Showing papers by "Nuffield Orthopaedic Centre published in 1982"

The effect of knee injury on the number of muscle fibres in the human quadriceps femoris.

Abstract: By means of ultrasound scanning, bilateral measurements of the cross-sectional area of the quadriceps muscle groups were made in 14 young adults with unilateral thigh muscle wasting after knee injury. Needle biopsy specimens from the lateral mass of the muscle were used to estimate the myofibre cross-sectional area for both quadriceps of each subject. 2. The cross-sectional area of the quadriceps of each patient's injured limb was always smaller than that of the contralateral muscle. The wasting was largely localized to the quadriceps, with relative sparing of the other thigh muscles. 3. None of the biopsies showed any abnormality apart from the reduction in fibre size. In each case, the injured limb's reduced quadriceps cross-sectional area was associated with a reduced mean fibre area. 4. The ratio of the cross-sectional area of a muscle to its mean fibre area is a reduced mean fibre area. 4. The ratio of the cross-sectional area of a muscle to its mean fibre area is a function of the number of fibres it contains. The ratio varied considerably from patient to patient but there was close agreement between the values obtained for the two limbs of each patient. 5. The quadriceps wasting produced by knee injury was due to muscle fibre atrophy. There was no evidence for a change in the number of fibres in the muscle.

The slit catheter: a comparison with the wick catheter in the measurement of compartment pressure.

Abstract: The slit catheter, a new instrument for the measurement of compartment pressure, has been compared with the wick catheter in experimental conditions. The two catheters were inserted into the anterior tibial compartments of 8 human legs and controlled external pressures were applied by means of an inflatable limb bag. The mean resting intramuscular pressure of 8.5 +/- 6.2 mmHg for the slit and 8.7 mmHg +/- 6.2 mmHg for the wick catheter agrees with that of other workers, and the slit catheter records a pressure at all applied external pressures not significantly different from the wick catheter (paired t test). The slit catheter provides a simple and inexpensive way of estimating compartment pressure which is as accurate as a method widely used both experimentally and clinically in North America.

Arthrodesis of the Wrist in Rheumatoid Disease

Abstract: Twelve cases of wrist fusion for rheumatoid disease have been assessed pre and postoperatively in terms of symptoms, function, union, and complications. Improvement in hand function can be attributed to the provision of a painless stable wrist, and fusion in the straight position is in no way detrimental to personal hygiene. Delayed wound healing and pin migration are not uncommon complications but do not affect the end-results, which is radiological union from third metacarpal to radius - a definitive situation.

Regional hip blockade in osteoarthrosis. Effects on pain perception.

Abstract: Eighteen patients with unilateral osteoarthrosis of the hip were investigated in a trial which involved the injection of nine with bupivacaine and nine with normal saline. All the patients completed daily pain analogue charts. Their pain, mobility and functional activity were assessed and gait characteristics analysed, once before the injection and then at three monthly intervals. All the patients recorded a decrease in pain level within two weeks of injection, but it subsequently rose to pre-injection levels. There were no other significant general improvements after the injection. A significant increase in the maximum force at toe-off for the good leg was recorded one month after the injection. However, no further significant differences were found in the gait performance of either group of patients throughout the study. It is concluded that the hip nerve regional blockade offers no useful relief to the pain of osteoarthrosis of the hip joint.

Normal Performance on Some Tests of Perception in Adults

Abstract: Geometric shapes 4.00 000 4 4 Size recognition 4.00 0.00 4 4 Series 3A9 1.2H 0 4 Grading 3.20 1.60 0 4 Animal halves 3.97 0.24 2 4 Missing article 3.HH O.5H 0 4 Figure ~ ground 3.5H 0.76 I 4 Sequencing pictures 3.5H n.ss 0 4 Sequencing numbers 26.51 5.70 0 2H Body image 10.51 1.75 5 12 Self id. verbal 3.94 11.34 2 4 Self id. demonstration 4.00 0.00 4 4 R/L identification 3.77 0.67 I 4 Verbal commands 3.65 0.74 I 4 Round block design 23.97 0.17 23 24 R/L copying shapes 67.15 9.67 19 72 RjL copying words 3032 5.56 I 32

Characterisation of the dynamic vertical force distribution under the foot

Abstract: Measurement of force distribution under the sole of the foot during walking can provide enormous quantities of data with modern recording techniques. Methods are described for presenting such data in pictorial, in parametric and in graphical form. Parametric characterisations include magnitude, timing and location of peak forces and ‘impulses’ (the force-time integrals), parameters describing the local concentration of force and the distribution of the ‘impulse’ over areas of the foot sole. Pictorial displays include force-time graphs for selected areas of the foot, display of movement of the centre of pressure on specific areas and cross-sections through the pressure distribution profile at a specified recorded instant. Such characterisations were considered useful if they provided information on pathological conditions of the feet. A ‘normal’ group was studied to give a baseline for comparisons. An example of abnormality, compared with the normal group, in a patient with rheumatoid arthritis is given. This demonstrates an abnormal distribution of force on the forefoot, and abnormal movement of the centre of pressure consistent with the patient favouring a painful region for weight-bearing.

Periosteal chondromyxoid fibroma of the tibia: a case report.

Abstract: A case of periosteal chondromyxoid fibroma of the tibia is presented. A search of the literature revealed only two other possible similar cases, and these are discussed.

Rheumatoid arthritis: vocational rehabilitation.

Abstract: The consequences of inflation and accelerating introduction of automation and microprocessors into industry are a shift from unskilled to skilled work, the lessening of opportunities for the unskilled worker, and growing unemployment. If disabled people are competing for employment they must take every opportunity to extend education and acquire skills. Juvenile chronic arthritis presents one set of problems in vocational rehabilitation at the beginning of a working career and adult rheumatoid arthritis another, commonly in those over 45 years old and previously established in work. The prevalence of severe disability in juvenile chronic arthritis is about 1 in 20 000 of the population, females are affected twice as often as males and 1 in 10 has defective vision or blindness due to chronic iridocyclitis. At school, besides education, there must be emphasis on encouraging independence, self-confidence, mobility and determination. A School Leavers' Conference early in the last year at school gives the adolescent the best chance of choosing a career. Rheumatoid arthritis is three times more common in women and increasingly, over the last 40 years, women are working besides home-making. Morning stiffness, fatigue, immobility and pain are the common symptoms of widespread involvement of joints and systemic disturbance. The principal determinant in the success of vocational rehabilitation is personality, and the social and environmental factors are more significant than the degree of disability. The Disablement Resettlement Officer can assure continuity of rehabilitation between the health and employment services: a favourable outcome is work, self-derived income independence and freedom of movement using whatever technical aids are required to achieve this.

Pneumatic Trouser Splints in the Treatment of Severe Osteogenesis Imperfecta

Abstract: Twelve patients with severe osteogenesis imperfecta have been managed by closed osteotomy to correct lower limb long bone deformity, followed by support in pneumatic trouser splints. The apparatus was well tolerated, fractures were rare, and there was a significant improvement in patient mobility. This conservative method compares favourably with the published series of multiple osteotomies and intramedullary rodding.

Development of the Hip

Abstract: The most important phase in the treatment of the congenitally dislocated hip is the follow-up. Treatment is not complete when the child leaves hospital. The hip has a great many years in which to grow, and the way in which it grows is all-important.

The Secondary Changes

Abstract: If the golden opportunity for early diagnosis and treatment has been missed and displacement of the head of the femur persists, whether small or great, secondary structural changes will develop, which can become permanent as the likelihood that damage will be irreversible increases with continuing duration of displacement.

Age 0–9 Months

Abstract: The importance of early diagnosis was first propounded by Putti (1927, 1929). In 1937 Ortolani described a test to enable the diagnosis to be made at the time of birth. In 1962 von Rosen in Malmo and Barlow in Salford reported excellent results of treatment obtained following early diagnosis, with very few failures.

Biomechanical and Clinical Assessment of Hip Nerve Block in Unilateral Osteoarthrosis

Abstract: This paper combines a biomechanical analysis with a clinical assessment of eighteen patients with unilateral hip osteoarthrosis. A double blind trial was established to evaluate the potential of a regional hip nerve block in relieving pain. The characteristics of the vertical ground-reaction forces were analysed using two Kistler force plates, once before the injection and at three-monthly intervals following it. At the same time pain, mobility and functional activity were assessed clinically. A significant change in some of the gait parameters for the good leg was recorded for the total patient group one month after the injection. However, no further significant differences were found. When the symmetry of gait was evaluated no significant differences at the 1 per cent level were observed at any period. These results suggest that gait symmetry is not a significant factor in assessment of patients with hip osteoarthrosis. There was a transient decrease in subjective pain level following the injection, but this rose to pre-injection levels by the fourth week. There were no other significant general improvements after the injection. It is concluded that the biomechanical/clinical assessment has demonstrated that the hip nerve block does not provide any useful long-term pain relief.

Operations on the Pelvis

Abstract: The foregoing chapters in this book have been devoted to demonstrating how the development of the acetabulum is dependent on the mechanics of the joint and that if concentric movement of the femoral head in the acetabulum can be achieved the acetabulum will develop satisfactorily, often in the most unlikely cases. It is logical that if the acetabulum can be made to develop normally without any alteration to its shape or direction this is preferable to carrying out some plastic procedure on the joint. Nevertheless, when such damage has been done to the acetabulum, either by time or trauma, that it is too difficult to restore concentric movement it may become necessary to alter the shape or direction of the acetabulum.

Nine Months to Three-and-a-Half Years

Abstract: In the age group 9 months to 3 1/2 years the clunk tests of Ortolani and Barlow are only rarely possible. The diagnosis is most commonly made at the age of about 20 months, by which time the child will have been walking long enough for an abnormality of gait to have been noticed. If the displacement is bilateral the diagnosis will be made about 4 months later, presumably because a bilateral limp will be less easily recognised than one which is unilateral.

Development of the Upper End of the Femur

Abstract: From what has already been said it should be clear that the development of the upper end of the femur must play an important part in the way in which the hip joint develops both in health and in disease. There is a further condition, congenital coxa vara, which throws light on the way in which this development takes place and wȧrrants consideration.

Persistent Foetal Alignment

Abstract: Typical congenital dislocation of the hip may be a disease entity in itself, but it is closely allied to variants in the shape of the upper end of the femur. The importance of ante version has already been emphasised. Since it plays such a large part in the development of displacement, in its persistence, and in its recurrence, it seems pertinent to include a chapter on the problem.