bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Positioning and Notching of Resurfaced Femurs on Femoral Neck Strength: A Biomechanical Test
Authors: Nabavi A , Yeoh KM , Shidiac L , Appleyard R , Gillies RM , Turnbull A
Published: October 2016

Purpose.

To assess the effects of positioning and notching of resurfaced femurs on the mechanical strength of third-generation saw bone (TGSB) femurs using an in vitro analogue bone model.

Methods.

30 TGSB femurs were equally divided into 6 resurfaced femur groups (intact, anatomic, varus, valgus, anatomically notched, and valgus notched) for testing the load to failure, stiffness, and total energy.

Results.

Compared to the intact femurs, the load to failure in all resurfaced femurs was significantly decreased by 29 to 57%. Among the resurfaced femurs, valgus and anatomic femurs had the highest load to failure, followed by valgus notched, varus, and anatomically notched femurs. Notching weakened the construct by a further 24 to 30%.

Conclusion.

To minimise the risk of femoral neck fracture, resurfaced femoral heads should be placed in an anatomic or valgus orientation, and the superior cortex of the femoral neck should remain intact.
Posterior Lumbar Apophyseal Ring Fractures in Adolescents: A Report of Four Cases
Authors: Yen CH , Chan SK , Ho YF , Mak KH
Published: October 2016

Posterior lumbar apophyseal ring (PLAR) fractures are rare in adolescents. We report 4 such cases in Chinese adolescents. Two of the patients had a slipped capital femoral epiphysis; 3 of them were overweight/obese. All presented with low back pain and radicular pain. Apophyseal fractures of the upper lumbar spine usually involve the lower end plate, whereas those of the lumbar sacral spine usually involve the upper end plate. The radiological features and pathophysiology are discussed. Two of the patients were treated with laminotomy and diskectomy after conservative treatment failed. All patients had complete resolution of their neurological deficits at a mean follow-up of 2 years. Despite its benign nature, long-term follow-up is necessary to define the natural course and prognosis of the disease. A high index of suspicion is needed to diagnose these fractures in adolescents.
Botulinum Toxin Type a for Rehabilitation after a Spinal Cord Injury: A Case Report
Authors: Naicker AS , Roohi SA , Chan JLL
Published: October 2016

A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.
Hereditary Multiple Exostoses of the Hip
Authors: El-Fiky Tarek AM , Chow Wang , Li Yun Hoi , To Michael
Published: October 2016

Purpose.

To assess the radiographic features of 36 hips with hereditary multiple exostoses (HME).

Methods.

Hip parameters of 12 males and 6 females (36 hips) aged 2 to 28 years with HME were assessed using anteroposterior radiographs. The recorded features included the sites of osteochondromas, the femoral head/neck ratio, the Reimer's migration percentage, Sharp's acetabular angle, the centre edge angle, the femoral neck-shaft angle, and degenerative changes.

Results.

15 of the 18 patients were asymptomatic; 3 complained of pain (2 underwent excision or bone biopsy); no lesion was malignant. Osteochondromas were most commonly located in the femur followed by the ilium; only one was intra-articular. 32 hips had coxa valga; 26 had an abnormal Reimer's migration percentage; 17 had an abnormal Sharp's acetabular angle; 12 had an abnormal centre edge angle; 32 had an abnormal femoral neck-shaft angle; and 6 had degenerative changes. Acetabular and femoral dysplasia as well as subluxation are common in patients with HME.

Conclusion.

Borderline subluxated hips and those with marked coxa valga and/or acetabular dysplasia should be closely monitored to determine the need for surgery in the future. Subluxated hips should be operated on early, particularly in children and symptomatic adults.
Comparison of Total Knee Arthroplasty Using Computer-Assisted Navigation versus Conventional Guiding Systems: A Prospective Study
Authors: Pang CH , Chan WL , Yen CH , Cheng SC , Woo SB , Choi ST , Hui WK , Mak KH
Published: October 2016

Purpose.

To compare knee alignments in total knee arthroplasty (TKA) using computer-assisted navigation versus conventional guiding systems.

Methods.

Five men and 49 women aged 49 to 79 years underwent TKA for primary osteoarthritis of the knee with varus deformity. All valgus knees were associated with inflammatory arthritis and thus excluded. Computer-assisted navigation was used for the first 35 TKAs, whereas conventional extramedullary tibial and intramedullary femoral guiding systems were used for the next 35 TKAs. The mechanical axis, coronal tibial and femoral angles, sagittal tibial and femoral angles in the 2 groups were compared.

Results.

Sagittal tibial and femoral angles aligned more optimally in TKAs using computer-assisted navigation. In the respective computer-assisted navigation and conventional guiding systems, 33 (94%) and 26 (74%) of the TKAs attained a postoperative mechanical axis of <3° varus/valgus.

Conclusion.

Computer-assisted navigation gives a more consistent alignment correction and reduces outliers during implant positioning.
Fixed- versus Mobile-Bearing Total Knee Arthroplasty in Indian Patients
Authors: Vasdev Attique , Kumar Satish , Chadha Gaggan , Mandal Shyama Prasad
Published: October 2016

Purpose.

To compare the mid-term clinical outcomes in Indian patients after total knee arthroplasty (TKA) using a fixed- or mobile-bearing prosthesis.

Methods.

120 consecutive patients (50 men and 70 women) aged 55 to 76 (mean, 63) years who had arthritis of the knee with similar deformity and range of motion were randomised to undergo TKA using a fixed- or mobile-bearing prosthesis. Patients with mediolateral instability and infective arthritis were excluded. Knee Society knee and functional scores, range of motion, and the presence of flexion contracture were assessed.

Results.

The mean follow-up duration was 3.5 (range, 1–4.6) years. The mid-term outcome of the 2 groups was comparable. One patient with a mobile-bearing prosthesis had recurrent dislocation at postoperative week 2, owing to iatrogenic medial collateral ligament injury.

Conclusion.

Long-term studies of both functional and radiological outcomes are needed to determine the indications for fixed- versus mobile-bearing prostheses.
Modified Incision for Brostrom Lateral Ligament Reconstruction of the Ankle
Authors: Mahajan Ravindra H , Dalal Rakesh B
Published: October 2016

Purpose.

To describe a modified incision for the Brostrom procedure to correct lateral ankle instability.

Methods.

14 men and 12 women aged 23 to 38 (mean, 27) years with lateral ankle instability underwent the Brostrom procedure with a modified incision to repair both the anterior talofibular and calcaneofibular ligaments, without endangering the sural or superficial peroneal nerves. The incision ran longitudinally over the distal fibula extending 2.5 cm distal to the tip of the lateral malleolus.

Results.

There were no instances of wound healing problems, neurological damage, and repair failure. Surgical exposure of all patients was graded as excellent.

Conclusion.

The modified incision enables easy repair without endangering the sural and superficial peroneal nerves. Access to the peroneal tendons is allowed if necessary.
Giant Cell Tumour in the Foot of a Skeletally Immature Girl: A Case Report
Authors: Baker Joseph F , Perera Anthony , Kiely Paul D , Lui Darren F , Stephens Michael M
Published: October 2016

We present a case of delayed diagnosis of a benign giant cell tumour (GCT) of the third metatarsal in a skeletally immature girl. The patient underwent en bloc excision of the tumour. The tumour had replaced the third metatarsal and had infiltrated the surrounding soft tissue and the second and fourth metatarsal bases. Deep, lateral and medial margins were all involved. A high index of suspicion is needed when evaluating any tumours of the foot, because the compact structure of the foot may delay diagnosis. Early detection is important for avoiding amputation, as the hindfoot and midfoot are classified as one compartment and radical resection is impossible to achieve. Tumours grow faster in the foot than in other bones. GCT in this location and age-group are rare and should be considered in the differential diagnosis of a destructive bony lesion in skeletally immature patients.
Review Article: Patellar Instability after Total Knee Arthroplasty
Authors: Motsis Efstathios K , Paschos Nikolaos , Pakos Emilios E , Georgoulis Anastasios D
Published: October 2016

Patellar instability after total knee arthroplasty (TKA) is a serious complication that impairs functional outcome and may lead to revision surgery. Its aetiology can be related to the surgical technique and component positioning, extensor mechanism imbalance, and other causes. After TKA, the presence of anterior knee pain, especially during stressful activities, is indicative of patellar instability. Diagnosis can be made by radiological evaluation of the patella position, alignment, and component fixation. Main treatment options include revision of the TKA components (in case of malposition) and lateral retinacular release with or without a proximal or distal realignment (in case of soft-tissue imbalance).
Traumatic Spondylolisthesis of the Lumbar Spine: A Report of Three Cases
Authors: Lim Chin Tat , Hee Hwan Tak , Liu Gabriel
Published: October 2016

Traumatic spondylolisthesis of the lumbar spine is uncommon and can result in canal narrowing and spinal cord injury. Early decompression promotes recovery of neurological function. We report 3 such cases: one in the lumbosacral joint and 2 in the lumbar spine. The former patient had an open fracture-dislocation and underwent (delayed) posterior decompression and instrumentation without interbody fusion. The connecting rods broke at 3 years and the patient had a residual neurological deficit. We recommend early decompression with posterior instrumentation and interbody fusion for maximum recovery of neurological function and stability of the spine.
Quality of Life, Knee Function, and Physical Activity in Japanese Elderly Women with Early-Stage Knee Osteoarthritis
Authors: Watanabe Hiroyuki , Urabe Ken , Takahira Naonobu , Ikeda Noriaki , Fujita Mamoru , Obara Shinichi , Hendona Takashi , Aikawa Jun , Itoman Moritoshi
Published: October 2016

Purpose.

To compare quality of life, knee function, and physical activity in 33 elderly women with or without early-stage knee osteoarthritis (OA).

Methods.

33 Japanese elderly women (mean age, 66 years) with (n=18) or without (n=15) early-stage knee OA symptoms (knee pain and decreased range of motion [ROM]) were recruited. The height, weight, and body mass index, disease severity, quality of life (according to the Japanese Knee Osteoarthritis Measure [JKOM]), knee function (knee extension strength, ROM, 10-m gait time), and the amount of physical activity (net energy expenditure and step count) of the 2 groups were compared.

Results.

The 2 patient groups did not differ significantly with respect to mean patient age, height, and body mass index, except for weight. Regarding knee function, mean knee extension strength, ROM (extension but not flexion), and 10-m gait speed (comfortable and maximum) were significantly inferior in patients with knee OA than in controls. Regarding the mean amount of physical activity undertaken, patients with knee OA did not differ significantly from controls with respect to net energy expenditure (179 vs. 212 Kcal/day) and step count (8016 vs. 9729 steps/day). Net energy expenditure ( r= −0.65, p=0.04) and step count ( r= −0.62, p=0.02) correlated negatively with JKOM scores in patients with knee OA but not in the controls.

Conclusion.

In Japanese elderly women with knee OA, quality of life (JKOM scores) correlated negatively with physical activity (net energy expenditure and step count). The 2 groups undertook similar amounts of physical activity, although those with knee OA exhibited less knee extension strength. Decreased knee extension strength coupled with high levels of physical activity may exacerbate the development of knee OA.
Short Proximal Femoral Nail Fixation for Trochanteric Fractures
Authors: Gadegone Wasudeo M , Salphale Yogesh S
Published: October 2016

Purpose.

To review outcomes of 100 patients who underwent short proximal femoral nailing for stable and unstable intertrochanteric fractures.

Methods.

Records of 62 men and 38 women aged 56 to 83 (mean, 67) years who underwent short proximal femoral nailing for stable peritrochanteric A1 (n=36), unstable peritrochanteric A2 (n=40), and unstable intertrochanteric A3 (n=24) fractures were reviewed.

Results.

80 patients achieved anatomic reduction. At the one-year follow-up, 90% of the patients had good or excellent outcomes, and 50% had returned to their pre-injury functional level. One patient with avascular necrosis noted at 20 months and another patient with non-union/pseudarthrosis underwent a revision bipolar arthroplasty. Two patients had a Z effect and one a reverse Z effect. Six patients with osteoporosis had superior migration of the nail with varus collapse. Two patients had cutting out of the screw, but the fractures eventually healed. Ten patients had shortening of <2 cm. Seven patients had lateral thigh discomfort attributed to irritation of the protruding screws against the tensor fascia lata, and 5 of them underwent screw removal. None had fractures of the femoral shaft or trochanter or experienced nail breakage.

Conclusion.

The short proximal femoral nail is a superior implant for stable and unstable intertrochanteric fractures in terms of operating time, surgical exposure, blood loss, and complications, especially for patients with relatively small femora.
Effect of Cage Geometry on Sagittal Alignment after Posterior Lumbar Interbody Fusion for Degenerative Disc Disease
Authors: Takahashi Hiroshi , Suguro Toru , Yokoyama Yuichiro , Iida Yasuaki , Terashima Fumiaki , Wada Akihito
Published: October 2016

Purpose.

To compare the sagittal alignment of the lumbar spine after one-segment posterior lumbar interbody fusion (PLIF) using the horizontal cylinder (HC) or open box (OB) type cage.

Methods.

66 patients underwent instrumented one-segment PLIF with bone grafting for lower lumbar degenerative disease. HC-type cages were used in 33 men and 13 women aged 20 to 73 (mean, 47) years between September 2001 and July 2004. OB-type cages with a 3° lordotic angle were used in 9 men and 11 women aged 25 to 70 (mean, 53) years between July 2004 and September 2006. Pre- and post-operative lumbar lordosis and intervertebral body angles in the fused and upper adjacent levels in the 2 groups were compared.

Results.

There was no significant difference between the 2 groups with regard to changes in the lumbar lordosis and intervertebral body angle in the fused and upper adjacent levels. In both groups, the upper adjacent intervertebral body angle increased significantly by about 2°.

Conclusion.

Lumbar alignment was similar after the use of the HC- or OB-type cages. This may be due to the surgical procedure and insufficient cage lordotic angle.
Occult Posterior Pelvic Ring Fractures in Elderly Patients with Osteoporotic Pubic Rami Fractures
Authors: Lau Tak-Wing , Leung Frankie
Published: October 2016

Purpose.

To evaluate postoperative walking status of elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures.

Methods.

33 women and 4 men aged 66 to 95 (mean, 85) years presented with osteoporotic pubic rami fractures after a fall. 22 (59%) of the patients had additional posterior pelvic ring fractures (9 had lateral compression type-II fractures involving the ilium and 13 had lateral compression type-I fractures involving the sacroalar region). Seven of the 9 patients with lateral compression type-II fractures underwent open reduction and internal fixation using plates and/or screws. The remaining 30 patients were treated conservatively.

Results.

Postoperative walking status was similar in elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. Conclusion. Posterior pelvic ring fractures are easily missed in elderly patients with pubic rami fractures. Routine computed tomography of the pelvis is useful in making the diagnosis.
Risk Factors for Early Dislocation after Total Hip Arthroplasty: A Matched Case-Control Study
Authors: Dudda Marcel , Gueleryuez A , Gautier E , Busato A , Roeder C
Published: October 2016

Purpose.

To evaluate risk factors for early dislocation after primary total hip arthroplasty (THA).

Methods.

Records of 175 cases with dislocation during hospitalisation after THA and 651 controls without dislocation were reviewed. Cases and controls were matched for age, gender, body mass index classification, primary diagnosis, cup design, hospital, and year of intervention. Version and inclination of the acetabular component and version of the femoral component were assessed intra- and post-operatively. Various risk factors were analysed, including surgical approach, cup positioning, combined cup and stem positioning, and femoral head size.

Results.

The posterior approach was 6 fold more prone to dislocation (odds ratio [OR]=6.3, p<0.018) than the anterolateral or straight lateral approach. With regard to combined cup and stem positioning, the acceptable position was at significantly higher risk of dislocation than the ideal position (OR=2.59, p=0.033). Larger femoral head sizes were associated with significantly lower risk of dislocation (OR=0.84, p=0.02).

Conclusion.

Surgical approach, combined cup and stem positioning, and femoral head size were significant risk factors for dislocation during hospitalisation.
Continuous Infiltration of Local Anaesthetic following Total Knee Arthroplasty
Authors: Ong Johnny CA , Lin Chin Pak , Fook-Chong Stephanie MC , Tang Andrew , Ying Yang Kuang , Keng Tay Boon
Published: October 2016

Purpose.

To determine whether continuous infiltration of local anaesthetic can reduce the pain score and morphine use over 48 hours after total knee arthroplasty (TKA).

Methods.

11 men and 43 women aged 50 to 82 years who underwent unilateral TKA for osteoarthritis were recruited. They were randomised into 3 groups. In group 1, 17 patients who acted as controls received patient-controlled analgesia (PCA) with intravenous morphine for 48 hours. In group 2, 16 patients received continuous infiltration of bupivacaine to the subcutaneous tissue and intra-articular space for 48 hours, in addition to PCA. In group 3, 21 patients received an intra-articular injection of local anaesthetic, followed by continuous infiltration of bupivacaine to the subcutaneous tissue and intra-articular space for 48 hours, in addition to PCA. For each patient, a visual analogue score (VAS) for pain was recorded postoperatively at 2, 4, 6, 12, 24, 36, and 48 hours. The total amount of morphine used was recorded at 24 and 48 hours.

Results.

Over 48 hours, the VAS for pain and morphine use was significantly higher in controls than patients in groups 2 and 3.

Conclusion.

Continuous infiltration of local anaesthetic into the intra-articular space and subcutaneous tissues, in addition to PCA with intravenous morphine, provides significantly more pain relief and reduces morphine use.
Resection and Arthrodesis of the Knee Joint for Giant Cell Tumours of Bone
Authors: Saikia KC , Bhuyan SK , Saikia SP , Rongphar R , Jitesh P
Published: October 2016

Purpose.

To evaluate functional outcomes and complications following resection and arthrodesis of the knee for giant cell tumours (GCTs) of bone, in comparison to treatment by endoprosthetic replacements reported elsewhere.

Methods.

18 men and 14 women aged 18 to 40 (mean, 28) years underwent resection and arthrodesis of the knee for GCTs of bone involving the distal femur (n=17) and proximal tibia (n=15). After wide resection, 2 struts were fashioned from the harvested fibula/fibulae and inserted into the medullary canal at the resected ends of the tibia and femur. The corresponding ends of the struts were inserted into peg holes made in the unaffected condyles in a divergent fashion. The knee was arthrodesed in 5° to 10° of flexion, with the limb kept 1 cm short. A 95° AO condylar blade-plate (10–12 holes) was fixed at the resected ends, with a minimum of 8 cortices purchase. Cancellous bone grafts were placed transversely along the struts and circumferentially over the host-graft junctions. Outcomes and complications were evaluated and compared with those of endoprosthetic arthroplasty reported elsewhere.

Results.

Patients were followed up for a mean of 8 (range, 3–12) years. The mean size of the tumours was 10times;8×6 cm. All patients achieved arthrodesis and full weight bearing without pain within 6 to 10 (mean, 6) months. No shortening, loss of alignment, loosening, implant breakage ensued. One patient had a deep infection and absorption at the host-graft junction. Another had a stress fracture of the fibular strut after plate removal. Two patients had a transient peroneal nerve palsy. One patient had local recurrence and extensive fungation and underwent amputation. The mean functional score was 26 (87% of the full score), compared to 66 to 85% in endoprosthetic arthroplasty reported elsewhere.

Conclusion.

Arthrodesis is a viable alternative to customised arthroplasty and provides a long-lasting and cost-effective reconstruction for average patients in developing countries.
Risk Factors Leading to Total Hip Arthroplasty in Patients with Subchondral Insufficiency Fractures of the Femoral Head
Authors: Miyanishi Keita , Ishihara Kohei , Jingushi Seiya , Torisu Takehiko
Published: October 2016

Purpose.

To retrospectively evaluate factors leading to total hip arthroplasty (THA) in patients with subchondral insufficiency fractures (SIF) of the femoral head.

Methods.

5 men and 22 women aged 51 to 85 (mean, 72) years with SIF of the femoral head initially underwent conservative treatment. THA was later performed for 13 patients, as the hip pain became worse secondary to joint space narrowing and/or femoral head collapse. Patient demographics and radiological variables were retrieved. Risk factors leading to THA in patients with SIF of the femoral head were identified. Receiver operating characteristic curves were used to determine optimal cut-off values for the significant risk factors.

Results.

2 men and 11 women aged 62 to 85 (mean, 74.9) years underwent THA and were followed up for 0.2 to 62 (mean, 13) months. The remaining 3 men and 11 women aged 51 to 81 (mean, 68) years underwent conservative treatment and were followed up for 9 to 93 (mean, 28) months. Patient age was the only risk factor for THA (p=0.047, odds ratio=1.13), the cut-off value being 71 years (sensitivity, 77%; specificity, 64%). The survival rate was significantly lower in patients aged ≥71 years than in those aged <71 years (p<0.05).

Conclusion.

Elderly patients with SIF of the femoral head are at higher risk of undergoing THA.
Percutaneous Vertebroplasty for Osteoporotic Compression Fractures Using Calcium Phosphate Cement
Authors: Ishiguro Shigeo , Kasai Yuichi , Sudo Akihiro , Iida Koji , Uchida Atsumasa
Published: October 2016

Purpose.

To compare percutaneous transpedicular vertebroplasty using calcium phosphate cement (CPC) versus conservative treatment for osteoporotic vertebral fractures.

Methods.

Eight men and 28 women aged 61 to 99 (mean, 80) years with osteoporotic vertebral fractures underwent percutaneous transpedicular vertebroplasty using CPC. During the same period, 6 men and 32 women aged 53 to 93 (mean, 77) years underwent conservative treatment. The indication for vertebroplasty was a painful unstable fracture, with mobility of the vertebral body shown on flexion and extension lateral radiographs. Fractures without mobility despite deformity were treated conservatively.

Results.

In the vertebroplasty group, all patients benefited from reduced back pain immediately after surgery, and pain relief was maintained at the latest follow-up. However, correction loss continued until one month after the operation. The mean visual analogue score for pain decreased significantly from preoperation to one day after surgery (9.3 vs. 6.2, p=0.02), and further decreased to 2.8 (p=0.04) on day 3 or 4 when ambulation began, and to 1.5 at the one-month follow-up and 1.4 at the final follow-up (mean, 14 months). The mean duration of analgesic treatment was significantly shorter in the vertebroplasty than conservatively treated group (10.2 vs. 63.5 days). All patients in the vertebroplasty group achieved bone union, with no adjacent vertebral fractures. However, in patients having conservative treatment, there were 2 adjacent vertebral fractures and 4 pseudarthroses, and the collapse continued for several months.

Conclusion.

Percutaneous transpedicular vertebroplasty using CPC achieves immediate pain relief and reduces the risk of vertebral body collapse and pseudarthrosis among elderly patients with osteoporotic vertebral compression fractures.
Traumatic Dislocation of the Pisiform: A Case Report
Authors: Goriainov Vitali , Bayne Grant , Warwick David J
Published: October 2016

Isolated pisiform dislocation is rare. We present one such case in a 20-year-old man occurring after a direct injury to the wrist. After an initial delay in diagnosis and unsuccessful closed reduction, he underwent resection of the pisiform. At 12-month follow-up, he had full range of movement of the wrist and no residual pain.
Neglected Femoral Neck Fractures in Adults
Authors: Kainth Gurvinder Singh , Yuvarajan P , Maini Lalit , Kumar Vinod
Published: October 2016

Purpose.

To assess treatment outcomes in adults with neglected femoral neck fractures, and propose a treatment protocol based on bone quality measured by the Singh index.

Methods.

16 men and 6 women aged 18 to 48 (mean, 33) years presented with neglected (>3 weeks old) femoral neck fractures. Those with good bone quality (Singh index, >3) underwent closed reduction and valgus osteotomy and fixation with 120° double angle blade plates (group 1, n=8), whereas those with poor bone quality (Singh index, <3) and/or communition of the posterior femoral neck underwent fibular grafting and internal fixation with one or two 7-mm cannulated cancellous screws (group 2, n=14). Functional outcome was assessed at the 6-month follow-up, according to modified Askin and Bryan criteria.

Results.

The mean delay in surgery was 12 (range, 4–21) weeks. Patients were followed up for a mean of 19 (range, 12–24) months. The mean time to union was 20 (range, 12–52) weeks. The mean time to full weight bearing was 18 (range, 12–40) weeks. All patients achieved bone union except one in group 1 who had non-union and breakage of the blade plate at week 20 and underwent total hip arthroplasty. Other complications included slippage of fibular graft (n=1), delayed union (n=1), avascular necrosis of the femoral head (n=2, Fig. 6), limb length discrepancy (n=3), and superficial infection (n=1). Functional outcome was excellent in 2 patients, good in 17, and poor in 3.

Conclusion.

Valgus osteotomy and double angle blade plate fixation, and fibular grafting and cancellous screw fixation appeared to be appropriate treatments for neglected femoral neck fractures in adults.
Day Surgery for Major Paediatric Foot and Ankle Procedures
Authors: Jagodzinski Nikolas Alan , Gul Rubena , Khanum Samia , Prem Hari
Published: October 2016

Purpose.

To review outcomes in 19 children who underwent major foot and ankle procedures as day cases.

Methods.

A consecutive series of 24 major foot and ankle procedures in 19 children performed as day cases by a single surgeon were reviewed in terms of the immediate postoperative pain relief, severe swelling (necessitating cast removal), and complications. Parental satisfaction was assessed using a telephone survey with respect to pain relief of the patients, and their views on management as day cases.

Results.

The 24 procedures comprised tendon transfers (n=18), posterior releases (n=3), and excisions of a tarsal coalition (n=3). During the post-discharge 24 hours, no patient developed complications that entailed hospital services. All parents of the patients were satisfied with the overall service provided. The analgesia prescribed at discharge was sufficient to control pain in 20 out of the 22 procedures. In the remaining 2 procedures (under caudal and general anaesthesia), the parents considered the analgesia insufficient, but did not contact the helpline for advice. One child bled through the bandages to a minor extent.

Conclusion.

Some major paediatric foot and ankle procedures can be safely performed as day cases and achieved adequate analgesia with appropriate advice. More such procedures can be added to the day case list, even on an afternoon list.
Fixation Techniques for Non-Union of the Scaphoid
Authors: Raju PK , Kini Sunil Gurpur
Published: October 2016

Purpose.

To compare outcomes of 3 fixation modalities for scaphoid non-union.

Methods.

27 men and 6 women aged 20 to 48 (mean, 28) years with non-union of the scaphoid involving the proximal pole (n=13), waist (n=12), and distal pole (n=8) were randomised to undergo the Herbert screw fixation (n=11), the Matti Russe bone grafting (n=9), or the Kohlman modification of vascularised muscle pedicle graft procedure (n=13). The mean duration of non-union was 10 (range, 6–30) months.

Results.

The mean follow-up duration was 28 months. 30 of 33 achieved correction of both scapholunate and radiolunate angles. The mean range of motion increased from 112° to 155°. The mean grip strength increased by 30%. Functional outcomes of the 3 groups were comparable; they were excellent in 13 patients, good in 10, fair in 6, and poor in 4. There was no hardware failure or any iatrogenic fracture during pedicle dissection. One patient had a superficial infection, which was resolved after antibiotic treatment. At the 6-month follow-up, in the respective 3 groups, 8, 6 and 11 patients achieved scaphoid union after mean intervals of 17, 16, and 15 weeks.

Conclusion.

The time to union was earliest in the Kohlman modification of vascularised muscle pedicle graft procedure, which is recommended for patients with old non-union (>1 year) or proximal pole fractures.
Sensitivity, Specificity and Accuracy of Magnetic Resonance Imaging for Differentiating Vertebral Compression Fractures Caused by Malignancy, Osteoporosis, and Infections
Authors: Abdel-Wanis ME , Solyman Mohamed Tharwat Mahmoud , Hasan Nahla Mohamed Ali
Published: October 2016

Purpose.

To evaluate the sensitivity, specificity and accuracy of various magnetic resonance imaging (MRI) features in differentiating vertebral compression fractures caused by malignancy, osteoporosis, and infections.

Methods.

35 men and 45 women aged 40 to 78 (mean, 59) years underwent MRI to assess the underlying pathology of already diagnosed vertebral compression fractures (n=152). The interval from presentation to imaging ranged from 7 to 95 (mean, 62) days. MRI features of each vertebral compression fracture were assessed. The sensitivity, specificity, and accuracy for each of the MRI features were calculated. Association between each MRI feature and various underlying pathologies (malignancy, osteoporosis, and infections) of vertebral compression fractures was evaluated.

Results.

Regarding these 80 patients, the MRI diagnosis was correct in 78 and inconclusive in 2 with malignancy. MRI features suggestive of malignant fractures were a convex posterior border of the vertebral body, pedicle involvement, posterior neural element involvement, an epidural mass, a paraspinal mass, and other spinal metastases. MRI features suggestive of osteoporotic fractures were retropulsion, low signal intensity band, spared normal marrow signal intensity, and the fluid sign. MRI features suggestive of infective fractures were contiguous vertebral involvement, end plate disruption, disc involvement, and paraspinal and epidural abscesses.

Conclusion.

Combination of several MRI features can provide clues to differentiate between malignant, osteoporotic, and infective vertebral compression fractures.
Hemiarthroplasty for Comminuted Proximal Humeral Fractures
Authors: Babhulkar Ashish , Shyam Ashok K , Sancheti Parag K , Shah Koshish , Rocha Steve
Published: October 2016

Purpose.

To evaluate early functional outcomes of hemiarthroplasty for 3- or 4-part proximal humeral fractures.

Methods.

16 men and 11 women aged 27 to 83 (mean, 56) years underwent hemiarthroplasty for comminuted 3-part (n=13) or 4-part (n=14) proximal humeral fractures. All the patients reported normal shoulder function prior to injury. The range of shoulder motion and muscle power were evaluated, as were subjective pain and satisfaction (using the UCLA scoring system).

Results.

At the final follow-up, the mean maximum abduction was 111° (SD, 47°; range, 30°–180°), and the mean maximum forward flexion was 143° (SD, 41°; range, 45°–180°). All patients had radiographic union of the tuberosities. The mean UCLA score was 28; 21 patients attained good-to-excellent scores (≥27), whereas 6 attained lower (fair-to-poor) scores. The mean UCLA score was higher in patients aged <60 (n=13) than those who were older (n=14) [30 vs. 26, p=0.008] and in patients operated after 7 days (n=6) than those operated before 7 days (n=21) [32 vs. 27, p=0.02], but did not differ significantly in terms of gender and fracture type and side. Patient age and gender, fracture type, and injury-to-surgery interval did not have a significant impact on maximum forward flexion and abduction.

Conclusion.

Early functional outcomes of hemiarthroplasty for comminuted proximal humeral fractures is good in medically fit and cooperative patients.
Screening for Developmental Dysplasia of the Hip in Hong Kong
Authors: Tong Sara HY , Eid Mohamed AM , Chow Wang , To Michael KT
Published: October 2016

Purpose.

To review records of children referred to ousr hospital for developmental dysplasia of the hip (DDH) and evaluate the effectiveness of hip screening in Hong Kong.

Methods.

Records of children suspected of DDH and referred to our hospital between 1 January 2005 and 31 March 2010 were reviewed. The diagnosis was based on static and dynamic ultrasonography of the hips and/or radiographic features of hip subluxation, dislocation, and pelvic dysplasia. The age of the children at presentation was recorded. Late diagnoses were those presenting after the age of 6 months. Late presentations were those presenting after the walking age.

Results.

Of 213 referred children, 33 were diagnosed to have DDH. Their mean age at presentation was 90.8 (range, 9–559) days. The female-to-male ratio was 2.9:1, and the mean follow-up duration was 25.1 (range, 4.2–50.3) months. 30 of the DDH infants were diagnosed before the age of 6 months, one at 8 months, and 2 were late presenters. Hence, the failure rate of the hip screening was 0.09 per 1000 live births. The remaining 180 were confirmed to be normal and followed up until the walking age. The point prevalence of DDH on Hong Kong Island was 0.87/1000 live births.

Conclusion.

In light of the low point prevalence of DDH in Hong Kong born children, the protocol of universal clinical assessment and selective ultrasonographic screening of suspected cases is justified.
Review Article: Bone Defect Classifications in Revision Total Knee Arthroplasty
Authors: Qiu Yi Yan , Yan Chun Hoi , Chiu Kwong Yuen , Ng Fu Yuen
Published: October 2016

There are several classification systems for bone defects in revision total knee arthroplasty. Each has its own drawbacks, and none satisfies all the clinical demands. Therefore, a new classification system and treatment guideline based on a combination of criteria (location, side, containment, and severity of the bone defect) is necessary.
Breakage of an Intramedullary Rod after Bone Union in Congenital Pseudoarthrosis of the Tibia: A Report of Two Cases
Authors: Sulaiman Abdul Razak , Simbak Nordin , Ismail Wan Faisham Wan , Wan Zulmi , Halim Ahmad Sukari
Published: October 2016

We report 2 patients with congenital pseudoarthrosis of the tibia who underwent intramedullary Rush rod transfixation through the ankle joint following refracture and nonunion of vascularised fibular grafting 6 and 8 months earlier. After 9 and 5 years, both Rush rods were broken at the level of the ankle joints, while the reconstructed area was solidly united. The growth of the distal tibia increased the distance of the tips of the broken rod and hence the ankle joint motion. The broken tips may damage the articular cartilage and result in valgus deformity of the ankle and limb length discrepancy.
Predictors of Length of Hospital Stay after Total Hip Replacement
Authors: Abbas Kashif , Umer Masood , Qadir Irfan , Zaheer Jaweria , ur Rashid Haroon
Published: October 2016

Purpose.

To identify variables affecting length of hospital stay after total hip replacement (THR) while controlling for potential confounders.

Methods.

Records of 199 consecutive elective unilateral THRs were reviewed. Clinical and demographic data including age, gender, body mass index, comorbidities, surgical factors (surgical approach, type of prosthesis, use of cement, operating time), anaesthetic factors (type of anaesthesia, ASA physical status), and length of hospital stay were recorded.

Results.

64% of patients left hospital within 12 days, 28% within 3 weeks, and 8% after 3 weeks. The median length of hospital stay was longer in women than men (11.5 vs. 9 days, p=0.009), in patients aged >65 years than those younger (13 vs. 9 days, p<0.0001), and in those with American Society of Anesthesiologists (ASA) grades 3 and 4 than grades 1 or 2 (14 vs. 9 days, p<0.0001). A greater proportion of women than men (45% vs. 27%, p=0.007), patients aged >65 years than those younger (61% vs. 37% or 24%, p<0.0001), and those with ASA grades 3 and 4 than grades 1 and 2 (68% vs. 25%, p<0.0001) stayed 12 days or longer. In the multiple regression analysis, the predictors for prolonged hospital stay (≥12 days) were patient age >65 years (p<0.003), female gender (p<0.05), and ASA grades 3 and 4 (p<0.0001). Of the 72 patients with prolonged stay, 7% had no, 26% had one, 42% had 2, and 25% had all 3 predictors.

Conclusion.

Prolonged hospital stay after THR is largely predetermined by case mix. Our study helps to identify individuals who need longer rehabilitation and more care.
Multifocal Osteoarticular Tuberculosis in Children
Authors: Agarwal Anil , Khan Shariq Azam , Qureshi Nadeem Akhtar
Published: October 2016

Purpose.

To review records of 16 children with multifocal osteoarticular tuberculosis.

Methods.

Records of 7 girls and 9 boys aged one to 14 (mean, 6) years with multifocal osteoarticular tuberculosis were reviewed. Haematological tests and radiographs of the chest, whole spine, pelvis, knees, elbows, hands, and feet were taken. The diagnosis was confirmed histologically. Patients were treated with standard 4-drug antitubercular chemotherapy (isoniazid, rifampicin, ethambutol, pyrazinamide) for 2 months, followed by a 2-drug regimen (isoniazid and rifampicin) for 10 months. Supportive treatment (deworming and nutritional advice) was also provided.

Results.

All 16 patients were immunocompetent. Pain and swelling around the lesions were the main symptoms; fever was not common (2 cases only). No patient reported weight loss or night sweats. The mean number of bony lesions was 3.4 (range, 2–15) per patient. Appendicular (hands and feet) involvement was more common than axial (spinal) involvement. Radiological appearances of the lesions were cystic, irregular, lytic, and with or without sequestrum/periosteal reaction. Some lesions were asymptomatic and detected incidentally on radiographs. Only one patient had active chest lesions. Five patients had spinal involvement but no neurological deficit. No patient underwent any surgical intervention, except for diagnostic biopsy. The mean follow-up period was 18 (range, 6–24) months. All patients showed complete healing within one year of chemotherapy. There were residual deformities and restriction of joint movement in patients with advanced articular and axial osteoarticular involvement.

Conclusion.

Children with multifocal osteoarticular tuberculosis were usually immunocompetent. Appendicular involvement was common, but concomitant chest involvement was uncommon. Standard multidrug antitubercular therapy and nutritional supplementation achieved good outcome.
Concurrent Palmar Lunate Dislocation and Posterior Elbow Dislocation: A Case Report
Authors: Papanna Madhavan Chikkapapanna , Al-Hadithy Nawfal , Sarkar JS
Published: October 2016

We report a rare case of concurrent palmar lunate dislocation of the left wrist combined with a posterior dislocation of the left elbow joint in a 40-year-old man. He sustained both injuries after falling onto his outstretched left hand. The elbow was reduced by the closed method. The wrist was treated with open reduction with carpal tunnel decompression and fixation with a Kirschner wire through the volar approach. Both the scapholunate and radioscaphocapitate ligaments were also repaired. At month 3, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a porter.
Serum 25-Hydroxy-Calciferol Level and Failed Back Surgery Syndrome
Authors: Waikakul Saranatra
Published: October 2016

Purpose.

To assess the association of serum 25-hydroxy-calciferol levels with pain and low back function in patients with failed back surgery syndrome.

Methods.

Records of 6 men and 3 women aged 25 to 54 (mean, 39.2) years who had failed back surgery syndrome after pedicular screw and rod instrumentation for lower lumbar degenerative diseases were reviewed. They had moderate-to-severe pain (visual analogue scale [VAS] score of >6) and low back function disability (Japanese Orthopaedic Association [JOA] back score of <10). In all patients, the serum 25-hydroxy-calciferol level was <30 ng/ml, indicating vitamin D deficiency. Vitamin D2 (20 000 IU per day) was given for 10 days, and vitamin D3 (600 IU per day) was given for maintenance. Patients were followed up at months 3 and 6. Three men and 4 women aged 27 to 55 (mean, 41.3) years who were age- and disease-matched but achieved good outcomes (VAS score of 0–1 and mean JOA low back score of 14.7) were used as indirect referents. All 7 matched patients except one had a normal serum 25-hydroxy-calciferol level (mean, 40.6 ng/ml).

Results.

In the 9 patients with failed back surgery syndrome, the mean duration of chronic pain was 2.6 years; the mean VAS score for pain was 7.7; the mean JOA low back score was 7.6; the mean number of reoperations was 2.2; and the mean serum 25-hydroxy-calciferol level was 17.0 ng/ml. Two male patients had grade-IV motor weakness and decreased sensory function based on the pin prick test. One patient had a history of prolonged (>3 months) antibiotic use after primary surgery, but had no evidence of infection. Six months after vitamin D2 and vitamin D3 supplementation, the mean serum 25-hydroxy-calciferol level improved significantly (17.0 vs. 42.5 ng/ml), as did the mean pain score (7.7 vs. 4.2) and mean JOA back score (7.6 vs. 11.1). Seven of the patients had a pain score of <6 and a JOA back score of >10, the remaining 2 patients had neurological deficits and only slight improvement.

Conclusion.

Vitamin D supplementation may be used as an adjuvant treatment for patients with failed back surgery syndrome.
Serum Intact-Parathyroid Hormone Level following Total Knee Arthroplasty
Authors: Papavasiliou Kyriakos A , Nikopoulou Aggeliki , Kenanidis Eustathios I , Potoupnis Michael E , Kyrkos Margaritis J , Sayegh Fares E , Kapetanos George A
Published: October 2016

Purpose.

To evaluate short-term parathyroid hormone (PTH) secretion following total knee arthroplasty (TKA).

Methods.

119 Caucasian postmenopausal women aged 49 to 81 (mean, 69.8) years who underwent TKA for end-stage knee osteoarthritis were included. Serum levels of intact-PTH, calcium, phosphorus, and creatinine were evaluated pre- and post-operatively (on days −1 and 7). Creatinine clearance was also calculated.

Results.

In 67 of the patients, serum intact-PTH levels decreased after TKA; this sample proportion was not significant (p=0.82). In 16 of the patients, such levels elevated abnormally (above normal range). In the remaining 36 patients, such levels elevated within the normal range. Therefore, the mean serum intact-PTH level of all patients increased slightly after TKA (45.4 vs. 45.3, p=0.162). The serum intact-PTH level did not correlate to body weight ( r=–0.045, p=0.624), patient age ( r=–0.061, p=0.508), serum creatinine level ( r=0.084, p=0.366), and clearance of creatinine ( r=–0.037, p=0.692).

Conclusion.

In most postmenopausal women, the serum intact-PTH level decreased moderately following TKA, but in some, the level was abnormally elevated. This may interfere the prosthesis incorporation process.
Comparison of Cross-Sections of Different Femoral Components for Revision Total Knee Replacement
Authors: Zietz Carmen , Bergschmidt Philipp , Fritsche Andreas , Kluess Daniel , Mittelmeier Wolfram , Bader Rainer
Published: October 2016

Purpose.

To compare the inner contour of the femoral component of 10 total knee replacement (TKR) designs for possible exchange in use.

Methods.

Inner contours of the femoral components of 10 cemented, cruciate-retaining TKR designs (e.motion, Genesis, Genia, Innex, LCS, Multigen Plus, NexGen, PFC, Scorpio, Vanguard) were scanned and reconstructed to 2-dimensional contours. Their cross-sections were compared by superimposition and aligning at the distal and anterior cuts. The patellar notch and outer contour were not analysed.

Results.

The maximum deviation was 5 mm in the posterior and posterior oblique cuts and 10 mm in the anterior oblique cut. Based on similarity of the inner contour, LCS and Innex was classified as group I, e.motion, Genesis, Scorpio, Vanguard, and Multigen Plus as group II, and Genia, NexGen, and PFC as group III. All 2 designs in group I were not compatible with the other 8 designs. Four of the 5 designs in group II showed good compatibility. All 3 designs in group III significantly differed in the posterior and oblique cuts.

Conclusion.

A standardised inner contour of the femoral component can increase compatibility of different TKR systems in revision surgery and reduces the extent of bone resection.