50 results on '"McElwain JP"'
Search Results
2. A Delayed and Rather Unusual Presentation of a Bladder Injury after Pelvic Trauma: 5 Years after a Road Traffic Accident
- Author
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Davarinos, Nikolaos, Thornhill, John, McElwain, JP, and Moore, David
- Subjects
Article Subject - Abstract
Associated injuries frequently occur in patients who sustain fractures of the pelvis. Specifically, high-energy trauma resulting in pelvic fractures places the bladder and urethra at risk for injury, often resulting in significant complications. Timely identification and management of genitourinary injuries minimize associated morbidity. Prompt injury identification depends upon a systematic evaluation with careful consideration of the mechanism of injury. Physical examination is pertinent as well as analysis of the urine and appropriate diagnostic imaging. Despite such increased vigilance genitourinary injuries get missed and delayed presentations in the order of a few weeks have been well documented. To our knowledge, this is the first report of its kind in the literature showing such a particularly delayed (5 years) and rather unusual presentation of a bladder injury after pelvic trauma.
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- 2014
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3. iTrauma - The Use of Smartphones in The Assessment of Trauma Patients, an App For The Future?
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Crockett, Matthew T, Guerin S, and McElwain JP
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- 2012
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4. Bilateral hip and knee replacement for rheumatoid arthritis
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McElwain, JP and Sheehan, JM
- Abstract
A series of 19 patients with severe rheumatoid arthritis had replacement of both hips and both knees. They are reviewed after a mean follow-up of 27 months. The preferred programme is to replace hips before knees. Pain was relieved in all the patients and function was improved in all but two. Severe rheumatoid disease and prolonged immobilisation before the operations were not contra-indications to a successful outcome, but the presence or the development of cervical myelopathy combined with gross upper limb deformity militated against a good result.
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- 1985
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5. Major pelvic injuries in equestrian sports.
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O'Farrell DA, Irshad F, Thorns BS, McElwain JP, O'Farrell, D A, Irshad, F, Thorns, B S, and McElwain, J P
- Abstract
A series of pelvic and acetabular injuries caused by horse riding accidents is reported. The importance of wearing appropriate protective clothing when riding is emphasised. [ABSTRACT FROM AUTHOR]
- Published
- 1997
6. The Early Results of Porous-coated Total Shoulder Arthroplasty
- Author
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English E and McElwain Jp
- Subjects
medicine.medical_specialty ,business.industry ,Chirurgie orthopedique ,Radiography ,medicine.medical_treatment ,General Medicine ,Fibrous tissue ,Arthroplasty ,Prosthesis ,Surgery ,medicine.anatomical_structure ,Early results ,Orthopedic surgery ,medicine ,Upper limb ,Orthopedics and Sports Medicine ,business - Abstract
A porous-coated total shoulder arthroplasty of the authors' design was investigated over a period of six years. Thirteen of the first 21 arthroplasties, with an average follow-up period of three years, revealed the difficulty of proving stability by either bony or fibrous tissue ingrowth or both. With the exception of two patients (one glenoid and one humeral component), there was no gross evidence of radiographic loosening. Clinically, the early results were encouraging, but long-term follow-up observations are necessary before definitive conclusions are possible.
- Published
- 1987
7. Review of the Operative Treatment of Achilles Tendon Rupture
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James F Kellam, Gordon A. Hunter, and McElwain Jp
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medicine.medical_specialty ,business.industry ,General Medicine ,Surgery ,Nonoperative treatment ,Activity Status ,medicine ,Orthopedics and Sports Medicine ,Complication rate ,Achilles tendon rupture ,medicine.symptom ,business ,Clinical evaluation - Abstract
Sixty-eight patients' charts were reviewed for ascertainment of the complication rate following operative repair of ruptured Achilles tendons. Ninety-two percent of 48 patients whose cases underwent clinical evaluation returned to their preinjury activity status: 13% had incisional complications, most of which resolved. The rerupture rate was 3% (2/68). The results of this series and a literature review show that operative treatment can be regarded as an acceptable method. Nonoperative treatment should be considered in a nonathletic patient over the age of 50 years because of potentially serious problems with wound healing.
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- 1985
8. Irish (Republic) versus British (North West) orthopaedic trainees: what are the differences?
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Banks LN, Cashman J, Mohil R, Morris S, and McElwain JP
- Published
- 2010
9. Pelvic and acetabular trauma care in Ireland: the past, present and future.
- Author
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Queally JM, O'Daly B, Leonard M, and McElwain JP
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- Forecasting, Humans, Ireland, Acetabulum injuries, Fractures, Bone therapy, Pelvic Bones injuries
- Published
- 2017
10. Heterotopic Ossification following acetabular fixation: Incidence and risk factors: 10-year experience of a tertiary centre.
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Elhassan Y, Abdelhaq A, Piggott RP, Osman M, McElwain JP, and Leonard M
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- Acetabulum surgery, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Child, Diclofenac therapeutic use, Female, Follow-Up Studies, Fracture Fixation, Internal adverse effects, Fractures, Bone diagnostic imaging, Fractures, Bone pathology, Humans, Incidence, Indomethacin therapeutic use, Ireland epidemiology, Male, Middle Aged, Ossification, Heterotopic drug therapy, Ossification, Heterotopic pathology, Postoperative Complications drug therapy, Postoperative Complications pathology, Prognosis, Radiography, Retrospective Studies, Risk Factors, Treatment Outcome, Young Adult, Acetabulum injuries, Fracture Fixation, Internal methods, Fractures, Bone surgery, Ossification, Heterotopic diagnosis, Postoperative Complications diagnosis
- Abstract
Background: Heterotopic Ossification (HO) is a well-recognized complication following acetabular fracture fixation and its presence is prognostic for suboptimal clinical outcome. There are many controversies pertaining to its aetiology, including surgical approach, associated injuries and the use of HO prophylaxis. Long term data from high volume centres is necessary to address these issues., Aim: To determine the incidence of HO post open reduction and internal fixation (ORIF) of acetabular fractures and to examine the associated risk and prognostic factors., Method: We studied a cohort of 369 consecutive acetabular fractures that underwent ORIF at our institution over a 10 year period. Data was analyzed using univariate and multivariate logistic regression., Results: The existence of HO was evident in 65 patients (17.62%), of these 39 (60.0%) were Class I, 16 (24.6%) were Class II, 8 (12.3%) were Class III, and 2 (3.1%) were Class IV according to Brooker Classification. We found a significant association between admission to an Intensive Care Unit (ICU) (P-value=0.039), chest injury (P-value=0.013), multiple fractures (P-value=0.005), and the time lapse between injury and operation (P-value=0.025), and some statistical significance with surgical approach, ipsilateral fractures, open fractures, tibial and patellar fractures. Age over 30 years as the only prognostic factor for severe HO. Prophylaxis with Indomethacin did not appear to confer any benefit in our patient group., Conclusion: The risk factors for developing HO following acetabular fracture fixation are multifactorial and include admission to ICU, associated chest injuries, multiple fractures and delay between injury and surgery. Surgical approach, ipsilateral fractures and tibia and patellar fractures may also play a role. Age over thirty years was the only prognostic factor for developing severe HO., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2016
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11. Impact of road traffic "penalty points" on high energy pelvic trauma.
- Author
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Ellanti P, Davarinos N, Morris S, and McElwain JP
- Abstract
Background: The penalty points system (PPS) was introduced in 2002 in an attempt to reduce the increasing rate of road traffic accident (RTA) related fatalities and serious injuries. Points are awarded based on the severity of the offence and are cumulative. A total of 12 points results in the disqualification from driving., Objective: A few studies have looked at the immediate or short term impact of PPS on trauma services or specific injuries such as spine trauma in Ireland. Little data is available on the long term effect of the PPS. The aim of this study is to see if the PPS system has had an influence on the number of pelvic injuries referred to our unit for surgical intervention and if this influence is sustained in the longer term., Materials and Methods: A retrospective review of all pelvic and acetabular injuries admitted to our unit from 1999 to 2008 was undertaken. The mechanism of injury, the site and patient demographics were noted., Results: A total of 467 patients were identified over the ten year period. 454 patients were included in the study. There was a significant male preponderance of 76%. Mean age was 36.5 years (range 16 to 83). RTA's were the cause in 74% (n = 335) of the cases. The annual work load remained similar over the years. There has been a reduction in the number of RTA related pelvic injuries. There have been notable drops in the number of these cases corresponding to the introduction of the PPS and its subsequent expansion. The number of pelvic injuries due to falls continues to rise., Conclusion: The introduction of the PPS and its subsequent expansion has had a positive influence on the number of RTA related pelvic trauma. Continued surveillance and enforcement of the PPS is important for a sustained benefit from it in the long term.
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- 2013
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12. Fatigue fracture of tibial arthroplasty implant masked by contralateral knee arthritis.
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O'Neill BJ, Cleary M, and McElwain JP
- Abstract
Introduction: The wear of polyethylene components is a well-recognised long-term complication of total knee arthroplasty., Presentation of Case: We present a case of fatigue fracture of a geomedic tibial tray 17 years after implantation. The symptoms were masked by primary osteoarthritis of the contralateral knee., Discussion: The mode of failure in this case differs from that most commonly reported in the literature in that it occurred late as the result of prolonged use, not due to implant failure, physiological factors, or surgical technique. The case also demonstrates the incredible 'masking' effect of arthritic knee pain., Conclusion: This case highlights the importance to clinicians of keeping a high index of suspicion for prosthesis complications in patients with unilateral joint replacement with contralateral arthropathy., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)
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- 2013
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13. Clavicle hook plate fixation for displaced lateral-third clavicle fractures (Neer type II): a functional outcome study.
- Author
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Good DW, Lui DF, Leonard M, Morris S, and McElwain JP
- Subjects
- Adult, Clavicle diagnostic imaging, Cohort Studies, Databases, Factual, Device Removal, Female, Follow-Up Studies, Fracture Fixation, Internal methods, Fracture Healing physiology, Fractures, Bone diagnostic imaging, Humans, Injury Severity Score, Joint Dislocations diagnostic imaging, Male, Middle Aged, Pain Measurement, Prospective Studies, Radiography, Recovery of Function, Time Factors, Treatment Outcome, Young Adult, Bone Plates, Clavicle injuries, Fracture Fixation, Internal instrumentation, Fractures, Bone surgery, Joint Dislocations surgery
- Abstract
Background: Controversy exists with the use of the acromioclavicular hook plate for the treatment of lateral-third clavicle fractures (Neer type II). This is thought to stem from problems associated with the hook plate causing impingement symptoms, which can cause long-term limitation of movement and pain. Our aim was to evaluate the functional outcomes of patients with lateral-third clavicle fractures treated with the hook plate., Methods: We prospectively reviewed all patients who underwent surgery from July 2005 to August 2009 using our prospectively recorded electronic patient information database. All patients were assessed in the clinic to determine both Oxford and Constant shoulder scores., Results: We identified 36 patients who underwent surgery with the hook plate, 26 men and 10 women. The mean age was 36.2 years (range, 22-60 years). Of the patients, 46% were smokers. The median length of hospital stay was 2 days (interquartile range [IQR], 1-3). The median follow-up was 28 months (IQR, 23-37). The median time from date of injury to surgery was 7 days (IQR, 4-76). The mean time to union was 3 months (IQR, 2-4), and the union rate was 95%. In total, 92% of plates were removed. The median time to removal was 4.5 months (IQR, 3-8.75). There were no complications. Two patients presented months later after falls with fractures around the medial end of the hook plate., Conclusion: Hook plates are an effective form of treatment for lateral third clavicle fractures. The best outcomes occur with plate removal before 6 months postoperatively, provided that the fracture has healed., (Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)
- Published
- 2012
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14. A hypoplastic patella fracture in nail patella syndrome: a case report.
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Neill SC, Murphy CG, and McElwain JP
- Abstract
Introduction: Nail patella syndrome is a rare autosomal dominant hereditary condition, with an incidence of 22 per million in the United Kingdom. The syndrome's most common features include iliac horns, hypoplastic patella and nail dysplasia., Case Presentation: We report the case of a 26-year-old Caucasian man with nail patella syndrome who sustained a fracture of his right hypoplastic patella after a fall. His right knee became swollen and he was unable to extend against gravity immediately post fall. Radiographs revealed a fracture of the lower pole of his right patella with associated complete disruption of the extensor mechanism of the knee. He underwent operative fixation and his post operative course was uneventful. He was further treated post operatively with a full knee cast and graded immobilization. At six months he had regained the full range of motion at the knee joint., Conclusions: To the best of our knowledge, this is the only case report in the literature describing a patella fracture in an individual with nail patella syndrome. We hypothesize that given the extent of pre-existing knee joint impairment in these individuals, functional outcome may be inferior, suggesting the need for more frequent follow-up.
- Published
- 2012
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15. Minimum ten-year follow-up of acetabular fracture fixation from the Irish tertiary referral centre.
- Author
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Magill P, McGarry J, Queally JM, Morris SF, and McElwain JP
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- Acetabulum surgery, Adult, Female, Follow-Up Studies, Fracture Fixation, Hip Prosthesis, Humans, Ireland epidemiology, Male, Middle Aged, Osteoarthritis, Hip surgery, Radiography, Time Factors, Treatment Outcome, Acetabulum injuries, Arthroplasty, Replacement, Hip methods, Fractures, Bone diagnostic imaging, Fractures, Bone surgery
- Abstract
Background: Successful outcome from acetabular fracture fixation is multi-factorial. Long-term results are not frequently reported. Pooling such data from high output centres will help progress acetabular fixation. This paper presents the first ten-year data from the Irish tertiary referral centre., Aim: To audit the radiographic and clinical outcome of all patients who had acetabular fracture fixation in the unit a minimum of ten years previously., Methods: Patients were identified from the unit database. Each patient was contacted and invited to attend the hospital for clinical and radiographic review. Clinical review consisted of examination and three separate scoring systems using both subjective and objective parameters. Radiographic review consisted of a standard AP pelvis and Judet views., Results: Forty-four patients were identified. Follow up of 68% was achieved. Total hip arthroplasty rate was 13.8%. Twenty percent of the remaining native hips had radiographic evidence of established arthritis. Sixty-three percent of functional outcome scores were classified as 'good' or 'excellent'. Radiographic and functional data did not strongly correlate. The strongest correlating factor with poor functional outcome was concurrent injuries, particularly sciatic nerve injury., Conclusions: These data support the role of operative intervention for acetabular fractures in a tertiary referral centre and allow better counselling of patients on prognosis., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2012
- Full Text
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16. Skype: a tool for functional assessment in orthopaedic research.
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Good DW, Lui DF, Leonard M, Morris S, and McElwain JP
- Subjects
- Acromioclavicular Joint surgery, Adult, Bone Plates, Clavicle injuries, Clavicle surgery, Female, Follow-Up Studies, Fracture Fixation, Internal, Fractures, Bone surgery, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Young Adult, Fractures, Bone therapy, Internet statistics & numerical data, Orthopedics organization & administration, Range of Motion, Articular, Telemedicine statistics & numerical data
- Abstract
Skype is a free program which enables PC users to make video calls to other users with Internet access. We carried out a prospective review of all acromioclavicular joint hook plates for lateral-third clavicle fractures over a five-year period. Functional assessment with Oxford and Constant shoulder scores were carried out using Skype and compared to outpatient review using the Bland-Altman method. Of 36 patients (mean age 36 years), 33 had a computer with a video camera, all 33 had Internet access and 22 were already users of Skype. In total 29 patients were happy to take part in Skype assessment (83%). In comparison with outpatient review, there was a mean difference in the Oxford score of -0.48 (95% confidence interval -0.84, -0.12); the mean difference for the Constant score was -0.68 (95% confidence interval -1.08, -0.29). These differences were not clinically significant, confirming that Skype can be used as an alternative to goniometry in this clinical setting. A survey showed that 93% of 29 patients surveyed preferred the use of Skype for follow-up, mainly due to the convenience and cost-saving involved. The study demonstrates the potential for this new technique in providing patients with more options for follow-up.
- Published
- 2012
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17. Acetabular fractures following rugby tackles: a case series.
- Author
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Good DW, Leonard M, Lui D, Morris S, and McElwain JP
- Abstract
Introduction: Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury., Case Presentation: In a six-month period from July to December, two open reduction and internal fixations of acetabular fractures were performed in young Caucasian men (16 and 24 years old) who sustained their injuries after rugby tackles. Both of these cases are described as well as the biomechanical factors contributing to the fracture and the recovery. Acetabular fractures of the hip during sport are rare occurrences., Conclusion: Our recent experience of two cases over a six-month period creates concern that these high-energy injuries may become more frequent as rugby continues to adopt advanced training regimens. Protective equipment is unlikely to reduce the forces imparted across the hip joint; however, limiting 'the tackle' to only two players may well reduce the likelihood of this life-altering injury.
- Published
- 2011
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18. An unusual mode of failure of a tripolar constrained acetabular liner: a case report.
- Author
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Banks LN and McElwain JP
- Subjects
- Adult, Female, Hip Dislocation diagnostic imaging, Hip Dislocation etiology, Humans, Joint Instability etiology, Joint Instability surgery, Radiography, Reoperation, Acetabulum, Arthroplasty, Replacement, Hip adverse effects, Hip Dislocation surgery, Hip Prosthesis adverse effects, Prosthesis Failure
- Abstract
Dislocation after primary total hip arthroplasty (THA) is the most commonly encountered complication and is unpleasant for both the patient and the surgeon. Constrained acetabular components can be used to treat or prevent instability after primary total hip arthroplasty. We present the case of a 42-year-old female with a BMI of 41. At 18 months post-primary THA the patient underwent further revision hip surgery after numerous (more than 20) dislocations. She had a tripolar Trident acetabular cup (Stryker-Howmedica-Osteonics, Rutherford, New Jersey) inserted. Shortly afterwards the unusual mode of failure of the constrained acetabular liner was noted from radiographs in that the inner liner had dissociated from the outer. The reinforcing ring remained intact and in place. We believe that the patient's weight, combined with poor abductor musculature caused excessive demand on the device leading to failure at this interface when the patient flexed forward. Constrained acetabular components are useful implants to treat instability but have been shown to have up to 42% long-term failure rates with problems such as dissociated inserts, dissociated constraining rings and dissociated femoral rings being sited. Sometimes they may be the only option left in difficult cases such as illustrated here, but still unfortunately have the capacity to fail in unusual ways.
- Published
- 2010
- Full Text
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19. Minimally invasive percutaneous plate fixation of distal tibia fractures.
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Bahari S, Lenehan B, Khan H, and McElwain JP
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- Adolescent, Adult, Aged, Arthrodesis adverse effects, Female, Fracture Healing, Health Status Indicators, Humans, Male, Middle Aged, Patient Satisfaction, Postoperative Complications, Radiography, Recovery of Function, Tibial Fractures diagnostic imaging, Treatment Outcome, Arthrodesis methods, Bone Plates, Fracture Fixation, Internal instrumentation, Minimally Invasive Surgical Procedures instrumentation, Tibial Fractures surgery
- Abstract
We report a series of 42 patients reviewed at a mean of 19.6 months after treatment of distal tibial and pilon fractures using the AO distal tibia locking plate with a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Mean time to union was 22.4 weeks. All fractures united with acceptable alignment and angulation. Two cases of superficial infection were noted, with one case of deep infection. Mean SF36 score was 85 and mean AOFAS score was 90 at a mean of 19 months follow-up. We report satisfactory outcomes with the use of the AO distal tibia locking plate in treatment of unstable distal tibial fractures. Eighty-nine percent of the patients felt that they were back to their pre injury status and 95% back to their previous employment.
- Published
- 2007
20. "Osteoporosis and orthopods" incidences of osteoporosis in distal radius fracture from low energy trauma.
- Author
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Bahari S, Morris S, Lenehan B, and McElwain JP
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- Aged, Aged, 80 and over, Body Mass Index, Bone Density physiology, Female, Humans, Middle Aged, Osteoporosis, Postmenopausal physiopathology, Radius Fractures physiopathology, Osteoporosis, Postmenopausal complications, Radius Fractures etiology
- Abstract
Fracture of the distal radius from low energy trauma is a common presentation to orthopaedic trauma services. This fragility type fracture is associated with underlying osteoporosis. Osteoporosis is a 'silent disease' where fragility fracture is a common presentation. Orthopaedic surgeons may be the only physician that these patients encounter. We found a high percentage of female patients who sustained a fragility fracture of the distal radius have an underlying osteoporosis. Further management of osteoporosis is important to prevent future fragility fractures.
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- 2007
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21. Periprosthetic malignancy as a mode of failure in total hip arthroplasty.
- Author
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O'Shea K, Kearns SR, Blaney A, Murray P, Smyth HA, and McElwain JP
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- Aged, Female, Humans, Lung Neoplasms pathology, Male, Middle Aged, Stomach Neoplasms pathology, Arthroplasty, Replacement, Hip, Hip Prosthesis, Lymphoma complications, Prosthesis Failure, Soft Tissue Neoplasms complications, Soft Tissue Neoplasms secondary
- Abstract
The presence of periprosthetic malignancy in proximity to arthroplasty implants has been infrequently reported. We present the clinical, radiographic, and pathological features of three patients in whom loosening and failure of total hip arthroplasties occurred secondary to malignant infiltration. They consisted of a 66-year-old man with the first presentation of metastatic gastric carcinoma as a periacetabular lytic lesion, a 64-year-old man presenting with femoral metastases from a previously undiagnosed lung carcinoma, and a 75-year-old woman presenting with a painless discharging thigh sinus around a total hip arthroplasty subsequently diagnosed as immunoblastic lymphoma. Malignant infiltration should be considered part of the differential diagnosis in aseptic and septic loosening of prosthetic implants. Joint aspiration and isotope bone scanning provide useful additional information before surgical intervention.
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- 2006
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22. Hylamer wear rates and shelf life: a clinical correlation.
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Kiely PD, Harty JA, and McElwain JP
- Subjects
- Acetabulum, Adolescent, Adult, Female, Humans, Male, Middle Aged, Molecular Weight, Prosthesis Failure, Reoperation, Retrospective Studies, Hip Prosthesis, Polyethylene
- Abstract
We evaluated the performance of 84 Hylamer polyethylene components and zirconia modular femoral heads which were implanted in a single institution over a 5 year period. Patients were followed up for a mean of 6.2 years. The mean rate of penetration was 0.58 mm/year (0.05-1.0). Lot/batch numbers were available in the clinical case notes of 54 patients. Using the lot/batch numbers, we were able to determine the Hylamer cups' shelf lifes. We found that liners with a shelf life greater than 10 months had a significantly greater linear wear (0.38 mm/year) than those implanted in less than 10 months (0.05 mm/year).
- Published
- 2005
23. Altered signal intensity in the posterior horn of the medial meniscus: an MR finding of questionable significance.
- Author
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Sproule JA, Khan F, Rice JJ, Nicholson P, and McElwain JP
- Subjects
- Adolescent, Adult, Arthroscopy, Female, Humans, Knee Injuries classification, Male, Menisci, Tibial surgery, Retrospective Studies, Knee Injuries diagnosis, Magnetic Resonance Imaging, Menisci, Tibial pathology, Tibial Meniscus Injuries
- Abstract
Introduction: MR imaging has emerged as an important modality in the non-invasive evaluation of osseous and soft-tissue structures in the post-traumatic knee. However, it is sometimes impossible to determine with confidence if a focus of high signal intensity in the meniscus is confined to the substance of the meniscus or if it extends to involve the joint surface. This is a critical differentiation because the latter represents meniscal tears that can be found and treated arthroscopically, whereas the former represents degeneration, intrasubstance tears or perhaps normal variants that are not amenable to arthroscopic intervention. The aim of this study was to investigate the occurrence of such borderline findings in relation to the posterior horn of the medial meniscus and to correlate the arthroscopic results., Materials and Methods: Sixty-four patients with suspected post-traumatic internal derangements of the knee who underwent MR imaging prior to arthroscopy were evaluated retrospectively. There were 48 men and 16 women. Their mean age was 28.2 years., Results: Tears of the posterior horn of the medial meniscus were diagnosed unequivocally (grade 3 signal) in 18 patients and equivocally (grade 2/3 signal) in 10 patients. Arthroscopic correlation revealed 16 tears (89%) in the unequivocal group and only 1 tear (10%) in the equivocal group., Conclusion: A meniscal tear is unlikely when MR shows a focus of high signal intensity in the posterior horn of the medial meniscus that does not unequivocally extend to involve the inferior or superior joint surface. An appropriate trial of conservative treatment is recommended in such questionable cases. MR is a useful diagnostic tool-however, it should be used selectively, and in conjunction with history and clinical examination in evaluating internal derangements of the knee.
- Published
- 2005
- Full Text
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24. Retrospective review of outcome post open reduction and K-wire fixation for grade III acromioclavicular joint subluxations.
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Murphy M, Connolly P, Murphy P, and McElwain JP
- Abstract
There is controversy about the therapy for grade III acromioclavicular dislocation according to Tossy and Rockwood's classification. We identified 25 patients who underwent acromioclavicular joint wiring for grade III subluxations under the care of a single consultant in the last 5-year period. All patients were asked to fill in a DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire to assess outcome following acromioclavicular joint repair, and their clinical notes were reviewed. Our results show that open reduction and Kirschner- (K) wire fixation of grade III AC joint disruptions results in good strength and range of motion of the affected shoulder. It is associated with DASH scores, which are comparable to those of the general population for the same age, indicating little residual disability. All patients returned to their pre-injury occupation, and all but one returned to previous sporting activities. Complications occurred in four patients, but only one required K-wire repositioning.
- Published
- 2004
- Full Text
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25. Plating of humeral shaft fractures--has the pendulum swung back?
- Author
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Niall DM, O'Mahony J, and McElwain JP
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Humeral Fractures diagnostic imaging, Male, Middle Aged, Radiography, Range of Motion, Articular, Bone Plates, Fracture Fixation, Intramedullary methods, Humeral Fractures surgery
- Abstract
We reviewed 49 patients following plate osteosynthesis of humeral shaft fractures. There were no complications as a result of surgery. Union occurred in 47 patients (96%) at a mean of 9 weeks. Two patients required secondary procedures to achieve union. All patients had full range of motion in the elbow and shoulder joints following union. In the light of the popularisation of intramedullary nailing techniques in the last decade, with recognised complications of iatrogenic radial nerve injury, inadequate rotational stabilisation, non-union and shoulder impingement, we advocate plating of humeral shaft fractures as the surgical treatment of choice.
- Published
- 2004
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26. Traumatic retrovesical testicular dislocation.
- Author
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O'Brien MF, Collins DA, McElwain JP, Akhtar M, and Thornhill JA
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- Adult, Fractures, Bone complications, Humans, Male, Pelvic Bones injuries, Rupture, Urinary Bladder, Testis injuries
- Published
- 2004
- Full Text
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27. Outcome after acetabular fracture. Prognostic factors and their inter-relationships.
- Author
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Murphy D, Kaliszer M, Rice J, and McElwain JP
- Subjects
- Acetabulum surgery, Adolescent, Adult, Age Factors, Aged, Female, Follow-Up Studies, Fracture Fixation, Internal methods, Humans, Male, Middle Aged, Odds Ratio, Prognosis, Sex Factors, Treatment Outcome, Acetabulum injuries, Fractures, Bone surgery
- Abstract
The aim of this study was to examine how commonly implicated prognostic factors are associated with late clinical outcome after reconstruction of acetabular fractures. The clinical outcomes of 180 fractures, treated by a single surgeon over a 10-year period, were assessed using the scoring system of Merle d'Aubigné and Postel. A statistical model was constructed comprising the clinical outcome and nine postulated prognostic factors. The association between these factors and sub-optimal outcome was explored by logistic regression and log linear analysis, and a model of causality was postulated. Associated fracture type, imperfect reduction (>3mm), the presence of local complications and heterotopic bone were prognostic factors independently associated with a sub-optimal outcome. The sex or age of the patient, the presence of hip dislocation, sciatic palsy, or an interval from injury to surgery of 1-18 days were factors which were not directly associated with a poor outcome. Imperfect reduction was itself affected by associated fracture type and increasing age, and it is the latter connection that may explain any apparent association between sub-optimal outcome and increasing age.
- Published
- 2003
- Full Text
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28. Ireland in the World Cup: trauma orthopaedic workloads.
- Author
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Murphy SM, Myers E, Kingston R, Connolly P, and McElwain JP
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Case-Control Studies, Female, Humans, Ireland epidemiology, Male, Middle Aged, Patient Admission statistics & numerical data, Patient Transfer statistics & numerical data, Soccer, Emergency Service, Hospital statistics & numerical data, Fractures, Bone epidemiology, Musculoskeletal Diseases epidemiology, Television
- Abstract
To determine if whether there were any changes in numbers of orthopaedic injuries at the emergency/ orthopaedic trauma department requiring treatment that could be related to televised home matches during World Cup 2002. Numbers of patients attending with musculoskeletal injuries directly attributable to world cup celebrations were collected during the four home matches. Attendances from midnight before the match until midday the day after the match were recorded. Control groups were matched from the previous month of May, and matched with the same day of the week for each of the four groups. Significantly more patients were admitted to the trauma service, referred to orthopaedic outpatients, and referred to the minor trauma clinic in the match versus control groups. 280 patients required onward referral during the match period compared with 233 during the control period. Televised Irish matches during the World Cup significantly increased the workload of the trauma orthopaedic service with musculoskeletal injuries. This should be taken into account when planning for such events in the future.
- Published
- 2003
29. Computed tomography wire localisation-assisted operative retrieval of a migrated symphysis pubis plate from the ischiorectal fossa.
- Author
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Murphy SM, Connolly P, Browne RF, Quinlan J, Torreggiani W, and McElwain JP
- Subjects
- Foreign-Body Migration diagnostic imaging, Humans, Male, Middle Aged, Pubic Symphysis diagnostic imaging, Time Factors, Bone Plates, Foreign-Body Migration surgery, Pubic Symphysis surgery, Tomography, X-Ray Computed methods
- Abstract
We report an unusual case of migration of a metal plate from the symphysis pubis to the left ischiorectal fossa, and a technique of using pre-operative CT guided wire localisation of the plate as a successful method of assisting plate retrieval.
- Published
- 2003
30. Treatment of anaemia in the polytrauma Jehovah's Witness.
- Author
-
Murphy DP, O'Donnell T, McDonnell J, and McElwain JP
- Subjects
- Anemia blood, Antifibrinolytic Agents therapeutic use, Blood Substitutes therapeutic use, Blood Transfusion ethics, Fluorocarbons therapeutic use, Hemodilution, Ireland, Prone Position, Tranexamic Acid therapeutic use, Anemia therapy, Jehovah's Witnesses, Wounds and Injuries therapy
- Abstract
The management of Jehovah's Witnesses can prove quite challenging to the surgeon who routinely uses blood and blood products in the treatment of anaemia and hypovolaemia. The medical and legal dilemmas are exacerbated when the patient has a critically low haemoglobin level or has suffered life-threatening blood loss following polytrauma. It is essential that the treating physician should have some knowledge and understanding of the beliefs of the Jehovah's Witness in order to effectively minimise and treat blood loss. This paper reviews the ethical and medicolegal aspects involved, as well as alternatives to allogenic blood products in the treatment of anaemia in the polytrauma Jehovah's Witness patient.
- Published
- 2003
31. Antibiotic prophylaxis for dental or urological procedures following hip or knee replacement.
- Author
-
Kingston R, Kiely P, and McElwain JP
- Subjects
- Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis statistics & numerical data, Dentists, Disclosure, Hip Prosthesis, Humans, Knee Prosthesis, Physicians, Risk Factors, Surveys and Questionnaires, Antibiotic Prophylaxis standards, Dental Care adverse effects, Practice Guidelines as Topic, Prosthesis-Related Infections etiology, Prosthesis-Related Infections prevention & control, Urologic Surgical Procedures adverse effects
- Abstract
Objectives: Reports of prosthetic joint infection associated with urological or dental procedures have prompted suggestions that these patients require antibiotic prophylaxis, but no guidelines have been agreed. We have polled orthopaedic surgeons, urologists, and dentists on this issue., Methods: The questions asked were: could infection of a joint prosthesis result from a dental or urological procedure; does the risk of infection warrant patients informing their dentist or urologist about their joint replacement; should these patients have prophylactic antibiotics for (a) routine procedures and (b) lengthy procedures., Results: Urologists and orthopaedic surgeons agreed that infection could probably result from urological procedures and that patients should definitely inform their urologist about their prosthesis. Orthopaedic surgeons thought that antibiotics were definitely indicated for routine and lengthy urological procedures while urologists thought antibiotics were probably indicated. Orthopaedic surgeons thought that infection probably could result from dental procedures, while dentists answered "don't know". Both groups agreed that patients should definitely inform their dentist about their prosthesis. Orthopaedic surgeons thought that antibiotics probably were necessary for routine and lengthy dental procedures, whereas dentists answered "probably not" and "don't know", respectively., Conclusions: These results could provide the basis for a consensus regarding prophylactic antibiotic use in this growing patient population.
- Published
- 2002
- Full Text
- View/download PDF
32. Outcomes following quadriceps tendon ruptures.
- Author
-
O'Shea K, Kenny P, Donovan J, Condon F, and McElwain JP
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Knee Joint physiopathology, Male, Middle Aged, Patient Satisfaction, Postoperative Complications, Range of Motion, Articular, Retrospective Studies, Rupture surgery, Tendon Injuries physiopathology, Tendon Injuries rehabilitation, Thigh, Treatment Outcome, Tendon Injuries surgery
- Abstract
Complete rupture of the quadriceps femoris tendon is a well-described injury. There is a scarcity of literature relating to the outcome of patients with this injury after surgery. We undertook a retrospective analysis of patients who had surgical repair of their ruptured quadriceps tendon at our institution over a seven year period-totalling 27 patients. Males were more commonly affected with a M:F ratio of 8:1. The peak incidence was in the sixth decade of life. The non-dominant limb was twice as likely to be affected. Assessment consisted of completion of a functional knee questionnaire, clinical examination and isokinetic testing on a Biodex dynanometer. Symptomatic outcome following surgical repair was excellent with a mean symptom score generated of 22.7 out of a maximum of 25. 18/19 patients returned to their premorbid level of activity on average 18.1 weeks following injury. There was no difference in quadriceps girth comparing affected and unaffected limbs. Less than 5 degrees deficit in range of motion existed between affected and unaffected limbs. Approximately two-thirds of patients were the same or better when comparing peak torque/body weight, average power, maximum average peak torque and total work/body weight in affected and unaffected limbs.
- Published
- 2002
- Full Text
- View/download PDF
33. Comparison between clinical and radiologic outcome measures after reconstruction of acetabular fractures.
- Author
-
Rice J, Kaliszer M, Dolan M, Cox M, Khan H, and McElwain JP
- Subjects
- Adolescent, Adult, Aged, Fractures, Bone diagnostic imaging, Hip Joint physiopathology, Humans, Middle Aged, Radiography, Range of Motion, Articular, Treatment Outcome, Acetabulum injuries, Fractures, Bone surgery
- Abstract
Objectives: To compare clinical and radiologic outcome measures in patients after reconstruction of acetabular fractures and to investigate whether an objective radiologic outcome could be used as a proxy for a clinical outcome., Design: Follow-up survey with retrospective analysis of consecutive case records., Patients and Intervention: Over a ten-year period, 201 consecutive patients had open reduction and internal fixation of acetabular fractures performed by a single surgeon. The outcome measures on 166 fractures were available for analysis when the twenty-six patients who were lost to follow-up and the fourteen patients who had salvage total hip replacement were excluded., Main Outcome Measurements: The assessment of patients was performed by one of two independent assessors, who used the Merle d'Aubigné (1954) clinical outcome score and a radiologic score of degenerative hip disease (Matta, 1994)., Results: Although the overall correlation between the clinical and radiologic outcome grades was good (r = 0.63, p < 0.001), their agreement (i.e., the prediction of a specific clinical outcome by a corresponding radiologic one) was poor (Kappa = 0.24). The authors found that the clinical scoring system was difficult to apply specifically to acetabular trauma in 29 percent of fractures because of complications related to associated injuries. When the individual Merle d'Aubigné scores for pain, range of motion, and walking were correlated with the radiologic score, it was found that the walking score had a significant association with the radiologic score and the pain and range of movement scores., Conclusions: The Merle d'Aubigné score has shortcomings as an outcome measure for acetabular fractures. Our aim to use a radiologic outcome as a proxy for this clinical grading system was not realized, but we propose that the patient's walking ability could be used as an objective local outcome measurement.
- Published
- 2002
- Full Text
- View/download PDF
34. Padding under tourniquets in tourniquet controlled surgery: Bruner's ten rules revisited.
- Author
-
Kutty S and McElwain JP
- Subjects
- Humans, Practice Guidelines as Topic, Bandages, Orthopedic Procedures instrumentation, Tourniquets
- Published
- 2002
- Full Text
- View/download PDF
35. Diagnosis, treatment and management of osteoporosis in the orthopaedic setting.
- Author
-
Murphy D, Rice J, and McElwain JP
- Subjects
- Absorptiometry, Photon, Bone Density, Diphosphonates therapeutic use, Exercise Therapy, Hormone Replacement Therapy, Humans, Life Style, Osteoporosis physiopathology, Protective Devices, Osteoporosis diagnosis, Osteoporosis therapy
- Published
- 2001
36. Kinin-mediated anaphylactoid reaction implicated in acute intra-operative pulseless electrical activity.
- Author
-
O'Sullivan S, McElwain JP, and Hogan TS
- Subjects
- Aged, Anaphylaxis metabolism, Anesthesia, General, Arthroplasty, Replacement, Hip adverse effects, Drug and Narcotic Control, Fatal Outcome, Humans, Hypotension chemically induced, Hypotension metabolism, Male, Pulse, Anaphylaxis chemically induced, Death, Sudden, Cardiac etiology, Kinins metabolism, Plasma Substitutes adverse effects, Polygeline adverse effects
- Abstract
A 65-year-old patient undergoing total hip replacement under general anaesthesia suffered acute pulseless electrical activity with a fatal outcome. A kinin-mediated analphylactoid reaction following administration of a polygeline plasma expander (Haemaccel) was implicated by in vitro testing. This case report illustrates the diagnostic difficulties posed by non-histaminoid anaphylactoid reactions and the resistance to epinephrine of kinin-mediated hypotension.
- Published
- 2001
- Full Text
- View/download PDF
37. A critical appraisal of the out-patient fracture clinic: is communication really the key?
- Author
-
O'Toole GC, O'Grady P, Beddy P, and McElwain JP
- Subjects
- Ambulatory Care trends, Communication, Female, Fracture Fixation trends, Fractures, Bone diagnosis, Health Care Surveys, Humans, Ireland, Male, Outcome Assessment, Health Care, Patient Satisfaction, Prospective Studies, Ambulatory Care standards, Fracture Fixation standards, Fractures, Bone therapy, Physician-Patient Relations
- Abstract
The most common factor in an adversarial doctor-patient relationship is failed communication. We audited our communication skills, patient satisfaction and assessed patients' capacity for retaining information. 120 consecutive first time patients with one of 5 fracture types were assessed. Patients scored (a) the doctor's communication skills and (b) their overall fracture clinic experience. Patient satisfaction was high, mean 8.2 (range 2-10, SD 1.76) points. There was a statistically significant difference in a patient's knowledge pre and post consultation. Forty-three patients (36%) could recall a specific consequence of the fracture (p<0.005). Forty (31%) and twenty six (22%) patients could recall the name of the Registrar and Consultant respectively. Doctors scored 9.2 (range 7-10, SD 1.23) points for communication skills. Patients are concerned with a fracture's impact on daily activities, often failing to register who treats them and any serious consequences. With doctors being scored so highly, the dilemma remains of how better to deliver the message.
- Published
- 2001
38. Closed interlocking nailing of humeral shaft fractures with the Russell-Taylor nail.
- Author
-
Cox MA, Dolan M, Synnott K, and McElwain JP
- Subjects
- Adult, Aged, Aged, 80 and over, Device Removal, Equipment Design, Female, Follow-Up Studies, Fracture Healing physiology, Fractures, Ununited diagnostic imaging, Humans, Humeral Fractures diagnostic imaging, Male, Middle Aged, Postoperative Complications diagnostic imaging, Radiography, Range of Motion, Articular physiology, Retrospective Studies, Risk Factors, Fracture Fixation, Intramedullary instrumentation, Humeral Fractures surgery
- Abstract
Objective: To assess the role of the Russell-Taylor humeral nail in the treatment of humeral shaft fractures., Study Design: Retrospective with a mean radiologic and clinical follow-up at thirty-two months., Setting: University teaching hospital., Patients: Total of thirty-seven patients treated with the Russell-Taylor humeral nail., Intervention: All patients were treated with the Russell-Taylor humeral nail inserted in an antegrade fashion., Outcome Measures: Radiologic union and shoulder function in terms of pain, power, range of movement, and activities of daily living., Results: There were four established nonunions and four cases of delayed union (time to union > four months). Age of patient was the only predictor of nonunion. There was one infection and one intraoperative fracture. Two prominent proximal screws required removal, and one nail was removed after union because of impingement. Three patients required manipulation under anesthesia to improve shoulder movement. At review, six patients had residual poor shoulder function as per Constant score, four attributable to shoulder stiffness and two to residual pain., Conclusion: The authors' findings indicate a significant rate of delayed or nonunion in the elderly patient. When the high rate of union with conservative treatment is considered, the indications and rationale for intramedullary humeral nailing should be clearly defined.
- Published
- 2000
- Full Text
- View/download PDF
39. Role of carbon fibre implants in osteochondral defects of the knee.
- Author
-
Nicholson P, Mulcahy D, Curtin B, and McElwain JP
- Subjects
- Adult, Carbon, Female, Humans, Magnetic Resonance Imaging, Male, Cartilage, Articular pathology, Joint Diseases therapy, Knee Joint pathology, Prostheses and Implants
- Abstract
Articular cartilage defects of the knee are a common condition diagnosed at arthroscopy. The management of these osteochondral lesions is controversial. We present our experience using carbon fibre implants to repair these defects in 18 patients. Eleven patients (61 per cent) had an osteochondral defect of the medial femoral condyle. Two patients had isolated patellar defects. The mean knee assessment and functional scores were 75 and 80 respectively using The Knee Society Clinical Rating System. Serial post-operative M.R.I. scanning revealed that there was no loss of implant position with an extensive local tissue response and good joint congruity. Overall, 11 patients (61 per cent) returned to their normal sporting activity, while 3 patients (18 per cent) had a poor result. One of these underwent a patellectomy. We conclude that carbon fibre implants may have a role to play in the management of osteochondral defects of the femoral condyles.
- Published
- 1998
- Full Text
- View/download PDF
40. Patellofemoral contact forces and pressures during intramedullary tibial nailing.
- Author
-
Devitt AT, Coughlan KA, Ward T, McCormack D, Mulcahy D, Felle P, and McElwain JP
- Subjects
- Arthralgia etiology, Biomechanical Phenomena, Cadaver, Femur physiopathology, Fracture Fixation, Intramedullary adverse effects, Fracture Fixation, Intramedullary methods, Humans, Patella physiopathology, Range of Motion, Articular, Transducers, Bone Nails, Knee Joint physiopathology, Tibia surgery
- Abstract
Patellofemoral joint forces and pressures were measured in a cadaver model during intramedullary nailing of the tibia. A significant increase in contact pressures was found at the lateral facet of the patellofemoral articulation using the medial paratendinous approach (P = 0.01) and at the medial facet when using the trans-patellar tendon approach (P = 0.001) to the proximal tibia. Increased contact pressures at the patello-femoral joint may result in chondral injury, which in turn may cause anterior knee pain, a common complication of tibial nailing.
- Published
- 1998
- Full Text
- View/download PDF
41. Herbert screw insertion in the scaphotrapezial joint. A cause of degenerative change?
- Author
-
Callanan I, Lahoti O, and McElwain JP
- Subjects
- Adult, Carpal Bones diagnostic imaging, Carpal Bones surgery, Female, Follow-Up Studies, Humans, Male, Middle Aged, Radiography, Risk Factors, Wrist Injuries diagnostic imaging, Bone Screws, Carpal Bones injuries, Fracture Fixation, Internal instrumentation, Osteoarthritis diagnostic imaging, Postoperative Complications diagnostic imaging, Wrist Injuries surgery
- Abstract
The method of insertion of the Herbert screw for scaphoid fractures and its long-term presence in the scaphotrapezial joint may predispose to degeneration in that joint. We examined a group of patients with long-term follow-up to assess this risk and found it to be insignificant.
- Published
- 1996
- Full Text
- View/download PDF
42. Elbow fractures with carpal injuries.
- Author
-
Lahoti OP, Callanan I, Reidy DP, Kelly EP, and McElwain JP
- Subjects
- Adult, Carpal Bones diagnostic imaging, Fractures, Bone diagnostic imaging, Humans, Joint Dislocations diagnostic imaging, Joint Dislocations therapy, Male, Radiography, Wrist Injuries diagnostic imaging, Carpal Bones injuries, Fractures, Bone therapy, Wrist Injuries therapy, Elbow Injuries
- Abstract
We report four cases with six episodes of concurrent carpal and elbow fractures or dislocations. Few such combinations of injuries have been reported in the literature. We discuss the mechanism and management of such injuries and conclude that elbow injuries should be suspected in severe carpal injuries. Surgical treatment may be required in their management.
- Published
- 1995
- Full Text
- View/download PDF
43. Intraoperative suction catheter tip contamination.
- Author
-
Mulcahy DM, McCormack D, and McElwain JP
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Intraoperative Period, Male, Middle Aged, Orthopedics methods, Prospective Studies, Wounds and Injuries surgery, Catheterization instrumentation, Equipment Contamination, Suction instrumentation
- Abstract
Suction catheter tip contamination is a potential source of intraoperative inoculation of wounds with bacteria. The continuous passage of large quantities of air through a blood-soaked catheter tip during the course of surgical procedures can lead to significant contamination. This in turn may contribute to late wound infection due to inoculation of the deeper recesses of the wound via the contaminated suction catheter tip. We have conducted a prospective clinical study to confirm the incidence of suction catheter tip contamination during orthopaedic trauma surgery and propose changes to current practice to reduce the incidence.
- Published
- 1994
44. Operative fixation of unstable pelvic ring injuries in polytrauma patients.
- Author
-
O'Flanagan SJ, Fulton G, O'Beirne J, and McElwain JP
- Subjects
- Adolescent, Adult, Aged, Bone Plates standards, Child, External Fixators standards, Female, Follow-Up Studies, Fractures, Bone diagnostic imaging, Fractures, Bone etiology, Humans, Male, Middle Aged, Tomography, X-Ray Computed, Fractures, Bone surgery, Multiple Trauma complications, Pelvic Bones injuries
- Abstract
Sixteen polytraumatized patients with a variety of unstable pelvic ring fractures were treated with operative fixation. We have found that an aggressive approach with adequate early stabilization of the pelvis offers many advantages over conservative management particularly in polytraumatized patients.
- Published
- 1992
- Full Text
- View/download PDF
45. Interlocking intramedullary nailing for the treatment of tibial fractures.
- Author
-
O'Beirne J, Seigne P, and McElwain JP
- Subjects
- Adolescent, Adult, Aged, Female, Follow-Up Studies, Fracture Fixation, Intramedullary standards, Humans, Ireland epidemiology, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Radiography, Tibial Fractures classification, Tibial Fractures diagnostic imaging, Treatment Outcome, Fracture Fixation, Intramedullary methods, Tibial Fractures surgery
- Abstract
Thirty-seven tibial shaft fractures in 34 patients were treated with the Grosse-Kempf interlocking intramedullary nail over a two year period. Thirty-six tibiae were consolidated at a median of 17 weeks; one had re-fractured following nail removal in a separate injury, but was now uniting on conservative treatment. Using very detailed clinical and radiological analysis, and excluding the patient who had re-fractured, the results were excellent in 19, good in 8, fair in 6 and poor in 3. The most significant complications were haematoma formation and additional comminution during nail insertion. Overall, we found tibial nailing to be a satisfactory procedure, facilitating rapid rehabilitation with early weight bearing and resulting in predictable fracture healing in good alignment.
- Published
- 1992
- Full Text
- View/download PDF
46. Derotation varus osteotomy in Perthes disease.
- Author
-
McElwain JP, Regan BF, Dowling F, and Fogarty E
- Subjects
- Casts, Surgical, Child, Child, Preschool, Evaluation Studies as Topic, Female, Femur Head diagnostic imaging, Femur Head surgery, Humans, Legg-Calve-Perthes Disease diagnostic imaging, Male, Radiography, Retrospective Studies, Splints, Traction, Femur Head Necrosis surgery, Legg-Calve-Perthes Disease surgery, Osteotomy methods
- Abstract
Two groups of patients with severe forms of Perthes disease were studied. Containment was obtained by performing a derotation varus osteotomy in 32 hips, and by casts and splints in 12 hips. The clinical results were better in the operated group than in the nonoperated group. Seventy-five percent of the hips in the operated group had good to fair radiological results, compared with 41% fair results only in the nonoperated group. The various radiological methods of assessment are outlined. It is concluded that derotation varus osteotomy has advantages over nonoperative treatment in severe Perthes disease, especially in Catterall grade 4 hips.
- Published
- 1985
47. Syme's amputation in adults: a long-term review.
- Author
-
McElwain JP, Hunter GA, and English E
- Subjects
- Adult, Amputation, Traumatic surgery, Ankle Joint, Female, Foot Diseases surgery, Foot Injuries, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Amputation, Surgical methods, Foot surgery
- Abstract
A retrospective study was undertaken in two patient populations to establish the failure rate of Syme's amputation. Failure was defined as an amputation requiring revision to a more proximal level. For traumatic lesions of the foot the failure rate was 29% and for dysvascular lesions it was 41%. The long-term functional results in 55 patients who underwent Syme's amputation for traumatic, dysvascular or congenital lesions were studied. Overall, 73% had good function. The ideal Syme's stump, where the fat pad is centred securely over the distal tibia, was noted in only 22% of patients. The authors conclude that, in the past, technical details may have been overemphasized, because in this study the functional results of Syme's amputation were more dependent on prosthetic fitting. This type of amputation is not recommended for patients with dysvascular lesions because of the high failure rate.
- Published
- 1985
48. The early results of porous-coated total shoulder arthroplasty.
- Author
-
McElwain JP and English E
- Subjects
- Aged, Aged, 80 and over, Arthritis, Rheumatoid diagnostic imaging, Arthritis, Rheumatoid surgery, Follow-Up Studies, Humans, Middle Aged, Osteoarthritis diagnostic imaging, Osteoarthritis surgery, Postoperative Complications diagnostic imaging, Postoperative Complications epidemiology, Prosthesis Design, Prosthesis Failure, Radiography, Shoulder Joint diagnostic imaging, Time Factors, Joint Prosthesis adverse effects, Shoulder Joint surgery
- Abstract
A porous-coated total shoulder arthroplasty of the authors' design was investigated over a period of six years. Thirteen of the first 21 arthroplasties, with an average follow-up period of three years, revealed the difficulty of proving stability by either bony or fibrous tissue ingrowth or both. With the exception of two patients (one glenoid and one humeral component), there was no gross evidence of radiographic loosening. Clinically, the early results were encouraging, but long-term follow-up observations are necessary before definitive conclusions are possible.
- Published
- 1987
49. Acute ruptures of the lateral ligament of the ankle.
- Author
-
McElwain JP, Brady PG, Regan BF, Colville J, and Vella L
- Subjects
- Acute Disease, Adolescent, Adult, Ankle Joint surgery, Female, Humans, Ligaments, Articular surgery, Male, Prospective Studies, Rupture, Ankle Injuries, Ligaments, Articular injuries
- Published
- 1985
- Full Text
- View/download PDF
50. Review of the operative treatment of Achilles tendon rupture.
- Author
-
Kellam JF, Hunter GA, and McElwain JP
- Subjects
- Achilles Tendon surgery, Adolescent, Adult, Athletic Injuries surgery, Child, Female, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Rupture, Achilles Tendon injuries
- Abstract
Sixty-eight patients' charts were reviewed for ascertainment of the complication rate following operative repair of ruptured Achilles tendons. Ninety-two percent of 48 patients whose cases underwent clinical evaluation returned to their preinjury activity status: 13% had incisional complications, most of which resolved. The rerupture rate was 3% (2/68). The results of this series and a literature review show that operative treatment can be regarded as an acceptable method. Nonoperative treatment should be considered in a nonathletic patient over the age of 50 years because of potentially serious problems with wound healing.
- Published
- 1985
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