Spontaneous rheumatoid fistula of the elbow joint.
A case of rheumatoid arthritis, whose presenting problem was a non-infective fistula of the elbow joint, is described. Penicillamine therapy was ineffective, but synovectomy led to healing.
Aged↗
Biomedical subjects
R J Newman
Publications and source records attributed to R J Newman.
Primary bone tumours of the thoracic skeleton: an audit of the Leeds regional bone tumour registry.
An audit of the Leeds regional bone tumour registry found that primary bone tumours of the thoracic skeleton constituted 90 of the 2004 cases (4.5%). Thirty seven per cent occurred in the ribs, 32% in the scapulae, 11% in the thoracic vertebrae, 11% in the sternum, and 9% in the clavicles. Malignant tumours were more common than benign (54 v 36) and occurred in an older population (mean ages 47 and 31 years). The scapula was the most common site for malignant lesions and the ribs the most common site for benign tumours. Chondrosarcoma was the commonest tumour in older patients, fibrous dysplasia and plasmacytoma in the middle age group, and eosinophilic granuloma in children. Presenting symptoms were a poor guide to whether the lesion was malignant or not. This and the small proportion of correct preoperative diagnoses indicate the need for early biopsy. Bone tumour registries provide a valuable source of cumulative information about uncommon tumours and facilitate accurate diagnosis, teaching, and research.
Adolescent↗
Major joint replacement surgery for rheumatoid arthritis.
The results of total joint arthroplasty are exciting but certainly they are not yet good enough to warrant complacency. Further advances in design and materials are required. It is also clear that there is a positive relationship between the technical expertise with which the surgery is performed and the long term functional results (especially with regard to the knee). Nonetheless, the benefits that this type of surgery can confer on the severely afflicted rheumatoid patient with regard to pain relief and function are such that there should be little hesitation in offering this form of treatment to all patients who fail conservative treatment. However, it has always to be remembered that the results of even the most sophisticated surgery can be improved by an intensive rehabilitation programme including pre- and post-operative occupational therapy and physiotherapy, the prescription of appropriate appliances and the optimisation of medical therapy.
Arthritis, Rheumatoid↗
Medial and lateral wall decompression for thyroid ophthalmopathy.
A two-wall decompression of the orbit, consisting of removal of the medial and lateral walls, was successful in eight patients with thyroid ophthalmopathy. The lateral wall was by removed by using the standard orbitotomy technique in addition to enlarging the space with a pneumatic burr, and the medial wall was removed through a direct medial canthal incision. Two patients had optic neuropathy, one had intermittent subluxation of the globe, and five had symptoms of exposure or increased pressure in the orbital area. In our eight patients, the two with optic neuropathy improved, the patient with subluxation of the globe became asymptomatic, and the other five had less exposure and were more comfortable. The amount of decompression ranged between 4 and 7 mm. The lacrimal sac was injured in one patient; temporary silicone intubation avoided any permanent sequela.
Aged↗
NHS review. Internal markets for surgical services: opportunity for trade in orthopaedics.
Explore the source record for details and available documents.
Hospitals↗
Soft tissue cervical spinal injuries in motor vehicle accidents.
Soft tissue cervical spinal injuries occurred in 179 out of 1197 consecutive victims of road traffic accidents who needed to attend hospital; an incidence of 15 per cent. It was most common in female (P less than 0.01), restrained car occupants (P less than 0.05) in the 40-49 years age group (P less than 0.025). It was less common in rear seat passengers (P less than 0.001). Most were victims of collisions from the rear but significant numbers also occurred in other types of accidents. The incidence of associated injuries was low.
Accidents, Traffic↗
Implant failures in patients with proximal fractures of the femur treated with a sliding screw device.
A review of 385 proximal fractures of the femur treated with a telescopic screw system revealed that in nine cases the device had cut out of the head of the femur necessitating its removal. In two cases the head of the femur had been penetrated at the time of insertion. In all but one of the remaining seven cases the screw had been inserted in the superior half of the head and neck of the femur. The overall cut-out rate was 2.25 per cent but was 11.9 per cent when the screw was placed in the superior half of the head. When the screw was placed in the inferior half of the head, the cut-out rate was only 0.29 per cent. There was no correlation between this mechanical failure and age, sex, type of fracture or the presence of metabolic bone disease. These results indicate that if this otherwise effective form of internal fixation is to be used in the treatment of proximal fractures of the femur, care must be taken to avoid placement of the device in the superior half of the head and neck of the femur.
Aged↗
The three-dimensional anatomy of the proximal femur in Perthes' disease.
A new method of recording the three-dimensional anatomy of the proximal femur from a single anteroposterior radiograph is described. This technique shows that in Perthes' disease the femoral head and neck are in significant anteversion and true varus. This anatomical configuration may be important in the pathogenesis and treatment of this disorder.
Child↗
Late fracture associated with retained internal fixation.
Explore the source record for details and available documents.
Aged↗
M marinum infections in a Chesapeake Bay community.
Their proximity to Eastern Virginia's abundant waterways has given the authors experience in managing the destructive tenosynovitis and deep tissue infections caused by M marinum. They present nine cases, discuss diagnosis and treatment, review the literature, and urge urban physicians to be on the alert for the disease in patients recently returned from fishing trips.
Aged↗
Prospective randomised study of an orthopaedic geriatric inpatient service.
A randomised controlled trial of two management regimens was carried out in women patients over 65 years of age with hip fractures. Ninety seven patients were admitted to a designated orthopaedic geriatric unit and 125 to orthopaedic wards. No difference was observed in mortality, length of stay, or placement of patients between the two groups. More medical conditions were recognised and treated in patients in the orthopaedic geriatric unit group. It is concluded that designated orthopaedic geriatric units can provide medical care to these patients and should be administered without additional cost.
Activities of Daily Living↗
Brachial plexus anaesthesia for upper limb surgery: a review of eight years' experience.
1248 supraclavicular brachial plexus blocks and 665 axillary plexus blocks were administered to 1913 patients undergoing upper limb surgery. Plexus block alone was successful in 83.5%. In a further 11.4% of cases, adequate anaesthesia was obtained following augmentation by other regional or local techniques. This resulted in an overall success rate of 94.9% and general anaesthesia was required in only 5.1%. The two percutaneous approaches to the brachial plexus did not differ in their success-rates but clinically apparent pneumothorax occurred in 0.8% of supraclavicular blocks. Brachial plexus block anaesthesia is recommended as a safe and satisfactory alternative to general anaesthesia for upper limb surgery.
Adult↗
Are combined orthopaedic and rheumatology clinics worth while?
The practice of holding combined orthopaedic and rheumatology clinics is widespread, but no attempt has been made to assess their usefulness. In a one year prospective study patients were randomised either to a combined clinic with a rheumatologist and an orthopaedic surgeon or to a clinic with an orthopaedic surgeon alone. The details of the patients' disease, the interview, the surgeons' and rheumatologists' responses, and the patients' opinions were recorded on questionnaires. Interviews were appreciably longer in the combined clinic, and more referrals for surgery were made. The rheumatologist correctly predicted the need for surgery in 95% of cases, and his presence in the clinic was considered desirable by the surgeon, principally when the referral letter was inadequate. It is concluded that most patients with rheumatic diseases can be seen more efficiently in routine orthopaedic clinics provided a good quality letter of referral is sent.
Female↗
Accelerated fracture union in association with severe head injury.
Union occurred unusually rapidly in 13 fractures of long bones in 11 patients who had sustained severe head injuries. Possible metabolic mechanisms for this are discussed and it is suggested that respiratory alkalosis associated with severe head injury or its treatment affects the rate of deposition of callus by modifying the pH at the fracture site. Fractures in patients with severe head injuries should be restored to an acceptable position early in order to avoid malunion.
Adult↗
Excision of the distal ulna in patients with rheumatoid arthritis.
The results of excision of the distal ulna in 34 wrists of 25 patients with chronic rheumatoid arthritis of the distal radio-ulnar joint were reviewed. Rest pain had been cured or relieved in 77%, pain on pronation-supination in 86%, and limitation of pronation-supination in 90%, while 88% of the patients graded the result as excellent or fair. Despite this marked relief of symptoms, function of the upper limb was improved in only 25% of patients and remained unchanged in 60%. Ulnar subluxation of the carpus had occurred in 24% but seemed to be related to the destructive disease process rather than to the operation itself. The length of ulna resected was not related to the outcome of the operation.
Arthritis, Rheumatoid↗
Nuclear magnetic resonance studies of experimentally induced delayed fracture union.
Delayed fracture union was produced in the rat tibia with parenteral administration of prednisolone. Phosphorus nuclear magnetic resonance spectroscopy was used to monitor the local pH changes that occurred at the fracture site throughout repair. During the fracture healing in control animals, the pH of the fracture site changed from 7.2 on Day 2 to 7.5 on Day 20 following fracture, i.e., alkaline with respect to the pH of normal extracellular fluid. Deposition of radioopaque callus occurred mainly during the alkaline phase. In the steroid-treated rats the rate and extent of pH change were significantly less and the fracture site became alkaline five to ten days later than in the control animals. Because radiopaque callus deposition still occurred predominantly in the alkaline phase, union was also delayed by about the same interval of time. The rat prednisolone model differs significantly from the human condition of delayed union. Clinical investigations are indicated to ascertain whether abnormalities of fracture site pH occur in delayed union in humans.
Animals↗
A low-pressure tourniquet system for the lower limb.
An unusually wide pneumatic tourniquet which has recently been introduced into clinical practice was shown to occlude the lower limbs' blood flow at lower inflation pressures than the conventional narrower instrument. Based on a prospective study of volunteers as well as on a recording of peroperative fluctuations of blood pressure it was suggested that lower limbs' blood flow could be reliably occluded with this wide tourniquet inflated to no more than 125 mm Hg above the systolic pressure measured on admission. Theoretically a change to the lower pressures permitted by this instrument will lead to a reduction in complications caused by the tourniquet.
Adolescent↗
A prospective evaluation of the protective effect of car seatbelts.
A 3-year prospective study of road traffic accidents was performed in Oxfordshire by a combined team of surgeons and engineers in which injury severity was accurately recorded and related both to seatbelt use and velocity change during the collision--an objective, computer-derived index of impact severity. Analysis of the injuries sustained in relation to the average crash severity from which they resulted has shown that for frontal impacts the use of seatbelts has had a major protective effect in reducing injury severity.
Accidents, Traffic↗