bluuebunny/crossref_metadata_2025 huggingface dataset:
A Multidisciplinary Rehabilitation Programme for Patients with Chronic Low Back Pain: A Prospective Study
Authors: Luk Keith Dip Kei , Wan Thomas Wai Man , Wong Yat Wa , Cheung Kenneth Man Chee , Chan Keith Ying Kei , Cheng Aldous Chun Shing , Kwan Mike Wing Wang , Law Karlen Kar Pui , Lee Peter Wing Ho , Cheing Gladys Lai Ying
Published: October 2016

Purpose.

To examine the effectiveness of a multidisciplinary rehabilitation programme for patients with chronic low back pain in Hong Kong, and to identify factors associated with work resumption.

Methods.

57 men and 8 women aged 20 to 56 (mean, 39) years who had a >3-month history of low back pain and were unresponsive to >6 months of conventional treatment participated in a 14-week multidisciplinary rehabilitation programme involving physical conditioning, work conditioning, and work readiness. Training protocols entailed flexibility and endurance training, hydrotherapy, weight lifting, and work stimulation. Patients were assessed at baseline (week 1), week 7, week 14, and month 6 with regard to the intensity of low back pain, self-perceived disability, range of lumbar motion, isoinertial performance of the trunk muscles, and depression level. Patient demographics that influenced work resumption were identified using a prediction model. Patients who did and did not return to work were compared.

Results.

Of the 54 patients who completed all follow-up assessments, 28 returned to work and 26 did not. The latter was significantly older (37 vs. 42 years, p=0.038) and absent from work longer (11 vs. 22 months, p=0.029) than the former. The rehabilitation programme helped patients regain physical function and the ability to work. Patients who returned to work showed greater improvement in self-perceived disability and physical function.

Conclusion.

This rehabilitation programme facilitated regain of physical functioning and the ability to return to work. The pre-programme employment status, duration of absence from work, and patient age were the most important predictors for work resumption.
Cementing Polyethylene Liners into Non-Modular Acetabular Components in Revision Total Hip Arthroplasty
Authors: Khanuja Harpal S , Aggarwal Ajay , Hungerford Marc W , Hungerford David S , Jones Lynne C , Mont Michael A
Published: October 2016

Purpose.

To review mid-term results after replacing the polyethylene liner in a well-fixed acetabular shell.

Methods.

22 patients underwent replacement of the polyethylene liner in a well-fixed acetabular shell using cementation. The inner surface of the metal shell was scored with grooves (1 to 2 mm deep) for cement interdigitation. Trial liners were used to assess the appropriate size, with an aim to provide at least 2 mm of an even cement mantle behind the polyethylene liner. None of the liners were constrained or lipped. Clinical and radiographic outcomes were evaluated, and Harris Hip Scores obtained. Radiographic loosening of the acetabular shell was recorded. Implant survival was evaluated using the Kaplan-Meier estimator.

Results.

After a mean follow-up of 70 (range, 21–189) months, 17 patients had stable hips and their mean Harris Hip Score was 89 (range, 72–93). Four patients underwent re-revision after 28 to 108 months for aseptic loosening of the acetabular shell (n=2) and recurrent dislocation (n=2). One patient showed radiographic evidence of acetabular migration but was stable. The femoral components of all patients were stable. 92% of patients had good-to-excellent results. Implant survival at 60 months was 81% (95% confidence interval [CI], 51–94%); it became 91% (95% CI, 61–99%) if reductions for dislocations were excluded.

Conclusion.

Cementation of an undersized polyethylene liner into a non-modular shell is one option for revision of a well-fixed acetabular shells. Nonetheless, further follow-up is required to determine if it remains a viable option in the long term. If there is any doubt about the stability of the acetabular shell, a complete revision should be performed.
Pseudoaneurysm and Intramuscular Haematoma after Dynamic Hip Screw Fixation for Intertrochanteric Femoral Fracture: A Case Report
Authors: Chan Winnie Sze-Wun , Kong Siu-Wah , Sun Kin-Wai , Tsang Pui-Ki , Chow Hung-Lit
Published: October 2016

We report the case of an 83-year-old woman who developed a pseudoaneurysm of the profunda femoris artery after dynamic hip screw fixation for an intertrochanteric femoral fracture. 23 days after the fixation, radiological investigations including colour Doppler ultrasonography and computed tomographic angiography identified a pseudoaneurysm surroundedbyalarge intramuscular haematoma close to the profunda femoris. The patient underwent emergency evacuation and was under intensive care for 3 days and was discharged 6 weeks later, with no complications. At one-year follow-up, the wound and fracture had healed, but the patient was confined to a wheelchair. A high index of clinical suspicion and radiological imaging are necessary for making the diagnosis.
Mortality after Hip Fracture in Japan: The Role of Nutritional Status
Authors: Miyanishi Keita , Jingushi Seiya , Torisu Takehiko
Published: October 2016

Purpose.

To assess factors that influence 4-year mortality following hip fracture surgery in a Japanese population.

Methods.

Records of 129 hips in 24 men and 103 women aged 50 to 103 (mean, 79) years who underwent surgery for femoral neck or trochanteric fractures were reviewed. Clinical data reviewed included age, gender, body mass index (BMI), side of fracture, fracture type, fracture stability, surgery type, interval from admission to surgery, length of hospital stay, number of pre-fracture comorbidities, pre-fracture ambulatory level, pre-fracture place of residence, preoperative dementia, preoperative skeletal traction, blood haemoglobin level, serum albumin level, number of postoperative complications, and postoperative delirium. Univariate and multiple logistic regression analyses were performed to identify the relative contribution of the variables to mortality. Receiver operating characteristic (ROC) curves were used to identify optimal cut-off levels.

Results.

The 4-year mortality was 48%. Multiple logistic regression analysis showed that serum albumin level (p=0.0004, odds ratio [OR]=5.8541) and BMI (p=0.0192, OR=1.1693) significantly influenced mortality; the cut-off points were 36 g/l and 18.9 kg/m2, respectively, based on the ROC curves. Kaplan-Meier curves showed that survival rates were significantly worse in patients with values below these cut-off points.

Conclusion.

Serum albumin level and BMI on admission are predictive of mortality after hip fracture surgery.
Knee Joint Effusion following Ipsilateral Hip Surgery
Authors: Christodoulou AG , Givissis P , Antonarakos PD , Petsatodis GE , Hatzokos I , Pournaras JD
Published: October 2016

Purpose.

To correlate patellar reflex inhibition with sympathetic knee joint effusion.

Methods.

65 women and 40 men aged 45 to 75 (mean, 65) years underwent hip surgery. The surgery entailed dynamic hip screw fixation using the lateral approach with reflection of the vastus lateralis for pertrochantric fractures (n=49), and hip hemiarthroplasty or total hip replacement using the Watson-Jones approach (n=38) or hip hemiarthroplasty using the posterior approach (n=18) for subcapital femoral fractures (n=28) or osteoarthritis (n=28). Knee joint effusion, patellar reflex, and thigh circumference were assessed in both legs before and after surgery (at day 0.5, 2, 7, 14, 30, and 45). Time-sequence plots were used for chronological analysis, and correlation between patellar reflex inhibition and knee joint effusion was tested.

Results.

In the time-sequence plot, the peak frequency of patellar reflex inhibition (on day 0.5) preceded that of the knee joint effusion and the thigh circumference increase (on day 2). Patellar reflex inhibition correlated positively with the knee joint effusion ( r=0.843, p=0.035). These 2 factors correlated significantly for all 3 surgical approaches (p<0.0005). All 3 approaches were associated with patellar reflex inhibition on day 0.5 (p=0.033) and knee joint effusion on day 2 (p=0.051).

Conclusion.

Surgical trauma of the thigh may cause patellar reflex inhibition and subsequently knee joint effusion.
Biopsy of Vertebral Tumour Metastasis for Diagnosing Unknown Primaries
Authors: Buyukbebeci Orhan , Karakurum Gunhan , Tutar Ediz , Gulec Akif , Arpacioglu Omer
Published: October 2016

Purpose.

To examine patients with vertebral tumour metastasis using transpedicular biopsy for diagnosing unknown primary tumours.

Methods.

13 men and 8 women aged 41 to 80 (mean, 61) years with vertebral tumour metastasis of unknown primary origin underwent transpedicular biopsy of the affected vertebra.

Results.

The origins of the primary tumours were lung cancer (n=6), prostate cancer (n=5), colorectal cancer (n=5), kidney cancer (n=4) and lymphoma (n=1). All the specimens matched pathological characteristics of their corresponding primary tumours, except in one patient. This 42-year-old man had stage-4 colon cancer, in whom the pathologic findings could not enable differentiation between colon and prostate cancer.

Conclusion.

Transpedicular biopsy of the vertebra is a cost-effective diagnostic tool for evaluating unknown primary tumours.
Microendoscopic versus Open Discectomy for Lumbar Disc Herniation: A Prospective Randomised Study
Authors: Garg Bhavuk , Nagraja Upendra Bidre , Jayaswal Arvind
Published: October 2016

Purpose.

To compare the outcomes of microendoscopic discectomy (MED) versus open discectomy for lumbar disc herniation.

Methods.

80 men and 32 women aged 26 to 57 (mean, 37) years with a single-level disc herniation were randomised to undergo MED (n=55) or open (fenestration/laminotomy) discectomy (n=57). Patients were assessed pre- and post-operatively (at week 6, month 6, and year one). The 2 groups were compared with respect to surgical time, anaesthesia time, duration of hospital stay, intra-operative blood loss, weight of disc material removed, and self-evaluated low back pain and functional outcome (using the Oswestry low back pain disability questionnaire).

Results.

Surgical and anaesthesia times were significantly longer, but blood loss and hospital stay were significantly reduced in patients having MED than open discectomy. The improvement in the Oswestry score in both groups was significant at week one, but not at other follow-ups. The complication rate was similar in both groups. One patient with MED had a recurrence of disc herniation after 7 months and was treated with open discectomy.

Conclusions.

Both methods are equally effective in relieving radicular pain. MED entailed shorter hospital stay, less morbidity, and earlier return to work. Nonetheless, it is a demanding technique and should not be attempted without specific instruction and training.
Open Wedge Osteotomy of the Proximal Medial Tibia for Malunited Tibial Plateau Fractures
Authors: Singh Harpreet , Singh Vikas Rajesh , Yuvarajan P , Maini Lalit , Gautam VK
Published: October 2016

Purpose.

To review outcomes of open wedge osteotomy of the proximal medial tibia for malunited tibial plateau fractures.

Methods.

Seven men (mean age, 36 years) underwent open wedge osteotomy of the proximal medial tibia for instability secondary to malunited tibial plateau fractures of Schatzker types IV (n=3), V (n=1), and VI (n=3). Five patients had been treated conservatively and 2 surgically.

Results.

Patients were followed up for 12 to 30 months. Five patients achieved complete correction of the deformity, whereas 2 had residual articular surface depression of <2 mm. All patients were satisfied with their improvement in stability and knee function. One patient developed anterior cruciate ligament deficiency and instability and underwent anterior cruciate ligament reconstruction. No patient developed any complication related to wound healing. No delayed loss of correction was observed.

Conclusion.

Open wedge osteotomy of the proximal medial tibia is recommended for young adults with instability of the knee joint secondary to malunited proximal tibial plateau fractures. The technique is simple and does not require specialised training or any specific instrumentation.
Isolated Neck Extensor Myopathy Causing a Dropped Head: A Case Report
Authors: Takahashi Hiroshi , Yokoyama Yuichiro , Terajima Fumiaki , Hasegawa Keiji , Suguro Toru , Shibuya Kazutoshi , Wada Akihito
Published: October 2016

This report is of a 71-year-old woman who presented with a dropped head and difficulty in extending her neck. She was diagnosed with isolated neck extensor myopathy. Conservative treatment (use of a cervical collar and muscular strength training) temporarily improved her symptoms. However, destruction of cervical vertebrae and myelopathy progressed secondary to repeated microfractures from mechanical stress. The patient underwent 2-stage combined anterior and posterior decompression and fusion using autografts. At one-year follow-up, numbness of the bilateral upper limbs had resolved, and bone union was achieved. The patient was able to look straight ahead and was very satisfied with the outcome.
Medium-Term Outcome of Titanium Uncemented Stems in Revision Total Hip Arthroplasty
Authors: Murray Rachel C , Horne J Geoffrey
Published: October 2016

Purpose.

To assess the medium-term outcome of titanium uncemented modular tapered stems in revision total hip arthroplasty (THA).

Methods.

A questionnaire was mailed to 421 patients who underwent revision THA using a titanium uncemented modular tapered stem. 66 of whom underwent re-revision THA. The questionnaire was composed to reveal the Charnley classification, the modified 12-item Oxford hip score, and the Devane patient activity level.

Results.

323 (77%) of the patients responded. The mean follow-up time was 6.6 years. 12 patients underwent bilateral revision THA. The mean Oxford hip score was 35.7, compared to 35.8 for all-component revision at postoperative month 6 in the New Zealand Joint Registry. The median Oxford hip scores for the subgroups of the stem-only revision (n=92), all-component revision (n=215), and re-revision (n=16) were 38, 39.9, and 30, respectively. The difference was significant between all-component revision and re-revision (adjusted p=0.003), and between stem-only revision and re-revision (adjusted p=0.037). Regarding patient distribution according to the Charnley class and the Devane patient activity level, the difference was significant between the mean Oxford hip scores of Charnley classes B and C (adjusted p=0.017), and between the Devane patient activity levels of Charnley classes A and C (adjusted p=0.043).

Conclusion.

The medium-term outcome of revision THA using a titanium uncemented modular tapered stem was comparable to that reported for other stems.
Cementless Total Hip Arthroplasty Using Titanium, Plasma-Sprayed Implants: A Study with 10 to 15 Years of Follow-up
Authors: Sanz-Reig Javier , Lizaur-Utrilla Alejandro , Llamas-Merino Isabel , Lopez-Prats Fernando
Published: October 2016

Purpose.

To evaluate long-term outcomes of total hip arthroplasty (THA) using the Perfecta cementless system.

Methods.

73 men and 76 women aged 65 to 88 (mean, 71) years underwent 168 THAs using the Perfecta cementless system and were followed up for a mean of 13 (10 to 15) years. 19 patients had bilateral THA. The diagnoses were idiopathic osteoarthritis (n=121), osteonecrosis of the femoral head (n=25), rheumatoid arthritis (n=14), and post-traumatic osteoarthritis (n=8). Patients were evaluated clinically and radiographically before and after THA.

Results.

The mean Harris hip score improved from 40 to 84 (p<0.001); the score was excellent or good in 130 hips, fair in 17, and poor in 21. The mean Merle D'Aubigne score improved from 4 to 10 (p<0.001); the score was excellent or good in 138 hips, fair in 9, and poor in 21. Poor results were due to aseptic revision of the cup (n=16) or stem (n=3) or deep infection (n=2). Thigh pain that limited activities of daily living was noted in 3 hips. 142 patients could walk without a limp, 5 had a slight limp, and 3 had a moderate limp and used a cane. The mean Short Form-12 score for the physical function was 49 and for the mental health was 56; the mean Western Ontario and McMaster Universities Osteoarthritis Index was 39; the mean visual analogue scale score for satisfaction was 8. Two patients developed deep infection at postoperative months 8 and 50 and were treated with 2-staged revision. Five patients had hip dislocation within 2 months; 3 of whom endured recurrent dislocation and underwent revision surgery; they had acetabular malposition with excessive anteversion despite a correct acetabular angle. 13 other cups were revised because of loosening or extensive osteolysis (n=10) and polyethylene wear (n=3) after a mean interval of 6 (range, 4–10) years. Three stems were revised because of aseptic loosening after a mean interval of 7 (range, 6–9) years. The survivorship at 14 years was 99% for stems and 91% for cups.

Conclusion.

The long-term outcome of the Perfecta cementless stem was good; most major complications occurred in the cup.
Giant Cell Tumour of the Tendon Sheath of the Hand
Authors: Garg Bhavuk , Kotwal Prakash P
Published: October 2016

Purpose.

To review outcomes of 106 patients after complete excision of the giant cell tumour of the tendon sheath of the hand, with or without postoperative radiotherapy.

Methods.

Records of 77 women and 29 men aged 11 to 61 (mean, 31) years who underwent excision of giant cell tumours of the tendon sheath of the hand were reviewed. All patients presented with gradually progressive swelling; only 3 of them also presented with pain. The lesions were located on the dorsal aspect (n=11), the palmar aspect (n=66), both aspects (n=10), or circumferentially (n=14). No patient had multiple lesions. Five patients had bony erosion and 3 had neurovascular bundle involvement.

Results.

The mean follow-up period was 12 (range, 4–22) years. 56 patients with well-encapsulated giant cell tumour in the palmer and/or dorsal aspects were classified as at low risk of recurrence. The remaining 50 patients were classified as at high risk of recurrence and underwent postoperative radiotherapy. None of the patients at low risk had any recurrence; 4 of those at high risk had recurrence despite radiotherapy. No complication was attributable to the irradiation, except that 3 patients had some dark pigmentation around the wound scar.

Conclusion.

Postoperative radiotherapy may have a role in reducing recurrence of the giant cell tumour of the tendon sheath of the hand.
Dysplasia Epiphysealis Hemimelica of the Ankle Joint: A Case Report
Authors: Gokkus Kemal , Aydin Ahmet Turan , Uyan Ayca , Cengiz Menekse
Published: October 2016

Dysplasia epiphysealis hemimelica is a rare non-hereditary epiphyseal disease that mimics synovial chondromatosis of the joints. The disease mainly targets long bones of the lower extremities and tarsal bones. We report one such case manifesting in the lateral tibia of a 13-year-old boy. He presented with a 7-month history of pain and a bony mass (3×4 cm) at the right ankle. The mass restricted ankle dorsiflexion over the lateral malleolar area. It was ossific with a lobulated appearance and reached the marrow with the underlying epiphysis and adjacent bones. The mass was excised completely from the epiphysis. The detached syndesmos was sutured anatomically.
Delayed Presentation of Cervical Facet Dislocations
Authors: Basu Saumyajit , Malik Farid H , Ghosh Jay Deep , Tikoo Agnivesh
Published: October 2016

Purpose.

To review treatment outcomes of 19 patients with delayed presentation of cervical facet dislocations.

Methods.

Records of 17 men and 2 women aged 21 to 63 (mean, 39) years who presented with unilateral (n=14) or bilateral (n=5) cervical facet dislocation after a delay of 7 to 21 (mean, 14) days were reviewed. The most common level of dislocation was C5–C6 (n=9), followed by C4–C5 (n=6), C3–C4 (n=2), and C6–C7 (n=2). The neurological status was graded according to the Frankel classification. One patient (with bilateral facet dislocation) had complete quadriplegia (grade A), 11 had incomplete spinal cord injury (grades C and D), and 7 had nerve root injury. Closed reduction using continuous skull traction for 2 days was attempted. In patients achieving closed reduction, only anterior discectomy and fusion was performed. Those who failed closed reduction underwent posterior partial/complete facetectomy and fixation. If there was traumatic disk prolapse, anterior decompression and fusion was then performed.

Results.

The mean follow-up was 46 (range, 12–108) months. 10 of 14 patients with unilateral facet dislocation were reduced with traction and then underwent anterior discectomy and fusion. The remaining 4 patients who failed closed reduction underwent posterior facetectomy and fixation; 3 of them had traumatic disk prolapse and thus also underwent anterior discectomy and fusion with cage and plate. Four of the 5 patients with bilateral facet dislocations failed closed reduction and underwent posterior facetectomy and lateral mass fixation, as well as anterior surgery. The remaining patient achieved reduction after traction and hence underwent only anterior discectomy and fusion. All patients achieved pain relief and sufficient neck movement for normal activities. All 7 patients with nerve root injury improved completely; 9 of the 11 patients with incomplete spinal cord injury improved by one Frankel grade, and the remaining 2 by 2 grades. The patient with complete quadriplegia showed no improvement.

Conclusion.

Preoperative traction is a safe and effective initial treatment for neglected cervical facet dislocation, as it reduces the need for extensive (anterior and posterior) surgery. If closed reduction is successful, anterior discectomy and fusion is the surgery of choice. If not, posterior facetectomy and fusion followed by anterior surgery is preferred.
Discectomy for Primary and Recurrent Prolapse of Lumbar Intervertebral Discs
Authors: Ahsan Kamrul , Najmus-Sakeb Kamrul , Hossain Alamgir , Khan Shahidul Islam , Awwal MA
Published: October 2016

Purpose.

To reviewed 416 patients who underwent discectomy for primary or recurrent prolapse of lumbar intervertebral discs (PLID).

Methods.

Records of 296 men and 102 women aged 19 to 60 (mean, 39) years who underwent discectomy for a primary PLID, and 14 men and 4 women aged 28 to 50 (mean, 40) years who underwent revision discectomy for a recurrent ipsilateral (n=14) or contralateral (n=4) PLID at L4–5 (n=14), L5-S1 (n=3), or L3–4 (n=1) were reviewed. The pain-free interval, side and degree of herniation, operating time, length of hospital stay, and pre- and post-operative visual analogue score (VAS) for pain were recorded. Clinical outcomes were evaluated using the modified Macnab criteria and the Oswestry Disability Index.

Results.

Patients were followed up for one to 4 years. The mean operating time was significantly longer in revision discectomy (65 vs. 141 minutes, p<0.001, unpaired t-test). There was no significant difference between revision and primary discectomy in terms of length of hospital stay or clinical improvement rates. Age, gender, smoking, profession, level and extent of herniation, and pain-free interval did not affect clinical outcomes. In the 18 revision cases, the mean pain-free interval until recurrence was 31 (range, 1–42) months. At the one-year follow-up, results were excellent in 8, good in 6, fair in 3, and poor in one. Three of the patients had persistent pain despite taking analgesics. 14 of the patients had returned to their normal daily activities. Complications included foot drop (n=1), dural tear (n=3), and superficial wound infection (n=1).

Conclusion.

Discectomy achieved satisfactory results for both primary and recurrent PLIDs.
Questionnaire to Assess Treatment Outcomes of Acetabular Fractures
Authors: Borg Tomas , Carlsson Marianne , Larsson Sune
Published: October 2016

Purpose.

To construct a questionnaire to assess outcomes in patients who underwent internal fixation for acetabular fractures.

Methods.

27 female and 100 male consecutive patients (mean age, 50 years) who underwent internal fixation for acetabular fractures were included. Patients were asked to report their outcomes at months 6, 12, and 24 using a questionnaire. The initial questionnaire was constructed by an expert group. There were 11 closed questions, each came with 6 responses from ‘no discomfort’ to ‘very severe discomfort’. Three open questions were added to cover topics that were not included. The content validity and relevance of the 11 closed questions was determined using factor analysis to determine the number of factors involved. Factorability of the correlation matrix was measured via the Bartlett test of sphericity and Kaiser-Meyer-Olkin (KMO) measure of sampling sufficiency. Factor loadings of >0.50 were considered acceptable for factor representation. Reliability in terms of internal consistency was expressed as Cronbach alpha coefficients. The responses to the 3 open questions were analysed and categorised by a single assessor.

Results.

120 (94%) of the patients completed at least one questionnaire, and 92 (72%) completed all 3 questionnaires during the follow-up period. Based on responses to the 6-month questionnaire, responses to the 11 closed questions were significantly inter-correlated (Spearman 0.17–0.80). After factor analysis and analysis of responses to open questions, the number of questions was reduced to 6 and included questions related to pain, walking, hip motion, leg numbness, sexual life, and operation scar. Reliability of the questionnaire was estimated to α=0.89. Criterion validity was adequate with a high correlation with the Short Form 36 ( r=0.56–0.80).

Conclusion.

Patients treated with acetabular fractures can be adequately assessed using the 6-item questionnaire and one global question concerning impact on activities of daily living.
Review Article: Treatments for Bone Loss in Revision Total Knee Arthroplasty
Authors: Qiu Yi Yan , Yan Chun Hoi , Chiu Kwong Yuen , Ng Fu Yuen
Published: October 2016

Bone deficiency hinders implant alignment and stabilisation of the bone-implant interface in revision total knee arthroplasty (TKA). Treatments for bone defects include bone cement, bone cement with screw reinforcement, metal augments, impaction bone grafts, structural allografts, and tantalum, depending on the location and size of the defects. Small defects are usually treated with cement, cement plus screws, or impaction allograft bone. Large defects are repaired with structural allografts or metal augments. Recent developments involve the use of highly porous osteo-conductive tantalum. We reviewed the pros and cons of each method for bone defect management in revision TKA.
Intra-Operative Identification of Conjoined Lumbosacral Nerve Roots: A Report of Three Cases
Authors: Morishita Yuichiro , Ohta Hideki , Matsumoto Yoshiyuki , Shiba Keiichiro , Naito Masatoshi
Published: October 2016

We report 3 cases of conjoined nerve root anomalies identified during micro-endoscopic discectomy (MED). Between 2009 and 2010, 61 men and 20 women aged 18 to 84 (mean, 42) years underwent MED for symptomatic lumbar disc herniation of L3–4 (n=1), L4–5 (n=44), and L5–S1 (n=36). Magnetic resonance imaging (MRI), myelogram, and post-myelo computed tomography did not identify the anomalies. All 3 patients were male and had type 2A S1 conjoined nerve roots, with a herniated disc at L5-S1. None of them had any preoperative pseudolocalising neurological signs, but all demonstrated stiffer positive straight leg raise sign and deterioration of the Achilles tendon reflex. Postoperatively, all 3 patients achieved excellent clinical outcomes
Massive Psoas Haematoma Causing Lumbar Plexus Palsy: A Case Report
Authors: Conesa Xavier , Ares Oscar , Seijas Roberto
Published: October 2016

An 84-year-old man who was receiving oral anticoagulation therapy presented with complete lumbar plexus palsy caused by a massive psoas haematoma. Conservative treatment rather than drainage of the haematoma was undertaken, because of the risk of bleeding complications and mortality. At the one-year follow-up, the patient had no clinical signs of neurological recovery. The patient died 2 months later due to his concurrent medical problems. A high degree of suspicion is needed for the diagnosis because of the insidiously developing neurological deficit.
Breakage of the Radiopaque Wire from the Medullary Tube during Closed Antegrade Intramedullary Nailing for Femoral Shaft Fracture
Authors: Chan Ping Keung , Chan Kwok Bill , Lui Tun Hing , Ngai Wai Kit
Published: October 2016

We report a complication of radiopaque wire breakage from the medullary tube during closed antegrade intramedullary nailing for a femoral shaft fracture. To avoid such complication, the medullary tube should be checked carefully for colour changes and surface defects, and tested for flexibility before each use. The medullary tube should also be replaced before 100 exposures to autoclaving.
Total Knee Arthroplasty for Rheumatoid Arthritis Patients with Large Tibial Condyle Defects
Authors: Yamanaka Hajime , Goto Kenichiro , Suzuki Munetaka
Published: October 2016

Purpose.

To review clinical results of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients with large bone defects of the tibial condyle.

Methods.

Records of 33 knees in 27 women and 3 men aged 44 to 80 (mean, 63.6) years who underwent primary TKA for RA with large tibial bone defects were reviewed. 16 knees had peripheral defects extending to the bone cortex, whereas 17 knees had central defects that did not extend to the bone cortex. The femorotibial angle (FTA) was <170° in 15 knees, 170° to 180° in 3 knees, and >180° in 15 knees. The mean duration of RA was 13.5 (range, 3–35) years. In 14 knees with severe bone defects, bone grafts (harvested from articular surfaces of knee bones and fixed without screws or Kirschner wires) and/or metal wedges (for peripheral defects) were used to fill the defects. Clinical outcome was assessed pre- and post-operatively using Knee Society scores.

Results.

The mean follow-up duration was 6.3 (range, 2.3–13.2) years. The mean depth of tibial bone defects was 11.2 (range, 1–25) mm, whereas the mean width ratio of the bone defects was 36.5% (range, 16.4–76.9%). Mean extension and flexion (range of motion) improved from −12.5° and 113.4° to −5.1° and 115.6°, respectively. The mean Knee Society knee score improved from 35 (range, 21–59) to 85 (range, 49–95), whereas the mean Knee Society function score improved from 30 (range, 25–53) to 80 (range, 44–97) [p<0.001, Wilcoxon signed rank test]. The cruciate retention prosthesis was used in 6 knees; the posterior stabilised prosthesis was used in 27 knees; and the constrained condylar knee prosthesis was used in 3 knees. No patient had any infection or implant loosening.

Conclusion.

TKA achieved favourable outcome for RA patients with large tibial bone defects. The type of prosthesis used and the use of bone grafts and/or metal wedges were based on the depth and width ratio of the bone defects.
Arthroscopic Synovectomy for Rheumatoid Wrists and Elbows
Authors: Chung Chor-Yat Stephen , Yen Chi-Hung , Yip Man-Lung Ronald , Koo Siu-Cheong Jeffrey Justin , Lao Weng-Nga Virginia
Published: October 2016

Purpose.

To evaluate the treatment outcome of wrist and elbow arthroscopic synovectomy for patients with rheumatoid arthritis.

Methods.

3 men and 18 women aged 27 to 71 (mean, 54) years underwent arthroscopic synovectomy for rheumatoid arthritis of the wrist (n=12) and elbow (n=13). All patients had received multiple medications including non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and steroids, as well as physiotherapy and splintage for 6 months, but the joint pain and disability persisted. The median duration of rheumatoid arthritis was 89 (range, 24–156) and 108 (range, 36–360) months for the wrist and elbow joints, respectively. According to the Larsen grading, the radiographic stages of the wrists and elbows were classified as grade 1 (n=4+4), grade 2 (n=4+5), and grade 3 (n=4+4). Visual analogue scale for pain, the wrist and elbow flexion-extension arcs, grip strength, key pinch strength, inflammatory markers, disability and symptoms were compared pre- and post-operatively.

Results.

The median follow-up period was 30 (range, 18–78) and 34 (range, 18–78) months for wrists and elbows, respectively. There was significant improvement in pain, joint motion, inflammatory markers, and disability score. All patients were satisfied with the surgery. There was no neurovascular or wound complication. No patient was taking long-term pain-control drugs. One patient underwent a second arthroscopic synovectomy after 15 months owing to exacerbation of arthritis.

Conclusion.

Arthroscopic synovectomy is recommended for patients with rheumatoid arthritis who fail conservative treatment.
Factors Associated with Persistent Sequelae after Fasciotomy for Acute Compartment Syndrome
Authors: Dover Mary , Memon Adeel R , Marafi Hanan , Kelly Gabrielle , Quinlan John F
Published: October 2016

Purpose.

To determine factors associated with persistent sequelae after fasciotomy for acute compartment syndrome.

Methods.

Records of 57 men and 3 women aged 8 to 84 (mean, 31.9) years who underwent fasciotomy of the lower (n=48) or upper (n=12) limbs for acute compartment syndrome following limb trauma were retrospectively reviewed. 58 of the fasciotomies were therapeutic and 2 were prophylactic. The mean follow-up was 3.9 (range, 1–8) years. Patients were assessed through a telephone survey for persistent sequelae (parasthaesia, dysasthaesia, and/or motor weakness), using a scale of one to 4 to indicate asymptomatic, mild, moderate, and severe, respectively. Associations of persistent sequelae with the aetiology, mechanism of injury, site of fasciotomy, time to fasciotomy (from admission to anaesthesia induction), number of operations, method of closure, time to closure, and perioperative complications were assessed.

Results.

18 patients were asymptomatic and 42 reported having persistent sequelae including motor weakness (n=26), parasthaesia (n=28), and dysasthaesia (n=30). In terms of severity, these sequelae were mild (n=10), moderate (n=12), or severe (n=20). Persistent sequelae were associated with higher number of operations, post-fasciotomy complications, closures with skin grafting, and increased time to closure.

Conclusion.

To reduce the risk of persistent sequelae after fasciotomy, careful preoperative planning and meticulous perioperative care is needed to avoid multiple operations and post-fasciotomy complications. Patients whose wounds healed by secondary intention showed the best outcome.
Safety of Peri-Operative Low-Dose Aspirin as a Part of Multimodal Venous Thromboembolic Prophylaxis for Total Knee and Hip Arthoplasty
Authors: Cossetto David J , Goudar Anil , Parkinson Karen
Published: October 2016

Purpose.

To examine whether it is safe to continue low-dose (100 mg/day) aspirin perioperatively as a part of standard multimodal venous thromboembolic prophylaxis for total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods.

79 women and 60 men aged 52 to 91 years who underwent THA (n=50) or TKA (n=89) were prospectively studied. Preoperatively, 63 of the patients were on 100 mg of aspirin every morning for various medical reasons and continued in the perioperative period, except for the operation day. The remaining 76 patients were controls. Pre- and post-operative haemoglobin levels, postoperative blood drainage, and the amount of reinfused drained blood were recorded. Intra-operative blood loss and operative times were recorded for THA only. These parameters for the aspirin and control groups were compared.

Results.

All the parameters, namely blood loss (intraoperative and postoperative), operative time, surgical wound healing, and drop in the haemoglobin level (determined on day 3) did not differ significantly between the 2 groups.

Conclusion.

It is safe to continue low-dose (100 mg/day) aspirin in the perioperative period as a part of multimodal prophylaxis against deep vein thrombosis.
Functional Outcome after Computer-Assisted Total Knee Arthroplasty Using Measured Resection versus Gap Balancing Techniques: A Randomised Controlled Study
Authors: Singh Vinay Kumar , Varkey Ranjive , Trehan Ravi , Kamat Yogeesh , Raghavan Ramakrishna , Adhikari Ajeya
Published: October 2016

Purpose.

To compare the 2-year outcome of total knee arthroplasty (TKA) using the measured resection versus the gap balancing techniques.

Methods.

21 men and 31 women aged 41 to 89 (mean, 73) years who underwent primary TKA by a single surgeon for osteoarthritis and had an American Society of Anesthesiologists I or II physical status were prospectively studied. Patients were randomised to undergo computer-assisted TKA using the measured resection technique (n=26) or the gap balancing technique (n=26). At the 2-year followup, patients were assessed by a single orthopaedic registrar blinded to the type of surgery using the Knee Society score (KSS), functional Knee Society score (FKSS), and revised Oxford Knee score (ROKS).

Results.

In the measured resection group, the mean KSS, FKSS, and ROKS increased from 34.3, 48, and 21 to 85.9, 89.6, and 36.5, respectively. In the gap balancing group, the respective scores increased from 35.4, 50, and 22.5 to 89.1, 92.4, and 40.6. Postoperative with the gap balancing technique; the respective p values were 0.46, 0.44, and 0.12.

Conclusion.

Improvements in the knee scores were comparable with the 2 techniques.
Pain during Percutaneous Pin Removal in Children with Elbow Fractures
Authors: Tay Guan Tzu , Lokino Elvin Salioc , Ong Ling Ling , Abdullah Sharifah Nazrah Syed , Wong Mee Leng , Boon Kevin , Lim Leong
Published: October 2016

Purpose.

To survey caregivers with regard to the pain they perceived their children were having during the removal of the percutaneous Kirschner wires, as well as the need for analgesia.

Methods.

23 male and 18 female patients aged 1 to 15 (mean, 7) years who underwent closed reduction and percutaneous Kirschner wire fixation for elbow fractures and subsequent removal of the wires were included. Before the removal procedure, caregivers of these patients were asked to select one of 4 options for the procedure: no analgesia, paracetamol, sedation, and general anaesthesia. Approximately one month following the procedure, the caregivers were interviewed via telephone to retrospectively score the pain (on a scale of 1 to 10) they perceived their children were having during the removal procedure.

Results.

The mean retrospective pain score given by these caregivers was 3.88. Of the 41 caregivers, 30 considered analgesia unnecessary, 10 opted for paracetamol, and only one opted for sedation. None considered general anaesthesia necessary.

Conclusion.

For these children with elbow fractures, most caregivers considered analgesia unnecessary during the removal of percutaneous wires
Allografts with Autogenous Platelet-Rich Plasma for Tibial Defect Reconstruction: A Rabbit Study
Authors: Nather Aziz , Wong Keng Lin , David Vikram , Pereira Barry P
Published: October 2016

Purpose.

To evaluate the effect of autogenous platelet-rich plasma (PRP) for fresh-frozen allografts in tibial defect reconstruction in rabbits.

Methods.

40 adult New Zealand white rabbits underwent tibial defect reconstruction with autografts (n=12), allografts without PRP (n=12), or allografts with PRP (n=12) and were observed for 12, 16, and 24 weeks (4 for each period). Tibias of the remaining 4 rabbits were used as donor allografts, and the remaining allografts were procured from recipient rabbits. A 1.5-cm cortical segment of the tibia was osteotomised, and then fixed with a 9-hole mini-compression plate and 2 cerclage wires. Allografts were stripped off the periosteum and soft tissues and medullary contents, and then stored in a freezer at −80°C. All allografts were deep frozen for at least 4 weeks before transplantation. 7 ml of whole blood was drawn to prepare 1 ml of PRP. The PRP was then mixed with 1.0 ml of human thrombin to form a platelet gel. The PRP gel was then packed into the medullary canal of the allograft and applied on the cortical surface before tibial defect reconstruction. Rabbits were sacrificed at 12, 16, and 24 weeks. The specimens were assessed for bone union at host-graft junctions and for bone resorption, new bone formation, callus encasement, and viable osteocyte counts.

Results.

There were 4 specimens in each group at each observation period. Osteoid bridging the gap at host-graft junctions was noted in all specimens in the autograft and allograft-with-PRP groups at week 12 and in the allograft-without-PRP group at week 24. Bone union in allografts without PRP was delayed. All indices for biological incorporation (resorption index, new bone formation index, callus encasement index, and viable osteocyte count) were significantly greater in the autograft than allograft-without-PRP groups, except for the resorption index at week 24, whereas the differences were not significant between the autograft and allograft-with-PRP groups. The differences between the 2 allograft groups were usually not significant, except for the resorption index.

Conclusion.

PRP-augmented allografts behaved similarly to autografts for tibial defect reconstruction in rabbits. PRP increased bone union and bone resorption.
Acute Calcific Tendinitis of the Flexor Carpi Ulnaris Causing Acute Compressive Neuropathy of the Ulnar Nerve: A Case Report
Authors: Yasen Sam
Published: October 2016

This study reports a case of acute calcific tendinitis of the flexor carpi ulnaris in a 64-year-old woman. She presented with symptoms of acute ulnar nerve compression mimicking a volar compartment syndrome. Owing to rapidly progressive symptoms, emergency surgical exploration was carried out. Intra-operatively a large mass of calcium phosphate carbonate was noted in association with the flexor carpi ulnaris near its insertion at the wrist compressing the ulnar nerve and artery in Guyon's canal. Postoperatively the patient had complete resolution of symptoms. Conservative management with non-steroidal anti-inflammatory drugs, rest, splinting, and steroid therapy is recommended for acute calcific tendinitis, but this case suggests a role for surgical treatment when there is acute neural compression and severe pain.
Flatfoot in Indian Population
Authors: Pandey Sudhakar , Pal Chandra Prakash , Kumar Deepak , Singh Pulkesh
Published: October 2016

Purpose.

To compare outcomes of different conservative treatments for flatfoot using the foot print index and valgus index.

Methods.

150 symptomatic flatfoot patients and 50 controls (without any flatfoot or lower limb deformity) aged older than 8 years were evaluated. The diagnosis was based on pain during walking a distance, the great toe extension test, the valgus index, the foot print index (FPI), as well as eversion/inversion and dorsiflexion at the ankle. The patients were unequally randomised into 4 treatment groups: (1) foot exercises (n=60), (2) use of the Thomas crooked and elongated heel with or without arch support (n=45), (3) use of the Rose Schwartz insoles (n=18), and (4) foot exercises combined with both footwear modifications (n=27).

Results.

Of the 150 symptomatic flatfoot patients, 96 had severe flatfoot (FPI, >75) and 54 had incipient flatfoot (FPI, 45–74). The great toe extension test was positive in all 50 controls and 144 patients, and negative in 6 patients (p=0.1734, one-tailed test), which yielded a sensitivity of 96% and a positive predictive value of 74%. Symptoms correlated with the FPI (Chi squared=9.7, p=0.0213). Combining foot exercises and foot wear modifications achieved best outcome in terms of pain relief, gait improvement, and decrease in the FPI and valgus index.

Conclusion.

The great toe extension test was the best screening tool. The FPI was a good tool for diagnosing and grading of flatfoot and evaluating treatment progress. Combining foot exercises and foot wear modifications achieved the best outcome.
Conservative Treatment for Acute Achilles Tendon Rupture: Survey of Current Practice
Authors: Osarumwense Donald , Wright Jonathan , Gardner Kikachukwu , James Laurence
Published: October 2016

Purpose.

To survey the practice of orthopaedic consultants in the Greater London area for treating Achilles tendon ruptures.

Methods.

221 orthopaedic consultants working in 28 hospitals within the Greater London area were identified. A questionnaire regarding conservative treatment for acute Achilles tendon ruptures was sent. The choice of immobilisation, the period of immobilisation, the time to weight bearing, the use of heel raises, and the use of diagnostic ultrasonography were enquired about.

Results.

62 of 86 respondents treated Achilles tendon ruptures conservatively by below-knee casts (n=51), above-knee casts (n=5), or functional braces (n=6). The most common immobilisation regimen (n=7) was to keep the foot in a sequence of an equinus position, a semi-equinus position, and a neutral position (3 weeks in each position). After cast removal, 45 of respondents preferred to use a heel raise for a median duration of 4 (range, 2–36) weeks. Respectively for foot and ankle specialists (n=24) and other orthopaedic specialists (n=38), the median immobilisation period prescribed was 8 (range, 3–13) and 9 (range, 6–36) weeks, respectively (p=0.625), whereas the median time to weight bearing prescribed was 6 (range, 0–9) and 6 (range, 0–12) weeks, respectively (p=0.402).

Conclusion.

Functional bracing was not as widely used as below-knee cast immobilisation. There was no consensus on the optimal immobilisation regimen.
The Endolog System for Moderate-to-Severe Hallux Valgus
Authors: Giorgio Luigi Di , Touloupakis Georgios , Simone Simonetta , Imparato Luca , Sodano Luca , Villani Ciro
Published: October 2016

Purpose.

To report the midterm outcome of the Endolog system for correction of moderate-to-severe hallux valgus.

Methods.

23 women and 2 men (33 feet) aged 35 to 80 (mean, 52) years underwent minimally invasive surgery for moderate (n=25) and severe (n=8) hallux valgus using the Endolog system. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the proximal articular set angle (PASA) were measured on radiographs. The feet were also assessed based on the American Orthopaedic Foot and Ankle Society (AOFAS) scale.

Results.

The mean follow-up duration was 18.2 (range, 12–36) months. The mean HVA, IMA, PASA, and the mean AOFAS score improved significantly after surgery (all p<0.0001). Periosteal reaction was noted by week 4, and callus formation after 3 months. There were no delayed or non-union or other complications.

Conclusion.

The Endolog system achieved good outcome for moderate-to-severe hallux valgus.
Proximal Disinsertion of the Common Extensor Tendon for Lateral Elbow Tendinopathy
Authors: Cusco Xavier , Alsina Montserrat , Seijas Roberto , Ares Oscar , Alvarez-Diaz Pedro , Cugat Ramon
Published: October 2016

Purpose.

To evaluate surgical outcomes of disinsertion of the common extensor tendon for lateral elbow tendinopathy.

Methods.

Records of 277 men and 128 women who underwent surgery for lateral elbow tendinopathy were reviewed. The indication for surgery was insufficient improvement of pain and inability to return to work after 3 weeks of physiotherapy (stretching, ultrasound) and local corticosteroid injections. According to the Tavernier technique, the origin of the tendons of the extensor carpi radialis brevis and extensor digitorum communis was located, and proximal disinsertion of the common extensor tendon was performed.

Results.

Outcome was excellent in 344 (85%) of the patients, good in 46 (11.5%), regular in 9 (2%), and poor in 2 (0.5%). The mean time to return to work was 29 (range, 5–93) days. Immediate complications included infection (n=1), seroma (n=1), cicatricial fibrosis (n=10), radial neuritis (sensory) [n=4], and reactive dermatitis (n=2). Late complications included Frohse's arcade syndrome (n=1) and carpal tunnel syndrome (n=2).

Conclusion.

Disinsertion of the proximal common tendon is a good option for treating lateral elbow tendinopathy.