bluuebunny/crossref_metadata_2025 huggingface dataset:
Tumoral Calcinosis: A Case Report
Authors: Leung Yuen Yee , Lai Raymond
Published: October 2016

An 11-year-old girl presented with a progressive swelling of the right elbow after a contusion. Radiography and magnetic resonance imaging showed a densely calcified lesion with no periosteal reaction or fracture. The underlying bone and muscles had normal signal intensity. A bone scan revealed increased uptake over the right elbow and the left buttock and acetabulum. Blood tests revealed no abnormality. As the mass progressively increased in size and malignancy could not be excluded, excision was performed 4 months after presentation. A lobulated, yellowish mass with a pseudo-capsule measuring 9×7×4 cm was excised. It was not attached to surrounding muscles, and some chalky, well-defined material emerged from the surface. Histological findings confirmed the diagnosis of tumoral calcinosis. The mass was transversed by fibrous septa with fibroblastic proliferation. Foreign body giant cells and histiocytic cells were found within the septa. There was no evidence of malignancy. Four months later, excision of the left elbow and buttock lesions was performed, and histology of both revealed the same diagnosis. At the 4-year follow-up, there was no recurrence.
Osteomyelitis Variolosa: A Case Report
Authors: Balaji Douraiswami
Published: October 2016

Osteomyelitis variolosa is an infection of bone and joints by smallpox virus variola major, most commonly in the elbows, wrists, ankles, hands, and feet. We report one such case in a 70-year-old woman who presented with deformities of the right knee, both elbows and ankles, and the left hand, and a history of childhood fever with rashes. Her lateral femoral condyle of the right knee was hypoplastic with patella baja. Her right elbow was ankylosed and her left elbow was dislocated with multidirectional instability. Her third and fourth metacarpals on the left hand were shortened. Both ankles were stiff with valgus deformity; both taluses were destroyed.
Minimally Invasive Plate Osteosynthesis Using a Locking Compression Plate for Distal Femoral Fractures
Authors: Nayak Ravi M , Koichade Ravi MR , Umre Alok N , Ingle Milind V
Published: October 2016

Purpose.

To evaluate treatment outcomes of minimally invasive plate osteosynthesis (MIPO) for distal femoral fractures in 31 patients.

Methods.

22 male and 9 female consecutive patients aged 21 to 65 (mean, 42) years underwent minimally invasive plate osteosynthesis using a locking compression plate (LCP) for distal femoral fractures. The causes of injury were vehicular accidents (n=24), falls (n=6), and assault (n=1). According to the AO classification, the fractures were classified as types A1 (n=10), A2 (n=7), and A3 (n=14). Most fractures were closed; 3 were Gustilo type-II fractures. Clinical and functional outcomes were assessed using the Knee Society Scores.

Results.

The mean operating time was 70 (range, 60–100) minutes. The mean length of hospital stay was 9 (6–14) days. The mean time to union was 3.7 (range, 2.8–4.6) months. The mean follow-up period was 18 (14–26) months. At the one-year follow-up, 29 of the patients had good or excellent outcomes. No patient had angular or rotational deformity of >10°. One osteoporotic woman with a type-A1 fracture had implant failure at 10 weeks and underwent revision surgery. Another patient with a type-A1 fracture had persistent pain on the lateral aspect of the distal thigh and underwent implant removal at 22 months. No patient developed deep infection, malunion or nonunion.

Conclusion.

MIPO using a LCP achieves favourable biological fixation for distal femoral fractures with few complications. Bone grafting is not needed even in cases of metaphyseal comminution. Proper patient selection and preoperative planning are essential to prevent complications.
Internal Fixation and Strut Allograft Augmentation for Periprosthetic Humeral Fractures
Authors: Martinez Angel A , Calvo Angel , Cuenca Jorge , Herrera Antonio
Published: October 2016

Purpose.

To report 6 patients with periprosthetic humeral fractures treated with open reduction and internal fixation with plate and strut allograft augmentation.

Methods.

6 women aged 69 to 79 (mean, 73) years underwent open reduction and internal fixation with plate and strut allograft augmentation for periprosthetic humeral fractures (type C) after a fall. They had undergone reverse shoulder arthroplasty for rotator cuff arthropathy. The mean interval between the initial arthroplasty and the fracture was 17 (range, 11–21) months.

Results.

The mean follow-up period was 14 (range, 12–16) months. The mean time to union was 5.4 (range, 4–6) months. All fractures united without complications. The mean Constant score at the last follow-up was 64 (range, 56–80). The range of shoulder movement and patient satisfaction were restored to pre-fracture status in all patients, except for one who had more pain in the lateral area of the arm (probably because of soft-tissue irritation by the plate and wires). Three patients had evidence of graft-to-host union and 3 others had graft resorption.

Conclusion.

Internal fixation with plate, cable wires and strut allogaft augmentation achieves satisfactory results for periprosthetic humeral fractures.
Ilizarov Technique of Lengthening and Then Nailing for Height Increase
Authors: Emara Khaled , Farouk Amr , Diab Rami
Published: October 2016

Purpose.

To investigate the risks and types of complications associated with the Ilizarov technique of lengthening and then nailing in persons of normal height.

Methods.

Records of 26 men and 6 women aged 21 to 47 (mean, 27) years with body height of 160 to 176 (mean, 170) cm who underwent tibial and fibular lengthening and then intramedullary nailing were reviewed. They were skeletally mature healthy persons, with no systemic/local bone disease, deformity or limb length discrepancy. Pain was assessed using the visual analogue scale (VAS). Patient satisfaction in terms of the treatment outcomes and expectations was also assessed. Complications encountered during or after treatment were recorded.

Results.

The mean lengthening achieved was 7.6 (range, 3.5–12) cm or 26% (range, 10–40%) of the original length. The mean duration of external fixation was 96 (range, 45–135) days. The mean follow-up duration after intramedullary nailing was 38.7 (range, 24–93) months. The mean VAS pain score was 9.3 at week 1, 6.6 at week 4, and 5.7 at week 8. After intramedullary nailing, the mean VAS pain score was 2.6 at week 4, 0.9 at month 6, and 0.3 at year 1. 91% of the patients were satisfied with the outcome at week 6; 81% after intramedullary nailing, and 94% at the one-year follow-up. Four patients had revision operations: one for pin exchange owing to pin bending after a fall, one for adjusting external rotation of the tibia after nailing, one for bone grafting for delayed union, and one for drainage of a haematoma just after nailing.

Conclusion.

Most complications related to patient discomfort and psychological stress, which were important issues in this type of patients.
Radial Neck Fractures in Children
Authors: Tan Bryan Hsi Ming , Mahadev Arjandas
Published: October 2016

Purpose.

To review records of 108 children with radial neck fractures and develop an algorithm for treatment.

Methods.

Records of 50 girls and 58 boys aged 2 to 14 (mean, 8.7) years with radial neck fractures were reviewed. The most common injury mechanism was tripping and falling on an outstretched hand while running (n=44), followed by falling from monkey bars (n=11). Fractures were classified into grade 1 (n=25), grade 2 (n=60), grade 3 (n=16), grade 4a (n=6), and grade 4b (n=1). 21 patients had associated fractures involving the olecranon, proximal ulna, and/or the humeral supracondyle. The time from injury to treatment ranged from 0 to 7 days. Treatments included casting without manipulation (n=86), closed reduction and casting (n=8), percutaneous Kirschner wire–assisted reduction and casting (n=7), and open reduction and casting (n=7).

Results.

Patients were followed up for a mean of 2.7 (range, 1–5) years. Outcome was excellent in 93 patients, good in 11, and fair in 4. Higher fracture grades correlated positively with poorer outcomes (p=0.001) and more invasive treatment (p=0.001). Nonetheless, the post-reduction angles of all the patients were not significantly different (p>0.05). Older children sustained more severe fractures (p=0.04) and had poorer outcomes, even after correction for fracture grade (p=0.007). Patients with associated fractures had significantly poorer outcomes (p<0.05). Two patients developed synostosis of the proximal radioulnar joint. One of whom had an associated olecranon fracture and underwent open reduction and casting. The other had an associated proximal ulnar fracture and underwent repeated percutaneous Kirschner wire–assisted reduction owing to loss of reduction. Five patients developed heterotopic ossification. Four of whom had associated fractures (3 involved the olecranon and one the proximal ulna). 14 patients developed cubitus valgus deformity of 3° to 10°.

Conclusion.

Open reduction should only be performed after more conservative treatments fail to achieve reduction.
Anterior Cruciate Ligament Reconstruction Using the Medial Third of the Patellar Tendon
Authors: Marimuthu Kanniraj , Joshi Narendra , Sharma Mrinal , Sharma Chandra Sekar , Bhargava Rakesh , Rajawat Ajay Singh , Rangdal Sushil Subash
Published: October 2016

Purpose.

To evaluate the mid-term outcome of anterior cruciate ligament (ACL) reconstruction using the medial third of the patellar tendon as the bone-patellar tendon-bone (BPTB) graft.

Methods.

79 men (34 right knees and 45 left knees) aged 20 to 52 (mean, 28) years underwent ACL reconstruction using the medial third of the patellar tendon with bone plugs and were followed up for a minimum of 3 years. Stability was assessed using the Lachman test and the pivot shift test. The range of motion, donor-site symptoms, Lysholm knee score, and International Knee Documentation Committee (IKDC) score were also recorded.

Results.

In terms of stability, only 4 patients had a grade-2 laxity postoperatively, compared to all having a grade-2 or −3 laxity preoperatively. Regarding the range of motion, extension loss was <3° in 76 patients and 3° to 5° in 3, whereas flexion loss was <5° in 73 patients, 5° to 15° in 5, and 16° to 25° in one. No patient had patellar tendon rupture/shortening, patellar fracture, or patellar maltracking. The mean Lysholm knee score improved from 48 to 92 (p<0.0001); scores were excellent (>90) in 46 patients and good (83–90) in 32 patients. The overall IKDC score was grade A (normal) in 9 patients, grade B (near normal) in 66, and grade C (abnormal) in 4. Three of the latter patients had osteoarthritic changes and pain on minimal physical activity. Only one patient had a sensation of partial giving way during moderate physical activity. 20% of the patients had anterior knee pain.

Conclusion.

Outcome of ACL reconstruction using the medial third of the patellar tendon was comparable to that using the central third of the patellar tendon. In addition, there were no instances of patellar tendon rupture/shortening, patellar fracture, or patellar maltracking.
High-Flexion versus Conventional Total Knee Arthroplasty: A 5-Year Study
Authors: Endres Stefan
Published: October 2016

Purpose.

To compare mid-term outcomes of a high-flexion prosthesis with a conventional prosthesis.

Methods.

Records of 107 consecutive patients who underwent total knee arthroplasty (TKA) for primary osteoarthritis by a single surgeon were reviewed. 21 men and 36 women (mean age, 65 years) used a high-flexion prosthesis (NexGen CR-Flex Mobile, Zimmer), whereas 38 men and 12 women (mean age, 67 years) used a conventional prosthesis (Genesis II, Smith & Nephew) that preserves the posterior cruciate ligament, with mobile-bearing polyethylene inlay. The Knee Society knee and functional scores and the range of motion (especially maximum passive flexion) were assessed. Radiographs were evaluated to identify radiolucent lines at the bone cement interface, patella tracking, tibiofemoral alignment, and implant positioning.

Results.

The mean follow-up period was 68 (range, 51–70) months. In terms of the mean Knee Society scores and range of motion, the difference between groups was not significant (p>0.05), but the improvement in both groups after TKA was significant (p<0.005). Respectively in the high-flexion and conventional TKA groups, 2 and one of the patients developed deep vein thrombosis and were treated with anticoagulants for 3 months. One and 5 of the patients had an unsatisfactory range of motion (<60°) in week 1, which was resolved with mobilisation under general anaesthesia in combination with a peridural catheter for analgesia. No patient developed implant-specific complications such as aseptic loosening (osteolysis, progressive radiolucent lines, implant deviation) or dislocation of the polyethylene insert.

Conclusion.

The high-flexion prosthesis revealed no significant advantages over the conventional prosthesis in terms of the Knee Society scores and range of motion. Long-term studies are needed to determine whether the high-flexion implant is superior to the conventional implant in terms of polyethylene wear and aseptic loosening.
Predictors of Early Stem Loosening after Total Hip Arthroplasty: A Case-Control Study
Authors: Melloh Markus , Eggli Stefan , Busato Andre , Roder Christoph
Published: October 2016

Purpose.

To evaluate the influence of patient characteristics on stem loosening after cemented or uncemented total hip arthroplasty (THA) using a matched case-control study.

Methods.

Consecutive records of 4372 cemented (716 cases and 3656 controls) and 809 uncemented (115 cases and 694 controls) primary THAs between 1981 and 2003 in 30 hospitals in 8 European countries were reviewed. Cases and controls were defined as patients with and without stem loosening, respectively. In cases of bilateral THA, patients were their own controls. Cases and controls were matched for hospital, date of surgery, date of follow-up, stem type, and head size. Patient characteristics such as gender, age, weight, height, body mass index (BMI), diagnosis, presence of previous surgery on the affected hip, and walking restrictions according to the Charnley classification were recorded.

Results.

Male patients were at higher risk of cemented stem loosening (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.4–2.2). Older patients were at lower risk of cemented stem loosening; the odds decreased by 3% per year older (OR, 0.97; 95% CI, 0.96–0.98). Regarding BMI, the odds of cemented stem loosening increased by 3% for each additional unit of BMI over 25 kg/m2 (OR, 1.03; 95% CI, 1.004–1.05). Patients in Charnley class B had a lower risk of cemented stem loosening (OR, 0.75; 95% CI, 0.61–0.93).

Conclusion.

Advanced age, female gender, and Charnley class B (as a proxy measure of reduced walking activity) have a protective effect on survival of cemented stems, whereas a higher BMI was a risk factor.
Lower Limb Alignment in Anterior Cruciate Ligament–Deficient versus –Intact Knees
Authors: Chung Stephen Chor-Yat , Chan Wai-Lam , Wong Sze-Hung
Published: October 2016

Purpose.

To compare anatomic lower limb features of anterior cruciate ligament (ACL)–deficient versus –intact knees in Chinese subjects.

Methods.

Anatomic lower limb features (mechanical axis, tibiofemoral angle, posterior tibial slope, notch width index, and hip neck-shaft angle) of 25 men and 3 women aged 18 to 39 (mean, 26) years with ACL-deficient knees, and 16 men and 4 women aged 24 to 31 (mean, 28) years with ACL-intact knees were compared using radiography.

Results.

The notch width index (0.26 vs. 0.29, p=0.02) was significantly smaller in ACL-deficient than ACL-intact knees.

Conclusion.

Small notch width was associated with a thin ACL and can be regarded as an anatomic intrinsic risk factor for ACL injuries.
Correlation between Metal Allergy and Treatment Outcomes after Ankle Fracture Fixation
Authors: So Sarah , Harris Ian A , Naylor Justine M , Adie Sam , Mittal Rajat
Published: October 2016

Purpose.

To determine correlation between metal hypersensitivity and long-term foot and ankle function and pain after internal fixation using stainless steel implants.

Methods.

60 men and 46 women (mean age, 47 years) who underwent internal fixation for ankle fractures completed a questionnaire 13 to 38 (mean, 26) months after surgery to assess their existing medical condition, history of metal hypersensitivity, problems and outcome of the implant (revision or removal), and the American Academy of Orthopaedic Surgeons (AAOS) foot and ankle score. A subset of 12 men and 15 women then underwent patch testing for metal hypersensitivity to molybdenum, chromium, iron, manganese, and nickel. Patients with positive and negative reactions were compared.

Results.

21 of the 106 patients underwent removal of the metal implants. The AAOS score was not associated with any of the variables, except for a history of metal hypersensitivity from dental implants and irritation around the surgical scar. Multiple linear regression analysis showed that only irritation around the surgical scar remained associated with poorer AAOS scores. Five of the 27 tested patients had a positive reaction. The mean AAOS scores did not differ significantly between patients with positive and negative reactions (34 vs. 31, p=0.73). Gender was not associated with the test results (p=0.63). None of the 5 patients with a positive reaction underwent revision surgery or reported any history of asthma or metal hypersensitivity. Of the 27 patients, one of the 8 who reported itching, irritation, redness or rash around the surgical scar had a positive reaction, compared to 4 of 19 patients who reported no such symptoms (p=1). Two of the 27 patients reported development of eczema after fixation, one of whom had a positive reaction. Only one of the 27 patients reported a history of metal hypersensitivity to jewellery, but had a negative reaction‥

Conclusion.

Neither a history of metal hypersensitivity nor positive patch testing correlated with poor outcomes after internal fixation for ankle fractures using stainless steel implants.
Factors Influencing Mortality in Patients on Antiplatelet Agents Presenting with Proximal Femoral Fractures
Authors: Maheshwari Rohit , Acharya Mehool , Monda Maureen , Pandey Radhakant
Published: October 2016

Purpose.

To identify factors predicting one-year mortality in patients on clopidogrel presenting with proximal femoral fractures.

Methods.

9 men and 22 women aged 64 to 97 (mean, 81; standard deviation, 8) years who had been taking clopidogrel for ischaemic heart disease (n=15), cerebrovascular disease (n=6), or both (n=10) presented with proximal femoral fractures. The time from injury to operation, type of anaesthesia, treatment method, and postoperative complications were reviewed. One-year mortality was analysed using the Kaplan-Meier curve. Factors predicting one-year mortality were identified. Results. The fracture configurations of the 31 patients included intracapsular femoral neck fracture (n=17), intertrochanteric fracture (n=13), and subtrochanteric fracture (n=1). 30 of the patients underwent hemiarthroplasty (n=16), dynamic hip screw fixation (n=9) or intramedullary hip screw fixation (n=5). The remaining patient underwent conservative treatment owing to metastatic prostate cancer. Of the 30 patients who underwent surgery, clopidogrel was discontinued at least 7 days prior to surgery, with the mean delay to surgery being 8.4 (range, 2–16) days. No patient had excessive blood loss at operation, although 7 patients received a blood transfusion postoperatively. 13 (43%) patients developed postoperative complications. The one-year mortality was 26% (8/31). Univariate analysis showed that factors predicting one-year mortality were spinal anaesthesia (p=0.04), postoperative blood transfusion (p=0.03), postoperative complications (p=0.03), and delay to surgery (p=0.03). Multiple regression analysis showed that delay to surgery (p=0.03) was the only independent predictor of one-year mortality, with a hazard ratio of 1.357 (95% confidence interval, 1.03–1.79).

Conclusion.

Surgery should be performed as soon as possible in medically fit patients having proximal femoral fractures who are taking clopidogrel, as delay to surgery is associated with increased one-year mortality.
Monitoring the Use of Halo Fixation Device through an Assessment Form
Authors: Ho Chin-Hung , Li Ka-Kin , Chin Raymond Ping-Hong , Lee Helen Wai-Man , Kwong William Yan-Yee , Kwan Hung-Hei
Published: October 2016

Purpose.

To compare the use of the halo fixation device in our hospital before and after implementation of a new compliance protocol.

Methods.

From 2003 to 2008, 17 (47%) of 36 patients had dislodgement of their halo fixation device. All rings and vests and some of the pins were reused. Documentation of poundage assessment and change of skull pins before dislodgement was lacking. There was no protocol for assessing superstructure throughout the course of the application. To improve the standard of care, knowledge about the application of the halo fixation device in orthopaedic and orthotic departments was reinforced and compliance documented. From September 2008 to April 2010, 15 patients used the halo fixation device for cervical immobilisation. Patients were reminded to minimise shoulder shrugging and report any discomfort. Poundage checking was strictly observed during and after application. The integrity of the device was regularly checked by orthotists. The conditions of the skull pins, halo ring, and vest were also documented after removal.

Results.

Two (13%) of the 15 patients had ring dislodgement. One occurred a day after application owing to malposition of a posterior skull pin, and the other was related to a fall in a toilet at week 4. Both involved reused skull pins. 45% of the skull pins were new, whereas 44% were found defective after removal of rings. Compliance with the new assessment form was satisfactory.

Conclusion.

Clinical audit improved outcome achieved with the halo fixation device. Reuse of titanium skull pins should be avoided. Re-torquing of the pin should be avoided when the tip is blunted or hooked. The new assessment form enabled compliance with the principle of application by orthotists and patients.
Cervical Transpedicular Fixation Aided by Biplanar Flouroscopy
Authors: Kotil Kadir , Sengoz Ahmet , Savas Yildiray
Published: October 2016

Purpose.

To evaluate the accuracy of fluoroscopy-assisted cervical transpedicular fixation in different pathologies.

Methods.

28 men and 17 women aged 34 to 65 (mean, 41) years underwent 210 one-stage cervical transpedicular fixations. The indications were trauma (n=35), degenerative disease leading to cervical spondylotic myelopathy (n=4), tumours (n=4), and Pott's disease (n=2). Regarding the 35 trauma patients, fractures were at C5–C6 (n=22), C4–C5 (n=8), and C3–C5 (n=5); 16 of them had dislocated vertebrae, of whom 13 had cervical disc herniation. Two of the patients with degenerative disease underwent additional laminectomy. Both anterior and posterior surgeries were performed for the 2 of the patients with tumours; all other patients underwent posterior surgery only. The length, diameters, and frontal, sagittal, and longitudinal angles of all pedicle screws were calculated. The dominant vertebral artery was detected using Doppler ultrasonography. Biplanar fluoroscopy was also used. Postoperatively, patients were allowed to mobilise at day 1; a collar was not used. The position of the pedicle screws was graded.

Results.

The mean operating time was 105 (range, 90–155) minutes. The mean follow-up period was 26 (range, 17–34) months. Of the 210 pedicles fixed, 192 (91%) were at the correct screw position (grade I), 16 (8%) were at an acceptable position (grade II), and 2 (1%) were completely perforated but without morbidity (grade III). The overall perforation rate was 9%. There were no neurovascular injuries or instrumentation-associated complications (failure of implant components, screw loosening, or lucent zone formation around the pedicle screws). The fusion rate was 100%.

Conclusion.

Cervical transpedicular fixation provides strong stabilisation. With the aid of biplanar fluoroscopy, the risk of pedicle perforation was about 8%, but no neurovascular injury was ensued.
Non-Vascularised Fibular Graft as an Intramedullary Strut for Infected Non-Union of the Humerus
Authors: Gopisankar G , Justin Arockiaraj SV , Nithyananth Manasseh , Cherian Vinoo M , Lee VN
Published: October 2016

Purpose.

To review outcomes of 7 patients who underwent revision surgery for infected non-union of the humerus using a fibular graft as an intramedullary strut.

Methods.

Records of 7 men aged 29 to 59 (mean, 40) years with humeral diaphyseal infected nonunion who underwent fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut were reviewed. The mean number of previous surgeries was 2.7 (range, 2–4). Three of the patients had active draining sinuses previously. Their C-reactive protein levels were normal and tissue cultures negative. The remaining 4 patients had active draining sinuses. They first underwent implant removal and debridement. Tissue cultures confirmed infection in 3 of them. The mean duration between debridement and the index surgery was 5 (range, 3–10) months.

Results.

The mean length of the fibulae harvested was 13 (range, 12–15) cm. All 7 non-unions healed. The mean time to healing was 5.4 (range, 4–8) months. The mean follow-up period was 15 (range, 13–24) months. All patients had weakness of the extensor hallucis longus, which improved to near normal at month 3. There was no donor-site morbidity. Three patients with active infection at presentation underwent repeat surgery. Two of them had wound washouts, and their non-unions went on to heal successfully; one underwent implant removal after union due to an active sinus. Six of the patients returned to their pre-injury activity level, and one endured a brachial plexus injury.

Conclusion.

Fixation using a compression plate and a non-vascularised fibular graft as an intramedullary strut achieved good outcome for infected non-union of the humerus despite prior multiple failed surgeries.
Cannulated Cancellous Screw Fixation for Capitellum Fractures in Adolescents
Authors: Ong Kee Leong , Mahadev Arjandas
Published: October 2016

Purpose.

To review the outcome of 9 adolescents treated with 2 to 3 cannulated cancellous screws for type-1 capitellum fractures.

Methods.

Records of 8 boys and one girl aged 12 to 14 (mean, 14) years with type-1 capitellum fractures were reviewed. The mechanism of injury was a fall on the flexed elbow. No patient had associated injuries or neurovascular compromise. In 2 patients, the fracture was minimally displaced and treated with a cast. The remaining 7 patients with displaced fractures underwent open reduction and internal fixation using 4.0-mm cannulated partially threaded cancellous screws inserted in a posterior-to-anterior direction. In one patient, a Kirschner wire was added to fix a small comminuted fragment. Elbow pain, range of motion, stability, and function were evaluated using the Mayo Elbow Performance Index.

Results.

The mean follow-up period was 7 (range, 2–18) months. The mean Mayo Elbow Performance Index score was 100, indicating excellent outcome. No patient developed avascular necrosis or heterotrophic ossification. All patients achieved anatomic bone union. All implants were removed after a mean of 4.7 (range, 2–7) months.

Conclusion.

The fixation of type-1 capitellum fractures with 2 to 3 cannulated cancellous screws inserted posteroanteriorly achieved excellent functional outcome.
Musculoskeletal Oncology Training during Residency
Authors: Burke Neil G , Moran Cathal J , Hurson Brian , Dudeney Sean , O'Toole Gary C
Published: October 2016

Purpose.

To evaluate the efficacy of a musculoskeletal oncology training module during residency.

Methods.

24 orthopaedic residents with differing years of experience were recruited. 12 of them received musculoskeletal oncology training for 6 months. The remaining 12 were controls who did not attend the training and had no clinical experience in a musculoskeletal oncology unit but had at least 3 years of postgraduate surgical training. Upon completion, residents in both groups were assessed by a knowledge test and then an objective structured clinical examination (OSCE).

Results.

Residents who attended the training module had better mean knowledge test scores (48 vs 25 out of 58, p<0.0001) and OSCE scores (32 vs 22 out of 42, p<0.004), compared to those who did not attend. No residents who attended the training module marked an inappropriate biopsy site that would have compromised definitive surgery, compared to 5 (42%) of the untrained residents who marked an inappropriate biopsy site that may have resulted in an unnecessary amputation. All residents who attended the training module agreed that such a module should be included in the orthopaedic residency programme.

Conclusion.

Residents who attended the training module were more aware of the biopsy principles and risks. A training module for musculoskeletal oncology should be included in the orthopaedic residency programme.
Review Article: Plica Syndrome of the Knee
Authors: Al-Hadithy Nawfal , Gikas Panagiotis , Mahapatra Anant M , Dowd George
Published: October 2016

Plica syndrome is a pathological condition secondary to inflammation. Plicae around the knee are common and generally asymptomatic. They often are misdiagnosed. The morphology of knee plicae varies; mediopatellar plicae are the most common cause of the plicae syndrome. An intermittent dull pain is the most common symptom. Diagnosis is made by exclusion. Ultrasonography is useful; arthroscopy is the gold standard. Arthroscopic removal of the plica may be necessary when conservative treatment for up to 6 months fails.
Avulsion-Fracture of the Anterior Superior Iliac Spine with Meralgia Paresthetica: A Case Report
Authors: Hayashi Shinya , Nishiyama Takayuki , Fujishiro Takaaki , Kanzaki Noriyuki , Kurosaka Masahiro
Published: October 2016

We present a rare case of avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica in a 16-year-old male basketball player. He had sensory disturbance affecting his left lateral thigh 10 days after the injury. Tinel's sign was elicited on percussing the avulsed bony fragment of the anterior superior iliac spine. He underwent open reduction and internal fixation. The lateral femoral cutaneous nerve was noted to be entrapped by one third of the avulsed bony fragment. That fragment was removed, and the remaining portion was reduced and fixed with 2 screws. At week 6, the patient had returned to basketball playing without pain. At week 8, sensory distribution in the left lateral thigh had returned to normal.
Tension Band Wire for Acetabular Fracture Fixation: A Technical Note
Authors: Lal Hitesh , Bansal Pankaj , Sabarwal Vinod Kumar , Mittal Deepak
Published: October 2016

Maintaining reduction of an acetabular fracture during internal fixation is difficult. A variety of clamps can be used to facilitate reduction, but they are cumbersome and may damage the sciatic nerve. We developed a simple and cost-effective technique for provisional reduction and fixation of acetabular fractures using 2 screws and a tension band wire.
Pyogenic Discitis following Discectomy
Authors: Moon Myung-Sang , Kim Sung-Soo , Lee Bong-Jin , Moon Jeong-Lim , Sihn Jang-Cheol , Moon Seog In
Published: October 2016

Purpose.

To assess the treatment outcome for disc infection in 35 patients.

Methods.

Records of 23 men and 12 women aged 36 to 62 (mean, 43) years who underwent treatment for pyogenic discitis after open discectomy were reviewed. All patients had single-level disc herniation of L4–5 (n=28) or L5-S1 (n=6), except for one who had 2-level disc herniation of L4-S1. Single antibiotic was given one day prior to discectomy and continued for 2 days. All excised discs were found to be sterile. Discitis was classified into acute (n=26), subacute (n=7), and chronic (n=2). Antibiotic therapy was started immediately when the clinical diagnosis was made. 31 patients were treated with antibiotics alone; the remaining 4 underwent surgery entailing simple posterior superficial wound drainage (n=1), anterior radical surgery (n=2), or posterior instrumentation and posterolateral fusion for post-discectomy syndrome (n=1). Six of the 12 patients who had percutaneous disc space aspiration underwent disc space irrigation.

Results.

The initial symptoms included mild-to-moderate fever (n=4), severe back pain (n=27), back muscle spasms (n=26), back pain radiating to the limb (n=2), Gower sign (n=11), and a draining wound (n=1). The wound aspirates of the 12 patients grew organisms, although blood cultures were negative in all. After antibiotic therapy, symptoms gradually subsided in parallel with normalisation of white blood cell count and inflammatory markers. Surgery was indicated only when symptoms worsened and the disease progressed. Spontaneous intercorporal fusion did not occur.

Conclusion.

Early diagnosis and treatment with appropriate antibiotics is important for post-discectomy discitis.
Continuous Femoral Nerve Block versus Patient-Controlled Analgesia following Total Knee Arthroplasty
Authors: Ng Fu-Yuen , Chiu Kwong-Yuen , Yan Chun Hoi , Ng Kwok-Fu Jacobus
Published: October 2016

Purpose.

To compare total knee arthroplasty (TKA) patients who received continuous femoral nerve block (FNB) with local anaesthetics through a catheter versus patient-controlled analgesia (PCA) with intravenous morphine.

Methods.

50 women and 10 men aged 51 to 84 years with matched characteristics underwent TKA and received either continuous FNB with local anaesthetics through a catheter (n=30) or PCA with intravenous morphine (n=30). None of the patients had had previous knee surgery. All operations were performed according to the standard protocol. Daily mean pain numerical rating scale at rest (NRS-R) and during movement (NRS-M), requirement of extra pain control, complications related to pain control, and overall patient satisfaction in both groups were compared.

Results.

Both groups were similar in terms of pain NRS-R and NRS-M, overall satisfaction, and length of hospital stay. Within each group, pain NRS-M score was significantly higher than pain NRS-R score. In the FNB group, 3 patients had dislodgement of the femoral catheter on day 1 and switched to PCA with intravenous morphine. Two of them had fair satisfaction. Patients in the PCA group had significantly more side-effects (nausea, vomiting, dizziness, and pruritis); 2 of the 5 patients with nausea and vomiting had fair satisfaction. No patients had any surgical complication.

Conclusion.

Both FNC and PCA provide reliable pain control.
Acutrak versus Herbert Screw Fixation for Scaphoid Non-Union and Delayed Union
Authors: Oduwole Kayode O , Cichy Benedikt , Dillon John P , Wilson Joan , O'Beirne John
Published: October 2016

Purpose.

To compare the treatment outcome of Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union.

Methods.

Records of 132 patients who underwent Herbert screw fixation (n=61) or Acutrak screw fixation (n=71) with or without bone grafting for scaphoid non-union and delayed union by a single surgeon were reviewed. The most common fracture site was the waist of the scaphoid (n=95), followed by the proximal pole (n=31) and the distal pole (n=6). Screw placement was considered accurate (n=120) when the screw was placed in the central one-third (axially) of the scaphoid; otherwise it was eccentric (n=12). Bone union was assessed radiographically and clinically. Functional outcome was assessed using the modified Mayo wrist score.

Results.

Respectively in the Herbert and Acutrak screw groups, the mean patient ages were 25.3 and 27.3 years (p=0.28), the mean intervals between injury and screw fixation were 12.2 and 17 months (p=0.38), the mean durations to bone union were 2.1 and 1.8 months (p=0.63), and the union rates were 77% and 93% (p=0.01). The union rate was significantly higher in fractures of the waist of the scaphoid than in the proximal and distal poles (94% vs. 71% vs. 33%, p=0.001). The union rate was significantly higher when the screw was placed accurately (axially) than eccentrically (Herbert screw: 84% vs. 40%, p=0.006; Acutrak screw: 96% vs. 0%, p=0.004). 84% of the Herbert screws were placed axially, compared to 97% for the Acutrak screws. Respectively, 67% and 85% of patients had satisfactory functional outcomes (p=0.03), whereas 23% and 7% of the patients had persistent non-union (p=0.05).

Conclusion.

The Acutrak screw enabled more accurate screw placement and achieved higher union rates and modified Mayo wrist scores than the Herbert screw did.
Ultrasonographic Evaluation of Achilles Tendons in Clubfeet before and after Percutaneous Tenotomy
Authors: Agarwal Anil , Qureshi Nadeem Akhtar , Kumar Pawan , Garg Amit , Gupta Neeraj
Published: October 2016

Purpose.

To measure the size of the Achilles tendons in congenital clubfeet using ultrasonography before and after percutaneous tenotomy.

Methods.

15 boys and 12 girls (39 feet) aged one to 11 (mean, 5) months with idiopathic clubfeet underwent percutaneous tenotomy (Ponseti method). The size of each Achilles tendon was measured ultrasonographically by a single radiologist before and after surgery. In patients with unilateral clubfoot, the normal foot was used as a referent. Longitudinal scans assessed the echotexture, echogenicity, and continuity of the tendon. Transverse scans assessed the shape, echotexture, echogenicity, thickness, and width of the tendon. The size of the Achilles tendon was estimated as an elliptical area using the formula: π(thickness)x(width)/4.

Results.

Before tenotomy, homogenous, hyperechoic, and linear continuous shadows were noted in longitudinal scans of both the normal and affected Achilles tendons. In transverse scans, the tendons were elliptical, homogenous, and echogenic in appearance. Four weeks after tenotomy, the tendons appeared as heterogeneous, linear continuous shadows with regular margins irrespective of patient age. There was decreased echogenicity in the treated foot. The transverse section of the tendons was elliptical with a heterogeneous echotexture that was predominantly hypoechoic. There was no significant difference in normal, unilateral, and bilateral tendons before and after tenotomy.

Conclusion.

The study reasserts functional continuity of the Achilles tendons 4 weeks after tenotomy using clinical and ultrasonographic methods.
Fractures of the Scaphoid, Capitate and Triquetrum in a Child: A Case Report
Authors: Foley Kieran , Patel Sandeep
Published: October 2016

Carpal fractures in children are rare, especially with a combination of scaphoid, capitate, and triquetrum fractures. We report one such case in a 10-year-old boy who was successfully treated with Kirschner wires.
Non-Union of the Triquetrum with Pseudoarthrosis: A Case Report
Authors: Sin Cheuk-Hang , Leung Yuen-Fai , Ip Shirley Pui-Sheung , Wai Yuk-Leung , Ip Wing-Yuk
Published: October 2016

We report a case of symptomatic non-union of the triquetrum with pseudoarthrosis in a 34-year-old man. Motion of the pseudoarthrosis was noted from radial to ulnar deviation. The patient was treated with bone grafting and screw fixation. The non-union healed and the symptoms subsided. The Mayo wrist score had improved from 65 (fair) to 90 (excellent).
Patient-Specific Instrumentation for Total Knee Replacement Verified by Computer Navigation: A Case Report
Authors: Chan Kok-Yu , Teo Yee-Hong
Published: October 2016

Patient-specific instrumentation (PSI) enables better restoration of the mechanical axis in total knee replacement (TKR) than conventional instrumentation (alignment guides) does. We verified the accuracy of the PSI by computer navigation. The PSI jigs were accurate only if they were pinned accurately onto the distal femur and proximal tibia. Any slight malposition of the jigs leads to malalignment of the bone cuts. In the absence of computer navigation, the accuracy of the jig alignments cannot be checked and may result in malalignment.
Femoral Canal Obliteration Secondary to Prolonged Alendronate Use: A Case Report
Authors: Lim Chin Tat , Setiobudi Tony , De Shamal Das
Published: October 2016

Insufficiency fractures secondary to prolonged alendronate use is due to inhibition of osteoclastic activity and suppressed bone turnover. Complications of fracture fixation include non-union, mal-union, and difficulty in intramedullary nail insertion. We report a technical challenge in intramedullary nailing of an obliterated femoral canal in a patient on long-term bisphosphonate treatment. The fracture site was explored. The medullary canal was re-created by drilling. Patience and caution during drilling and reaming are necessary to avoid iatrogenic fractures.
Platelet-Rich Plasma for Calcific Tendinitis of the Shoulder: A Case Report
Authors: Seijas Roberto , Ares Oscar , Alvarez Pedro , Cusco Xavier , Garcia-Balletbo Montserrat , Cugat Ramon
Published: October 2016

We report a 44-year-old woman with calcific tendinitis of the shoulder treated with platelet-rich plasma injection. Prior to this, she had no improvement of the symptoms after 6 weeks of ultrasound treatment, Codman exercises, and anti-inflammatory treatment. Platelet-rich plasma was injected into the subacromial area 3 times at 2-week intervals. She had progressive improvement of pain after 2 weeks, and was asymptomatic at week 6. The patient then underwent the previous protocol of rehabilitation. At the one-year follow-up, the patient was pain-free and had complete resolution of calcific tendinitis. The patient had regained full range of movement and had resumed all her activities.
Intra-Osseous Lipoma of the Talus: A Case Report
Authors: Rajmane Shivkumar , Kulkarni PN , Patil Adish , Patil VC , Rajmane Vijaya
Published: October 2016

Intra-osseous lipomas are rare benign tumours. We report one such case in the talus of a 60-year-old man. The patient underwent curettage and bone grafting. At the 22-month follow-up, radiographs of the talus showed dense sclerosis with multiple cortical breaks in the anterior process and no evidence of local recurrence or avascular necrosis. The patient had a painless ankle joint with normal range of movement.
Comparison of Tibial Bone Coverage of 6 Knee Prostheses: A Magnetic Resonance Imaging Study with Controlled Rotation
Authors: Wernecke Gregory C , Harris Ian A , Houang Michael TW , Seeto Bradley G , Chen Darren B , MacDessi Samuel J
Published: October 2016

Purpose.

To compare the extent of tibial bone covered by the tibial tray in 6 most commonly used total knee arthroplasty designs in order to strike a balance between mediolateral cortical fit and optimal tibial component rotation.

Methods.

In 74 men and 27 women aged 17 to 60 (mean, 32) years with suspected soft-tissue injuries, their magnetic resonance images of the knee in full extension were superimposed with scans of the tibial trays of the 6 designs (one asymmetric and 5 symmetric). The tibial coverage by the tray and any posterolateral/posteromedial overhang/underhang were measured.

Results.

All 6 tray designs achieved tibial bone coverage of over 80%. Only 28% of all trays achieved optimal posterolateral fit, whereas 49% had posterolateral overhang enough to cause popliteal tendon impingement. Although the asymmetric tray provided highest tibial coverage (88%), its rates of relative and absolute posterolateral and posteromedial overhang were also highest (64%).

Conclusion.

The asymmetric tray provided improved tibial coverage at the expense of posterolateral and posteromedial overhang of the tibial tray.
Gender-Specific High-Flexion Knee Prosthesis in Indian Women: A Prospective Randomised Study
Authors: Singh Harjoban , Mittal Vivek , Nadkarni Biren , Agarwal Shekhar , Gulati Divesh
Published: October 2016

Purpose.

To compare outcomes in Indian women who underwent total knee arthroplasty (TKA) using the standard Legacy Posterior Stabilised (LPS) versus the gender-specific LPS high-flexion knee prosthesis.

Methods.

100 women (200 knees) aged 60 to 80 years with an arc of flexion of ≥90° underwent simultaneous sequential TKA for primary osteoarthritis of both knees. They were randomised to receive the standard NexGen LPS prosthesis (n=50) or the gender-specific NexGen LPS High-Flex prosthesis (n=50). Both knees in each patient received the same prosthesis. The resected bone from the posterior femoral condyle was 2 mm greater when the gender-specific prosthesis was used. Patients were followed up at 3, 6, 12, and 24 months. Range of motion, Knee Society score, and Hospital for Special Surgery score were evaluated pre- and post-operatively by a single assessor.

Results.

The mean follow-up duration was 2.1 (range, 1.6–2.5) years. Respectively for the standard and gender-specific groups, the mean range of motion was 111° and 112° preoperatively and 120° and 123° at the latest follow-up. The gender-specific group gained approximately 3° more in range of motion (p=0.007). The Knee Society score and the Hospital for Special Surgery score between groups were not significantly different pre- and post-operatively.

Conclusion.

The perceived advantage of a gender-specific prosthesis over a standard prosthesis did not translate into better clinical and functional outcome scores.
Rates of Pin Site Infection during Distraction Osteogenesis Based on Monthly Observations: A Pilot Study
Authors: Saw Aik , Chua Yeok Pin , Hossain Golam , Sengupta Subir
Published: October 2016

Purpose.

To assess the monthly rates of infection of individual pin sites in 7 patients during distraction osteogenesis.

Methods.

Five men and 2 women aged 15 to 35 (mean, 23) years underwent distraction osteogenesis for 8 tibias using the Ilizarov ring external fixator or Taylor Spatial Frame. Patients were taught to perform standard daily pin site care at home, and were evaluated monthly for pin site infection by a single observer using a standardised grading system.

Results.

Of 1334 observations made on 110 pin/wire sites, there were 83 (6%) pin site infections; 44 (3%) were grade 1 and 39 (3%) were grade 2. The risk of infection was higher at half pin than wire sites. The highest rates occurred in the distal segment.

Conclusion.

Monthly evaluation of individual pin sites enables comparison between studies
The Male Osteoporosis Risk Estimation Score and the Osteoporosis Self-Assessment Screening Tool for Indonesian Men
Authors: Fransiska Yuliana , Tiksnadi Bambang , Chaidir Rizal , Ismiarto Yoyos Dias
Published: October 2016

Purpose.

To evaluate the male osteoporosis risk estimation score (MORES) and the osteoporosis self-assessment screening tool (OST) score as a means of screening for osteoporosis in men.

Methods.

Records of 113 Indonesian men aged 50 to 91 (mean, 71) years who underwent evaluation of bone mineral density (T-score) using Dual-energy X-ray absorptiometry were retrospectively reviewed. The MORES was determined by 3 osteoporosis risk factors: age (in years), body weight (in kg), and chronic obstructive pulmonary disorder. A MORES of ≥6 indicated osteoporosis and corresponded to a T-score of ≤-2.5. The OST score was calculated as body weight (in kg) minus age (in years) multiplied by 0.2. An OST score of ≤2 indicated osteoporosis and corresponded to a T-score of ≤-2.5. Sensitivity, specificity, and positive and negative predictive values of the MORES and the OST score were determined.

Results.

Respectively for the MORES and the OST score, sensitivity values were 100% and 74%, specificity values were 7% and 41%, positive predictive values were 25% and 28%, and negative predictive values were 100% and 83%. Using receiver operating characteristic curves, the area under curve was 0.535 for the MORES and 0.574 for the OST score.

Conclusion.

The MORES and the OST score should be used together to screen for osteoporosis in men.