Publications by authors named "Stephen A Brennan"

14 Publications

  • Page 1 of 1

Standardized traction versus side-bending radiographs in adolescent idiopathic scoliosis: a preliminary study.

J Pediatr Orthop B 2019 Jan;28(1):17-21

Adelaide and Meath Hospital Tallaght, Dublin, Ireland.

The aim of this study was to develop a new type of preoperative flexibility test for adolescent idiopathic scoliosis. The objective was to develop a test that was standardized and allow for the measurement of in-vivo forces required for curve correction. It was undertaken to compare the results of this new test with side-bending radiographs. Various preoperative radiographic techniques have been used to assess flexibility in patients awaiting scoliosis correction surgery. The major limitation of these investigations is a lack of standardization. The side-bending radiograph is the current gold standard, against which this new test was compared. A prospective clinical study was conducted. An axial traction force of 1.5 times body weight was applied through the spine of patients using a traction jig. Posteroanterior, side-bending and traction radiographs were taken. Cobb angle and apical vertebra axial rotation measurements were obtained. Flexibility indices in the coronal and axial planes were calculated. Cobb angle reduction and axial derotation were compared between the two methods. A total of 15 (12 female and three male) patients, with a mean age of 15.1 years, were assessed. The mean force imparted on traction films was 800 N. The major curve Cobb angle measurements were 60.4° on standing posteroanterior radiograph, 52.7° on side-bend film and 44.5° on traction at 1.5 times body weight. The corresponding apical vertebrae axial rotations were 23.9°, 22.2° and 16.5°, respectively. The mean Cobb angle reduction was 15.9 for traction and 7.7 for side-bend radiographs (P<0.0001). The mean apical vertebra derotation was 7.4 for traction and 1.7° for side-bend radiographs (P=0.0083). The mean flexibility index in the coronal plane was 0.479. The mean flexibility index in the axial plane was 0.240. Our novel method of traction radiographs at 1.5 times body weight is a safe and reproducible method of assessing curve flexibility in patients with scoliosis. This method achieves a larger Cobb angle and axial derotation when compared with side-bending radiographs.
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http://dx.doi.org/10.1097/BPB.0000000000000550DOI Listing
January 2019

Response to Letter to the Editor on "Acetabular Revision Using Trabecular Metal Augments for Paprosky Type 3 Defects".

J Arthroplasty 2018 06 26;33(6):1983. Epub 2018 Mar 26.

Department of Orthopaedic Surgery, Bon Secours Hospital, Cork, Ireland.

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http://dx.doi.org/10.1016/j.arth.2018.01.044DOI Listing
June 2018

Acetabular Revision Using Trabecular Metal Augments for Paprosky Type 3 Defects.

J Arthroplasty 2018 03 6;33(3):823-828. Epub 2017 Dec 6.

Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.

Background: Trabecular Metal (TM) augments are one option when reconstructing bone loss during acetabular side revision surgery.

Methods: We studied 38 consecutive patients with Paprosky type 3 defects that were revised using a TM shell and one or more augments over a 6-year period. There were 29 Paprosky type 3A defects and 9 Paprosky type 3B defects. The mean age of the patients at the time of surgery was 68.2 years (range 48-84). The mean length of follow-up was 36 months (range 18-74).

Results: The mean preoperative short form 12 health survey improved from 27.7 before operation to 30.1 at the time of final follow-up (P = .001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 53 preoperatively to a mean of 78.8 at final follow-up (P < .0001). There was evidence of radiographic loosening in 7 of the cup-augment constructs. One patient developed a deep infection requiring re-revision. Two patients required revision for aseptic loosening.

Conclusion: The use of TM in complex acetabular reconstruction is associated with good outcome in the short to medium term.
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http://dx.doi.org/10.1016/j.arth.2017.10.031DOI Listing
March 2018

Volar plate versus k-wire fixation of distal radius fractures.

Injury 2016 Feb 7;47(2):372-6. Epub 2015 Sep 7.

University College Hospital Galway, Galway, Ireland.

The optimal management of distal radius fractures remains controversial. The aim of this study was to compare the radiographic and functional outcomes of 318 patients who underwent k-wire fixation or volar plating for fractures of the distal radius. Patients were aged between 20 and 65 years and followed for a mean of 32 months. The mean values for volar tilt, radial inclination, radial length and ulnar variance were all significantly better in the volar plate group. Malunion occurred in 13.2% of patients undergoing k-wiring and 4% of patients treated with a volar plate (p<0.007). Higher values for radial inclination, radial length and volar tilt correlated with better functional outcome as measured by disabilities of the arm shoulder and hand (DASH) and patient rated wrist evaluation (PRWE) scores. Lower values for ulnar variance correlated with better functional outcome. Although volar plate treatment resulted in a superior radiological outcome, there was no evidence that this translated into a superior functional outcome (DASH 13.12 vs. 11.25, p=0.28) (PRWE 17.56 vs. 16.31, p=0.69). The k-wiring procedure remains a suitable inexpensive option for simple fractures. Volar plating should be reserved for complex fractures that cannot be reduced by closed means.
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http://dx.doi.org/10.1016/j.injury.2015.08.040DOI Listing
February 2016

Permeability of rapid prototyped artificial bone scaffold structures.

J Biomed Mater Res A 2014 Nov 29;102(11):4127-35. Epub 2014 Jan 29.

School of Mechanical and Manufacturing Engineering, Dublin City University, Glasnevin, Dublin 9, Ireland; Advanced Processing Technology Research Centre, Dublin City University, Dublin 9, Ireland.

In this work, various three-dimensional (3D) scaffolds were produced via micro-stereolithography (µ-SLA) and 3D printing (3DP) techniques. This work demonstrates the advantages and disadvantages of these two different rapid prototyping methods for production of bone scaffolds. Compared to 3DP, SLA provides for smaller feature production with better dimensional resolution and accuracy. The permeability of these structures was evaluated experimentally and via numerical simulation utilizing a newly derived Kozeny-Carman based equation for intrinsic permeability. Both experimental and simulation studies took account of porosity percentage, pore size, and pore geometry. Porosity content was varied from 30% to 70%, pore size from 0.34 mm to 3 mm, and pore geometries of cubic and hexagonal closed packed were examined. Two different fluid viscosity levels of 1 mPa · s and 3.6 mPa · s were used. The experimental and theoretical results indicated that permeability increased when larger pore size, increased fluid viscosity, and higher percentage porosity were utilized, with highest to lowest degree of significance following the same order. Higher viscosity was found to result in permeabilities 2.2 to 3.3 times higher than for water. This latter result was found to be independent of pore morphology type. As well as demonstrating method for determining design parameters most beneficial for scaffold structure design, the results also illustrate how the variations in patient's blood viscosity can be extremely important in allowing for permeability through the bone and scaffold structures.
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http://dx.doi.org/10.1002/jbm.a.35084DOI Listing
November 2014

Bilateral neck of femur fractures secondary to seizure.

Pract Neurol 2013 Dec 18;13(6):420-1. Epub 2013 Sep 18.

Department of Orthopaedic Surgery, Beaumont Hospital, , Dublin, Ireland.

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http://dx.doi.org/10.1136/practneurol-2013-000669DOI Listing
December 2013

Dislocation of primary total hip arthroplasty and the risk of redislocation.

Hip Int 2012 Sep-Oct;22(5):500-4

Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.

6554 primary total hip arthroplasties were reviewed. Risk factors for dislocation were analysed to assess which were important in terms of predicting recurrent instability. The patients risk of having a second dislocation was independently associated with the surgical approach adopted (p = 0.03) and the time to first dislocation from the primary hip replacement (p = 0.002). Early dislocators whose surgery was performed through an anterolateral approach had less recurrence than late dislocators through a posterior or transtrochanteric approach. None of the other risk factors including head size (p = 0.59), modularity (p = 0.54), mechanism of dislocation (p = 0.23), leg length discrepancy (p = 0.69) and acetabular inclination (p = 0.31) were influential. The use of an abduction brace was not useful in preventing a further dislocation with 69.2% of those braced re-dislocating compared to 68.5% who were not braced (p = 0.96).
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http://dx.doi.org/10.5301/HIP.2012.9747DOI Listing
May 2013

Periprosthetic fractures in the resurfaced hip--a case report and review of the literature.

Injury 2013 Feb 4;44(2):263-5. Epub 2012 Oct 4.

Adelaide and Meath Hospital, Dublin, Ireland.

Traumatic periprosthetic fractures adjacent a hip resurfacing prosthesis are rare. When proximal fractures are encountered the obvious surgical solution is to revise to a large head stemmed femoral component. A previously well functioning implant may however be retained as various non-operative and operative treatment options exist. This paper reports the case history of a traumatic periprosthetic fracture successfully treated with cannulated screw fixation and reviews the current literature.
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http://dx.doi.org/10.1016/j.injury.2012.09.004DOI Listing
February 2013

Talonavicular synostosis with lateral ankle instability--A case report and review of the literature.

Foot Ankle Surg 2012 Sep 7;18(3):e34-6. Epub 2012 Mar 7.

University College Hospital Galway, Ireland.

Talonavicular coalition is a rare autosomal recessive congenital anomaly that is usually asymptomatic and detected incidentally on radiographs. It is associated with symphalangism, clinodactyly, a great toe that is shorter than the second toe, clubfoot, calcaneonavicular coalition, talocalcaneal coalition and a ball-and-socket ankle joint. The authors present a review of the literature and case report of a patient with complete osseous talonavicular coalition, talocalcaneal coalition and lateral ankle instability which was successfully treated with subtalar fusion and lateral ligament reconstruction.
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http://dx.doi.org/10.1016/j.fas.2012.01.002DOI Listing
September 2012

Influence of weather variables on pain severity in end-stage osteoarthritis.

Int Orthop 2012 Mar 29;36(3):643-6. Epub 2011 Jun 29.

University College Hospital Galway, Galway, Ireland.

Purpose: Patients often attribute increasing pain in an arthritic joint to changing weather patterns. Studies examining the impact of weather on pain severity have yielded equivocal and sometimes contradictory results. The relationship between subchondral pseudocysts and the role they play in this phenomenon has not been explored.

Methods: Fifty-three patients with end-stage osteoarthritis of the hip completed daily pain severity visual analogue scale (VAS) scores over a one month period. Radiographs were reviewed to determine the presence of pseudocysts. Data pertaining to precipitation, atmospheric pressure and temperature were collected from the nearest weather station. A generalised linear mixed model was used to explore the relationship between weather variables, cysts and pain severity.

Results: Pain levels increased as a function of absolute change in atmospheric pressure from one day to the next. Precipitation, temperature and the presence of subchondral pseudocysts were not shown to influence pain severity.

Conclusions: This data supports the belief held by many osteoarthritic patients that changing weather patterns influence their pain severity.
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http://dx.doi.org/10.1007/s00264-011-1304-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291761PMC
March 2012

Assessment of a new undergraduate module in musculoskeletal medicine.

J Bone Joint Surg Am 2011 Feb;93(3):e9

Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, Ireland.

Background: Despite the high prevalence of musculoskeletal disorders seen by primary care physicians, numerous studies have demonstrated deficiencies in the adequacy of musculoskeletal education at multiple stages of medical education. The aim of this study was to assess a newly developed module in musculoskeletal medicine for use at European undergraduate level (i.e., the medical-school level).

Methods: A two-week module in musculoskeletal medicine was designed to cover common musculoskeletal disorders that are typically seen in primary care. The module incorporated an integrated approach, including core lectures, bedside clinical examination, and demonstration of basic practical procedures. A previously validated examination in musculoskeletal medicine was used to assess the cognitive knowledge of ninety-two students on completion of the module. A historical control group (seventy-two students) from a prior course was used for comparison.

Results: The new module group (2009) performed significantly better than the historical (2006) control group in terms of score (62.3% versus 54.3%, respectively; p < 0.001) and pass rate (38.4% versus 12.5%, respectively; p = 0.0002). In a subgroup analysis of the new module group, students who enrolled in the graduate entry program (an accelerated four-year curriculum consisting of students who have already completed an undergraduate university degree) were more likely to perform better in terms of average score (72.2% versus 57%, respectively; p < 0.001) and pass rates (70.9% versus 21.4%, respectively; p < 0.001) compared with students who had enrolled via the traditional undergraduate route. In terms of satisfaction rates, the new module group reported a significantly higher satisfaction rate than that reported by the historical control group (63% versus 15%, respectively; p < 0.001).

Conclusions: In conclusion, the musculoskeletal module described in this paper represents an educational advance at undergraduate (i.e., medical-school) level as demonstrated by the improvement in scores in a validated examination. As pressure on medical curricula grows to accommodate advancing medical knowledge, it is important to continue to improve, assess, and consolidate the position of musculoskeletal medicine in contemporary medical education.
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http://dx.doi.org/10.2106/JBJS.J.01220DOI Listing
February 2011

Imaging of soft tissues adjacent to orthopedic hardware: comparison of 3-T and 1.5-T MRI.

AJR Am J Roentgenol 2010 Jan;194(1):W60-4

Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Republic of Ireland.

Objective: The purpose of this study was to compare metal artifact reduction techniques at 1.5-T and 3-T MRI.

Materials And Methods: A titanium plate with steel screws was placed in a freshly harvested pig leg. The leg was imaged with 1.5-T and 3-T MRI. A T2-weighted turbo spin-echo sequence was used with echo-train lengths of 8, 16, 32, and 64 and a constant readout bandwidth of 31.2 kHz. The images were compared qualitatively, and the optimal echo-train length was selected. Images were acquired at the optimal echo-train length with four different readout bandwidths. Artifact was measured quantitatively, and image quality was ranked qualitatively. The qualitatively best image acquired at 1.5 T was compared with the qualitatively highest-ranked image acquired at 3 T.

Results: At both 1.5 T and 3 T, optimal images of equal quality were produced at echo-train lengths of 8 and 16. At higher readout bandwidths, there was quantitatively less artifact. The qualitatively best images were acquired at a readout bandwidth of 31.2 kHz at 1.5 T and 62.5 kHz at 3 T (Cronbach's alpha=1.00). The optimal image at 3 T was qualitatively superior to that at 1.5 T.

Conclusion: Optimizing image acquisition parameters in this phantom model resulted in similar quantitative susceptibility artifact at 3 T and 1.5 T and better qualitative images at 3 T than at 1.5 T.
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http://dx.doi.org/10.2214/AJR.08.1740DOI Listing
January 2010

Tourniquets and exsanguinators: a potential source of infection in the orthopedic operating theater?

Acta Orthop 2009 Apr;80(2):251-5

Cappagh National, Orthopaedic Hospital, Dublin, Ireland.

Background And Purpose: Fomites are increasingly being recognised as a source of hospital-acquired infection. We have therefore assessed tourniquets and exsanguinators for the presence of bacterial pathogens in 1 elective and 2 trauma orthopedic hospitals.

Material And Methods: Swabs were taken prior to and after decontaminating these devices with 1 of 3 different cleaning modalities. These were then assessed for colony counts and organisms identified.

Results: Bacteria commonly implicated in surgical site infections such as coagulase-negative staphylococci, Staphylococcus aureus and Proteus spp. were prevalent. We also found a resistant strain of Acinetobacter and Candida. Exsanguinators were the most heavily contaminated devices, and colony counts in the trauma hospitals were up to 400% higher than in the elective hospital. Alcohol- and non-alcohol-based sterile wipes were both highly effective in decontaminating the devices.

Interpretation: Infectious organisms reside on the tourniquets and exsanguinators presently used in the orthopedic theater. These fomites may possibly be a source of surgical site infection. We have demonstrated a simple and effective means of decontaminating these devices between cases.
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http://dx.doi.org/10.3109/17453670902930016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2823160PMC
April 2009

Superior pole sleeve fracture following patellar stabilisation.

Knee 2009 Jun 17;16(3):235-7. Epub 2008 Dec 17.

Sports Surgery Clinic, Santry, Dublin, Ireland.

Sleeve fractures of the superior pole of the patella are rare. The importance of their diagnosis lies in the fact that the avulsed fragment contains a source of bone forming tissue which may lead to duplication or enlargement of the patella. We report a case in a 16 year old boy who underwent plication of the medial patellofemoral ligament, vastus medialis obliquus advancement and percutaneous lateral release, for recurrent instability. Interruption of the blood supply with subsequent avascular necrosis is one possible mechanism for this complication. Another more likely mechanism is that of failure of the repair and re-dislocation, which may have been contributed to by prolonged cast immobilization.
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http://dx.doi.org/10.1016/j.knee.2008.11.005DOI Listing
June 2009
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