bluuebunny/crossref_metadata_2025 huggingface dataset:
Bicycle and Motorcycle Wheel Spoke Injury in Children
Authors: Mak CY , Chang JHT , Lui TH , Ngai WK
Published: October 2016

Purpose.

To review bicycle and motorcycle wheel spoke injuries around the foot and ankle in 24 children.

Methods.

Medical records of 12 boys and 12 girls aged 2 to 11 (mean, 5.3) years who presented with an isolated posterior heel injury caused by wheel spokes of a motorcycle (n=9) or bicycle (n=15) were reviewed.

Results.

All 9 motorcycle injury patients and 8 of 15 bicycle injury patients had lacerations. The remaining 7 bicycle injury patients had abrasions and developed skin necrosis and ulcerations, with 5 requiring debridement. The most common site of laceration was the posterolateral heel; 7 of these patients had deep soft tissue injury, and in 5 the Achilles tendon was partially cut or completely severed. The mean number of operations was 2.2 in the motorcycle group and 1.3 in the bicycle group. Seven patients with severe skin loss required skin grafting or flap surgery for wound coverage. The mean time from injury to definitive treatment was 8.2 days. The mean length of hospital stay was 18.4 days in the motorcycle group and 8.1 days in the bicycle group. Delayed definitive treatment was associated with more operations (r=0.499, p=0.013) and longer hospital stay (r=0.567, p=0.004).

Conclusion.

Wheel spoke injuries may result in severe soft tissue damage and bony trauma. Poor prognostic factors included high-energy injury, contamination and infection, and delayed treatment.
Blood Management Protocol for Total Knee Arthroplasty to Reduce Blood Wastage and Unnecessary Transfusion
Authors: Lee Qunn-Jid , Mak Wai-Ping , Yeung Sze-Tsun , Wong Yiu-Chung , Wai Yuk-Leung
Published: October 2016

Purpose.

To compare outcomes of 2 cohorts of patients who underwent total knee arthroplasty (TKA) before and after the introduction of a blood management protocol.

Methods.

Records of 97 and 96 consecutive patients who underwent unilateral TKA before and after introduction of the blood management protocol, respectively, were reviewed. Before introduction of the protocol, patients were cross-matched for blood before surgery. Transfusion after surgery was at the discretion of the surgeons or the on-call doctors. After introduction of the protocol, only patients with a preoperative haemoglobin level of <110 g/l underwent ‘type and screening’ of blood group. 2 units of blood were cross-matched preoperatively when multiple red-cell antibodies were identified or postoperatively when blood transfusion was required. Only patients with a postoperative haemoglobin level of <80 g/l or being symptomatic received blood transfusion until the haemoglobin level reached >100 g/l. Those with a postoperative haemoglobin level of 80 to 100 g/l were given iron sulphate 300 mg twice daily for a month.

Results.

The 2 groups did not differ significantly in age, sex ratio, pre- and post-operative haemoglobin levels, and drain output. Comparing outcome before and after introduction of the protocol, the transfusion rate (10.3% vs. 3.1%, p=0.046), cross-match rate (100% vs. 3.1%, p<0.001), and cross-match to transfusion ratio (9.7:1 vs. 1:1, p<0.001) decreased. Among transfused patients, the decreased postoperative haemoglobin level indicated a lower transfusion trigger point (100 g/l vs. 75 g/l, p<0.006) No patient developed infection, cardiovascular or cerebrovascular complications within 30 days.

Conclusion.

The blood management protocol for TKA is effective in reducing unnecessary allogeneic blood transfusions and wastage of unused blood, without an increase in postoperative complications.
Gait Parameters in Women with Bilateral Osteoarthritis after Unilateral versus Sequential Bilateral Total Knee Arthroplasty
Authors: Mine Takatomo , Ihara Koichiro , Kawamura Hiroyuki , Kuriyama Ryutaro , Date Ryo
Published: October 2016

Purpose.

To compare gait parameters in women after unilateral total knee arthroplasty (TKA) versus sequential bilateral TKA to determine the need for sequential TKA.

Methods.

35 women aged 60 to 74 (mean, 70) years with bilateral varus knee osteoarthritis (OA) underwent unilateral (n=23) or sequential bilateral (n=12) TKA by a single surgeon. All patients underwent unilateral TKA; 12 patients then underwent sequential TKA after 3 to 6 months of the first TKA. Gait parameters (step length, step width, gait velocity, single support phase value, and the maximum centre of gravity ratio) were compared before and after TKA, and between patients with unilateral versus bilateral TKA.

Results.

Patients with sequential bilateral TKA had more severe OA in their contralateral knee than patients with unilateral TKA. In patients with unilateral and sequential bilateral TKA respectively, the mean step width differed at postoperative one month (12.9 vs. 19.1, p<0.01) and 3 months (11.9 vs. 16, p=0.03), and the mean maximum centre of gravity ratio differed at postoperative 3 months (2.43 vs. 1.75, p=0.02), whereas the mean step length, mean gait velocity, and mean single support phase values did not differ significantly between groups.

Conclusion.

After unilateral TKA, contralateral TKA may not be necessary in some patients whose gait has improved.
Pedicled Vascularised Fibular Grafting in a Flow-through Manner for Reconstruction of Infected Non-Union of the Tibia with Preservation of the Peroneal Artery: A Case Report
Authors: Hattori Yasunori , Doi Kazuteru , Sakamoto Soutetsu , Satbhai Nilesh , Kumar Kannan Karuppiah
Published: October 2016

We report on an 82-year-old man with an infected non-union of the right tibia in which the peroneal artery was the sole artery supplying the lower leg, owing to peripheral arterial disease. He underwent tibial reconstruction using the pedicled vascularised fibular graft in a flow-through manner (without ligation of either the proximal or distal ends of the peroneal artery) and achieved successful bony union.
Bipartite Patella Causing Knee Pain in Young Adults: A Report of 5 Cases
Authors: Vaishya Raju , Chopra Surender , Vijay Vipul , Vaish Abhishek
Published: October 2016

We report on 5 patients who underwent arthroscopic excision or open reduction and internal fixation for bipartite patella. All patients presented with refractory anterior knee pain. The diagnosis of bipartite patella was made using radiography, and confirmed with magnetic resonance imaging or computed tomographic arthrography. All 5 patients achieved complete resolution of symptoms after surgery, and remained pain-free after a mean follow-up period of 13 months.
Morphology and Fixation Pitfalls of a Highly Unstable Intertrochanteric Fracture Variant
Authors: Tan Bryan Yijia , Lau Adrian Cheng Kiang , Kwek Ernest Beng Kee
Published: October 2016

Purpose.

To describe a variant of intertrochanteric fracture not well-characterised in the existing classification systems.

Methods.

10 women and 2 men aged 59 to 98 (median, 80) years with intertrochanteric fractures characterised by a low intertrochanteric fracture, a basicervical fracture fragment, and a thin or fractured lateral wall with greater trochanteric comminution were reviewed.

Results.

The 12 fractures were classified as A2.1 (n=1), A2.2 (n=7), A2.3 (n=1), and A3 (n=3) according to the AO/OTA classification, and as type 3 (n=2), type 5 (n=7), and type 6 (n=3) according to the Evans classification. The fractures were characterised by greater trochanter comminution and a coronal plane fracture extending into the greater trochanter resulting in a loss of superolateral support. Patients were treated with the Proximal Femoral Nail Antirotation (n=5), the Proximal Femur Locking Plate (n=6), or the reversed Less Invasive Stabilization System for distal femur (n=1). Within the mean follow-up period of 6 months, 3 patients with plating and one patient with nailing had mechanical failure defined as loss of alignment of >10° or screw cutout.

Conclusion.

This intertrochanteric fracture variant is highly unstable with a high failure rate. Loss of superolateral support rather than the medial calcar buttress is the main contributing factor to mechanical failure. Computed tomography is important in preoperative planning. Intramedullary nailing is more appropriate than extramedullary plating for such unstable fractures.
Osteoporotic Hip Fractures: 10-year Review in a Singaporean Hospital
Authors: Tan Wei Loong Barry , Low Siew Leng , Shen Liang , De Shamal Das
Published: October 2016

Purpose.

To review records of 2702 patients with osteoporotic hip fractures in a Singaporean hospital.

Methods.

Medical records of 1905 women and 797 men, aged 50 to 112 (median, 78) years, who were admitted to a Singaporean hospital with an osteoporotic hip fracture (ICD9 820) between January 2000 and December 2010 were reviewed.

Results.

Female patients were significantly older than male patients (p<0.0005). The trend for the median patient age over the 10-year period has increased significantly in women ( r=0.826, p=0.002) but not in men. Of the hip fractures, 49.4% were femoral neck fractures and 50.6% were intertrochanteric/basicervical fractures. The rate of intertrochanteric/basicervical fractures was higher in men than women (61.2% vs. 46.1%, p<0.0005). Increased age, ischaemic heart disease, Parkinson's disease, and being Malay or Caucasian or Sikh were more likely to have intertrochanteric/basicervical fractures than femoral neck fractures. Femoral neck fractures were usually treated with hemiarthroplasty (68.8%), cancellous screw fixation (20.6%), and conservative methods (20.5%), whereas intertrochanteric/basicervical fractures were usually treated with dynamic hip screw fixation (76.3%) and conservative methods (15.6%). 84 women and 26 men sustained a subsequent osteoporotic hip fracture on the contralateral side after a median interval of 2 (range, 0–8) years. 11 of these 110 patients were already on osteoporosis medication.

Conclusion.

The rate of osteoporotic hip fractures has increased, particularly among women, over the 10-year period. The rate of intertrochanteric/basicervical fractures was higher in men than women.
Local Infiltration Analgesia versus Standard Analgesia in Total Knee Arthroplasty
Authors: Suthersan Mayuran , Pit Sabrina , Gordon Loris , Loman Mark , Pezzutti Brian , Freihaut Richard
Published: October 2016

Purpose.

To compare outcome and cost following local infiltration analgesia (LIA) versus standard analgesia in total knee arthroplasty (TKA).

Methods.

13 men and 33 women (mean age, 67.5 years) underwent TKA by a single surgeon and received LIA (n=24) or standard analgesia (n=22), depending on the availability of the senior anaesthetist.

Results.

The 2 groups were comparable at baseline in terms of age, gender, body mass index, American Society of Anesthesiologists score, and range of motion. Compared with the standard analgesia group, the LIA group resulted in a shorter mean length of hospital stay (4.9 vs. 2.7 days, p<0.0001) and higher proportion of patients able to straight leg raise on discharge (38% vs. 86%, p=0.0011), as well as lower pain scores in the first 3 days and greater range of motion at all time points. Respectively in the standard analgesia and LIA groups, the mean cost per patient for all analgesic medication was A$129.25 and A$153.63, the mean cost per patient for all nights spent in hospital was A$1600.36 and A$901.50, and thus the mean total cost per patient was A$1729.61 and A$1055.13.

Conclusion.

Compared with standard analgesia, LIA results in greater pain relief and improvement in range of motion immediately after TKA, and lower hospital costs.
Intra-Operative Fractures in Cementless Bipolar Hemiarthroplasty
Authors: Kuo Chung-Liang , Tan Si Heng Sharon , Lee Haw Chou
Published: October 2016

Purpose.

To compare patients with or without intra-operative fracture during cementless bipolar hemiarthroplasty.

Methods.

Records of 76 men and 202 women who underwent cementless bipolar hemiarthroplasty for femoral neck fractures were reviewed. Patients with and without intra-operative fractures and patients with different types of intra-operative fractures were compared.

Results.

Two men and 22 women aged 62 to 93 (mean, 80) years sustained intra-operative fractures at the lesser trochanter (n=18), the greater trochanter (n=5), and the subtrochanter (n=1). All 18 lesser trochanteric fractures and 4 of the greater trochanteric fractures were recognised intra-operatively and managed with cerclage wiring (n=21) or conversion to cemented hemiarthroplasty with cerclage wiring (n=1). The remaining 2 fractures were recognised postoperatively on radiographs and managed conservatively or with revision surgery and cerclage wiring and plating on day 4. Intra-operative fractures correlated with female gender (p=0.03) and operative delay to optimise patients (p=0.02), whereas the fracture site correlated with the time of fracture recognition (p=0.01). Postoperatively, 5 patients were allowed partial weight bearing and 18 were instructed to mobilise with a wheelchair for at least 6 weeks. One patient died from an unrelated cause. At one year, 21 patients reported no hip pain and 2 reported minimal pain. 17 could walk with or without aids and 6 were wheelchair-bound.

Conclusion.

Surgeons should be familiar with the size difference in trial and actual implants used in bipolar hemiarthroplasty in order to better estimate the extent of broaching required. In most patients with an intra-operative fracture, the one-year outcome was not compromised, despite the poorer short-term outcome.
Arthroscopic Fixation for Acute Acromioclavicular Joint Disruption Using the TightRope Device
Authors: Chaudhary Deepak , Jain Vineet , Joshi Deepak , Jain Jitesh Kumar , Goyal Ankit , Mehta Nitin
Published: October 2016

Purpose.

To review outcome after arthroscopic fixation for acute acromioclavicular (AC) joint dislocation using the TightRope device.

Methods.

Records of 15 men and 2 women aged 19 to 52 (mean, 35) years who underwent arthroscopic fixation using the TightRope device for acute (<3 weeks) AC joint dislocation of Rockwood type III (n=6), type IV (n=1), and type V (n=10) were reviewed. Outcome was evaluated using the Constant score. The coracoclavicular (CC) distance before and after surgery was compared.

Results.

The mean follow-up period was 22.1 (range, 12–37) months. The mean time to return to work was 4 (range, 1.5–12) months, excluding one failure. The mean postoperative Constant score was 86.4 (range, 63–96). The CC distance decreased from 21.5±5.2 mm preoperatively to 9.8±3.5 mm at 6 months and to 10±3.2 mm at one year. There was no over-correction. All patients had satisfactory outcome except for one who had rupture of the TightRope suture at 6 months. Two patients had partial loss of reduction (≥2 mm) after 3 to 6 months secondary to osteolysis at the clavicular button site.

Conclusion.

Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory outcome.
Single Tendon Transfer of the Flexor Carpi Ulnaris for High Radial Nerve Injury
Authors: Sankaran Ajeesh , Thora Ankit , Arora Sumit , Dhal Anil
Published: October 2016

Purpose.

To evaluate the outcome after single tendon transfer of the flexor carpi ulnaris (FCU) to the digital extensors for high radial nerve palsy.

Methods.

Records of 10 patients aged 16 to 43 (median, 27) years who underwent single tendon transfer of the FCU to the digital extensors for high radial nerve palsy secondary to closed (n=4) or open (n=4) diaphyseal humeral fractures or deltoid injection (n=2) were reviewed. Two of the patients with open fractures also underwent treatment for non-union in a staged manner. Grip strength (power grip and precision grip) was measured monthly using an automated dynamometer. The range of motion of the wrist, and metacarpophalangeal joints of the thumb and fingers was measured monthly using a goniometer.

Results.

All patients were followed up for at least one year. Preoperatively, the overall power grip strength of the injured hands was about 1/5 of the normal hands. At 12 months, the mean improvement was 202.5% for overall power grip strength and 43% to 57% for precision grip strength parameters. Compared with the normal hands, the mean deficit of the operated hands was 39% for overall power grip strength and 32% to 37% for precision grip strength parameters. At 12 months, mean wrist extension was 50.4°, with about 10° lag in finger and thumb extension. The mean total active motion was 86.7° in the operated wrists and 128.1° in normal wrists. The decrease in wrist flexion and ulnar deviation was 7.8° and 6.8°, respectively.

Conclusion.

Single tendon transfer of the FCU is a viable option to restore hand function and strength following high radial nerve injuries.
Open Carpal Tunnel Decompression by Specialist versus Nurse Practitioner
Authors: Patel Nimesh , Roberton Andy , Batten Timothy , Millyard Cathy , Birdsall Paul
Published: October 2016

Purpose.

To compare the outcome after open carpal tunnel decompression by specialists versus a nurse practitioner.

Methods.

Of 1361 cases of open carpel tunnel decompression under local anaesthesia from 1996 to 2008, 807 were performed by specialists (consultant, specialist registrar, or specialty and associate specialist) and 554 by a nurse practitioner (since May 2006). The 2 groups were compared in terms of surgical time, total theatre time, postoperative pain, and patient satisfaction with the service.

Results.

The mean surgical time was shorter in cases performed by specialists (13 vs. 18 minutes, p<0.0001), as was the mean total theatre time (26 vs. 29 minutes, p=0.0154). The rate of postoperative pain was higher in cases performed by specialists (31.5% vs. 24.5%, p=0.0125), as was the rate of patient dissatisfaction (1.6% vs. 0.18%, 0.0113). Nonetheless, since May 2006, outcome was comparable for specialists and the nurse practitioner. This could be due to the change from short-acting to long-acting/mixed local anaesthetic, and the technique for infiltration. The waiting time for surgery reduced from a mean of 16 to 3 weeks.

Conclusion.

Specialists and the nurse practitioner achieved comparable outcome after open carpal tunnel decompression.
Trends in the Incidence of Atypical Femoral Fractures and Bisphosphonate Therapy
Authors: Clout Andrew , Narayanasamy Naveen , Harris Ian
Published: October 2016

Purpose.

To report the trends in the incidence of typical and atypical femoral fractures (AFF) in patients aged >50 years from 2009 to 2014 and in the prescription of bisphosphonates for osteoporosis from 2001 to 2013 in Australia.

Methods.

175 patients aged >50 years presenting to our hospital with an AO type 32 femoral shaft fracture between October 2009 and October 2014 were identified using a trauma database. Of them, 21 male and 110 female patients with a mean age of 75 years were reviewed. Radiographs were reviewed by 2 investigators blinded to the use of bisphosphonates. The femoral shaft fractures were classified as typical or atypical using the American Society of Bone and Mineral Research definition, and their annual incidence was compared. The trend and number of prescriptions for various bisphosphonates in Australia was determined using the Pharmaceutical Benefits Scheme statistics from 2001 to 2013.

Results.

Of the 131 femoral shaft fractures, 65 were typical and 66 were atypical subtrochanteric (n=19) or diaphyseal (n=47) fractures that were complete (n=60) or incomplete (n=6). Four patients had sequential bilateral AFF. The 66 AFFs accounted for 5% of hip and shaft fractures. Women accounted for 80% of all femoral shaft fractures and 95% of AFF. The proportion of AFF was higher in women than men (63/110 vs. 3/21, relative risk=3.95, 95% CI=1.37–11.39, p=0.0006). The mean length of hospital stay was 9.7 days shorter in the AFF patients (14.1 vs. 23.8 days, 95% CI=2.6–16.8 days, p=0.008). Patients with AFF were 8 years younger than those with proximal femoral fracture (73 vs. 81 years, p<0.0001). There was no trend in the annual incidence or proportion of AFF from 2009 to 2014 (p=0.70). The bisphosphonate usage was highest in 2007 with 260 000 yearly patient treatments and had declined by 30% by the end of 2013.

Conclusion.

AFF accounted for half of all femoral shaft fractures in patients aged >50 years. Women accounted for 80% of all femoral shaft fractures and 95% of AFF. The incidence of AFF was no longer increasing possibly related to decreased prescription of bisphosphonates in preceding years.
A Clinical and Ultrasonographic Study of Risk Factors for Elbow Injury in Young Baseball Players
Authors: Tajika Tsuyoshi , Kobayashi Tsutomu , Yamamoto Atsushi , Kaneko Tetsuya , Shitara Hitoshi , Shimoyama Daisuke , Iizuka Yoichi , Okamura Koichi , Yonemoto Yukio , Warita Toshiro , Ohsawa Takashi , Nakajima Ichiro , Iizuka Haku , Takagishi Kenji
Published: October 2016

Purpose.

To determine the risk factors for elbow injury and its association with glenohumeral internal rotation deficit among young baseball players.

Methods.

229 baseball players aged 9 to 14 (mean, 11) years completed a self-administered questionnaire with items related to years of playing baseball, hours of training per weekday, days of training per week, and past and present experience of elbow pain. Two orthopaedic surgeons measured the range of motion of both shoulders and elbows. Another 2 orthopaedic surgeons performed ultrasonography to detect any elbow abnormality such as fragmentation of the medial epicondylar apophysis and osteochondritis dissecans of the capitellum. Using univariate and multivariable analyses, participants with or without elbow abnormality were compared to determine the risk factors for elbow abnormality.

Results.

Elbow abnormality was detected in 100 of the participants and comprised osteochondritis dissecans of the capitellum (n=18) and fragmentation of the medial epicondylar apophysis (n=82). Elbow abnormality was associated with being a pitcher, past and present experience of elbow pain, loss of elbow extension, and the side-to-side internal rotation difference. The 100 participants with elbow abnormality were stratified into symptomatic (n=57) or asymptomatic (n=43) of elbow pain. Those with elbow abnormality and elbow pain was associated with being a pitcher.

Conclusion.

Being a pitcher was a risk factor for both elbow abnormality and elbow pain. Nonetheless, 43% of baseball players with elbow abnormality were asymptomatic. The use of ultrasonography was effective in detecting elbow abnormality and enabling early treatment.
Risk Factors for Early Implant-Related Surgical Site Infection
Authors: Kok Ta Wei Kevin , Agrawal Nikunj , Sathappan SS , Chen Weijing Kelven
Published: October 2016

Purpose.

To identify the risk factors and microbes associated with early implant-related surgical site infection (SSI).

Methods.

Records of 193 implant-related SSIs secondary to primary orthopaedic surgery were reviewed. Early and late SSI was defined as infection diagnosed within and after 3 months of surgery, respectively.

Results.

Of the 193 implant-related SSIs, 29 were superficial incisional, 127 were deep incisional, and 37 were organ/space-related. 144 (90%) out of 160 SSIs used cefazolin in their prophylactic antibiotic regimen. In univariate analysis, early SSI was associated with diabetes mellitus, American Society of Anesthesiologists (ASA) score of >2, emergency procedures, and lack of antibiotic prophylaxis. In multivariable analysis, early SSI was associated with an ASA score of >2 (p=0.016).

Conclusion.

It is important to cross-check ASA score with co-morbidities to reduce early SSIs. Perioperative optimisation and antibiotic prophylaxis should be administered prior to surgery. Appropriate modification of antibiotic prophylaxis should be considered.
Wrist Fusion through Centralisation of the Ulna for Recurrent Giant Cell Tumour of the Distal Radius
Authors: Meena Dinesh Kumar , Thalanki Srikiran , Sharma Shiv Bhagwan
Published: October 2016

Purpose.

To review the outcome of wide resection and wrist fusion through centralisation of the ulna for recurrent giant cell tumour (GCT) of the distal radius in 10 patients.

Methods.

Records of 7 women and 3 men aged 25 to 40 years who underwent wide resection and wrist fusion through centralisation of the ulna for grade I (n=6) and grade II (n=4) recurrent GCT of the distal radius were reviewed. Functional outcome was evaluated using the modified Musculoskeletal Tumor Society scoring system. Grip strength and range of motion of the metacarpophalangeal joint were also assessed.

Results.

The mean follow-up period was 45 (range, 30–60) months. All tumours were benign and there was no evidence of metastasis. The mean grip strength was 45% (range, 30–70%) of the contralateral side. All patients achieved normal range of motion of the metacarpophalangeal and interphalangeal joints, but 4 patients had an extensor lag of the thumb. The mean time to wrist fusion was 6 (range, 4–8) months: 3 to 4 months for the 6 patients with bone grafting and 5 to 6 months for the 4 patients without bone grafting who developed painful subluxation necessitating total wrist arthrodesis using a plate and morcellised bone grafts.

Conclusion.

Wrist fusion through centralisation of the ulna for recurrent GCT of the distal radius is a viable option, despite a loss of wrist motion.
Cage Subsidence after Anterior Cervical Discectomy and Fusion Using a Cage Alone or Combined with Anterior Plate Fixation
Authors: Pinder Elizabeth M , Sharp David J
Published: October 2016

Purpose.

To compare the extent of cage subsidence after anterior cervical discectomy and fusion (ACDF) using a cage alone or combined with anterior plate fixation, and to assess the effect of end plate removal on cage subsidence.

Methods.

Records of 23 men and 13 women aged 32 to 82 (mean, 54) years who underwent ACDF for 61 levels using the Solis cage alone (n=46) or combined with anterior plate fixation (n=15) were reviewed. The extent of cage subsidence was determined by comparing immediately postoperative (within one week) with final follow-up radiographs. Cage subsidence was defined as the sum subsidence of the superior and inferior part of the cage into the vertebral body. Mild and major cage subsidence was defined as ≤2 mm and >2 mm, respectively.

Results.

Patients who underwent ACDF using a cage alone or combined with anterior plate fixation were comparable in terms of age, gender, follow-up duration, and number of levels decompressed. Cage subsidence occurred in 33 (54%) of the 61 levels decompressed. In the cage alone group, the extent of cage subsidence was greater (1.68 vs. 0.57 mm, p=0.039) and the rate of major cage subsidence was higher (28% vs. 7%, p=0.08). The inferior part of the cage was more vulnerable to subsidence compared with the superior part (median subsidence: 3.0 vs. 1.4 mm, p<0.0001). Cage subsidence occurred more often when the end plate was removed rather than preserved (58% vs. 18%, p<0.002).

Conclusion.

The extent of cage subsidence was greater after ACDF with cage alone. Cage subsidence occurred more often when the end plate was removed. Additional anterior plate fixation is recommended when the end plate is removed.
Expression of Inflammation/Pain-Related Genes in the Dorsal Root Ganglion following Disc Puncture in Rats
Authors: Fujioka Yuki , Stahlberg Anders , Ochi Mitsuo , Olmarker Kjell
Published: October 2016

Purpose.

To determine the expression of inflammation- and pain-related genes at days 1 and 3 in the dorsal root ganglion (DRG) of rats with or without disc puncture, using real-time quantitative polymerase chain reaction (RT-qPCR) with the TaqMan low-density array (TLDA).

Methods.

53 female Sprague-Dawley rats were used. The left facet joint between L4 and L5 was removed, and the DRG and intervertebral disc between the vertebrae were exposed. The L4–5 intervertebral disc was punctured using a 0.4-mm diameter injection needle (disc puncture group) or left unpunctured (sham group). After one or 3 days, the 53 DRGs were harvested, frozen, and assessed for expression of inflammation-related genes. Total RNA was isolated from the DRGs. Expression of 119 genes related to inflammation and pain in the DRG after disc puncture were analysed using RT-qPCR with the TLDA.

Results.

Of the 95 inflammation-related genes, 78 genes were reliably detected. Two genes were significantly up-regulated: cysteinyl leukotriene receptor 1 (CYSLTR1) at day 3 and interleukin 2 receptor gamma (IL2RG) at day 1, and one gene was significantly down-regulated: phospholipase C beta 3 (PLCB3) at day 1. Of the 24 pain-related genes, 18 genes were reliably detected. Two genes were significantly up-regulated: nitric oxide synthase 1 (NOS1) at days 1 and 3 and 5-HT2A receptor (HTR2A) at day 1.

Conclusion.

Disc puncture may elicit changes in the expression of a variety of genes. Gene expression profiling is a useful tool for detecting new potential pharmaceutical targets for spinal pain syndromes.
Osteochondromatosis and Osteochondroma Involving Bilateral Patella and Patellar Tendon: A Case Report
Authors: Pandian Sankaralingam , Jayaraman Thiyageswaran , Rajendiran Chakravarthy
Published: October 2016

We present a 22-year-old man with osteochondromatosis and osteochondroma involving bilateral patella and patellar tendon with restriction of joint movement and severe arthritis.
Osteosarcoma of the Talus Misdiagnosed as Ankle Arthritis: A Case Report
Authors: Salunke Abhijeet Ashok , Chen Yongsheng , Tan Junhao , Chen Xi , Pearce Christopher , Puhaindran Mark
Published: October 2016

We present a 65-year-old man with osteosarcoma of the talus that was misdiagnosed as osteoarthritis. The patient eventually underwent below-knee amputation and adjuvant chemotherapy.
Subjective Listening Effort and Electrodermal Activity in Listening Situations with Reverberation and Noise
Authors: Holube Inga , Haeder Kristina , Imbery Christina , Weber Reinhard
Published: October 2016

Disturbing factors like reverberation or ambient noise can impair speech recognition and raise the listening effort needed for successful communication in daily life. Situations with high listening effort are thought to result in increased stress for the listener. The aim of this study was to explore possible measures to determine listening effort in situations with varying background noise and reverberation. For this purpose, subjective ratings of listening effort, speech recognition, and stress level, together with the electrodermal activity as a measure of the autonomic stress reaction, were investigated. It was expected that the electrodermal activity would show different stress levels in different acoustic situations and might serve as an alternative to subjective ratings. Ten young normal-hearing and 17 elderly hearing-impaired subjects listened to sentences from the Oldenburg sentence test either with stationary background noise or with reverberation. Four listening situations were generated, an easy and a hard one for each of the two disturbing factors, which were related to each other by the Speech Transmission Index. The easy situation resulted in 100% and the hard situation resulted in 30 to 80% speech recognition. The results of the subjective ratings showed significant differences between the easy and the hard listening situations in both subject groups. Two methods of analyzing the electrodermal activity values revealed similar, but nonsignificant trends. Significant correlations between subjective ratings and physiological electrodermal activity data were observed for normal-hearing subjects in the noise situation.
2016 Roger A. Mann Award - Comparison of All-Inside Arthroscopic and Open Techniques in Treatment for Chronic Lateral Ankle Instability
Authors: Lee Young Koo , Yeo Eui Dong , Lee Kyung Tae , Lee Sun Geon
Published: October 2016

Category:

Sports.

Introduction/Purpose:

The modified Broström operation (MBO) is frequently used to treat chronic lateral ankle instability. The open MBO is currently the gold standard procedure for treatment of chronic lateral ankle instability. The all-inside arthroscopic MBO has been developed for chronic lateral ankle instability. Clinical outcome of all-inside arthroscopic MBO was reported as good or excellent. Biomechanically, the stiffness, torque to failure, and degree to failure of all-inside arthroscopic MBO and open MBO have the same results. But there were no report about comparison of clinical outcome between all-inside arthroscopic MBO and open MBO for chronic lateral ankle instability. The purpose of this study is to compare the clinical outcomes of the all- inside arthroscopic MBO and open MBO for chronic lateral ankle instability.

Methods:

From September 2013 to August 2014, MBO was performed in 87 patients. Of these, 50 consecutive patients were included in terms of inclusion criteria. All patients had giving way, persistent pain and an inability to resume one’s preinjury activity level for more than 6 months. Patients were randomized into 2 groups: all-inside arthroscopic MBO and open MBO using permuted block randomization method. Evaluation was performed preoperatively, at 6 weeks and 6 months postoperatively, and at a final follow-up a minimum of 12 months postoperatively using the Karlsson score, the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score, pain Visual Analogue Scale (VAS), anterior talar translation, and talar tilt angle.

Results:

After randomization, 25 ankles were allocated in the all-inside arthroscopic MBO group, and 25 ankles were placed in the open MBO group. Two ankles in the open MBO group were excluded from analysis due to loss of follow-up. Therefore the evaluation was performed for 25 ankles in the all-inside arthroscopic MBO group and 23 ankles in the open MBO group. There were no differences in age, sex, symptom duration, preoperative Karlsson, AOFAS, and VAS scores between the 2 groups (P >.05). At final follow-up, the Karlsson, AOFAS, and VAS scores were significantly improved in both groups (P < .001). There were no differences in the Karlsson, AOFAS, VAS scores, anterior talar translation and talar tilt angle between the 2 groups at final follow-up (P >.05).

Conclusion:

There was no difference in the clinical evaluation and radiologic evaluation between all-inside arthroscopic MBO group and open MBO group at a minimum 12 months follow-up. All-inside arthroscopic MBO should be carefully considered as a reasonable alternative method in patients who have chronic lateral ankle instability.
Wound Complications Following 760 Total Ankle Replacements
Authors: Gross Christopher E. , Hamid Kamran S. , Green Cynthia , Adams Samuel B. , DeOrio James K. , Easley Mark E. , Nunley James A.
Published: October 2016

Category:

Ankle Arthritis.

Introduction/Purpose:

Wound complications following total ankle replacement (TAR) potentially lead to devastating consequences. The aim of this study is to compare the surgical and demographic differences in those with and without wounds which require operative management. We hypothesize that increased tourniquet and surgical time negatively influences wound healing.

Methods:

We retrospectively identified a consecutive series of 760 primary TARs performed between January 1998 and December 2014 whose data was prospectively collected. We then identified patients who required a secondary surgery to treat wound complications (ie operative debridement, split-thickness skin grafting, soft tissue reconstruction). All patients had operative wound debridement. We then compared demographics, surgical characteristics, and functional scores to see if there were any differences between the two groups. Clinical outcomes including secondary procedures and implant failure rate were recorded.

Results:

Twenty-seven patients (3.6%) had a total of 50 procedures to treat wound issues. 18 patients had flaps and 13 had split- thickness skin grafts. The mean time to operatively treating the wound was 12.6 weeks after the index TAR. The follow-up time from wound procedure was 28 months. Compared to the control group, patients with major wounds had a significantly longer surgery (215.6 vs. 189.2 min, p=.028) and tourniquet time (150.9 vs. 140 min, p=.0037). The control patients were more likely to have post-traumatic arthritis, whereas those with wound complications were more likely to have osteoarthritis (p=.002). Post- operatively, only the FAOS pain score was worse in patients with wounds (p=.047). There were seven failures in the major wound complication cohort (25.9%), including 2 BKAs.

Conclusion:

Ankle wounds which require operative management have high failure rates and may result in devastating outcomes. Given our data, we recommend limiting tourniquet time.
Effect of First Metatarsophalangeal Joint Arthrodesis on PROMIS Functional Outcomes and Radiographic Alignment for Hallux Rigidus
Authors: Dekker Robert G. , Alshouli Mohammed , Alvarez Andrew P. , Kadakia Anish R.
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Improvement in first ray alignment after arthrodesis of the arthritic first metatarsophalangeal (MTP) joint has been shown, yet few studies have attempted to correlate radiographic alignment with functional outcomes. The purpose of this study was to determine if 1st MTP joint deformity due to hallux rigidus correlates with patient reported pain and function, and whether there is a correlation between outcomes and radiographic measurements made before and after surgery. We also sought to determine how 1st MTP joint arthrodesis affects patient reported pain and function in a series of patients with hallux rigidus using a validated outcome measure.

Methods:

We conducted a retrospective study on patients treated with 1st MTP joint arthrodesis for diagnosis of hallux rigidus from 2012 to 2014 using a single surgical technique. The hallux-valgus angle (HVA), intermetatarsal angle (1-2 IMA) and lateral talar first metatarsal angle (L1TMTA) were measured independently by the senior author and an Orthopaedic Surgery fellow on pre- and post-operative radiographs. Inter-observer and intra-observer coefficients of repeatability were calculated. Pre- and post- operative physical function and pain scores were generated using the Patient Reported Outcome Measurement Information System (PROMIS). Paired t-test was used to detect differences. Bivariate analysis was used to assess radiographic measurement and PROMIS score correlation.

Results:

30 subjects met inclusion criteria for radiographic analysis. Mean pre- and post-operative IMA, HVA and LT1MTA are shown in Table I. 23 subjects had pre-operative PROMIS data. Mean pre-operative pain and function were 72.7 and 32.0. Only pre-operative HVA significantly correlated with pre-operative physical function scores, with Pearson correlation value of 0.507 (p = 0.014). 7 subjects had pre- and post-fusion PROMIS data with average follow up 173 days post-fusion (minimum 130, maximum 196). Mean change in pain and function were -9.14 (p = 0.094) and 6.57 (p = 0.31), respectively. Only change in patient reported pain significantly correlated with change in HVA, with a Pearson correlation value of -0.76 (p = 0.05). Interclass correlation coeffecients for interoperator reliability ranged from 0.835 to 0.998.

Conclusion:

1st MTP joint arthrodesis significantly improved radiographic IMA, HVA and LT1MTA for patients with hallux rigidus. In a small series of patients, arthrodesis improved patient reported pain and function, but this was not significant. Only pre-operative HVA correlated with pre-operative physical function, while only change in HVA correlated with change in patient reported pain after arthrodesis. Special attention should be paid to the HVA for the patient undergoing 1st MTP arthrodesis for hallux rigidus.
Partial Calcanectomy for Heel Ulcers Revisited – a Possible Solution to a Difficult Problem
Authors: Gellman Yechiel N. , Leibner Efraim D. , Haze Amir , Khaimov Nissim , London Eli , Elishoov Ofer
Published: October 2016

Category:

Diabetes

Introduction/Purpose:

Diabetic heel ulcers are a major problem, often leading to amputations. Partial or total calcanectomy has been described as a possible salvage procedure, by allowing soft tissue coverage after debridement of necrotic and infected tissue, and possibly allowing walking. We report on our experience with this technique which is not commonly used

Methods:

Fourteen patients, who presented with diabetic heel ulcers between 2010-15, and who were BKA candidates, underwent debridement and partial calcanectomy. Average age was 67.8 ±12.7 years, M:F ratio was 6:1 Extent of procedures, need for additional procedures and complications were noted. Outcome assessment included wound closure and walking status. No patients were lost to follow up.

Results:

Nine patients underwent partial calcanectomy as the initial procedure while others underwent prior debridement. Calcanectomies were subtotal (1), wedge (5) or partial (8). Primary closure was mostly achieved (11), the remainder requiring local skin graft (2) or myocutaneous flap (1). Ten patients underwent re-vascularization prior to calcanectomy, either angiographic (8) or bypass (2). Most calcanectomies (9/14) healed successfully, while five subsequently required amputations. Most failures were noticed within 24 days, with similar prevalence in wedge and partial calcanectomies. One patient had wound complications requiring BKA. At one year, the nine patients had full wound closure and could bear weight. Five patients regained full ambulatory status wearing specially modified shoes with custom fillers.

Conclusion:

Partial calcanectomy is a little-known procedure, that is a viable alternative to BKA. We present our positive experience with this procedure, which in a majority of cases not only prevented BKA, but also allowed weight bearing. Poor vascular supply is not necessarily a contraindication, as re-vascularization prior to calcanectomy is a viable option.
Hyaluronic Acid Dressing in the Treatment of Diabetic Foot Ulcer
Authors: Hwang Yeokgu , Park Yoo Jung , Shim Dong-Woo , Lee Moses , Park Kwang Hwan , Suh Jae Wan , Han Seung Hwan , Choi Woo Jin , Lee Jin Woo
Published: October 2016

Category:

Diabetes

Introduction/Purpose:

Fast and complete healing of a diabetic foot ulcer (DFU) is challenging due to the hostile wound healing environment of the diabetic patients. As a part of a multimodal treatment approach, advanced dressing material using hyaluronic acid (HA) has been found to be effective. However, previous studies have used HA with additional biologics, which interferes in determining the true clinical effect of HA in DFU. The purpose of this study is to examine the effectiveness and safety of a new HA dressing material in the treatment of DFU.

Methods:

This study was a prospective, randomized, placebo-controlled, single-center study conducted between September 2012 and January 2014. The inclusion criteria were type 1 or 2 diabetes, a ulcer size ≥ 1.0 cm2 that did not exhibit signs of healing for 6 weeks, Wagner grade 1 or 2, and palpable pulses at the ankle. The assessments of DFU included size, microbial culture study, detailed description of the DFU, and clinical photos. Patients in the study group were treated with an HA dressing material (hyaluronic acid 80 ± 5% and poloxamer 10 ± 5%), while patients in the control group were treated with a conventional moisture- retentive dressing (petrolatum gauze). Weekly follow-up was conducted with the dressing change up to maximum 12 weeks. Complete ulcer healing rate was evaluated as a primary endpoint. Additionally, healing velocity and the mean duration for achieving a 50% ulcer size reduction was compared between the two groups as a secondary endpoint.

Results:

Twenty-five patients were included in the final analysis (study group: 13, control group: 12). There were no significant differences between two groups regarding demographic factors and baseline DFU characteristics. The study group presented a significantly higher complete healing rate as compared to that in the control group [84.6% (11/13), 41.6% (5/12), respectively, P = 0.041]. Faster ulcer healing velocity and shorter mean duration for achieving a 50% ulcer size reduction were observed in the study group (P = 0.022, P = 0.004, respectively). The Kaplan-Meier analysis for the median time for 50% ulcer healing rate also showed a significantly shorter duration in the study group (21 days vs 39 days, P = 0.012). There were no adverse events related to the dressing materials.

Conclusion:

This study supports that a HA dressing without additional substances may offer a safe and effective treatment for DFU.
Outcomes of Iliac Crest Bone Marrow Aspirate Injection for the Treatment of Recalcitrant Non- Insertional Achilles Tendinitis
Authors: Talusan Paul G. , Dein Eric J. , Tan Eric W. , Zahoor Talal A. , Friedman Guy , Schon Lew C.
Published: October 2016

Category:

Sports

Introduction/Purpose:

Non-insertional Achilles tendinitis is a common cause of posterior ankle and heel pain in active and sedentary patients. Though the majority of patients respond to first-line non-operative management including activity modification, immobilization, orthotics, and physical therapy with tendon stretching, there is no consensus for patients that fail these treatments. We evaluate the role of iliac crest bone marrow aspirate concentrate (BMAC) as a safe and effective treatment option for recalcitrant cases.

Methods:

A retrospective chart review was conducted of patients with greater than 12 months of non-insertional Achilles tendinitis symptoms despite appropriate conservative treatment. Each patient had BMA harvested from the iliac crest, concentrated by centrifugation, and then injected into the Achilles tendon. Symptoms were assessed using the Visual Analogue Scale (VAS) pain score, collected at the preoperative office visit and at 6 weeks, 12 weeks, and 24 weeks after the procedure. Co- morbidities, concurrent procedures, and complications were also recorded.

Results:

A total of 21 patients (22 feet) were treated with iliac crest BMA concentrate injections. Preoperatively, the average VAS pain score was 6.8 (SD 2.0). Postoperatively, the average VAS was 4.0 (SD 2.5) at 6 weeks, 2.7 (SD 2.1) at 12 weeks, and 2.2 (SD 2.1) at 24 weeks. At 24 weeks postoperatively, there was a statistically significant decrease VAS score from baseline (p < 0.001), with a mean decrease by 4.6 (SD 3.1). There were no adverse effects reported at the surgical site or donor site morbidity at the iliac crest such as wound infection, hematoma, or persistent pain.

Conclusion:

Iliac crest BMAC appears to be a safe, effective, and potentially lasting treatment option for patients with intractable, non-insertional Achilles tendinitis. Patients demonstrated a statistically significant decrease in VAS pain score postoperatively with no complications at the donor or injection site.