bluuebunny/crossref_metadata_2025 huggingface dataset:
Salvaging Unstable or Recurrent Dislocating Total Hip Arthroplasty with the Constrained Acetabular Component
Authors: Stanton DA , Bruce WJ , Goldberg JA , Walsh W
Published: October 2016

Purpose.

To review cases of implantation of constraining acetabular components for unstable or recurrent dislocating total hip arthroplasty at the Department of Orthopaedics, Concord Hospital, Sydney.

Methods.

A retrospective analysis was performed on prospectively collected data of 13 consecutively enrolled patients.

Results.

From 1989 to 2000, 13 constraining acetabular components were implanted into 13 patients as a revision procedure. The surgical approach for the implantation of the constrained liner was posterolateral in 11 cases; a modified Hardinge approach was applied in 2 cases. The mean clinical follow-up duration was 43 months (range, 14–121 months) and the mean age at the time of surgery was 73 years (range, 52–84 years). No patients were lost to follow-up. Indications for using the constrained acetabular component were recurrent dislocation in revision hip replacements (n=8), and intra-operative instability (n=5). There were no episodes of dislocation of the constrained arthroplasty. In 7 cases, the constrained component was implanted into a previously well-fixed shell.

Conclusion.

We recommend the judicious use of the constrained component in cases of hip instability during or after total hip arthroplasty when other methods are not successful.
Review Article: Knee Flexion after Total Knee Arthroplasty
Authors: Chiu KY , Ng TP , Tang WM , Yau WP
Published: October 2016

Many factors affect or predict the flexion range achieved after total knee arthroplasty. While the knees that have good preoperative flexion have better final flexion, knees with good preoperative flexion do lose some flexion whereas those with poor preoperative flexion can gain flexion. Although studies of different prosthetic designs have produced conflicting results, recent studies appear to favour posterior cruciate ligament (PCL)—substituting over PCL-retaining prostheses. Several factors related to surgical techniques have been found to be important. These include the tightness of the retained posterior cruciate ligament, the elevation of the joint line, increased patellar thickness, and a trapezoidal flexion gap. Vigorous rehabilitation after surgery appears useful, while continuous passive motion has not been found to be effective. Obesity and previous surgery are poor prognostic factors; certain cultural factors, such as the Japanese style of sitting, offer ‘unintentional’ passive flexion and result in patients with better range. If the flexion after surgery is unsatisfactory, manipulation under anaesthesia within 3 months of the total knee arthroplasty can be beneficial.
Reconstruction of a Scalp and Skull Defect with Free Latissimus Dorsi Myocutaneous Flap following Dermatofibrosarcoma Protuberans
Authors: Taniguchi Y , Tamaki T , Yoshida M , Uematsu Y
Published: October 2016

A 53-year-old male underwent more than 10 surgical treatments over 14 years, including a simple excision and local flap transfer, after recurrences of dermatofibrosarcoma protuberans of the head. Clinical results indicated that simple excision of dermatofibrosarcoma protuberans should not be performed as initial treatment. Instead, free flap transplantation, which permits a wide excision and complete reconstruction, should be the first treatment option.
Comparison of Bone Mineral Density among Residents of a Mountain Village and a Fishing Village in Japan
Authors: Sudo A , Miyamoto N , Kasai Y , Yamakawa T , Uchida A
Published: October 2016

Objective.

To compare the bone mineral density of residents of a mountain village with that of residents of a fishing village in Mie Prefecture, Japan.

Methods.

Microdensitometry was used to measure bone mineral density of the second metacarpal bone of 202 participants living in a mountain village and of 852 participants living in a fishing village to identify contributory factors for osteoporosis. The participants were interviewed using a questionnaire on alcohol consumption, fish intake, milk intake, and daily activity.

Results.

Analysis of covariance revealed that bone mineral density was significantly higher among the participants living in a fishing village than among those living in a mountain village (2.5–2.9 versus 2.1–2.7 mmAl; p<0.001). A higher proportion of women in the fishing village than of those in the mountain village consumed alcohol (17% versus 10%; p<0.05).

Conclusion.

Nutrition may be a contributory factor to the lower incidence of osteoporosis among residents of the fishing village compared with those of the mountain village.
Reaming Bone Grafting to Treat Tibial Shaft Aseptic Nonunion after Plating
Authors: Wu CC
Published: October 2016

Purpose.

To investigate the effects of using intramedullary reaming to provide cancellous bone graft, and reamed intramedullary nail stabilisation to provide fragment stability on treating tibial shaft aseptic nonunions after plating.

Methods.

31 consecutive patients with tibial shaft aseptic nonunions after plating were prospectively treated. Indications for this technique included a tibial shaft nonunion with an inserted plate, a fracture level fit for traditional or locked nail stabilisation, absence of suspected infection and segmental bony defect at the time, and shortening of less than 2 cm. The plate was removed and the marrow cavity was reamed as widely as possible. A stable unlocked or locked intramedullary nail was then inserted. No extra cancellous bone graft was supplemented.

Results.

28 patients were followed up for a median period of 2.2 years (range, 1.0–5.2 years). All patients achieved solid union. The median union period was 4.5 months (range, 3.0–7.5 months). There were no significant complications.

Conclusion.

When reamed intramedullary nails are used to treat tibial shaft aseptic nonunions after plating, supplemented cancellous bone grafting can be spared. Despite the technique being simplified, the success rate is high. We therefore recommend its wide use to treat all suitable cases.
An Age- and Sex-Controlled Matched Pair Analysis of T Scores in Ethnic Indians with Hip Fractures
Authors: Vaidya SV , Dholakia D , Yadav S
Published: October 2016

Objective.

The first study to predict peritrochanteric fractures by the use of T scores amongst the Indian population was performed. This study aimed to assess the risk of fracture around the hip in peri-menopausal and postmenopausal women, and in men over the age of 35 years using dual energy X-ray absorptiometry, and to analyse whether the result, i.e. the T score, can predict an impending hip fracture.

Methods.

T scores of the unaffected hip in 30 patients with peritrochanteric fractures were determined, and matched pair analysis was done using a control group without fracture. All patients were from a single centre and were evaluated using the same scanner.

Results.

The mean T score of the 30 patients in the fracture group was −3.34 (range, −1.2 to −5.1; standard deviation [SD], 1.032), compared with the mean T score of the 30 control subjects which was −2.41 (range, 0.6 to −5.0; SD, 1.378). T scores of patients from the fracture group were significantly lower than those in the control group.

Conclusion.

We infer that T scores are the best predictors for fracture risk. A score of −2.5 or lower effectively defines patients at risk and is useful for predicting fracture risk in the Indian population. In patients with osteoporosis, whether a fall precedes the fracture or the fracture precedes a fall may not be an issue of debate, but can serve as a basis for prevention of additional fractures by instituting appropriate measures in patients at risk.
Surgical Management of Malignant Soft Tissue Tumours in Patients Aged 65 Years or Older
Authors: Osaka S , Sugita H , Osaka E , Yoshida Y , Ryu J
Published: October 2016

Objective.

With the aim to determine the most effective treatment for primary malignant musculoskeletal tumours in patients aged 65 years or older, we reviewed cases of low- and high-grade neoplasms, surgical margins, surgical methods, and the prognoses of elderly and aged patients at our institution.

Methods.

Records of 25 patients aged 65 years or older who had malignant soft tissue tumours from December 1986 to February 1997 were reviewed. Low- and high-grade neoplasms accounted for 8 and 17 patients, respectively. 11 patients were aged 65 to 69 years, while 14 were 70 years or older. Surgical margins were wide in 19 cases, marginal in 4, and intralesional in 2. Reconstruction was done using 6 musculocutaneous flaps and/or 4 vessel grafts. As adjuvant therapy, radiotherapy was used in 5 cases and chemotherapy in 3. There was no recurrence in patients with wide surgical margins (determined on the basis of gross inspection of the excised tumour and the cut surface); but there was recurrence in 4 patients with marginal margins, and one patient with intralesional margin. Two patients with intralesional, 4 with marginal, and 2 with wide margins, died from recurrence at the primary site and metastasis, or from metastasis without recurrence at the primary site.

Results.

Follow-up periods ranged from 4 months to 180 months (mean, 91.6 months). The overall 5-year survival rate was 79.6%; for low- and high-grade neoplasms, the figures were 100% and 69.7%, respectively; for those aged 65 to 69 years and in their 70's or older, the figures were 90.9% and 70.1%, respectively.

Conclusion.

For geriatric patients, wide surgical margins are required to manage both low- and high-grade neoplasms, in order to avoid multiple surgeries.
Stabilisation of Fractured Thoracic and Lumbar Spine with Cotrel-Dubousset Instrument
Authors: Moon MS , Choi WT , Moon YW , Kim YS , Moon JL
Published: October 2016

Objective.

To evaluate the effectiveness of 2 different types of Cotrel-Dubousset instrument systems in stabilising thoracolumbar and lumbar spine fractures.

Methods.

Between January 1989 and December 1993, 45 fractures in 42 patients with unstable fracture or fracture dislocation of the thoracolumbar and lumbar spines were randomly assigned to 2 surgical treatments with Cotrel-Dubousset instrumentation—using either a long segment (Group 1) or a short segment (Group 2)—and short posterolateral fusion.

Results.

Consolidation of the fractured vertebral body and posterolateral fusion were achieved at a mean time of 4.5 months; fusion rates were 75% in Group 1 and 83% in Group 2. The average collapses of anterior vertebral body height in Group 1, in the immediate postoperative period and at the final follow-up, were 15% and 17%, respectively; and in Group 2, the figures were 16% and 24%, respectively. The correction of vertebral height and kyphosis at the last follow-up were lost more in Group 2 (5.7°) than in Group 1 (4.4°). There were neurological recoveries in 6 of the 9 cases of incomplete paraplegics, including complete recovery in 5, and one-Frankel grade increase in one. There were 15 instrument failures in 12 patients, including screw breakage in 3 Group 1 cases and 6 Group 2 cases. The plug dislodged in 3 Group 1 cases, and the hook dislodged in 3 Group 2 cases. In other words, instrument failures were more common in Group 2.

Conclusion.

Cotrel-Dubousset stabilisation of the fractured spine achieves fracture consolidation, but does not maintain the restored height and sagittal curve completely until fusion. The long rod and short fusion construct was more effective for all fracture types than was the short rod and fusion construct, although it leads to wider immobilisation of normal segments.
Use of Antibiotic-Loaded Polymethyl Methacrylate Beads in the Management of Musculoskeletal Sepsis — A Retrospective Study
Authors: Mohanty SP , Kumar MN , Murthy NS
Published: October 2016

Purpose.

To assess the use of antibiotic-loaded polymethyl methacrylate beads in the management of chronic osteomyelitis of different aetiologies: infected osteosynthesis, infected open fractures, and haematogenous osteomyelitis.

Methods.

Records of 49 patients with chronic osteomyelitis who were treated at Department of Orthopaedics, Kasturba Medical College, from 1995 to 1999 were studied retrospectively. The diagnosis of chronic osteomyelitis was made on the basis of clinical and radiographic features. Of the 49 patients, 4 had haematogenous osteomyelitis, which later proved to be tuberculosis, and were thus excluded. Antibiotic-loaded acrylic beads were implanted in the remaining patients after thorough debridement. The implant was removed primarily in 16 patients with infected osteosynthesis, who then underwent decompression and sequestrectomy. All wounds were closed primarily. Peri-operative antibiotics were given for 7 days. Beads were removed at the end of 3 weeks followed by bone grafting in 26 patients. Patients were followed up for an average period of 3.7 years.

Results.

The infective organisms were sensitive to gentamycin in 26 cases and resistant in 19 cases; 14 cases were sensitive to cefuroxime, 11 to cloxacillin, 8 to ampicillin, and 5 to cotrimoxazole. Seven cases were resistant to all antibiotics tested. Of the 19 patients with gentamycin-resistant infection, only one had a poor result. No adverse systemic side-effects such as ototoxicity or nephrotoxicity were seen. Infection did not recur in 39 patients, but 6 patients had low-grade persistent infection at the last follow-up visit.

Conclusion.

In chronic infections, especially those following osteosynthesis, antibiotic beads are a valuable adjuvant. The most valuable advantage is that the wound can be closed primarily, thereby reducing the incidence of nosocomial infections and requirement of nursing care.
Decreased Access to Health Care and Social Isolation among Young Adults with Cerebral Palsy after Leaving School
Authors: Ng SY , Dinesh SK , Tay SKH , Lee EH
Published: October 2016

Objective.

T o examine if leaving special schools has a negative impact on the health care and social isolation of young adults with cerebral palsy.

Methods.

Young adults with cerebral palsy, aged between 15 and 22 years, were divided into 2 cohorts: current students, who were still receiving services from special schools, and school-leavers, who had since been discharged from care. A questionnaire and physical examination were administered to assess the extent of disability, health care received by, and social isolation of these young adults.

Results.

School-leavers had a greater degree of dissability than did students, although the results were not statistically significant. Health care exposure to specialists, general practitioners, therapists (physiotherapists, occupational therapists, and/or speech therapists), and medical social workers decreased after leaving school; with the exception of contact with general practitioners, these results were significant (p<0.05). The entire cohort was more socially isolated than a control cohort. School-leavers participated in fewer activities outside their homes, but showed less concern about their disability than did current students.

Conclusions.

Young adults with cerebral palsy continue to have health care and lifestyle needs after leaving school, which are currently not being adequately met.
Autogenous Osteochondral Grafts for Osteonecrosis of the Femoral Condyle
Authors: Kotani A , Ishii Y , Sasaki S
Published: October 2016

Purpose.

To evaluate the long-term outcome following use of osteochondral autografts for the treatment of osteonecrosis of the femoral condyle.

Methods.

Clinical, radiographic and arthroscopic findings were evaluated at follow-up. Patients were 14 women and 2 men, with a mean age of 64.9 years (range, 58–74 years). The osteochondral lesion was equivalent to Lotke 1-B in 12 knees, and was equivalent to 1-C in 4 knees. Preoperative femoral tibia angle ranged from 178° to 190°.

Results.

The follow-up period ranged from 28 months to 111 months (mean, 67 months). Functional scores improved from 60 to 75 preoperatively to 80 to 100 postoperatively, and the grafts were satisfactorily accepted. Patients with a femoral tibia angle of less than 180° in particular were found to respond favourably.

Conclusion.

Transplant surgery using osteochondral autografting appeared effective for the treatment of osteonecrosis of femoral condyle.
Supracondylar Nailing for Difficult Distal Femur Fractures
Authors: Saw A , Lau CP
Published: October 2016

Purpose.

To evaluate outcome following supracondylar nailing for distal femur fractures.

Methods.

The clinical and radiological outcome for 13 patients treated between January 1995 and December 1998 at the University Malaya Medical Center was assessed. Patients were seen for follow-up for a mean duration of 20.2 months.

Results.

There were no cases of non-union or infection. Overall assessment of clinical outcome based on the criteria of Schatzker and Lambert was graded excellent in 6 patients, good in 3 patients, fair in 3 patients, and one graded as a failure.

Conclusion.

Supracondylar nailing for fixation of supracondylar (Arbeitsgemeinschaft für Osteosynthesefragen [AO] type A) and less comminuted intercondylar (AO type C1 and C2) fractures is recommended by the authors.
Gait Adaptations in Patients with Longstanding Hip Fusion
Authors: Thambyah A , Hee HT , De S Das , Lee SM
Published: October 2016

Purpose.

To examine the long-term effects of hip arthrodesis in terms of gait adaptations.

Methods.

Motion analysis was performed on 9 patients who underwent unilateral hip arthrodesis between 1979 and 1991. A standard clinical gait analysis 3-dimensional model for the lower limb was used to calculate the effect of the fused hip on walking, compared with the contralateral normal hip.

Results.

Significant (p<0.05) gait adaptations noted in the fused side were, compensatory hip hiking during the swing-phase, a 24% reduction in hip adduction moment, a 37% decrease in genu-varus moment, 80% reduced hip power, and excessive pelvic tilt.

Conclusion.

It appears that the excess pelvic tilt observed was to achieve relative hip extension via increased relative lumbar lordosis, while the decreased coronal plane moments of the hip and knee observed were to reduce joint loading on the affected side.
Medium-Term Results of Cementless Hydroxyapatite-Coated Primary Total Hip Arthroplasty: A Clinical and Radiological Review
Authors: Theis JC , Ball C
Published: October 2016

Purpose.

To evaluate the clinical and radiological outcomes following cementless primary hydroxyapatite-coated total hip arthroplasty.

Methods.

A retrospective study of 69 patients (82 hips) who underwent uncemented hydroxyapatite-coated Anatomic Benoist Girard total hip replacement between October 1991 and October 1995 at our institution was conducted. Patient records were reviewed. All patients were evaluated clinically using the Merle D'Aubigne hip score, and osteointegration was assessed radiographically by analysing the bone implant interface in the 7 zones of Gruen on follow-up review.

Results.

The mean follow-up period was 7.3 years. Clinical results were excellent with an improvement seen in clinical score from 9.9 preoperatively to 16.5 at last review. A total of 15% of patients recorded some thigh discomfort, which was intermittent and not functionally limiting, except in 2 cases. There were 3 cases of severe acetabular osteolysis and loosening requiring revision surgery, and 4 cases of localised proximal femoral osteolysis around well-ingrown implants. There were few perioperative complications, with the exception of 5 dislocations of which 3 were recurrent and required a revision procedure.

Conclusion.

Clinical and radiological outcomes following cementless hydroxyapatite-coated total hip arthroplasty were seen to be favourable in this medium-term retrospective study.
Lunate Migration following Darrach's Procedure: A Case Report
Authors: de Roeck NJ , Packer GJ
Published: October 2016

We report a case of a 28-year-old female patient who underwent Darrach's procedure to her dominant right wrist affected by rheumatoid disease. She developed severe pain in the wrist 4 weeks postoperatively. Collapse of the scaphoid and proximal migration of the lunate was noted. Total wrist arthrodesis using the Arbeitsgemeinschaft für Osteosynthesefragen wrist arthrodesis plate was performed, which alleviated the pain. Darrach's procedure is described for conditions causing derangement of the distal radio-ulnar joint, the classical inflammatory cause being rheumatoid arthritis. It is however a potentially destabilising procedure. The extreme complication encountered in this case highlights the risk of Darrach's procedure if pre-existing ligamentous instability is present.
Salmonella Osteomyelitis in an Otherwise Healthy Adult Male—Successful Management with Conservative Treatment: A Case Report
Authors: Arora A , Singh S , Aggarwal A , Aggarwal PK
Published: October 2016

A 21-year-old male presented with pain in the right thigh of insidious onset and 3 months' duration. He had a history of febrile illness lasting for 15 days, 2 months prior to the onset of pain. Examination revealed swelling over the lower lateral aspect of the right thigh with some induration and tenderness. Initial X-rays of the right femur and the computed tomography scan at 10 weeks after the onset of disease were normal. Magnetic resonance imaging scan showed signal alteration with minimal destruction of the anterior cortex in the mid-diaphyseal region of the right femur. A repeated X-ray taken at 15 weeks after the onset of illness showed erosive changes, along with periosteal reaction in the diaphyseal area. The Widal test was positive. Open biopsy of the lesion revealed inflammatory non-caseating tissue. Culture of the specimen grew Salmonella typhi. The patient was given antibiotic treatment. Both X-rays and the Widal titres were normal on subsequent follow-up at 3 months.
Group G Streptococcus—A Rare Cause of Osteomyelitis Simulating Bone Tumour: A Case Report
Authors: Tong SHY , Tang WM , Wong JWK
Published: October 2016

We report a case of osteomyelitis of the proximal femur caused by Lancefield group G streptococcus in a 71-year-old otherwise healthy man. The organism has rarely been identified as the cause of osteomyelitis. The subacute nature of the symptoms and the radiological appearance of the femur in this patient mimic bone tumour. The patient was successfully treated with conservative methods, including a prolonged period of oral antibiotics. We stress the importance of histological and bacteriological evidence in avoiding misdiagnosing patients with equivocal clinical and radiological presentation.
A Report of Two Cases of Werner's Syndrome and Review of the Literature
Authors: Yamamoto K , Imakiire A , Miyagawa N , Kasahara T
Published: October 2016

Two cases of Werner's syndrome are reported. The first case is that of a man with grey hair since his 20s, and alopecia since aged about 50 years. At the age of 53 years, Werner's syndrome was diagnosed, along with a malignant soft tissue tumour of the hand. The patient underwent ray amputation for the tumour. The subsequent histopathological diagnosis was synovial cell sarcoma, and the patient died of lung metastasis at 15 weeks postsurgery. The second case is that of a woman diagnosed with diabetes mellitus when aged 34 years. At 39 years, a bilateral cataract was diagnosed and at 40 years, diabetic gangrene of the left calcaneal region and calcaneal osteomyelitis necessitated left below-knee amputation. The incidence of Werner's syndrome in Japan is extremely high (about 1000 of the around 1300 cases reported worldwide) compared to other countries. Most patients develop malignant tumour or arteriosclerosis, the most important complications of this syndrome. The average life expectancy for patients with Werner's syndrome is 46 years. The incidence of epithelial cancer and mesenchymal sarcoma is 10 times that of the general population. The onset of symptoms of Werner's syndrome generally precedes any later symptoms of associated conditions, such as malignant tumour. Therefore, early recognition of Werner's syndrome is important to assist identification of malignant tumours at an early stage in this patient group.
Cementless Total Hip Arthroplasty Using an Autograft of the Femoral Head for Marked Acetabular Dysplasia: Case Series
Authors: Yamaguchi T , Naito M , Asayama I , Shiramizu K
Published: October 2016

Purpose.

To assess the short-term outcome of cementless total hip arthroplasty involving an autograft of the femoral head in Japanese patients.

Methods.

Cementless total hip arthroplasty with autogenous bone block grafting was performed on 18 hips in 15 patients with marked acetabular dysplasia. The resected femoral head was used as a graft for the superior-lateral region of the true acetabulum. Clinical outcome was correlated with the placement of the acetabular component, as revealed in radiographs.

Results.

The 13 women and 2 men had a mean age of 60.2 years (range, 37.0–73.0 years) at primary surgery and a mean follow-up duration of 3.3 years (range, 2.0–5.3 years). According to the classification of Crowe, 4 hips were in group I, 3 were in group II, one in group III, and 10 in group IV. The mean Harris Hip Score preoperatively was 45.7 (range, 19–69) and that at follow-up was 82.5 (range, 44–100). All 15 cases showed a good clinical outcome. There were no major intra-operative complications in this series. The grafted bones united in all patients. Two patients need surgical revision because the lateral insertion of the acetabular component resulted in loosening of it.

Conclusion.

Medial insertion of the acetabular component provides satisfactory short-term outcomes. Lateral insertion of the acetabular component during total hip arthroplasty should be avoided in patients with marked acetabular dysplasia.
Mini-Incision Total Hip Replacement—Surgical Technique and Early Results
Authors: Chung WK , Liu D , Foo LSS
Published: October 2016

Purpose.

To compare the results of mini-incision total hip replacement (MITHR) to the standard posterior approach and evaluate the advantages and disadvantages of MITHR.

Methods.

60 patients with osteoarthritis of the hip underwent total hip replacement utilising a mini-incision technique. They were compared to a matched cohort of patients who received the standard posterior approach. The average follow-up period was 14 months. The patients were compared with respect to the length of the incision, surgical time, intra-operative blood loss, narcotic requirements, length of hospital stay, requirement for walking aids, Harris hip score, and complications.

Results.

The length of the skin incision for MITHR, at an average of 9.2 cm, was half that of the standard approach. Statistically significant differences were found between the 2 groups in terms of intra-operative blood loss, length of hospital stay, and use of walking aids, all in favour of MITHR. There were no differences between the two approaches with regard to operating time, narcotic requirements, or Harris hip score. There were no cases of component malpositioning or major complications in the MITHR group.

Conclusion.

Uncemented total hip replacement can be effectively performed through a smaller incision utilising MITHR without increased risk of complications. Significant benefits include less intra-operative blood loss, shorter hospitalisation, and cosmesis.
Does Routine Blood Bone Biochemistry Predict Vitamin D Insufficiency in Elderly Patients with Low-Velocity Fractures?
Authors: Singh SK , Manjure S , Stott P , Shetty A , Iversen SA , Williams CR
Published: October 2016

Purpose.

Vitamin D deficiency impairs bone mineralisation and can predispose individuals to fractures. This study aimed at testing whether measurement of plasma calcium, alkaline phosphatase, and phosphate levels could detect vitamin D insufficiency.

Methods.

During a 10-week winter period from December 2000 to February 2001, all elderly patients presenting to a general hospital in Brighton—a British seaside town—with a fracture of the proximal femur and without known bone mineralisation problems were invited to participate in the study.

Results.

23 (63.9%) of the 36 eligible patients had insufficient levels of vitamin D, with a plasma concentration of less than 30 nmol/L. The mean parathyroid hormone level was 56 pg/mL (range, 12–193 pg/mL). 11 of the 36 patients had an elevated level of parathyroid hormone and were insufficient in vitamin D. The mean plasma concentration of calcium was 2.30 mmol/L (range, 2.05–2.98 mmol/L). The mean phosphate level was 0.98 mmol/L (range, 0.40–1.79 mmol/L), and the mean alkaline phosphatase level was 91 IU/L (range, 46–127 IU/L). There was poor correlation between vitamin D insufficiency and plasma calcium, alkaline phosphatase, or phosphate levels.

Conclusion.

Plasma calcium, alkaline phosphatase, and phosphate testing cannot detect vitamin D insufficiency. We recommend that vitamin D and calcium supplementation be considered for patients with low-energy hip fractures.
Effects of Ethane-1-Hydroxy-1,1-Diphosphonate on Ossification of the Posterior Longitudinal Ligament in Zucker Fatty Rats
Authors: Yamamoto K , Imakiire A , Shishido T , Masaoka T
Published: October 2016

Purpose.

Using Zucker fatty rats as an animal model, we evaluate the effectiveness of ethane-1-hydroxy-1, 1-diphosphonate on ossification of the posterior longitudinal ligament by histopathologically investigating the prodromal, early, and advanced stages of ossification of the spinal ligaments.

Methods.

73 Zucker fatty rats were allocated to the ethane-1-hydroxy-1,1-diphosphonate group (n=33) and the control group (n=40). The former group was fed ethane-1-hydroxy-1,1-diphosphonate daily. The feed was given starting 2 months after birth and continued until the rats were killed at 3 to 18 months later. Chemical analysis of the blood, radiographic tests, and histopathological examination were then conducted for both groups.

Results.

The results showed that ossification of the spinal ligaments involved excessive cartilage cell proliferation around areas affected by enthesitis; enlargement of the fibrocartilage tissue layer; ligament thickening; calcification of the matrix around the cartilage cells; and ossification of the spinal ligaments through enchondral ossification. Radiographic examinations showed that osteoproliferation in vertebral bodies in rats receiving ethane-1-hydroxy-1, 1-diphosphonate was generally suppressed compared with controls, whereas histopathological examinations found no clear difference in cartilage cell proliferation in areas affected by enthesitis between the two groups, indicating the absence of calcification or osteoproliferation in areas affected by enthesitis for the rats receiving ethane-1-hydroxy-1,1-diphosphonate.

Conclusion.

Ethane-1-hydroxy-1,1-diphosphonate is effective in suppressing progressive ligament ossification.
Clinical and Immunohistochemical Characteristics of Benign Giant Cell Tumour of Bone with Pulmonary Metastases: Case Series
Authors: Osaka S , Sugita H , Osaka E , Yoshida Y , Ryu J , Hemmi A , Suzuki K
Published: October 2016

Purpose.

Giant cell tumour of bone with pulmonary metastases is rare. However, some patients die of pulmonary metastases, and histological examination cannot distinguish between benign tumour and malignant metastases. In this study, we present clinical and immunohistochemical findings associated with giant cell tumour of bone with pulmonary metastases.

Methods.

Five patients with benign giant cell tumour of bone with pulmonary metastases (one man and 4 women) were studied. Patients' ages ranged between 20 and 23 years (mean age, 21.8 years). Tumours were in the distal femur in 2 cases, and in the proximal tibia, distal tibia, and lumbar spine in one case each. The tissue specimens from primary tumours, recurrent tumours, and pulmonary metastases were studied using immunohistochemical techniques.

Results.

Three of the 5 primary tumours were of the spontaneous regression or growth cessation type, or the continuously slow-growing type, showing 4.2% to 6.2% of positive cells for Ki-67 after immunohistochemical staining. However, 2 patients with the rapid-growing type of disease died of pulmonary metastases; their primary, recurrent, and metastatic tumour specimens contained 9.0% to 11.5% of positive cells for Ki-67.

Conclusion.

Three of the 5 primary tumours had a benign clinical pattern and immunohistochemistry. Two of the 5 patients died of pulmonary metastases, which had an aggressive clinical pattern and a high prevalence of positive cells in Ki-67. Examination of Ki-67 should be carried out for aggressive type of giant cell tumour.
Single Photon Emission Computed Tomography Scanning in the Diagnosis of Knee Pathology
Authors: Vellala RP , Manjure S , Ryan PJ
Published: October 2016

Purpose.

To evaluate the role of single photon emission computed tomography (SPECT) bone scan for the diagnosis of knee lesions in routine clinical practice.

Methods.

40 consecutive case records were examined in patients who underwent a SPECT scan prior to knee arthroscopy in routine clinical practice. The accuracy of clinical examination, SPECT scan results, and arthroscopic findings (as the gold standard) in diagnosing knee lesions were compared.

Results.

The sensitivity of SPECT scans in detecting medial meniscal, lateral meniscal, anterior cruciate ligament lesions, osteochondral defects, and chondromalacia patellae was 77%, 14%, 33%, 50%, and 74%, respectively. The specificities for the same structural lesions were high at 89%, 94%, 97%, 94%, and 69%, respectively.

Conclusion.

SPECT bone scan appears to be useful in the diagnosis of knee pathology in routine practice and in selecting patients for arthroscopy, especially most useful for the diagnosis of medial meniscal tears.
Ilizarov Ring Fixation and Fibular Strut Grafting for C3 Distal Femoral Fractures
Authors: Ramesh LJ , Rajkumar SA , Rajendra R , Rajagopal HP , Phaneesha MS , Gaurav S
Published: October 2016

Purpose.

To evaluate treatment outcome following surgical repair of C3 distal femoral fractures using autogenous fibular strut, cortico-cancellous bone grafting, and Ilizarov ring fixation.

Methods.

A total of 15 patients with type C3 fractures (supracondylar and intercondylar fractures, with multiplane articular injury) underwent surgical repair at St. John's Medical College Hospital between 1994 and 2001, using autogenous fibular strut, cortico-cancellous bone grafting, and Ilizarov ring fixation. 13 were seen for ongoing follow-up and assessment. Definitive surgery was undertaken at a mean of 3 weeks after admission. Postoperatively, weight-bearing and mobilisation exercise were begun in 2 to 4 weeks.

Results.

The mean follow-up period was 47 months. Union was achieved in all 13 cases by an average time of 19 weeks. At the last follow-up, the mean range of knee motion was 77°. Assessment of functional outcome (using Neer's scoring criteria) revealed 10 cases with good or satisfactory outcomes, and 3 cases with poor or unsatisfactory results.

Conclusion.

Surgical repair with a fibular strut, cortico-cancellous bone graft and Ilizarov ring fixation appears a suitable treatment option for C3 distal femoral fractures.
Perioperative and Rehabilitation Outcome after Lower-Limb Amputation in Elderly Chinese Patients in Hong Kong
Authors: Leung HB , Wong WC , Wu FCJ , Guerin JS
Published: October 2016

Purpose.

Major amputation of the lower limb is considered the last resort when limb salvage is impossible. The aim of this study is to determine the morbidity, mortality, and rehabilitation outcome of patients that underwent a lower-limb amputation.

Methods.

A retrospective cohort study was conducted among 100 elderly patients who underwent a total of 120 lower-limb amputations in a regional hospital in Hong Kong from 1996 to 2001.

Results.

The mean age of the amputees was 77.9 years; 58 were female. 95% of the amputations were performed because of infection with or without vascular compromise; 55 transfemoral and 60 transtibial amputations contributed 96% of the case mix. Some 43% of patients experienced early complications and 12% required re-amputation. The early (30-day) mortality rate was 15%. Only 55% of the amputees survived after 4 years. A 44% return-home rate was achieved. However, only 11% of the amputees could walk without help from other people. Although prostheses were issued to 42% of the survivors, compliance was only 53%; 24% of the survivors lost their remaining leg within 2 years.

Conclusion.

The outcome of major lower-extremity amputation remains poor. Efforts should be made to retain these limbs. When it is proven impossible, one should strive to preserve the knee joint whenever feasible.
Bony Entrapment of Ulnar Nerve after Closed Forearm Fracture: A Case Report
Authors: Hirasawa H , Sakai A , Toba N , Kamiuttanai M , Nakamura T , Tanaka K
Published: October 2016

We report a case of ulnar nerve palsy following forearm fracture in a 13-year-old girl. Significant anterior angulation and displacement of the ulna were noted. Operation was performed 3 months after the injury, when no recovery of numbness and claw hand deformity were demonstrated. Intra-operatively the ulnar nerve was found to be embedded between fragments of the fractured ulna, which showed lack of callus formation on the preoperative radiograph. The patient achieved complete recovery of sensory and motor functions 4 months after the surgery.
Autologous Blood Transfusion in Total Hip Arthroplasty
Authors: Yamamoto K , Imakiire A , Masaoka T , Shinmura K
Published: October 2016

Purpose.

To determine the possibility of avoiding homologous blood transfusion during total hip arthroplasty, and to clarify the problems associated with autologous blood transfusion.

Methods.

A total of 253 patients received autologous blood transfusion during total hip arthroplasty between April 1990 and December 2000. Patients were assessed for the volume of haemorrhage during surgery, possibility of avoidance of homologous blood transfusion, and the disposal of autologous blood.

Results.

There were no significant differences in the mean volume of haemorrhage among different underlying diseases. The mean total volume of haemorrhage was 2039 (standard deviation, 992) ml in revision surgery and 1673 (717.3) ml in primary surgery (p<0.05). The rate of avoidance of homologous blood transfusion was 75% among patients who underwent primary surgery, and 61% among those who underwent revision surgery. The rate was 95% in cases in which a combination of preoperative blood pooling and intra-operative recovery was used, 49% in cases where the preoperative blood pooling system alone was used, and 42% in those in which the intra-operative recovery system alone was employed. The autologous blood had to be disposed of in 3 (1%) cases, all of which were revision procedures with replacement of the polyethylene liner alone.

Conclusion.

Combined use of the preoperative blood pooling and intra-operative recovery systems is effective for avoiding homologous blood transfusion.
Total Hip Arthroplasty: The Relationship between Posterolateral Reconstruction, Abductor Muscle Strength, and Femoral Offset
Authors: Yamaguchi T , Naito M , Asayama I , Ishiko T
Published: October 2016

Purpose.

To evaluate the relationship between posterolateral reconstruction, abductor muscle strength, and femoral offset following total hip arthroplasty.

Methods.

Of 28 patients (56 limbs) we assessed, 12 underwent posterolateral reconstruction (reconstruction group) and 16 did not (non-reconstruction group). Isometric abductor muscle strength was measured with a handheld dynamometer. Each patient's muscle strength was converted into a force to body weight ratio, and this ratio was used in the comparisons.

Results.

The reconstruction group showed a higher value in abductor muscle strength than the non-reconstruction group (p<0.05). Significant correlation between abductor muscle strength and femoral offset was found in the reconstruction group (p=0.016; r=0.674).

Conclusion.

Posterolateral reconstruction and appropriate reconstruction of femoral offset following total hip arthroplasty are important to improve the abductor muscle strength.
Unreamed Interlocking Nailing in Open Fractures of Tibia
Authors: Joshi D , Ahmed A , Krishna L , Lal Y
Published: October 2016

Purpose.

To assess the clinical outcome of unreamed intramedullary interlocking nailing in open fractures of tibia, and to evaluate the incidence of complications in these open fractures as a result of the unreamed intramedullary nailing.

Methods.

Between June 1999 and May 2000, a total of 60 cases of open tibial shaft fractures were operated on with unreamed interlocking nails at Safdarjung Hospital, New Delhi, India. Records of 56 patients (4 women and 52 men) were available for study. Only injuries associated with the tibial shaft were included. Traffic accidents were the cause of fractures in all patients. All fractures were classified according to Gustilo and Anderson system for open fractures. There were 30 (53.6%) type-I, 18 (32.1%) type-II, 4 (7.1%) type-IIIA, and 4 (7.1%) type-IIIB fractures. After thorough debridement under anaesthesia, an unreamed interlocking nail was inserted with assistance by an image intensifier. All nails were statically locked with one screw each proximally and distally.

Results.

The patients were followed up for a mean period of 20 months (range, 18–24 months) and were evaluated according to the modified Ketenjian's criteria. Results were good to excellent in 85.8% cases, and poor in 10.7% cases. Only 2 of 8 patients with type-III fractures had good results. Two of 4 type-IIIA and all 4 type-IIIB fractures had chronic osteomyelitis. Of 56 patients, 6 had early infection, 6 had delayed union, 6 had infected non-union, 2 had nail breakage, 8 had screw breakage, and 10 had anterior knee pain.

Conclusion.

Unreamed interlocking tibial nailing can be safely used for type-I and type-II open injuries even with delayed presentation. Use of unreamed nailing in those type-III fractures with delayed presentation was not recommended, because of high incidence of complications.
Open Reduction and Internal Fixation of Volar Barton's Fractures: A Prospective Study
Authors: Aggarwal AK , Nagi ON
Published: October 2016

Purpose.

To assess the functional and clinical outcomes of open reduction with internal fixation in the treatment of Barton's fracture of the wrist.

Methods.

From January 1997 to July 2003, a total of 19 cases of volar Barton's fracture were operated on by open reduction and internal fixation at the Nehru Hospital, Chandigarh, India. Records of 16 cases were available for study. Special care was taken during surgery to achieve articular congruity. The injury was caused by motor vehicle accidents in 13 cases and by a fall in 3. All cases were type-B3 fractures: 10 were of the B3.3 subtype, 4 of the B3.2 subtype, and 2 of the B3.1 subtype. Most (12) cases were operated on within one week of injury, 3 in one to 2 weeks, and one in 2 to 3 weeks.

Results.

All patients were assessed clinically and radiographically after a mean follow-up duration of 32.4 months (range, 12.0–65.0 months). Fractures healed after 7.0 to 10.0 weeks (mean, 8.8 weeks). Results of evaluations according to functional criteria were excellent in 9 cases, good in 5, and fair in 2. Radiocarpal osteoarthrosis developed secondary to trauma in 2 cases. There was no involvement of the median nerve in any of the 16 cases.

Conclusion.

Open reduction and internal fixation of volar Barton's fracture can restore articular congruity and result in good to excellent function.
Local Recurrence of Parosteal Osteosarcoma Adjacent to a Prosthesis after 20 Years: A Case Report
Authors: Lau TW , Wong JWK , Yip DKH , Chien EP , Shek TWH , Wong LLS
Published: October 2016

We describe the treatment of an uncommonly late presentation of a recurrent parosteal osteosarcoma of the distal femur. The osteosarcoma had originally been detected 20 years earlier, and had been treated with wide excision and mega-prosthesis to reconstruct the femur. The tumour recurred in close proximity to the femur prosthesis and encased half the femoral stem. Because there was a large piece of metal at the site of recurrence, which might have interfered with computed tomography and magnetic resonance imaging, ultrasonography was used to locate the lesion. The tumour was successfully treated with wide local re-excision. This case emphasises the importance of the long-term follow-up of patients with parosteal osteosarcoma.
Multiple Carpometacarpal Dislocations and an Ipsilateral Scapho-Trapezium-Trapezoid Fracture-Dislocation: A Rare Pattern of Injury
Authors: Kirkham SG , Gray RJ
Published: October 2016

We report a rare case of simultaneous dorsal dislocation of 4 ulnar carpometacarpal joints and dorsoradial dislocation of the trapezium with an associated fracture of the scaphoid tuberosity. The injuries were diagnosed early and treated successfully with closed reduction and transfixation using Kirschner wires. The functional results were excellent at 17-month follow-up.
Morphological Studies on the Ageing and Osteoarthritis of the Articular Cartilage in C57 Black Mice
Authors: Yamamoto K , Shishido T , Masaoka T , Imakiire A
Published: October 2016

Purpose.

To study the cause and mechanism of joint degeneration in osteoarthritis, through histopathological and ultrastructural-histochemical experiments on the articular cartilage of the knees of the C57 black mouse.

Methods.

192 C57 black mice and a control group of 64 C57BL/6J mice were used in this study. The left and right knee articular capsules of the joints were removed and stained. Each articular cartilage sample was examined and osteoarthritic changes were assessed using a transmission electron microscope. The severity of osteoarthritis in the knee joint cartilage of C57 black mice was histologically assessed using a classification system described by Okabe, based on Maier's system.

Results.

The incidence and the severity of osteoarthritis gradually increased with age; the incidence increased from 20% at 2 months to 80% at 16 months. Irreversible changes appeared at an advanced stage, and the process of degeneration was quite similar to that in human osteoarthritis. Through transmission electron microscopy, we observed poorly developed Golgi apparatus, markedly increased intracellular microfilaments, decreased proteoglycan granules, and broken collagen networks in all stages of osteoarthritis. By contrast, Golgi apparatus and other organelles were well developed in histologically normal mice of all ages. Proteoglycan granules, which mainly consisted of keratan sulphate, were observed; collagen networks were maintained.

Conclusion.

Disturbed protein transport and sugar synthesis in chondrocytes, caused by the deficient development of the Golgi apparatus, could result in degenerative changes in articular cartilage. The structure and function of the matrix were maintained mainly because of the continued presence of keratan sulphate.