Publications by authors named "Dafydd S Edwards"

10 Publications

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Finger abduction as a novel function of the extensor digitorum brevis manus muscle.

Surg Radiol Anat 2021 Jun 13. Epub 2021 Jun 13.

Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.

A 25-year-old female presented with a chronic scapho-lunate ligament injury with development of carpal instability requiring reconstruction. During a standard dorsal longitudinal mid-line approach to the carpus, an extensor digitorum brevis manus (EDBM) muscle was found taking its origin from the dorsal wrist capsule overlying the lunate with innervation from the posterior interosseous nerve (PIN). Electrical stimulation of the muscle belly demonstrated abduction of the middle finger. The EDBM is a rare anatomical variant of the extensor compartment of the wrist and may be encountered during surgical approaches. Where possible these variant muscles should be carefully dissected off underlying structures, preserved and repaired at the conclusion of a procedure to ensure no perceived functional deficit to the patient. We present a case of a previously undescribed EDBM muscle function of pure finger abduction with no extension and a surgical technique of preserving its origin. We propose that the middle finger variant of the EDBM should be re-named the extensor digitorum brevis medius to reflect our findings.
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http://dx.doi.org/10.1007/s00276-021-02770-1DOI Listing
June 2021

Primary amputation versus limb salvage in upper limb major trauma: a systematic review.

Eur J Orthop Surg Traumatol 2021 May 29. Epub 2021 May 29.

Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.

Purpose: Severe upper limb injuries can result in devastating consequences to functional and psychological well-being. Primary objectives of this review were to evaluate indications for amputation versus limb salvage in upper limb major trauma and whether any existing scoring systems can aid in decision-making. Secondary objectives were to assess the functional and psychological outcomes from amputation versus limb salvage.

Methods: A systematic review was carried out in accordance with PRISMA guidelines. A search strategy was conducted on the MEDLINE, EMBASE, and Cochrane databases. Quality was assessed using the ROBINS-I tool. The review protocol was registered in PROSPERO.

Results: A total of 15 studies met inclusion criteria, encompassing 6113 patients. 141 underwent primary amputation and 5972 limb salvage. General indications for amputation included at least two of the following: uncontrollable haemodynamic instability; extensive and concurrent soft tissue, bone, vascular and/or nerve injuries; prolonged limb ischaemia; and blunt arterial trauma or crush injury. The Mangled Extremity Severity Score alone does not accurately predict need for amputation, however, the Mangled Extremity Syndrome Index may be a more precise tool. Comparable patient-reported functional and psychological outcomes are seen between the two treatment modalities.

Conclusions: Decision regarding amputation versus limb salvage of the upper limb is multifactorial. Current scoring systems are predominantly based on lower limb trauma, with lack of robust evidence to guide management of the upper extremity. Further high-quality studies are required to validate scoring systems which may aid in decision-making and provide further information on the outcomes from the two treatment options.
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http://dx.doi.org/10.1007/s00590-021-03008-xDOI Listing
May 2021

Injury risk of interphalangeal and metacarpophalangeal joints under impact loading.

J Mech Behav Biomed Mater 2019 09 22;97:306-311. Epub 2019 May 22.

Department of Bioengineering, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom. Electronic address:

Injuries to the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the hand are particularly disabling. However, current standards for hand protection from blunt impact are not based on quantitative measures of the likelihood of damage to the tissues. The aim of this study was to evaluate the probability of injury of the MCP and PIP joints of the human hand due to blunt impact. Impact testing was conducted on 21 fresh-frozen cadaveric hands. Unconstrained motion at every joint was allowed. All hands were imaged with computed tomography and dissected post-impact to quantify injury. An injury-risk curve was developed for each joint using a Weibull distribution with dorsal impact force as the predictive variable. The injury risks for PIP joints were similar, as were those for MCP joints. The risk of injury of the MCP joints from a given applied force was significantly greater than that of the PIP joints (p = 0.0006). The axial forces with a 50% injury risk for the MCP and PIP joints were 3.0 and 4.2 kN, respectively. This is the first study to have investigated the injury tolerance of the MCP and PIP joints. The proposed injury curves can be used for assessing the likelihood of tissue damage, for designing targeted protective solutions such as gloves, and for developing more biofidelic standards for assessing these solutions.
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http://dx.doi.org/10.1016/j.jmbbm.2019.05.037DOI Listing
September 2019

Wide-Awake Wrist and Small Joints Arthroscopy of the Hand.

Hand Clin 2019 02;35(1):85-92

Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK.

The minimally invasive nature of wrist and small joint arthroscopy renders it particularly suitable for the application of the wide-awake local anesthesia no tourniquet (WALANT) technique. The application of WALANT wrist and small joint arthroscopy has given surgeons the ability to visualize both static and dynamic movements of a joint, to show the pathology and discuss with the patient, and to visualize a patient's repaired structures. This reinforces confidence in surgeons and encourages patients to comply with postoperative rehabilitation.
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http://dx.doi.org/10.1016/j.hcl.2018.08.010DOI Listing
February 2019

The contribution of the posterolateral capsule to elbow joint stability: a cadaveric biomechanical investigation.

J Shoulder Elbow Surg 2018 Jul 22;27(7):1178-1184. Epub 2018 Apr 22.

Department of Trauma and Orthopaedics, Wrightington Hospital, Wrightington Wigan and Leigh National Health Service Trust, Appley Bridge, Lancashire, UK.

Background: Elbow posterolateral rotatory instability occurs after an injury to the lateral collateral ligament complex (LCLC) in isolation or in association with an osteochondral fracture of the posterolateral margin of the capitellum (Osborne-Cotterill lesion [OCL]). The contribution to elbow stability of the posterolateral capsule, attached to this lesion, is unknown. This study quantified the displacement of the radial head on simulated posterior draw with sectioning of the posterior capsule (a simulated OCL) or LCLC.

Methods: Biomechanical testing of the elbow was performed in 8 upper limb cadavers. With the elbow 0°, 30°, 60°, and 90° degrees of flexion, posterior displacement of the radius was measured at increments of a load of 5 N up to 50 N. A simulated OCL and LCLC injury was then performed.

Results: A simulated OCL results in significantly more displacement of the radial head compared with the intact elbow at 30° to 60° of elbow flexion. LCLC resection confers significantly more displacement. An OCL after LCLC resection does not create further displacement.

Conclusions: The degree of radial head displacement is greater after a simulated OCL at 30° to 60° of flexion compared with the intact elbow with the same load but not as great as seen with sectioning of the LCLC. This study suggests that the posterior capsule attaching to the back of the capitellum is important to elbow stability and should be identified as the Osborne-Cotterill ligament. Clinical studies are required to determine the importance of these biomechanical findings.
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http://dx.doi.org/10.1016/j.jse.2018.02.045DOI Listing
July 2018

Heterotopic Ossification: A Review of Current Understanding, Treatment, and Future.

J Orthop Trauma 2016 Oct;30 Suppl 3:S27-S30

*The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, United Kingdom; †The Royal Centre for Defence Medicine, Birmingham, United Kingdom; ‡Naval Medical Center, San Diego, CA; §Orthopaedic Surgery Service, Uniformed Services University of Health Sciences-Walter Reed National Military Medical Center, Department of Surgery, Bethesda, MD; and ‖Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD.

Heterotopic ossification is the formation of bone at extraskeletal sites. The incidence of heterotopic ossification in military amputees from recent operations in Iraq and Afghanistan has been demonstrated to be as high as 65%. Heterotopic ossification poses problems to wound healing, rehabilitation, and prosthetic fitting. This article details the current evidence regarding its etiology, prevention, management, and research strategies.
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http://dx.doi.org/10.1097/BOT.0000000000000666DOI Listing
October 2016

Heterotopic Ossification: A Review of Current Understanding, Treatment, and Future.

J Orthop Trauma 2016 Oct;30 Suppl 3:S27-S30

*The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, United Kingdom; †The Royal Centre for Defence Medicine, Birmingham, United Kingdom; ‡Naval Medical Center, San Diego, CA; §Orthopaedic Surgery Service, Uniformed Services University of Health Sciences-Walter Reed National Military Medical Center, Department of Surgery, Bethesda, MD; and ‖Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD.

Heterotopic ossification is the formation of bone at extraskeletal sites. The incidence of heterotopic ossification in military amputees from recent operations in Iraq and Afghanistan has been demonstrated to be as high as 65%. Heterotopic ossification poses problems to wound healing, rehabilitation, and prosthetic fitting. This article details the current evidence regarding its etiology, prevention, management, and research strategies.
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http://dx.doi.org/10.1097/BOT.0000000000000666DOI Listing
October 2016

"Doomed to go in company with miserable pain": surgical recognition and treatment of amputation-related pain on the Western Front during World War 1.

Lancet 2014 Nov 7;384(9955):1715-9. Epub 2014 Nov 7.

Pain Research, Department of Surgery and Cancer, Imperial College, London, UK; Department of Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.

The principal feature of injuries from World War 1 was musculoskeletal trauma and injury to peripheral nerves as a result of damage to the upper and lower limbs caused by gunshot wounds and fragments of artillery munitions. Amputation was used as a treatment in field hospitals to save lives; limb conservation was a secondary consideration. A century later, the principal feature of injuries to soldiers in today's wars in Iraq and Afghanistan is also musculoskeletal trauma and injury to the peripheral nerves caused by improvised explosive devices. Common to both types of injury is postamputation pain. We searched The Lancet's archives in this Series paper to show the efforts of surgeons in World War 1 to understand and treat postamputation pain in its own right both during and immediately after the war. Despite unprecedented patient numbers and levels of civilian medical expertise, little progress was made in providing relief from this type of pain, a grave concern to the surgeons treating these soldiers. Today postamputation pain is understood beyond a surgical context but remains a complex and poorly understood condition with few effective treatments.
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http://dx.doi.org/10.1016/S0140-6736(14)61643-3DOI Listing
November 2014

Heterotopic ossification: a systematic review.

J R Army Med Corps 2015 Dec 11;161(4):315-21. Epub 2014 Jul 11.

Defence Professor of Trauma & Orthopaedics, Academic Department of Military Surgery and Trauma, RCDM Birmingham, UK.

Heterotopic ossification (HO) is the formation of mature lamellar bone in extraskeletal soft tissues. It was first described 1000 years ago in the healing of fractures, and in relation to military wounds, texts from the American Civil War and World War I refer to HO specifically. It continues to cause problems to injured service personnel; the consequences of wound and soft tissue complications in traumatic amputations pose particular problems to rehabilitation and prosthetic use. While HO is seen in rare genetic conditions, it is most prevalent after joint replacement surgery and trauma. In the civilian setting HO has been commonly described in patients after traumatic brain injuries, spinal cord injuries and burns. Militarily, as a consequence of recent operations, and the characteristic injury of blast-related amputations, a renewed interest in HO has emerged due to an increased incidence seen in casualties. The heterogeneous nature of a blast related amputation makes it difficult for a single aetiological event to be identified, although it is now accepted that blast, amputation through the zone of injury, increased injury severity and associated brain injuries are significant risk factors in HO formation. The exact cellular event leading to HO has yet to be identified, and as a consequence its prevention is restricted to the use of anti-inflammatory medication and radiation, which is often contraindicated in the acute complex military casualty. A systematic review in PubMed and the Cochrane Database identified research articles related to HO to illustrate the military problem of HO and its management, current research concepts and experimental theories regarding HO. This also served as a gap analysis providing the researchers detail of any knowledge deficit in this field, in particular to the military aspects of HO; 637 out of 7891 articles initially identified that referenced HO were relevant to this review.
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http://dx.doi.org/10.1136/jramc-2014-000277DOI Listing
December 2015

Rapid tracheal deviation and airway compromise due to fluid extravasation during shoulder arthroscopy.

J Shoulder Elbow Surg 2014 Jul;23(7):e163-5

Department of Trauma and Orthopaedics, Basingstoke Hospitals, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK.

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http://dx.doi.org/10.1016/j.jse.2014.03.006DOI Listing
July 2014
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