bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding of Informed Consent and Surgeon Liability by the Public and Patients
Authors: Amarasekera SS , Lander RO
Published: October 2016

Purpose.

To evaluate understanding of the fundamental concepts of informed consent by the public and patients.

Methods.

Questionnaires were distributed to any persons (aged more than 16 years) attending the Palmerston North Hospital (excluding in-patients). The first 1000 completed questionnaires were analysed using the Chi squared test.

Results.

The fundamental concepts of informed consent were not appreciated by most respondents; only 18%, 13%, and 5% of them agreed with its implications in terms of self-autonomy, confidentiality, and battery, respectively. 64% of respondents preferred to take sole responsibility to decide which procedure to undergo, 31% preferred to be guided by the surgeon, and 5% by a brief explanation only. 21% of the respondents considered the surgeon liable in the event of an unmentioned rare complication, 43% considered the surgeon not liable, and 34% were undecided.

Conclusion.

Understanding of medico-legal implications of informed consent (e.g. self-autonomy, confidentiality, and battery) by the public and patients is poor. Their expectations regarding self-autonomy seem unrealistic. It is time for surgeons, legal experts, and the public to confer and make informed consent a practical, user-friendly tool rather than the legal obstacle that it is today.
Effect of the Deyo Score on Outcomes and Costs in Shoulder Arthroplasty Patients
Authors: Humphries W , Jain N , Pietrobon R , Socolowski F , Cook C , Higgins L
Published: October 2016

Purpose.

To evaluate the effect of preoperative comorbidity status (defined by the Deyo index) on hospital mortality, postoperative complications, length of hospital stay, and hospital costs for shoulder arthroplasty patients.

Methods.

The overall mean hospital mortality and postoperative complication rates, and length of hospital stay and hospital costs stratified by the Deyo score were compared using the Pearson Chi squared test and the F-test, respectively. The effects of the Deyo score on hospital mortality and postoperative complications were estimated using multiple logistic regression. The length of hospital stay and hospital costs were estimated using multiple linear regression. The magnitude of the estimated effects of the Deyo score on the 4 outcomes were expressed as crude odds ratios (ORs) and adjusted ORs for age, race, gender, surgeon volume, and hospital volume.

Results.

Higher Deyo scores tended to be associated with higher hospital mortality, length of hospital stay, postoperative complications, and hospital costs. Compared with the referent group (Deyo score=0), patients with the highest Deyo scores (5–36) exhibited adjusted ORs of 11.8 for hospital mortality (p=0.011) and 1.1 for developing postoperative complications (p=0.098), and had the highest length of hospital stay (mean, 4.1 days) and hospital costs (mean, US$18 549).

Conclusion.

The Deyo score was a predictor of outcomes and costs in the shoulder arthroplasty population. By identifying relevant factors, health care providers can better determine who should be referred for shoulder arthroplasty and what should be considered when assessing risks and benefits.
Harris-Galante II Acetabular Cup: A Survival Analysis
Authors: Curry HG , Lynskey TG , Frampton CM
Published: October 2016

Purpose.

To determine the survival rate of the Harris-Galante (HG) II cup and identify factors contributing to failure.

Methods.

271 primary total hip arthroplasties (THAs) performed between 1992 and 1999 in our hospitals using the HG II acetabular cup were retrospectively reviewed due to a high incidence of liner dissociation.

Results.

48 THAs were revised, 32 (67%) of which were due to liner dissociation. The Kaplan-Meier 10-year survival rate was 73%. Dislocation (p<0.001) and acetabular size (p=0.042) were independent predictors of acetabular component failure in the Cox's regression model.

Conclusion.

The long-term outcome of the HG II cup is unsatisfactory. Although the HG II cup is no longer produced, numerous patients have this prosthesis in situ and should be reviewed regularly, as liner dissociation and retroacetabular osteolysis may occur.
Laminoplasty for Patients Aged 75 Years or Older with Cervical Myelopathy
Authors: Ishii M , Wada E , Ishii T , Kawai H , Kaneko N , Fuji T
Published: October 2016

Purpose.

To assess the neurological and walking status of 56 elderly patients after cervical myelopathy to determine whether the surgery was justified.

Methods.

Records of 23 men and 33 women aged 75 to 86 (mean, 79) years who underwent laminoplasty for cervical myelopathy were retrospectively reviewed. They had been followed up for a mean of 3.5 (range, 0.2–8.6) years. Walking status was assessed according to long-term care insurance criteria. In 45 patients with more than 2 years of follow-up, neurological status was evaluated according to the Japanese Orthopaedic Association (JOA) score. Neurological recovery rate was classified as excellent, good, fair, poor, and worse.

Results.

Postoperatively, of the 47 patients still living, 22 could walk independently, 22 required assistance outdoors, 2 were using a wheelchair, and one was bedridden. The mean JOA score was 9.7 preoperatively, 12.2 one year postoperatively, and 11.8 at final assessment (p<0.001). The mean neurological recovery rate was 29% at one-year follow-up and 24% at final assessment (p=0.06).

Conclusion.

Although excellent results were not expected in elderly patients, surgery to maintain independent walking status was justified in most of our patients.
Axillary Artery Injury Secondary to Displaced Proximal Humeral Fractures: A Report of Two Cases
Authors: Modi CS , Nnene CO , Godsiff SP , Esler CNA
Published: October 2016

We report 2 cases of axillary artery injury secondary to low-energy proximal humeral fractures. In case 1, early diagnosis based on signs of acute ischaemia of the arm enabled early treatment and a favourable outcome. In case 2, there were no signs of ischaemia or neurological deficit, resulting in delayed diagnosis and increased severity of the injury. The patient developed a false aneurysm and sepsis and eventually died. A high index of suspicion is necessary for diagnosing an axillary artery injury. We recommend that all patients with proximal humeral fractures with severe medial displacement of the shaft and a bone spike should routinely undergo Doppler ultrasound scanning to rule out vascular injuries and the presence of a false aneurysm.
Surgical Wound Mucormycosis Necessitating Hand Amputation: A Case Report
Authors: Chew HH , Abuzeid A , Singh D , Tai CC
Published: October 2016

We report an unusual case of cutaneous mucormycosis in a 17-year-old man who had no risk factors for fungal infection. The aggressive nature of cutaneous mucormycosis is illustrated. A high index of suspicion is crucial for identifying and preventing progression of this disease, which can lead to limb amputation, even death. Extra vigilance should be given to those who are immunocompromised, including those receiving short courses of steroids. Early recognition, prompt surgical intervention and initiation of an appropriate antifungal treatment are crucial in the management of this rare but potentially limb- and life-threatening infection.
Dynamic Movement of the Long Head of the Biceps Tendon in Frozen Shoulders
Authors: Kanbe K , Inoue K , Inoue Y
Published: October 2016

Purpose.

To assess the importance of the dynamic movement of the long head of the biceps (LHB) tendon for treatment of frozen shoulder.

Methods.

87 consecutive patients (with 88 frozen shoulders) aged 36 to 77 (mean, 54) years underwent arthroscopic capsular release by a single surgeon. Preoperative treatments included rehabilitation, steroid and/or hyaluronic acid injections. The inclusion criteria were severe night pain, no improvement of flexion and external rotation, and poor response to rehabilitation for at least 6 months. Shoulders were divided into 3 types; types A/B/C indicate slight/moderate/severe degree of synovitis and adhesion of the LHB tendon to the rotator interval. 23 shoulders were type A, 26 type B, and 39 type C. 18 of the 39 type-C shoulders were controls with release of the capsule alone but not the LHB tendon. Patients were followed up for a mean of 21 (range, 12–35) months. Changes in the American Shoulder and Elbow Surgeons (ASES) score, range of movement, and muscle strength (flexion and external rotation) among types A, B, C, and controls were compared.

Results.

The severity of the adhesion of the LHB tendon to the rotator interval was associated with the ASES score. In all adhesion types, muscle strength and the range of movement in flexion, external rotation, and internal rotation improved postoperatively.

Conclusions.

Arthroscopic capsular release for adhesion of the LHB tendon to the rotator interval improves the sliding movement and thereby shoulder function.
Anatomic Study for Pubic Medullary Screw Insertion
Authors: Suzuki T , Soma K , Shindo M , Minehara H , Itoman M
Published: October 2016

Purpose.

To study the anatomy of the pubic ramus and adjacent structures in 160 Japanese to establish a safer pubic screw fixation technique.

Methods.

80 male and 80 female Japanese aged 16 to 89 (mean, 50) years (10 persons in each decade of age) underwent 3-dimensional computed tomographic scanning of their pelvises. The angle at which the screw should be targeted, the appropriate length of the screw, the size of the canal for screw insertion, and the proximity to the bladder, iliac artery, and iliac vein were determined. Correlations between the canal diameters (of the acetabular, base, and parasymphyseal areas) and body features (age, height, and weight) were analysed.

Results.

In men and women respectively, the appropriate mean screw length was 124.6 and 123.8 mm; the guide wire should be targeted at a mean of 66° and 67° cephalad and 54.1° and 55.9° laterally for insertion of a retrograde pubic screw; the minimum distances from the pubis to the bladder/iliac artery/iliac vein were 0 and 0 mm/4.9 and 4.6 mm/0.8 and 0.2 mm. In both men and women, the canal diameters at the base were positively correlated to weight. In women, the canal diameters at the parasymphyseal area were correlated to height and weight. Canal diameters at the acetabulum were not correlated to height and weight.

Conclusion.

Pubic screw fixation may be potentially disastrous (owing to joint penetration and iliac vein injury) and should be performed with caution. When the canal diameter at the acetabulum is extremely narrow, plate fixation, computer-assisted surgery, or changing to a smaller-diameter screw is recommended.
Reconstruction of Large Sacral Defects following Tumour Resection: A Report of Two Cases
Authors: Cheong YW , Sulaiman WA , Halim AS
Published: October 2016

Sacral tumours often present surgical resection and reconstruction challenges. Wide resections result in large sacral defects and neoadjuvant radiotherapy impairs wound healing. The wounds need to be covered with bulky, well-vascularised, healthy tissues. We present 2 cases where large sacral defects were reconstructed following tumour resection. Both defects were reconstructed with inferiorly based, transpelvic, pedicled vertical rectus abdominis myocutaneous flaps. This is a robust flap and carries a well-vascularised muscle bulk and skin paddle. The donor site is distant from the lesion site and is thus unaffected by both the resection and radiotherapy. This is a useful flap for reconstructing large sacral defects.
Spinal Infection Caused by Mycobacterium Avium Complex in a Patient with No Acquired Immune Deficiency Syndrome: A Case Report
Authors: Wong NM , Sun LK , Lau PY
Published: October 2016

Spinal infection caused by Mycobacterium avium complex (MAC) is rarely seen in people who do not have acquired immune deficiency syndrome. We report such a case in a 60-year-old man who underwent anterior spinal fusion after treatment with antibiotics had failed. The presentation of MAC spinal infection is different from that seen in MAC lung infection, with more than half presenting with urgent or semi-urgent neurological deficits. Younger patients who are not immunocompromised can also be infected. It should be considered as a differential diagnosis in patients with tuberculosis of the spine. The use of antibiotics should be based on the cultured organism's sensitivity results. Indications for surgery are progressive bony destruction, abscess formation, and neurological compression.
The Use of a Reverse Flow Sural Fasciocutaneous Flap in a Patient with Multiple Trauma: A Case Report
Authors: Ip KC , Lee KB , Shen WY
Published: October 2016

Provision of soft-tissue coverage for defects in the distal leg and foot is a challenge, especially in patients with multiple injuries and major soft-tissue defects. Major flap reconstruction requires expertise and the results are variable, with high morbidity. We report a case in which a reverse flow sural fasciocutaneous flap was used for treatment of an open fracture-dislocation of the right ankle after repeated debridement in a 64-year-old man with a history of chronic smoking, diabetes mellitus, and hypertension.
Salvage Arthrodesis for Fracture-Dislocation of the Cuneonavicular and Calcaneocuboid Joints: A Case Report
Authors: Kang GC , Rikhraj IS
Published: October 2016

We present a 22-year-old man with dislocation of both the calcaneocuboid and cuneonavicular joints and fractures of the calcaneum and navicular of the right foot. The joints were reduced with percutaneous Kirschner wires, but the disrupted dorsal cuneonavicular ligaments were left unrepaired. Reduction was suboptimal and the joints were subluxed resulting in disabling arthralgia. Six months later, he underwent salvage arthrodesis of the subluxed calcaneocuboid and cuneonavicular joints. At 24-month follow-up, the patient had returned to work and remained pain-free when walking, with good fusion of both joints. Early anatomic reduction, stable fixation, and ligament reconstruction are essential for a good outcome. Arthrodesis is indicated when subluxation and posttraumatic arthritis are present. Primary arthrodesis is a viable option for severe midfoot fracture-dislocations, because it facilitates rehabilitation and functional recovery, and obviates the need for a secondary arthrodesis should arthritis arise.
Heparin versus Danaproid for Prevention of Venous Thromboembolism after Hip Surgery
Authors: Nakase J , Toribatake Y , Mouri Y , Seki H , Kitaoka K , Tomita K
Published: October 2016

Purpose.

To compare the prevalence of deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), and bleeding complications in patients receiving heparin or danaproid after hemiarthroplasty or osteosynthesis for hip fractures.

Methods.

37 men and 138 women aged 47 to 100 (mean, 80) years underwent either hemiarthroplasty or osteosynthesis for hip fractures; 5 patients with dementia were excluded. All patients received preoperative elastic stocking and postoperative intermittent pneumatic compression. They were divided into 3 groups based on their admission period: controls (n=71), unfractionated heparin (n=44), and danaproid sodium (n=55). Drugs were administered from postoperative day 1 to 7. At day 7, all patients undertook radioisotope venography of the legs and lung perfusion scintigraphy.

Results.

In the control, heparin, and danaproid groups respectively, the DVT rates were 31%, 9.1%, and 5.5%, and the PTE rates were 5.6%, 4.5%, and 1.8%. Only the DVT rate in the control group was significantly higher than that in the heparin and danaproid groups. In the heparin group, one patient had gastrointestinal bleeding, 5 developed wound haematomas, and one had leakage from the drain site for 2 weeks.

Conclusion.

Danaproid sodium appeared more effective and safer than heparin, with no bleeding complications occurred.
Philos Plate Fixation for Proximal Humeral Fractures
Authors: Martinez AA , Cuenca J , Herrera A
Published: October 2016

Purpose.

To evaluate the efficacy of Philos plate fixation for proximal humerus fractures.

Methods.

Functional outcomes of 31 men and 27 women aged 36 to 73 (mean, 61) years who underwent Philos plate fixation for proximal humeral fractures were retrospectively reviewed. Indications for surgery were 3-part (n=33) or 4-part (n=25) closed proximal humeral fractures with angulation of more than 45 degrees or displacement of more than 1 cm. Functional outcomes and shoulder range of movement were assessed based on the Constant scoring system.

Results.

Patients were followed up for 12 to 18 (mean, 15) months. All fractures healed satisfactorily, except in one patient with a valgus 4-part fracture who had malunion. No wound infections, vascular injuries, avascular necrosis, or loss of fixation ensued. Two patients with axillary nerve palsy recovered spontaneously within 3 months. Functional outcome was excellent in 13 patients, good in 36, moderate in 8, and poor in 1. The mean Constant score was 80 (range, 40–100).

Conclusion.

The Philos plate fixation is appropriate treatment for proximal humeral fractures.
Unreamed Intramedullary Nailing with Oblique Proximal and Biplanar Distal Interlocking Screws for Proximal Third Tibial Fractures
Authors: Singh VK , Singh Y , Singh PK , Goyal RK , Chandra H
Published: October 2016

Purpose.

To assess the outcome of unreamed intramedullary nailing through the lateralised entry point using oblique proximal and biplanar distal interlocking screws.

Methods.

15 men and 3 women aged 25 to 58 (mean, 37) years underwent unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws for proximal third metaphyseal tibial fractures. The entry point was kept proximal to the tibial tuberosity and slightly lateral to midline. Proximal locking was at 45° to the coronal and sagittal planes. Biplanar distal locking was in the coronal and sagittal planes.

Results.

16 patients had bone union within 20 (mean, 17; range, 14–27) weeks; 2 underwent dynamisation for delayed union. Three patients had valgus angulation of <5°; 2 had a loss of terminal knee flexion; 3 had a loss of ankle dorsiflexion; and 3 had shortening of >0.5 cm. Functional outcomes were excellent in 13, good in 4, and fair in one patient. No patient endured neurovascular injury, compartment syndrome or implant failure.

Conclusion.

Unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws for proximal third tibial fractures was effective in preventing malalignment.
Total Hip Arthroplasty Using Proximal Porous Coating Stem with Distal Sleeve: Mid-Term Outcome
Authors: Saito M , Takahashi KA , Fujioka M , Ueshima K , Sakao K , Inoue S , Kubo T
Published: October 2016

Purpose.

To report mid-term results of total hip arthroplasty (THA) using the Opti-Fix Plus Hip System (Opti-Fix Hip), and to assess the correlations between peri-implant bone changes and the distal medullary occupancy rate.

Methods.

11 men (13 hips) and 53 women (58 hips) aged 24 to 87 (mean, 61) years underwent THA using the Opti-Fix Hip, with a modular stem and a distal sleeve, and were followed up for a mean of 6.5 (range, 4.8–9.6) years. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) hip score. Implant stability, bone changes around the implant, and the occupancy rate of the stem in the medullary space were examined radiologically. Bone changes around the implant were assessed based on the radiological evidence of a pedestal, osteolysis, stress shielding, and radiolucent lines.

Results.

The mean JOA score increased significantly after surgery and was maintained at the latest follow-up. Around the acetabular and femoral components respectively, 38 and 58 hips had radiolucent lines, whereas one and 54 hips developed osteolysis. A pedestal appeared in 21 hips and grade-III or higher stress shielding in 30 hips. Two hips showed loosening of the acetabular components, but none in the femoral components. Osteolysis around the stem was frequently observed in hips with poor distal medullary occupancy.

Conclusion.

Clinical and radiological outcomes of the Opti-Fix Hip were favourable. The low incidence of osteolysis in the distal stem suggests that the proximal circumferential porous coating was effective. Minor osteolysis around the proximal stem was frequently observed, indicating early excessive wear of the polyethylene liner. Its high distal medullary occupancy rate could inhibit stem micromotion and aseptic loosening.
Comparison of Acetabular Reamings during Hip Resurfacing versus Uncemented Total Hip Arthroplasty
Authors: Brennan SA , Harty JA , Gormley C , O'Rourke SK
Published: October 2016

Purpose.

To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA).

Methods.

62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed.

Results.

The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57).

Conclusion.

In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.
Arthroscopy-Assisted Computer Navigation in High Tibial Osteotomy for Varus Knee Deformity
Authors: Lo WN , Cheung KW , Yung SH , Chiu KH
Published: October 2016

Purpose.

To assess the accuracy of knee alignment after high tibial osteotomy (HTO) for varus knee deformity using arthroscopy-assisted computer navigation.

Methods.

Six men and 4 women aged 47 to 53 (mean, 49) years underwent medial open wedge HTO for varus knee deformity and medial unicompartmental osteoarthritis using arthroscopy-assisted computer navigation with fluoroscopy. Patients were followed up for a mean of 23 (range, 11–32) months. Intra- and post-operative leg alignments were compared.

Results.

The mean postoperative coronal plane alignment was 2.7 (range, 1–4) degree valgus; the mean deviation from intra-operative computer images was one (range, 0.1–1.9) degree; 5 knees had less valgus in the postoperative radiographs than the intra-operative computer images.

Conclusion.

Despite being more technically demanding, time consuming, and costly, arthroscopy-assisted computer navigation is safe, accurate, and reliable for HTO.
Cytokine Synthesis by Chondroblastoma: Relation to Local Inflammation
Authors: Uchikawa C , Shinozaki T , Nakajima T , Takagishi K
Published: October 2016

Purpose.

To investigate cytokine production by chondroblastoma in inducing local inflammation and adjacent-joint arthritis.

Methods.

Immunohistochemical analyses of curetted tissues using anti-human interleukin (IL)-1β, IL-6, IL-8, and tumour necrosis factor (TNF)-α were performed for 6 patients with chondroblastoma and 3 patients with giant cell tumour (GCT) of bone. In addition, prostaglandin E2, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, and TNF-α in the cyst fluid of one of the patients with chondroblastoma and 2 with GCT of bone were measured using immunoassay kits.

Conclusion.

Cytokines such as IL-1β, IL-8, TNF-α, and particularly IL-6 play an important role in local inflammation in patients with chondroblastoma.
Continuous Decompression Using a Cannulated Ceramic Pin for Simple Bone Cysts
Authors: Morii T , Mochizuki K , Satomi K
Published: October 2016

Purpose.

To report the outcomes of continuous decompression using a cannulated ceramic pin for simple bone cysts (SBCs).

Methods.

Seven boys and 3 girls aged 7 to 16 (mean, 11) years with SBCs underwent curettage and continuous decompression using a cannulated ceramic pin. The pin was made of hydroxyapatite and tricalcium phosphate. The clinical course, radiological findings, and complications were retrospectively assessed.

Results.

The mean follow-up duration was 41 (range, 12–84) months. Five patients were evaluated as ‘healed’, 2 as ‘healing with defect’, one as ‘persistent cyst’, and 2 as ‘recurrent cysts’. No peri-operative complications were encountered. One patient had a postoperative fracture at the pin insertion site. Seven patients had pain relief and good outcomes; 2 had a thin cortical rim and complained of occasional pain and their sports activities were restricted.

Conclusion.

Decompression using a cannulatedceramic pin for SBCs is minimally invasive, highly osteoconductive, and does not require bone grafting or a second operation to remove the device.
Conservative Management of Idiopathic Clubfoot: Kite versus Ponseti Method
Authors: Sanghvi AV , Mittal VK
Published: October 2016

Purpose.

To compare the long-term results of the Kite and Ponseti methods of manipulation and casting for clubfoot.

Methods.

42 patients (with 64 idiopathic clubfeet) were equally randomised to Kite or Ponseti treatments in the early weeks of life. 14 males and 7 females (34 clubfeet) were treated by the Kite method, whereas 13 males and 8 females (30 clubfeet) were treated by the Ponseti method. All the clubfeet were manipulated, casted, and followed up (for a mean of 3 years) by one experienced orthopaedic surgeon. The final results were compared.

Results.

The success rates for the Kite and Ponseti treatments were similar (79% vs 87%). With the Ponseti method, the number of casts was significantly fewer (7 vs 10); the duration of casting required to achieve full correction was significantly shorter (10 vs 13 weeks); the maximum ankle dorsiflexion achieved was significantly greater (12 vs 6 degrees); and the incidence of residual deformity and recurrence was slightly lower.

Conclusion.

The Ponseti method can achieve more rapid correction and ankle dorsiflexion with fewer casts, without weakening the Achilles tendon.
Review Article: Validity of the KT-1000 Knee Ligament Arthrometer
Authors: Arneja S , Leith J
Published: October 2016

The KT-1000 knee arthrometer (KT-1000) is an objective instrument to measure anterior tibial motion relative to the femur for anterior cruciate ligament (ACL) reconstruction. Four studies between 1950 and 2007 regarding validity of the KT-1000 were identified using a Medline search. One had interpretable information on sensitivities, specificities, and predictive values to validate the instrument as a diagnostic tool in patients with acute or chronic ACL injuries. Three had limitations in methodology. We suggest that the KT-1000 should be used with caution as an objective instrument. Rather, using a KT-1000 score derived by subtracting the anterior tibial motion relative to the femur of the injured knee to that of the uninjured knee may be more appropriate as a dichotomous diagnostic test with a threshold of 2 or 3 mm.
Open Reduction and Internal Fixation for Concomitant Talar Neck, Talar Body, and Medial Malleolar Fractures: A Case Report
Authors: Isaacs J , Courtenay B , Cooke A , Gupta M
Published: October 2016

Fractures of the talus are rare and generally associated with severe trauma. The mechanism of injury is usually forced dorsiflexion or a fall from a height. Severe talar fractures pose a challenge for surgeons as they are often associated with complications such as avascular necrosis, collapse, malunion, secondary osteoarthritis and pain. This has led some institutions to advocate primary arthrodesis for these injuries. We report an unusual complex fracture of the talus that was successfully managed with open reduction and internal fixation. By restoring a near-normal range of motion and function to a fit, young male, the severely limiting effects of arthrodesis were avoided or at least delayed. We use this case to highlight that primary arthrodesis should only be reserved for cases that fail to respond to open reduction and internal fixation or deteriorate to the point where it is the only reasonable and justifiable alternative.
Chronic Recurrent Multifocal Osteomyelitis of the First Metatarsal Bone: A Case Report
Authors: Chiu CK , Singh VA
Published: October 2016

We report a case of chronic recurrent multifocal osteomyelitis in a 9-year-old girl. She presented with a 9-month history of gradually worsening pain and swelling in her left foot. Non-steroidal anti-inflammatory drugs were prescribed but the symptoms persisted. She underwent curettage through a small oval corticotomy window on the first metatarsal bone. The pain and swelling improved promptly and she was able to walk without pain 2 weeks later. Curettage enabled rapid symptomatic relief and induced remission, with little risk of complications.
Tubercular Osteomyelitis of the Clavicle: A Report of Four Cases
Authors: Aggarwal AN , Dhammi IK , Singh AP , Kumar S , Goyal MK
Published: October 2016

We report the clinicoradiological features of tuberculosis in the clavicle in 4 patients. The patients' ages ranged from 9 months to 29 years. All patients were managed with antitubercular drug therapy for one year and one underwent surgical debridement and curettage as well. Clinicians should be aware of the varied presentation (pain, non-healing ulcer, abscess, multifocal osteoarticular tuberculosis) of this condition. With the worldwide resurgence of turberculosis, clinicians should maintain a high index of suspicion. The diagnosis of osteoarticular tuberculosis is usually made on clinico-radiological features.
Pigmented Villonodular Synovitis of the Elbow with a Fenestrated Fossa: A Case Report
Authors: Wyatt MC , Rolton N , Veale GA
Published: October 2016

We report a case of pigmented villonodular synovitis of the elbow in a 55-year-old woman. Its radiological feature, the fenestrated fossa, may be characteristic of the advanced stage of this disorder.
Morphology of the Scapula Relative to the Reverse Shoulder Prosthesis
Authors: Torrens Carlos , Corrales Monica , Gonzalez Gemma , Solano Alberto , Caceres Enrique
Published: October 2016

Purpose.

To analyse the morphology of the scapula relative to the reverse shoulder prosthesis.

Methods.

Scapulas of 46 women and 27 men aged 16 to 84 (mean, 53) years with proximal humeral fractures (n=52) or recurrent antero-inferior instability (n=21) were assessed using 3-dimensional computed tomography (CT). For comparison, 108 cadaveric scapulas with unknown epidemiology were assessed using a goniometer and a caliper. The length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula, and the angles between the major craneocaudal glenoid axis and (1) the base of the coracoid process and (2) the upper posterior column of the scapula were assessed.

Results.

The length of the glenoid neck was classified into short and long. In the respective CT and cadaveric groups, the anterior glenoid neck was short in 42% and 18% of scapulas and long in 58% and 82%, whereas the posterior glenoid neck was short in 34% and 60% of scapulas and long in 66% and 40%. The angle between the glenoid surface and the upper posterior column of the scapula was classified into types I (50°–52°) and II (62°–64°). In the respective CT and cadaveric groups, 61% and 71% of scapulas were type I and 39% and 29% were type II. All differences between groups were significant. The mean angles between the major craneocaudal glenoid axis and (1) the base of the coracoid process and (2) the upper posterior column of the scapula were 18° and 8°, respectively.

Conclusion.

Because of variations in scapular morphology, individualised adjustment is needed for reverse shoulder prostheses. Three-dimensional CT is valuable in preoperative planning.
Early Results of Total Knee Arthroplasty with a Low Contact Stress Anteroposterior Glide
Authors: Bauze Adrian J , Falworth Mark S , Oakeshott Roger D
Published: October 2016

Purpose.

To present early results of 400 consecutive low contact stress (LCS) anteroposterior (AP) glide total knee arthroplasties (TKAs) performed by a single surgeon.

Methods.

304 consecutive patients aged 30 to 96 (mean, 66) years underwent 400 TKAs using LCS AP glides performed by a single surgeon. Only patients with an intact posterior cruciate ligament, a fixed flexion deformity of <15°, and a valgus deformity of <15° were included. Patients were assessed pre- and post-operatively using the American Knee Society (AKS) and Hospital for Special Surgery (HSS) scores. Range of motion was measured using a goniometer. AP and lateral radiographs were assessed for radiolucencies and osteolysis.

Results.

The mean follow-up period was 4.2 (range, 1–8) years. The mean fixed flexion improved to 1° from 11° and the mean active flexion improved to 120° from 111°. Both AKS and HSS scores improved significantly. There were 28 anterior soft tissue impingements; 9 of them were in the first year of the study. Thereafter, the anterior lip of the bearing was modified and any offending osteophytes, soft tissue, or fat pads were excised. Of 39 (10%) knees that underwent re-operation (16 were due to anterior soft tissue impingement), 20 (5%) did not require change of the AP glide bearing and the remaining 19 were converted to a rotating platform bearing. No patellar baja was noted after fat pad excision. No patient had catastrophic wear or failure of the polyethylene bearing. The survival rate of the AP glide bearing was 95%.

Conclusion.

The early-to-mid-term outcomes of the LCS AP glide TKA are promising.
Pick-up Test: An Indication for Opponensplasty in Patients with Severe Carpal Tunnel Syndrome
Authors: Yip Siu-Leung , Yen Chi-Hung , Chan Wai-Lam , Leung Hon-Bong , Mak Kan-Hing
Published: October 2016

Purpose.

To use a pick-up test to assess thenar motor deficit and results of opponensplasty.

Methods.

Eight consecutive patients with idiopathic severe carpal tunnel syndrome and severe thenar motor deficit were identified. All were females aged 39 to 60 (mean, 53) years and right-hand dominant. The severity of thenar motor deficit was assessed using the pick-up test. Failure to pick up a coin with the thumb and index finger only in a normal pulp-to-pulp pincer grip was an indication for an opponensplasty (in addition to open carpal tunnel release) to hasten recovery of thumb abduction. Treatment outcome was assessed using the pick-up test at 6, 8, and 12 weeks.

Results.

Preoperatively, all patients were unable to perform the pick-up test. At postoperative 6 weeks, all patients could pick up the coin with no difficulty and were satisfied with the result of opponensplasty. There was no relapse at subsequent follow-ups and no donor-site morbidity in terms of cosmesis, scar pain or infection. Grip strength and the range of wrist motion were 63% and 92% of the normal side, respectively.

Conclusion.

The pick-up test is a simple and reliable means of identifying those in need of an opponensplasty.
Flexor Hallucis Longus Tendon Transfer for Reconstruction of Chronically Ruptured Achilles Tendons
Authors: Mahajan Ravindra H , Dalal Rakesh B
Published: October 2016

Purpose.

To report the mid-term results of flexor hallucis longus (FHL) tendon transfer for reconstruction of chronically ruptured Achilles tendons.

Methods.

24 men and 12 women aged 56 to 78 (mean, 70) years underwent FHL tendon transfer for reconstruction of chronically ruptured Achilles tendons by a single surgeon. Ruptures were secondary to trauma (n=20), long-term steroid intake (n=12), or chronic renal failure (n=6). Two patients had bilateral ruptures. The mean interval from rupture to surgery was 15 (range, 12–24) weeks. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scores were compared. Wound healing, push-off, and patient satisfaction were evaluated.

Results.

The mean follow-up period was one year. The mean AOFAS scores were 69 (range, 58–76) preoperatively and 88 (range, 79–94) postoperatively; the mean improvement was 19 (p<0.001). 28 patients had excellent and 8 had fair results. 33 patients graded their outcome as ‘very satisfactory’ and 3 as ‘satisfactory’. Five patients developed wound healing complications but only one needed debridement. There was no fixation-related complication or sural nerve injury.

Conclusions.

Transfer of the FHL for reconstruction of chronically ruptured Achilles tendons is effective, safe and easily performed in patients with low-to-moderate demands.
A Life-Threatening Abscess in a Patient Treated with a Tumour Necrosis Factor-Alpha Antagonist: A Case Report
Authors: Cadosch Dieter , Neukom Lisa , Gautschi Oliver P , Zellweger Rene
Published: October 2016

A 25-year-old man with a 3-year history of ankylosing spondylitis presented with a sudden onset of pain in his left thigh. His ankylosing spondylitis had been treated for 2 years with the tumour necrosis factor-alpha (TNF-α) antagonist infliximab. The initial diagnosis was a muscular tear, and non-steroidal anti-inflammatory drugs were prescribed. 40 days later, the patient had tender swelling with warmth and light redness on his left thigh. His knee function had decreased markedly. His C-reactive protein level was 320 mg/l and white cell count was 30.4 times109/l, indicating severe infection. Magnetic resonance imaging revealed a loculated fluid collection in the quadriceps musculature measuring 30 cm. Hyperintensity seen on T1-weighted images was suggestive of infection. The infliximab therapy was stopped and repeated debridement and drainage performed, with about 2.5 litres of pus evacuated. Flucloxacillin was administered for 2 weeks. The wound was closed 9 days later. The patient was discharged 20 days after surgery. An alternative immunosuppressive therapy—abatacept—was introduced. At the 18-month follow-up, the patient reported only light discomfort in the thigh during exercise, with a mildly impaired range of knee movement. No infectious complications recurred.
Arthroscopic Repair of the Triangular Fibrocartilage Complex Using a Hypodermic Needle: A Technical Note
Authors: Mahajan Ravindra H , Kim Sung-Jae , Song Dae-Heup , Kang Young-Hoon , Park Kwang-Yeoul
Published: October 2016

Tears of the triangular fibrocartilage complex (TFCC) often lead to chronic wrist pain. The commonly used 2-needle outside-in and inside-out suturing techniques require an extra incision to tie the sutures subcutaneously. We use a practical and cost-effective arthroscopic technique for treatment of peripheral Palmer type 1B TFCC tears using a hypodermic needle. This obviates the need for an additional skin incision, thus lowering the risk of neurovascular damage, reducing postoperative pain, and enabling faster rehabilitation and better cosmesis.
Autologous Transplantation of the Interphalangeal Joint: A Case Report
Authors: Zein Ali , Alkhooly AA
Published: October 2016

A 35-year-old woman presented with a pathological fracture of a solitary cystic enchondroma in the proximal phalanx of her right index finger (extending to the articular surface with expansion of the cortex). The affected segment was excised and reconstructed with an autograft from the proximal phalanx of her right third toe. At the 2-year follow-up, the graft was well taken, the articular cartilage was intact, and the range of motion was good. There was no evidence of osteoarthrosis.
Bilateral Pathological Hip Fractures in a Patient with a Bipulmonary Transplant: A Case Report
Authors: Seijas Roberto , Ares Oscar , Malik Aamer , Maled Ignacio
Published: October 2016

The use of immunosuppressive agents to prevent tissue rejection may predispose patients to osteoporosis and fractures. We report a case of bilateral pathological hip fractures in a woman with osteoporosis who had undergone a bipulmonary transplant. To reduce the risk of pathological fractures, patients are given prophylaxes for osteoporosis prior to organ transplantation, but they remain at increased risk of fractures. They should be informed that this side-effect may occur after transplantation.
Fracture of the Unresurfaced Patella after Total Knee Arthroplasty: A Report of Two Cases
Authors: Seijas Roberto , Orduna Juan Manuel , Castro MC , Granados Nuria , Baliarda Jordi , Alcantara Emili
Published: October 2016

Patellar fractures are unusual in total knee arthroplasty without patellar resurfacing. We present 2 such cases that occurred within postoperative 2 months and were managed conservatively. Both patients had their knee function preserved.
Thrombosis Markers in Hip versus Knee Arthroplasty: A Pilot Study
Authors: Reikeras Olav , Clementsen Torkil
Published: October 2016

Purpose.

To compare the thrombosis markers for thrombosis and fibrinolysis in patients undergoing hip versus knee arthroplasty.

Methods.

Seven women aged 38 to 61 years who underwent total hip arthroplasty (THA) and 7 women aged 57 to 67 years who underwent total knee arthroplasty (TKA) were studied. Thromboprophylaxis was given before and after surgery. In patients undergoing TKA, an automatic pneumatic tourniquet was used. Blood samples were drawn (1) before surgery (control value), (2) at wound closure (immediately before release of the tourniquet in TKA), and (3) 4 hours after surgery. Thrombosis markers (prothrombin fragment 1.2 [F1.2], plasmin/α2-antiplasmin complex [PAP], and D-dimer) of the 2 groups were compared.

Results.

The F1.2 level increased significantly at wound closure and remained elevated 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group. The PAP level was constant peri- and post-operatively in the THA group, whereas it increased significantly 4 hours after surgery in the TKA group. The D-dimer level increased significantly at wound closure and 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group.

Conclusion.

Systemic thrombin generation starts perioperatively in THA and after tourniquet deflation in TKA, indicating that wound blood must reach the systemic circulation to activate the relevant mediators.
Pulse-Lavage Brushing Followed by Hydrogen Peroxide-Gauze Packing for Bone-Bed Preparation in Cemented Total Hip Arthroplasty: A Bovine Model
Authors: Ackland David C , Yap Vincent , Ackland Margaret L , Williams John F , de Steiger Richard
Published: October 2016

Purpose.

To compare the effectiveness of pulse-lavage brushing followed by hydrogen peroxide–gauze packing with either technique alone or normal-saline irrigation in bone-bed preparation for cemented total hip arthroplasty.

Methods.

44 fresh-frozen ox femoral canals were prepared for cemented total hip arthroplasty using 4 techniques: normal-saline irrigation, pulse-lavage brushing, hydrogen peroxide–soaked gauze packing, and a combination of the latter 2 techniques. The maximum tensile pull-out force required to separate the prosthesis from the femoral canal was measured as an indicator of the strength of the cement-bone interface.

Results.

The mean pull-out force to separate the prosthesis from the femoral canal was significantly higher in specimens prepared with pulse-lavage brushing followed by hydrogen peroxide–soaked gauze packing or pulse-lavage brushing alone than those prepared with normal-saline irrigation or hydrogen peroxide–soaked gauze packing alone (p<0.001).

Conclusions.

Pulse-lavage brushing is more effective at cleansing the femoral canal and increasing mechanical strength at the cement-bone interface than preparation with normal-saline irrigation or hydrogen peroxide–soaked gauze packing.
Outcomes of Total Knee Arthroplasty in English-Versus Non–English-Speaking Patients
Authors: Dowsey Michelle M , Broadhead Matthew L , Stoney James D , Choong Peter F
Published: October 2016

Purpose.

To compare outcomes of total knee arthroplasty (TKA) in English- versus non–English-speaking patients.

Methods.

193 women and 85 men (mean age, 72 years) underwent 117 left and 161 right primary TKAs. 237 and 41 patients were English and non–English speaking, respectively. Interpretation was provided. Pre- and post-operative functional outcomes were measured using the International Knee Society (IKS) score.

Results.

Most non–English-speaking patients were female (38 vs 3 of 41, p<0.001). The mean body mass index of non–English-speaking patients was significantly higher (34 vs 31 kg/m2, p=0.003). 14 foreign languages were spoken among the 41 non–English-speaking patients, of which Greek and Italian were the most common. Non–English-speaking patients had significantly worse IKS scores both preoperatively and at the 12-month follow-up. The proportions of poor postoperative IKS scores were significantly higher in non–English-speaking patients (58% vs 27%, p<0.001), in whom pain was also significantly worse (p=0.017). In a multiple logistic regression analysis, being non–English speaking was the only predictor of poor functional outcome at the 12-month follow-up (odds ratio=2.77, confidence interval=1.25–6.14, p=0.012).

Conclusion.

The non–English-speaking background of a patient is a predictor of less favourable functional outcome after TKA.
The Influence of the Acromioclavicular Joint Degeneration on Supraspinatus Outlet Impingement and the Acromion Shape
Authors: Roidis Nikolaos T , Motamed Soheil , Vaishnav Suketu , Ebramzadeh Edward , Karachalios Theofilos S , Itamura John M
Published: October 2016

Purpose.

To assess the anatomic association of acromioclavicular joint degeneration to supraspinatus outlet impingement and the acromion shape.

Methods.

Sagittal oblique magnetic resonance images of 49 shoulders in 49 patients were reviewed. 29 of them (mean age, 59 years) underwent surgery for impingement with or without rotator cuff tear (group 1), whereas the 20 controls (mean age, 27 years) were treated for shoulder instability without rotator cuff disease or acromioclavicular joint derangement (group 2). The supraspinatus outlet and the acromion shape of the 2 groups were compared. Results. The difference in the mean supraspinatus outlet between groups 1 and 2 was 11% (514 vs 577 mm2, p=0.095) and between the subgroup (of group 1) with full thickness rotator cuff tears and group 2 was 17% (481 vs 577 mm2, p=0.036). Six of the acromions in group 1 were type III (hooked) compared to none in group 2.

Conclusion.

In severe acromioclavicular degeneration, distal clavicular excision is recommended, even in cases with an asymptomatic acromioclavicular joint, so as to prevent further osteophyte formation.
Cranial Subdural Haematoma with Concomitant Spinal Epidural and Spinal Subarachnoid Haematomas: A Case Report
Authors: Kishen Thomas , Etherington Greg , Diwan Ashish
Published: October 2016

A 76-year-old man presented with a 4-day history of bilateral leg pain. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed a spinal subarachnoid and spinal epidural haematomas. MRI of the brain revealed a chronic intracranial subdural haematoma with a midline shift. On further questioning, the patient reported a history of a fall 6 weeks earlier and had no evidence of coagulopathy. He underwent a burr-hole decompression of the intracranial subdural haematoma. At the one-year follow-up, the patient was symptom free with no leg pain or headache. The concomitant occurrence of an intracranial subdural haematoma with spinal epidural and spinal subarachnoid haematomas is rare. MRI of the brain and the entire spine is essential in the presence of a spontaneous spinal haematoma.