Showing papers by "Nuffield Orthopaedic Centre published in 1979"
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TL;DR: Primary total hip replacement for displaced subcapital fractures may be performed with an acceptable mortality and the majority of patients who were reviewed after operation experienced few symptoms and 87 per cent were able to walk independently.
Abstract: Primary total hip replacement for displaced subcapital fractures may be performed with an acceptable mortality. The majority of a series of patients who were reviewed after operation experienced few symptoms and 87 per cent were able to walk independently. These results compared favourably with other forms of management, and deterioration was seldom observed.
58 citations
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TL;DR: Except for one patient with persistent radial paraesthesiae, full spontaneous recovery occurred in 7 patients who had sustained either anterior interosseous, posterior interOSseous or radial nerve lesions, and the mean time of follow-up was three years and nine months.
Abstract: Twenty-one patients with acute injury of either the median, ulnar, radial, anterior interosseous or posterior interosseous nerves associated with 1540 closed fractures or dislocations of the elbow have been reviewed. The mean time of follow-up was three years and nine months. Nine patients, 6 of whom had ulnar nerve lesions, had persistent evidence of nerve damage. Five patients sustained median nerve lesions complicating supracondylar fractures of the humerus. One patient, in whom there was no evidence of nerve recovery at five months, made a full recovery following neurolysis. Of the 9 patients who sustained ulnar nerve lesions, 2 required neurolysis and anterior transposition of the nerve, at two months and five months respectively, to facilitate recovery. Except for one patient with persistent radial paraesthesiae, full spontaneous recovery occurred in 7 patients who had sustained either anterior interosseous, posterior interosseous or radial nerve lesions.
58 citations
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TL;DR: Investigation in the rat sciatic nerve shows an increasing resistance to elongation of the nerves with increasing tension, which may reduce the success of surgery.
Abstract: Tension introduced into peripheral nerves during their surgical repair may reduce the success of this procedure.Two mechanical factors are important; the tension required to effect a repair, and th...
37 citations
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TL;DR: In this paper, the authors examined normal male articular cartilage (34 specimens, age range 1-30 years) for response to somatomedin (SM) activity.
Abstract: Normal male articular cartilage (34 specimens, age range 1–30 years) has been examined in vitro for response to somatomedin (SM) activity. Basal3H-thymidine and35S-sulfate incorporation both decreased with increasing age of the cartilage donor. However, enhancement of isotope incorporation which was attained on addition of 10% normal plasma (containing IU SM/ml) was greatest in cartilage from adolescents in the age range 12–17 years. The mean enhancement of3H-thymidine incorporation (expressed as % basal) was as follows: age 1–10 years=184 ± 28 (SE),N=9; 12–17 years=436 ± 101 (11); 18–30 years=231 ± 49 (8); and for35S-sulfate incorporation was 1–10 years=389 ± 100 (8); 12–17 years=824 ± 273 (11); and 18–30 years=572 ± 56 (8). The increased response of cartilage in the 12–17 year group suggests that a greater sensitivity to the somatomedins may contribute to the increased skeletal growth during adolescence.
37 citations
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01 Jan 1979TL;DR: A comparison was made between functional assessments in hospital before discharge and at home shortly after discharge and a small number of the activities assessed showed a significant change at home and these changes were all towards a lower level of independence.
Abstract: The level of functional achievement gained during a rehabilitation programme provides the basis for supplying aids and requesting community services on discharge. In a study of follow up regimes for patients with rheumatoid arthritis a comparison was made between functional assessments in hospital before discharge and at home shortly after discharge. A small number of the activities assessed showed a significant change at home and these changes were all towards a lower level of independence.
35 citations
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TL;DR: Longitudinal growth of immature rat femurs was studied in diffusion chambers after circumferential periosteal division and stripping and after 14 days significant overgrowth of thePeriosteally divided femurs had occurred.
Abstract: Longitudinal growth of immature rat femurs was studied in diffusion chambers after circumferential periosteal division and stripping. After 14 days significant (P < 0.02) overgrowth of the perioste...
30 citations
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01 Jul 197924 citations
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TL;DR: Changes in the isometric contraction force of the quadriceps muscle were found to reliably indicate whether the muscle was in a state of breakdown or repair in a patient with polymyositis who was being treated with prednisolone and azathioprine.
Abstract: Muscle breakdown and repair were measured by metabolic balance techniques in a patient with polymyositis who was being treated with prednisolone and azathioprine Changes in body muscle mass that had been estimated from nitrogen and phosphorus balances correlated with antropometric assessments of thigh muscle mass and quadriceps strength Decline in muscle strength was associated with a net rate of muscle breakdown of 148 g/day Recovery was associated with a net rate of muscle repair of up to 100 g/day Early reduction in corticosteroid treatment appeared to enhance the rate of repair Changes in the isometric contraction force of the quadriceps muscle (but not in clinical symptoms, plasma creatine kinase [CK] or erythrocyte sedimentation rate [ESR] were found to reliably indicate whether the muscle was in a state of breakdown or repair Treatment of the individual patient may be quantitatively monitored by metabolic balance studies or, more simply, by measurement of muscle strength
21 citations
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TL;DR: The production of large amounts of prostaglandins by bones in response to infection may be the cause of the rapid bone resorption and sequester formation observed in osteomyelitis.
20 citations
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TL;DR: A study of the incidence and grading of osteoarthritis in all the other thirty-two joints in the hands of twenty-one patients with osteOarthritis of the carpometacarpal joint of the thumb.
Abstract: A study of the incidence and grading of osteoarthritis in all the other thirty-two joints in the hands of twenty-one patients with osteoarthritis of the carpometacarpal joint of the thumb.
19 citations
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TL;DR: It is suggested that the clinical improvement induced by D-penicillamine could reflect an inhibition of collagen proliferation in the synovium, and both collagen and general protein synthesis were inhibited in vitro.
Abstract: Collagen biosynthesis was measured in skin biopsies taken from 13 patients with rheumatoid arthritis before and after at least 6 months' continuous treatment with D-peniciilamine, 1.0 g/day. There was a significant 36% reduction in mean collagen biosynthesis (p<0.0125) as assayed by 14C-hydroxyproline formation from 14C-proline during 24 h of tissue culture. The changes in 14C-hydroxy-proline formation were correlated with the total doses of D-penicillamine taken (r=0.71, p<0.01) and the falls in ESR (r=0.72, p<0.01). No significant change in general protein synthesis was observed. 500 μg/mlD-penicillamine added to skin cultures in vitroinhibited both collagen and general protein synthesis (p<0.01). It is suggested that the clinical improvement induced by D-penicillamine could reflect an inhibition of collagen proliferation in the synovium.
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TL;DR: In patients with congenital vascular abnormalities the change of leg length discrepancy was variable in degree and unpredictable in pattern, even in those with similar venous anomalies.
Abstract: Twenty-eight patients with congenital total hypertrophy and ten patients with lower limb hypertrophy with congenital vascular abnormalities are reviewed. The pattern of increase in leg length discrepancy during growth and its influence on surgical management is discussed and the clinical features of the affected limbs are described. In congenital total hypertrophy the maximal increase in leg length discrepancy of more than 2.5 cm at age 4 years are likely to develop significant limb overgrowth that will require eventual surgical correction. In patients with congenital vascular abnormalities the change of leg length discrepancy was variable in degree and unpredictable in pattern, even in those with similar venous anomalies. The outcome for the limb was detergiography.
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TL;DR: A relative deficiency of calcium due to a low dietary calcium intake and intestinal malabsorption of calcium, together with a dialysate calcium of only 1·5 mmol/l, may be more important causes of bone loss in patients in this study.
Abstract: 1. Bone loss was assessed by measurement of cortical thickness of metacarpal bone by X-ray and of trabecular bone area in serial bone biopsies in 49 patients with chronic renal failure, six before and 45 during maintenance haemodialysis treatment. 2. Metacarpal cortical measurements (MCM) were very reproducible (coefficient of variation 1·95%), whereas bone area measurements by histology showed great variability. There was no correlation between rates of change of MCM and bone area over the same period, although both tended to fall with time. 3. The mean annual rate of bone loss measured by MCM for patients on dialysis was 2·08 ± 0·32 mm/year (mean ±1 sem) and this rate was not significantly different from the mean rate of loss of 2·49 ± 0·78 mm/year for the six patients who were not on maintenance haemodialysis. 61% of all patients showed a significant decrease during the period of study (1–6 years), but none had symptoms attributable to bone loss. 4. The loss tended to be greatest in women over the age of 40 years. The initial amount of bone and the rate of loss measured by MCM or bone histology were not influenced significantly by the presence or absence of histological or radiological evidence of parathyroid overactivity or of osteomalacia, nor by differences in the causes of renal disease. 5. Loss of metacarpal cortical bone correlated with heparin consumption during haemodialysis in men but not in women. The amount of bone and its rate of loss was not influenced by the presence of an arteriovenous shunt in one arm compared with the other. In neither sex did bone loss correlate with physical activity. 6. A relative deficiency of calcium due to a low dietary calcium intake and intestinal malabsorption of calcium, together with a dialysate calcium of only 1·5 mmol/l, may be more important causes of bone loss in patients in this study.
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01 Jul 1979TL;DR: In this article, a single-sided fixation system was proposed for the medial aspect of the tibia, which gives adequate skeletal support, and was preferred to a double-sided unit as it would not inhibit the action of muscles, would reduce the number of pin holes, and would be more convenient for the patient.
Abstract: External skeletal fixation of long bone fractures is the procedure of choice for the treatment of certain clearly established types of fracture. In particular, it is appropriate when the skin and soft tissue at the site of the fracture is at risk and requires careful management.For sound bone union to be achieved correct orientation and stability of the fracture is needed. A rigid fixation method is therefore required, and this rigidity determines the degree of post-operative mobility that the patient can exercise during the healing phase.A single-sided fixation system when applied, for example, to the medial aspect of the tibia, which gives adequate skeletal support, would be preferred to a double-sided unit as it would not inhibit the action of muscles, would reduce the number of pin holes, and be more convenient for the patient.From experience with existing equipment available for this surgical technique, a specification to meet the performance criteria needed was drawn up, and from this a design emerg...
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TL;DR: It is concluded that in most subjects after injury hepatic glucose release after galactose administration is not suppressed despite hyperglycaemia.
Abstract: 1. The increase in blood glucose after intravenous galactose was measured at 6−8 h and 14 days after hip replacement (14 patients) and accidental injury (14 patients). 2. After hip replacement there was a greater rise of glucose after galactose on the day of the operation than on recovery, despite basal hyperglycaemia. This earlier period was also associated with inappropriately low insulin concentrations for the prevailing glucose concentration, and hyperketonaemia (13 out of 14 patients). 3. After accidental injury patients with initial hyperketonaemia (nine out of 14) also had a greater rise of blood glucose after galactose than on recovery and had relative insulin deficiency; in contrast those who were initially normoketonaemic (five out of 14) showed a rise in glucose comparable with that after recovery and basal insulin concentrations more appropriate to the existing glucose concentration. 4. It is concluded that in most subjects after injury hepatic glucose release after galactose administration is not suppressed despite hyperglycaemia.
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01 Jul 1979••
01 Jan 1979••
01 Jan 1979TL;DR: The symptoms, signs, and investigation of metabolic bone disease are discussed, which include proximal myopathy, in osteomalacia and rickets, and the symptoms of any underlying disorder.
Abstract: This chapter discusses the symptoms, signs, and investigation of metabolic bone disease. The sophisticated studies used in metabolic bone diseases have tended to obscure the usefulness of the history and physical examination, which still have an important part to play in diagnosis. Growth may be abnormal in many diseases both of the skeleton and of other systems. The main features are short stature and disproportion; however, excessive height may also cause problems. Knowledge of the normal growth of the skeleton and the relationships between its different parts is essential for diagnosis and treatment in both children and adults. Pain, deformity, and fracture are the common features of metabolic bone disease. To this may be added proximal myopathy, in osteomalacia and rickets, and the symptoms of any underlying disorder. The cause of bone pain in metabolic bone disease is not well understood. Nerve fibers in bone are found mainly in the periosteum and around the blood vessels. Thus, pain may follow stretching of the periosteum because of increased vascularity of bone, or to distortion and bending of the bone, or to fracture.
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TL;DR: It is all the more important in designing undergraduate teaching programmes in these specialist subjects to provide a comprehensive basic training programme that is flexible enough to move with the specialty.
Abstract: Musculoskeletal disease in the community is common, and much of it responds to early diagnosis and preventive care. At the same time, modern orthopaedics, like so many specialist subjects, has increased significantly in depth and detail pari passu with its advances. It therefore becomes all the more important in desiging undergraduate teaching programmes in these specialist subjects to provide a comprehensive basic training programme that is flexible enough to move with the specialty. The orthopaedic undergraduate education programme in Oxford meets these requirements, embraces all aspects of the subject, and enables the medical student to examine the musculoskeletal system with confidence to interpret his findings, without making him an embryo specialist.
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01 Jan 1979••
01 Jan 1979TL;DR: This chapter discusses osteopetroses and hyperostoses, hyperph phosphatasia and hypophosphatasia, fibrous Dysplasia, and fibrogenesis imperfecta ossium.
Abstract: This chapter discusses osteopetroses and hyperostoses, hyperphosphatasia and hypophosphatasia, fibrous Dysplasia, and fibrogenesis imperfecta ossium. There are a number of separate conditions characterized by varying combinations of excessive amounts of mineralized bone and defects of bone modeling. These may be called osteopetroses or osteoscleroses, and the names are to some extent interchangeable. According to Beighton, Horan, and Hamersma the osteopetroses may be divided into the osteoscleroses, the craniotubular dysplasias, the craniotubular hyperostosis, and miscellaneous conditions. The commonly used name for hyperphosphatasia disorder is derived from the very high level of plasma alkaline phosphatase. In hypophosphatasia condition two biochemical changes can be demonstrated —a reduction in circulating alkaline phosphatase and an increase in urinary phosphoethanolamine.
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01 Jan 1979TL;DR: The cells of bone, the structures they produce, and the many hormones that influence them are discussed, including a specific glycoprotein of plasma apparently made by the liver and incorporated into mineralizing bone.
Abstract: This chapter discusses the cells of bone, the structures they produce, and the many hormones that influence them Bone is considered to have two main functions, the mechanical support and protection of the body, and the maintenance of normal mineral metabolism The control of these respective functions is often referred to as skeletal and mineral homeostasis In the chemistry of bone, the importance of the organic matrix is being increasingly recognized, although little is yet known of the factors that control its metabolism However, it is now realized that collagen exists in different genetic types and that disorders may arise from defects in its synthesis, posttranslational modifications, and cross-linkage Additionally, relevant components of the minor non-collagen protein fraction of bone have been identified, that include a specific glycoprotein of plasma apparently made by the liver and incorporated into mineralizing bone The source of bone cells has been much debated Bone marrow contains two histogenetically distinct cell lines, the haemopoietic and the reticulo-endothelial systems
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01 Jan 1979TL;DR: Parathyroid hormone is an 84 amino acid polypeptide, whose secretion by the parathyroid glands is controlled by the circulating level of ionized calcium, which stimulates PTH secretion which by its effect on its target organs tends to restore the plasma calcium to normal, thus removing the stimulation.
Abstract: This chapter discusses parathyroids and bone disease. Parathyroid hormone (PTH) is an 84 amino acid polypeptide, whose secretion by the parathyroid glands is controlled by the circulating level of ionized calcium. A reduction in the plasma-ionized calcium stimulates PTH secretion which by its effect on its target organs tends to restore the plasma calcium to normal, thus removing the stimulation. PTH is secreted into the plasma as the whole molecule, but circulates as fragments. The main fragments are the C-terminal and N-terminal fragments, named according to the end of the PTH molecule from which they are derived. The C-terminal portion of the molecule appears to have a long half-life but to be biologically relatively inert; the N-terminal portions have opposite properties. The known target organs of PTH or its fragments are the renal tubules, the bones, and the intestine. The main effects of PTH are to lower the renal phosphate threshold, to stimulate osteoclastic bone resorption, to stimulate renal reabsorption of calcium, and calcium absorption across the small intestine.
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01 Jan 1979TL;DR: In ectopie ossification, true bone forms outside the skeleton and often within the connective tissues of muscle as mentioned in this paper, and the major disability results from the progressive fixation of joints.
Abstract: Publisher Summary
This chapter focuses on ectopie mineralization. The deposition of mineral in the soft tissues, either as calcification or ossification, provides a number of challenging physiological and clinical problems. In some of them the cause appears obvious, but in others it is quite unknown. Where the circulating level of calcium and/or phosphate is consistently high, mineralization can occur in many soft tissues. The distribution of the mineral varies according to its cause, and includes the blood vessels, the skin, the cornea, the conjunctivae, the brain, and the kidneys. In ectopie ossification, true bone forms outside the skeleton and often within the connective tissues of muscle. The cause is unknown and it is not always clear where the process first starts. However, the first important change is the appearance of extra-skeletal bone matrix, and this subsequently mineralizes. Attempts to prevent mineralization are important, but do not cope with the underlying disorder. The major disability results from the progressive fixation of joints.
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01 Jan 1979TL;DR: This chapter discusses Marfan's syndrome, homocystinuria, and the Ehlers–Danlos syndrome, a dominantly-inherited disorder characterized by skeletal deformity, arachnodactyly, dislocated lenses, and aortic dilatation.
Abstract: This chapter discusses Marfan's syndrome, homocystinuria, and the Ehlers–Danlos syndrome. There are several inherited disorders of connective tissue in which, unlike osteogenesis imperfecta, the skeletal manifestations are only one aspect of a complex clinical picture. Scoliosis is a common feature of Marfan's syndrome, of homocystinuria, and many inherited disorders of connective tissue. Separate consideration is given to the condition known as congenital contractural arachnodactyly that is closely related to Marfan's syndrome. The classification of the several distinct disorders which together comprise the Ehlers–Danlos syndrome is still incomplete and depends both on the clinical picture and on the underlying biochemical abnormality, where this has been identified. Marian's syndrome is a dominantly-inherited disorder characterized by skeletal deformity, arachnodactyly, dislocated lenses, and aortic dilatation. Typically, the patient with Marfan's syndrome is very tall and often, but not always thin. The fingers are long and thin (arachnodactyly), the chest is often deformed with a protuberant and distorted sternum or with pectus excavatum; the limbs are disproportionately long compared with the trunk and the palate is high-arched.
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TL;DR: This chapter provides an overview on the growing points in biochemical disorders of the skeleton as it clearly has other important functions in basement membranes, in platelet aggregation and in tissues, such as muscle, during their development.
Abstract: Publisher Summary
This chapter provides an overview on the growing points in biochemical disorders of the skeleton. One of the most striking aspects of collagen is its almost universal distribution. No longer should it be regarded merely as a protein of fibrous tissues, as it clearly has other important functions in basement membranes, in platelet aggregation and in tissues, such as muscle, during their development. Calcitonin may be measured within the physiological range in plasma, though the recorded normal values differ according to the method used. In 1978, Hillyard, Stevenson, and Maclntyre confirmed that levels of immunoreactive calcitonin are low in women compared with men, and are increased by oral oestrogen — progestagen pills, and by pregnancy.
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01 Jan 1979TL;DR: This chapter presents the clinical aspects of osteogenesis imperfecta, probably the commonest of the inherited disorders of connective tissue that primarily affect the skeleton, which is about as rare as haemophilia and one-third as common as Duchenne muscular dystrophy.
Abstract: Publisher Summary
This chapter presents the clinical aspects of osteogenesis imperfecta. Osteogenesis imperfecta, probably the commonest of the inherited disorders of connective tissue that primarily affect the skeleton, is about as rare as haemophilia and one-third as common as Duchenne muscular dystrophy. Osteogenesis imperfecta produces severe crippling and its cause is still unknown. The brittle bones that give osteogenesis imperfecta its name are the manifestation of a number of separate disorders. Patients with osteogenesis imperfecta are seen by a variety of specialists, particularly orthopedic surgeons, physicians and pediatricians, and their care tends to be fragmented. The main clinical features of osteogenesis imperfecta are fragile bones, dwarfism, blue sclerae, dentinogenesis imperfecta, and deafness. The established classifications of patients with osteogenesis imperfecta recognize a severe sporadic form with intra-uterine fractures and early death, osteogenesis imperfecta congenita, and milder often dominantly inherited forms in which fractures may be present at birth or within the first year of life, or after the first year.
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01 Jan 1979TL;DR: Paget's disease as discussed by the authors is a metabolic bone disease that involves excessive and disorganized activity of bone that involves both matrix and mineral, and it is a disorder of the Anglo-Saxon races and their offspring.
Abstract: Publisher Summary
This chapter focuses on Paget's disease of bone. The pathological hallmark of the Paget's bone disease is excessive and disorganized activity of bone that involves both matrix and mineral. There is no idea of its cause and little knowledge of its natural history; however, the biochemical changes produced by the overactive bone justify its inclusion as a metabolic bone disease. It is the control of these abnormalities by agents that appear to act directly on bone that accounts for much of the recent interest in Paget's disease. Paget's disease is common in Britain, and the accepted overall incidence of about 3% in people older than 40 years is based on radiological or post mortem evidence. As the incidence increases rapidly with age, this 3% is the average of up to 10% in subjects in their 80s, and 1% in their 40s. Surveys refer to a selected part of the population who has been x-rayed for some medical reason, or who has come to autopsy. The incidence in the whole population is not known. The geographical distribution of Paget's disease is remarkable and inexplicable. Thus, it is almost unknown in Scandinavia and Japan, common in Australia, but rarely described in the tropics. It is said to be a disorder of the Anglo-Saxon races and their offspring.