Search PubMed⌕ Search

Biomedical subjects

W J Sharrard

Publications and source records attributed to W J Sharrard.

At least 37 records · Page 2Linked to original sources
PubMed1984

Treatment of congenital and infantile pseudarthrosis of the tibia with pulsing electromagnetic fields.

The management of congenital and infantile pseudarthrosis of the tibia poses difficult problems because of the variability in the type and prognosis of the lesion and varied response to surgical treatment. Whatever the severity of the lesion, the use of pulsed electromagnetic fields can be expected to improve the prognosis for union by a factor of at least 20 per cent. In a very few patients, usually those with pseudarthrosis presenting later in life, pulsed electromagnetic fields alone together with plaster immobilization may be sufficient to produce union. In some, partially successful previous surgery may be made completely successful by subsequent application of pulsed electromagnetic fields. In patients with a fair or good prognosis as regards the type of lesion, a combination of surgery and pulsed electromagnetic treatment, some period of which may also be given before surgical treatment, gives a moderately high rate of success. In the three groups already described, the overall success rate is likely to be more than 70 per cent. In lesions with a poor prognosis, or after multiple surgical procedures in an older child, a combination of very adequate further surgery and pulsed electromagnetic fields can produce union in perhaps 30 per cent of cases, but it is unwise to commence any treatment if the limb is already unacceptably short, if there is gross wasting of the limb with evidence of inadequate vascular supply, and/or if the joints of the foot and ankle are stiff and associated with deformity. In such cases, the procedure of choice is amputation.

Adolescent↗
PubMed1982

Iliopsoas transfer in the management of established dislocation and refractory progressive subluxation of the hip in cerebral palsy.

The authors have reviewed 25 hips in 23 patients with cerebral palsy in which iliopsoas transfer had been performed for established dislocation or refractory progressive subluxation of the hip. The iliopsoas tendon was transferred either postero-laterally or antero-laterally, depending upon the degree of fixed flexion of the hip. An adductor release was performed in all cases and an open reduction when necessary. A painfree stable joint was produced except for one hip in which the iliopsoas tendon had become detached because of sepsis. The loss of flexor power at the hip due to the transfer is thought to be a small price to pay for the relief of pain and spasm and the increase in function.

Adolescent↗
PubMed1982

The treatment of fibrous non-union of fractures by pulsing electromagnetic stimulation.

Fifty-three ununited fractures with a median time since injury of 28 months were treated by electrical stimulation using pulsing electromagnetic fields. Union was achieved in 38 cases (71.7 per cent) in a median time of six months. For ununited fractures of the tibia the success rate was higher at 86.7 per cent. Previous or active sepsis, the presence of plates or nails, the age of the patient or the time since the injury did not affect the results. Analysis of the failures suggests that inadequate immobilisation, a fracture gap of more than five millimetres or the presence of a screw in the fracture gap was responsible. In four patients no cause of failure could be determined.

Adolescent↗
PubMed1980

The pathophysiology of arthrogryposis multiplex congenita neurologica.

Eleven patients with arthrogryposis multiplex congenita neurologica have been reviewed. Distinct patterns of deformity and muscle activity were identified which have been correlated with specific levels of segmental neurological motor deficit without sensory loss. The clinical picture was consistent with localised lesions of the anterior horn cell cell columns. This finding agreed with the recorded pathological lesions. Orthopaedic treatment should take account of the paralytic nature of the deformities.

Adolescent↗
PubMed1979

Osteoid osteoma and benign osteoblastoma in childhood.

Three cases of osteoid osteoma and one of benign osteoblastoma in children are described. The main complaint was severe pain which was worse at night; it was relieved by aspirin or other analgesics. The diagnosis was made on clinical and radiological grounds and was confirmed on histological examination of the central nidus removed at operation. The pain was relieved in the patients with osteoid osteoma, and it was very much less after operative removal of the benign osteoblastoma. Both conditions are probably variations of the same disease process, depending on the anatomical site and the type of bone affected.

Adolescent↗
PubMed1977

The treatment of flexion contracture of the knee in myelomeningocele.

A follow-up study, on average four years after operation, of seventy-six cildren with myelomeningocele who had surgical treatment for flexion contracture of the knee, is reported. After a single operation sixty-eight knees (55 per cent) had a contracture of less than 20 degrees, which was the main criterion of success. About half of the cases of transplantation of the hamstrings to the femur, division or elongation of the hamstrings, or supracondylar osteotomy had successful results. Transfer of the hamstring tendons to the patella was successful in nine of twelve instances, so giving the lowest rate of failure. Forty-five patients were active walkers at follow-up as compared to eighteen before operation. However, only one of the eleven patients over twelve years of age with a motor level above T.12 was an active walker at review. Several conclusions are drawn. A flexion contracture of the hip greater than 30 degress should be corrected before operation of the knee. Supracondylar osteotomy as a primary procedure should only be used to correct flexion contracture of the knee secondary to malunited fractures. Faradic stimulation is useful in the evaluation of muslce function before operation. An intelligence quotient below 65 and weakness of the arms are relative contraindications for correction of the deformity of the knee.

Adolescent↗
PubMed1975

Surgical prophylaxis of subluxation and dislocation of the hip in cerebral palsy.

The clinical and radiological state of the hips of a group of children with cerebral palsy treated without operation is compared with that in a group treated by operation to correct adduction and flexion deformity and to obtain balanced action in the hip muscles. In the first group, 11 per cent of hips were dislocated, 28 per cent subluxated, 46 per cent dysplastic and 15 per cent normal. In the second group no hip was dislocated, 13 per cent were subluxated, 35 per cent dysplastic and 52 per cent normal. Surgical intervention is indicated clinically for a range of abduction diminishing to less than 45 degrees and--on radiological criteria--for early dysplastic changes, especially a break in Shenton's line, irrespective of the patient's age, severity of involvement or neurological maturity. Prevention of subluxation or dislocation improves function and diminishes the liability to develop a painful hip in adolescence or early adult life.

Adolescent↗