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Biomedical subjects

N S Broughton

Publications and source records attributed to N S Broughton.

35 records · Page 2Linked to original sources
PubMed1989

Reliability of radiological measurements in the assessment of the child's hip.

We investigated the reproducibility of the various radiological methods of assessment of hip dysplasia by making 474 assessments of hips and quantifying the inter-observer and intra-observer variation. There was a wide range of variability between the readings made by different observers and by one observer on two occasions. A measurement of acetabular index has to be given a range of +/- 6 degrees in order to be 95% confident of including the true measurement. We found the most helpful measurements to be the acetabular index, up to the age of eight years; the centre-edge angle, over the age of five years; and Smith's c/b ratio and neck-shaft angle. We feel, however, that the change in value over a series of radiographs in the same child is much more valuable. Single readings of all the radiological measurements investigated in this study were unreliable.

Acetabulum↗
PubMed1989

Tibial shortening for leg length discrepancy.

Over a 25-year period, 12 patients had from 2.5 to 5.1 cm operative shortening of the tibia and fibula for leg length discrepancy at between four and 18 years of age. All recovered normal function and there was minor cosmetic impairment in only two cases. The only vascular complication was temporary delay in return of the circulation to the foot after tourniquet removal in one patient. The procedure is valuable for discrepancy of tibial length in patients when they present too late for epiphyseal arrest, when there is doubt as to the appropriate timing for epiphyseal arrest, or when it is uncertain at an earlier stage whether there is need for surgical correction.

Adolescent↗
PubMed1988

Treatment of metatarsalgia by sliding distal metatarsal osteotomy.

A consecutive series of 113 patients who had distal sliding metatarsal osteotomy performed between 1976 and 1983 at Winford Orthopaedic Hospital were reviewed. All patients originally had symptoms and signs of pressure metatarsalgia. A total of 124 feet in 94 patients were available for assessment. Review was performed using a symptomatic scoring system, clinical examination, AP and lateral standing radiographs, and walking foot pressure studies obtained from a Harris-Beath mat. The mean follow-up period was 3 years and 4 months (range nine to 102 months). Symptomatically, 58 feet (47%) were rated as good, 43 (34%) as fair, and 23 (19%) as poor. Eighteen feet (14%) had required revision procedures prior to the time of review because of persistent symptoms. Persistent tender prominence of one or more metatarsal heads associated with plantar callosities was seen in 49 feet (40%). Results were significantly worse in patients older than 65 years of age, when first and fifth metatarsal osteotomies were performed, and when plaster immobilization was used postoperatively.

Adult↗
PubMed1988

Open reduction of the severely slipped upper femoral epiphysis.

The results of open reduction of the severely slipped upper femoral epiphysis are reported for 115 hips with an average follow-up of 12 years 11 months (range 2 to 33 years). In 70 hips with a chronic slip and an open growth plate the incidence of complications was low: two developed avascular necrosis, five chondrolysis, and one had both. There were more complications in the 38 hips with an acute-on-chronic slip: six developed avascular necrosis, one chondrolysis, and three had both. Of the seven hips operated upon with a partially fused plate, only one did well. All these complications were obvious within the first year but there were also three hips in the series in which osteoarthritis developed between 10 and 20 years after operation.

Adolescent↗
PubMed1988

The predictability of acetabular development after closed reduction for congenital dislocation of the hip.

We have reviewed the serial radiographs of 63 hips in 53 children treated by closed reduction for congenital dislocation with a view to finding a radiological measurement which can predict subsequent acetabular development. All had been followed for more than seven years, and at latest review, 34 hips were dysplastic. Failure to obtain concentric reduction or its loss by migration of the femoral head within one year of reduction were the best predictors of persisting acetabular dysplasia and were best quantitated by the h/b ratio (Smith et al. 1968). The acetabular index at reduction or its decrease in the first year were not reliable predictors. Late treatment was less likely to lead to normal acetabular development, but avascular necrosis did not appear to have a significant influence. The average age at which the acetabulum stopped developing was five years, but ranged from 17 months to eight years. The failure of a dysplastic acetabulum to improve in each annual radiograph after closed reduction should lead to consideration of operation on the acetabulum.

Acetabulum↗
PubMed1986

Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. A comparative study after 5-10 years' follow-up.

We have made a retrospective comparison between the results of 49 high tibial osteotomies and 42 unicompartmental replacement arthroplasties performed for the treatment of osteoarthritis of the knee, assessed 5 to 10 years after operation. The type of operation depended on the policy of the consultant responsible for treatment but analysis of the pre-operative findings showed that the two groups were sufficiently similar for direct comparison between them. In the replacement group, 32 (76%) were good, 4 were fair, 3 were poor and 3 had been revised. In the osteotomy group 21 (43%) were good, 11 were fair, 7 were poor and 10 had been revised. It was concluded that, in this series, the results of unicompartmental replacement were significantly better and that this group had shown no sign of late deterioration.

Aged↗
PubMed1985

The use of a microcomputer for inpatient audit in an orthopaedic department.

A microcomputer has been used to assist in the inpatient audit of an orthopaedic unit in a district general hospital. The aims were to provide a more detailed, accurate audit, more rapidly than previous manual methods had allowed. The clinical details of 609 patients treated over a 9-month period were fed into the computer and various statistical analyses performed. The results of the audit are presented. The extent to which our aims have been achieved is discussed together with the specific problems encountered with computer hardware, software and organisation of the system.

Computers↗
PubMed1982

The effect of cimetidine on basal gastric acid secretion in the rat.

1. The effect of cimetidine on the basal gastric acid secretion of the rat has been investigated in an anaesthetized lumen-perfused preparation. 2. Six rats previously given large doses of cimetidine orally showed no significant difference in basal gastric acid secretion when compared with six control rats. 3. Intravenous administration of 1 mg and 8 mg of cimetidine failed to inhibit significantly basal gastric acid secretion. 4. Although rats with a basal gastric acid secretion above 2.5 micro Eq/10 min. showed a consistent small reduction in basal gastric acid secretion after intravenous cimetidine, this was not seen in rats with a basal gastric acid secretion below 2.5 micro Eq/10 min. 5. THese results contrast sharply with the pronounced inhibition of basal gastric acid secretion by cimetidine in man and the possible reasons for this are discussed. 6. The results are also contrasted with previous work on gastric fistula rats which showed higher basal gastric acid secretion and significant inhibition by cimetidine.

Administration, Oral↗
PubMed1982

Revision hip arthroplasty. A retrospective survey.

A survey of revision hip arthroplasties was performed, using a retrospective review of the patients' case notes and radiographs, and an assessment of the patients, at least 1 year after the revision. The patients were divided into three categories: a) First revision hip arthroplasty (41 patients); b) Second revision hip arthroplasty (8 patients); c) Revision of femoral hemi-arthroplasty (14 patients). The reasons for revision, the type of revision and the final outcome have been identified in each group. This is the first study which allows direct comparison of the final outcome, as assessed by accurate objective criteria, between patients having revision hip arthroplasty for different reasons. Radiographs of the hip arthroplasty after the original operation and after revision have been analysed. The final outcome of first revision hip arthroplasty and revision of hemi-arthroplasty to total hip replacement was generally good. The outcome of second revision hip arthroplasty was generally poor.

Adult↗
PubMed1978

Endoscopic retrograde cholangiography in primary biliary tract carcinoma.

The appearance of primary biliary tract carcinoma revealed at endoscopic retrograde cholangiography in 16 patients and surgically confirmed, are classified as to location, type of margin of the lesion and degree of obstruction. Differential diagnosis towards infiltrating tumour of the gallbladder is considered. The conclusion is drawn that endoscopic retrograde cholangiography will establish the diagnosis of malignancy of the biliary tract with an acceptable certainty.

Adult↗
PubMedDate not supplied

Traumatic hip dislocation in childhood.

Eighteen cases of traumatic dislocations of the hip in children under 15 years of age presenting between 1985 and 1995 were reviewed. Fifteen of the dislocations were posterior. There were two groups: a younger group dislocating with minimal trauma and an older group whose injuries involved significantly more trauma. All patients were treated by closed reduction, but two required open reduction because of intraarticular fragments preventing a full reduction. On long-term follow-up of the 16 available patients (average length of follow-up, 5 years 10 months; range, 17-132), there were no cases of avascular necrosis or early degenerative change.

Adolescent↗
PubMedDate not supplied

Natural history of knee contractures in myelomeningocele.

The natural history of knee contracture was determined in a prospective study of 850 myelomeningocele (MM) patients, ranging in age from neonate to 23 years, excluding patients after knee surgery. Fixed flexion contracture of 10 degrees at birth decreased by age 9 months but increased thereafter if the patient's MM level was higher than L3. In the thoracic/L1-L3 level patients, the mean fixed flexion contracture was 18 degrees with and 17 degrees without knee flexor spasticity. Range of knee flexion remained at 126 degrees until age 3 years, and decreased thereafter if the patient's MM was higher that L3. This study demonstrates that muscle imbalance and spasticity play a minimal role in development of knee contracture.

Adolescent↗
PubMedDate not supplied

Lower extremity alignment in children with spina bifida.

Our purpose was to describe the natural history of lower extremity alignment in spina bifida patients. We prospectively evaluated all spina bifida patients seen at the Children's Hospital in Seattle since 1971 and at the Royal Children's Hospital in Melbourne since 1979. Serial examinations were performed on 434 patients, ranging from birth to 23 years of age. The lower limbs of children with spina bifida had neutral alignment at birth that gradually increased to 6 degrees of valgus--a pattern different from normal children. Valgus greater than 10 degrees was observed in only 6% of patients, and the degree of angular deformity was not affected by walking, the use of an above-knee orthosis, or neurosegmental level. An above-knee orthosis to prevent malalignment does not appear to be warranted and continued ambulation does not significantly contribute to lower extremity deformity.

Adolescent↗
PubMedDate not supplied

Range of knee motion in normal neonates.

Fifty-seven normal neonates were examined at birth and at 3 and 6 months (to within 7 days). Range of knee motion and of hip flexion contracture were measured. Mean knee flexion contracture was 21.4 degrees at birth, reducing to 10.7 degrees at 3 months and 3.3 degrees at 6 months. Decreasing range of knee flexion was noted in the same period. The natural history of normal knee motion is important in interpreting findings in patients with neuromuscular disorders.

Hip Joint↗
PubMedDate not supplied

Incidence and type of hindfoot deformities in patients with low-level spina bifida.

In a consecutive series of 174 children with low-level spina bifida, there was hindfoot deformity in 263 of the 348 feet; 86 were in equinus, 108 were in calcaneus, 41 were in valgus, 20 were in varus, and eight had convex pes valgus. Surgery was performed on 222 (64%) feet. The deformities were symmetric in 114 children. Spasticity causing deformity necessitated surgery in only 44 feet. Calcaneus deformity in the foot is considerably more common in patients with L4 lesions, and in these circumstances, muscle imbalance is clearly a major factor. However, many patients with calcaneus deformity had L5 or sacral lesions. This suggests that muscle imbalance is not so important a factor as has been thought in the causation of deformity in the lower limb in myelomeningocele.

Child, Preschool↗
PubMedDate not supplied

Bilateral dislocation of the hip in spina bifida: a long-term follow-up study.

Nineteen patients with spina bifida and bilateral dislocation of the hips were studied with a minimal follow-up of 10 years. The average age at review was 21 years (range, 10-31). Ten patients had an upper neurologic level (thoracic to L3), and nine had a low lesion (L4 to sacrum). Three patients had no hip surgery. A closed or open reduction was performed in 12 hips, supplemented by one or more surgical procedures. Of these, 10 remained enlocated, and two had redislocated. In all other hips, several surgical procedures were performed, aimed at improvement of hip-flexion deformity or stability. At follow-up, one patient had occasional pain in one hip, which was dysplastic. Of the 10 patients with a high lesion, only two were walkers, but both had bilateral dislocation of the hips at follow-up. In contrast, all nine patients were walkers, but four of these had bilateral dislocation at follow-up. We found that a level pelvis and good range of motion of the hips are more important for ambulation than is reduction of bilateral hip dislocation.

Adolescent↗