-time ultrasonography.

Examination of the infant hip with a real-time sector scanner permits accurate and reliable determination of the anatomic structures and relationships of the hip joint. A technique using two transducer orientations has been found most effective. In 100 hip examinations, the method failed to differentiate an abnormal hip in only one instance.

Child, Preschool↗
PubMed1983

Intervertebral lumbar disc prolapse in children and adolescents.

The radiographs and records of 58 cases of lumbar disc prolapse in children and adolescents were reviewed, and 28 cases were followed up after an average of 6.8 years. Trauma was not a significant aetiological factor, but there was a high incidence of back pain in relatives of affected patients. The clinical picture is similar to that in the adult except for a relative paucity of neurological signs. This review of patients treated by surgical or conservative methods suggests that good results may be obtained in patients with a short history who are offered surgery early. Preoperative radiculography is considered to be essential because of the inaccuracy in localising the level of disc prolapse by clinical signs. The result of treatment in patients with long histories is usually disappointing.

Adolescent↗
PubMed1983

Osteochondritis of the trochlear epiphysis.

The trochlear epiphysis is subject to an osteochondritic process which has a natural history similar to that affecting other sites. This report deals with three patients in whom radiological signs of fragmentation, fissuring, and increased density of the ossific nucleus occurred in conjunction with mild symptoms which gradually resolved within 1 year to 18 months.

Child↗
PubMed1983

The sagging rope sign: a critical appraisal.

Certain features of the sagging rope sign recently analysed by Apley and Weintroub (1981) are examined in detail. Evidence is presented to show that the line is a radiological shadow cast by the lateral edge of a severely deformed femoral head rather than a condensation of the spongiosa within the neck. An explanation is offered to explain the common association of the presence of this radiological sign with premature epiphysial fusion.

Adolescent↗