bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Attrition on Implementing and Evaluating a Mental Health Continuing Education Program for Nursing Personnel in Long-Term Care Facilities
Authors: Kreiter Clarence D , Albanese Mark A , Buckwalter Kathleen C , Smith Marianne , Garand Linda
Published: April 2021

ABSTRACT

Background: The effects of attrition on a continuing education program for nursing personnel within long-term care facilities are described.

Methods: Allowing flexible participation can enhance the impact of a continuing education program designed for paraprofessional staff. Increasing the number of nursing staff who experience only a portion of the training has implications for the instructional design and the evaluation. Recommendations to improve accommodation of staff and enhance dissemination of training are offered as well as appropriate evaluation techniques.

Conclusion: Self-contained short units of instruction allow those with minimal time to benefit from the training. Effective evaluation requires special sampling and measurement strategies. Cross-sectional methods make good use of training resources but usually yield measurable changes only in lower-level program objectives.
FDA Issues Antidepressant Suicide Warning
Authors: Anonymous
Published: April 2021

THIS ISSUE: SUICIDE
Rethinking Influenza Vaccination
Authors: Anonymous
Published: April 2021

Helping to Stimulate the Natural Defense Pathways
The Role, Education, and Experience of Health Care Assistants in End-of-Life Care in Long-Term Care: A Scoping Review
Authors: Cronin Una , McCarthy Joan , Cornally Nicola
Published: April 2021

The changing age profile of the human population globally means that the requirement for residential long-term care (LTC) for older adults is escalating, with an associated increase in deaths in these facilities. Health care assistants (HCAs), whose main role is provision of direct care to residents, comprise the largest staff cohort in residential care for older adults. The purpose of this scoping review was to explore three key areas related to HCAs: their role and responsibilities, end-of-life (EOL) education, and their views and experiences of caring for residents at EOL. The literature search included five databases and 32 studies were ultimately reviewed. Key issues were as follows: HCAs feel marginalized and undervalued, they need and desire EOL education, and resident deaths impact negatively on them. The changing care needs for older adults with complex comorbidities at EOL in LTC will place an increased onus on HCAs' skills, knowledge, and personal and professional development. [
Journal of Gerontological Nursing, 46
(1), 21–29.]
TEMPORARY OCCLUSION OF THE COMMON ILIAC ARTERY DURING HEMIPELVECTOMY
Authors: Wu Kent K , Guise Edwin R , Frost Harold M , Mitchell C Leslie
Published: April 2021

ABSTRACT: The surgical technique for temporarily occluding the common iliac artery during hemipelvectomy has been described. Not only can this technique significantly reduce the blood loss and operative time, but it may also minimize postoperative complications and increase the chances of a complete eradication of the primary malignant disease.
COLOR SUBTRACTION ARTHROGRAPHY IN THE DIAGNOSIS OF COMPONENT LOOSENING IN HIP ARTHROPLASTY
Authors: Drinker Henry , Turner Roderick H , McKenzie Joseph D , Bierbaum Benjamin E , Lawsing James F
Published: April 2021

ABSTRACT: While component loosening in arthroplasty of the hip joint may not always be associated with pain, the painful total hip arthroplasty frequently can be shown to be associated with loosening of one or both components. The application of color subtraction techniques to routine arthrography of the hip has greatly increased the authors' accuracy in identifying component loosening in the painful total hip. The technique and its method of application are described in this preliminary report. Several examples of its use are presented. The authors have found this technique to be a useful adjunct to routine arthrography of the hip in selected instances. It has improved overall diagnostic accuracy and is more rapid and less costly than standard photographic subtraction techniques.
ACUTE CALCAREOUS TENDINITIS OF THE SHOULDER IN A PREADOLESCENT
Authors: Paulos Lonnie , Allred S W
Published: April 2021

ABSTRACT: This paper discusses the case report of a 7-year-old white female who presented with acute onset of left shoulder pain. No history of trauma or overuse could be elicited. Physical examination and radiographs confirmed the diagnosis of calcific tendinitis of the subscapularis muscle. Because of continued severe symptoms, the patient underwent surgical decompression of the involved shoulder with complete resolution of symptoms. A search of the literature failed to confirm one documented case of calcific tendinitis in the immature skeleton. A discussion as to the etiology of calcific tendinitis and/or bursitis as it relates to this case is presented.
PATHOLOGICAL FRACTURE IN CHRONIC OSTEOMYELITIS
Authors: Lee Casey K , Hansen Harold T , Weiss Andrew B
Published: April 2021

ABSTRACT: Little has been written in the literature concerning the pathological fracture of the long bones in chronic osteomyelitis, although it has been thought to be not uncommon in practice.

Authors present five cases of pathological fractures of the long bones as a complication of chronic osteomyelitis. Three fractures occurred in tibiae and two in femurs. Two tibial fractures were treated by amputation surgery, and one tibial and two femoral fractures healed after systemic and local treatments. A most important factor affecting fracture healing of the pathological fracture is the condition of surrounding soft tissues.
PATELLA GLIDE BEARING TOTAL REPLACEMENT
Authors: Lubinus Hans H
Published: April 2021

ABSTRACT: The technical procedure and results with the author's patella glide bearing total prosthesis is reported. The endoprosthesis is made of polyethylene on the patellar side and a cobalt-chrome alloy on the femoral side. It can be applied solely or in connection with intramedullary total endoprostheses and also in combination with sled-type endoprostheses. In our immediate and early experience we find that this patella endoprosthesis does relieve retropatellar pain. We feel it is more physiologic than the simple patellectomy and enhances results of other endoprostheses of the knee joint.
CARPONAVICULAR SUBLUXATION: REPORT OF A CASE TREATED WITH PERCUTANEOUS PINS
Authors: Rask Michael R
Published: April 2021

ABSTRACT: While carponavicular subluxation has been reported before, treatment by percutaneous pins of the carponavicular bone has not. A patient with this injury had percutaneous pinning to hold the closed reduction of the subluxed carpal bone and has since progressed to a gradual complete return of function.
THE MANAGEMENT OF 'DEVELOPMENTAL FEMORAL ANTEVERSION': SHAM OR SCIENCE?
Authors: Weiner Dennis S , Weiner Scott D
Published: April 2021

ABSTRACT: A retrospective clinical review of 1,260 consecutive cases of intoeing arising from hip rotation has provided conclusive evidence as to the natural history by spontaneous resolution at the time of skeletal maturation. A concomitant review of 200 randomly selected teenagers failed to provide a single case of manifest intoeing of clinical importance. The conclusion is drawn that treatment other than watchful waiting is unnecessary.
SYNOVIAL SARCOMA: A CASE REPORT
Authors: Jazayeri Mahmood , Gallo Gary
Published: April 2021

ABSTRACT: A case of synovial sarcoma in a six year old boy is reported. A brief discussion of the tumor is also included.
THE NATURAL EVOLUTION OF INTERNAL TIBIAL TORSION
Authors: Weiner Dennis S , Weiner Scott D
Published: April 2021

ABSTRACT: Faced with a confusing body of literature concerning the necessity for treatment of internal tibial torsion, the authors conducted a retrospective review of 395 consecutive cases of manifest intoeing arising from internal tibial torsion. An additional Group of 200 uninvolved teenagers served as older controls. The conclusion drawn supports an attitude of patience and observation as spontaneous resolution is to be routinely expected by skeletal maturity.
TOTAL SHOULDER ARTHROPLASTY FOR THE ARTHROPATHY OF HEMOCHROMATOSIS: A CASE REPORT
Authors: Rand James A , Sim Franklin H
Published: April 2021

ABSTRACT: Hemochromatosis presentingwithonly the manifestations of arthropathy is unusual. Although severe joint involvement by hemochromatosis, leading to total joint arthroplasty in the lower extremities, has been previously reported, involvement of the shoulder has been noted infrequently. We describe a patient with severe arthropathy of hemochromatosis requiring total shoulder arthroplasty and review the orthopedic implications of hemochromatosis. Key words: Arthropathy; Hemochromatosis; Total shoulder arthroplasty.
Bacterial Meningitis Following Pantopaque Myelography: A Case Report and Literature Review
Authors: Schelkun Steven R , Wagner Kenneth F , Blanks James A , Reinert Charles M
Published: April 2021

ABSTRACT: A case of acute bacterial meningitis following Pantopaque myelography is reported, and the literature reviewed pertaining to this uncommon but potentially fatal complication. A positive Gram's stain is most helpful in differentiating bacterial from chemical meningitis. Treatment of the meningitis before and after determination of its cause is described. Preventive steps include removal of Pantopaque from the subarachnoid space immediately at the conclusion of fluoroscopy, and observance of strict sterile technique during myelography, including use of face masks.
Reflex Sympathetic Dystrophy in Children: A Case Report and Review of Literature
Authors: Forster R Scott , Fu Freddie H
Published: April 2021

ABSTRACT: A case of reflex sympathetic dystrophy in a child is reviewed. The work-up, treatment modalities, and a review of the literature are presented.
The UCLA Experience in Limb Salvage Surgery for Malignant Tumors
Authors: Eckardt Jeffrey J , Eilber Frederick R , Dorey Frederick J , Mirra Joseph M
Published: April 2021

ABSTRACT: Between December 1980 and January 1985, 95 patients with 98 malignant bone tumors were treated at UCLA by a multidisciplinary approach. Seventy-eight patients with 81 lesions underwent primary limb salvage procedures utilizing 66 custom endoprostheses and, in 15 instances, soft tissue reconstruction alone. Sixty-three of 78 (80.7%) underwent successful limb salvage without complication. The 22 local complications in 15 patients (19.2%) were all successfully managed either by surigcal or nonoperative techniques salvaging all 15 extremities at risk. Seventeen patients underwent primary amputation for local control of their tumor. The local recurrence rate of 6.4% in the limb salvage group is comparable to the 5.8% found in the amputation group. The selection of patients for limb salvage did not adversely prejudice these patients in terms of rates of progression or ultimate survivorship. The cosmetic and functional results of limb sparing surgery is felt to be at least comparable with that obtained by primary amputation and the use of external prostheses.
Expanding Applications for the Herbert Scaphoid Screw
Authors: Lange Richard H , Engber William D , Clancy William G
Published: April 2021

ABSTRACT: A distinctive new bone screw developed for the management of scaphoid fractures and nonunions promises to have expanding applicability. Its utilization for osteochondral fractures, small joint arthrodeses, osteochondritic lesions, and fractures involving small bones is described. Its unique design affords significant advantages over more conventional management techniques of these problems.
Southern Hip Exposure
Authors: Hunter Stephen C
Published: April 2021

ABSTRACT: The efficacy of the posterior approach to the hip was analyzed in a retrospective study of 168 consecutive procedures performed by the author. Surgical technique is redefined historically and described in detail. Results are studied in two subgroups of hip surgery patients: endoprosthetic replacement (98) and total joint replacement (70). The factors evaluated were surgical time and blood loss, morbidity (dislocation, infection, pain, and limp), mortality, and complications of surgery.

The posterior approach to the hip allowed excellent exposure without transecting tissue planes and creating dead spaces. Operative time averaged less than one hour for all cases, and blood loss, less than 500 cc. The four dislocations that occurred postoperatively were in patients with pre-existing flexion contractures. One superficial infection was noted but there was no increase in morbidity due to pain, limp, or loss of motion. Two total joint replacements were complicated by hematoma formation but occurred in patients who had extensive capsule resection and acetabuloplasty.

Excellent and rapid exposure with minimal soft tissue destruction or blood loss coupled with few postoperative complications should encourage orthopedic surgeons to include the posterior approach in their treatment of hip problems.
Subacute Pyogenic Osteomyelitis
Authors: Gillespie W J , Moore T E , Mayo K M
Published: April 2021

ABSTRACT: Records of 110 cases of subacute osteomyelitis were reviewed. Twenty percent of the cases with a subacute clinical course had diffuse radiological changes more characteristic of an acute disease. Classic metaphyseal (Brodie) abscesses were most common. Diaphyseal lesions, of which over half were in adults, had a significantly higher rate of recurrence. The distribution by site and age of metaphyseal lesions resembled that of acute osteomyelitis. Staphylococcus aureus was the most common isolate, but 10% of lesions grew S. epidermidis. A modification of current classification is suggested which offers a basis for management and studies of outcome.
Comparison of Ceforanide and Cephalothin Prophylaxis in Patients Undergoing Total Joint Arthroplasty
Authors: Soave Rosemary , Hirsch Judith C , Salvati Eduardo A , Brause Barry D , Roberts Richard B
Published: April 2021

ABSTRACT: One hundred one patients undergoing total hip and knee arthroplasty were randomly assigned to receive either two 1 gm doses of ceforanide or five doses of cephalothin perioperatively. Simultaneous plasma and cancellous bone specimens were obtained intraoperatively and assayed for antibiotic concentration.

Ceforanide plasma and bone levels remained sustained over six hours. Cephalothin plasma and bone levels obtained three to four hours post administration were 91% lower than levels obtained one hour post-dose. Patients were examined for infection for up to 18 months following surgery. None of the patients developed an infected implant. The sustained plasma and bone levels achieved with ceforanide obviate the need for intraoperative dosing necessary with other agents.
The Effects of Pulsed Fluid Irrigation on Bony Ingrowth in Porous Polyethylene Implants
Authors: Ritter Merrill A , Sieber Jon M
Published: April 2021

ABSTRACT: Twelve adult dogs were used to evaluate the effect of pulsed isotonic saline irrigation on bony ingrowth. The distal supracondylar ridge of the knee was transected. Six dogs had the area irrigated with a pulsed lavage system for 15 sec and six dogs did not. A porous piece of polyethylene was then stapled to the cancellous surface. Three of each were evaluated histologically at 3 weeks and 6 weeks. The pulsed irrigation significantly decreased the depth of bone penetration into the sections of polyethylene.
Complete Posterior Acromioclavicular Dislocation: A Case Report
Authors: Barber F Alan
Published: April 2021

ABSTRACT: While acromioclavicular joint injury is not uncommon, a complete posterior dislocation in which the distal clavicle penetrates and is entrapped by the trapezius muscle is among the most rare. Early open reduction with reconstruction of the periosteal-muscular envelope as well as repair of the coracoclavicular ligaments permitted a rapid and full recovery. No previous report has indicated any concurrent pulmonary problems, but as this case report and literature review indicate, a careful evaluation of the pulmonary status is mandatory since pneumothorax and pulmonary contusions are possible.
A Review of Applications of MRI in Soft Tissue and Bone Tumors
Authors: Kalmar John A , Eick John J , Merritt Christopher R B , Shuler Stanton E , Miller Kenneth D , McFarland Gordon B , Jones Jerry J
Published: April 2021

ABSTRACT: Due to excellent soft tissue contrast and multiplanar imaging capability, MRI is assuming a major role in recognition, staging, and treatment planning of soft tissue and bone tumors. Direct sagittal, coronal, and axial images permit assessment of intraosseous and extraosseous extension of tumors and their relationship to the joints and neurovascular structures, and detection of "skip" lesions. MRI allows improved detection of recurrent tumors in the presence of non-ferromagnetic metallic implants as compared to CT. In the evaluation of soft tissue tumors, MRI is more sensitive than CT and allows differentiation among fat, muscle, tendon, bone, and vascular structures based on signal characteristics. Over a period of 18 months, 100 soft tissue masses and bone tumors were evaluated using MRI. Spin echo sequences with T1 and T2 weighted images were most valuable in differentiating normal and abnormal tissues. Calculated comparative measurements of relaxation times showed no reliable difference between benign and malignant tumors.
Naproxen Sodium: Comparative Efficacy and Tolerability of Two Dosages for Pain After Joint Surgery
Authors: Goldberg Marc A , McLaughlin George E , Kieffer David A , Stern Lawrence , Hirose Hideo , Akeson Wayne , Hewson George E
Published: April 2021

ABSTRACT: In a multicenter, randomized, double-blind, parallel trial, the efficacy and tolerability of two regimens of naproxen sodium were compared in a two-day treatment of moderate to severe pain following open surgery of the hip, shoulder, knee, and ankle joints. Of 147 patients enrolled, the data of 99 were valid for efficacy analysis, 45 in the low-dose regimen (day 1, 1,100 mg; day 2,825 mg) and 54 in the highdose regimen (1,650 mg/day). At 12 interviews each day, patients evaluated intensity of pain using numerical scales and recorded complaints. At the end of the study, overall efficacy was evaluated. Although there were no statistically significant differences between the two regimens for efficacy or tolerability, the highdose regimen achieved greater pain relief in patients who had hip or shoulder surgery, suggesting that this regimen had greater cumulative efficacy for these patients.
Recurrent Osteoblastoma of the Carpal Hamate
Authors: Menon Jayasanker , Rankin Donald , Jacobson Charles
Published: April 2021

ABSTRACT: A case of recurrent osteoblastoma of the hamate is reported. Curettage and bone grafting is usually followed by recurrence. Wide excision of the tumor is the treatment of choice if anatomically feasible.
Transpedicular Segmental Fixation: Description of a New Procedure
Authors: Karlström Göran , Olerud Sven , Sjöström Lennart
Published: April 2021

ABSTRACT: The treatment of unstable fractures of thoracolumbar vertebrae is a controversial issue in the orthopedic community. The various methods employed for operative stabilization of these injuries have to date been found to have major disadvantages. A new therapeutic principle and a new device for stable internal fixation are presented.
Staging Systems for Musculoskeletal Neoplasms
Authors: Finn Henry A , Simon Michael A
Published: April 2021

ABSTRACT: In the treatment of musculoskeletal neoplasms, preservation of limb function and prolongation of survival have improved over the past decade. With the current emphasis on limb salvage procedures for local control of tumors, and with the addition of adjunctive therapy, the ability to classify and stage these unusual tumors is important in determining prognosis and treatment. In such classifications, a number of prognostic factors are identified and used to define stages. Three recognized staging systems exist for sarcomas of soft tissues and two for sarcomas of bone; there is one system for benign tumors of bone. The prognostic variables used in assigning stages are common to all of these systems, but the relative significance assigned to these variables differs. Documented improvement in survival and preservation of function suggests that current staging systems are significantly affecting outcome in the management of musculoskeletal tumors.
Complications of the PCA Anatomic Patella
Authors: MacCollum Maxwell S , Karpman Robert R
Published: April 2021

ABSTRACT: A retrospective review of the total knee arthroplasties performed using the PCA anatomic patella (Howmedica, Rutherford, NJ) was undertaken after a high rate of complications was noted. Eighty-seven knees in 75 patients were evaluated with an average follow up of 16 months. Eighteen complications of the patella in 14 knees were found (16%); these included lateral subluxation (10 knees), fracture of the patella (5 knees), patellar tendon rupture (2 knees) and prosthetic loosening (1 knee). Seven patients required secondary procedures with the ultimate result greatly compromised in four patients. It is proposed that if the component is not precisely aligned, the eccentric shape and central ridge increases the forces acting at the patella and leads to an increased risk for complications, making the component less forgiving than the more standard dome-shaped patellar component.
A Physiological Comparison of the Short-Leg Walking Cast and an Ankle-Foot Orthosis Walker Following 6 Weeks of Immobilization
Authors: Neumann Holm , O'Shea Patrick , Nielson Jean-Paul , Climstein Michael
Published: April 2021

ABSTRACT: latrogenically induced weakness, stiffness, and functional impairment associated with classical methods of short-leg cast immobilization have long been recognized. This study compares the effects of "controlled" immobilization with an ankle-foot orthosis (AFO) and short-leg cast (SLC) immobilization for 6 weeks. A significant reduction in loss of range of motion, muscular strength, and muscular atrophy, ie, functional impairment, at the time of cessation of immobilization was noted when an AFO was used. The additional advantages of an AFO are the elimination of multiple cast changes including economic benefits, ease in the assessment of functional improvement during treatment, and convenient adjustment for swelling and atrophy.
Analysis of Mechanical Factors Affecting Fixation of Olecranon Fractures
Authors: Homer Steven R , Sadasivan Kalia K , Lipka John M , Saha Subrata
Published: April 2021

ABSTRACT: Fractures of the most distal part of the olecranon process differ from more proximal fractures because a plane of instability exists between the humerus and the radial head. Thus, the fixation of these fractures must resist the deforming forces of the forearm flexor muscles. The investigators fixed 10 paired cadaver ulnae with either the tension-band wire technique or a one-third tubular plate, and tested the specimens to simulate the effect of the biceps and brachialis muscles. The average maximum fixation stiffness for specimens fixed with the one-third tubular plate was found to be 1 63 N/mm compared with 53 N/mm for the tension-band wire group. This study indicates that for fractures of the distal part of the olecranon, fixation with screws and a one-third tubular plate affords better resistance to the forces applied by the brachialis and the biceps brachii than the tension-band wire technique.
Orthopedic Research: An Overview of Data Entry, Database Management, and Statistical Analysis
Authors: Kassing David R , Ritter Merrill A , Faris Philip M , Keating E Michael , Nyhuis Allen W
Published: April 2021

ABSTRACT: An orthopedic practitioner can facilitate clinical research and analyze quality assurance data with a minor investment in a personal computer, an optical scanner, and two software packages, namely a database manager and a statistics program. One of the most time-consuming stages in the research process includes entering patient chart data, editing and manipulating the data (database management), and analyzing the data (statistical analysis). This can be automated to a large extent with the above mentioned equipment. This article focuses on the steps involved in organizing an orthopedic office for research. The steps include choosing a method of data entry, choosing and implementing a database package, and choosing and implementing a statistics package. This discussion is followed by a practical review of basic statistics applicable to orthopedic research. Several simple and advanced tests are described and examples are given for each.
THE MENISCUS
Authors: Bessette Gary C
Published: April 2021

ABSTRACT

Abnormalities and injuries of the meniscus have been studied for decades. An expanded knowledge of knee biomechanics and the advent of arthroscopy have changed the diagnosis and treatment of meniscal pathology over the past decade. This review highlights some of the relevant literature concerning the meniscus.
POLYMETHYLMETHACRYLATE-ANTIBLASTIC DRUG COMPOUNDS: AN IN VITRO STUDY ASSESSING THE CYTOTOXIC EFFECT IN CANCER CELL LINES-A NEW METHOD FOR LOCAL CHEMOTHERAPY OF BONE METASTASIS
Authors: Greco Francesco , de Palma Luigi , Specchia Nicola , Jacobelli Stefano , Gaggini Cristiana
Published: April 2021

ABSTRACT

An in vitro study was performed assessing the pharmacologic properties of polymethylmethacrylate (PMMA)-antiblastic agent (doxorubicine and cisplatinum) mixtures in normal and neoplastic cell lines cultures. The study's aim was to analyze the polymerization capacity of PMMA in the presence of doxorubicine and cisplatinum, the release of drug from the mixture, the kinetics of release, and the effect of the released drugs in normal and neoplastic cell cultures. Our data show that even at high concentrations neither doxorubicine nor cisplatinum inhibit the polymerization of PMMA. Moreover, mixtures in vitro can release the antiblastic drug which maintains its pharmacologic activity on sensitive neoplastic cells. Therefore, the PMMAantiblastic drug mixtures, along with current anti-cancer therapy (systemic chemotherapy and radiation therapy), may provide better local control of the metastatic lesion and of some bone tumors.
UNILATERAL FACET DISLOCATIONS AND FRACTURE-DISLOCATIONS OF THE CERVICAL SPINE: A REVIEW
Authors: Beyer Craig A , Cabanela Miguel E
Published: April 2021

ABSTRACT

Unilateral facet dislocations or fracture-dislocations of the cervical spine constitute an important subgroup of cervical spine injuries. According to the literature, the diagnosis of this entity is often missed and the treatment is controversial. On the basis of our patient review, we conclude that operative intervention appears superior to nonoperative treatment of these injuries. Nonoperative management is often fraught with inability to obtain and maintain anatomic reduction and, in addition, late pain and instability frequently ensue. Alternatively, operative intervention provides the greatest probability for achieving and maintaining anatomic reduction and appears to eliminate chances of late symptoms.
LOW LUMBAR BURST FRACTURES: COMPARISON BETWEEN CONSERVATIVE AND SURGICAL TREATMENTS
Authors: An Howard S , Simpson J Michael , Ebraheim Nabil A , Jackson W Thomas , Moore Joseph , O'Malley Neil P
Published: April 2021

ABSTRACT

Twenty-two low lumbar burst fractures (L3-L5) were treated, with an average follow up of 56.2 and 39.0 months in the conservative and surgically treated groups, respectively. Twenty patients were available for review; seven were treated conservatively and 13 were stabilized surgically. All patients were evaluated clinically for work status, activity level, residual pain, and subsequent development of neurologic symptoms. Roentgenograms were reviewed for severity of initial fracture, canal compromise, and maintenance of initial correction. In general, neurologically intact patients in both groups returned to similar postinjury employment levels. Persistent back pain was found to be more disabling in the surgically treated group, in which a fusion incorporating four or five lumbar segments was performed. There was no evidence of significant loss of initial reduction, and no patients experienced late neurological compromise in the surgical group. An average follow-up kyphosis of 9.2° and 31% loss of vertebral height were observed in the conservative group, while a follow-up lordosis of 1° and 19% loss of vertebral height were observed in the surgical group. Conservative treatment of low lumbar burst fracture is a viable option in neurologically intact patients, but loss of lordosis and vertebral height may persist. Biomechanical and anatomic characteristics of the low lumbar spine differ from the thoracolumbar region and may account for the inherent stability of these injuries. If surgery is chosen, a long fusion with distraction instrumentation should be avoided in the low lumbar spine. A short rigid fixation with pedicular instrumentation may be of greater benefit.
PHYSEAL INJURIES OF THE DISTAL HUMERUS
Authors: Peterson Hamlet A
Published: April 2021

ABSTRACT

Physeal injuries of the distal humerus comprise approximately 10% of all physeal injuries. Diagnosis of these injuries at a young age before the ossification centers have ossified and become visible radiographically is difficult. Poor outcome of distal humeral physeal injuries is not uncommon and can be best prevented by knowledge of anatomy and the use of all appropriate imaging techniques. The focus of this article is to correlate anatomy at different ages with the occurrence of specific injuries.
SPINAL CORD INJURY OCCURRING IN PATIENTS WITH ANKYLOSING SPONDYLITIS: A MULTICENTER STUDY
Authors: Apple David F , Anson Carol
Published: April 2021

ABSTRACT

Treatment of spinal fractures causing paralysis in patients with ankylosing spondylitis is difficult. A multicenter concurrent study evaluated 59 patients-22 managed operatively and 37 nonoperatively. The two groups were compared for neurologic outcome, complications, mortality, and length of stay. The results indicated that patients in the nonoperative group had a significantly shorter length of stay and, therefore, a significantly lower cost of care. No other differences between operative and nonoperative groups were identified in regard to other outcome variables. Results of descriptive analyses of patient characteristics and treatment choices have significant implications for practitioners.
Follow up on Uncemented Total Knee Arthroplasty
Authors: Fanning John W , Joseph James , Kaufman Eugene E
Published: April 2021

ABSTRACT

Follow up data on 42 uncemented total knee arthroplasty patients were examined at an average follow-up period of 5 to 7 years. The prosthetic components were examined clinically using the modified Hospital for Special Surgery knee rating system and radiographicalIy using fluoroscopically guided radiographs. When compared to the preliminary report, the knee rating score dropped from an average of 94 to 78, with most of the poor results due to patellar failure requiring revision. As in our preliminary study, complications centered on the metal-backed patellar component. Revision of the patellar component was required in 1 9 of 42 knees (45%). Three of 42 (7%) tibial components required revision, and 2 of 42 (5%) femoral components were revised. Interface lucencies were examined and changes were documented. Other complications included osteolysis in 4 of 42 (1 0%), bent patellar component in 3 of 42 (7%), and loose titanium mesh (5%).
Open vs Endoscopic Carpal Tunnel Release
Authors: Gibbs Karen E , Rand William , Ruby Leonard K
Published: April 2021

ABSTRACT

We examined a consecutive group of patients who had undergone either open (34 patients) or single portal endoscopic (12 patients) carpal tunnel release performed by one surgeon over a period of 3 years. Fiftyseven total procedures were performed. There were no operative complications. Retrospective evaluation was done by questionnaire. We were unable to demonstrate any statistically significant difference between the two groups in terms of return to work, return to activities of daily living, or on a symptom severity scale.
Repair of Soft Tissue to Bone Using a Biodegradable Suture Anchor
Authors: Ono Kozo , Williams Gerald R , Clem Michael , Chong James Lee , Wirth Michael A , Aufdemorte Thomas B , Groh Gordon I , Rockwood Charles A
Published: April 2021

ABSTRACT

The medial collateral ligaments of 1 8 New Zealand rabbits were surgically detached from bone. In one knee, the ligament was repaired using a biodegradable suture anchor composed of a co-polymer of lactic and glycolic acid. The contralateral medial collateral ligament was not repaired. Animals were sacrificed at 4, 8, and 1 2 weeks after the operation, and the knee that had the ligament repair was compared with the contralateral control knee. All knees were tested manually tested for stability to valgus stress and then prepared for histologic examination. Medial collateral ligaments repaired using the biodegradable suture anchor demonstrated stability to valgus stress and anatomic healing at the bone-tendon junction. Resorption of the implant was virtually complete by 1 2 weeks. All specimens demonstrated less inflammatory reaction to the suture anchor than to the attached Vicryl suture. This contrasts with the control group, which was grossly unstable and demonstrated scarring in this nonanatomic position. These results demonstrate efficacy of this particular material of biodegradable implant and justify further investigative efforts.
Ceramics for Total Hip Replacement - What a Surgeon Should Know
Authors: Willmann Gerd
Published: April 2021

ABSTRACT

Numerous clinical results reported in the literature prove that ceramic femoral heads reduce wear, osteolysis, and revision rates in total hip replacements (THRs). Femoral heads and cups made out of alumina ceramics were introduced about 25 years ago, and femoral heads made out of zirconia were introduced about 10 years ago. Today, the wear couples of alumina-on-polyethylene or zirconia-on-polyethylene have become the standard in THR. The wear couple offering the lowest wear rate is alumina-on-alumina. This article discusses the state of the art and lists advantages as well as problems with the various materials used for prostheses in THR.
Revision Arthroplasty of Femoral Cortex Defect Using a Noncemented Stem, Mennen Plate, and Bone Graft
Authors: Kligman M , Othrimski I , Roffman M
Published: April 2021

ABSTRACT

Twelve patients who underwent total hip replacement complicated by aseptic loosening with severe bone loss were included in this study. Two patients had aseptic loosening of the second revision, six of the third revision, and the remaining four patients of the fourth revision total hip replacement. In all patients, the radiographs revealed an extremely thin cortex around the stem of the prosthesis and almost complete disappearance of one cortex. All patients were treated by revision total hip replacement in conjunction with Mennen plate fixation and allograft bone support. The allograft bone support included three cortical struts and nine massive bone grafts that used cement as a strew.

The results were satisfactory in 10 patients in respect to functional activity, pain and radiographic evaluation. In two patients who underwent their fifth revision, the results were unsatisfactory but better than before the operation. Mennen plate fixation provides a sufficient and easy technique for aseptic loosening of total hip replacement with severe bone loss. By preserving the periosteal blood supply, the time required for bone graft incorporation is shortened, resulting in an early final outcome.
Posterior Atlantoaxial Fixation: The Magerl Screw Technique
Authors: Silveri Christopher P , Vaccaro Alexander R
Published: April 2021

ABSTRACT

Atlantoaxial transarticular fixation is a proven stabilization technique used to augment conventional sublaminar fusion. Along with its superior biomechanicai profile comes the inherent risk of neurovascular injury and potential compromised fixation during its application. This article presents a detailed systematic guide to this procedure including preoperative evaluation, positioning, and the more subtle aspects of the surgical technique. A new instrumentation design that has enhanced the ease and accuracy of screw placement with less operative frustration and potential morbidity of previous systems also is presented.
RADIOLOGIC CASE STUDY: Ulnar collateral ligament injury
Authors: Tan Franklin , Lomasney Laurie M , Demos Terence C
Published: April 2021

This 22-year-old semi-pro, right-handed baseball pitcher (Fig 1) has had persistent elbow pain distal to the humeral epicondyle since pitching for seven innings 2 weeks ago. Your diagnosis?
Red Blood Cell Transfusion Practices in Patients Undergoing Orthopedic Surgery: A Multi-Institutional Analysis
Authors: Audet A M , Andrzejewski C , Popovsky M A
Published: April 2021

ABSTRACT

This retrospective review analyzed and compared transfusion practices in patients undergoing orthopedic surgery in five Massachusetts hospitals with current practice guidelines; opportunities for improvement were identified. Patient-specific clinical information and data about transfusion practices were obtained from the medical records of 384 Medicare patients undergoing orthopedic surgery between January 1992 and December 1993.

The number of patients who donated autologous blood preoperatively differed significantly among hospitals as did the number of autologous units that were unused. The number of blood units transfused at each transfusion event also differed significantly; some surgeons transfused ≥2 units in the majority of their patients, while others transfused 1 unit at a time. This variation in practice was not explained by differences in patients' clinical status. The mean pretransfusion hematocrit was higher for autologous versus allogeneic blood, suggesting more liberal criteria to transfuse autologous blood. Nearly half of all transfusion events were determined to have been potentially avoidable. Avoidable transfusions were also three to seven times more likely with autologous than with allogeneic blood.

Significant inter-hospital differences existed in the number of elective surgery patients exposed to allogeneic blood. The major determinant of allogeneic blood use in these patients was the availability of autologous blood. Each additional autologous blood unit available decreased the odds of allogeneic blood exposure twofold. Differences in intraoperative and postoperative blood salvage use also were noted. These findings indicate that significant variations in practice exist. Comparative data enabled hospitals to identify and target specific areas for improvement.
Cervical Facet Dislocation: Management Following Delayed Diagnosis
Authors: Kahn Anthony , Leggon Robert , Lindsey Ronald W
Published: April 2021

ABSTRACT

This study examined the influence of early versus late initial presentation of patients with cervical spine facet dislocation on presentation, neurologic deficit, and the success of closed reduction. Thirty-four patients were studied, and approximately 35% presented at least 72 hours following their injury. Compared with patients who presented early, this late group demonstrated less neurologic deficit, and closed reduction was less likely to be successful. These findings suggest that a distinction should exist in the management algorithm between early versus late presentation of cervical facet dislocation.
The Role of Fixation of the Fibula in Open Fractures of the Tibial Shaft With Fractures of the Ipsilateral Fibula: Indications and Outcomes
Authors: Whorton Adrian M , Henley M Bradford
Published: April 2021

ABSTRACT

To determine the indications for fibular fixation in cases of combined fractures of the tibia and fibula and the effect of fibular fixation on tibial healing, a retrospective study of open fractures of the tibial shaft with concomitant fibula fractures was conducted at a level one trauma center. Apparent indications for fibular fixation included the presence of a syndesmotic injury and location of fracture within the distal third of the fibula. No significant differences were found in the healing rates, incidence of nonunion and malalignment, or in the number of required subsequent procedures between patients who did and did not undergo fibular stabilization. These results suggest that fixation of the fibula in open fractures of the tibia and fibula has no effect on fracture healing or alignment. A randomized, prospective study is needed to properly validate these findings.
Avulsion Injuries of the Thumb: Survival Factors and Functional Results of Replantation
Authors: Aziz Waqar , Noojin Frank , Arakaki Akira , Kutz Joseph E
Published: April 2021

ABSTRACT

Twenty-seven cases of replantation for avulsion injuries of the thumb from 1979 to 1987 were analyzed retrospectively. Inclusion criteria required all thumbs to have tendinous attachments (either the extensor pollicis longus or the flexor pollicis longus) to the amputated part. Thirteen replants survived for an overall survival rate of 48%. Avulsions at or proximal to the metacarpophalangeal joint had a survival rate of 83% compared with a 38% survival rate distal to the metacarpophalangeal joint. This difference was not statistically significant. Of the 13 patients with surviving replanted thumbs, 11 (85%) achieved protective sensation only and 2 attained a two-point discrimination <10 mm. Of the 13 replanted thumbs that survived, 7 were treated with primary arthrodesis, 4 at the level of the interphalangeal joint and 3 at the metacarpophalangeal joint. The other 6 thumbs were treated with primary or secondary tendon transfers.

In a literature review of thumb avulsion injuries, survival rates range from 26% to 100%. In this study, tendon transfers and primary arthrodesis were useful adjuncts in the management of thumb avulsions, and the majority of patients with successfully replanted thumbs attained protective sensation only. Larger studies are needed to better define statistically significant relationships affecting replantation survival.
A Comparison of Danaparoid and Warfarin for Prophylaxis Against Deep Vein Thrombosis After Total Hip Replacement
Authors: Comp Philip C , Voegeli Thomas , McCutchen John W , Skoutakis Vasilios A , Trowbridge Arthur , Overdyke William L
Published: April 2021

ABSTRACT

Orgaran (danaparoid sodium injection) is a novel antithrombotic agent. Early studies suggest that this compound may be beneficial in preventing deep vein thrombosis in predisposed patients. This multicenter, randomized, assessor blinded, clinical trial compared subcutaneous danaparoid with warfarin for the prevention of deep vein thrombosis in patients undergoing hip replacement surgery. Bilateral venography was used to detect thrombi. Patients also underwent follow-up examinations 1, 2, and 3 months after discontinuation of the study to determine the after effects of treatment.

Nearly 27% of patients who received warfarin and 14.6% of patients who received danaparoid developed deep vein thrombosis, a risk reduction of 46%. The absolute difference in the incidence of deep vein thrombosis was 12.3% in favor of danaparoid. The incidence of venographically documented proximal deep vein thrombosis was 1.5% for danaparoid and 4.1% for warfarin. These results demonstrate that danaparoid is more effective than warfarin in preventing deep vein thrombosis following hip replacement surgery. The preoperative administration of danaparoid does not increase surgical blood loss compared with warfarin.
Allografting in Uncemented Acetabular Revision
Authors: Reikeraas Olav , Folleraas Gunnar , Winge Johan F
Published: April 2021

ABSTRACT

From 1987 to 1991, a total of 43 acetabular revisions were performed in 39 patients aged 36 to 79 years. In group A (26 revisions in 24 patients), morselized allograft was used to fill in cavitary acetabular defects, and in group B (17 revisions in 15 patients), a solid (bulk) allograft was used to reconstruct defects of the acetabular rim, mainly superiorly. An uncemented acetabular cup was used in all cases. Follow-up ranged from 4 to 7 years. Results demonstrated that while large structural or morselized allografts are useful in reconstructing the anatomy, there is a high rate of loosening due to resorption. The failure rate of bulk graft was higher than that of morselized graft, but because the bone stock in failures is usually restored, a second revision is easier.
Fatal Pulmonary Embolism After Total Hip Arthroplasty: Diurnal Variations
Authors: Wroblewski B M , Siney Paul D , Fleming Patricia A
Published: April 2021

ABSTRACT

From 1970 through 1986, a total of 18,104 Charnley low-friction arthroplasties were performed; of these, 122 deaths occurred from pulmonary embolism within 1 year of surgery. Diagnosis was confirmed by post-mortem examination in 71% of cases. The exact time of the onset of the complication was recorded in 90 cases. In 74 (82%) cases, the time of collapse occurred during the 7-hour period from 9:00 AM to 4:00 PM, and in 16 (18%) cases, it occurred in the 17-hour period from 4:00 PM to 9:00 AM. The patient's activity at the time of collapse was recorded in 73 cases. Sixty (82%) were mobile, 3 were in the bathroom, and 10 (14%) were in bed. Sixty-six (70.2%) patients died within 1 hour of the onset of symptoms.
Arthroscopic Findings in the Initial Stages of Hip Osteoarthritis
Authors: Santori N , Villar R N
Published: April 2021

ABSTRACT

Standard radiographic projections have poor diagnostic ability in detecting early degenerative changes of the hip. Comparison of arthroscopic and radiographic findings is the best method to assess the accuracy of conventional radiography. This study reviewed the records and radiographs of 234 hip arthroscopies. One hundred eighty-six of the patients had normal preoperative radiographs; of these, 60 (32.2 %) had evidence of osteoarthritis at arthroscopy. The extent and location of the chondral damage were studied, and both of these parameters were correlated to the radiographic appearance of osteoarthritis. Hips with normal radiographs but arthroscopic osteoarthritis were found to have less damage compared with the radiographically osteoarthritic hip. Hips with normal radiographs also were more likely to have only one side (60%) of the joint damaged, either the acetabulum or femoral head. Conversely, when osteoarthritis was evident radiographically, both sides of the joint were usually involved (75.7%). These patients are often young (average age: 36 years), and women are more likely to be affected than men (71 % versus 29%).
The Lumbosacral Nerves in Relation to Dorsal S1 Screw Placement and Their Locations on Plain Radiographs
Authors: Ebraheim Nabil A , Haman Steve P , Xu Rongming , Stanescu Stephan , Yeasting Richard A
Published: April 2021

ABSTRACT

Seven adult cadaver lumbopelvises were harvested to study the anatomic relationship of the L4 and L5 nerves to Sl dorsal screw placement and the location of the L4, L5, and Sl nerves on plain radiographs. The mean lateral angle of Sl screw trajectory toward the L4 nerve was 31 ±8°, and the mean screw trajectory length was 53±8 mm. The mean lateral angle of the screw trajectory toward the L5 nerve was 21 ±8°, and the mean screw trajectory length was 38±4 mm. On both inlet and outlet radiographs, the lateral angle of the nerves increased from L4 to Sl . The L4 nerve coursed over the middle third of the superior ala in the inlet view and the middle third of the lateral mass in the outlet view. The L5 nerve coursed over the inner third of the superior ala and inner third of the lateral mass. On the lateral view, the mean distances from the sacral promontory to the L4, L5, and Sl nerves along the anterior border of the sacrum were 4±7 mm, 12±5 rnm, and 28±8 mm, respectively. This study suggests that Sl sacrai screws be directed between 30° and 40° lateral to avoid compromising the lumbosacral trunk and sacroiliac joint.