bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Study of Multiple Level Compression of the Spinal Cord in the Rat
Authors: Chow SP , Furamachi K
Published: October 2016

A rat model study was performed to evaluate the effects of compression of the thoracic spinal cord. Dorsal screw compression of the thoracic spinal cord up to 50% canal diameter was created at T5 (Group A), T5 and T11 (Group B), and T5 and T8 (Group C). Clinical grading (Tarlov criteria), sensory evoked and motor evoked potentials, horse raddish peroxidase neural transport, and microangiography were studied. Single level compression had little effect. For double compression, there were marked detrimental effects both clinically and electrophysiologically, especially when the compression was close together. Neutral transport was affected in all groups, but the difference was not significant between them.
Sports Related Fractures: A Review of 113 Cases
Authors: Hon Wan Hazmy Che , Kock Shong Hing
Published: October 2016

To establish a profile of fractures related to sporting activities, to determine the extent to which these injuries resulted in morbidity, and to find suitable target areas for injury prevention, a one-year study was undertaken at Seremban Hospital, Negeri Sembilan, Malaysia, from July 15, 1998 to July 14, 1999. All patients presenting to the Department of Orthopaedic & Traumatology with fractures sustained during sporting activities were enrolled. Fractures related to sporting activities are increasing and an entity to be recognized despite the good function outcome of the treatment. Suitable target areas for injury prevention were found to be football (for males), netball (for females), the second decade of life and competitive sporting events.
Bilateral Total Knee Arthroplasty: One Mobile-Bearing and One Fixed-Bearing
Authors: Chiu KY , Ng TP , Tang WM , Lam P
Published: October 2016

We compared the early results of mobile-bearing knee prosthesis with fixed-bearing knee prosthesis in 16 patients who had one-stage, sequential, bilateral replacements. In each patient, a Low Contact Stress (LCS, Depuy) rotating-platform prosthesis was inserted in one side, and an Anatomic Modular Knee (AMK, Depuy) posterior-stabilised prosthesis was inserted in the other side. The same surgical routines were adopted for both sides in each patient. There were significant improvements in the Knee Society knee score and functional score, as well as the Oxford Knee score after both mobile-bearing and fixed-bearing knee replacements (p < 0.001). However, we could not find any significant difference between the clinical results of the two prostheses. The authors' early experience with the mobile-bearing total knee prosthesis was as favourable as the medium-term experience of the fixed-bearing total knee prosthesis in this prospective, match-pair study.
Infection of the Inguinal Region Treated by Musculocutaneous Flaps
Authors: Ikeda Kazuo , Matsuda Masaki , Yamauchi Daisuke , Tomita Katsuro
Published: October 2016

This study documented the treatment of the inguinal dead space with chronic infection using musculocutaneous flaps. The average age of the patients (5 males and 2 females) was 50.0 years. Six cases of reconstruction after malignant tumor resection and one case after total hip arthoroplasty were treated. Six rectus abdominis flaps and 2 vastus lateralis flaps were used. Previous radiation therapy had been performed on five patients. The duration of chronic infection averaged 2.3 months, excluding a 4- year long case. All flaps survived and the average follow-up period was 2.8 years. Five cases had no relapse of the infection but two cases relapsed 18 months and 2 years respectively after the surgery. These two did not have tumor prostheses removed prior to the surgery.
Pachydermoperiostosis: Three Case Reports
Authors: Bhaskaranand Kumar , Shetty Rohit R , Bhat Anil K
Published: October 2016

Three patients with pachydermoperiostosis are reported. All patients presented with moderate pain and swelling in multiple joints unresponsive to treatment, characteristic facial features which were marked in two cases, clubbing of nails and enlargement of distal parts of the extremities. One patient had spondylolisthesis of L5-S1 vertebrae, an association not previously described in this syndrome. The natural history of the disease is reviewed and the differential diagnosis is discussed.
A Study of Vascular Injuries in Pediatric Supracondylar Humeral Fractures
Authors: Kumar Ritabh , Trikha Vivek , Malhotra Rajesh
Published: October 2016

194 children with supracondylar fractures of the humerus were reviewed. Of the 49 children with Gartland grade III displacement, signs of vascular compromise were clinically suspected in 5 cases. Immediate open reduction, internal fixation and exploration were performed. Four children had a satisfactory outcome. One child required amputation. A careful clinical evaluation for vascular injury and an aggressive surgical approach is suggested, when indicated.
Intradural Spinal Metastasis from Renal Cell Carcinoma: A Case Report
Authors: Mak Kan-Hing , Kwok John Ching-Kwong
Published: October 2016

Intradural spinal metastasis is rare. This is the third case ever reported on the finding of intradural spinal metastasis from a renal cell carcinoma that had been removed surgically. The patient had a history of epidural metastasis for which excision and anterior stabilization were done 3 years before the new presentation with cauda equina lesion. Seeding from the involved osseous structure to the cerebrospinal fluid through the dura was believed to be the course that tumour had taken to reach the intradural space.
A Modified Direct Lateral Approach in Total Hip Arthroplasty
Authors: Pai V.S.
Published: October 2016

A modified lateral approach of Hardinge allows adequate access for orientation of the implant was described. Although this approach is more difficult than the posterior approach, there is a learning curve, when mastered, it'll definitely reduce the incidence of dislocation. In the Author's opinion, this approach should be used routinely for total hip arthroplasty for fractured neck of femur where the incidence of dislocation is unacceptably high using the posterior approach.
True Aneurysm of a Thumb Digital Artery in a Radiographer: A Case Report
Authors: Taniguchi Yasunori , Enyo Yoshio , Tamaki Tetsuya , Yoshida Munehito
Published: October 2016

True aneurysms of the digital artery are very rare. We report a case of true aneurysm of a proper digital artery of the right thumb in a radiographer. Treatment by ligation and excision resulted in complete relief of symptoms.
Spinal Fusion and Instrumentation for Paediatric Neuromuscular Scoliosis: Retrospective Review
Authors: Thacker M , Hui JHP , Wong HK , Chatterjee A , Lee EH
Published: October 2016

Purpose.

A retrospective study was conducted to review the surgical results among 24 patients with neuromuscular scoliosis, who were treated with spinal instrumentation and fusion at the Department of Orthopaedic Surgery, National University Hospital, Singapore between March 1993 and December 1998.

Methods.

We examined complete hospital records of patients who had scoliosis due to aetiologies such as spinal muscular atrophy, cerebral palsy, Duchenne muscular dystrophy, and congenital myopathies. The mean age of patients was 10.6 years (range, 6–14 years) and the mean follow-up duration was 5.5 years.

Results.

18 patients had posterior surgery alone, whereas 4 had an anterior release with posterior instrumentation, and 2 had an anterior fusion with instrumentation. The mean length of stay in the intensive care unit was 2 days and the mean duration of hospital stay was 11 days. The mean correction in scoliosis angle ranged from 75.6° to 25.7°. All patients could at least sit without support postoperatively. The one-second forced expiratory volume and forced vital capacity were, in general, maintained throughout the follow-up. There were 2 major complications and 2 minor ones; these were pseudarthrosis with rod breakage requiring revision, deep infection necessitating hardware removal, superficial infection that responded to antibiotics, and urinary tract infection requiring 3 weeks of antibiotic treatment. There were no deaths or any neurological complications after instrumentation.

Conclusion.

Spinal stabilisation and fusion in children with neuromuscular scoliosis is a safe and effective treatment modality. The effect of surgery on long-term pulmonary function, however, remains controversial and needs to be addressed.
Repetition of an Unusual Stress Fracture in an Anorexic Man: A Case Report
Authors: Myers S , Bell D , Gorman J , Best J , Rooney J
Published: October 2016

Stress fractures of the fibula commonly occur distally in runners, whereas stress fractures of the proximal fibula are uncommon and typically occur in jumpers. Furthermore, it is rare for a stress fracture to be repeated in the same bone. We report a case of a repeated stress fracture of the proximal fibula in a male runner with abnormal gait that primarily involved excessive pronation. Unusual risk factors in this case were anorexia nervosa and use of an inhaled corticosteroid. The patient was treated conservatively, and healing of the fracture was completed at 12 weeks.
Changes in Proximal Femoral Bone Mineral Density around a Hydroxyapatite-Coated Hip Joint Arthroplasty
Authors: Theis JC , Beadel G
Published: October 2016

Objective.

To present the results of a prospective analysis of proximal femoral bone mineral density changes around a hydroxyapatite-coated total hip joint replacement.

Methods.

14 patients with osteoarthritis of the hip were enrolled in the study and treated with an uncemented ABG prosthesis. Dual energy X-ray absorptiometry scanning was performed in 9 patients preoperatively, and at 3, 6, 12, and 24 months postoperatively. An orthopaedic software program was used to determine the bone mineral density in the proximal femur, expressed as a percentage of the preoperative value.

Results.

The values of Gruen zones 1 to 6 averaged between 96.0% and 113.8% of the preoperative value by 24 months (overall average, 104.1%). In zone 7, however, there was a gradual decline in bone mineral density to an average of 72.1% of the preoperative value by 24 months. This represented ongoing loss of bone from the calcar; although this may not pose a problem to the prosthetic's short-term stability, it may render potential revision surgery more difficult.

Conclusion.

The initial outcome of uncemented total hip replacement appears to be promising. There was excellent maintenance of bone around the femoral component in all regions other than the calcar and lesser trochanter. Further scans are required to see if these trends continue in the long term.
Implantation Metastasis in a 13-Year-Old Girl: A Case Report
Authors: Singh C , Ibrahim S , Pang KS , Shanti S
Published: October 2016

We report a case of a 13-year-old girl with an osteosarcoma of the right humerus, which had been diagnosed as an aneurysmal bone cyst at our institution. She underwent curettage and bone grafting of the lesion, which resulted in implantation metastasis of the tumour to the ilium. She died 15 months after presentation owing to pulmonary metastases. This report highlights the possibility of metastasis occurring by direct implantation to a graft donor site. We strongly recommend that a biopsy be performed in cases of presumed benign lesions before proceeding with the definitive surgery.
Use of Bisphosphonate to Manage Avulsion Fracture of Tibial Tuberosity with Underlying Angiomatosis: A Case Report
Authors: Wong JWK , Yip DKH , Kong JKF , Chien EP , Shek TWH
Published: October 2016

An unusual case of avulsion fracture of the tibial tuberosity with underlying angiomatosis in a middle-aged man is described, with particular emphasis on the successful use of bisphosphonate in its treatment and the value of serial dual energy X-ray absorptiometry in its subsequent disease monitoring. This case illustrates the importance of careful correlation of the clinical, radiological, and histological findings in the management of skeletal tumour and tumour-like lesions. The differential diagnosis of osteolysis with vascular ectasia is discussed.
Fractured Neck of Femur in the Mobile Independent Elderly Patient: Should We Treat with Total Hip Replacement?
Authors: Pai VS , Ardern D , Wilson N
Published: October 2016

Purpose.

To report the outcome of displaced subcapital neck of femur fractures in the independent elderly (>70 years) managed with total hip arthroplasty through a modified Hardinge approach.

Methods.

Between 1998 and 2000, a surgeon performed a cemented hip replacement using a modified lateral approach in 35 consecutive patients in the Hawke's Bay Regional Hospital, Hastings. Medical charts and out-patient follow-up clinic records were reviewed with respect to outcomes, with particular reference to complications. Independent review of functional outcome was completed at one year postsurgery using a questionnaire.

Results.

At an average follow-up of 1.8 years (range, 1–3 years), no patient needed further surgery. One patient had died, giving a mortality rate at one year of 2.9%. All other medical complications were successfully treated. The overall prevalence of early medical complications was 43%. There were no dislocations, and 80% of patients had a good clinical outcome at their latest follow-up.

Conclusion.

The modified lateral approach of Hardinge minimises the incidence of postoperative dislocation. However, there was a high incidence of medical complications and aggressive treatment of such complications was necessary, both preoperatively and postoperatively. The number of pre-existing medical conditions was a significant factor influencing patient morbidity.
Small Stem Exeter Total Hip Replacement: Clinical and Radiological Follow-up over a Minimum of 2.5 Years
Authors: Sivananthan S , Arif M , Choon DSK
Published: October 2016

Purpose.

To evaluate the clinical and radiological outcome in patients undergoing small stem Exeter total hip replacement.

Methods.

A total of 46 small stem Exeter total hip replacements were performed on 44 consecutive patients (18 men and 26 women) attending the University of Malaya Medical Centre. The mean age at the time of operation was 58 years (range, 24–81 years). Of the 46 procedures performed, 35 were primary total hip replacements and 11 were revision operations, with aseptic loosening of the original implant being the main indication for revision. The main indications for surgery in primary cases were avascular necrosis and rheumatoid arthritis. Clinical and radiographic outcomes were assessed at 6 weeks', 12 weeks', 6 months' follow-up, and annually thereafter. Postoperative cementing technique was also assessed.

Results.

The mean follow-up period was 4 years. The mean Oxford Hip Score improved from 46 points preoperatively to 17 points at the final follow-up examination. There were no revision operations, no implant breakages, and no excessive migration of the implants. The potential complications of implant failure due to smaller implant size and increased patient activity were not observed.

Conclusion.

Due to the smaller size of Asian femora, the small stem Exeter implant is a very useful development. This study suggests that it will perform as well as its larger counterparts.
The Incidence of Deep Vein Thrombosis after Hip and Knee Arthroplasties in Japanese Patients: A Prospective Study
Authors: Sudo A , Sano T , Horikawa K , Yamakawa T , Shi D , Uchida A
Published: October 2016

Purpose.

To document the incidence of proximal deep vein thrombosis and pulmonary embolism in 58 consecutive Japanese patients undergoing total hip arthroplasty or total knee arthroplasty.

Methods.

Patients were routinely examined for proximal deep vein thrombosis by B-mode ultrasonography before and after surgery. Those patients who had ultrasonographic findings of deep vein thrombosis were also investigated for pulmonary embolism by ventilation-perfusion lung scan.

Results.

The incidence of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty were 9.1% and 4.0% respectively, and the incidence of pulmonary embolism were 3.0% and 0%, respectively. There were no cases of fatal pulmonary embolism.

Conclusion.

The incidence of deep vein thrombosis and pulmonary embolism in Japanese patients may have increased over the last few decades.
Malaysian Orthopaedic Surgeons' Approach to Venous Thromboembolic Disease Prophylaxis: Attitudes and Practice
Authors: Zairul-Nizam ZF , Gul YA
Published: October 2016

Purpose.

To survey Malaysian orthopaedic surgeons' attitudes to and use of venous thromboembolic disease prophylaxis.

Methods.

A total of 144 orthopaedic surgeons from various governmental and private institutions responded to a questionnaire.

Results.

Only slightly more than half of these surgeons considered venous thromboembolic disease as common a problem in Malaysia as in western countries. The majority of surgeons (91.0%) reported using prophylaxis selectively for patients based on various indicators such as risk grading of surgery, obesity, and malignancy etc. Bleeding tendencies were cited as the greatest fear against the use of pharmacological prophylaxis. Low-molecular-weight heparin appeared to be the most commonly used pharmacological prophylaxis, used either singly or in combination with other forms of prophylaxis. The majority of surgeons employed prophylaxis until their patients were mobile.

Conclusion.

There should be greater awareness among surgeons in Malaysia of the need for protection against venous thromboembolic disease. Current practice needs to be reviewed and further recommendations made for existing protocols.
The Incidence of Proximal Deep Vein Thrombosis following Total Knee Arthroplasty in an Asian Population: A Doppler Ultrasound Study
Authors: Nathan S , Aleem Md A , Thiagarajan P , De S Das
Published: October 2016

Purpose.

To investigate the incidence of deep vein thrombosis (DVT) following total knee arthroplasty in an Asian population.

Methods.

A prospective study of 149 consecutive cases of total knee arthroplasty done for osteoarthritis was conducted over a 5-year period. All patients underwent duplex ultrasonographic assessment of the lower limbs within the first postoperative week.

Results.

The incidence of proximal DVT was found to be 4.38% in this study. Symptomology was statistically significant in predicting the presence of proximal DVT in all cases. General anaesthesia was associated with a statistically significant–higher incidence of DVT as compared with regional anaesthesia. There was a significant association between a sedentary lifestyle and the development of DVT.

Conclusion.

The incidence of proximal DVT in Asian patients after total knee arthroplasty is higher than that previously reported for this demographic group.
Bilateral Capitellum Humeri Fracture: A Case Report and Review of the Literature
Authors: Schindler OS
Published: October 2016

We report a case of a 37-year-old woman who sustained a bilateral Hahn-Steinthal type fracture of her capitellum humeri. Open reduction and internal fixation, using extra-articular insertion of Herbert screws, were performed. Both elbows were immobilised for 3 weeks postoperatively. Radiographic signs of union were present at week 8. Within the observation period of 18 months, no signs of avascular necrosis were detected. At the end of the recovery period, despite intensive physiotherapy, the patient was left with a 20° loss of flexion in her right elbow and a 15° loss of extension in her left elbow. We found the use of Herbert screws particularly suitable for this type of injury: it allows good inter-fragmentary compression due to the sub-articular positioning that avoids the risk of damaging the articular surface. Mobilisation should start early to prevent joint stiffness and long-term disability.
Revision of Total Hip Arthroplasty Using an Anterior Cortical Window, Extensive Strut Allografts, and an Impaction Graft: Follow-up Study
Authors: Arif M , Sivananthan S , Choon DSK
Published: October 2016

Purpose.

To report the outcome of revised total hip arthroplasty procedures involving an anterior cortical window, extensive strut allografts, and an Exeter impaction graft.

Method.

Eight patients (9 hips) with a mean age of 58 years underwent revision of total hip arthroplasty using the Exeter hip impaction graft system and strut allografts between 1995 and 1998. An extensile anterior approach was used, and an anterior cortical window was created in the femur, to remove the old implant. External strut allografts were attached by wires to provide cortical support. The mean follow-up duration was 74 months. Indications for surgery were aseptic loosening of previous implants in 8 hips and infection of one hip that had previously undergone total arthroplasty.

Results.

19 Dall Miles cables, 4 ordinary cerclage wires, and 8 cerclage wires tightened with the clincher knot technique were used to secure the allograft to the host bone. The strut grafts were found to be incorporated in all cases. No wires became loose. One patient developed 20° of angulation at the allograft-host bone junction. Using the method of Fowler and Gie, we found that one femoral implant had subsided 2 mm within the cement mantle. Two other implants had 1 mm of subsidence at the cement bone interface, and one patient had a major subsidence of 15 mm that required revision.

Conclusion.

Using an anterior cortical window in the femur to remove the old implant does not predispose to failure of the allograft to incorporate into the host bone.
How Often Should Computed Tomographic Scans following Cross-Table Lateral Cervical Films Be Performed?
Authors: Suzuki T , Morimura N , Sugiyama M , Kitahara T , Soma K
Published: October 2016

Purpose.

In patients with blunt trauma, a cross-table lateral cervical (CTLC) film is followed by a focused computed tomographic (CT) scan of the cervical spine to assess an area inadequately delineated by common techniques and suspected injuries, based on recent guidelines in the United States. The purpose of this study was to calculate the frequency of such supplemental CT scans and to evaluate the efficacy of the recent guidelines describing the use of CTLC films as an indicator of supplemental focused CT scanning in Japan.

Methods.

A review of CTLC films was performed. 100 initial CTLC films with injuries and another 100 films without injuries were evaluated for the lowest vertebra visualised on the CTLC film. The frequency of abnormal signs on the CTLC films was then examined.

Results.

Technically adequate CTLC films that showed the upper border of the T1 vertebra were not obtained from 70 patients with injuries and 63 patients without injuries. 88 patients with injuries and 28 patients without injuries had abnormal findings on CTLC films. Overall, 97 patients with injuries and 74 patients without injuries should have received supplemental CT scans.

Conclusion.

CTLC films require frequent supplemental use of CT, even for patients without cervical spine injuries. Thus, the guidelines that consider CTLC film as an indicator of the necessity for CT scanning are not efficient and need revision.
Traumatic Anterior Dislocation of the Hip Associated with Ipsilateral Femoral Shaft Fracture in a Child: A Case Report
Authors: Yamamoto K , Ko M , Masaoka T , Shishido T , Imakiire A
Published: October 2016

Traumatic anterior dislocation of the hip joint in children is rare, and only one case with ipsilateral femoral fracture has been reported in Japan. We report a case of such dislocation and a review of the literature. The patient was a 31-month-old girl who was injured in a car accident while asleep on a tilted front passenger seat. Radiographic examination showed dislocation of the right obturator foramen and transverse fracture of the ipsilateral femoral shaft. The dislocation of the right hip was easily reduced without anaesthesia during radiography. We applied Bryant traction after reduction for 4 weeks, followed by cast application for 3 weeks. Walking with support and full weightbearing were permitted 14 weeks and 16 weeks after the injury, respectively. Radiography at 4.5 years after the injury showed a mildly enlarged right femoral head and femur overgrowth of approximately 8 mm. Magnetic resonance imaging showed no evidence of suspected avascular necrosis of the femoral head. The patient has no subjective or objective symptoms, and is able to engage in all usual activities. The detailed mechanism of the injury is unknown. We assume that the lower leg was dislocated through abduction during flexion, or abducent, external flexion, considering that the child was sleeping at the time of the accident. Since she was hurled to the back seat, it was assumed that strong external force was vertically added to the femur, which caused the abducent force.
Factors Leading to Blood Transfusion among Chinese Patients Undergoing Total Knee Replacements: A Retrospective Study
Authors: Yau WP , Tang WM , Ng TP , Chiu KY
Published: October 2016

Purpose.

To investigate the risk factors leading to blood transfusion among Chinese patients undergoing total knee replacement.

Methods.

From July 2001 to June 2002, a total of 128 primary total knee replacements were performed in 83 Chinese patients (38 unilateral and 45 one-stage sequential bilateral). No pharmaceutical prophylaxis against deep vein thrombosis was used. The risk factors leading to allogenic blood transfusion were analysed.

Results.

The important predictive factors for postoperative blood transfusion were preoperative haemoglobin level (p=0.005), intra-operative blood loss (p<0.001), and bilateral total knee replacements (p<0.001).

Conclusion.

To reduce the need of allogenic blood transfusion, we suggest administering erythropoietin or iron supplements to increase the haemoglobin level for patients undergoing total knee replacement. Routine use of intra-operative blood salvage can be considered for patients undergoing one-stage bilateral total knee replacement. Use of a postoperative blood salvage system is recommended for surgeries that may result in major intra-operative blood loss.
Deep Vein Thrombosis after Total Hip Arthroplasty in Indian Patients with and without Enoxaparin
Authors: Jain V , Dhal AK , Dhaon BK , Pradhan G
Published: October 2016

Purpose.

To study the incidence of deep vein thrombosis in Indian patients undergoing total hip arthroplasty with or without prophylaxis, and the effect of enoxaparin on deep vein thrombosis.

Methods.

The study covered a total of 50 hips in 40 patients who underwent total hip arthroplasty. Patients were assessed for deep vein thrombosis using Doppler ultrasonography. The hips were numbered and divided into 2 groups: the odd-numbered hips did not receive any thrombo-prophylaxis, whereas the even-numbered hips received 40 mg of enoxaparin subcutaneously, once a day for 2 weeks, until the time of discharge.

Results.

Deep vein thrombosis was not found in both groups. We found wound haematomas in 9 patients (all of whom were on enoxaparin) (p <0.05), superficial infection in 2 patients (one on enoxaparin, one not), and local bruising in 4 patients (all of whom were on enoxaparin). Major haemorrhage did not occur in any of the cases.

Conclusion.

The incidence of deep vein thrombosis in Indian patients is very low compared to that in European and American patients. Enoxaparin failed to provide any advantage to the patients. It is therefore not advisable to give prophylaxis/low-molecular-weight heparin for deep vein thrombosis to patients undergoing total hip arthroplasty without any risk factors.
Assessment of Blood-Induced Cartilage Damage in Rabbit Knees Using Scanning Electron Microscopy
Authors: Tan AHC , Mitra AK , Chang PCC , Tay BK , Nag HL , Sim CS
Published: October 2016

Purpose.

To investigate the harmful effects of a single episode of intra-articular bleeding on articular cartilage of rabbit knees using scanning electron microscopy.

Methods.

Autologous blood was injected into the right knee joints of 18 New Zealand white rabbits. Surface and cellular damages were examined by the scanning electron microscope (n=9) and light microscope (n=34), respectively. The injected right knees were then compared with the corresponding control left knees at one, 3, and 6 weeks after the blood injection.

Results.

The articular surface of the injected knees turned uniformly rough with multiple pits after one week. Maximal changes with elevations and depressions were observed at 3 weeks. These changes reversed at 6 weeks with the irregularities smoothing out. A similar pattern of transient cartilage damage was noted histologically.

Conclusion.

Both scanning electron microscopic and light microscopic findings suggest that a single episode of intra-articular bleeding leads to articular cartilage damage but this appears to be reversible. Our findings of transient damage to the articular cartilage suggest that there is no need for intra-articular evacuation and washout following an acute episode of haemarthrosis.
Clinical Pathology and Therapeutic Results of Neurilemmoma in the Upper Extremity
Authors: Takase K , Yamamoto K , Imakiire A
Published: October 2016

Purpose.

To evaluate the clinical pathology and postoperative outcomes of patients with neurilemmoma in the upper extremity who underwent tumour enucleation, and the correlation factors for neurological deficits apart from enucleation of nerve fascicles.

Methods.

Magnetic resonance imaging was used to evaluate the state of lesions of the patients with upper-extremity neurilemmoma who underwent tumour enucleation. To find out the correlation factors for neurological deficits, the patients were then divided into 2 groups based on their recovery period—group A (shorter than 6 months) and group B (at 6 months or longer). Duration of the illness, the affected nerve, and the size and histological type of the tumour were then compared between the 2 groups.

Results.

Of the 20 patients who underwent tumour enucleation for neurilemmoma in the upper extremity, 19 had a single nerve affected and one had multiple lesions involving two nerves. The tumours in 6 patients were of Antoni A type histology and in the remaining 14 patients were of a mixed type. Antoni B type alone was not observed. 15 patients showed postoperative neurological deficits. No neurological deficits were observed in 5 patients. Neurological deficits were fully recovered in all patients except the one with a lesion in the digital nerve. Apart from enucleation of nerve fascicles, the period required for the recovery of neurological deficits was correlated to the duration of the illness (p=0.04) and the histological type of the tumour (p=0.03).

Conclusion.

Most of the patients with neurilemmoma (95%) had a single nerve affected. A majority of patients (70%) had the mixed type of Antoni A and Antoni B histology; Antoni B type alone was not observed. Neurological deficits were observed in 75% of patients. In patients with neurilemmoma developing in the upper extremity, the period required for recovery from postoperative neurological deficits was short when the duration of illness was short and when Antoni A type histology was present.
Palmar Dislocation of the Radio-Carpal Joint: A Case Report
Authors: Takase K , Yamamoto K , Yoshino S , Imakiire A
Published: October 2016

Radio-carpal joint dislocation, with or without fracture of the radius, is an uncommon injury; only 21 cases have previously been reported. Successful treatments of closed reduction and surgery have also been reported. A 35-year-old right-handed man was injured in a traffic accident and taken to an emergency room of a hospital, where radiographic examination showed a right palmar radio-carpal joint dislocation. Three days after injury, the patient was transferred to our department at Tokyo Medical University, Tokyo. We performed percutaneous pin fixation to maintain the position of his reduced radio-carpal joint. Two years postoperatively, radiographic examination showed a complete union of the avulsion fracture of the radius and a reduction of the joint. He had no marked disturbance in his daily activities apart from a slight pain while working. He had no limitation on the range of motion of the wrist joint and his grip strength was 41.6 kg. He returned to work 3 months after injury.
Benign Fibrous Histiocytoma of the Distal Radius with Congenital Dislocation of the Radial Head: A Case Report
Authors: Sanatkumar S , Rajagopalan N , Mallikarjunaswamy B , Srinivasalu S , Sudhir NP , Usha K
Published: October 2016

Benign fibrous histiocytoma is such a rare tumour that only a few cases have been reported in the literature. A patient with an apparently benign lesion of the distal radius, along with congenital dislocation of the radial head, was presented at St. John's Medical College Hospital in Bangalore, India. Pain was the chief symptom. There were histological features of non-ossifying fibroma in the lesion. Because of its unusual radiological appearance and atypical clinical course, the lesion was diagnosed as fibrous histiocytoma. In this case report, we review similar cases in the literature and discuss an unusual association with congenital dislocation of the radial head.
The Effect of Total Knee Arthroplasty on Joint Movement during Functional Activities and Joint Range of Motion with Particular Regard to Higher Flexion Users
Authors: Rowe PJ , Myles CM , Nutton R
Published: October 2016

Purpose.

To evaluate active and functional knee excursion of patients before and after total knee arthroplasty (TKA) and to determine whether TKA restores quality of life related to functional activities of daily living.

Methods.

Electrogoniometry was used to measure the functional movement of the knee during 11 activities of daily living in 50 patients who underwent TKA. These data were compared with the patient's active range of motion and quality-of-life scores.

Results.

A cut-off point existed between loss and gain in flexion at between 90 and 95 degrees of preoperative active flexion. Two thirds of patients had preoperative flexion of more than 90 degrees, 83% of them had reduced flexion postoperatively. The remaining one third had preoperative flexion of 90 degrees or less, 85% of them had improved flexion postoperatively. A similar pattern of loss and gain occurred for functional movement of the knee. Reduced functional range was associated with significantly reduced physical quality of life compared with age-matched healthy subjects.

Conclusion.

Although TKA offers excellent pain relief and contributes to the overall well-being of the patient, these results suggest that it also leads to a reduced range of active and functional motion in the majority of patients. This is associated with a lower-than-normal physical quality of life. The design of implants and rehabilitation programmes should be reconsidered so that better range of motion and quality of life can be achieved for patients.
Volar Fixation of Dorsally Displaced Distal Radial Fracture Using Locking Compression Plate
Authors: Wong KK , Chan KW , Kwok TK , Mak KH
Published: October 2016

Purpose.

To evaluate the functional and radiological results of treating unstable fractures of the dorsal distal radius with a volar locking plate.

Methods.

Dorsally displaced distal radial fractures in 30 patients (11 men and 19 women; mean age, 58.6 years) were fixed by volar locking compression plate and followed up for a minimum of one year.

Results.

At final functional assessment, 24 patients achieved excellent and 5 achieved good outcomes, with one patient exhibiting fair results. Radiological scores demonstrated 22 excellent and 8 good outcomes. No nonunion or infection occurred.

Conclusion.

Volar locking compression plating is a safe and effective treatment for unstable fractures of the dorsal distal radius.
Technetium-99m Ciprofloxacin Imaging in the Diagnosis of Postsurgical Bony Infection and Evaluation of the Response to Antibiotic Therapy: A Case Report
Authors: Singh B , Mittal BR , Bhattacharya A , Aggarwal A , Nagi ON , Singh AK
Published: October 2016

The use of radiolabelled antibiotics is fast emerging as a promising diagnostic test for the detection of infective lesions, because of their specific binding to the bacterial component. Ciprofloxacin is a broad-spectrum antibiotic that has been used as a radiolabelled antibiotic in both the diagnosis of infections in rabbits and in clinical trials on humans. The diagnosis of skeletal microbial infections remains a challenge, especially in orthopaedic patients with implants. We present a case report of a patient with undiagnosed and unrelenting pain in the lower third of the left leg, which had persisted for 6 months. A novel scintigraphy, which was developed in-house using a 99mTc ciprofloxacin single vial kit, was used for diagnosing the active bacterial infection. A 99mTc methylene diphosphonate bone scan was also performed to locate precisely the site of the lesion. Gradually increasing concentrations of both the radiotracers confirmed the presence of active bacterial infection in the distal third of the left tibia. Follow-up scanning after antibiotic therapy showed the disappearance of the pooling of 99mTc ciprofloxacin, indicating a good response. Therefore, 99mTc ciprofloxacin has good diagnostic and prognostic applications in deep-seated covert skeletal microbial infections. However, the persistence of a focal concentration detected by the 99mTc methylene diphosphonate scan was attributed to the inflammatory and not the infective pathology.
Massive Calcaneal Enthesopathy in a Non-Healing Leg Ulcer: A Case Report
Authors: Amaravati RS , Saji MJ , Kowshik JD , Rajagopal HP
Published: October 2016

Enthesopathy at the superior or inferior surface of a calcaneus may be seen in normal individuals having degenerative osteoarthrosis. This condition is also known to occur in patients with rheumatoid arthritis, seronegative spondyloarthropathy, trauma, as well as inflammatory and metabolic diseases. Enthesopathy may sometimes be the first manifestation of a variety of rheumatic diseases. In this report, we present a case of massive enthesopathy of the superior and inferior surface of the calcaneus giving rise to an ‘axe effect’.
Management of Malignant Atlanto-Axial Tumours
Authors: Fung KY , Law SW
Published: October 2016

Purpose.

To review the management and outcomes of patients with malignant tumours of the atlanto-axial spine treated over a 4-year period at a tertiary hospital.

Methods.

A total of 12 patients (9 female and 3 male) with a mean age of 56.5 years (range, 35–71 years) were consecutively enrolled. At the time of presentation, 7 patients had received treatment for a known primary malignancy of the lung (n=4), colon (n=1), nasopharynx (n=1), or breast (n=1). The atlanto-axial spine was the first presentation of malignant disease in the remaining 5 patients, whose subsequent diagnoses were multiple myeloma (n=1), carcinoma of the thyroid (n=1), malignant fibrous histiocytoma (n=2), and adenocarcinoma of unknown origin (n=1). Preoperative, postoperative, and follow-up radiographs and computed tomographic and magnetic resonance imaging scans were analysed with regard to the extent of tumour involvement, other spinal metastases, instability, and evidence of cord compression. Surgeries were performed for surgically fit patients with a life expectancy of more than 3 months.

Results.

All patients presented with severe sub-occipital neck pain. Two had mild neurological deficits (Frankel grade D). Two patients were treated conservatively with rigid neck collars and survived for 3 and 11 months. Surgical stabilisation with posterior instrumentation was performed in 10 patients. One patient received additional anterior surgery for tumour debulking and bone grafting. No neurological complications were recorded in the series. Excellent relief of pain was achieved, and the mean visual analogue scale pain score of the operated patients improved from 9.3 to 1.9. The mean survival of 9 patients after surgery was 13.1 months, while one patient was still living at the time of review (at postoperative 11 months).

Conclusion.

Surgical stabilisation in selected patients provided pain relief and preserved ambulatory status before the deterioration of overall function.
Radiographic Assessment of Congenital Talipes Equinovarus: Strapping versus Forced Dorsiflexion
Authors: Yeung EHK , Li YH , Ng ON , Chow W
Published: October 2016

Purpose.

To compare 2 radiographic assessment methods for congenital talipes equinovarus: strapping the ankle with tapes versus dorsiflexion with a wooden block.

Methods.

Anteroposterior and lateral radiographs were taken with the ankle strapped by tapes or dorsiflexed by a wooden block. Talocalcaneal and tibiocalcaneal angles were measured and analysed.

Results.

20 radiographic assessments were performed on 14 patients. From the anteroposterior view, the mean talocalcaneal angle with strapping was 19.4 degrees (range, 0–34.0; standard deviation [SD], 11.2 degrees). From the lateral view, the mean talocalcaneal angle with strapping was 22.0 degrees (range, 8.0–38.8; SD, 8.9 degrees) and with forced dorsiflexion was 21.0 degrees (range, 0–52.7; SD, 11.3 degrees), with a mean absolute difference of 9.4 degrees between the 2 groups. The mean tibiocalcaneal angle with strapping was 77.9 degrees (range, 43.2–120.0; SD, 18.8 degrees) and with forced dorsiflexion was 78.2 degrees (range, 29.5–134.0; SD, 24.7 degrees), with a mean absolute difference of 15.7 degrees between the 2 groups. The difference between the tibiocalcaneal measurements in the 2 groups was statistically significant (p=0.026).

Conclusion.

Similar results were obtained for talocalcaneal and tibiocalcaneal angles measured with strapping and forced dorsiflexion. However, the strapping method provides better stabilisation while radiographs are taken.
Periacetabular Limb Salvage for Malignant Bone Tumours
Authors: Asavamongkolkul A , Pimolsanti R , Waikakul S , Kiatsevee P
Published: October 2016

Purpose.

To evaluate treatment outcomes in primary malignant periacetabular bone tumour removal and limb salvage with or without bone-graft reconstruction.

Methods.

A total of 13 patients were treated for malignant periacetabular bone tumours at Siriraj Hospital, Bangkok, Thailand. The diagnoses were chondrosarcoma (n=8), Ewing's sarcoma (n=2), osteosarcoma (n=1), well-differentiated osteosarcoma (n=1), and malignant giant cell tumour (n=1). 11 patients did not undergo reconstruction following tumour resection; 2 patients received fibular bone grafts bridging the periacetabulum to the remaining sacrum. Adjuvant chemotherapy was administered for high-grade malignant tumours, and postoperative radiation therapy was performed on patients with a closed surgical margin.

Results.

At a mean follow-up of 24.3 months (range, 8.9–43.9 months), 9 patients remained disease-free, 3 had died of the disease, and one was alive with disease. According to the Musculoskeletal Tumor Society classification system, the mean functional analysis at final follow-up was 68.7%. Patients who underwent internal hemipelvectomy experienced a subsequent leg-length discrepancy ranging from 3 to 10 cm. Four patients had complications (one each for deep wound infection, skin necrosis, seroma, and vascular spasms) and were successfully treated with multiple debridements and appropriate antibiotics. Three patients had local recurrences; one required a classic hemipelvectomy.

Conclusion.

Malignant periacetabular tumours are difficult to manage. Functional results of our patients with no reconstruction or with bone-graft bridging were fair. Patients undergoing internal hemipelvectomy may experience leg-length discrepancies, which can be balanced with shoe lifts.
Comminuted Refracture of the Distal Femur and Condyles in Patients with an Intramedullary Nail: A Report of 5 Cases
Authors: Sen RK , Gul A , Aggarwal S , Kumar SR , Nagi ON
Published: October 2016

Patients with in situ intramedullary nails sustaining a second distal femoral fracture following high-velocity trauma are infrequently reported in the literature. We report 5 such patients who sustained a second injury after 6 to 24 months, resulting in another fracture at the nail-tip level. These second fractures severely comminuted the femoral condyles. These patients required removal of the intramedullary nail, reconstruction of the comminuted femoral condyles, and stabilisation using an angled or buttress plate. Four of the 5 patients were followed up for a mean period of 36 months and were evaluated for knee status and outcome using Judet's criteria. Postoperative knee stiffness was common, and further interventions such as manipulation, hardware removal, arthrolysis, and quadricepsplasty were needed. One patient was lost to follow-up. The final results of the knees were good, with more than 100 degrees range of movement. It is important to adhere to established internal fixation protocols in the treatment of these complex nail tip fractures.
Iatrogenic Bilateral Pneumothorax Arising from Acupuncture: A Case Report
Authors: Lee WM , Leung HB , Wong WC
Published: October 2016

Acupuncture is often regarded as innocuous. However, its complication can be serious and deadly if unattended. We report a case of iatrogenic bilateral pneumothorax after acupuncture therapy. Setting up a government regulatory body and using needles with safety design can prevent further inadvertent incidences from occurring.
Hydatid Bone Disease: A Case Report and Review of the Literature
Authors: Kalinova K , Proichev V , Stefanova P , Tokmakova K , Poriazova E
Published: October 2016

Hydatid disease may develop in almost any part of the body and can be identified with a combination of clinical history, imaging findings, and serologic results; however, the diagnosis of bone hydatidosis is primarily based on radiographic findings. Bone hydatid disease is often asymptomatic, and its diagnosis is usually made at an advanced stage when lesions have become extensive. We present a case of a 45-year-old woman who was admitted to the University Hospital, Stara Zagora, Bulgaria complaining of pain in her left tibia. Radiographs revealed an oval cyst with a diameter of 3.5 cm, located in the diaphyseal part of the tibia. The cyst was excised, and no recurrence was observed on follow-up. Functional outcome was excellent.
Recurrent Spinal Meningioma: A Case Report with Review of the Literature
Authors: Nadkarni B , Arora A , Kumar S , Bhatia A
Published: October 2016

Spinal meningioma generally responds favourably to surgical excision and has a low rate of recurrence. However, follow-up data on patients under 50 years of age are limited. We report a recurrence of intraspinal meningioma 18 years after the initial surgery in a 45-year-old woman. She presented with weakness in both lower limbs that had gradually progressed over the previous 8 months, and difficulty in walking for the last 2 months. She had no history of sensory loss or visceral involvement, but had undergone a major surgical intervention of the upper spine for a similar episode of weakness in both lower limbs 18 years earlier. She underwent a second surgery at the same site, and a greyish-white tumour was excised, which was histopathologically confirmed as recurrent psammomatous meningioma. The patient demonstrated complete neurological recovery in 8 months.