Biomedical subjects

P A Frawley

Publications and source records attributed to P A Frawley.

6 recordsLinked to original sources

PubMed1996

Anterior release for fixed flexion deformity of the hip in spina bifida.

We reviewed the results of anterior hip release for fixed flexion deformity in 57 hips in 38 children with spina bifida at an average follow-up of 8.9 years (2 to 22). The indication for this operation was a fixed flexion deformity of more then 30 degrees which interfered with function. In 43 hips there was a good outcome in that the fixed flexion deformity remained less than 30 degrees at follow-up. Four hips had a good initial result but deteriorated after an average of five years, and ten had a poor outcome with deformity of over 30 degrees. Six hips required a repeated anterior hip release and two of these were successful. The success of anterior hip release could not be related to the neurological level or the age at operation. Successful surgery correlated with the walking ability of the child at the latest follow-up.

Child↗

PubMed1995

Bone scanning in the multiply injured patient.

A prospective study was undertaken to evaluate the role of radionuclide bone scanning in the management of patients with multiple injuries. During a 7 month period, 14 patients with multiple injuries underwent a bone scan in order to identify occult skeletal injuries. All of the patients had new injuries diagnosed. The majority of new injuries occurred either in a limb in which an injury had already been diagnosed at presentation, or in the chest. Such findings are consistent with previously published data. Infrequently, there was a change in management of the patients in this series following the bone scan.

Adolescent↗

PubMed1995

Treatment outcome of major fractures of the talus.

Twenty-six patients with major fractures of the talus were studied to assess the long-term outcome. The patients were admitted to a university teaching hospital and major trauma center from 1983 to 1991. The study excluded isolated fractures of the talar dome and posterior tubercle. Fifteen patients were treated using internal fixation and 11 patients were treated using nonsurgical methods. Avascular necrosis was detected in only four of the 26 patients. Subtalar osteoarthritis was a significant problem in 61%. Seven of these patients have come to secondary fusion procedures, with another three contemplating fusion procedures at the time of review. Only one patient developed significant avascular necrosis requiring a fusion procedure. Only three of 26 patients had not returned to work at a mean 6 years after their injury. Eleven of the 26 (42%) had not returned to their premorbid activity level. The majority of these patients (25/26) had sustained multiple injuries, which compromised the functional recovery from the talar injury. Early accurate diagnosis and anatomical reduction gave the best results. The low incidence of avascular necrosis in this study has been attributed to early anatomical stabilization of the fracture. We believe an early CT scan can more accurately assess the severity of the talar fracture and offers the best information for an appropriate treatment plan.

Adult↗

PubMed1993

Missed injuries in the multiply traumatized.

The delayed diagnosis of injuries in traumatized patients is a recognized problem. A retrospective review of trauma patients admitted to a major teaching hospital has been performed. The records of all patients admitted to the intensive care unit (ICU) have been checked to determine the incidence of late diagnosed injuries. The notes written by the staff of the emergency department and the ICU, and the attending surgical registrars have been used as the criteria of initial diagnosis. Comparing them to the injuries listed in the progress notes, investigation reports, discharge summary and follow-up outpatient notes led to the discovery of a number of missed injures (19 of 50 patients had one or more). In 4 cases the management involved further surgery due to new diagnoses. This is consistent with overseas literature. A review of the literature is presented and methods to improve the missed diagnosis rate are discussed.

Adolescent↗

PubMed1991

Trauma management.

Explore the source record for details and available documents.

Emergency Service, Hospital↗

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↗