bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous Dislocation of Proximal and Distal Radio-Ulnar Joints: A Case Report
Authors: Wong Billy LK , Rama Krishna Boddu Siva , Kumar Ajeet
Published: October 2016

Simultaneous dislocation of the radial head and distal radio-ulnar joint is rare. We report a 71-year-old man with volar dislocation of the radial head and dorsal dislocation of the distal radio-ulnar joint, and discuss the injury mechanism and its management with closed reduction.
Surgical Outcome for Hip Fractures in Patients with and without Parkinson's Disease
Authors: Yuasa Takahito , Maezawa Katsuhiko , Nozawa Masahiko , Kaneko Kazuo
Published: October 2016

Purpose.

To compare surgical outcome of hip fractures (in terms of the ability to walk and complications) in patients with and without Parkinson's disease (PD).

Methods.

Records of 207 patients who underwent surgery for femoral neck fractures were reviewed. Of whom, 9 men and 26 women with PD aged 58 to 89 (mean, 76.8) years underwent hemiarthroplasty for subcapital fractures (n=22) or internal fixation for intertrochanteric fractures (n=13). The remaining 36 men and 136 women with no PD aged 61 to 96 (mean, 81.8) years underwent hemiarthroplasty (n=108) or internal fixation (n=64) for subcapital (n=120) or intertrochanteric (n=52) fractures. None of the patients had pathological fractures, and all had been ambulatory prior to the fracture. According to the Columbia classification system, severity of PD was grade II in 11, grade III in 11, and grade IV in 13 patients.

Results.

Respectively for the patients with and without PD at the one-year follow-up, 68.2% and 79.6% of those treated with hemiarthroplasty and 46.2% and 62.5% of those treated with internal fixation were able to walk with or without assistive devices. 81.8%, 63.6%, and 38.5% of the patients with grade-II, -III, and -IV PD, respectively, were able to walk at the one-year follow-up, compared to 73.3% of the patients without PD.

Conclusion.

Surgical treatment for hip fractures was appropriate for patients with grade-II or -III PD.
Blocking Screws: An Adjunct to Retrograde Nailing for Distal Femoral Shaft Fractures
Authors: Gavaskar Ashok S , Chowdary Naveen
Published: October 2016

Purpose.

To review records of 11 patients who underwent retrograde nailing in conjunction with blocking screws to aid fracture reduction for distal femoral shaft fractures.

Methods.

Records of 8 men and 3 women aged 27 to 60 (mean, 41) years who underwent retrograde nailing with the use of blocking screws for distal femoral shaft fractures were reviewed. Two of the fractures were open and graded as Gustilo-Anderson grade II. The mean surgical delay was 2 (range, 1–5) days.

Results.

All fractures united after a mean of 14 (range, 11–16) weeks without malalignment. There was no screw breakage, screw bending, or wound infection.

Conclusion.

Blocking screws increase the stability of the construct and thereby minimise macro-motion at the fracture site.
Revision Total Knee Arthroplasty for Septic versus Aseptic Failure
Authors: Rajgopal Ashok , Vasdev Attique , Gupta Himanshu , Dahiya Vivek
Published: October 2016

Purpose.

To compare the medium-term outcome of revision total knee arthroplasty (TKA) for septic versus aseptic failure.

Methods.

Records of 142 patients who underwent revision TKA by a single senior surgeon for septic (n=65) or aseptic (n=77) failure were reviewed. In the septic group, 67 knees in 42 women and 23 men were included. In the aseptic group, 88 knees in 51 women and 26 men were included. The Knee Society Score was measured. The Kaplan Meier survival curve at months 36, 60, and 95 was plotted, with revision as the end point. The survival rates at each specific time point between the 2 groups were compared using the Z test.

Results.

The Knee Society Scores improved 18% from 51 to 69 in the septic group and 18% from 52 to 70 in the aseptic group (p=0.72). The range of motion improved 30% from 72° to 102° in the septic group and 39% from 62° to 100° in the aseptic group (p<0.001).

Conclusion.

Results of the 2 groups were similar in terms of the Knee Society Score, range of motion, and the Kaplan-Meier survivorship.
Correlation between Trochlear Dysplasia and the Notch Index
Authors: Botchu Rajesh , Obaid Haron , Rennie WJ
Published: October 2016

Purpose.

To evaluate the correlation between trochlear dysplasia and the notch index.

Methods.

Magnetic resonance images (MRI) of 95 knees in 54 male and 36 female patients aged 4 to 74 (mean, 28) years were reviewed by 2 musculoskeletal radiologists. Standard MRI sequences were used. Based on the Dejour classification of trochlear dysplasia, the knees were classified into normal or types A, B, C, and D. A notch index of <0.2 was considered narrow. Normal knees and knees with trochlear dysplasia were compared.

Results.

60 of the 95 knees had trochlear dysplasia, of which 39 were Dejour type A, 13 were type B, 7 were type C, and one was type D. Dejour types B, C, and D were combined as non-type A. Inter-observer agreement in assessing the notch index was good (Kappa=0.6). The mean notch indices in normal knees and knees with trochlear dysplasia were comparable (0.161 vs. 0.157, p=0.18), as were in Dejour type A and non-type A knees (0.154 vs. 0.160, p=0.54) and in Dejour types A, B, C, and D knees (0.154 vs. 0.165 vs 0.153 vs. 0.2, p=0.17–0.7). The rate of ACL injuries was similar in patients with normal knees and those with type-A trochlear dysplasia. A low notch index (narrow notch) was not associated with ACL injury.

Conclusion.

The notch index and trochlear morphology are 2 independent entities. A narrow notch does not imply a shallow trochlear grove.
Grafted Tendon Healing in Femoral and Tibial Tunnels after Anterior Cruciate Ligament Reconstruction
Authors: Nakase Junsuke , Kitaoka Katsuhiko , Toratani Tatsuhiro , Kosaka Masahiro , Ohashi Yoshinori , Tsuchiya Hiroyuki
Published: October 2016

Purpose.

To evaluate tendon-to-bone healing after anterior cruciate ligament (ACL) reconstruction in the fibrous interzone (FIZ) of the femoral and tibial tunnels using magnetic resonance imaging (MRI).

Methods.

Five men and 5 women (mean age, 29 years) underwent arthroscopic ACL reconstruction by a single surgeon, using the semitendinosus and gracilis tendon. The tendon-to-bone healing in the FIZ was evaluated using sagittal and coronal MRI at 1, 3, 6, 9, 12, and 24 weeks, with the knee flexed at 60° and the tendon graft straight in both images. The signal intensity of the FIZ was visually assessed by comparing it with anatomic landmarks in the same patient's knee, and classified into 4 grades. It was grade 3 when similar to that of the patellar tendon, grade 2 when similar to that of skeletal muscle, grade 1 when greater than that of muscle but less than that of joint fluid, and grade 0 when similar to that of joint fluid. At 24 weeks, subjective and objective functional outcomes were evaluated using the Lysholm score and the International Knee Documentation Committee score.

Results.

At 24 weeks, no patient had knee laxity. All patients had an International Knee Documentation Committee score of A, and their mean Lysholm score was 98.5. In the femoral tunnel, the FIZ did not change during the first 9 weeks (in particular the anterior part), but healing occurred rapidly thereafter. In the tibial tunnel, the FIZ healed over time in all locations, and healing was complete in the lateral and posterior parts at 12 weeks, and in all locations at 24 weeks. The mean signal intensity grade was significantly higher in the tibial than femoral FIZ at 3 to 12 weeks (p<0.01).

Conclusion.

After ACL reconstruction, the tendon-to-bone healing in the FIZ of the tibial tunnel was faster than that of the femoral tunnel.
Fixation of Delayed Union or Non-Union Posterior Cruciate Ligament Avulsion Fractures
Authors: Singla Rohit , Devgan Ashish , Gogna Paritosh , Batra Amit
Published: October 2016

Purpose.

To report the outcome of fixation for delayed union or non-union posterior cruciate ligament (PCL) avulsion fractures.

Methods.

Seven men and 4 women aged 24 to 35 (mean, 28) years underwent lag screw or suture fixation for non-union or delayed union of avulsion fracture of PCL tibial attachment after a mean delay of 8.6 (range, 4–14) months. Patient satisfaction was assessed using a visual analogue scale (VAS). Functional outcome was evaluated using the Lysholm scale.

Results.

The mean follow-up period was 17 (range, 8–36) months. The mean Lysholm score improved from 82 preoperatively to 92 at the final follow-up (p=0.34), the mean range of knee motion improved from 82° to 87° (p=0.008), and the mean VAS score for patient satisfaction improved from 4.3 to 7.4 (p=0.0004). All patients but one achieved bone union after a mean of 7.5 (range, 7–9) weeks. Functional outcome was excellent for 6 patients, good for 4, and fair for one. Posterior drawer test was positive (grade 1 laxity) in 3 patients whose outcome was good for 2 and fair for one. The latter had non-union after Ethibond suture repair for a communited fracture. There were no instances of wound complications or implant loosening.

Conclusion.

Fixation with lag screw or suture combined with bone grafting for delayed union or non-union of PCL avulsion fractures achieves acceptable functional outcome.
Standardised Multidisciplinary Protocol for Haemodynamically Unstable Pelvic Fractures
Authors: Ip Ka Chun , Lee Kin Bong
Published: October 2016

Purpose.

To review treatment results of 29 patients with haemodynamically unstable pelvic fractures after implementation of a standardised multidisciplinary protocol.

Methods.

Records of 14 men and 15 women aged 14 to 84 (mean, 46) years who were treated for haemodynamically unstable closed (n=27) or open (n=2) pelvic fractures were reviewed. The survival rates before and after implementation of a standardised protocol were compared.

Results.

Of these 29 patients, 19 survived, 6 died of exsanguination, and 4 died of multi-organ failure. Survival was significantly improved after implementation of the protocol (66% vs. 31%, p=0.0006).

Conclusion.

A standardised protocol involving a dedicated multidisciplinary team for management of haemodynamically unstable pelvic fractures improved survival.
Insertional Torque and Pullout Strength of Pedicle Screws with or without Repositioning: A Porcine Study
Authors: Tan Chun Ee , Fok Margaret Woon Man , Luk Keith Dip Kei , Cheung Kenneth Man Chee
Published: October 2016

Purpose.

To evaluate the insertion torque and pullout strength of pedicle screws with or without repositioning.

Methods.

20 fresh porcine lumbar vertebrae of similar size were used. The entry point was at the site just lateral and distal to the superior facet joint of the vertebra, and to a depth of 35 mm. A 6.2-mm-diameter, 35-mm-long pedicle screw was inserted parallel to the superior end plate on one side as control. On the other side, an identical screw was first inserted 10° caudal to the superior end plate, and then repositioned parallel to the superior end plate. The insertional torque and pullout strength were measured.

Results.

Three of the specimens were excluded owing to pedicle fractures during the pullout test. Repositioned pedicle screws were significantly weaker than controls in terms of the maximum insertional torque (3.20±0.28 vs. 2.04±0.28 Nm, 36% difference, p±0.01) and pullout strength (1664±378 vs. 1391±295 N, p±0.01).

Conclusion.

Repositioning pedicle screws should be avoided, especially when the pedicle wall is breached. If repositioning is deemed necessary, augmentation with polymethyl methacrylate or a screw with a larger diameter should be considered.
Early Reimplantation for Open Total Talar Extrusion
Authors: Mohindra Mukul , Gogna Paritosh , Thora Ankit , Tiwari Anurag , Singla Rohit , Mahindra Pankaj
Published: October 2016

Purpose.

To review outcome of early reimplantation for open total talar extrusion in 7 patients.

Methods.

Medical records of 5 men and 2 women aged 19 to 53 years who underwent reimplantation for open total talar extrusion within 6 hours after road traffic accident (n= 6) or industrial injury (n=1) were reviewed. The talus was first irrigated with 9 to 10 litres of saline solution, followed by 10% povidone iodine. It was then reduced after thorough debridement and fixed with tension band wiring or external fixation. Ankle mobilisation exercises were started at week 6 and full weight bearing at week 14. Outcome was assessed using the American Foot And Ankle Society score.

Results.

After a mean follow-up of 31.9 (range, 24–46) months, the mean American Foot and Ankle Society score was 81, and the mean dorsiflexion-plantar flexion arc was 36.9° (range, 25°–45°). All patients were able to walk with a balanced, unaided gait with mild-to-moderate pain (n=3) or pain-free (n=4). No patient developed deep infection or instability. Three patients developed avascular necrosis of the talus; restriction of motion was moderate at the ankle joint and severe at the subtalar joint. None of these 3 patients opted for revision surgery, as the pain was tolerable and did not limit their daily activities, but their condition was expected to deteriorate with time.

Conclusion.

Early reimplantation is recommended for open total talar extrusion, as it restores (to some extent) hind foot mechanics, heel height, and bone stock for activities of daily living and future reconstructive options.
Giant Cell Tumour of the Distal Humerus: A Case Report
Authors: Hegde Atmananda S , Shenoy Ravindra M , Rai Mahabala P
Published: October 2016

Giant cell tumour of the distal humerus is rare. We report one such case in a 30-year-old man who underwent wide resection of the tumour followed by total elbow arthroplasty using a cemented ‘sloppy-hinged’ total elbow prosthesis. At the 18-month follow-up, the patient had pain-free range of motion of 15° to 120° and no evidence of recurrence.
Retrograde Locked Intramedullary Nailing for Aseptic Supracondylar Femoral Nonunion following Failed Locked Plating
Authors: Wu Chi-Chuan
Published: October 2016

Purpose.

To review the outcome of retrograde locked nailing for aseptic supracondylar femoral nonunions following failed locked plating.

Methods.

Records of 20 men and 4 women aged 20 to 57 (mean, 39) years who underwent retrograde locked intramedullary nailing for aseptic supracondylar femoral nonunion following failed locked plating were reviewed. There were 20 closed and 4 open Gustilo type II or IIIA fractures secondary to motor vehicle accidents (n=21) or falls (n=3). Patients had undergone one to 3 operations. The mean time from injury to the present revision surgery was 1.3 years. No patient had a flexion contracture. The locked plate was removed and replaced with a retrograde dynamic locked nail (with or without buttress plate augmentation) followed by bone grafting.

Results.

17 men and 4 women were followed up for a mean of 3.4 years. The rest were lost to follow-up. The 21 patients achieved bone union after a mean of 4.3 months. The mean maximal knee flexion improved from 97.1° to 107.6° (p=0.03). Knee function was excellent in one, good in 15, and fair in 5 knees. The fair outcome was due to extension contracture, varus knee deformity, or knee pain. There were 3 malunions with varus deformity of 7°, 8°, and 9° each. No patient had deep infection causing a nonunion. All 21 patients could walk without aids.

Conclusion.

Retrograde locked intramedullary nailing for aseptic supracondylar femoral nonunions following failed locked plating achieved a high union rate.
Early Outcome after Total Knee Replacement Using Computed Tomography–Based Patient-Specific Cutting Blocks versus Standard Instrumentation
Authors: Nabavi Arash , Olwill Caroline M
Published: October 2016

Purpose.

To compare early outcome of total knee replacement (TKR) using computed tomography (CT)–based patient-specific cutting blocks versus standard instrumentation.

Methods.

40 men and 44 women (90 knees) aged 45 to 88 (mean, 65) years who underwent TKR using standard instrumentation were compared with 39 men and 43 women (90 knees) aged 44 to 85 (mean, 64) years who underwent TKR using CT-based patient-specific cutting blocks. A single surgeon performed all TKRs through the medial parapatellar approach using a cemented prosthesis, with the posterior cruciate ligament retained and the patella resurfaced.

Results.

Respectively in the standard and patient-specific instrumentation groups, 74 and 70 patients were followed up for a mean of 30 and 14 months. The mean Oxford Knee Score was 19 and 19 preoperatively, 34 and 34 at 3 months, and 37 and 40 at 12 months (p=0.02). 71% and 88% of patients achieved good-to-excellent outcome (Oxford Knee Score of >34) at 12 months (p=0.008). The respective mean EQ-5D score was 54 and 52 preoperatively, 73 and 76 at 3 months, and 77 and 78 at 12 months. 18% and 2% of patients required a blood transfusion (p=0.0002), with a mean blood loss of 292 and 254 g/l (p=0.049). The mean tourniquet time was 45 minutes in both groups. There was no infection or revision in either group.

Conclusion.

Compared with standard instrumentation, the use of CT-based patient-specific cutting blocks for TKR achieved higher Oxford Knee Score at 12 months and lower blood loss and transfusion rate.
Intra-Operative Fracture in Posterior-Stabilised Total Knee Arthroplasty
Authors: Pun Alex HF , Pun Wai-Ki , Storey Peter
Published: October 2016

Purpose.

To review records of 17 patients who sustained a tibial or femoral intra-operative fracture during primary cemented total knee arthroplasty (TKA)

Methods.

Records of 1346 primary cemented TKAs using the NexGen LPS fluted tibial component performed by a single surgeon were reviewed. 12 tibial and 5 femoral intra-operative fractures occurred in 5 men and 12 women aged 54 to 83 (mean, 71.6) years. No patient had any condition that may predispose to osteoporosis.

Results.

All 12 tibial fractures occurred during hammering down of the final tibial component. They were vertical crack fractures of the anterior cortex of the medial tibial plateau with minimal displacement and did not extend beyond the tip of the tibial stem. Four of the 5 femoral fractures were avulsion fractures in the coronal plane of the medial femoral condyles and occurred during removal of the intercondylar notch. The remaining femoral fracture involved the medial cortex of the medial femoral condyle and occurred during removal of a large medial femoral condyle osteophyte. All fractures were immediately fixed with 3.5-mm partially threaded AO cancellous screws. All patients achieved bone union and good function.

Conclusion.

Intra-operative tibial fractures are more common than femoral fractures; fixation with multiple AO screws achieves good outcome.
Mini-Open Transthoracic Approach for Resection of a Calcified Herniated Thoracic Disc and Repair of the Dural Surface with Fibrin Glue: A Case Report
Authors: Yoshioka Katsuhito , Murakami Hideki , Demura Satoru , Kato Satoshi , Tsuchiya Hiroyuki
Published: October 2016

This study reports a case of severe anterior compression of the spinal cord by a calcified herniated thoracic disc at the T9/10 level in a 46-year-old woman. She underwent resection of the calcified herniated thoracic disc and the integrated dura, using a microscopically assisted mini-open transthoracic approach. The remaining dura mater was shaped and repaired by alternate overlapping without suture. The dural surface was reinforced with a combination of fibrin glue and a polyglycolic acid sheet. This novel procedure prevented postoperative cerebrospinal fluid leakage. The patient made an excellent recovery, without any complications.
Risk Factors for Periprosthetic Joint Infection in Total Knee Arthroplasty
Authors: Lee Qunn Jid , Mak Wai Ping , Wong Yiu Chung
Published: October 2016

Purpose.

To evaluate the incidence and risk factors of periprosthetic joint infection (PJI) in patients undergoing total knee arthroplasty (TKA) in a high-volume hospital.

Methods.

Records of 1133 primary TKAs were reviewed. Correlation between surgery volume and infection rate was determined. Risk factors for PJI were identified using case-control analysis of variables. TKAs performed between October 2012 and March 2013 without infection were used as controls.

Results.

Of 1133 TKAs, 8 (0.71%) PJI occurred. The organisms involved were Staphylococcus aureus (n=4), coagulase-negative staphylococci (n=2), Pseudomonas aeruginosa (n=1), and methicillin-resistant S aureus (n=1). In the 6-month period chosen as the control period, one (0.52%) out of 192 TKAs developed PJI. Hospital annual volume did not correlate with infection rate (p=0.766). Significant risk factors included young age, comorbidities such as diabetes, anaemia, thyroid disease, heart disease, lung disease, and long operating time. Six of the 8 patients with PJIs had at least one risk factor. However, the number of patients with infection was too small to have sufficient power.

Conclusion.

Comorbidities are a risk factor for PJI. Perioperative optimisation of comorbidities and the use of antibiotic-loaded cement in patients with severe comorbidities should be considered.
Epidural versus Intra-Articular Infusion Analgesia following Total Knee Replacement
Authors: Kasture Sarang , Saraf Hrushikesh
Published: October 2016

Purpose.

To compare the efficacy of epidural versus intra-articular infusion analgesia following total knee replacement (TKR).

Methods.

25 men and 50 women aged 55 to 75 (mean, 67) years who underwent primary TKR by a single surgeon were randomised and consented to receive either epidural (n=35) or intra-articular (n=40) infusion analgesia for 48 hours at 5 ml/hr. All patients also received intravenous aqueous diclofenac 50 mg twice a day. Patients were assessed 6 hourly for visual analogue score (VAS) for pain to determine the analgesic effect. Complications such as paraesthesia in the lower limbs, hypotension, urinary retention, and abdominal distension were recorded, as was the rehabilitation progress with respect to the time to stand, climb stairs, use of commode chair, and discharge.

Results.

The epidural and intra-articular infusion groups were comparable with respect to age, sex, weight, and operating time, as was the analgesic efficacy within 48 hours of TKR. Patients with epidural infusion analgesia had a higher complication rate in terms of hypotension (51.4% vs. 22.5%, p=0.015) and troublesome paraesthesia in the lower limbs (45.7% vs. 12.5%, p=0.028), and a trend of higher abdominal distension rate (20% vs. 5%, p=0.073). Patients with intra-articular infusion analgesia were able to stand/walk earlier (2.08 vs. 2.54 days, p<0.001). The 2 groups did not differ significantly in the time needed to climb stairs, use of commode chair, and discharge.

Conclusion.

The efficacy of epidural and intra-articular infusion analgesia was comparable. Intra-articular infusion was associated with fewer complications and earlier rehabilitation.
Early versus Late Surgery for Closed Ankle Fractures
Authors: Singh Rohit Amol , Trickett Ryan , Hodgson Paul
Published: October 2016

Purpose.

To compare the outcome after early versus late surgery for closed ankle fractures in terms of the length of hospital stay and infection rate.

Methods.

Records of 95 men and 119 women aged 14 to 92 (mean, 46) years who underwent open reduction and internal fixation for ankle fractures during three 6-month periods in 2004, 2007, and 2010 were reviewed. 82 and 132 patients underwent surgery <24 hours and >24 hours after presentation, respectively. The most common reason for delayed surgery was unavailability of the operation theatre, followed by delayed admission to the fracture clinic and excess soft tissue swelling.

Results.

Patient and injury characteristics of the 3 study periods were comparable (p=0.399). The early and late surgery groups were comparable in proportions of various fracture patterns but not in patient age (40 vs. 49 years, p=0.002). The mean postoperative length of hospital stay was shorter in the early surgery group (2.9 vs. 5.5 days, p=0.009). The 2 groups did not differ significantly in the infection rate (7% vs. 11%, p=0.589) or the need for additional surgery (3.7% vs. 5.3%, p=0.63).

Conclusion.

Patients with delayed surgery for ankle fracture had a longer postoperative length of hospital stay. Surgery should be performed within 24 hours of injury to minimise the length of hospital stay.
A Kirschner Wire as a Transverse-Axis Guide to Improve Acetabular Cup Positioning
Authors: Ishidou Yasuhiro , Hirotsu Masataka , Setoguchi Takao , Nagano Satoshi , Kakoi Hironori , Yokouchi Masahiro , Yamamoto Takuya , Komiya Setsuro
Published: October 2016

Purpose.

To compare cup-positioning accuracy in total hip arthroplasty (THA) with or without use of a Kirschner wire as a transverse-axis guide for pelvic alignment.

Methods.

Records of 18 men and 73 women (mean age, 60 years) who underwent primary THA with (n=49) or without (n=42) use of a Kirschner wire as a transverse-axis guide for pelvic alignment were reviewed. A 2.4-mm Kirschner wire as a transverse-axis guide was inserted to the anterior superior iliac spine and was parallel to a line linking the left and right anterior superior iliac spine. The safe zone for cup positioning was defined as 30° to 50° abduction and 10° to 30° anteversion. Of the 5 operative surgeons, 2 were classified as experienced (total surgical volume >300) and 3 as inexperienced (total surgical volume of <50). The proportion of patients with the cup in the safe zone was compared in patients with or without use of the transverse-axis guide and in experienced and inexperienced surgeons.

Results.

For inexperienced surgeons, the use of the transverse-axis guide significantly improved the proportion of patients with the cup in the safe zone from 90% to 100% for abduction, from 50% to 82.4% for anteversion, and from 40% to 82.4% for both. Patients with the cup inside or outside the safe zone were comparable in terms of body height, weight, BMI, subcutaneous fat thickness, incision length, and acetabular cup size.

Conclusion.

The use of the transverse-axis guide improved the accuracy of cup positioning by inexperienced surgeons.
Symptomatic Epidural Haematoma after Cervical Laminoplasty: A Report of Three Cases
Authors: Takahashi Yoshimasa , Sato Tetsuro , Hyodo Hironori , Kawamata Tomomaro , Takahashi Eiji
Published: October 2016

Symptomatic epidural haematoma after cervical laminoplasty is rare. We report 3 patients who required emergency evacuation of an epidural haematoma. Timely diagnosis and removal of the haematoma is important to prevent neurological deficits. The causative factors in these patients were preoperative coagulopathy, hypertension, and the malfunction of a closed-suction drain.
Determinants of Efficiency in the Malaysian Banking Sector: Evidence from Semi-parametric Data Envelopment Analysis Method
Authors: Sufian Fadzlan
Published: October 2016

This article follows Simar and Wilson’s (2007 , Journal of Econometrics, 136(1), 31–64) two-stage procedure to analyse the efficiency of the Malaysian banking sector. In the first stage, we employ the data envelopment analysis (DEA) method to compute the efficiency of individual banks during the period 1999–2008. We then use panel regressions to examine the impact of ownership on bank efficiency while controlling for the potential impacts of contextual variables. The DEA results indicate an increase in efficiency over the sample period. The results from the panel regression suggest that productive efficiency is positively related to bank size, capitalization and foreign ownership. On the other hand, the publicly listed and government-owned banks have been relatively inefficient in their intermediation function.
A Binaural Grouping Model for Predicting Speech Intelligibility in Multitalker Environments
Authors: Mi Jing , Colburn H. Steven
Published: October 2016

Spatially separating speech maskers from target speech often leads to a large intelligibility improvement. Modeling this phenomenon has long been of interest to binaural-hearing researchers for uncovering brain mechanisms and for improving signal-processing algorithms in hearing-assistive devices. Much of the previous binaural modeling work focused on the unmasking enabled by binaural cues at the periphery, and little quantitative modeling has been directed toward the grouping or source-separation benefits of binaural processing. In this article, we propose a binaural model that focuses on grouping, specifically on the selection of time-frequency units that are dominated by signals from the direction of the target. The proposed model uses Equalization-Cancellation (EC) processing with a binary decision rule to estimate a time-frequency binary mask. EC processing is carried out to cancel the target signal and the energy change between the EC input and output is used as a feature that reflects target dominance in each time-frequency unit. The processing in the proposed model requires little computational resources and is straightforward to implement. In combination with the Coherence-based Speech Intelligibility Index, the model is applied to predict the speech intelligibility data measured by Marrone et al. The predicted speech reception threshold matches the pattern of the measured data well, even though the predicted intelligibility improvements relative to the colocated condition are larger than some of the measured data, which may reflect the lack of internal noise in this initial version of the model.
Sources of resilience for children and youth in residential slums of Eldoret city in Kenya
Authors: Ombati Mokua , Ombati Victor
Published: October 2016

This study utilizes insights from resilience presuppositions, combined with perspectives from the theory of everyday tactics, to highlight strategies of creative adaptation, methodologies of survival, and ways of making do used by children and youth in urban residential slums and informal settlements of a Kenyan city to cope and deal more effectively with adversity. Based on qualitative inquiry, results show that individual attributes, bonding to family and support systems, involvement in extracurricular activities, lower levels of parental discord, fewer adverse life events, and being less involved with delinquent peers constitute protective factors that enhance resiliency.
Anatomical Lateral and Medial Ligament Reconstruction in Rotational Chronic Ankle Instability
Authors: Wiewiorski Martin J. , Alrashidi Yousef , Stelzenbach Christian , Herrera-Perez Mario , Barg Alexej , Valderrabano Victor
Published: October 2016

Category:

Sports.

Introduction/Purpose:

Rotational (combined lateral and medial) chronic ankle instability (CAI) can present with pain and tenderness at the ankle joint, and can be associated with feeling of giving way, repetitive sprains, and life quality limitation. In case of surgery, anatomical reconstruction of the ligaments and treatment of comorbidities are essential for a solid outcome.

Methods:

A retrospective chart review of 81 rotational CAI patients (average age: 35.3 years, age range: 16-64; right sided: 41(50.6%); left sided: 40(49.4%)) was performed. The average latest follow-up visit was 10.8 months (range: 3-47 months). The patients underwent in our center a standardized surgical treatment protocol. Following diagnostic ankle arthroscopy, a combined lateral and medial anatomical ligament reconstruction was performed. Hindfoot realignment procedures and treatment of associated pathologies (such as talar osteochondral lesions) were carried out at the same time. Postoperatively, all patients were mobilised with partial weight bearing (15 kg) for six weeks in an Aircast walker ® (DJO, LLC, USA). Adequate postoperative analgesia and physiotherapy were initiated.

Results:

Combined lateral and medial ligament reconstruction without additional surgeries was performed in 20 cases (24.7%). In the other cases, to address associated pathologies, additional surgeries were performed, such as: lateral calcaneal lengthening osteotomy (LCLO) in 42 cases (51.9%), medial sliding calcaneal osteotomy (MSCO) in 3 Cases (3.7%), osteochondral lesion reconstruction in 20 cases (24.7%), peroneal tendon pathology treatment in 3 cases (3.7%), cavovarus foot correction in 1 case (1.2%), supramalleolar osteotomy in 1 case (1.2%), and calcaneonavicular coalition excision in 1 case (1.2%). The outcome variables will be presented at the conference.

Conclusion:

Anatomical lateral and medial ligament reconstruction of rotational CAI is a safe surgical treatment and leads to a favourable outcome. Beside the ligament reconstruction, associated comorbidities, as malalignment, osteochondral lesions, and others, have to be addressed at the same surgery to achieve physiological biomechanics and a complete pain relieve.
Fluid Dynamics Play a Role In Distributing Ankle Stresses in Anatomic and Injured States
Authors: Hamid Kamran S. , Scott Aaron T. , Nwachukwu Benedict U. , Parekh Selene G. , Adams Samuel B. , Danelson Kerry A.
Published: October 2016

Category:

Basic Sciences/Biologics

Introduction/Purpose:

In 1976, Ramsey and Hamilton published a landmark cadaveric study demonstrating a dramatic 42% decrease in tibiotalar contact area with only 1 mm of lateral talar shift. An increase in principal stress of at least 72% is predicted based on these findings though the delayed development of arthritis in minimally misaligned ankles does not appear to be commensurate with the results found in dry cadaveric models. We hypothesize that synovial fluid is a previously unrecognized factor that contributes significantly to stress distribution in the tibiotalar joint in anatomic and injured states.

Methods:

As it is not possible to directly measure contact stresses with and without fluid in a cadaveric model, finite element analysis (FEA) was employed for this study. FEA is a modeling technique used to calculate stresses in complex geometric structures by dividing them into small, simple components called elements. Four test groups were investigated utilizing a finite element model (FEM): baseline ankle alignment, 1 mm laterally translated talus and fibula, and the previous two bone orientations with fluid added. The FEM selected for this study was the Global Human Body Models Consortium (GHBMC) M50 version 4.2, a validated model of an average sized male. The ankle was loaded at the proximal tibia with a distributed load equal to the GHBMC body weight and first principal stress (which is also the maximum principal stress) was computed.

Results:

All simulations were stable and completed with no errors. In the baseline anatomic configuration, the addition of fluid between the tibia, fibula and talus reduced the maximum principal stress measured in the distal tibia at maximum load from 31.3 N/mm2 to 11.5 N/mm2. Following 1 mm lateral translation of the talus and fibula there was a modest 30% increase in the maximum stress in fluid cases. Qualitatively, translation created less high stress locations on the tibial plafond when fluid was incorporated in the model (Figure 1).

Conclusion:

The findings in this study demonstrate a potential role for synovial fluid in distributing stresses within the ankle that has not been considered in historical dry cadaveric studies. The increase in maximum stress predicted by simulation of an ankle with fluid is less than half that projected by cadaveric data, indicating a protective effect of fluid in the injured state. The trends demonstrated by these simulations suggest that bony alignment and fluid in the ankle joint change loading patterns on the distal tibia and should be accounted for in future experiments.
Biomechanical Consequences of First Metatarsophalangeal Joint Arthrodesis on Lesser Toes Movement
Authors: Tan Chin Yik , Fadil Muhammad Farhan Mohd
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

Effect of 1st metatarsophalangeal joint (MTPJ) arthrodesis on lesser toes active range of motion (ROM) is clinically important as limitation of lesser toe active ROM may predispose to metatarsalgia and decrease push off strength during terminal stance phase of gait. This effect was however not studied in the current literature. We aim to investigate this effect and study the role of Knot of Henry as a contributing factor to this effect.

Methods:

10 fresh frozen cadaveric specimens were used. Musculotendinous junction of flexor digitorum longus (FDL) was identified at medial ankle and proximal tensile force was then exerted to this part to simulate active muscle contraction. 3rd toe range of motion (ROM) and FDL excursion were measured. 1st MTPJ arthrodesis was performed by 2 crossed Kirschner wires in the standard arthrodesis angles. Measurements of 3rd toe range of motion (ROM) and FDL excursion with active muscle contraction were repeated. Knot of Henry was then identified and soft tissues connection here was then released. Same measurements were repeated.

Results:

There was significant decrease in the 3rd toe ROM and FDL excursion post 1st MTPJ arthrodesis, with significant improvement after knot of Henry release. Pre 1st MTPJ arthrodesis, mean 3rd toe MTPJ and PIPJ ROM, and FDL excursion were 20°, 22° and 6 mm respectively. Post 1st MTPJ arthrodesis, the respective measurements were 9.5°, 14° and 4.7 mm. Post knot of Henry release, the respective measurements were 16.5°, 19°, and 5 mm.

Conclusion:

Limitation of lesser toe active ROM post 1st MTPJ arthrodesis was shown in our study. In addition, our study also showed that this effect is partly contributed by knot of Henry soft tissue connection, as release of this connection improved lesser toe ROM. These results improve our understanding of 1st MTPJ arthrodesis biomechanics and also suggest potential benefits of knot of Henry release in 1st MTPJ arthrodesis to improve lesser toe active ROM and therefore decrease rate of metatarsalgia and improve push off strength during terminal stance phase of gait.
Evaluation of Brake Response Time Following Primary Bunionectomy Surgery
Authors: Raikin Steven , Lynch Mary-Katherine , Pedowitz David I. , Daniel Joseph N. , Winters Brian S. , Ahmad Jamal , Madden Anne Marie
Published: October 2016

Category:

Bunion

Introduction/Purpose:

Although primary bunionectomies are among the most common procedures performed by Foot and Ankle surgeons, there are currently no studies investigating postoperative driving safety in this group of patients. The purpose of this study was to evaluate postoperative brake response time (BRT) in primary right-sided bunionectomy patients as a means to determine driving preparedness. Brake response time is defined as the time, in milliseconds, between presentation of a perceived hazardous stimulus and the application of pressure to the brake pedal. We hypothesized that primary bunionectmomy patients would demonstrate BRTs comparable to control subjects at their 6-week follow-up appointment.

Methods:

Following IRB approval, 45 primary right-sided bunionectomy patients were prospectively identified and enrolled. All patients were managed with the same postoperative protocols. Patients were excluded if they were under the age of 18, were not in possession of a current driver’s license, had undergone a revision surgery for recurrent hallux valgus, or opted not to partake in the study. All patients were tested for their BRT utilizing a validated driving simulator at their 6-week postoperative follow-up appointment. Those patients that failed to achieve a safe brake response time less than 0.850 seconds were re-tested at weekly intervals until a safe braking time was achieved. The passing brake response time of 0.850 seconds was determined from the published control data and from testing 20 healthy volunteers in the same simulator. At each BRT test, patients were also asked to fill out an AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale and a Driving Preparedness survey.

Results:

Each subject underwent 3 sequential drive-braking simulation tests, with their BRT being calculated as an average of the 3 times. At six weeks, the overall average BRT for all 45 patients was 0.769 seconds. 40 out of 45 patients (89%) demonstrated safe average BRT at their 6-week appointment of equal to or less than 0.850 seconds. 4 out of 45 patients (9%) were cleared to drive at their 7-week re-test, and 1 out of 45 patients (2%) was cleared to drive at an 8-week re-test. 37 of the 40 patients whose test demonstrated a safe BRT at 6 weeks responded in their survey that they “Agreed” or “Strongly Agreed” they were ready to drive at the time of testing. The average AOFAS-MT-IP score was 65.2/100.

Conclusion:

The present study revealed that approximately 90% of primary right-sided bunionectomy patients were able to demonstrate a BRT comparable to those of healthy control subjects at their 6-week post-op appointment. 37 of these 40 patients (93%) also reported that after completing the test, they felt ready to return to driving. Therefore, we believe that it is reasonable to offer bunionectomy patients an estimate of 6-weeks recovery time before driving.
Pes Planovarus – The Description of a New Foot Form
Authors: Frigg Arno , Aebi Janic , Maquieira Gerardo Juan J.
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

In classic anatomy textbooks probably based on dissections of European executed convicts it is written, that according to the direction of the subtalar joint, a deformity of the foot is generally going either into supination (cavovarus foot) or pronation (planovalgus foot). However today we live in a multiethnic society and the author has encountered feet with hindfoot varus and flat mid- and forefoot, without mueller-weiss-syndrome. This deformity should theoretically not exist and has not been described in the literature yet. Its treatment is unclear.

Methods:

From 8/2012 to 8/2015 984 new patients were seen in the clinic and included in the study if they showed clinically a hindfoot varus and flat mid-/forefoot on exam. 29 patients (2.9%) with 38 feet were identified (44.6+/-16.2 years, 12 male/17 female). Their main complaints and therapy were retrospectively analyzed. Two independent observers (intraobserver variability ICC 0.998) measured on a DICOM/PACS-monitor the following radiographic parameters (Fig. 1): (1) position in the Saltzman- view, (2) talus-metatarsal-1 angle dorso-plantar (dp) and lateral, (3) talus-calcaneus angle dp and lateral, (4) calcaneal pitch angle. Standard values were taken from the literature.

Results:

Main complaints were chronic ankle instability (n=22), pain in sports (n=18), achillestendon-tendinitis (n=14), heel pain (n=14), hallux valgus (n=10), metatarsalgia (n=8), midfoot pain (n=6), posterior tibial tendon tendinitis (n=3), midfoot osteoarthritis (n=3). There was no mueller-weiss disease. 25 feet were treated conservatively, 13 with operation. Radiological results: The hindfoot alignment view was significantly in varus 6.57+/-3.74mm (standard 1.6+/-7.2mm, P < 0.001), the talus-MT1 angel lateral was significantly flat with 5.97+/-8.3° towards a negative arch (standard 8.4+/-5.85° positive arch, P < 0.001), the talus- MT1- angle dp was 2.4+/-8.2° in abduction (standard 7.7+/-8.2°, P=0.2), the calcaneus pitch angle was 18.63+/-6.45° (standard 24.5+/- 3.0, P < 0.001), the talus-calcaneus angle lateral was 48.13+/-6.76° (standard 43.4+/-7.1°, P < 0.001), the talus calcaneus angle dp was 25.35+/-8.22° (standard 24.1+/-5.7+, P=0.38).

Conclusion:

We found in 2.9% of our patients this new foot form, which is significantly different from standard feet characterized by a simultaneous hindfoot varus and flatfoot with negative arch. This seems paradox, as this is not in line with the axis of the subtalar joint. These feet pose a difficulty in treatment as for example a correction of the hindfoot varus in chronic ankle instability would increase the flatfoot and the correction of flatfoot in midfoot pain/metatarsalgia/heel pain would increase the hindfoot varus. Therefore conservative treatment was the primary choice because surgery would include a simultaneous correction of both deformities. Further research is necessary.
New Technique for Measuring Limb Occlusion Pressure Facilitates Personalized Tourniquet Systems
Authors: Younger Alastair S. , Jeyasurya Jeswin , McEwen James , Masri Bassam , Day Brian
Published: October 2016

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Optimal tourniquet safety depends on accurately determining the minimum pressure necessary to achieve a bloodless surgical field, known as a patient’s limb occlusion pressure (LOP). However, LOP is not yet routinely measured in all patients due to limitations of current techniques. We have evaluated a novel technique for measuring the LOP through the tourniquet cuff that overcomes many limitations of current LOP measurement techniques.

Methods:

The new technique of measuring LOP involves the use of unique dual-purpose disposable tourniquet cuffs along with a tourniquet instrument containing LOP calculation sensors and software. A randomized crossover multicenter trial with 143 pre-surgical or post-surgical patients enrolled in the study. Pneumatic cuffs were applied to the non-operative upper and lower limbs and LOP was measured using the new technique and the Doppler ultrasound technique. For each patient a set of four LOP measurements was taken, using the new technique (experimental) and the Doppler technique (control) on one upper and one lower limb. Blinding was achieved during LOP measurement by using two experimenters and blinding the experimenter who measured the LOP using Doppler ultrasound from the LOP reading using the new automatic technique. Participants were blinded from all LOP measurement results by keeping the displays of measurement equipment out of their view.

Results:

The differences between the new technique and Doppler technique were neither statistically nor clinically significant and the new technique is as robust as the Doppler technique. The results of this study can be used to develop personalized tourniquet systems consisting of unique dual-purpose cuffs connected to instruments suitable for measuring tourniquet LOP with the new measurement technique. The simplicity, effectiveness, and accuracy of this technique should lead to broader clinical usage and acceptance of LOP measurement, thus leading to safer, personalized pressures in surgical tourniquet applications.

Conclusion:

The new technique is equally robust as the Doppler technique. Both techniques worked successfully in the 252 limbs from which usable data was collected. Of the 34 limbs for which there were data collection errors or exclusion, only two measurements were excluded because of an instrument error using the automatic technique compared to one measurement excluded because of a Doppler technique measurement error.