bluuebunny/crossref_metadata_2025 huggingface dataset:
Avulsion Fractures of the Tibial Tubercle
Authors: Abalo A , Akakpo-Numado KG , Dossim A , Walla A , Gnassingbe K , Tekou AH
Published: October 2016

Purpose.

To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients.

Methods.

Records of 12 patients aged 11 to 17 (mean, 14) years with avulsion fractures of the tibial tubercle presenting to our hospital from April 1998 to September 2004 were studied. Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed.

Results.

Eight patients injured the right side, 3 the left side, and one both sides. They all engaged in sports or active play during the injury. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. Three patients with type-I fractures and one with a type-IIB fracture were treated with closed reduction and cast immobilisation for 3 to 4 (mean, 3.8) weeks. The remaining 9 fractures were treated with open reduction and internal fixation. The mean follow-up period was 39 (range, 23–59) months. No complications were noted. Ten patients had excellent results and 2 had fair results.

Conclusion.

Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes.
Review Article: Kinematic Evaluation of the Spine: A Kinetic Magnetic Resonance Imaging Study
Authors: Morishita Y , Hymanson H , Miyazaki M , Zhang HH , He W , Wu G , Kong MH , Wang JC
Published: October 2016

Kinetic magnetic resonance images (kMRIs) of 587 lumbar and 459 cervical spines of symptomatic patients in axially loaded, upright neutral (0°), flexion (40°), and extension (-20°) positions were evaluated. Imaging took 10 to 12 minutes to complete in each position. Cervical kinematics were significantly affected by intervertebral disc degeneration, cervical cord compression, and sagittal alignment of the cervical spine. kMRI was effective in diagnosing lumbar disc herniations that are often missed using conventional MRI. kMRI is effective for diagnosing, evaluating, and managing degenerative disease or injury within the spine.
Osteomyelitis Variolosa: A Report of Two Cases
Authors: Arora A , Agarwal A , Kumar S
Published: October 2016

We present 2 patients with osteomyelitis variolosa in both elbow joints—sequelae of smallpox. The condyles were elongated and the central portions of the distal humeri were absorbed and the elbow joints were unstable. One of the patients sustained a closed fracture of the distal humerus. The fracture united uneventfully following stabilisation and bone grafting. At the 13-year follow-up, the patient had satisfactory elbow function.
Giant Cell Reparative Granuloma of the Proximal Tibia: A Case Report
Authors: Hori T , Kanamori M , Ohmori K , Nobukiyo M , Kimura T
Published: October 2016

Giant cell reparative granulomas (GCRGs) are non-neoplastic inflammatory lesions, usually of the jaw or gingiva or small bones of the hands and feet. We report one such case in the right proximal tibia of a 45-year-old man. Radiological studies showed a lytic lesion with marginal sclerosis in the epiphysis and metaphysis. After open biopsy, a preliminary diagnosis of a benign giant cell tumour was made. One month after admission, the lesion was curetted and filled with cancellous bone and hydroxyapatite. Based on the histology of the curetted lesion, the diagnosis was changed to a GCRG. The patient had an uneventful postoperative course, with no evidence of local recurrence and metastasis. He died from gastric cancer 2 years later.
Isolated Rupture of the Lateral Collateral Ligament during Yoga Practice: A Case Report
Authors: Patel SC , Parker DA
Published: October 2016

We report a case of isolated rupture of the lateral collateral ligament (LCL) of the knee while attempting to place the left foot behind the head during yoga practice. The 34-year-old man had discomfort of the lateral aspect of the knee particularly with varus strain. A magnetic resonance image revealed rupture of the LCL at the insertion onto the fibula. The patient had grade-II laxity of the LCL and was treated non-operatively. At the 12-month follow-up, grade-I laxity of the LCL remained clinically evident, but function was not impaired.
Intramedullary Nailing for Adult Hypophosphatasia: A Case Report
Authors: Leung HW , Wong CW , Shen WY
Published: October 2016

Hypophosphatasia is a rare genetic metabolic disorder characterised by defective bone mineralisation secondary to serum and bone alkaline phosphatase deficiency. We report a 46-year-old woman who underwent multiple intramedullary nailings for fractures and deformities of 6 long bones over 13 years.
Two-Plate Fixation for Humeral Shaft Nonunions
Authors: Martinez Angel Antonio , Cuenca Jorge , Herrera Antonio
Published: October 2016

Purpose.

To review 22 patients who underwent 2-plate fixation for non-union of the humeral shaft.

Methods.

13 women and 9 men aged 32 to 76 (mean, 48) years underwent fixation for non-union of the humeral shaft, using a 2-plate construct, together with decortication, debridement, and bone grafting. The two 3.5-mm reconstruction plates were parallel and lying at 90° to each other and fixed with screws purchasing into at least 6 cortices of each fragment for both plates. Fractures were located in the upper third (n=8) or middle third (n=14) of the humerus. Initial treatments included casting (n=9), coaptation splinting (n=8), multiple retrograde pinning (n=4), and Marchetti-Vicenzi nailing (n=1). 18 non-unions were atrophic and 4 were hypertrophic. Shoulder and elbow range of motion as well as functional results were evaluated.

Results.

The time for union was 4.6 (range, 4–6) months. No implants were loose or broken. No nonunion or infection was noted. Functional results were excellent in 17 and good in 5 patients. One patient had iatrogenic radial nerve palsy that recovered within 3 months.

Conclusion.

Two-plate fixation achieves good results for humeral shaft non-unions.
Six-Year Experience with the Delta III Reverse Shoulder Prosthesis
Authors: Grassi Federico Alberto , Murena Luigi , Valli Federico , Alberio Riccardo
Published: October 2016

Purpose.

To report the clinical and radiographic results and complications of the Delta III reverse prosthesis.

Methods.

24 women and 2 men aged 62 to 84 (mean, 75) years underwent total shoulder replacement using the Delta III reverse prosthesis. Patient diagnoses were massive rotator cuff tear (n=20), disabling sequelae of proximal humeral fractures (n=3), and failure of an unconstrained arthroplasty (n=3). Clinical and functional results were assessed using the Constant scale. Active range of motion (ROM) was measured. Scapular notching and radiolucent lines around the humeral component were evaluated using radiographs. Patient satisfaction of the treatment was evaluated by a direct interview.

Results.

23 patients were followed up for 26 to 84 (mean, 42) months. Two patients had loosening of the glenoid component (at 6 months and 5 years) and underwent revision surgery. There were no instances of infection, instability, or acromial fracture. Only active elevation improved significantly after surgery, as did both the absolute and adjusted Constant scores. 12 patients were completely pain-free, 9 complained of slight pain, and one of moderate pain. The severity of scapular notching progressed with time. 15 patients were satisfied with the treatment, 6 were partially satisfied, and 2 were not satisfied.

Conclusion.

The Delta III prosthesis restores shoulder function but has biomechanical limits. Its use should be limited to elderly patients with severe impairment of the glenohumeral joint. Scapular notching is a main concern for the long-term survival of the implant.
Distal Femoral Rotational Axes in Indian Knees
Authors: Mullaji Arun B , Sharma Amit K , Marawar Satyajit V , Kohli Anirudh F , Singh Dharmendra P
Published: October 2016

Purpose.

To measure the angular relationships of distal femoral rotational axes in 100 normal Indian knees.

Methods.

42 men and 8 women aged 26 to 40 (mean, 31) years, with 100 normal non-arthritic knees were recruited. Anatomic landmarks were measured using computed tomography. They included the posterior condylar axis, the transepicondylar axis, the anteroposterior axis (Whiteside's line), the posterior condylar angle (PCA), the Whiteside-epicondylar angle (W-EP), and the Whiteside-posterior condylar angle (W-PC).

Results.

The mean PCA, W-EP, and W-PC were 5°, 90.8°, and 95.8°, respectively. The mean femorotibial alignment was 179.6°. The differences between the left and right sides were significant only for the W-EP and W-PC. Only the PCA and W-EP were weakly correlated ( r=0.338, p=0.001).

Conclusion.

There are differences in distal femoral rotational axes among Indian, Caucasian, and Japanese knees. Our data can be used to evaluate changes in those axes in ageing or arthritic patients.
Transforaminal Lumbar Interbody Fusion for Failed Graf Ligamentoplasty: A Report of Two Cases
Authors: Nagano Akihito , Miyamoto Kei , Nishimoto Hirofumi , Hosoe Hideo , Suzuki Naoki , Shimizu Katsuji
Published: October 2016

We report 2 cases of transforaminal lumbar interbody fusion for failed Graf ligamentoplasty. Both patients had residual or recurrent low back pain and leg pain after Graf ligamentoplasty, caused by lumbar segmental instability or narrowing of their intervertebral foramens. The pain improved markedly after the revision surgery. We recommend transforaminal lumbar interbody fusion for failed Graf ligamentoplasty, as it provides rigid interbody bony fusion and obviates complete exposure of the dural sac or dural tube.
One-Stage Osteotomy and Fixation Using a Long Proximal Femoral Nail and Fibular Graft to Correct a Severe Shepherd's Crook Deformity in a Patient with Fibrous Dysplasia: A Case Report
Authors: Kataria Himanshu , Sharma Neeraj , Kanojia Rajesh Kumar
Published: October 2016

We report a case where a one-stage osteotomy and fixation, using a long proximal femoral nail and fibular graft, was performed to correct a severe shepherd's crook deformity (70° varus and 50° retroversion) of the femoral neck with a pathological stress fracture in a patient with fibrous dysplasia. The neck shaft angle was corrected to 125°. At the 57-month follow-up, the patient was free of pain and had no limp or evidence of recurrence.
Intramedullary Nailing and Plate Osteosynthesis for Fractures of the Distal Metaphyseal Tibia and Fibula
Authors: Krishan Ajay , Peshin Chetan , Singh Dara
Published: October 2016

Purpose.

To assess the results of concurrent intramedullary nailing plus plate osteosynthesis for fractures of the distal tibia and fibula.

Methods.

15 men and 10 women (mean age, 35 years) with concurrent fractures of the distal tibia and fibula underwent intramedullary nailing (for the tibia) and plate osteosynthesis (for the fibula). 17 fractures were type A1, 6 type A2, and 2 type A3. Compound type IIIB or more extensive fractures were excluded.

Results.

The mean follow-up duration was 2 years. The mean time to bone union was 20 weeks. Six patients underwent dynamisation and 4 bone grafting. Two patients had malalignment (angulation of >5° in any plane), but none was rotational. No patient had shortening, hardware breakdown, or deep-seated infection. Two patients had superficial cellulitis at the site of the distal locking screws.

Conclusion.

Concurrent intramedullary nailing and plate osteosynthesis for fractures of the distal tibia and fibula is effective in preventing malalignment. Plate osteosynthesis for the fibula provides additional stability even when a single distal locking bolt is used to fix the intramedullary nail to the tibia.
Radiofrequency Coblation for Chronic Foot and Ankle Tendinosis
Authors: Yeap Ewe Juan , Chong Keen Wai , Yeo William , Rikhraj Inderjeet Singh
Published: October 2016

Purpose.

To evaluate outcomes of radiofrequency coblation for chronic tendinosis of the foot and ankle tendons.

Methods.

Records of 7 men and 8 women (16 feet) aged 27 to 65 years who underwent radiofrequency coblation for chronic tendinosis (combined with other procedures for other pathology) of the Achilles, posterior tibial, and peroneal tendons were retrospectively reviewed. The visual analogue scale (VAS) for pain status, the Short Form (SF-36) questionnaire for quality of life, and the American Orthopaedic Foot and Ankle Society (AOFAS) scores for functional status of the patients were determined pre- and post-operatively.

Results.

All patients reported significant reduction in pain at 3 months, with more than 63% attaining VAS scores of 0 at 6 months. AOFAS scores were significantly improved at both 3 and 6 months. Most components of SF-36 scores improved at 6 months except those for general health and role emotional; only those for bodily pain improved significantly. At postoperative month 3 and 6 respectively, 93 and 100% of the patients had their expectations met, whereas 93 and 88% had good-to-excellent satisfaction. There were no major complications.

Conclusions.

Radiofrequency coblation for chronic tendinosis of the foot and ankle achieves good short-term outcomes and pain relief. It may be combined with other procedures for maximal benefit.
Rotary Subluxation of the Metacarpophalangeal Thumb Joint: A Case Report
Authors: Cheng Sze-Chung , Yen Chi-Hung , Chan Wai-Lam , Wong Wing-Cheung , Mak Kan-Hing
Published: October 2016

Irreducible rotary subluxation of the metacarpophalangeal joint (MCPJ) of the thumb is a rare entity. Open reduction is indicated when signs of irreducibility are seen on the radiographs. We present one such case caused by displacement of the sesamoid bone into the intercondylar notch of the first metacarpal bone. A 35-year-old woman sustained a twisting injury to her right thumb by pronating and hyperextending it while attempting to retrieve things that she had dropped into a basin conduit. True lateral radiographs showed rotary subluxation of the thumb MCPJ, a sesamoid bone overlapping with the metacarpal head, and loss of the subsesamoid joint space and an incongruent MCPJ on full flexion. A high level of clinical suspicion is needed to diagnose this rare entity.
Eleven-Year follow-up of Second-Generation Metal-on-Metal Total Hip Arthroplasty
Authors: Park Myung-Sik , Chung Woo-Chul , Yoon Sun-Jung , Cho Hong-Man , Kwon Suk-Hyun
Published: October 2016

Purpose.

To investigate the cause of failure in matte-surface cemented stems in second-generation metal-on-metal total hip arthroplasty (THA).

Methods.

Records of 26 men and 11 women (39 hips) aged 29 to 72 years who underwent primary cementless THAs by a single surgeon using second-generation metal-on-metal prostheses and were followed up for a mean of 122 (range, 120–141) months were reviewed. Two types of femoral stems were used: a cementless Ti-alloy stem (n=21) and a matte-surface, iron-based alloy, cemented stem (n=18). Clinical outcomes were measured using the Harris hip score. Radiographs were assessed for stem loosening and osteolysis. Patient activity levels were graded. Surfaces of the retrieved femoral stems and periprosthetic tissue samples were examined. Metallic and cement particles were studied. Hypersensitivity to metal was tested.

Results.

None of the cementless stems were revised; no osteolysis or stem loosening occurred. In contrast, 7 of 18 matte-surface cemented stems were revised owing to stem loosening or osteolysis. Periprosthetic tissues revealed abundant cement-related particles; 90% were zirconium oxides but a few were iron particles. Histological examination of periprosthetic tissues showed perivascular infiltration of lymphocytes and macrophages containing tiny foreign materials. Metal hypersensitivity was not associated with aseptic loosening.

Conclusion.

Metal-on-metal THA with cementless components could be recommended for young, active patients to prevent wear and osteolysis. The matte-surface cemented stem is more likely to fail owing to friction during the earlier stage and cement-related biological processes during the later stage.
Open Interlocking Nailing and Bone Grafting for Neglected Femoral Shaft Fractures
Authors: Gavaskar Ashok S , Kumar Ramesh
Published: October 2016

Purpose.

To review the treatment outcome of patients with neglected femoral shaft fractures.

Methods.

Records of 22 men and 3 women aged 20 to 55 (mean, 36) years who underwent open interlocking nailing and bone grafting for neglected (≥2-month-old) closed femoral shaft fractures were reviewed. 21 had nonunion and 4 had malunion. All patients had deformed, shortened, and wasted lower limbs, with knee stiffness. The mean delay in presentation was 3 (range, 2–7) months.

Results.

Patients were followed up for a mean of 18 (range, 14–30) months. The mean time for radiological union was 5 (range, 4–7) months. Three patients had delayed union (≥6 months) and underwent secondary procedures (dynamisation or bone marrow injection). None had non-union. All had some degree of shortening; in 3 it was >2 cm. None had neurological injury following acute gain in length. None had deep infections; 2 had superficial wound infections and 6 had pin tract infections. Mean knee flexion improved 50° (from 70° to 120°) and the mean extensor lag decreased 7° (from 15° to 8°). After a mean of 18 weeks, 23 of the patients were able to return to their work.

Conclusion.

Open interlocking nailing and bone grafting coupled with aggressive rehabilitation can achieve acceptable results for patients with neglected femoral shaft fractures.
Anatomic Variations of Neurovascular Structures of the Ankle in Relation to Arthroscopic Portals: A Cadaveric Study of Chinese Subjects
Authors: Woo Siu-Bon , Wong Tak-Man , Chan Wai-Lam , Yen Chi-Hung , Wong Wing-Cheung , Mak Kong-Ling
Published: October 2016

Purpose.

To investigate anatomic variations of neurovascular structures in the ankle and the safety margin for arthroscopic portals.

Methods.

11 left and 12 right ankles from 8 female and 15 male fresh cadavers of Chinese ethnicity aged 53 to 88 (mean, 68) years were used. The ankle was standardised in a plantigrade position, zero-degree inversion, and neutral rotation. Four ankle portals, namely anteromedial (AM), anterolateral (AL), posteromedial (PM) and posterolateral (PL), were identified using 23-gauge needles. Skin and subcutaneous fat were dissected from the underlying fascia to visualise neurovascular structures. Distances were measured from: (1) the AM portal to the saphenous vein and nerve and its branches, (2) the AL portal to branches of the superficial peroneal nerves, of which the lateral one was labelled as the intermediate dorsal cutaneous branch and the medial one as the medial dorsal cutaneous branch, (3) the PM portal to the posterior tibial neurovascular bundles, and (4) the PL portal to the sural nerve.

Results.

The distances from (1) the AM portal to branches of the great saphenous vein and nerve, and (2) the AL portal to the intermediate dorsal cutaneous branch of the superficial peroneal nerve were short and may be an anatomic hazard. Variations were significant among the cadavers in terms of distances of the portals to the neurovascular structures.

Conclusion.

In Chinese cadavers, variations of neurovascular structures are significant. Care must be taken to avoid inadvertent injury during ankle arthroscopy.
Review Article: Thromboprophylaxis after Total Hip Replacement
Authors: Kurmis Andrew P
Published: October 2016

The risk of secondary haematologic complications such as deep vein thrombosis or pulmonary embolism increases significantly when a transient period of hypercoagulability is induced after total hip replacement (THR). A number of drug-based anticoagulant approaches are available to modulate this risk, but the optimal length of therapy for such approaches remains unclear. The literature was reviewed for evidence-based support of the routine use of an extended course (>14 days) of thromboprophylaxis after THR. Electronic databases and real-time online literature searches were performed, using the PubMed (Medline), EMBASE, CINAHL and GoogleScholar, and the Cochrane and British Medical Journal Clinical Evidence libraries. Author-defined key word searches were performed. Only articles in the English language, for which full text could be retrieved, were reviewed. There is robust evidence to support an extended course (>14 days) of thromboprophylaxis after THR. Such recommendations have been translated into the guidelines of key professional bodies, including those of the American College of Chest Physicians. Meta-review suggests a clear benefit of such regimens and supports wider adoption, even when weighed against a small increase in adverse events.
Use of a Cement-Loaded Kuntscher Nail in First-Stage Revision Hip Arthroplasty for Massive Femoral Bone Loss Secondary to Infection: A Report of Four Cases
Authors: Richards Corey , Bell Chris J , Viswanathan Sameer , English Hugh , Crawford Ross W
Published: October 2016

A 2-stage revision total hip replacement (THR) is the standard treatment for a chronically infected THR with severe metadiaphyseal bone loss. A long-stem cemented prosthesis as part of a temporary articular spacer is commonly used during the first-stage procedure. Nonetheless, this option is expensive and can pose difficulties for patients with a small medullary canal. A construct using an antibiotic cement-loaded Kuntscher nail cemented with a highly polished Exeter stem has been devised and used in 4 patients.
Late Recurrence of Giant Cell Tumour of Bone after Curettage and Adjuvant Treatment: A Case Report
Authors: Suehara Yoshiyuki , Nozawa Masahiko , Kim Sung-Gon , Nagayama Masataka , Kojima Tomoko , Torigoe Tomoaki , Kubota Daisuke , Yazawa Yasuo , Takagi Tatsuya , Matsumoto Toshiharu
Published: October 2016

We report a rare case of late recurrence of a giant cell tumour (GCT) of bone 16 years after curettage and cryosurgery treatment. A 46-year-old man presented with swelling and progressively worsening pain in the lateral aspect of his right distal femur. He had undergone 4 procedures elsewhere to manage a GCT of bone and its recurrence 16 to 23 years previously. He underwent en bloc resection with an adequate wide margin and reconstruction with prosthesis. At the one-year follow-up, there was no evidence of recurrence or metastasis.
Effect of Lag-Screw Positions on Modes of Fixation Failure in Elderly Patients with Unstable Intertrochanteric Fractures of the Femur
Authors: Wu Chi-Chuan , Tai Ching-Lung
Published: October 2016

Purpose.

To investigate the effect of lag-screw positions in the femoral head on modes of fixation failure.

Methods.

591 patients aged ≥65 years underwent sliding compression screw fixation for type A1 (n=249) and type A2 (n=342) intertrochanteric fractures of the femur after low-energy injuries. There were 18 cases of fixation failure; in 13 (group 1) the lag screw was placed in the central-central area, and in 5 (group 2) in the inferior 1/3-central area. Clinical variables of the 2 groups were compared.

Results.

All 18 cases of fixation failure were actually type A23 and misinterpreted as type A22 fractures. In 13 cases, failure was attributable to cut-out of the lag screws at the superolateral edge of the femoral head. In 3 cases, failure was attributable to telescoping and >2 cm shortening of the femur. In one case, failure was due to penetration of the lag screw into the acetabulum. In another case, failure was due to plate loosening with breakage of cortical screws. In the 13 cases with cut-out of the lag screw (group 1), the lag screw was placed in the central-central area (p<0.001). In the remaining 5 cases with no cut-out (group 2), the lag screw was placed in the inferior 1/3–central area (p<0.01). Complications occurred significantly earlier in group 1 than in group 2 patients (2.6 vs. 4.6 months, p=0.02). The tip-apex distance was significantly shorter in group 1 than in group 2 patients (19 vs. 30 mm, p<0.001).

Conclusion.

Misinterpretation of type A23 fractures as type A22 may lead to fixation failure. Operative treatment should not be delayed once complications occur. The positions of the lag screw may affect the mode of fixation failure.
Bicycle-Spoke Injuries of the Foot in Children
Authors: Agarwal Anil , Pruthi Manish
Published: October 2016

Purpose.

To evaluate the characteristics of bicycle-spoke injuries in a suburban Indian population.

Methods.

30 male and 11 female children aged 4 to 12 (mean, 6) years with bicycle-spoke injuries were prospectively studied. Data collected included patient age, gender, position at the time of injury, site, type, and characteristics of the injury. According to the Oestern and Tscherne classification, soft-tissue injuries were classified into grades 0 to 3.

Results.

37 patients injured the right foot, and 4 the left foot; 34 by the rear wheel and 7 by the front wheel. All front-wheel injuries involved the forefoot and midfoot. 73% of injuries involved the lateral aspect of the ankle. The most common injury site was the posterior ankle (n=30), followed by the medial midfoot (n=7), and the forefoot (n=3). Partial avulsion of heel flap and an exposed Achilles tendon were each noted in 2 patients. 10, 13, 14, and 4 patients sustained soft-tissue injuries of grades 0, 1, 2, and 3, respectively. Eight patients had associated fractures. All fractures healed uneventfully. Marginal necrosis of the wound was noted in 5 patients, but none required a skin graft. No patient had functional impairment or residual tenderness of the foot.

Conclusion.

Bicycle-spoke injuries usually affected the ankle region, and the wound was usually deeper than it appeared on initial examination. Reassessment of the wound after 48 hours is recommended. Severity of soft-tissue injury was the determinant of overall function; bone fractures by themselves did not alter the duration of recovery. To prevent bicycle-spoke injuries, spoke guards and foot rests should be used, and children being carried on a bicycle should wear proper shoes. Education on injury mechanism, severity, and preventive measures is also important.
Corresponding Scapular Pain with the Nerve Root Involved in Cervical Radiculopathy
Authors: Mizutamari Masaya , Sei Akira , Tokiyoshi Akinari , Fujimoto Toru , Taniwaki Takuya , Togami Wakana , Mizuta Hiroshi
Published: October 2016

Purpose.

To correspond scapular pain with the nerve root involved in cervical radiculopathy.

Methods.

In the anatomic study, 11 Japanese adult cadavers were dissected to examine the numbers and courses of the cutaneous nerves from C3 to C8 dorsal rami. In the clinical study, 14 men and 11 women aged 34 to 77 years who presented with scapular pain as well as pain, numbness or motor weakness in the upper limbs secondary to cervical radiculopathy were assessed. The involved nerve roots were identified based on the symptoms and signs in the arm and/or fingers, the radiological diagnosis, and the pain response to cervical nerve root blocks. The sites and characteristics of radicular pain were assessed.

Results.

In the anatomic study of 22 cutaneous nerves from medial branches of dorsal rami, 18 involved the C5 nerve root, 0 the C6 root, one the C7 root, and 8 the C8 root. In the clinical study, the radicular pain often occurred in the suprascapular region involving the C5 root, in the suprascapular to posterior deltoid region involving the C6 root, in the interscapular region involving the C7 root, and in the interscapular and scapular regions involving the C8 root. All patients with C5 or C8 radiculopathy had both superficial and deep pain, whereas almost all patients with C6 or C7 radiculopathy had deep pain only. No patient had superficial pain only.

Conclusion.

Cervical radiculopathy can cause scapular pain. Pain sites and characteristics are related to the affected nerve root.
Conservative Treatment for Mild Femoroacetabular Impingement
Authors: Emara Khaled , Samir Wail , Motasem EL Hausain , Ghafar Khaled Abd EL
Published: October 2016

Purpose.

To report early results of conservative treatments (including modifications in activities of daily living) for mild femoroacetabular impingement.

Methods.

27 male and 10 female athletic patients aged 23 to 47 years presented with unilateral hip pain secondary to femoroacetabular impingement and an alpha angle of <60°. Patients were instructed to adapt to their safe range of movement and perform activities of daily living with minimal friction. The Harris Hip Score and non-arthritic hip score before and after treatment were compared. Open or arthroscopic hip surgery to remove the impinging bone was indicated when conservative treatment failed.

Results.

Patients were followed up for 25 to 28 months. Of the 37 patients, 4 underwent surgical treatment after conservative management failed. For the remaining 33 patients, the mean Harris Hip Score improved significantly from 72 before treatment to 91 at the 24-month follow-up. The mean non-arthritic hip scores improved from 72 to 91, and the mean visual analogue scores for hip pain from 6 to 2. Six of the 33 patients had recurrent hip pain and discomfort but not severe enough for surgical treatment.

Conclusion.

Conservative treatment did not improve the range of hip movement, despite improvement in function and symptoms. Yet it achieved good early results, as long as the patients could modify activities of daily living to adapt to their hip morphology.
Long-Term Results of Total Knee Arthroplasty for Valgus Knees: Soft-Tissue Release Technique and Implant Selection
Authors: Rajgopal Ashok , Dahiya Vivek , Vasdev Attique , Kochhar Hemanshu , Tyagi Vipin
Published: October 2016

Purpose.

To report long-term results of total knee arthroplasty (TKA) for valgus knees.

Methods.

34 women and 19 men aged 39 to 84 (mean, 74) years with valgus knees underwent primary TKA by a senior surgeon. Of the 78 knees, 43, 29, and 6 had type-I, type-II, and type-III valgus deformities, respectively. A preliminary lateral soft-tissue release was performed, and the tibia and femur were prepared. The tight lateral structures were released using the pie-crusting technique. In 92% of the knees, cruciate-retaining implants were used. In knees with severe deformity and medial collateral ligament insufficiency, the posterior cruciate ligament was sacrificed and constrained implants were used. The Hospital for Special Surgery (HSS) knee score was assessed, as were tibiofemoral alignment, range of motion, stability, and evidence of loosening or osteolysis.

Results.

Patients were followed up for 8 to 14 (mean, 10) years. All knees had a good patellar position and were clinically stable in both mediolateral and anteroposterior planes. No radiolucency was noted. The mean HSS knee score improved from 48 to 91 (p<0.001). The mean tibiofemoral alignment improved from valgus 20° to 5° (p<0.001). The mean range of motion improved from 65° to 110° (p<0.001). One patient developed a deep infection at year 4, and 2 had periprosthetic fractures at years 6 and 8.

Conclusion.

Adequate lateral soft-tissue release is the key to successful TKAs in valgus knees. The choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release needed to obtain a stable, balanced flexion and extension gap, in order to achieve minimal constraint with maximum stability.
Shoulder Ultrasonography versus Arthroscopy for the Detection of Rotator Cuff Tears: Analysis of Errors
Authors: Singisetti Kiran , Hinsche Andreas
Published: October 2016

Purpose.

To compare shoulder ultrasonography with arthroscopy for detecting specific rotator cuff tears. Methods. 96 shoulders in 56 men and 34 women aged 28 to 65 (mean, 42) years with rotator cuff problems underwent a shoulder ultrasonography by a single radiologist, and then a shoulder arthroscopy by a single surgeon. The ultrasonographic and arthroscopic findings were compared with regard to tendon-specific tears and disparities in diagnosis.

Results.

For detection of supraspinatus tendon tears, ultrasonography attained a sensitivity of 89%, specificity of 43%, positive predictive value of 76%, and negative predictive value of 100%. For detection of subscapularis tendon tears, ultrasonography attained a sensitivity of 30%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 78%. Sensitivity, specificity, and predictive values were good in larger full-thickness tears, but were significantly reduced in sub-centimetre and partial-thickness tears, particularly of the subscapularis tendon.

Conclusions.

Surgeons should be aware of the potential disparities between ultrasonographic and arthroscopic findings and be prepared to adjust the surgical procedure during arthroscopy.
Alendronate-Associated Femoral Insufficiency Fractures and Femoral Stress Reactions
Authors: Wang Kemble , Moaveni Afshin , Dowrick Adam , Liew Susan
Published: October 2016

Purpose.

To report characteristics and outcomes of 8 patients who underwent intramedullary nailing for alendronate-associated femoral insufficiency fractures.

Methods.

Records of 7 women and one man aged 54 to 91 (mean, 72) years who underwent intramedullary nailing for spontaneous or low-energy, alendronate-associated femoral insufficiency fractures were retrospectively reviewed. Contralateral femurs were assessed for stress reactions.

Results.

All patients had at least 4 (range, 4–10) years of alendronate use. Five patients had experienced prodromal pain lasting one day to 5 months. Five patients had received concurrent glucocorticoid therapy. At the 6-month follow-up, 6 patients had bony union, one had hypertrophic non-union and underwent dynamisation and nail exchange and eventually achieved union at month 16, and one had fixation loss and underwent nail exchange and bone grafting and eventually achieved union at month 9. In 3 patients, the contralateral femurs were painful, and cortical stress reactions were noted. They underwent prophylactic intramedullary nailing. Radiographs showed no evidence of new stress reactions or fractures.

Conclusion.

Contralateral involvement in patients with alendronate-associated femoral insufficiency fractures is not uncommon. Early prophylactic intramedullary nailing may provide effective pain relief and prevent progression to a fracture.
Neural Fibrolipoma of the Digital Nerve: A Case Report
Authors: Gundes Hakan , Alici Tugrul , Sahin Mustafa
Published: October 2016

A 32-year-old woman underwent microsurgical resection of a neural fibrolipoma of the digital nerve of the ring finger. At the 6-month follow-up, the patient had good recovery, no recurrence, and preservation of neural function. Caution should be exercised while planning microsurgical dissection on soft-tissue masses of fingers and hands. Total resection of the lesion and nerve grafting should be avoided.
Factors Predicting Progression in Early Degenerative Lumbar Scoliosis
Authors: Kohno Shinsuke , Ikeuchi Masahiko , Taniguchi Shinichirou , Takemasa Ryuichi , Yamamoto Hiroshi , Tani Toshikazu
Published: October 2016

Purpose.

To review early radiographs of patients with de novo degenerative lumbar scoliosis to determine factors predicting early scoliosis progression.

Methods.

Standing anteroposterior and lateral radiographs of 7 men and 20 women aged 48 to 83 (mean, 63) years with Cobb angles between >5° and <20° were reviewed. They were followed up for a mean of 12 (range, 10–18) years. Radiographic variables measured included (1) the Cobb angle, (2) the grade of rotation of the apical lumbar vertebra, (3) the presence of a lateral vertebral translation of ≥3 mm, (4) the degree of osteoporosis, and (5) the Harrington factor (the degree of scoliosis divided by the number of vertebrae involved).

Results.

During the follow-up period, the mean Cobb angle increased 5.3° from 10.1° to 15.4°, representing an increase of 0.4° per year. In initial radiographs, the apical vertebral rotation was rated as grade 0 in 3 patients, grade 1 in 19, grade 2 in 4, and grade 3 in one. A lateral vertebral translation of ≥3 mm was noted in 9 patients. The degree of osteoporosis was rated as grade 0 in 9 patients, grade 1 in 11, grade 2 in 5, and grade 3 in 2. The mean Harrington factor was 2.4. In the multiple regression analysis, only the grade of apical vertebral rotation was significantly correlated with scoliosis progression (regression coefficient=0.502, p=0.009).

Conclusion.

Apical vertebral rotation may help predict the scoliosis progression and determine the timing of surgical intervention in patients with early degenerative lumbar scoliosis.
Collagen Membranes for Host-Implant Integration: A Pilot Clinical Study
Authors: Nathan Saminathan Suresh , Guerzon Edwin Ravanzo , Bhavanam Kishore , Tan Lay Hong , Zarchi Khin , Pereira Barry P
Published: October 2016

Purpose.

To evaluate host-implant integration with collagen membranes in 14 patients who underwent limb salvage surgery for musculoskeletal oncological disease.

Methods.

8 females and 6 males aged 10 to 69 (mean, 30) years underwent limb savage surgery with collagen membranes (Tutomesh; Tutogen Medical, Germany) for osteosarcoma (n=7), chondrosarcoma (n=3), giant cell tumour (n=1), malignant fibrous histiocytoma (n=1), arteriovenous malformation (n=1), and pigmented villonodular synovitis (n=1). The procedures performed were proximal humeral resection (n=3), partial scapulectomy (n=1), proximal femoral resection (n=2), total femoral resection (n=2), proximal tibial resection (n=3), and wide resection of soft tissues of the knee (n=3). In addition, 10 patients underwent endoprosthesis reconstruction. Reconstruction of musculoskeletal defects was classified into type I (intercalary, n=2), type II (joint, n=4), and type III (both, n=8). Graft incorporation and local recurrence were monitored. Clinical outcome measures entailed the Short Form-36, Toronto Extremity Salvage Score (TESS), and Musculoskeletal Tumor Society Score (MSTS).

Results.

Two patients with proximal tibial resection and one with total femoral resection had wound healing problems. No patient had any infection or any foreign body reaction necessitating implant removal. Eight patients with type II or III reconstruction were followed up for a mean of 11 (range, 1–23) months. Their scores in the Short Form-36, TESS, and MSTS were similar to those who had undergone reconstructions without the membrane, with the exception of type II reconstructions for which the membrane conferred good results.

Conclusion.

The Tutomesh membrane facilitated host-implant integration and provided a feasible anatomic reconstruction for ligaments in the shoulder, knee, and hip.
Long-Term Outcome of Total Hip Replacement in Patients with or without Femoral Head Contamination
Authors: Ibrahim Talal , Aswad Mayyar Ghazal , Dias Joseph J , Brown Andrew R , Esler Colin N
Published: October 2016

Purpose.

To compare long-term outcomes of total hip replacement (THR) in patients with or without contamination of the femoral head.

Methods.

After a mean period of 12 (range, 8–17) years, 104 female and 71 male THR patients aged 47 to 96 (mean, 77) years were reassessed via a self-administered questionnaire, and 25 other THR patients were reassessed by review of case notes. The questionnaires comprised the 12-item Oxford hip score and the European Quality Of Life (EuroQOL). 87 and 88 patients had positive and negative cultures in the donated femoral heads, respectively. The 2 groups were compared with respect to the Oxford hip score, the EuroQOL, and rates of complication and revision surgery.

Results.

Long-term outcomes of THR patients with or without femoral head contamination were not significantly different. Respectively, the mean Oxford hip scores were 36 and 39 (p=0.4); 16 and 14 patients had the maximum score of 48; 2 and 3 patients scored <10 (mostly owing to aseptic loosening). The respective mean visual analogue scale score of the EuroQOL were 65 and 73 (p=0.07); only the dimension of self care was significantly different between groups (p=0.04). Respectively, 14 and 12 patients had complications (16% vs. 15%, χ2=0.05, p=0.8), whereas 11 and 5 patients had revision surgery (13% vs. 6%, χ2=2.2, p>0.1).

Conclusion.

Microbiological screening of donated femoral heads plays no role in predicting long-term failure of THR in the donors.
Sacroiliitis Caused by Salmonella Typhi: A Case Report
Authors: Garg Bhavuk , Madan Mohit , Kumar Vijay , Malhotra Rajesh
Published: October 2016

Sacroiliitis caused by Salmonella typhi is rare. In India, unilateral sacroiliitis is usually caused by tuberculosis. We report a 22-year-old man who presented with a high-grade fever and positive blood culture for Salmonella typhi. The patient was treated with intravenous vancomycin and levofloxacin for 15 days and then oral levofloxacin for 6 weeks.
Chondromyxoid Fibroma of the Lateral Malleolus: A Case Report
Authors: Giorgio Luigi Di , Touloupakis Georgios , Mastantuono Marco , Vitullo Fabrizio , Imparato Luca
Published: October 2016

Chondromyxoid fibromas account for <1% of primary bone neoplasms. We report one such case occurring in the distal fibula of a 27-year-old woman. The patient underwent curettage, followed by phenolisation, insertion of a Steinmann pin, and cementation. This treatment reduced morbidity, restored stability, and enabled rapid functional recovery. There was no recurrence after 2 years.
Patellar Tracking during the Gait Cycle
Authors: Abbas Ghulam , Diss Ceri
Published: October 2016

Purpose.

To assess normal patellar tracking during walking using the 9-camera infrared system.

Methods.

Four men and 6 women aged 25 to 33 (mean, 29) years each performed 16 walking trials on one occasion. They had prominent patellae with minimal soft tissues (minimising skin artefacts), and their knees and lower limbs were normal and symmetrical. 12 retro-reflective markers (2.5 cm in diameter) were taped to anatomic landmarks of the lower body. Two additional markers (1.4 cm in diameter) were first placed on the medial and lateral points and then proximal and distal points of the patella. Patellar motion relative to the centre of the knee joint was defined as angles between the centre of the knee joint and the 2 sets of patellar markers (medial-lateral and proximal-distal). The mean, maximum, and minimum values of these angles in a standing position were recorded, as was patellar tracking during walking. The X, Y, and Z coordinates for each marker were smoothed out throughout the capturing time. A single gait cycle per trial was chosen for analysis.

Results.

During walking, the centre of the knee joint and the patella did not move in unison, and the extent of separation was subject dependent. In 70% of the participants, the maximum angle between the centre of the knee joint and each set of markers occurred in the swing phase (0–43%) of the gait cycle. When analysing both sets of markers together, the percentage of participants became 60%. The extent of knee flexion was subject dependent. There was more medial-lateral motion (shift) of the patella than proximal-distal (tilt) motion during the gait cycle. These indicated that the maximum amount of patellar shift and tilt occurred in the swing and early stance phases of the gait cycle and that abnormal patellar motion can be detected if excessive shift or tilt occurs outside of these phases.

Conclusion.

Patella mal-tracking could be attributed to the position of the lower body segments rather than the absorption or generation of forces.
Lengthening of the Normal Tibia in a Patient with Hemihypertrophy Caused by Klippel-Trenaunay-Weber Syndrome: A Case Report
Authors: Takata Munetomo , Watanabe Koji , Matsubara Hidenori , Takato Kei , Nomura Issei , Tsuchiya Hiroyuki
Published: October 2016

We report a case of Klippel-Trenaunay-Weber syndrome in a 31-year-old woman who presented with hypertrophy of the left leg. She had severe osteoarthritic changes in the left hip joint secondary to the lack of acetabular coverage of the femoral head as the result of lateral inclination of the pelvis owing to leg-length discrepancy of 4 cm. The centre-edge angle (coverage ratio of the acetabulum to the femoral head) was improved from 15° to 33° after a foot lift. She underwent osteotomy and lengthening of the normal contralateral tibia using a Taylor spatial frame. Hip arthroplasty could be avoided as osteoarthritic changes of the hip joint had improved.
Atypical Essex-Lopresti Injury of the Forearm: A Case Report
Authors: Hey Hwee Weng , Chong Alphonsus Khin Sze , Peng Li Lee
Published: October 2016

The Essex-Lopresti injury of the forearm is difficult to diagnose. A missed diagnosis can lead to persistent pain and instability of the wrist. We report a 33-year-old man with a pre-existing cubital varus deformity who sustained an atypical Essex-Lopresti injury after a fall on his elbow. Accurate diagnosis requires understanding of force transmission and anatomy of the radius and ulna, as well as the proximal and distal radioulnar joints as a unit.
Neonatal Separation of Distal Humeral Epiphysis during Caesarean Section: A Case Report
Authors: Sabat Dhananjaya , Maini Lalit , Gautam VK
Published: October 2016

We report a rare injury of distal humeral epiphyseal separation in a newborn during a Caesarean section. The diagnosis was made using magnetic resonance imaging. Emergency Caesarean deliveries with considerable traction applied to extract the baby can be the risk factor of such an injury.
Lumbar Fractures Involving Five Vertebrae: A Case Report
Authors: Jettoo Prithee , Sharma Himanshu , Andrews John R , Sanderson Paul L
Published: October 2016

We report a 20-year-old man who sustained lumbar fractures involving 5 vertebrae following a road traffic accident. He was initially treated non-operatively to allow multiple pedicles to heal. He developed post-traumatic kyphosis for which corrective osteotomy and posterior spinal instrumented fusion was performed. He achieved a good functional outcome. We emphasise the need for careful radiological evaluation in patients with high-energy trauma, and the option of treating such complex injuries by non-operative means. If post-traumatic kyphosis develops, it can be dealt with later and the most mobile segments of the lumbar spine can be preserved.
Posterior Interbody Grafting and Instrumentation for Spondylodiscitis
Authors: Endres Stefan , Wilke Axel
Published: October 2016

Purpose.

To report outcomes of 7 patients with bacterial spondylodiscitis treated through a posterior approach.

Methods.

Five men and 2 women aged 40 to 80 years underwent one–stage posterior interbody debridement and instrumentation for single-segment bacterial spondylodiscitis of lumbar (n=5) or thoracic (n=2) vertebrae. The Oswestry Disability Score, the Frankel classification, the Cobb angle, and the visual analogue scale (VAS) for pain as well as bone union on radiographs were assessed.

Results.

Patients were followed up for 19 to 36 months. None had relapses or complications. Postoperatively, 5 patients had no pain or used analgesics only occasionally; their VAS scores varied from 0 to 20. The remaining 2 patients had residual symptoms and received regular peripheral pain medication and opiates; their VAS scores ranged from 30 to 50. The mean Oswestry Disability Score improved to 21 (range, 12–38). The mean Cobb angle improved from 13.1° to 11.1°. The segments were probably fused in 5 patients and questionable in 2.

Conclusion.

Posterior debridement and instrumentation was adequate for single-segment spondylodiscitis and achieved good outcomes.