bluuebunny/crossref_metadata_2025 huggingface dataset:
FRACTURES OF THE CORACOID PROCESS
Authors: Ogawa K. , Yoshida A. , Takahashi M. , Ui M.
Published: February 2018

We reviewed 67 consecutive patients with fractures of the coracoid process, classifying them by the relationship between the fracture site and the coracoclavicular ligament. The 53 type-I fractures were behind the attachment of this ligament, and the 11 type-II fractures were anterior to it. The relationship of three fractures was uncertain. Type-I fractures were associated with a wide variety of shoulder injuries and consequent dissociation between the scapula and the clavicle. Treatment was usually by open reduction and fixation for type-I fractures and conservative methods for type-II.

At follow-up of the 45 available patients, 87% had excellent results, with no significant differences between the operative and non-operative groups or between the type-I and type-II fractures. We consider that operative treatment should be reserved for patients with multiple shoulder injuries with severe disruption of the scapuloclavicular connection.
THE SHORT FORM-36 HEALTH SURVEY QUESTIONNAIRE IN SPINE SURGERY
Authors: Grevitt M. , Khazim R. , Webb J. , Mulholland R. , Shepperd J.
Published: February 2018

The Short Form-36 (SF-36) health questionnaire has been put forward as a general measure of outcome in health care and has been evaluated in several recent studies in the UK. We report its use in three groups of patients after spinal operations and have compared it with the Oswestry and Low Back Pain disability scales.

There was a significant correlation between all variables of the SF-36 and the low-back scores. The mental-health items had the weakest correlation. Our study shows that the SF-36 questionnaire is valid and has internal consistency when applied to these patients.
SPONTANEOUS REGENERATION OF THE LATERAL MALLEOLUS AFTER TRAUMATIC LOSS IN A THREE-YEAR-OLD BOY
Authors: Park H.-W. , Kim H.-J. , Park B.-M.
Published: February 2018

We describe a three-year-old boy who had spontaneous regeneration of the entire lateral malleolus after injury, including the epiphysis, physis and metaphysis.
JOINT LOAD CONSIDERATIONS IN TOTAL KNEE REPLACEMENT
Authors: Kuster M. S. , Wood G. A. , Stachowiak G. W. , Gächter A.
Published: February 2018

Estimates of knee joint loadings were calculated for 12 normal subjects from kinematic and kinetic measures obtained during both level and downhill walking. The maximum tibiofemoral compressive force reached an average load of 3.9 times body-weight (BW) for level walking and 8 times BW for downhill walking, in each instance during the early stance phase. Muscle forces contributed 80% of the maximum bone-on-bone force during downhill walking and 70% during level walking whereas the ground reaction forces contributed only 20% and 30% respectively.

Most total knee designs provide a tibiofemoral contact area of 100 to 300 mm2. The yield point of these polyethylene inlays will therefore be exceeded with each step during downhill walking. Future evaluation of total knee designs should be based on a tibiofemoral joint load of 3.5 times BW at 20° knee flexion, 8 times BW at 40° and 6 times BW at 60°.
SUBSTANCE P LEVEL IN SYNOVIAL FLUID MAY PREDICT PAIN RELIEF AFTER KNEE REPLACEMENT
Authors: Pritchett J. W.
Published: February 2018

Substance P is readily detected in the synovial fluid of the knee in which it acts as a powerful inflammatory agent in response to injury and disease. It may be an objective predictor of pain after knee replacement surgery.

The level of substance P was measured in the synovial fluid in both knees of 114 patients having unilateral and in 86 patients having bilateral total knee replacement for osteoarthritis. All had severe pain in the knee to be replaced and joint destruction. Substance P was elevated in 73% of replaced knees but not in normal or asymptomatic knees. Good or excellent pain relief was achieved in 97% of patients with an elevated preoperative level of substance P and in 61% of those with a normal preoperative level (p < 0.05 compared with preoperative values).
JOINT MOTION AND SURFACE CONTACT AREA RELATED TO COMPONENT POSITION IN TOTAL HIP ARTHROPLASTY
Authors: Robinson R. P. , Simonian P. T. , Gradisar I. M. , Ching R. P.
Published: February 2018

A three-dimensional computer model of a total hip replacement was used to examine the relationship between the position of the components, the range of motion and the prosthetic joint contact area. Horizontal acetabular positions with small amounts of acetabular and femoral anteversion provide the largest contact areas, but result in limited joint movement.

These data will allow surgeons to select implant positions that will provide the largest possible joint contact area for a given joint range of motion although these are conflicting goals. In some component positions a truncated spherical prosthetic head resulted in smaller contact areas than a completely spherical head.
OSTEONECROSIS OF THE FEMORAL HEAD
Authors: Sakamoto M. , Shimizu K. , Iida S. , Akita T. , Moriya H. , Nawata Y.
Published: February 2018

We performed a prospective study using MRI to evaluate early necrosis of the femoral head in 48 patients receiving high-dose corticosteroids for the treatment of various autoimmune-related disorders. The mean interval from the initiation of corticosteroid therapy to the first MRI examination was 2 months (0.5 to 6). MRI was repeated, and the mean period of follow-up was 31 months (24 to 69).

Abnormalities were found on MRI in 31 hips (32%). The initial changes showed well-demarcated, band-like zones which were seen at a mean of 3.6 months after initiation of treatment with steroids. In 14 of these hips (45%) there was a spontaneous reduction in the size of the lesions about one year after treatment had started, but there was no further change in size with a longer follow-up.
SOFT-TISSUE BALANCING WITH PRESSURE DISTRIBUTION DURING TOTAL KNEE ARTHROPLASTY
Authors: Takahashi T. , Wada Y. , Yamamoto H.
Published: February 2018

We measured the pressure distribution across the tibiofemoral and patellofemoral joints during total knee arthroplasty (TKA) using Fuji pressure-sensitive film (Prescale) in 51 patients (63 joints) comparing the results with those in 21 patients in whom Prescale was not used.

We classified the stress-distribution patterns in the tibiofemoral joints into four types: normal, varus-valgus instability, rotational malalignment, and a combination of instability and malrotation. The medial ligaments were then released according to the information obtained from these patterns. The conformity ratio of the contact area between repeated trials was 87.0%. Pressure distribution across the patellofemoral joints was also considered.

There was a significant decrease in the mean valgus stress angle in the Prescale group compared with the control group (p < 0.01). Release of the lateral retinaculum according to the results showed no significant differences in subluxation of the patella between the released group and the group which did not appear to need this procedure.
TOTAL HIP ARTHROPLASTY AFTER PREVIOUS PROXIMAL FEMORAL OSTEOTOMY
Authors: Boos N. , Krushell R. , Ganz R. , Müller M. E.
Published: February 2018

We compared 74 total hip arthroplasties (THAs) carried out after previous proximal femoral osteotomy with a diagnosis-matched control group of 74 primary procedures performed during the same period. We report the perioperative results and the clinical and radiological outcome at five to ten years.

We anticipated a higher rate of complications in the group with previous osteotomy, but found no significant difference in the rate of perioperative complications (11% each) or in the septic (8% v 3%) and aseptic (4% each) revision rates. There was a trend towards improved survival in the group without previous osteotomy (90% v 82%), but this difference was not statistically significant. The only significant differences were a higher rate of trochanteric osteotomy (88% v 14%) and a longer operating time in the osteotomy group.

Our study indicates that THA after previous osteotomy is technically more demanding but not necessarily associated with a higher rate of complications. Furthermore, proximal femoral osteotomy does not jeopardise the clinical and radiological outcome of future THA enough to exclude the use of osteotomy as a therapeutic alternative in younger patients.
THE EFFECTS OF EARLY TOURNIQUET RELEASE DURING TOTAL KNEE ARTHROPLASTY
Authors: Barwell J. , Anderson G. , Hassan A. , Rawlings I.
Published: February 2018

We studied the effects of the timing of tourniquet release in 88 patients randomly allocated for release after wound closure and bandaging (group A), or before the quadriceps layer had been closed allowing control of bleeding before suture (group B). The groups were similar in mean age, weight, gender, preoperative knee score, radiographic grading, and prosthesis implanted.

Patients in group B had less postoperative pain, achieved earlier straight-leg raising, and had fewer wound complications. Five patients in group A had to return to theatre, three for manipulation under anaesthesia, one for secondary closure of wound dehiscence, and one for drainage of a haematoma. The last patient later developed a deep infection, which was treated by a two-stage revision. There were no significant differences between the two groups in operating time, or the decrease in haemoglobin concentration at 48 hours postoperatively.

Some of the adverse effects of the use of a tourniquet for knee surgery can be significantly reduced by early tourniquet release, with haemostasis before the quadriceps mechanism and the wound are closed.
COMPLEX NONUNION OF FRACTURES OF THE FEMORAL SHAFT TREATED BY WAVE-PLATE OSTEOSYNTHESIS
Authors: Ring D. , Jupiter J. B. , Sanders R. A. , Quintero J. , Santoro V. M. , Ganz R. , Marti Rene K.
Published: February 2018

We have treated 42 consecutive complex ununited fractures of the femoral shaft by wave-plate osteosynthesis at five different medical centres. There were 13 with previous infection, 12 with segmental cortical defects, and 3 were pathological fractures. In 39 cases there had been previous internal fixation and 21 patients had had more than one earlier operation.

Union was achieved in 41 patients at an average of six months, although three had required a second bone graft. Two patients had recurrence of infection and in one this resulted in the persistence of nonunion. There were no failures of the implant. All 41 patients with union are now fully weight-bearing, but four have a leg-length discrepancy, one has axial malalignment, and nine have residual stiffness of the knee. These results are surprisingly good, despite the complexity of the initial problem, and appear to confirm the biological and mechanical advantages of the wave plate over the conventional plate for such cases.
ATROPHIC NONUNION OF THE CLAVICLE
Authors: Boyer M. I. , Axelrod T. S.
Published: February 2018

We describe a new surgical treatment of atrophic nonunion of the clavicle. The nonunion is excised by cuts at 45° to the long axis and repair uses 3.5 mm pelvic reconstruction or dynamic compression plates, with a lag screw to provide interfragmentary compression. The site is grafted with cancellous bone.

We have been successful in all seven patients, with early return to normal function. The consequent narrowing of the shoulder girdle is fully acceptable for appearance and function.
EPIPHYSIODESIS USING A CANNULATED TUBESAW
Authors: Macnicol M. F. , Gupta M. S.
Published: February 2018

A technique for epiphysiodesis using a cannulated tubesaw has been developed to combine the precision of the original Phemister method with newer percutaneous methods. The approach is unilateral, and requires minimal access. Reinsertion of the removed core of bone reduces haemorrhage from the defect and augments arrest of the growth plate.

In 35 patients treated by this method predicted discrepancies of 2 to 4.5 cm were reliably reduced to 0.7 ± 0.6 cm, with no serious complications. The timing of surgery is critical, and relies upon careful monitoring of the pattern of discrepancy over several years, using clinical and radiographic measurements. Undercorrection of the disparity in three patients was the direct result of late referral.
CUBITAL TUNNEL RECONSTRUCTION FOR ULNAR NEUROPATHY IN OSTEOARTHRITIC ELBOWS
Authors: Tsujino A. , Itoh Y. , Hayashi K. , Uzawa M.
Published: February 2018

We operated on 16 patients for ulnar neuropathy associated with osteoarthritis of the elbow. They were all male manual workers, with an average age of 51 years at the time of surgery. The severity of the symptoms was McGowan grade 1 in five patients, grade 2 in nine and grade 3 in two. The mean follow-up was 36 months.

The operation consists of resecting the osteophytes around the postcondylar groove. The shallow and narrow cubital tunnel is made deep and wide and the ulnar nerve is replaced with its surrounding soft tissues in the enlarged groove.

All patients were relieved of discomfort and all showed some improvement or full recovery of motor and sensory function. The ulnar nerve showed no evidence of irritation or adhesion. This procedure also allows early movement of the elbow after operation, because the subcutaneous tissues and muscles have not been detached.
THE INTEROSSEOUS MEMBRANE IN RADIO-ULNAR DISSOCIATION
Authors: Wallace A. L. , Walsh W. R. , van Rooijen M. , Hughes J. S. , Sonnabend D. H.
Published: February 2018

In severe forearm injuries, the diagnosis of disruption of the interosseous membrane is frequently delayed and sometimes missed, giving difficulties in the salvage of forearm stability.

We studied the structure and function of the interosseous membrane in 11 cadaver preparations, using mechanical and histological analysis. Seven of the specimens tested in uniaxial tension sustained a mid-substance tear of the central band of the membrane at a mean peak load of 1038 ± 308 N. The axial stiffness was 190 ± 44 N/mm with elongation to failure of 10.34 ± 2.46 mm. These results provide criteria for the evaluation of reconstructive methods.

A preliminary clinical investigation of the use of ultrasound suggests that this may be of value in the screening of patients with complex fractures of the forearm, and for investigating the natural history of tears of the interosseous membrane.
EXTERNAL FIXATION AND SECONDARY INTRAMEDULLARY NAILING OF OPEN TIBIAL FRACTURES
Authors: Antich-Adrover P. , Martí-Garin D. , Murias-Alvarez J. , Puente-Alonso C.
Published: February 2018

We performed a prospective, randomised trial in 39 patients with open tibial fractures treated initially by external fixation to compare cast immobilisation (group A) and intramedullary nailing (group B) as a sequential protocol planned from the onset of treatment.

The results showed that group B achieved faster union (p < 0.05) than group A with less malunion or shortening and a greater range of movement. Patients treated by intramedullary nailing required fewer radiographs and outpatient visits (p = 0.0015) and had a more predictable and rapid return to full function.

We feel that these severe fractures are better treated by delayed intramedullary nailing and that this has an acceptable rate of complications.
MECHANOSENSITIVE AFFERENT UNITS IN THE LATERAL LIGAMENT OF THE ANKLE
Authors: Takebayashi T. , Yamashita T. , Minaki Y. , Ishii S.
Published: February 2018

We have studied the mechanosensitive afferent units in the lateral ligament of the ankle of the cat, with reference to the causes of lateral instability after injury, using electrophysiological recording from the lumbar dorsal rootlets.

We identified 30 mechanosensitive units in the lateral ligament; 28 (93%) were located near the attachment to the fibula and calcaneus, which included both low-threshold group-II units and low- and high-threshold group-III units. Our results indicate that there are both proprioceptors and nociceptors in the lateral ligament of the cat ankle, and confirm that afferent fibres from the lateral ligament may contribute to the stability of the joint by regulation of position and movement.
RESULTS OF NERVE GRAFTING FOR INJURIES OF THE AXILLARY AND SUPRASCAPULAR NERVES
Authors: Mikami Y. , Nagano A. , Ochiai N. , Yamamoto S.
Published: February 2018

We report the results in 33 patients who had nerve grafting of the axillary or the suprascapular nerve or of both. There were 32 men and one woman; their mean age was 21 years and the average interval between injury and operation was three months.

At a mean follow-up of 27 months, the deltoid had recovered to M3 or better in 23 of 30 patients (77%) and the infraspinatus in 18 of 25 patients (72%). Shoulder elevation had reached 120° or more in 27 patients (82%), with external rotation of 30° or more in 27 (82%). Twenty-six patients (79%) could reach to the top of their head with their hand.

Recovery of muscle strength, range of movement and shoulder function were satisfactory when surgery was performed within four months of the injury. Early exploration and nerve grafting can lead to a good functional recovery, but thorough exploration and careful repair of both nerves are essential.
FULL EXPOSURE OF THE AXILLARY AND SUPRASCAPULAR NERVES
Authors: Ochiai N. , Nagano A. , Mikami Y. , Yamamoto S.
Published: February 2018

We describe a method of exposing the whole length of the axillary and suprascapular nerves through a sabre-cut incision. The coracoid process is osteotomised and part of trapezius is detached from its insertions. The posterior deltoid is freed from its scapular origin to expose infraspinatus.

We have used this approach to explore combined injuries of the axillary and suprascapular nerves with good results, and no serious complications. Its success depends on a meticulous surgical technique.
INJURY TO THE BRACHIAL PLEXUS BY A FRAGMENT OF BONE AFTER FRACTURE OF THE CLAVICLE
Authors: Barbier O. , Malghem J. , Delaere O. , Vande Berg B. , Rombouts J. J.
Published: February 2018

Clavicular fractures are occasionally responsible for lesions of the brachial plexus. The symptoms are usually delayed and due to compression by hypertrophic callus, nonunion or a subclavian pseudoaneurysm.

We describe a patient in whom a displaced bone fragment was pressing on the retroclavicular part of the brachial plexus, leading to early symptoms of a lesion of the posterior cord. Internal fixation of the clavicle and external neurolysis of the brachial plexus gave an almost full recovery.
CLOSED TREATMENT OF DISPLACED MIDDLE-THIRD FRACTURES OF THE CLAVICLE GIVES POOR RESULTS
Authors: Hill J. M. , McGuire M. H. , Crosby L. A.
Published: February 2018

We evaluated 242 consecutive fractures of the clavicle in adults which had been treated conservatively. Of these, 66 (27%) were originally in the middle third of the clavicle and had been completely displaced. We reviewed 52 of these patients at a mean of 38 months after injury.

Eight of the 52 fractures (15%) had developed nonunion, and 16 patients (31%) reported unsatisfactory results. Thirteen patients had mild to moderate residual pain and 15 had some evidence of brachial plexus irritation. Of the 28 who had cosmetic complaints, only 11 considered accepting corrective surgery. No patient had significant impairment of range of movement or shoulder strength as a result of the injury.

We found that initial shortening at the fracture of ≥20 mm had a highly significant association with nonunion (p < 0.0001) and the chance of an unsatisfactory result. Final shortening of 20 mm or more was associated with an unsatisfactory result, but not with nonunion. No other patient variable, treatment factor, or fracture characteristic had a significant effect on outcome.

We now recommend open reduction and internal fixation of severely displaced fractures of the middle third of the clavicle in adult patients.
MALLET DEFORMITY OF THE FINGER
Authors: Okafor B. , Mbubaegbu C. , Munshi I. , Williams D. J.
Published: February 2018

We reviewed 31 patients at a mean of five years after mallet deformity of the finger had been treated with a thermoplastic splint. Intra-articular fractures were present in 35% of patients. Osteoarthritic changes had developed in 48%, most in association with fracture, and 29% had a swan-neck deformity. There was a loss of extension greater than 10° in 35%; the average deficit at the interphalangeal joint was 8.3° and the average flexion arc was 48.5°.

Despite these findings, patient satisfaction was generally high, with little evidence of functional impairment.
SKELETAL METASTASES FROM SOFT-TISSUE SARCOMAS
Authors: Yoshikawa H. , Ueda T. , Mori S. , Araki N. , Kuratsu S. , Uchida A. , Ochi T.
Published: February 2018

We reviewed 277 patients with soft-tissue sarcoma (STS) treated between 1975 and 1995 to study the incidence, distribution, time of appearance, and radiological findings of skeletal metastases. Of these, 28 (10.1%) had metastases within a mean period of 18.6 months after admission.

The incidence of skeletal metastases differed among the histological subtypes of sarcoma; alveolar soft-part sarcoma, dedifferentiated liposarcoma, angiosarcoma, and rhabdomyosarcoma tended to show higher incidences. The regional bones close to the primary tumour were affected in 13 (46.4%) of the 28 patients, and the axial bones in 18 (64.3%). Radiologically, the metastatic bony lesions predominantly showed osteolytic changes, and there were pathological fractures in 21 of 44 lesions.
ANTIBIOTIC PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY
Authors: Espehaug B. , Engesaeter L. B. , Vollset S. E. , Havelin L. I. , Langeland N.
Published: February 2018

We have assessed the effect of different regimes of antibiotic prophylaxis on the survival of total hip implants, comparing antibiotics administered both systemically and in the bone cement, systemically only, in the bone cement only and with no antibiotics given.

We studied 10 905 primary cemented total hip replacements, performed for osteoarthritis of the hip and reported to the Norwegian arthroplasty register between 1987 and 1995. Cox-estimated failure-rate ratios (FRR) are presented with adjustment for gender, age, the brand of cement, the prosthesis, the type of operating theatre and the operating time.

For revisions performed for infection (39 operations), the lowest rate of revision was found among patients receiving antibiotic-containing cement plus systemic antibiotics (n = 5804). The revision rate for the 4586 patients receiving systemic antibiotics only was 4.3 times greater (95% CI 1.7 to 11.0, p = 0.001); in 239 with antibiotics in the bone cement only it was 6.3 times greater (CI 1.6 to 25.0, p = 0.003); and in the 276 who did not receive antibiotics it was by 11.5 times greater (CI 2.1 to 63.0, p = 0.002). Adjustment for the total amount of systemic antibiotic administered did not change the results. We also observed an increased revision rate for aseptic loosening (109 operations) comparing the systemic-only (FRR = 1.8, CI 1.1 to 2.9, p = 0.01) and the cement-only regimes (FRR = 2.6, CI 1.2 to 5.9, p = 0.02) with the combined dosage.

Our findings show that systemic antibiotics combined with antibiotic-containing bone cement led to fewer revisions than the other methods.
ROTATOR-CUFF TEAR OF THE HIP
Authors: Bunker T. D. , Esler C. N. A. , Leach W. J.
Published: February 2018

We describe an apparently unreported finding during hip operations: a tear at the insertion of gluteus medius and gluteus minimus. This defect may well be known to many surgeons with experience of hip replacement and hemiarthroplasty for fractures of the neck of the femur, but a Medline search has failed to find a previous description.

We made a prospective study of 50 consecutive patients with fractures of the neck of the femur to quantify the incidence of this condition: 11 (22%) had such a tear.
ACUTE COLONIC PSEUDO-OBSTRUCTION AFTER TOTAL HIP REPLACEMENT
Authors: Ballaro A. , Gibbons C. L. M. , Murray D. M. , Kettlewell M. G. W. , Benson M. K.
Published: February 2018

Acute colonic pseudo-obstruction is a poorly recognised and potentially fatal complication of hip surgery.

Between 1991 and 1994 six patients were observed who required laparotomy after failure of medical management. In three the indication was signs of peritonism, while in the other three exploration was required to exclude segmental ischaemia and to decompress the bowel. In all, there was no evidence of mechanical obstruction.

Patients having total hip replacement are at risk of developing pseudo-obstruction due to their age, comorbidity, high doses of analgesics and the nature of the operation. If postoperative ileus persists for more than 48 hours acute colonic pseudo-obstruction should be suspected and confirmed by plain radiography. Prompt recognition and treatment with early referral to a colorectal unit are indicated. Laparotomy appears to carry less risk than that for patients with idiopathic pseudo-obstruction, but should be performed only if colonic ischaemia is suspected.
TEAR OF THE PLANTAR CALCANEONAVICULAR (SPRING) LIGAMENT CAUSING FLATFOOT
Authors: Borton D. C. , Saxby T. S.
Published: February 2018

Acquired flatfoot deformity after injury is usually due to partial or complete tearing of the tendon of tibialis posterior, with secondary failure of the other structures which maintain the medial longitudinal arch. We describe a patient in whom the rupture of the plantar calcaneonavicular (spring) ligament resulted in a clinical picture similar to that of rupture of the tendon of tibialis posterior. Operative repair of the ligament and transfer of the tendon of flexor digitorum gave an excellent result at four years with the patient returning to full sporting activities.
THE INFLUENCE OF SUBTALAR AND TRIPLE ARTHRODESIS ON THE TIBIOTALAR JOINT
Authors: de Heus J. A. C. , Marti R. K. , Besselaar P. P. , Albers G. H. R.
Published: February 2018

From 1975 to 1990 we performed subtalar or triple arthrodesis on 54 patients; 48 of them were reviewed after a mean follow-up of 10 years (6 to 15). There were 17 subtalar fusions in 14 patients and 37 triple arthrodeses in 28 patients. We assessed tibiotalar ankle function using the criteria of Mazur which gives a points score of a maximum of 100. Radiological evidence of degenerative change was graded on a scale of 0 to 4.

The mean Mazur score was 85 for the subtalar fusions and 78 for the triple arthrodeses. The radiological score showed no degenerative changes in 36 feet (24 triple and 12 subtalar arthrodeses) and an increase of one grade in 14 feet (10 triple and 4 subtalar), of two grades in three feet (all triple arthrodeses) and of three grades in one foot after a subtalar arthrodesis.

We found no statistically significant difference in the radiological score in unilateral fusions between feet with subtalar and triple arthrodeses and the contralateral foot. In all four feet which showed an increase in degenerative changes of two or more grades, there was an abnormality of the tibiotalar joint before the fusion operation. Of the 14 feet which showed an increase of one grade, there was a similar increase on the contralateral side in nine.

Our findings show that subtalar or triple arthrodesis has little adverse influence on the function of the tibiotalar joint, even after many years.
RESORPTION OF HYDROXYAPATITE AND FLUORAPATITE COATINGS IN MAN
Authors: Overgaard S. , Søballe K. , Lind M. , Bünger C.
Published: February 2018

The clinical use of hydroxyapatite (HA) coating is controversial especially in regard to the long-term performance of the coating and the effects of resorption. In each of 15 consenting patients we inserted two implants, coated with either HA or fluorapatite (FA) into the iliac crest. They were harvested at a mean of 13.6 ± 0.6 months after surgery.

Histological examination showed that bone ongrowth on the HA-coated implants was significantly greater (29%) than that on the FA-coated implants. When bone was present on the coating surface the HA coating was significantly thicker than the FA coating. When bone marrow was present, the HA coating was significantly thinner than the FA coating. The reduction in coating thickness when covered by bone or bone marrow was 23.1 ± 9.7 μm for HA and 5.1 ± 1.7 μm for FA (p < 0.01) suggesting that FA is more stable than HA against resorption by bone marrow.

The findings suggest that in man the osteoconductive properties of HA coating are superior to those of FA. Resorption rates for both coatings were approximately 20% of the coating thickness per year. Bone ongrowth appears to protect against resorption whereas bone marrow seems to accelerate resorption. No adverse reaction was seen in the surrounding bone.
PERIPROSTHETIC BONE REMODELLING AFTER CEMENTLESS TOTAL HIP REPLACEMENT
Authors: Ang K. C. , Das De S. , Goh J. C. H. , Low S. L. , Bose K.
Published: February 2018

In a prospective study of 14 patients undergoing total hip replacement we have used dual-energy X-ray absorptiometry (DEXA) to investigate remodelling of the bone around two different designs of cementless femoral prosthesis. The bone mineral density (BMD) was measured at 12-weekly intervals for a year. Eight patients (group A) had a stiff, collarless implant and six (group B) a flexible isoelastic implant.

Patients in group A showed a decrease in BMD from 14 weeks after operation. By 12 months, the mean loss in BMD was 27%, both medially and laterally to the proximal part of the implant. Those in group B showed an overall increase in BMD which reached a mean of 12.6% on the lateral side of the distal portion of the implant.

Our results support the current concepts of the effects of stem stiffness and flexibility on periprosthetic remodelling.
THE ANATOMY OF THE ANTERIOR ORIGIN OF THE DELTOID
Authors: Kumar V. P. , Satku K. , Liu J. , Shen Y.
Published: February 2018

We studied the origin of the anterior deltoid from the lateral third of the clavicle and the leading anterior edge of the acromion in 18 cadaver shoulders by anatomical and histological methods.

The main origin of the deltoid was from the superior surface of the anterior acromion, but muscle and tendinous attachments were also seen on the entire anterior surface of the acromion, its anteroinferior surface and on the whole width of the anterior surface of the clavicle.

Mock arthroscopic acromioplasty was shown to detach deltoid fibres from the anterior surfaces, leaving the superior attachment in continuity. Potentially, arthroscopic subacromial and clavicular resection can detach deltoid fibres originating from the anterior and anteroinferior surfaces of the acromion and clavicle and thus weaken the anterior deltoid.
TREATMENT OF DEVELOPMENTAL DISLOCATION OF THE HIP IN CHILDREN AFTER WALKING AGE
Authors: Mitani S. , Nakatsuka Y. , Akazawa H. , Aoki K. , Inoue H.
Published: February 2018

We treated 120 children between the ages of 12 and 31 months with 137 developmental dislocations of the hip and reviewed them at a mean follow-up of 14 years.

We had used two-directional arthrography of all hips before reduction to evaluate the anterior, superior, and posterior portions of the limbus. Of the 137 hips, 64 had no interposed limbus in the AP view of the arthrogram, but 45 of these had an interposed anterior or posterior portion of the limbus. The hips with good stability and no interposed limbus in either AP or lateral arthrograms had excellent results by closed methods; in the other cases the results were less satisfactory.

Our findings suggest that hips suitable for management by closed reduction can be identified by two-directional arthrography. Hips shown to have an interposed limbus are best managed by open reduction.
SOLITARY PLASMA-CELL MYELOMA OF THE SPINE IN AN ADOLESCENT
Authors: Boos N. , Goytan M. , Fraser R. , Aebi M.
Published: February 2018

We report an unusual presentation of a solitary plasma-cell myeloma of the spine in an adolescent patient. Our case indicates the need to consider plasma-cell myeloma as a differential diagnosis even in younger patients.
VARIATION OF THE GROOVE IN THE AXIS VERTEBRA FOR THE VERTEBRAL ARTERY
Authors: Madawi A. Abou , Solanki G. , Casey A. T. H. , Crockard H. A.
Published: February 2018

Transarticular screws at the C1 to C2 level of the cervical spine provide rigid fixation, but there is a danger of injury to a vertebral artery. The risk is related to the technical skill of the surgeon and to variations in local anatomy.

We studied the grooves for the vertebral artery in 50 dry specimens of the second cervical vertebra (C2). They were often asymmetrical, and in 11 specimens one of the grooves was deep enough to reduce the internal height of the lateral mass at the point of fixation to ≤2.1 mm, and the width of the pedicle on the inferior surface of C2 to ≤2 mm. In such specimens, the placement of a transarticular screw would put the vertebral artery at extreme risk, and there is not enough bone to allow adequate fixation.

Before any decision is made concerning the type of fixation to be used at C2 we recommend that a thin CT section be made at the appropriate angle to show both the depth and any asymmetry of the grooves for the vertebral artery.
THREE MODES OF OSSIFICATION DURING DISTRACTION OSTEOGENESIS IN THE RAT
Authors: Yasui N. , Sato M. , Ochi T. , Kimura T. , Kawahata H. , Kitamura Y. , Nomura S.
Published: February 2018

We developed a rat model of limb lengthening to study the basic mechanism of distraction osteogenesis, using a small monolateral external fixator. In 11-week-old male rats we performed a subperiosteal osteotomy in the midshaft of the femur with distraction at 0.25 mm every 12 hours from seven days after operation.

Radiological and histological examinations showed a growth zone of constant thickness in the middle of the lengthened segment, with formation of new bone at its proximal and distal ends.

Osteogenic cells were arranged longitudinally along the tension vector showing the origin and the fate of individual cells in a single section. Typical endochondral bone formation was prominent in the early stage of distraction, but intramembraneous bone formation became the predominant mechanism of ossification at later stages. We also showed a third mechanism of ossification, ‘transchondroid bone formation’. Chondroid bone, a tissue intermediate between bone and cartilage, was formed directly by chondrocyte-like cells, with transition from fibrous tissue to bone occurring gradually and consecutively without capillary invasion.

In situ hybridisation using digoxigenin-11-UTP-labelled complementary RNAs showed that the chondroid bone cells temporarily expressed type-II collagen mRNA. They did not show the classical morphological characteristics of chondrocytes, but were assumed to be young chondrocytes undergoing further differentiation into bone-forming cells.

We found at least three different modes of ossification during bone lengthening by distraction osteogenesis. We believe that this is the first report of such a rat model, and have shown the validity of in situ hybridisation techniques for the study of the cellular and molecular mechanisms involved in distraction osteogenesis.
NUMBER OF POLYETHYLENE PARTICLES AND OSTEOLYSIS IN TOTAL JOINT REPLACEMENTS
Authors: Kobayashi A. , Freeman M. A. R. , Bonfield W. , Kadoya Y. , Yamac T. , Al-Saffar N. , Scott G. , Revell P. A.
Published: February 2018

Our aim was to analyse the influence of the size, shape and number of particles on the pathogenesis of osteolysis. We obtained peri-implant tissues from 18 patients having revision surgery for aseptically loosened Freeman total knee replacements (10), Charnley total hip replacements (3) and Imperial College/London Hospital double-cup surface hip replacements (5). The size and shape of the polyethylene particles were characterised using SEM and their concentration was calculated. The results were analysed with reference to the presence of radiological osteolysis.

The concentration of polyethylene particles in 6 areas with osteolysis was significantly higher than that in 12 areas without osteolysis. There were no significant differences between the size and shape of the particles in these two groups.

We conclude that the most critical factor in the pathogenesis of osteolysis is the concentration of polyethylene particles accumulated in the tissue.
THE THREE-DIMENSIONAL GEOMETRY OF THE PROXIMAL HUMERUS
Authors: Boileau P. , Walch G.
Published: February 2018

We have studied the three-dimensional geometry of the proximal humerus on human cadaver specimens using a digitised measuring device linked to a computer. Our findings demonstrated the variable shape of the proximal humerus as well as its variable dimensions. The articular surface, which is part of a sphere varies individually in its orientation as regards inclination and retroversion, and it has variable medial and posterior offsets.

These variations cannot be accommodated by the designs of most contemporary humeral components. Although good clinical results can be achieved with current modular and non-modular components their relatively fixed geometry prevents truly anatomical restoration in many cases.

To try to restore the original three-dimensional geometry of the proximal humerus, we have developed a new type of humeral component which is modular and adaptable to the individual anatomy. Such adaptability allows correct positioning of the prosthetic head in relation to an individual anatomical neck, after removal of the marginal osteophytes. The design of this third-generation prosthesis respects the four geometrical variations which have been demonstrated in the present study. These are inclination, retroversion, medial offset and posterior offset.
GROWTH AFTER EXTENDIBLE ENDOPROSTHETIC REPLACEMENT OF THE DISTAL FEMUR
Authors: Cool W. P. , Carter S. R. , Grimer R. J. , Tillman R. M. , Walker P. S.
Published: February 2018

We report our results in 24 children with malignant primary bone tumours of the distal femur treated with a Stanmore extendible endoprosthesis (SEER). This consists of a femoral component that can be lengthened, a constrained knee and an uncemented sliding tibial component which crosses the proximal tibial physeal plate perpendicularly.

The average age of the patients at diagnosis was ten years and the mean follow-up was 4.7 years (2.5 to 7.9). The mean growth of the affected tibia was 76% (18 to 136) and of the fibula 83% (15 to 750) of the growth of the unaffected limb.

Measurement of growth arrest lines showed that the mean growth of the proximal tibial physis on the affected side was 69% (43 to 100) of that of the normal side. The great variability in the growth of the physis cannot yet be explained.
LENGTHENING OF SHORT GREAT TOES BY CALLUS DISTRACTION
Authors: Takakura Y. , Tanaka Y. , Fujii T. , Tamai S.
Published: February 2018

We lengthened seven first metatarsals in four patients with short great toes by callus distraction using an external fixator. Good clinical and cosmetic results were obtained. Bone lengthening is effective in patients with short great toes not only for cosmesis, but also to relieve pain and callosities on the plantar aspect of the second and third metatarsal heads.

Excessive lengthening of the first metatarsal resulted in limitation of the range of movement of the metatarsophalangeal joint of the great toe. To prevent this the amount of lengthening should not exceed 40% of the preoperative length of the metatarsal.
SYNTHETIC OSTEOCHONDRAL REPLACEMENT OF THE FEMORAL ARTICULAR SURFACE
Authors: Oka M. , Chang Y.-S. , Nakamura T. , Ushio K. , Toguchida J. , Gu H.-O.
Published: February 2018

We have studied damage to the tibial articular surface after replacement of the femoral surface in dogs. We inserted pairs of implants made of alumina, titanium and polyvinyl alcohol (PVA) hydrogel on titanium fibre mesh into the femoral condyles.

The two hard materials caused marked pathological changes in the articular cartilage and menisci, but the hydrogel composite replacement caused minimal damage. The composite osteochondral device became rapidly attached to host bone by ingrowth into the supporting mesh.

We discuss the clinical implications of the possible use of this material in articular resurfacing and joint replacement.
Tendon transfer with a microvascular free flap for injured feet in children
Authors: Hahn S. B. , Lee J. W. , Jeong J. H.
Published: February 2018

We reviewed 11 patients who had been treated between January 1986 and June 1994 for severe foot injuries by tendon transfer with microvascular free flaps.

Their mean age was 5.6 years (3 to 8). Five had simultaneous tendon transfer and a microvascular free flap and six had separate operations. The mean interval between the tendon transfer and the microvascular free flap was 5.8 months (2 to 15) and the mean time between the initial injury and the tendon transfer was 9.6 months (2 to 21). The anterior tibial tendon was split in five of six cases. The posterior tibial tendon was used three times and the extensor digitorum longus tendon twice.

The mean follow-up was 39.7 months (24 to 126). There were nine excellent and two good results. Postoperative complications included loosening of the transferred tendon (2), plantar flexion contracture (1) mild flat foot deformity (1) and hypertrophic scars (2).

We recommend tendon transfer with a microvascular free flap in children with foot injuries combined with nerve injury and extensive loss of skin, soft tissue and tendon.
Percutaneous intramedullary Kirschner wiring for displaced diaphyseal forearm fractures in children
Authors: Yung S. H. , Lam C. Y. , Choi K. Y. , Ng K. W. , Maffulli N. , Cheng J. C. Y.
Published: February 2018

Displaced fractures of the forearm in children are often treated conservatively, but there is a relatively high incidence of redisplacement, malunion and consequent limitation of function. We have performed percutaneous Kirschner (K) wire fixation in 72 such children under the age of 14 years, of which 57 were reviewed for our study. Both the radius and ulna were fractured in 45 (79%), the radius only in eight and the ulna only in four. The mean initial angulation was 19° in the lateral plane and 9° in the anteroposterior plane for the radius and 15° and 9°, respectively, for the ulna. In 42 patients (74%) we performed closed reduction. In the remaining 15 (26%) closed reduction failed and an open reduction, through a minimal approach, was required before K wiring.

At a mean follow-up of 20 months all patients had good functional results with an excellent range of movement. Only five had angulation of from 10° to 15° and none had nonunion, premature epiphyseal closure or deep infection. Percutaneous intramedullary K wiring for forearm diaphyseal fracture is a convenient, effective and safe operation, with minimal complications.
Cemented and non-cemented replacements of the trapeziometacarpal joint
Authors: Wachtl S. W. , Guggenheim P. R. , Sennwald G. R.
Published: February 2018

We performed 88 primary ball-and-socket arthroplasties of the trapeziometacarpal joint in 84 patients (69 women and 15 men) with a mean age of 61 years (37 to 81). Cemented de la Caffinière prostheses were implanted in 43 joints from 1988 to 1991 and 45 cementless Ledoux implants were used between 1992 and 1994. Of the 61 surviving prostheses still in situ, 51 were reviewed clinically and radiologically with a mean follow-up of 25 months for the Ledoux and 63 months for the de la Caffinière implant.

The survival rate for the Ledoux prosthesis was 58.9% at 16 months and for the de la Caffinière implant 66.4% at 68 months. Loosening occurred in 15% of the Ledoux stems, in 46% of the Ledoux cups, in 24% of the de la Caffinière stems and in 28% of the de la Caffinière cups.

Both prostheses behaved similarly, and it is clear that a constrained ball-and-socket prosthesis is not suitable for the trapeziometacarpal joint.
Removal of proteoglycans from the surface of defects in articular cartilage transiently enhances coverage by repair cells
Authors: Hunziker E. B. , Kapfinger E. , Müller M. E.
Published: February 2018

Lesions within the articular cartilage layer of synovial joints do not heal spontaneously. Some repair cells may appear, but their failure to become established may be related to problems of adhesion to proteoglycan-rich surfaces. We therefore investigated whether controlled enzymatic degradation of surface proteoglycan molecules to a depth of about 1 μm, using chondroitinase ABC, would improve coverage by repair cells.

We created superficial lesions (1.0 × 0.2 × 5 mm) in the articular cartilage of mature rabbit knees and treated the surfaces with 1 U/ml of chondroitinase ABC for four minutes. The defects were studied by histomorphometry and electron microscopy at one, three and six months.

At one month, untreated lesions were covered to a mean extent of 28% by repair cells; this was enhanced to a mean of 53% after enzyme treatment. By three months, the mean coverage of both control and chondroitinase-ABC-treated defects had diminished dramatically to 0.2% and 13%, respectively, but at six months both untreated and treated lesions had a similar coverage of about 30%, not significantly different from that achieved in untreated knees at one month.

These findings suggest that, with time, chondrocytes near the surface of the defect may compensate for the loss of proteoglycans produced by enzyme treatment, thereby restoring the inhibitory properties of the matrix as regards cell adhesion. This supposition was confirmed by electron microscopy. Our results have an important bearing on attempts made to induce healing responses by transplanting chondrogenic cells or by applying growth factors.
Tenodeses destroy the kinematic coupling of the ankle joint complex
Authors: Rosenbaum D. , Becker H. P. , Wilke H.-J. , Claes L. E.
Published: February 2018

To study the effect of ligament injuries and surgical repair we investigated the three-dimensional kinematics of the ankle joint complex and the talocrural and the subtalar joints in seven fresh-frozen lower legs before and after sectioning and reconstruction of the ligaments. A foot movement simulator produced controlled torque in one plane of movement while allowing unconstrained movement in the remainder.

After testing the intact joint the measurements were repeated after simulation of ligament injuries by cutting the anterior talofibular and calcaneofibular ligaments. The tests were repeated after the Evans, Watson-Jones and Chrisman-Snook tenodeses. The range of movement (ROM) was measured using two goniometer systems which determined the relative movement between the tibia and talus (talocrural ROM) and between the talus and calcaneus (subtalar ROM).

Ligament lesions led to increased inversion and internal rotation, predominantly in the talocrural joint. The reconstruction procedures reduced the movement in the ankle joint complex by reducing subtalar movement to a non-physiological level but did not correct the instability of the talocrural joint.
Simultaneous measurements of sagittal knee laxity with an external device and radiostereometric analysis
Authors: Jorn L. P. , Fridén T. , Ryd L. , Lindstrand A.
Published: February 2018

We obtained simultaneous measurements of sagittal knee laxity in 12 consecutive patients after reconstruction of the anterior cruciate ligament (ACL), using the Stryker laxity tester and radiostereometric analysis (RSA).

The mean anteroposterior (AP) displacement when a 90 N load was applied in both directions was 5.3 ± 2.7 mm with RSA and 9.8 ± 1.6 mm with the external device (p < 0.001). The corresponding measurements at a load of 180 N were 5.7 ± 2.4 mm and 13.8 ± 3.7 mm, respectively (p < 0.001).

More than 50% of the sagittal knee movement, as measured by the external device at a load of 180 N, was not true femorotibial displacement of the joint but was due to soft-tissue deformation.
Rupture of flexor pollicis longus tendon
Authors: Bell J. S. P. , Wollstein R. , Citron N. D.
Published: February 2018

We report three complete ruptures and one partial rupture of the flexor pollicis longus tendon in association with the insertion of a volar plate for the treatment of fracture of the distal radius. Rupture was associated with the chronic use of steroids.