bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Bony Union following Surgical Stabilisation for Lumbar Spondylolysis: A Comparative Study between Radiography and Computed Tomography
Authors: Pai VS , Hodgson B
Published: October 2016

Purpose.

To compare the status of bony union seen on plain radiography versus computed tomography (CT) following tension band repair for refractory spondylolysis.

Methods.

14 patients (12 men and 2 women; mean age, 23 years; age range, 16–56 years) with a mean follow-up period of 6.35 years were included. All patients were operated on by one senior surgeon using either a Scott procedure (n=2) or van Dam modification of the Scott procedure (n=12). Bony union of the pars was assessed using both plain radiography (anteroposterior, lateral, and oblique views) and reverse gantry CT. The presence of bony union was determined if a bridging bone was shown in the images. The Oswestry Disability Index was measured at 6-year follow-up.

Results.

13 (93%) of 14 patients showed bony union on plain/oblique radiographs versus 7 (50%) on CT scan. The mean Oswestry Disability Index was 28 (good to excellent). The high incidence of nonunion shown on CT scanning did not correlate well with clinical results.

Conclusion.

Bony nonunion is more difficult to visualise on plain radiographs than reverse gantry CT. CT demonstrates more clearly the presence or absence of the bridging bone. Clinical results do not correlate with bony union, indicating that bony union is not required to achieve good results.
Basal Thumb Metacarpal Osteotomy for Trapeziometacarpal Osteoarthritis
Authors: Gwynne-Jones DP , Penny ID , Sewell SA , Hughes TH
Published: October 2016

Purpose.

To review the subjective and functional results of basal thumb metacarpal osteotomy for the treatment of trapeziometacarpal osteoarthritis.

Methods.

Between July 1993 and November 1998, 35 thumb osteotomies without internal fixation were performed on 33 patients in the Christchurch Hospital, New Zealand. Records of 28 thumbs (13 right and 15 left) of 26 patients (17 women and 9 men) were available for review. Patients were reviewed using strength testing and the Michigan Hand Outcomes Questionnaire.

Results.

The mean age of the 26 patients was 54 years (range, 30–69 years). Of the 28 thumbs, 22 (21 patients) had good or excellent results, 2 fair, one poor. The remaining 3 thumbs (3 patients) required further revision and were classified as failures. The mean follow-up period of the 25 thumbs (24 patients) not requiring revision was 34 months (range, 12–73 months). Good thumb motion was present in all hands with no trapeziometacarpal instability seen. Compared with the normative data, the strengths of key pinch, pulp pinch, and tripod pinch of our patients were significantly lower (22–32% lower), but not the grip strength. Michigan Hand Outcomes Questionnaire scores increased 28 (range, 1–56) points after surgery, with significant improvement especially in pain (+44 points), activities of daily living (one-handed tasks, +41 points), and satisfaction (+35 points).

Conclusion.

Basal thumb metacarpal osteotomy is a straightforward, conservative procedure that should be considered for grades II and III trapeziometacarpal osteoarthritis.
An Unusual Presentation of Eosinophilic Granuloma in an Adult: A Case Report
Authors: Garg B , Sharma V , Eachempati KK , Malhotra R , Bhan S
Published: October 2016

Eosinophilic granuloma is the most common and benign form of a rare proliferative disorder—Langerhans' cell histiocytosis. Spinal involvement is rare and only 15 adult cases have been reported. We present an unusual variant of eosinophilic granuloma in a 25-year-old woman with radiological evidence of vertebra plana. Plain radiography, magnetic resonance imaging, bone scan, and blood tests were carried out, and a specimen was taken from L4 using computed tomography–guided biopsy. Gram staining, acid fast bacillus smear, bacterial and fungal cultures were negative. Histological examination of the biopsy showed features of eosinophilic granuloma with aggregates of Langerhans histiocytes. The patient was treated with low-grade radiotherapy at 150 cGy per day for 7 days. She was asymptomatic at one-year follow-up although the radiological picture was unchanged.
Nicolau Syndrome following Intramuscular Diclofenac Administration: A Case Report
Authors: Lie C , Leung F , Chow SP
Published: October 2016

Nicolau syndrome (livedoid dermatitis) is a rare adverse reaction of a still largely unidentified pathogenesis at the site of intramuscular drug injection. The typical presentation is pain around the injection site soon after injection, followed by erythema, livedoid patch, haemorrhagic patch, and finally necrosis of skin, subcutaneous fat, and muscle tissue. The phenomenon has been related to the administration of a variety of drugs, including non-steroidal anti-inflammatory drugs, corticosteroids, and penicillin. We report a case of Nicolau syndrome following an intramuscular injection of diclofenac. The large ulceration over the right buttock was positive for Pseudomonas aeruginosa, and histology revealed subcutaneous fat necrosis and non-specific inflammation with no evidence of malignancy or vasculitis. The lesion required multiple debridements and a partial-thickness skin graft. Subcutaneous injection, rather than intramuscular injection, was found to be a determining factor in this case. Clinicians must be cautious in the use of proper injection procedures, including appropriate needle length, in order to minimise complications.
Effectiveness of Autologous Fibrin Tissue Adhesive in Reducing Postoperative Blood Loss during Total Hip Arthroplasty: A Prospective Randomised Study of 100 Cases
Authors: Mawatari M , Higo T , Tsutsumi Y , Shigematsu M , Hotokebuchi T
Published: October 2016

Purpose.

To evaluate the effectiveness of autologous fibrin tissue adhesive (auto-FTA) in reducing blood loss during cementless total hip arthroplasty (THA).

Methods.

From September 2000 to August 2001, 100 patients who predonated 400 ml of autologous blood were randomised to undergo either standard treatment with auto-FTA (auto-FTA group) or standard treatment alone (control group). The volume of postoperative blood loss and the decrease in haemoglobin level were measured. All patients were followed up for 3 years to evaluate the rate of bone ingrowth and heterotopic ossification.

Results.

The mean postoperative blood loss was 580 ml (standard deviation [SD], 240 ml) in the auto-FTA group and 810 ml (SD, 341 ml) in the control group; the difference was significant (230 ml, p<0.001). The decrease in haemoglobin concentration was 17 g/l (SD, 11 g/l) in the auto-FTA group and 22 g/l (SD, 12 g/l) in the control group. The difference was significant (5 g/l, p=0.03). The percentage of total blood loss of >1200 ml in any single patient was significantly lower in the auto-FTA group (4%) than in the control group (20%) [p=0.01].

Conclusion.

Auto-FTA is a safe and effective means of reducing perioperative blood loss in THA.
Variant of a Lumbar Disc Cyst in a 13-Year-Old Girl: A Case Report
Authors: Kishen TJ , Shetty AP , Rajasekaran S
Published: October 2016

A disc cyst is a rare entity with a clinical presentation that closely mimics an intervertebral disc herniation. Disc cysts are ventrally located, intraspinal, extradural cystic lesions that communicate with the parent intervertebral disc through a ruptured annulus. We present the clinical features, magnetic resonance imaging, intra-operative and histopathological findings of a variant of a lumbar intervertebral disc cyst in a 13-year-old girl who presented with a 6-month history of unilateral radiculopathy following an injury. Magnetic resonance imaging revealed a large posterocentral, fluid-filled cyst occupying the L5-S1 interspace and bulging into the spinal canal. The cyst was confined within an intact bulging annulus fibrosis and extended directly from the parent disc. The cyst was surgically decompressed, resulting in complete symptomatic relief.
Congenital Lumbosacral Limb Duplication: A Case Report
Authors: Zhao L , Li MQ , Sun XT , Ma ZS , Guo G , Huang YT
Published: October 2016

We report a case of congenital lumbosacral limb duplication at the pelvis, lower limb, and foot of a 4-year-old boy. The patient presented with a supernumerary lower limb joined at the lumbosacral region by a bony connection. A pseudo-navel and a pseudo-penis were found on the supernumerary limb and foot duplication was noted at the end. Radiography and a 3-dimensional computed-tomography reconstruction revealed duplication of an inversely oriented pelvis dorsal to the normal pelvis, semivertebrae in T7 to T9, thoracolumbar scoliosis, lumbosacral vertebral dysplasia, and dislocation of the left hip. Magnetic resonance imaging demonstrated a tethered spinal cord and an adipoma in the sacral canal. Motor conduction velocity was reduced in the left peroneal nerve. Surgery to remove the supernumerary limb was successfully performed. The patient recovered well and further surgery is planned for functional reconstruction of the left lower limb.
Chronic Posterior Dislocation of the Glenohumeral Joint Complicated by a Fractured Proximal Humerus: A Case Report
Authors: Takase K , Watanabe A , Yamamoto K
Published: October 2016

A 41-year-old right-handed woman was involved in a traffic accident and landed on the right arm while the right shoulder was in flexion. She experienced pain and severe impairment of right shoulder motion immediately following the accident. She was misdiagnosed with a fractured proximal humerus with no displacement and was treated conservatively by immobilisation. There was inadequate recovery in range of motion and gradual development of severe pain. Two years and 4 months after the injury, the patient presented to our hospital where a diagnosis of chronic posterior fracture dislocation of the shoulder with split articular surface of the humeral head was made. A humeral head replacement without resection of the greater tuberosity or the coracoid process was performed. Postoperative recovery was uneventful. The patient returned to work as a cook one year later. At 20-month follow-up, the patient had no pain, and her shoulder range of motion was forward flexion 160 degrees, abduction 140 degrees, external rotation 40 degrees, and internal rotation L3.
Osteonecrosis of the Medial Tibial Plateau: A Case Report
Authors: Schindler OS , Misra R , Spalding TJW
Published: October 2016

Medial tibial plateau osteonecrosis is a disease that lacks distinguishing signs and symptoms, especially in the early stage, and requires clinicians to exercise a high degree of suspicion to prevent disease progression. We present a case of spontaneous osteonecrosis of the medial tibial plateau in a 59-year-old woman. Within 5 months of the onset of symptoms, the entire medial tibial plateau collapsed down into the metaphyseal region, causing severe varus deformity, instability, and inability to walk without crutches and a hinged knee brace. Initial symptoms of medial joint line pain and generalised swelling of the knee were attributed to early degenerative changes. Subsequent radiographs were misinterpreted as simple medial compartment arthritis. Due to severe bone loss and significant lateral collateral ligament attenuation, a total joint arthroplasty was required, using a stemmed tibial component with medial metal block and bone graft augmentation. The speed of bone collapse and the extension into the metaphysis, requiring complex joint arthroplasty, makes this case unique.
Severe Scoliosis Associated with Costello Syndrome: A Case Report
Authors: Motosuneya T , Asazuma T , Tsuji T , Watanabe H , Nakayama Y , Nemoto K
Published: October 2016

Costello syndrome is characterised by dwarfism, unique cutaneous lesions, a distinct facial gestalt, and mental retardation. There have been no detailed reports of severe spinal deformities requiring surgical treatment as a complication of Costello syndrome. We report a case of a 10-year-old girl with progressive scoliosis associated with Costello syndrome. She underwent anterior release and posterior surgical correction and fusion from T5 to L2 using a third generation hook and rod system plus spinous process wiring. Congenital portal vein deficiency and coagulopathy were other major complications. At 15-month follow-up, the patient had good balance and no evidence of instrumentation failure.
Oldie but Goldie: Bristow-Latarjet Procedure for Anterior Shoulder Instability
Authors: Matthes G , Horvath V , Seifert J , Ptok H , Stengel D , Schmucker U , Ekkernkamp A , Hinz P
Published: October 2016

Purpose.

To analyse the functional and radiological outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability.

Methods.

Records of 29 patients were reviewed retrospectively. Date of first dislocation, injury mechanism, and number of recurring dislocations before and after surgery were recorded. The overall function and stability of the shoulder was evaluated.

Results.

24 (83%) of the glenohumeral instabilities were caused by trauma. The mean number of recurring dislocations was 8 (95% confidence interval [CI], 0–18); one patient had had 40 recurrences. No dislocation ensued postoperatively. The overall functional outcome was good, with a mean Rowe score of 90 points (95% CI, 78–100). Scores of 17 (59%) of the patients were excellent, 7 (24%) were good, 3 (10%) were fair, and 2 (7%) were poor.

Conclusion.

The Bristow-Latarjet procedure is a good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint.
Coronal Bowing of the Femur and Tibia in Chinese: Its Incidence and Effects on Total Knee Arthroplasty Planning
Authors: Yau WP , Chiu KY , Tang WM , Ng TP
Published: October 2016

Purposes.

To study the incidence of femoral or tibial bowing in the coronal plane in a Chinese population, and how it affects the accuracy of bone cuts for total knee replacement when an intramedullary alignment system is used.

Methods.

Standing radiographs of the entire lower limb of each patient with end-stage primary osteoarthritis of the knee were analysed. All radiographs were digitised and the extent of bowing in the coronal plane measured. A bowing was marked if an angulation was more than 2 degrees. The projected error of cutting was then calculated.

Results.

Of 93 lower limbs, 58 (62%) of the femurs had marked bowing in the coronal plane; 41 (44%) had a mean lateral bowing of 5.3 (standard deviation [SD], 3.2) degrees; 17 (18%) had a mean medial bowing of 4.4 (SD, 1.9) degrees. Marked tibial bowing in the coronal plane was less common (30 tibias, 32%). If a cutting error of more than 2 degrees was considered unacceptable, significantly more unacceptable cuts would ensue in the groups with marked bowing (p=0.003 for femurs and p<0.001 for tibia, respectively).

Conclusion.

The incidence of femoral or tibial bowing in the coronal plane was high in a Chinese population with end-stage osteoarthritis of the knee. This phenomenon may increase bone cut errors in total knee replacement if an intramedullary alignment system is used and the extent of bowing is not recognised.
Uncemented Primary Press-Fit Total Hip Arthroplasty: A 3 to 6 Years of Experience
Authors: Vidyadhara S , Rao SK
Published: October 2016

Purpose.

To analyse the 3 to 6 years' clinicoradiological outcome of 45 uncemented total hip arthroplasties performed in 37 patients using cementless Spotorno stem and St Nabor cup.

Methods.

The main indications for surgery were avascular necrosis of the femoral head and rheumatoid arthritis. Younger patients with good bone quality and a trumpet-shaped femur were eligible. A single surgeon performed all the operations using a posterolateral approach. Patients were reviewed at 6 weeks, 3 months, 6 months, and yearly thereafter. The clinical status was recorded using the Harris Hip Score. All radiographs were analysed by 2 independent blinded observers on 2 separate occasions.

Results.

The mean follow-up period was 49 months and the mean Harris Hip Score at the latest follow-up was 94. Osseointegration in the form of trabeculae running from the endosteum to the prosthesis surface along with tropism of the calcar was evident in 73% of the hips. None of the remaining hips showed any continuous radio-opaque lines suggestive of a lack of bone ongrowth. Patients with endosteal condensation had better Harris Hip Scores. Intra-operative stability of the implants could fairly predict outcome.

Conclusion.

Initial clinicoradiological results of uncemented total hip arthroplasty are promising in younger patients with good bone quality and a trumpet-shaped femur.
Pigmented Villonodular Synovitis of the Elbow in a 6-Year-Old Girl: A Case Report
Authors: Sekiya H , Ozawa H , Sugimoto N , Kariya Y , Hoshino Y
Published: October 2016

Pigmented villonodular synovitis of the elbow is rare and even rarer in children. We report a case of pigmented villonodular synovitis of the elbow in a 6-year-old girl who underwent total synovectomy after the diagnosis was confirmed by biopsy. The osteochondral defect at the olecranon was filled with calcium phosphate bone paste. Two years after surgery, neither recurrence nor joint degeneration was found.
Delayed Onset of Deep Infection after Total Knee Arthroplasty: Comparison Based on the Infecting Organism
Authors: Joshy S , Gogi N , Thomas B , Mahale A , Singh BK
Published: October 2016

Purpose.

To identify the organisms causing delayed deep infection following primary total knee arthroplasty (TKA) and to compare the differences in outcome based on the infecting organism.

Methods.

Between the period April 1998 and March 2004 inclusive, patients presenting with delayed deep infection following primary TKA and/or those who underwent a salvage procedure (amputation or arthodesis) were retrospectively studied.

Results.

Organisms were isolated in 27 patients; 44% were methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. When the organism was resistant, the mean number of surgical procedures per patient was significantly higher and the proportion of patients with satisfactory outcomes was significantly lower.

Conclusion.

Deep infection with methicillin-resistant S aureus or S epidermidis is increasing. Strict infection control measures must be in place to combat such problems.
Periprosthetic Femoral Fractures Treated with a Modular Distally Cemented Stem
Authors: Zaki SH , Sadiq S , Purbach B , Wroblewski BM
Published: October 2016

Purpose.

To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem.

Methods.

22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery.

Results.

Patients were followed up for a mean of 14 (range, 8–18) years. The mean Harris hip score improved from 29 (range, 5–40) to 78 (range, 56–88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6–14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations.

Conclusion.

Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.
Cement Leakage into the Posterior Spinal Canal during Balloon Kyphoplasty: A Case Report
Authors: Becker S , Meissner J , Tuschel A , Chavanne A , Ogon M
Published: October 2016

We report a case of cement leakage into the posterior spinal canal due to inadvertent pedicle perforation during balloon kyphoplasty. The leakage was corrected immediately without any sequelae. Features seen on radiography and the minimally invasive procedure used for removal are described. The postoperative radiographs of 100 consecutive patients treated with balloon kyphoplasty were subsequently reviewed. Only one patient had a similar leakage but had no neurological complications.
Extensor Digitorum Longus Tenosynovitis Caused by Talar Head Impingement in an Ultramarathon Runner: A Case Report
Authors: Kobayashi H , Sakurai M , Kobayashi T
Published: October 2016

Stenosing tenosynovitis of the extensor digitorum longus tendon is an injury related to ultramarathon running. A 32-year-old male ultramarathon runner developed chronic tenosynovitis of the ankle dorsiflexors. He was diagnosed with extensor digitorum longus tenosynovitis caused by talar head impingement associated with exostosis. He failed to respond to non-operative management and decided to undergo tenosynovectomy of the extensor digitorum longus tendon. The pain was relieved without functional disturbance of the foot and ankle, and the patient returned to running 3 weeks postoperatively. At the 2-year follow-up, he was participating fully in ultramarathons.
The Effectiveness of Capsular Decompression for Internal Fixation of Intracapsular Hip Fractures
Authors: Wong TC , Yeung SH , Ip FK
Published: October 2016

Purpose.

To compare the results of screw fixation plus capsular decompression versus screw fixation alone for managing intracapsular hip fractures.

Methods.

Of 201 patients with intracapsular hip fractures, 99 underwent screw fixation with capsular decompression (capsular decompression group) and 102 underwent screw fixation alone (control group). The incidence and time to development of avascular necrosis of the femoral head, union rate, time to union, and other clinical parameters were compared.

Results.

In patients with displaced fractures, the incidence of avascular necrosis was significantly higher in the control than capsular decompression group, whereas the time to development of this complication was significantly shorter.

Conclusion.

Capsular decompression did not improve the union rate and time to union in undisplaced intracapsular hip fractures, but in displaced fractures it appeared to reduce the incidence and delay the onset of avascular necrosis.
Coracoclavicular Ligament Reconstruction Using a Gracilis Tendon Graft for Acute Type-III Acromioclavicular Dislocation
Authors: Law KY , Yung SH , Ho PY , Chang HT , Chan KM
Published: October 2016

Purpose.

To review the functional and radiological results of patients after coracoclavicular ligament reconstruction.

Methods.

Five patients aged 21 to 50 (mean, 37) years with acute Rockwood type-III acromioclavicular dislocation underwent coracoclavicular ligament reconstruction with autogenous gracilis tendon grafts. Patients were either active in sports or heavy manual workers. Assessments on shoulder function (using the Constant score), wound size, pain (using a visual analogue scale), and reduction (using radiographs of both acromioclavicular joints) were made.

Results.

The mean follow-up period was 26 (range, 15–43) months; the mean time to return to work or sports was 14 (range, 12–20) weeks. The mean Constant score was 94 (range, 90–98). The mean donor-site scar size was 3 cm and the mean pain score was 0. No major complication or donor-site morbidity was noted. There was one subluxation.

Conclusion.

Coracoclavicular ligament reconstruction using an autogenous gracilis tendon graft was safe in physically active patients having acute type-III acromioclavicular dislocation.
Intramedullary Fixation Using Multiple Kirschner Wires for Forearm Fractures: A Developing Country Perspective
Authors: Abalo A , Dossim A , Assiobo A , Walla A , Ouderaogo A
Published: October 2016

Purpose.

To evaluate treatment results of intramedullary fixation using multiple Kirschner wires for diaphyseal forearm fractures.

Methods.

Between January 2001 and January 2004, 184 patients (122 men and 62 women) with 288 displaced diaphyseal forearm fractures underwent intramedullary fixation using multiple Kirschner wires. The wires were inserted by opening the fracture site because radiographic facility for closed pinning was unavailable. The time to union, functional recovery, and the complication rates were assessed.

Results.

11 patients were lost to follow-up, leaving 173 whose data was analysed. In 167 (97%) of the patients the fractures united, and in 14 (8%) of them union was delayed. The mean time to union for closed fractures was 13 (range, 7–16) weeks and for open fractures it was 15 (range, 12–22) weeks. The mean time in cast was 6 (range, 3–14) weeks. In all, 34/173 (20%) had complications: superficial infection (n=13), deep infection (n=4), cross-union between bones (n=4), open fracture ‘needing’ a skin graft (n=2), radial nerve palsy (n=3), paraesthesia (n=1), and non-union (n=7). Among the 173 analysed patients, the infection rate was 10% and the non-union rate was 4%. 130 (75%) of the patients had the wires removed; no re-fracture occurred after wire removal. Based on the Anderson criteria, 47 (27%) of the patients attained excellent, 78 (45%) satisfactory, and 39 (23%) unsatisfactory results. In 9 (5%) of the patients, union failed (7 plain non-union and 2 due to chronic osteomyelitis).

Conclusion.

Kirschner wires are much cheaper than plates and screws, and require minimal expertise for insertion and removal. They remain acceptable for stabilising displaced diaphyseal forearm fractures in developing countries.
Combined Pelvic Osteotomy for Deformed Dysplastic Acetabula: A 5-Year Prospective Study
Authors: Rejholec M
Published: October 2016

Purpose.

To assess clinical and radiological results of combined pelvic osteotomy (CPO) for deformed dysplastic acetabula.

Methods.

Nine girls and 3 boys, aged 28 to 54 months, underwent CPO (combination of innominate osteotomy and Lance acetabuloplasty) to restore both the original shape and the mal-alignment of the acetabulum. They were followed up for at least 5 years.

Results.

All patients attained concentric stable reduction with good acetabular cover.

Conclusion.

CPO corrected both deformed and dysplastic acetabula and prevented postoperative subluxation.
Anodyne Therapy for Recalcitrant Diabetic Foot Ulcers: A Report of Four Cases
Authors: Nather A , Sim YE , Chew LLJ , Neo SH
Published: October 2016

Four patients with diabetic foot ulcers that failed to heal after one month of treatment underwent anodyne therapy. Each therapy session lasted half an hour and was conducted 3 times a week for patients at home or daily for patients in hospital, for one to 2 months. The wound sizes and depths were graded according to the Wagner classification. Pictures were taken to evaluate the effects of anodyne therapy. All 4 patients had good healing of their foot ulcers. Anodyne therapy augments the effects of conservative treatment. Proper wound care and appropriate antibiotic coverage remain the basis of treatment.
Comparative Biomechanical Study of Cervical Spine Stabilisation by Cage Alone, Cage with Plate, or Plate-Cage: A Porcine Model
Authors: Hakalo J , Pezowicz C , Wronski J , Bedzinski R , Kasprowicz M
Published: October 2016

Purpose.

To compare stability and subsidence associated with 3 types of cervical spine stabilisation.

Methods.

The C3 to C4 vertebrae of 28 Polish pigs were used. Pigs with intact vertebrae (group 1) underwent standard anterior cervical discectomy (group 2), followed by stabilisation using a cage alone (group 3), a cage with plate (group 4), or a plate-cage (group 5). Cervical spine stability and subsidence were compared in all 5 groups.

Results.

Stability was significantly increased after stabilisation by a cage with plate or a plate-cage, but not by a cage alone. The difference between stabilisation by a cage with plate and a plate-cage was not significant. Subsidence was maximal after the cage-alone stabilisation (3.1 mm), being 1.6 mm after the cage-with-plate and plate-cage stabilisations.

Conclusion.

Additional plating as a supplement to anterior interbody cervical cage stabilisation significantly improves segmental stability and subsidence.
Association of Intra-Operative Metaphyseal Fractures with Prosthesis Size during Hemiarthroplasty of the Hip
Authors: Barlas KJ , Ajmi QS , Bagga TK , Howell FR , Roberts JA , Eltayeb M
Published: October 2016

Purpose.

To study the possible causes of intra-operative metaphyseal fractures in elderly patients undergoing hemiarthroplasty for displaced intracapsular femoral neck fracture.

Methods.

36 men and 228 women aged 61 to 89 years with 273 displaced femoral neck fractures underwent hemiarthroplasty using a hydroxyapatite ceramic–coated Furlong bipolar prosthesis. Anteroposterior and lateral radiographs were taken immediately after surgery to evaluate the presence and type of any intra-operative fractures (classified according to the Vancouver system) and their effect on stem stability or osseointegration. Pain and clinical outcomes were evaluated using a visual analogue scale and the Harris Hip Score.

Results.

Regarding the 273 surgeries for displaced femoral neck fracture, 28 (10%) were associated with intra-operative metaphyseal fracture (21 Vancouver type AL and 7 type AG). There was a correlation between intra-operative metaphyseal fractures and stem size. A size-9 stem was used in 64 surgeries without any fracture. A size-10 stem was used in 129 surgeries in which 11 (9%) sustained fractures, and a size-12 stem was used in 80 surgeries in which 17 (21%) sustained fractures. Postoperatively, 25 cases developed hip-related problems (thigh pain=14 and periprosthetic fractures=8) after 3 to 18 months. No patient whose metaphyseal fracture was fixed had hip problems.

Conclusion.

In elderly women with compromised bone quality, extra care is needed to achieve better fitting so as to avoid iatrogenic metaphyseal fractures. Under-sizing or cementing of the prosthesis is recommended when encountering difficulties.
Validation for the Reduced Western Ontario and McMaster Universities Osteoarthritis Index Function Scale
Authors: Whitehouse SL , Crawford RW , Learmonth ID
Published: October 2016

Purpose.

To assess the criterion validity, repeatability, and the missing value protocol of the reduced Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scale (‘reduced scale’).

Methods.

Three separate studies were performed: a cross-over study to compare the full- and reduced-scale scores in 66 UK patients for validity, a test-retest study for repeatability in 103 Australian patients, and a study for the missing value protocol of the reduced-scale questionnaire.

Results.

There was no significant difference between scores for the full- and reduced-scale questionnaires in both cross-over and test-retest studies. For the missing value protocol of the reduced-scale questionnaire, when 3 or more of the 7 items were missing, the patient's response was regarded as invalid and the sub-scale score was eliminated from further analysis; when 2 or fewer items were missing, the mean value of the sub-scale was substituted for the missing values.

Conclusions.

The reduced-scale questionnaire retains excellent validity and repeatability. Its use is recommended along with the original pain dimension in studies of total joint replacement.
Twenty-Year Survival of a Cementless Revision Hip Arthroplasty Using a Press-Fit Bulk Acetabular Allograft for Pelvic Discontinuity: A Case Report
Authors: Gul R , Jeer PJS , Oakeshott RD
Published: October 2016

Acetabular revision in a total hip arthroplasty (THA) with pelvic discontinuity is uncommon and challenging. Optimal management remains controversial, particularly with graft and implant selection. Interpretation of outcomes is confounded by the heterogeneity of patterns of bone loss and the lack of long-term results in great numbers for any given choice of treatment. We report a revision THA using a press-fit bulk acetabular allograft and an uncemented porous-coated anatomic prosthesis for the management of pelvic discontinuity. After 20 years, the patient still had an excellent functional outcome with radiographic evidence of graft incorporation and no signs of loosening.
An Intramedullary Alignment Guide Lodging within the Femoral Canal during Total Knee Arthroplasty: A Case Report
Authors: Saksena J , Kosmopoulos V , Schizas C
Published: October 2016

The usual complications of total knee arthroplasty include thrombo-embolism, infection, and loosening. We report an unusual and potentially serious complication of an intramedullary guide lodging within the femoral canal during the procedure. Considering the risk of fracture and additional exposure, the guide was not removed and was cut in situ. The rest of the operation was completed successfully and the patient made an uneventfully recovery.
Traumatic Deltoid Rupture Caused by Seatbelt during a Traffic Accident: A Case Report
Authors: Chiba D , Sano H , Nakajo S , Fujii G
Published: October 2016

A right-handed 53-year-old man presented with a subcutaneous bruise on his right shoulder caused by a seatbelt during a traffic accident. He had no history of shoulder pain or hydrocortisone injections. The contour of the anterior deltoid was deformed and its belly was retracted distally. The active range of movement of the shoulder was limited to 120 degrees and the strength weakened to 3/5. Magnetic resonance imaging demonstrated detachment of the anterior fibres of the deltoid. Surgical repair of the deltoid and supraspinatus tendon was performed 2 months later using a pull-out suture technique. After 12 months of follow-up, the patient had returned to work without any problems. Both the range of movement and muscle strength had recovered completely.
Mini-Incision Dynamic Condylar Screw Fixation for Comminuted Subtrochanteric Hip Fractures
Authors: Rohilla R , Singh R , Magu NK , Siwach RC , Sangwan SS
Published: October 2016

Purpose.

To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures.

Methods.

29 men and 14 women aged 25 to 65 (mean, 44) years with comminuted subtrochanteric femoral fractures underwent indirect reduction and mini-incision DCS fixation. Fractures were classified according to the AO classification (10 type 32B and 33 type 32C) and Seinsheimer classification (6 type III, 15 type IV, and 22 type V). Functional outcomes were assessed using the Harris hip score and Merle d'Aubigne score.

Results.

The mean time to full weight bearing was 11 (range, 8–19) weeks. The mean time to union was 16 (range, 13–22) weeks. There were no cases of non-union or implant failure after a mean follow-up period of 25 (range, 18–30) months. Seven patients had a mean limb length discrepancy of 1.5 (range, 1–2) cm. Two patients had coxa vara and persistent limp. According to the Harris hip score, functional results were excellent in 12 and good in 31 patients. The mean Harris hip score was 88 (range, 80–99) and the mean Merle d'Aubigne score was 17 (range, 14–18). There was no deep infection or avascular necrosis of the femoral head. Restriction of knee flexion beyond 90 degrees was noted in 2 patients.

Conclusion.

Results of indirect reduction and mini-incision DCS fixation for comminuted subtrochanteric femoral fractures are favourable. Proper planning and execution of the technique is required to achieve good functional outcomes and avoid complications. Preservation of vascularity of the medial fragments leads to rapid callus formation and early union and hence avoids implant failure and secondary bone grafting.
Computed Tomography–Guided Radiofrequency Ablation of Osteoid Osteomas
Authors: Khan SA , Thulkar S , Shivanand G , Kumar A , Varshney MK , Yadav CS , Rastogi S , Sharma DN
Published: October 2016

Purpose.

To report on 14 patients with osteoid osteomas treated by computed tomography–guided radiofrequency ablation.

Methods.

Nine males and 5 females aged 13 to 45 (mean, 25) years with osteoid osteomas were included. The proximal tibia was the commonest site involved. A bipolar 18-gauge radiofrequency probe with a 9-mm active tip was used. A 4.5-mm hollow drill was introduced into the nidus. Energy application was started at 2 W and increased to a maximum of 5 W. Heat was applied for 4 to 6 minutes at 90 degrees Celsius.

Results.

12 (86%) of the 14 patients had prompt pain relief; the remaining 2 underwent a repeat ablation. After a mean follow-up period of 19 (range, 9–25) months, no patient had pain recurrence.

Conclusion.

Radiofrequency ablation is a minimally invasive and cost-effective treatment for osteoid osteomas.
Comparison of Functional and Radiological Outcomes after Computer-Assisted versus Conventional Total Knee Arthroplasty: A Matched-Control Retrospective Study
Authors: Ek ETH , Dowsey MM , Tse LF , Riazi A , Love BR , Stoney JD , Choong PFM
Published: October 2016

Purpose.

To compare the radiological and functional outcomes of patients who underwent either computer-assisted or conventional total knee arthroplasty (TKA).

Methods.

Two groups of 50 patients each underwent either computer-assisted or conventional TKA were retrospectively studied. Patients were matched according to body mass index (BMI), gender, and age. Three senior orthopaedic surgeons with comparable experience performed all surgeries, using 3 different prostheses. The surgical approach and peri- and postoperative regimens were the same. The mechanical axis and the tibial and femoral angles were measured using standardised long-leg weight-bearing radiographs. Overall function was assessed using the Short Form-12 (SF-12) and International Knee Society (IKS) scores.

Results.

No intra-operative technical difficulties were encountered in either group. The computer-assisted group resulted in more consistent and accurate alignments in both the coronal and sagittal planes and better SF-12 and IKS scores. In obese patients (BMI≥30 kg/m2), computer-assisted TKA provided better alignment than the conventional technique.

Conclusion.

Computer-assisted TKA improves implant positioning, limb alignment, and overall functional outcome. It may be particularly advantageous for obese patients.
Midterm Outcome of the Duracon Total Knee Arthroplasty
Authors: Yong CK , Choon DSK , Soon HC
Published: October 2016

Purpose.

To present midterm results of Duracon total knee arthroplasty (TKA) performed between 1991 and 2001.

Methods.

One man and 43 women (65 knees) aged 46 to 84 (mean, 63) years who underwent primary TKAs using the Duracon prosthesis performed by a single surgeon were followed up for a mean of 8.5 (range, 5–11) years. All TKAs were cruciate-retaining and cemented, with only 9 of the patellae resurfaced. The diagnosis was osteoarthritis in 42 patients (61 knees), and rheumatoid arthritis in 2 patients (4 knees). Patients were assessed using the Knee Society Clinical Rating System, the Oxford Knee Score, and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System.

Results.

The mean Knee Society knee score was 86 (range, 43–100) and the function score was 68 (0–100). 94% of patients reported no or only mild pain. The mean Oxford Knee Score was 19. There was no patellofemoral complication, deep vein thrombosis or pulmonary embolism. Complications included a superficial infection and an uncontrolled deep infection. One patient had the insert exchanged for wear at the 11-year follow-up, and another had the polyethylene insert and tibial tray revised after a motorcycle accident.

Conclusion.

The Duracon TKA had good midterm clinical results with absence of patellofemoral complications.
The Use of Hydroxyapatite Blocks for Innominate Osteotomy: A Report of Three Cases
Authors: Amemiya M , Kikkawa I , Watanabe H , Hoshino Y , Ito K
Published: October 2016

We evaluated the use of hydroxyapatite blocks as spacers in pelvic osteotomy. The hydroxyapatite blocks fused with autologous bone tissue within 10 months and were highly biocompatible even after 10 years. They prevent pelvic deformities and are as effective as autogenous bone grafts.
Osteoid Osteoma of the Talus: A Case Report
Authors: Pai V , Pai VS
Published: October 2016

Diagnosing osteoid osteomas in the small bones of the hands and feet is difficult because of their atypical presentations. We report an 8-year-old boy who presented with pain in the left ankle and a limp. Plain radiographs of the ankle and foot were normal; the diagnosis was eventually made using magnetic resonance imaging.
Radiological Features of Osteoarthritis of the Acromiclavicular Joint and its Association with Clinical Symptoms
Authors: Pennington RGC , Bottomley NJ , Neen D , Brownlow HC
Published: October 2016

Purpose.

To determine whether increasing age is associated with increased radiological features of osteoarthritis of the acromioclavicular joint (ACJ) in a general population, and whether clinical symptoms correlate with radiological features.

Methods.

Anteroposterior and axillary shoulder radiographs of 240 patients aged 20 to 80 years were randomly selected. The presence of stigmata of osteoarthritis of the ACJ including sclerosis, cysts, lysis, and osteophytes were recorded, and the width of the ACJ was measured. To determine the correlation between clinical symptoms and radiological features, the same radiological features were assessed for 100 further patients who had undergone either arthroscopic subacromial decompression (ASD) alone (n=50) or ASD plus ACJ excision (n=50, age-matched controls) based on clinical examination.

Results.

Radiological features of osteoarthritis of the ACJ increased significantly with increasing age but were not related to gender or the side affected. Of the 10 features, only medial acromial sclerosis and superior clavicular osteophytes were more prevalent in patients with ASD plus ACJ excision than in those with ASD alone (p=0.016). The sensitivity, specificity, positive and negative predictive values of these features were poor. Therefore, clinical symptoms were not associated with radiological features of osteoarthritis of the ACJ.

Conclusion.

Radiological features should only be used as an adjunct in the decision to excise the ACJ. A thorough clinical examination is crucial in the assessment of ACJ pathology.
Microbiology of Infected Arthroplasty: Implications for Empiric Peri-Operative Antibiotics
Authors: Sharma D , Douglas J , Coulter C , Weinrauch P , Crawford R
Published: October 2016

Purpose.

To classify the spectrum and antibiotic susceptibility of bacteria isolated from infected hip and knee arthroplasty specimens, and to recommend appropriate empiric peri-operative antibiotics.

Methods.

From January 1999 to August 2006, specimens from revision hip and knee arthroplasties (with or without suspected infection) were routinely collected for identifying possible organisms and their susceptibility patterns. During the period, 147 patients had positive specimens yielding 248 micro-organisms (from 195 tissue specimens, 43 fluid specimens, and 10 swabs). 140 isolates were from hips and 108 from knees.

Results.

Most isolates were Gram-positive; their distribution was similar in hip and knee specimens. Of the 248 micro-organisms isolated, Staphylococcus was the most common genus encountered (131, 53%), followed by Gram-negative isolates (24%). 88% of Gram-negative organisms were detected within 48 hours of inoculation and 94% of Gram-positive organisms within 96 hours. Overall, 46% of isolates were susceptible to cephalothin. Only 35% of coagulase-negative staphylococci were sensitive to cephalothin. No Gram-positive vancomycin resistance was encountered.

Conclusion.

Empiric prophylactic antibiotics for revision hip and knee arthroplasties should include vancomycin to cover Gram-positive organisms and gentamicin for most Gram-negative bacteria.
Postoperative Fall after the Use of the 3-in-1 Femoral Nerve Block for Knee Surgery: A Report of Four Cases
Authors: Atkinson HDE , Hamid I , Gupte CM , Russell RC , Handy JM
Published: October 2016

We present a serious postoperative complication related to the use of femoral nerve block in 4 patients, each of whom fell and sustained further injury. Preoperatively, all patients underwent a 3-in-1 femoral nerve block with 30 to 35 ml of 0.25% levobupivacaine with 1:200 000 epinephrine, with guidance by a nerve stimulator. After the falls, neurological examination of the operated legs revealed reduced 2-point discrimination, pain, and/or light touch sensation. All patients underwent further operation for the fall injury and had delayed full weight bearing. We recommend that, after having a femoral nerve block, patients should undergo enhanced postoperative evaluation of blockade and proprioceptive function to ensure safe neurological function before mobilisation.
Diluted Povidone-Iodine versus Saline for Dressing Metal-Skin Interfaces in External Fixation
Authors: Chan CK , Saw A , Kwan MK , Karina R
Published: October 2016

Purpose.

To compare infection rates associated with 2 dressing solutions for metal-skin interfaces.

Methods.

60 patients who underwent distraction osteogenesis with external fixators were equally randomised into 2 dressing solution groups (diluted povidone-iodine vs. saline). Fixations were attained using either rigid stainless steel 5-mm diameter half pins or smooth stainless steel 1.8-mm diameter wires. Half-pin fixation had one metal-skin interface, whereas wire fixation had 2 interfaces. Patients were followed up every 2 weeks for 6 months.

Results.

Of all 788 metal-skin interfaces, 143 (18%) were infected: 72 (19%) of 371 in the diluted povidone-iodine group and 71 (17%) of 417 in the saline group. Dressing solution and patient age did not significantly affect infection rates. Half-pin fixation was more likely to become infected than wire fixation (25% vs 15%). Conclusion. Saline is as effective as diluted povidone-iodine as a dressing solution for metal-skin interfaces of external fixators. Saline is recommended in view of its easy availability and lower costs.
Use of Suture Anchors for Coronoid Fractures in the Terrible Triad of the Elbow
Authors: Pai V , Pai V
Published: October 2016

Purpose.

To report outcomes in 6 patients with the terrible triad of the elbow treated with our modified protocol.

Methods.

6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. They all underwent replacement of the radial head and repair of the lateral collateral ligament to the isometric part of the lateral condyle using suture anchors. Five had an additional capsular fixation to the anterior coronoid using suture anchors; in patient 6 the coronoid was not repaired because it was stable. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) elbow assessment score. Bone union, implant loosening, heterotopic ossification, and degenerative changes were assessed using anteroposterior and lateral radiographs.

Results.

After a mean follow-up of 2.2 (range, 1–3) years, the mean arc of flexion-extension was 116 degrees and the mean flexion contracture was 15 degrees. All patients maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation, with isometric fixation of the lateral collateral ligament. No patient had dislocation of the radial-head prosthesis. All had good-to-excellent HSS elbow scores, and none required re-operation. Patient 2 had neuropraxia of the radial nerve, which recovered within 3 months. Patient 4 had a range of movement of only 20 to 100 degrees, but was satisfied with the outcome.

Conclusion.

Repair of the articular capsule using suture anchors in addition to replacement of the radial head and repair of the lateral collateral ligament achieves favourable outcome in patients with the terible triad of the elbow.