Papers by Hadley Callaway
Clinical Journal of Sport Medicine Official Journal of the Canadian Academy of Sport Medicine, 1997
PURPOSE: A 28-year-old hypertensive professional football player suffered a lacunar stroke. Given... more PURPOSE: A 28-year-old hypertensive professional football player suffered a lacunar stroke. Given the rarity of stroke at this young age, the contributory roles of hypertension and competitive athletics merit consideration.CASE SUMMARY: A 28-year-old defensive lineman, with long-standing, albeit recently well-controlled hypertension, experienced slurred speech and veering to his right after a game. Computerized tomography revealed a small internal capsule infarct. Diagnostic investigation, including coagulation profiling, sickle screen, antiphospholipid antibody, carotid imaging, and echocardiography did not reveal a cause. The patient recovered within days with no residual impairment.DISCUSSION: Despite the extreme blood pressure elevation associated with isometric straining in young athletes, stroke almost never occurs. Vascular changes resulting from chronic hypertension and/or marked volume depletion, and hemoconcentration resulting from restricted salt intake, diuretic use, and heavy sweating, offer the only explanations for this stroke.RELEVANCE: The case suggests physicians should exercise caution in using diuretics and salt-restricted diets to treat hypertensive athletes. Guidelines for treatment are discussed.
Amer J Sport Med, 1995
The extent that the medial collateral ligament complex could be visualized by arthroscopy was det... more The extent that the medial collateral ligament complex could be visualized by arthroscopy was determined in 10 fresh cadaveric elbows from 10 individuals. We carefully exposed the medial collateral ligament complex through a muscle-splitting incision before performing arthroscopy. The anterior and posterior bundles were identified and marked by placing 4.0 nylon sutures deep to the bundles to aid in arthroscopic visualization. A portion of the anterior bundle was visible in only one elbow and in that elbow only the most anterior 25% of the anterior bundle was seen. Attempts to visualize the anterior bundle through additional portals were unsuccessful. Varying the flexion angle of the cadaveric elbow from 0 degrees to 130 degrees also failed to improve visualization. Conversely, the entire posterior bundle, including humeral and ulnar insertion sites, could be seen in all 10 specimens using the posterior portals. We also noted that direct pressure was placed on the ulnar nerve in all specimens when the arthroscope or any arthroscopic instrument was advanced into the posteromedial gutter in contact with the posterior bundle because of its proximity immediately adjacent to the ulnar nerve. The inability to reliably see the anterior bundle and the humeral or ulnar insertion sites of this ligament may limit the value of the arthroscope when assessing medial collateral ligament injuries. Additionally, great care should be taken when using the arthroscope or other instruments in the posteromedial gutter because the ulnar nerve lies immediately adjacent to the thin posterior bundle and capsule.
Although known as a possible graft option for decades, quadriceps tendon grafts have often been t... more Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24-36 months after primary anterior cruciate ligament (ACL) reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. Materials and methods: The study population included 55 patients, of whom 24 were female (43.6%). The mean age at the index procedure was 31.7 years (15-58 years). All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3-38.5 months) after the index procedure. The International Knee Documentation Committee (IKDC) subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Results: Graft harvesting was possible in all cases; a bony extension was never required. On average, graft length was measured at 8.8 cm (7.5-10 cm). The mean IKDC subjective score at follow-up was 80.44 points (55.17-100 points, standard deviation [SD] 12.05). The mean preinjury Tegner activity index was 4.98 (2-7) compared to a mean value of 4.16 (2-7, SD 0.8) at follow-up. There was a mean loss of 0.82 index points. The average Lysholm and Gillquist score was 89 points (65-100, SD 17.7). Of the results, 89.1% were in the good or very good groups; in one case (1.8%), the result was poor, while the rest were fair. Conclusion: ACL reconstruction using a bone plug-free quadriceps tendon autograft achieved satisfactory results in a midterm review.
Medicine & Science in Sports & Exercise, 1996
The Journal of Arthroplasty, 1995
Four of I84 ceramic femoral heads that the authors used in total hip arthroplasty fractured from ... more Four of I84 ceramic femoral heads that the authors used in total hip arthroplasty fractured from 5 to 9 months after surgery. A polyethylene-lined acetabular component was used in all cases. The fracture rate, 2.2%, was much higher than previously reported for ceramic head fractures when used with a polyethylene cup. The fractures occurred during normal daily activities. Possible causes included manufacturing defects, neck length (short in all cases), bearing diameter (28 mm in all cases), cone-trunnion mismatch, excess hoop stresses from impaction, or material deterioration. All patients were treated by removal of debris, wide excision of capsular tissue containing tiny abrasive fragments, exchange of the modular polyethylene liner, and implantation of a cobalt-chrome femoral head. The trunnion had been somewhat damaged by relatively brief exposure to the ceramic particles in every case. The authors' experience suggests that ceramic femoral heads be used with caution.
Clinical Orthopaedics and Related Research, 1994
Forty-four patients (46 hips) with infected total hip arthroplasties were evaluated. They were en... more Forty-four patients (46 hips) with infected total hip arthroplasties were evaluated. They were entered into a protocol that included resection arthroplasty, six weeks of intravenous antibiotics which obtained a minimum postpeak serum bactericidal titer of 1:8, and possible reimplantation. Thirty-two of 46 hips (70%) were reimplanted. At an average of 40 months (range, 24-74 months) after reimplantation, infection recurred in three hips (9%). In two of the three recurrent infections, 1:8 bactericidal titers were not attained. Both of these hips were infected with gram-negative organisms. Minimum postpeak serum bactericidal titers of 1:8 were attained in 28 of 32 hips that were reimplanted, and only one of these hips (4%) had a recurrent infection (p = 0.035). The presence of retained cement after resection arthroplasty (ten hips) was not associated with recurrent infection. Fourteen hips (12 patients were not reimplanted as a result of a combination of factors, including inadequate bone stock, poor soft-tissue quality, and antibiotic resistance of the infecting organism. The treatment of an infected total hip arthroplasty with resection arthroplasty, six weeks of intravenous antibiotics that attains a minimum postpeak serum bactericidal titer of 1:8, and reimplantation can be an effective and safe treatment.
Clinical Journal of Sport Medicine, 1997
A 28-year-old hypertensive professional football player suffered a lacunar stroke. Given the rari... more A 28-year-old hypertensive professional football player suffered a lacunar stroke. Given the rarity of stroke at this young age, the contributory roles of hypertension and competitive athletics merit consideration. A 28-year-old defensive lineman, with long-standing, albeit recently well-controlled hypertension, experienced slurred speech and veering to his right after a game. Computerized tomography revealed a small internal capsule infarct. Diagnostic investigation, including coagulation profiling, sickle screen, antiphospholipid antibody, carotid imaging, and echocardiography did not reveal a cause. The patient recovered within days with no residual impairment. Despite the extreme blood pressure elevation associated with isometric straining in young athletes, stroke almost never occurs. Vascular changes resulting from chronic hypertension and/or marked volume depletion, and hemoconcentration resulting from restricted salt intake, diuretic use, and heavy sweating, offer the only explanations for this stroke. The case suggests physicians should exercise caution in using diuretics and salt-restricted diets to treat hypertensive athletes. Guidelines for treatment are discussed.
Journal of Shoulder and Elbow Surgery, 1999
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Papers by Hadley Callaway