Biomedical subjects
Publications and source records attributed to P Burge.
A case of bilateral congenital pseudarthrosis of the olecranon is described. The clinical features, radiological appearance and prognosis are distinct from the type of congenital pseudarthrosis of the forearm reported previously. The lesion appeared to be a localised failure of ossification within the proximal ulnar metaphysis. Excision, stabilisation and bone grafting led to rapid fusion.
Persistent abduction of the little finger after ulnar nerve palsy has been attributed to the unopposed action of extensor digiti minimi. Evidence is presented that the deformity can also result when re-innervation reaches abductor digiti minimi but not the palmar interossei. Operative correction of the deformity, if required, should be delayed until it is clear that no further muscle recovery is likely to occur.
Loosening after total ankle arthroplasty may result from absorption of tensile and shear forces by relatively small bone-cement interfaces. A surface replacement arthroplasty similar in principle to the Oxford knee arthroplasty offers theoretical advantages over other designs. The ability of such a prosthesis to provide a stable articulation was tested by examination of ankle laxity before and after replacement of the tibiotalar articular surfaces. The motion response characteristics of four specimens were measured for internal-external rotation moment (+/- 3 nm), inversion-eversion moment (+/- 3 nm), and anteroposterior displacement (+/- 50 N). The prosthesis restored normal internal-external and inversion-eversion rotatory stability, but the mean anteroposterior laxity was increased from 5.5 to 9.7 mm (P less than 0.05). Anteroposterior stability could not be restored by increasing the thickness of the bearing interposed between the prosthetic surfaces. The findings can be explained by consideration of the anatomy of the ligaments in relation to the contour of the normal and prosthetic articular surfaces. The normal tibial articular surface, which is concave in the sagittal plane, provides restraint against anteroposterior motion which is lost when the surface is replaced by the flat prosthetic surface. The findings question the suitability of this type of prosthesis for the ankle.
In a 30-year-old man, the movement of a loose body between the knee joint and a popliteal cyst caused difficulty in locating the loose body. The first roentgenogram showed a posteromedial opacity, which was thought to be a sesamoid. On a subsequent film, a loose body appeared in the intercondylar notch and the posteromedial opacity was absent. At arthroscopy, the loose body could not be found within the joint and a peroperative radiograph showed that the opacity had returned to its original position. The loose body was visualized with the arthroscope inserted via a posteromedial portal and passed into the popliteal cyst. After manipulation of the loose body into the posteromedial compartment, it was removed via arthrotomy. The possibility that a loose body may lie in a popliteal cyst should be considered if all other attempts have failed to locate it.
Non-operative management has frequently been adopted for closed injuries of the infraclavicular brachial plexus and its branches in the belief that spontaneous recovery is likely to occur, and surgical exploration is performed only if recovery has not occurred in the expected time. This paper correlates the clinical and electrophysiological features with the operative findings in six patients with such injuries. The axillary nerve was ruptured in all six patients, the musculocutaneous nerve in two and the radial nerve in two. When the muscles supplied by a branch of the plexus were denervated, the differentiation between rupture of that branch and a lesion in continuity could only be made by surgical exploration, which should be performed as soon as other injuries permit.
A case is presented in which trans-scaphoid perilunate dislocation occurred through a scaphoid non-union. The place of open reduction and immediate bone grafting is discussed.