Biomedical subjects
Publications and source records attributed to N Maffulli.
A girl aged 11 years was referred to us with a medial upper right tibial exostosis. As the lesion was asymptomatic, surgery was not undertaken. The patient defaulted from follow up, and, when reviewed 32 months later, there was no clinical or radiographic evidence of the exostosis. Spontaneous involution of an exostosis may occasionally occur in childhood.
In a rabbit model, we studied the long-term biomechanical and biochemical effects of leaving the patellar tendon unsutured, or closing the defect with absorbable sutures, after harvesting one third. Using a prospective randomized design, after harvest of its central third, the patellar tendon was either sutured side to side with absorbable sutures, or left unsutured in 112 skeletally mature rabbits. The rabbits were killed at 2 and 6 weeks, and 6 and 9 months postoperatively. After an initial increase in both groups (.001 < P < .019), water content decreased from 2 weeks to 9 months after the operation (.02 < P < .0045), and remained significantly greater than in the control contralateral limb at all times (.00 1 < P < .003). Collagen content showed no significant differences between the two experimental groups. The operated tendons always showed a decreased collagen content at all time periods (.012 < P < .049). Failure load, ultimate stress, stiffness, and energy absorbed before failure tended to gradually return to normal over 9 months after a significant initial drop. There were no significant differences between the two experimental groups in failure load, ultimate stress stiffness, and energy absorbed before failure. At 9 months, the operated patellar tendon was significantly thicker (.0016 < P < .03) and had a greater cross-sectional area (.01 < P < .03) than the contralateral control regardless of whether it had been sutured or left open. After removal of the central third, closing the tendon gap with absorbable sutures or leaving it open makes little difference on the biomechanical and biochemical properties of the remaining patellar tendon.
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OBJECTIVE: To determine the relation of puberty, physical activity, physical fitness, and calcium intake with bone mineral content (BMC) of the distal radius, and on bone mineral density (BMD) of the L2 to L4 vertebrae in a group of healthy Chinese adolescents. DESIGN: Cross sectional survey. SUBJECTS: A group of 179 healthy Chinese adolescents (92 boys and 87 girls) aged 12 to 13 years enrolled in the first year of the Tii Junior High School in Shatin, Hong Kong. Ninety four of the pupils enrolled were in the physical education major class (PE), and the other 85 were in the art major class (ARTS). MAIN OUTCOME MEASURES: Correlation of BMC of the distal radius and BMD of the L2 to L4 vertebrae with level of physical activity, physical fitness (isometric and isokinetic), muscle strength of the upper and lower limb, and calcium intake. RESULTS: BMC of the distal radius and BMD of the L2 to L4 vertebrae were significantly positively correlated. Univariate and regression analysis showed that age, pubertal staging, physical fitness, and muscle strength were significantly associated with bone mass in a positive way. Calcium intake and type of sport practised did not exert a significant influence on BMC of the distal radius and BMD of the L2 to L4 vertebrae in boys. The results for the BMD of the L2 to L4 vertebrae were similar in girls and boys; however, in girls, the BMC of the distal radius had a negative correlation with calcium intake. Physical fitness was a significant positive predictor of BMD of the L2 to L4 vertebrae. CONCLUSIONS: Among Chinese adolescents bone mass was positively influenced by certain measures of physical fitness as well as by age, weight, and pubertal stage.
The association between Achilles tendon rupture and sciatica was investigated by questionnaire in 138 patients who underwent repair of an Achilles tendon rupture, and in a group of individuals nominated by the patients, matched for age, sex, and occupation. A total of 102 patients (74%) and 128 peer nominated controls (71%) replied to the questionnaire. Of the 102 respondent patients, 18 had an officebased job, 47 were involved in skilled nonmanual work, and 16 were retired. Back pain had been experienced by 63 of the patients who replied to the questionnaire, and by 91 (75%) of the individuals in the control group (difference not significant). In about 30% of both groups, the pain confined them to bed for at least two days, and resulted in absence from work. Thirteen of the patients and 16 of the controls had undergone thoracic, lumbar, or sacral radiography. One individual in each group had received surgery for back pain. However, 35 of 102 patients had experienced sciatic pain before Achilles tendon rupture. Pain of a similar nature had been experienced by only 15 individuals in the control group (12%) (p < 0.001). Using this study design, we found a highly significant association between Achilles tendon rupture and sciatica. We propose that this association could be due to impaired afferent signals from the lower leg, or to similar collagen or vascular anomalies of the vertebral disc and the Achilles tendon.
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Displaced fractures of the forearm in children are often treated conservatively, but there is a relatively high incidence of redisplacement, malunion and consequent limitation of function. We have performed percutaneous Kirschner (K) wire fixation in 72 such children under the age of 14 years, of which 57 were reviewed for our study. Both the radius and ulna were fractured in 45 (79%), the radius only in eight and the ulna only in four. The mean initial angulation was 19 degrees in the lateral plane and 9 degrees in the anteroposterior plane for the radius and 15 degrees and 9 degrees, respectively, for the ulna. In 42 patients (74%) we performed closed reduction. In the remaining 15 (26%) closed reduction failed and an open reduction, through a minimal approach, was required before K wiring. At a mean follow-up of 20 months all patients had good functional results with an excellent range of movement. Only five had angulation of from 10 degrees to 15 degrees and none had nonunion, premature epiphyseal closure or deep infection. Percutaneous intramedullary K wiring for forearm diaphyseal fracture is a convenient, effective and safe operation, with minimal complications.
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Data was collected on 208 Chinese males who underwent knee arthroscopy following trauma in the period from January 1993 through December 1994. For the purpose of comparison and analysis, the patients were classified according to their sporting habits as sedentary patients, recreational athletes, or competitive athletes. There were no significant differences in age between the three groups (average age: 25.82 +/- 10.6; range: 12 to 73 years). A hemarthrosis was present in 122 patients, and an effusion in 35. The most common mechanism of injury was direct impact (105 patients), followed by a twisting injury (58 patients). The most common arthroscopic finding was an anterior cruciate ligament (ACL) tear (partial in-37 patients and complete in 43 patients). In both sedentary and athletic patients, a hemarthrosis was significantly associated with ACL and meniscal tears (p = 0.02). When comparing the pattern of arthroscopic pathology between sports and casual injuries, a significantly greater number of ACL tears (both complete and partial) were caused during sports activity (p = 0.032). Sports injuries also resulted in a significantly greater number of meniscal injuries (p = 0.028). However, sedentary patients suffered from a greater prevalence of tibial osteochondral fractures (10%) than did those in the sports group (5%) (p = 0.04).
The records of 196 patients presenting with a clinical suspicion of scaphoid injury were reviewed to evaluate how junior accident and emergency doctors in a teaching hospital managed these patients. The management that was provided was assessed, and it was ascertained whether the presence of a unit policy meant that accident and emergency junior trainees managed patients accordingly. We found that 82% of patients were immobilized for 2 to 13 weeks, with 60 patients (37%) being immobilized for 6 weeks or more. Of the 196 patients presenting with clinical suspicion of scaphoid fracture, a definite scaphoid fracture was found in only 12%. Less than half of the patients (46%) were reviewed by senior accident and emergency doctors or by senior orthopaedic surgeons. Despite the presence of a unit policy, patients were being immobilized for prolonged periods in the absence of a radiographically evident scaphoid fracture. Advice from more experienced members of the staff was not being sought in dubious cases.
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