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Biomedical subjects

Robert U Ashford

Publications and source records attributed to Robert U Ashford.

7 recordsLinked to original sources
PubMed2006

Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry.

We conducted a review of the Leeds Regional Bone Tumour Registry for primary bone tumours of the spine since establishment in 1958 until year 2000. To analyse the incidence of primary tumours of the spine and to record the site of occurrence, sex distribution, survival and pathology of these tumours. Primary tumours of the spine are particularly rare, accounting for between 4 and 13% of published series of primary bone tumours. The Leeds Bone Tumour Registry was reviewed and a total of 2,750 cases of bone tumours and tumour-like cases were analysed. Consultants in orthopaedic surgery, neurosurgery, oncology and pathology in North and West Yorkshire and Humberside contribute to the Registry. Primary bone tumours of the osseous spine constitute only 126 of the 2,750 cases (4.6%). Chordoma was the most frequent tumour in the cervical and sacral regions, while the most common diagnosis overall was multiple myeloma and plasmacytoma. Osteosarcoma ranked third. The mean age of presentation was 42 years and pain was the most common presenting symptom, occurring in 95% of malignant and 76% of benign tumours. Neurological involvement occurred in 52% of malignant tumours and usually meant a poor prognosis. The establishment of Bone Tumour Registries is the only way that sufficient data on large numbers of these rare tumours can be accumulated to provide a valuable and otherwise unavailable source of information for research, education and clinical follow-up.

Adolescent↗
PubMed2006

Müller straight stem total hip arthroplasty for fractured neck of femur.

UNLABELLED: We present the results of a retrospective review of 50 Müller straight stem total hip replacements performed for femoral neck fracture over a 10-year period. PATIENTS AND METHODS: Between 1992 and 2002, 50 Müller straight stem total hip replacements were performed for femoral neck fracture in 42 female and 8 male patients with a mean age of 74 years. RESULTS: No hips have required revision surgery. Two patients have suffered early dislocations and there have been three major medical complications. The mean Merle D'Aubigne-Postel score was 15.1. Of the 25 radiographs available for review there were no cases of radiological loosening. DISCUSSION: This is further evidence that total hip replacement in the right hands provides good results for the treatment of displaced intracapsular femoral neck fractures. The Müller straight stem gives acceptable results in a select group of patients.

Aged↗
PubMed2004

Delays in open fracture management: where do they occur?

We audited the delays in the management of 29 patients presenting to our department with 30 open fractures over a 1-year-period to ascertain where the most lengthy delays were occurring. Gold standard treatment is the surgical debridement and stabilisation of the fracture within 6h of injury. In our series only 14 patients achieved this standard. The lengthiest delays were in getting a patient to the operating theatre following orthopaedic assessment. We have introduced an "open fracture proforma" to highlight the time-critical nature of the injury in an effort to speed-up the process.

Debridement↗
PubMed2004

Differences in attitudes to analgesia in post-operative limb surgery put patients at risk of compartment syndrome.

Missed compartment syndrome may result in severe disability. Complete masking of pain, the cardinal symptom of compartment syndrome, may contribute to delayed or missed diagnosis. Scenarios reported in the literature as cases of delayed or missed compartment syndrome (due to analgesia) were included in a questionnaire. Each of the respondents was requested to indicate the preferred choice of post-operative analgesia for each scenario. Significant differences were found between orthopaedic surgeons and anaesthetists regarding the preferred choice of post-operative analgesia in clinical situations which have been previously shown to be associated with a high risk of compartment syndrome. Use of analgesic methods which impair the ability to detect patients with abnormal levels of pain or unusual demands for analgesia may place such patients at risk of the devastating sequelae of a missed compartment syndrome. The differences in attitudes to local and regional nerve blockade between orthopaedic surgeons and anaesthetists suggests that some anaesthetists may be exposing patients to the risk of missed compartment syndrome following extremity surgery.

Analgesia↗
PubMed2004

Delayed presentation is no barrier to satisfactory outcome in the management of open tibial fractures.

The management of open tibial fractures is a challenge to all orthopaedic trauma surgeons. The major goals are fracture union, uncomplicated soft tissue healing and return to pre-injury level of function. The geographical isolation and vastness of the Northern Territory of Australia complicates the management of these injuries by adding a significant delay to treatment. Forty-five patients sustained 48 open tibial fractures over the 30-month period of the study. Twelve received primary surgical treatment within 6h of injury but 33 were treated more than 6h after injury. The mean time to treatment in this latter group was 12h 15min (median 9h 45min, range 6-37h). The majority of injuries were high energy, with 23 patients having multiple injuries and 29 fractures (60%) being classified as AO C3 with 35 (73%) having Gustilo III soft tissue injuries. There was a mean time to union of 7.5 months and an overall complication rate of 42.2%. Thirteen patients (29%) required additional (late) surgical procedures subsequent to definitive fracture and soft tissue management. The zone of injury infection rate was 12.5%. The high incidence of open tibial fractures places a large financial burden on the state. However, despite the absence of a plastic surgical service and delays in presentation, satisfactory outcomes can be obtained by the application of the established surgical principles of thorough debridement, soft tissue management and fracture stabilisation.

Adolescent↗