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The Journal of Bone & Joint Surgery British Volume
Vol. 69-B, Issue 1 | Pages 13 - 16
1 Jan 1987
Christodoulou A Prince H Webb J Burwell R

Fifty patients with adolescent idiopathic scoliosis treated by posterior fusion and Harrington instrumentation augmented by a Cotrel bar or by sublaminal Luque wires were studied in a prospective trial to ascertain the need for postoperative bracing. Twenty-five patients wore a plaster brace postoperatively for six months, while 25 were managed without a brace. The mean loss of correction from the first standing postoperative radiograph to one obtained two years later was 7 degrees in the braced group, and 6.3 degrees in the unbraced group, the difference not being statistically significant. We conclude that postoperative bracing is unnecessary after augmented Harrington instrumentation.

The Journal of Bone & Joint Surgery British Volume
Vol. 67-B, Issue 4 | Pages 594 - 601
1 Aug 1985
Nicolopoulos K Burwell R Webb J

Stature and its components were examined in 143 girls aged 11 to 15 years with adolescent idiopathic scoliosis. Correction was made for loss of height due to the lateral spinal curvature, and the findings were compared with those from 202 healthy girls of similar age. Using three components of stature (suprapelvic, pelvic and subischial heights) we were able to show that the relatively greater stature of girls with adolescent idiopathic scoliosis was due to changes in the pelvis and lower limbs but not significantly in the spine. Suprapelvic height was reduced relative to subischial height; this probably represents the growth pattern of predominantly ectomorphic individuals, reflecting the physique of many of these girls. Pelvic height was disproportionately increased, and this is considered to be a true rather than an apparent difference. Cephalocaudal disproportion involving two segments suggests a common mechanism of causation which is unlikely to be secondary to the scoliosis. These physical features may in some way be associated with a predisposition to progression of the scoliosis.

The Journal of Bone & Joint Surgery British Volume
Vol. 67-B, Issue 2 | Pages 232 - 236
1 Mar 1985
Upadhyay S Moulton A Burwell R

The factors involved in the mechanism leading to traumatic posterior dislocation of the hip are examined. In 47 adult patients who had previously suffered such a dislocation, ultrasound scans were used to measure femoral anteversion on both the affected and the uninjured side. In 36 normal adult volunteers, used as controls, similar measurements were made. Femoral anteversion on both the injured and uninjured side was significantly reduced in the patients compared with the volunteers. These findings are discussed in the light of previous work which indicates that medial rotation is a factor in the mechanism of posterior dislocation of the hip. It is suggested that reduced anteversion acts like medial rotation to make the hip more susceptible to posterior dislocation, and that the less the anteversion the more likely is the injury to be a dislocation rather than a fracture-dislocation. It is concluded that patients who suffer such dislocated hips belong at one extreme of the normal population, having either reduced femoral anteversion or even retroversion, and that this anatomical feature selects towards hip dislocation rather than to injury of the femoral shaft, knee or tibia during the appropriate type of accident.

The Journal of Bone & Joint Surgery British Volume
Vol. 65-B, Issue 4 | Pages 452 - 463
1 Aug 1983
Burwell R James N Johnson F Webb J Wilson Y

This paper reports a new method for expressing numerically asymmetry of the contour of the back in a forward-bending position. Information is given at three spinal levels (T8, T12 and L3) for 636 schoolchildren aged 8 to 15 years. Rib-hump and lumbar-hump scores were standardised to create trunk asymmetry scores (TASs) making comparison possible between children of different age, size and sex. Two groups of children were defined: those with clinically straight spines (585 children); and those with clinical evidence of lateral spinal curves (51 children). In the children with clinically straight spines the main findings were: about 1:4 had objectively detectable rib and lumbar humps; female-to-male ratios were 1.2:1 for the thoracic region and 1.4:1 for the lumbar region; right humps were about 10 times more common than left; TASs in the boys and girls at each spinal level had normal distributions about means to the right of zero (where zero represents perfect symmetry); at T8 and T12, a wider scatter of TASs in girls than in boys; at L3, larger TASs in girls than in boys; a relation between shortening of one lower limb and a contralateral hump on the back; and no relation to age (except at L3), stature (corrected for age) or handedness. The findings are discussed in relation to possible causes of back contour asymmetry, early diagnosis of scoliosis by screening, sexual dimorphism and significance for the pathogenesis of idiopathic scoliosis. Ten children with clinically straight spines and larger TASs, and 42 out of 51 children with clinical evidence of lateral spinal curves in the forward-bending position attended for radiographic examination. Twelve children had "scoliosis curves" of 11 degrees or more as defined by the Scoliosis Research Society. The results are reported in relation to TASs, spinal curve angle (Cobb) and vertebral rotation.

The Journal of Bone & Joint Surgery British Volume
Vol. 65-B, Issue 2 | Pages 153 - 156
1 Mar 1983
Merriam W Burwell R Mulholland R Pearson J Webb J

Modern anthropometric techniques were used to investigate two groups of subjects, one with various syndromes associated with pain in the lower back and the other a control group. Analysis confirmed previous reports that people prone to pain in the back have a greater standing height than people who are not. To investigate this further two new components of height, namely pelvic height and suprapelvic height, were calculated in addition to the established calculation of subischial height. Consecutive components, namely suprapelvic height, pelvic height and subischial height, together constituted the standing height of a subject. The main finding of this investigation was that the relatively large standing height of the subject prone to back pain was due only to the pelvic component.

The Journal of Bone & Joint Surgery British Volume
Vol. 61-B, Issue 1 | Pages 18 - 25
1 Feb 1979
Hall D Harrison M Burwell R

This paper reports a high incidence of minor congenital anomalies in boys and girls with Perthes' disease compared with that in a control population. There is a similarity of the incidence of minor anomalies in the children with Perthes' disease to that in babies with a single major congenital defect. Multiple major defects were more numerous and more severe than in the control children. It is speculated that there may be a congenital abnormality affecting skeletal development which in some way makes the hip susceptible to Perthes' disease at a later date.

The Journal of Bone & Joint Surgery British Volume
Vol. 60-B, Issue 4 | Pages 461 - 477
1 Nov 1978
Burwell R Dangerfield P Hall D Vernon C Harrison M

The Journal of Bone & Joint Surgery British Volume
Vol. 60-B, Issue 1 | Pages 1 - 3
1 Feb 1978
Burwell R

The Journal of Bone & Joint Surgery British Volume
Vol. 59-B, Issue 2 | Pages 189 - 196
1 May 1977
Nade S Burwell R

This paper examines the fate of decalcified allografts (homografts) of iliac cancellous bone impregnated with autologous red marrow and implanted intermuscularly into the anterior abdominal wall of rabbits. In contrast to the findings of Urist and other workers that cortical bone decalcified with hydrochloric acid (HCl) and then freeze-dried is inductive to new bone formation in various heterotopic sites, evidence is presented that iliac bone decalcified by HCl and grafted alone to a muscular site is itself very weakly inductive to bone formation. However, when combined with autologous bone marrow the HCl-decalcified bone provides a better substrate for bone formation by marrow cells than does either undecalcified iliac bone, or iliac bone decalcified with ethylene-diamine-tetra-acetic acid. The freezing or freeze-drying of decalcified bone does not affect new bone formation when implanted alone or with autologous marrow. The differences between the cortical and cancellous bone as inductive substrates for osteogenesis are discussed and the interrelationship of bone and marrow in combined bone grafts are re-evaluated.