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N Maffulli

Publications and source records attributed to N Maffulli.

At least 91 records · Page 5Linked to original sources
PubMed1999

Bone mineralization at the callotasis site after completion of lengthening.

We studied the course of bone mineralization of regenerate bone after callotasis lengthening. Twenty-three patients (eight boys) (mean age at operation 11.5 years, range 4-17 years; leg length discrepancy [LLD] at surgery ranging from 4 to 13 cm) underwent dual-energy X-ray absorptiometry (DEXA) scanning weekly during the distraction phase, at 2 week intervals until removal of the fixator, and at the time of their out-patient visits thereafter, for a mean of 794 +/- 420 days after removal of the apparatus. At removal of the fixator, the bone mineral content (BMC) of the regenerate was nearly 70% of the normal contralateral limb. With time, this value gradually increased, and tended to reach normal values, with no significant difference between femur and tibia. With time, the BMC of the regenerate tends to return to the value of the normal contralateral limb. Probably, once the limb length discrepancy has been equalized, the mechanical stimuli imparted through weight-bearing to the lengthened limb are of the same magnitude bilaterally. In this instance, then, the newly formed bone, responding to these physical stimuli, would normalize its mineral content, confirming that bone remodeling continues well after lengthening is terminated. Mineralization of the regenerate after completion of the lengthening process reaches values significantly greater than at removal of the fixator, with an increase of >50% of the prelengthening values, regardless of the underlying pathology. The final value of this increased BMC is not significantly different than in the normal contralateral unoperated limb. At least part of the increase in bone mineralization following callotasis lengthening is due to the normal process of growth and development.

Absorptiometry, Photon↗
PubMed1999

A quantitative analysis of the effect of insulin-like growth factor-1 infusion during mandibular distraction osteogenesis in rabbits.

AIM: To quantify, by histomorphometry, the effects of local insulin-like growth factor-1 (IGF-1) during mandibular distraction at various rates. METHODOLOGY: Mature rabbits underwent bilateral mandibular corticotomy and distraction lengthening. Recombinant IGF-1 was administered to two groups of rabbits via osmotic infusion pumps. Distraction regimes were as follows: Group A, 1 mm/day for 15 days; Group B, as for A plus IGF-1; Group C, 3 mm/day for 5 days; Group D, as for C plus IGF-1; and Group E, sham-operated controls. After a 28-day consolidation period, rabbits were sacrificed and bone deposition quantified using DEXA scanning, three-point bending, histological examination and sampled for histomorphometric analysis. RESULTS: DEXA scanning and three-point bending failed to detect any effect of distraction rate or of IGF-1 infusion. Histological and histomorphometric analysis suggested 1 mm/day to be the ideal distraction rate, as this was associated with greater osteoblastic activity and consistent bony union. However, IGF-1 infusion significantly enhanced osteoblastic activity at both distraction rates and resulted in bony union when distraction was performed at 3 mm/day. CONCLUSIONS: Distraction osteogenesis at a rate of 1 mm/day provides greater osteogenic stimulus than 3 mm/day. Exogenous IGF-1 has a positive influence on osteoblastic activity during distraction. Its effect is probably minimised by high levels of endogenous IGF-1.

Animals↗
PubMed1999

Nutritional differences in patients with proximal femoral fractures.

BACKGROUND: The reason why elderly human hips tend to break in one of two anatomical regions is uncertain. Nutritional factors may affect the site of fracture. OBJECTIVE: To assess possible nutritional differences in patients with proximal femoral fractures. DESIGN: Prospective observational cohort study. SETTING: University teaching hospital. SUBJECTS: 119 consecutive patients over the age of 65 with a hip fracture admitted to the trauma wards in a single centre. METHODS: One researcher measured triceps, biceps and supra-iliac skinfold thickness, and mid upper arm circumference on admission and on the fifth post-operative day. Body mass index was calculated for each patient, and used to classify patients as severely, moderately or mildly malnourished, normal, overweight or obese. Logistic regression was used to determine the influence of various factors on fracture site. RESULTS: According to their body mass index, 31% of patients were classified as malnourished and 11% as severely malnourished. Patients with intracapsular fractures were significantly more malnourished than patients with trochanteric fractures (P < 0.008). Nutritional status was not related to post-operative complications. Ability to weigh a patient on the fifth post-operative day was the single most important prognostic indicator for complications. CONCLUSIONS: Patients with intracapsular fractures are more malnourished. Those with trochanteric fractures tend to be overweight.

Aged↗
PubMed1999

Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy.

Thirty-eight athletes with unilateral patellar tendinopathy (17 with a tendinopathy of the main body of the tendon, and 21 with an insertional tendinopathy) underwent ultrasound-guided multiple percutaneous longitudinal tenotomy under local anaesthetic infiltration after failure of conservative management. Thirty-four patients were reviewed at least 24 months after the operation. Sixteen patients were rated excellent, nine good, eight fair, and five poor. Nine of the 13 patients with a fair or poor result had an insertional tendinopathy, and eight of them underwent a formal exploration of the patellar tendon. Before the operation, there were some areas of altered echogenicity at and around the site of involvement. These were still visible 6 wk after surgery in 70% of the patients. At the latest follow-up, in the patients with an excellent or good result, the tendon was generally isoechogenic but slightly thicker (P = 0.06) than the normal contralateral. In the patients with a fair or poor result, the tendon was significantly thicker than the contralateral (P = 0.03), and showed some areas of mixed echogenicity. In the patients in whom the procedure was successful, the thicker operated tendon did not interfere with physical training. Bilateral isokinetic peak torque (Nm), average work (Joules), and average power (Watts) were tested at 90 degrees x s(-1). Immediately before the operation, there was no significant difference in peak torque, but total work and average power were significantly lower in the limb to be operated (0.01 < P < 0.05). By the end of the study, although peak torque was, on average, within 7% of the unoperated limb, total work and average power were still significantly lower than in the unoperated limb (0.01 < P < 0.04). Percutaneous longitudinal internal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, does not hinder further surgery should it be unsuccessful, and, in our experience, has produced no significant complications. In our hands, it has become the first line operative intervention in the treatment of chronic patellar tendinopathy after failure of conservative management. However, patients should be advised that, if they suffer from an tendinopathy at the attachment of the patellar tendon at the lower pole of the patella, a formal surgical exploration with stripping of the paratenon is preferable.

Adolescent↗
PubMed1999

Surgical management of tendinopathy of the main body of the patellar tendon in athletes.

OBJECTIVE: To report the results of surgery for tendinopathy of the main body of the patellar tendon. DESIGN: Retrospective study. SETTING: A teaching hospital of the University of London. PATIENTS: Twenty-eight patients reviewed at an average follow-up of 42 months from surgery for tendinopathy of the main body of the patellar tendon after failed conservative treatment. INTERVENTION: Exploration of the affected patellar tendon, stripping of the paratenon, excision of pathological areas, and multiple longitudinal tenotomies. MAIN OUTCOME MEASURES: Postoperative complications, ability to return to sport, and subjective satisfaction, as measured by formal clinical assessment or telephone questionnaire. RESULTS: At follow-up, 23 patients were completely free of pain and had resumed full sporting activity at the same preoperative level. Three patients were improved enough to have returned to their preoperative sporting level or just below it. In two patients, the initial operation failed. In the patients who resumed sport, the average time from surgery to resuming full sporting activity was 7 months (range 6 weeks to 12 months). The most common early postoperative complications were wound hematoma and superficial infection. The most common late complications were related to the incision, with anterior knee pain on kneeling and skin dysesthesia. CONCLUSION: Surgical decompression of the patellar tendon with multiple longitudinal tenotomies is an effective treatment for patellar tendinopathy. In the middle term, patients do not seem to relapse once they have recovered, whereas those who do not respond to surgery do not recover at all and may need a new operation.

Adolescent↗
PubMed1999

Changing incidence of Achilles tendon rupture in Scotland: a 15-year study.

OBJECTIVE: To determine the incidence of Achilles tendon rupture in Scotland from 1980 to 1995. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Data were obtained from the National Health Service Information and Statistics Division and analyzed in terms of age- and gender-specific incidence rates and time trends by age group. PARTICIPANTS: A total of 4,201 patients with Achilles tendon ruptures occurring during the study period. MAIN OUTCOME MEASURES: Calculation of incidence and of seasonality. RESULTS: The overall incidence of Achilles tendon rupture increased from 4.7/100,000 in 1981 to 6/100,000 in 1994, with a peak in 1986. In men, the incidence rose from 6.3/100,000 to 7.3/100,000. In women, the increase in incidence was more pronounced, from 3/100,000 to 4.7/100,000. In men, peak incidence rate occurred in the 30- to 39-year age group, whereas in women, the peak age-specific incidence occurred in those aged 80 years and older, with a steady increase after age 60. There was no evidence of a seasonality effect in the rate of occurrence of Achilles tendon rupture. A bimodal distribution of age at time of Achilles tendon rupture was noted. CONCLUSION: There was a significant increase in the incidence of Achilles tendon rupture during the period from 1980 to 1995. This reflects the increased incidence of the injury noted in other Northern European countries.

Achilles Tendon↗
PubMed1999

Limb shortening for the management of leg length discrepancy.

Limb shortening is an option to manage leg length discrepancy (LLD). Before skeletal maturity, a LLD between 2 and 5 cm can be corrected by epiphyseodesis (open or closed) or stapling. All these procedures require exact timing of surgery. In skeletally mature patients, shortening of the femur is considered safer than tibial shortening. Subtrochanteric and supracondylar osteotomies fixed with a blade-plate can be used to correct associated deformity. Mid-shaft shortening can be performed by a closed or open method. Closed shortening has been widely used, but frequent malrotation, loss of function and acute respiratory distress syndrome following reaming have been reported. Therefore, the use of a nail locked proximally and distally, and caution in reaming the canal, are strongly recommended. For LLDs greater than 10 cm, lengthening should be considered, although a one-stage two-limb procedure can be used, whereby shortening is performed on the longer limb, and the excised bone segment is implanted in the contralateral limb to be lengthened. However, when shortening procedures are performed in skeletally immature patients, they require precise timing, and indications and technical details must be strictly observed.

Adolescent↗
PubMed1999

Musculoskeletal involvement in cystic fibrosis.

The purpose of this study was to review the published evidence of the effects of cystic fibrosis (CF) on the musculoskeletal system, and their implications on the quality of life of these patients. With increasing longevity of CF patients, musculoskeletal manifestations have become important. Decreased bone mineral density (BMD) and bone mineral content (BMC) are common at all ages in CF patients, and its cause is probably multifactorial. Risk factors contributing to decreased BMC include age of the patient, imbalance between bone accretion and degradation, body mass, nutrition, activity, exposure to glucocorticoid therapy, and gonadal dysfunction. BMC correlates strongly to fat-free mass in CF patients. Lung transplant, while increasing life span, can worsen osteoporosis. Twenty-nine percent of patients are below the 10th percentile for height. Fracture rates are approximately twofold greater in females aged 16 to 32 years and males aged 25 to 34 years. Female patients aged 6 to 16 have a higher than normal fracture rate and a higher rate than their male counterparts. Spinal consequences of osteoporosis include excessive kyphosis in up to 62% of patients. Back pain was noted in 94% of patients. Arthritis in CF, although less common, can be very incapacitating, and it is mainly of three types: CF arthritis, hypertrophic osteoarthropathy, and arthritis due to co-existent conditions and drug reactions. The treatment of arthritis is mainly symptomatic in the majority of cases.

Age Factors↗
PubMed1999

Functional bracing of Colles' fractures.

Colles' fracture is one of the most common injuries encountered in orthopaedic practice and yet there is no optimum method for its management. Various operative treatments have been proposed because of the instability of the fracture following reduction. However, considering the epidemiology of the fracture, the majority of these injuries will continue to be treated conservatively with closed reduction and immobilization of the wrist in a cast. Functional bracing is an alternative to cast immobilization, allowing early return of function while maintaining fracture reduction, and is an accepted method of treatment for a number of injuries. Although various methods of functional treatment of Colles' fractures have been described, it has not proved a popular management modality in this injury. We review previous studies of functional bracing and describe a novel method of bracing that we have developed.

Adolescent↗
PubMed1999

Epidemiology and genetic theories in the etiology of congenital talipes equinovarus.

The exact genetic mechanism of inheritance of congenital talipes equinovarus (CTEV) has been extensively investigated using family studies and other epidemiological methods, but to date no conclusive result has been reached. This may be due to the presence of a number of inheritance patterns, a number of different etiologies presenting as the same morphological condition, or complex gene-environment interactions. Indeed, a number of epidemiological factors have also been implicated in the etiology. While epidemiological studies can suggest inheritance patterns, only by identification of specific genes, can inheritance patterns be proven. This article reviews the epidemiological work on the etiology of CTEV and discusses some of the epidemiological principles involved.

Clubfoot↗
PubMed1999

Hip fractures. An epidemiological review.

A computerized literature search was performed to identify articles on the epidemiology of hip fractures. Information from a total of 56 papers was gathered, mainly from developed Western countries. Inclusion criteria were the method of randomization, sample size, and relevance for the topic. As the proportion of elderly in the general population has increased, the incidence of hip fractures has risen. Mortality is high: a third of patients do not survive beyond one year after fracturing their hip. There are two main determinants for hip fractures: falls and increased bone fragility. The most important risk factors identified are neuromuscular and visual impairment, pre-existing medical conditions, dementia, low bone density, alcohol intake, smoking, and immobilization. Also, thinner people are at higher risk because of the reduced energy dissipation following a fall. There is a significantly higher risk for institutionalized patients. Primary prevention focuses on eliminating the two main determinants by decreasing falls and their effects, by strengthening the bone either through elimination of risk factors or through medication. Surgical management and early rehabilitation should be favored. Prevention has been shown to be the single most important factor to slow down the increasing incidence of such fractures. More research into prevention is required.

Aged↗
PubMed1998

Articular cartilage lesions of the knee following immobilisation or destabilisation for 6 or 12 weeks in rabbits.

Eighty mature female New Zealand White rabbits were sacrificed 6 or 12 weeks after either section of the medial collateral and the anterior cruciate ligaments with removal of the anterior third of the medial meniscus of one knee, or immobilisation of one knee, using the contralateral non-treated knee as the control. The area of degenerated joint surface of the distal femur, and water and proteoglycan content were measured, and the articular cartilage stained using haematoxylin and eosin and safranin O. Destabilisation resulted in a significantly larger time-dependent degenerated joint surface area. Water content significantly increased after 6 weeks with no significant differences between immobilisation and destabilisation. Destabilisation resulted in a significantly greater decrease in proteoglycan content. At 12 weeks, the control knees of the animals undergoing destabilisation showed significant degenerative changes. There were more extensive lesions in destabilisation, while 6 weeks of immobilisation produced moderate degenerative joint disease.

Analysis of Variance↗
PubMed1998

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Journal Article↗