Biomedical subjects
Publications and source records attributed to W B Conolly.
We report a case of a fracture occurring in the proximal phalanx of a child following pulley reconstruction. The operative technique and the difficulties of pulley reconstruction in the immature skeleton are discussed.
30 cases of iatrogenic injection injuries to the hand and upper limb are reported. 16 followed therapeutic injections (steroids--11 cases, infusions--five cases) and 14 occurred during anaesthetics procedures (local blocks--ten cases, general anaesthetics--four cases). Guidelines for minimizing the risk of injection injury are outlined.
Closed ruptures of both normal flexor tendons in the same finger are extremely rare, only nine cases having been reported in the literature. We describe the case of a patient who sustained a closed rupture of both flexor digitorum profundus and flexor digitorum superficialis of the ring finger, following a forced hyperextension injury. The patient was treated by a two stage reconstruction of the flexor digitorum profundus. He regained full flexion and extension of the finger.
In the years 1981 to 1987, 50 patients had 59 replacements of the finger joints. Of these, 41 patients with 49 joint operations were reviewed, with follow-up ranging from two to eight years (average 32 months). About 80% of these patients were satisfied that silastic implant arthroplasty had relieved their pain and stiffness and improved function of the finger and hand. They were satisfied that this procedure was preferable to amputation or fusion. Success or failure was assessed not only on the range of movement of the joint being replaced, but on relief of pain, correction of deformity, stability and overall finger function. The seven patients regarded as failures are analysed in detail.
The implanted cylinder model was used to measure LDH activity and lactate and pyruvate concentrations in the extracellular fluid of wounds and wound tissue. Total LDH activity corresponded directly to lactic acid concentration and inversely to oxygen availability. LDH isoenzymes in wound fluid were in an anaerobic pattern soon after injury and evolved toward the aerotic pattern as oxygen supply more nearly matched metabolic capacity. Lactate levels in the wound space are elevated soon after wounding and remain elevated far above those in blood. These data again indicate that wound metabolism is characterized by a relatively poor oxygen supply. Current data from several sources indicate that lactate found in the hypoxic area of the wound may stimulate collagen synthesis in fibroblasts lying in the high lactate environment. We postulate that elevated concentration of lactate in wounds is a major signal for collagen synthesis and repair.
In the period 1972 to 1977, 35 patients with persistent pain and other disabilities after carpal tunnel decompression were referred for treatment. The pitfalls included: (i) wrong diagnosis--5 patients; (ii) inadequate decompression--9 patients; (iii) recurrent compression--4 patients; (iv) iatrogenic nerve injury--7 patients; and (v) postoperative complications--10 patients. The patients in Groups 1 and 5 were treated by non-operative measures. Most of the patients in Groups 2, 3, and 4 were treated by reoperation. This paper outlines the causes and prevention of pitfalls in carpal tunnel decompression.
Seventy reconstfuctive operations on the hand were done with the patient's full co-operation during the procedure. Anaesthesia was provided by a peripheral nerve block at the level of the wrist or the metacarpo-phalangeal joint. This technique enabled the surgeon to estimate the required extent of such operations as tenolysis, arthrolysis, arthroplasty, and tendon graft. It also helped the patient to appreciate the movement he could achieve post-operatively.
The case records of 218 patients with residual hand disability were reviewed. Sixty-six per cent had significant stiffness of the digital joints (metacarpophalangeal and proximal interphalangeal); 25% had amputation of part or whole of the digit; 33% of these had troublesome neuromata; 7% had residual numbness; 25% had more than one operation on their injured hand. The average age of the patients was 44 years. The average time off work was 10 weeks. The average experience in the job before injury was six years.
Observations have been made on the choice of wound drainage in 119 general surgical or urological procedures performed by surgeons in a general hospital. Complications of the drains used are reported. Softer and more pliable drains appear to cause less morbidity than the stiffer, more rigid variety. The literature dealing with drainage is reviewed.
This paper describes the use of intermittent pressure to reduce oedema of the limbs by assisting resorption. The rationale of the method is outlined with emphasis on the management of traumatic oedema. A safe, simple and inexpensive device to effect the intermittent pressure is described. The results of clinical trials on 63 patients with oedema are documented to substantiate the value of the treatment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.