bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally Invasive Plate Osteosynthesis for Tibial Plateau Fractures
Authors: Raza Hasnain , Hashmi Pervaiz , Abbas Kashif , Hafeez Kamran
Published: October 2016

Purpose.

To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) for tibial plateau fractures.

Methods.

35 men and 6 women aged 19 to 75 (mean, 40; standard deviation [SD], 14) years underwent MIPO for displaced tibial plateau fractures. According to the Schatzker system, the tibial plateau fractures were classified as types I (n=3), II (n=9), III (n=11), IV (n=6), V (n=7), and VI (n=5). Six patients had open fractures; 2 of them underwent debridement before MIPO. 10 patients needed additional bone grafting. Radiological (at immediate postoperation) and clinical (at the 12-month follow-up) assessments based on the Rasmussen anatomic and functional scoring system were recorded using a proforma. Patients with acceptable and unacceptable outcomes were compared in terms of age.

Results.

The mean Rasmussen anatomic score was 15.1 (SD, 2.2; range, 10–18); the mean Rasmussen functional score was 25.3 (SD, 3.2; range, 14–29); and the mean range of knee motion was 118° (SD, 10°; range, 90°–140°). Anatomic outcome was excellent in 10, good in 28, and unacceptable in 3 patients (one each had Schatzker type-I, -II, and -III fractures). 27 (71%) of the 38 patients with acceptable anatomic outcome were aged ≤45 years, whereas 2 (67%) of the 3 patients with unacceptable anatomic outcome were aged ≥60 years (p=0.001). Functional outcome was excellent in 18, good in 19, and unacceptable in 4 patients (2 had Schatzker type-III and another 2 had Schatzker type-I or -II fractures). 37 of the patients had a range of knee motion of ≥120°; 27 (73%) of them were age d ≤45 years, whereas 3 (75%) of the 4 patients with unacceptable functional outcome were aged ≥60 years (p=0.001).

Conclusion.

MIPO for tibial plateau fractures achieved good outcome with minimal soft-tissue complications. Older age was the predictor of unacceptable outcome.
Osteochondritis Dissecans of the Knee in Identical Twins: A Report of Two Cases
Authors: Onoda Satsuki , Sugita Takehiko , Aizawa Toshimi , Ohnuma Masahiro , Takahashi Atsushi
Published: October 2016

We report the second case of osteochondritis dissecans (OCD) of the knee in identical twins (bilaterally in one and unilaterally in the other). Fixations with bio-absorbable pins, cylindrical osteochondral graft, and osteochondral mosaicplasty were all successful and bone union was achieved. We considered that genetic factors remain essential even if other factors (particularly repetitive trauma) are mainly responsible for the occurrence of OCD.
Recurrent Shoulder Dislocations Secondary to Coracoid Process Fracture: A Case Report
Authors: Lal Hitesh , Bansal Pankaj , Sabharwal Vinod Kumar , Mawia Lalrin , Mittal Deepak
Published: October 2016

Coracoid process fracture is easily missed in recurrent anterior shoulder dislocation. We report one such case in a 48-year-old man. Radiology revealed the Bankart lesion and the Hill-Sachs lesion only; the coracoid process fracture was discovered intra-operatively. The anatomy of the shoulder was restored by fixing the fragment to its scapular remnant with a 4-mm cannulated cancellous screw. The tip and the proximal fragment were reamed before inserting the screw. This fragment was routed with attached short head of biceps and coracobrachialis through the lower one third of the subscapularis, before homing it and fixing it to the proximal coracoid fragment. This extra-articular repair resulted in less stiffness than any intra-articular procedure. At the 2-year follow-up, the patient had had no further shoulder dislocation.
Fixation Using Cannulated Screws and Fibular Strut Grafts for Fresh Femoral Neck Fractures with Posterior Comminution
Authors: Zahid Mohammad , Sabir Aamir Bin , Asif Naiyer , Julfiqar Mohammad , Khan AQ , Ahmad Sohail , Siddiqui Yasir S
Published: October 2016

Purpose.

To evaluate the use of fibular grafting for fresh femoral neck fractures with posterior comminution.

Methods.

18 women and 15 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=21) and IV (n=12) femoral neck fractures associated with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated.

Results.

The mean delay in presentation after injury was 3.2 (range, 1–12) days. The mean delay in operation was 8.8 (range, 5–21) days. The mean follow-up period was 2 (range, 1–4) years. According to the Harris hip score, outcome was good to excellent in 20 patients, fair in 7, and poor in 6. 27 of the 33 patients achieved bone union after a mean of 4.7 (range, 4.2–7) months. In 5 patients, the bone was united with a mean of 10° of varus collapse and a mean of 1 cm of shortening. Six patients had nonunion. Other complications included screw migration in the joint space (n=1), graft migration into the joint space (n=3), and screw pullout (n=5). No patient had avascular necrosis of the femoral head.

Conclusion.

Osteosynthesis and fibular grafting for freshly displaced femoral neck fractures with posterior comminution is an inexpensive and technically less demanding procedure for retaining a stable, painless, mobile, and functional hip.
Bilateral Subcapital Femoral Neck Fractures Secondary to Transient Osteoporosis during Pregnancy: A Case Report
Authors: Emami Mohammad Jafar , Abdollahpour Hamid Reza , Kazemi Ali Reza , Vosoughi Amir Reza
Published: October 2016

Transient osteoporosis during pregnancy is a rare, self-limiting disease. We report on a 36-year-old woman who had bilateral subcapital femoral neck fractures during the 6th month of pregnancy. The diagnosis was made 4 days after delivery, because radiography was declined by the patient for fear of radiation. Fixation was not feasible owing to bone resorption, and 2-stage bipolar hemiarthroplasty was therefore performed. Magnetic resonance imaging is the best non-invasive investigative tool for pregnant women with hip pain. Early detection can prevent complications and resorting to major surgeries.
Dynamic Hip Screw Blade Fixation for Intertrochanteric Hip Fractures
Authors: Leung Frankie , Gudushauri Paata , Yuen Grace , Lau Tak-Wing , Fang Christian , Chow Shew-Ping
Published: October 2016

Purpose.

To assess the one-year outcome of a dynamic hip screw (DHS) blade in the treatment of AO/OTA 31-A1 and 31-A2 intertrochanteric hip fractures.

Methods.

35 men and 65 women aged 47 to 100 (mean, 83) years underwent fixation with a DHS blade for A1 (n=47) and A2 (n=53) intertrochanteric hip fractures after a low-energy injury. Patients were operated on within 48 hours of admission. Anteroposterior and lateral radiographs were examined for the tip-apex distance and femoral shortening. Potential complications were looked for, including implant migration, cut-out, loosening, or breakage. Functional outcome was based on the Parker mobility score.

Results.

The 30-day and one-year mortality rates were 5% and 20%, respectively. At the one-year followup, 81 patients were available, and all fractures had healed without varus deformity. The mean tip-apex distance was 14.1 (range, 5.7–31.1; SD, 4.3) mm. The mean femoral shortening was 4.9 (range, 0–20.2; SD, 4.8) mm. The mean Parker score decreased to 3.8 at one-year follow-up from 5.9 before injury (p<0.001). There was one loss of fixation secondary to a nontraumatic subcapital fracture at 3 months, for which a bipolar hemiarthroplasty was performed.

Conclusion.

The DHS blade system is effective in treating AO/OTA 31-A1 and 31-A2 intertrochanteric hip fractures and results in a low complication rate.
Nutritional Status and Short-Term Outcome of Hip Arthroplasty
Authors: Nicholson Jamie A , Dowrick Adam S , Liew Susan M
Published: October 2016

Purpose.

To review nutritional status and outcome of 90 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty.

Methods.

Records of 51 women and 39 men aged 26 to 96 (median, 71) years who underwent elective THA (n=48) for osteoarthritis, or trauma-related THA (n=10) or hemiarthroplasty (n=32) for subcapital femoral neck fractures using an uncemented femoral stem were retrospectively reviewed. Patient demographics and intra- and post-operative complications were recorded. Patient co-morbidities were assessed according to the Charlson grading system. Nutritional status was assessed using haematological markers of serum albumin (ALB) level and total lymphocyte count (TLC). Samples were taken on the day of the operation and within 24 hours of operation. Suboptimal nutrition was defined as a serum ALB level of <3.5 g/dl and a TLC of <1.50 cells/mm.

Results.

86% of trauma patients and 30% of elective patients were malnourished preoperatively (p<0.001). Preoperatively, more males than females had suboptimal ALB levels (28% vs. 8%, p=0.033) and TLC (82% vs. 31%, p<0.001). Age was inversely proportional to preoperative ALB and TLC values; patients older than 75 years had significantly lower values. Of those staying >7 days in hospital, 67% were aged >75 years as opposed to 31% were aged ≤75 years (p=0.001). Male gender, old age, and presentation with trauma were risk factors for suboptimal nutritional parameters (p<0.001 for all). Patients with suboptimal ALB and TLC values had a significantly longer stay in hospital (p=0.032 and p=0.021, respectively).

Conclusion.

The rate of malnourishment was significantly higher in patients having trauma-related surgery than in those having elective surgery. Malnourished patients are at greater risk of prolonged hospital stay. Preoperative nutritional assessment may be useful in predicting patients at high surgical risk.
Blood Cultures for Evaluation of Early Postoperative Fever after Femoral Neck Fracture Surgery
Authors: Sivakumar Brahman , Vijaysegaran Praveen , Ottley Michael , Crawford Ross , Coulter Christopher
Published: October 2016

Purpose.

To evaluate the utility of blood cultures in the assessment of early postoperative fever in hip fracture patients with no other indicators of sepsis.

Methods.

101 blood cultures were drawn on postoperative days 0 to 5 to investigate 84 febrile episodes in 31 women and 30 men (mean age, 80 years) whose body temperature measured via the tympanic route was ≥38°C. Culture results of these 61 patients were divided into culture-positive and culture-negative groups for comparison.

Results.

Of the 101 blood cultures, only 2 were positive: one was obtained 5 days after dynamic hip screw fixation, and the other 4 days after hemiarthroplasty. Both blood cultures grew coagulase-negative staphylococcal species, which were deemed to be skin contaminants not requiring change of patient management. 44 of these patients were treated with oral or intravenous antibiotics for a period of time.

Conclusion.

The risk of bacteraemia in patients with postoperative fever but no other symptoms of infection is low. Routine procurement of blood cultures in such patients is ineffective and of limited utility.
Mobile-Bearing, Congruent Patellofemoral Prosthesis: Short-Term Results
Authors: Yadav Basavaraj , Shaw David , Radcliffe Graham , Dachepalli Sunil , Kluge Wolfram
Published: October 2016

Purpose.

To report the short-term outcome of the low contact stress (LCS) patellofemoral prosthesis in 51 knees.

Methods.

12 men and 37 women aged 23 to 79 (mean, 53.4) years underwent 51 consecutive LCS patellofemoral replacements. All patients had symptomatic isolated arthritis in the patellofemoral joint with well-preserved tibiofemoral compartments. All knees were evaluated pre- and post-operatively. The new Oxford scoring system was used. Anteroposterior, lateral, and skyline weight-bearing radiographs were reviewed.

Results.

The mean follow-up period was 4.2 years; no patient was lost to follow-up. The mean new Oxford Knee score was 13.9 preoperatively and improved by 13.7 at 3 months (p<0.001) and by further 7.1 at 12 months (p<0.001). Any change after 12 months was not significant (p=0.73). 18 of the knees developed patellar maltracking and resulted in subluxation and lateral tilt of the patella with severe polyethylene wear. 10 (20%) of the knees were revised; 8 with patellar maltracking were revised to total knee arthroplasty (n=3) or patellofemoral arthroplasty with a different implant (n=5), whereas 2 with disease progression were revised to total knee arthroplasty. The estimated survival rate of the prosthesis was 73% at 4.5 years and 48% at 5.5 years.

Conclusion.

The revision rate for the LCS patellofemoral prosthesis was high (20%).
Short-Term Outcome of Transforaminal Lumbar Interbody Fusion for Lytic and Degenerative Spondylolisthesis
Authors: Ali Yousuf , Najmus-Sakeb  , Rahman Muhibbur , Mhamud Salauddin
Published: October 2016

Purpose.

To compare early outcome of transforaminal lumbar interbody fusion (TLIF) for lytic versus degenerative spondylolisthesis.

Methods.

14 women and 8 men aged 20 to 60 (mean, 36) years underwent TLIF for lytic (n=15) or degenerative (n=7) spondylolisthesis. Of the 15 patients with lytic spondylolisthesis, 9 involved L4/ L5 and 6 L5/S1. Of the 7 patients with degenerative spondylolisthesis, 3 involved L4/L5, 2 L5/S1, one L2/L3, and one L3/L4. The spondylolistheses were classified as grade II (n=15), grade III (n=4), and retrolisthesis (n=3). 11 patients with lytic and 2 with degenerative spondylolisthesis had sensory deficits (n=12), motor deficits (n=9), and diminished reflexes (n=7). Visual analogue score (VAS) for pain and the Oswestry Disability Index (ODI) of each patient were assessed at months 3, 6, and 12, and 6 monthly thereafter. Fusion status was assessed by radiologists. Comprehensive outcome of each patient was graded as excellent, good, fair, or poor.

Results.

The mean VAS score for low back pain improved significantly from 7.4 preoperatively to 2.1 at year 1 (p<0.001), as did the mean VAS score for leg pain from 6.7 to 1.4 (p<0.001) and the mean ODI from 67.8% to 11.8% (p<0.001). No patient had any residual neurological deficit, and all achieved radiological fusion. The comprehensive outcome was excellent in 16 patients, good in 5, and fair in one. 16 patients returned to their previous level of activity.

Conclusion.

TLIF is a safe and effective surgical procedure for the treatment of lytic and degenerative spondylolisthesis.
Predictors of Posterior Cruciate Ligament Degeneration in Osteoarthritic Knees
Authors: Aggarwal Aditya K , Goel Akshay , Radotra Bishan D
Published: October 2016

Purpose.

To evaluate the tibial articular cartilage and histology of the posterior cruciate ligament (PCL) in osteoarthritic knees so as to determine predictors of PCL degeneration.

Methods.

23 advanced osteoarthritic knees (mean patient age, 61 years) treated with total knee arthroplasty (TKA) were prospectively studied. The Knee Society Score was assessed. Osteoarthritic changes on radiographs were graded as mild, moderate, or severe. Tibial articular cartilage erosion was assessed. The appearance of both cruciate ligaments was classified as normal, abnormal (thinner and sclerotic), or ruptured. Both ligaments were examined histologically for degenerative changes. Each degenerative change of the PCL was graded by 2 histopathologists twice separately. Higher scores indicated more severe degeneration.

Results.

Of the 23 knees, the gross appearance of the anterior cruciate ligaments (ACLs) was normal in 6, abnormal in 11, and ruptured in 6. Histologically, the PCLs were normal in 4, minimally degenerated in 2, mildly in 8, moderately in 5, and severely in 4. The predominant degenerative change was the presence of loose fibrous tissue. ACL appearance correlated positively with PCL degeneration ( r=0.883, p=0.001). The mean Knee Society Score was 24 (range, 0–43), and the mean function score was 30 (range, 5–55). PCL degeneration correlated positively with the Knee Society Score ( r=0.565, p=0.02) but not with the function score ( r=0.061, p=0.447). Anteroposterior instability correlated positively with PCL degeneration ( r=0.691, p=0.01). Erosion in the lateral tibiofemoral compartment and ACL insufficiency were indicators of PCL degeneration (despite a normal appearance). Inter-observer reliability and intra-observer reproducibility were 0.82 and 0.87, respectively.

Conclusion.

The Knee Society Score, anteroposterior instability, ACL appearance, and erosion in the lateral tibiofemoral compartment are predictors of PCL degeneration and can help decide on the optimal type of TKA implant (PCL-retaining vs. PCL-sacrificing design).
Coronal Shear Fracture of the Humeral Trochlea
Authors: Sen Ramesh Kumar , Tripathy Sujit Kumar , Goyal Tarun , Aggarwal Sameer
Published: October 2016

Purpose.

To review records of 5 patients with anterior coronal trochlear fractures.

Methods.

Four men and one woman aged 25 to 46 (mean, 34) years underwent cancellous screw (n=3) or Kirschner wire (n=2) fixation for anterior coronal fractures of the humeral trochlea after falling on a flexed elbow. Patients were operated on through a medial approach. Three patients who had a large osteochondral fragment underwent fixation using 4-mm AO partially threaded cancellous screws. Two patients who had a small un-amenable osteochondral fragment (with articular cartilage damage) underwent fixation using Kirschner wires. Patients were evaluated using the Mayo Elbow Performance Index (MEPI) based on pain, arc of motion, stability, and functional disability.

Results.

The mean time from injury to surgery was 7 (range, 5–10) days. The mean follow-up period was 2.7 years. No patient had any wound-related problems, postoperative neurovascular compromise, or avascular necrosis. Radiographic union was noted after a mean of 14 weeks. Outcome was excellent in 4 patients and good in one. The mean arc of flexion-extension was 101° and the mean arc of supination-pronation was 130°. The mean MEPI was 92. The MEPI was relatively low in the 2 patients with a small osteochondral fragment who underwent Kirschner wire fixation. One patient with articular cartilage damage developed mild degenerative changes and had to change his occupation. The remaining 4 patients were pain-free and had returned to their occupations within 4 months.

Conclusion.

Open reduction and screw fixation restores articular congruency and enables early mobilisation. Small coronal shear fractures of the trochlea not amenable to screw fixation should be fixed with Kirschner wires.
Correlation between the Forearm plus Little Finger Length and the Femoral Length
Authors: Naik Monappa A , Sujir Premjit , Tripathy Sujit Kumar , Goyal Tarun , Rao Sharath K
Published: October 2016

Purpose.

To assess the correlation between the forearm plus little finger length and the femoral length in 100 volunteers.

Methods.

The forearm plus little finger length and the ipsilateral femoral length of 68 male and 32 female volunteers aged 19 to 55 (mean, 35.8) years were measured using a measuring tape. The forearm plus litter finger length was measured from the tip of the olecranon to the tip of the little finger, whereas the femoral length was measured from the tip of the greater trochanter to the level of proximal pole of the patella over the outer aspect of thigh. Two observers made the measurements on 2 separate occasions. Intra- and inter-observer variations were calculated. A value of ≥0.75 indicated excellent agreement.

Results.

The mean forearm plus little finger length and femoral length were 39.87 (SD, 2.73) and 39.85 (SD, 2.44) cm, respectively. The mean difference between these 2 measurements was 0.028 (95% CI, −0.109 to 0.165) cm. The correlation between these 2 measurements was 0.861 (p<0.001). Patient age, sex, and body mass index did not affect this correlation. The intra- and inter-observer reliability was excellent.

Conclusion.

The forearm plus little finger length correlated with the femoral length. This method is simple, radiation-free, and can be applied in day-today practice.
Review Article: Treatment for Achilles Tendon Ruptures in Athletes
Authors: Stavrou Maria , Seraphim Andreas , Al-Hadithy Nawfal , Mordecai Simon C
Published: October 2016

Treatment for Achilles tendon ruptures in athletes is controversial. Surgical fixation has lower rates of rerupture and confers increased strength and function, whereas conservative treatment has lower risks of wound complications. We review the literature on the optimal treatment for Achilles tendon rupture in athletes.
Loeys-Dietz Syndrome with Bilateral Radial Head Dislocations: A Case Report
Authors: Rustagi Tarush , Agashe Mandar V , Dhamele Jaideep , Aroojis Alaric J , Mehta Rujuta
Published: October 2016

Loeys-Dietz syndrome is characterised by vascular aneurysms, hypertelorism, and a bifid uvula. We report on an 11-year-old boy with Loeys-Dietz syndrome who presented with bilateral radial head dislocations and severe osteopaenia with changes of avascular necrosis in both hips causing an outtoeing, wide gait. Considering the poor prognosis for elbow movement and possible radial head dysplasia, surgical reduction of the radial heads was deferred. A subtrochanteric de-rotation osteotomy of the left hip was performed to improve the gait.
Resemblance of Valgus Malalignment of the Distal Tibia in 15-Degree Craniocaudal Radiographs
Authors: McArthur John R , Makrides Panos , Wainwright David
Published: October 2016

Purpose.

To describe and quantify a radiological phenomenon where the distal tibial plafond appears in valgus malalignment in intra-operative fluoroscopy owing to 15° craniocaudal angulation of the X-ray beam.

Methods.

The lateral distal tibial angle (LDTA) of 14 male and 9 female skeletally mature patients was measured by a single reviewer using 2 types of anteroposterior radiographs, in which the X-ray beam was projected at 0° (orthogonal to the ankle) and then at 15° (in a craniocaudal direction). The LDTA was the angle between the long axis of the tibia and a line drawn across the most radiodense part of the tibial plafond. The paired t-test was used to compare the LDTA of the 2 measurements.

Results.

The mean LDTA on the 0° orthogonal radiographs was 89° (range, 87°-92°), whereas the mean LDTA on the 15° craniocaudal radiographs was 79° (range, 77°–81°). The mean difference was 10° (range, 9°-12°; p<0.0001). In the 15° craniocaudal radiographs, the ankle joint appeared to have valgus malalignment.

Conclusion.

During intramedullary nailing of the tibia, the knee is usually flexed and the image intensifier may not swing over far enough. This can result in well-aligned reduction being incorrectly viewed as having valgus malalignment or a varus-malaligned fracture being incorrectly viewed as reduced.
Fibroma of the Peroneus Longus Tendon Sheath in a Child: A Case Report
Authors: Nason Gregory J , Baker Joseph F , O'Toole Patrick , Walsh Anna , Lui Darren F , O'Neill Francis , O'Sullivan Maureen , Kelly Paula M
Published: October 2016

Tendon sheath fibromas are rare, benign soft-tissue tumours and usually involve tendons of the upper extremities, particularly the fingers. The most common presentation is a painless, slow-growing swelling. Tendon sheath fibromas are composed of dense fibrocollagenous stromas with scattered, spindle-shaped fibroblasts and narrow, slit-like vascular spaces. Ultrasonography and magnetic resonance imaging are useful diagnostic tools. We report on an 11-year-old boy with a fibroma involving the right peroneus longus tendon sheath.
Periprosthetic Fractures after Total Knee Arthroplasty
Authors: Agarwal Saurabh , Sharma Rajeev K , Jain Jitesh Kumar
Published: October 2016

Purpose.

To evaluate outcome in 20 patients treated for periprosthetic fractures after total knee arthroplasty (TKA).

Methods.

Records of 14 women and 6 men aged 45 to 85 (mean, 67) years who underwent operative (n=18) or conservative (n=2) treatment for periprosthetic fractures of the supracondylar femur (n=15), patella (n=3), and tibia (n=2) following minor falls (n=18) or high-velocity injury (n=2) were reviewed. The mean time from TKA to fracture was 43 (range, 14–98) months. Of the 15 supracondylar femoral fractures, 2 were managed with immobilisation in a long leg cast, 11 with internal fixation using locked compression plating, and 2 with revision arthroplasty. All 3 patellar fractures were managed with tension band wiring. Both tibial fractures were managed with revision arthroplasty. Radiographic and functional outcomes (the Knee Society scores) were assessed.

Results.

The mean follow-up was 35 (range, 24–48) months. All fractures healed after a mean of 15 (range, 12–38) weeks. One patient had delayed union. Postoperative alignment was satisfactory in all patients except one (with 5° varus). The mean tibiofemoral angle was 4° valgus. The mean range of motion was 98.5°. The mean Knee Society knee score was 85 (range, 75–89) and the functional score was 76 (range, 70–85). No patient had implant failure, loss of reduction, deep infection, deep vein thrombosis, or pulmonary embolism.

Conclusion.

The locked compression plate is effective in managing periprosthetic femoral fractures. Periprosthetic patellar and tibial fractures are uncommon. The latter often warrant revision arthroplasty owing to the loose implant.
Flexible Hinge Silicone Implant with or without Titanium Grommets for Arthroplasty of the First Metatarsophalangeal Joint
Authors: Kanzaki Noriyuki , Nishiyama Takayuki , Fujishiro Takaaki , Hayash Shinya , Hashimoto Shingo , Kuroda Ryosuke , Kurosaka Masahiro
Published: October 2016

Purpose.

To review outcomes of 37 patients who underwent arthroplasty of the first metatarsophalangeal joint using flexible hinge silicone implants with or without titanium grommets.

Methods.

36 women and one man (63 feet) underwent arthroplasty of the first metatarsophalangeal joint for rheumatoid arthritis (RA) using Swanson flexible hinge silicone toe implants with or without titanium grommets. 20 women (35 feet) aged 31 to 72 (mean, 52) years with Steinbrocker grade II (n=4), grade III (n=6), and grade IV (n=10) RA of the feet were treated with the implant without grommets, whereas 16 women and one man (28 feet) aged 48 to 73 (mean, 60) years with Steinbrocker grade III (n=4) and grade IV (n=13) RA of the feet were treated with the implant with grommets. Pain levels were self-rated. Degenerative changes and the presence of osteophytes or deformity were recorded, as were breakage or deformation of the implants, radiolucencies around the implant, implant loosening, silicone-induced synovitis, and sclerosis around the implant.

Results.

All patients reported pain relief from severe to mild or moderate. Respectively for the feet with and without grommets, the rates of implant deformation were 25% and 63% (p=0.031), whereas the rates of moderate-to-severe radiolucencies (>2 mm) were 4% and 34% (p=0.004). Sclerosis developed around the implant in all feet.

Conclusion.

Titanium grommets appear to protect the implant and improve clinical outcomes.
Flexibility of the Transverse Arch of the Forefoot
Authors: Kudo Shintarou , Hatanaka Yasuhiko , Naka Kenichirou , Ito Kazuhiro
Published: October 2016

Purpose.

To measure the percentage of the transverse arch length (%TAL) in 2 positions using a 3-dimensional motion capture system to determine the flexibility of the transverse arch of the forefoot.

Methods.

19 men and 10 women with no lower extremity injury or deformity were included. The %TAL of the left foot was measured using a digital caliper in the standing position and the lower leg maximum anterior tilting (LMAT) position. The difference in the %TAL between the 2 positions (δ%TAL) was calculated. 10 markers were mounted on skin over each metatarsal head and base of the left foot. Motion was captured using a 3-dimensional motion capture system. Coordinates of each marker were manually digitised. The percentage of the transverse arch height (%TAH) and angle between the first and fifth metatarsals (M1M5) were calculated, and differences in each forefoot parameter in the 2 positions were defined as δ%TAL, δ%TAH, δM1M5, and the fore foot flexibility magnitude (FFM) was calculated. Subjects were divided into 3 groups based on their δ%TAL: <25th percentile (hypo-flexibility group, n=7), >26th percentile to <74th percentile (control group, n=15), and >75th percentile (hyper-flexibility group, n=7). The 3 groups were compared in terms of the δ%TAL. δ%TAH, δM1M5, and FFM.

Results.

The δ%TAL correlated with δM1M5 ( r=0.61, p<0.001) and FFM ( r=0.60, p=0.001). For the δM1M5, the hyper-flexibility group differed significantly from other groups (p=0.01). For the FFM, the hyper-flexibility group differed significantly from the hypo-flexibility group (p=0.02).

Conclusion.

Measurement of the %TAL in both the standing and LMAT positions provides a simple and quantitative method of assessing the flexibility of the transverse arch of the forefoot.
Calcaneoplasty and Reattachment of the Achilles Tendon for Insertional Tendinopathy
Authors: Lin Heng An , Chong Keen Wai , Yeo William
Published: October 2016

Purpose.

To report the one-year outcome of 44 patients treated with a novel technique of calcaneoplasty and reattachment of the Achilles tendon.

Methods.

15 men and 29 women (mean age, 53 years) with insertional tendinopathy of the Achilles tendon underwent calcaneoplasty, retrocalcaneal bursa excision, debridement and reattachment of the Achilles tendon with suture anchors via a lateral approach. Outcome was measured using the visual analogue score (VAS) for pain, the SF-36 health survey, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. Patient expectation and satisfaction were also assessed.

Results.

Of the 44 patients, 37, 43, and 21 were followed up at 3, 6, and 12 months. The mean VAS for pain and AOFAS ankle-hindfoot score improved significantly up to 6 months. The mean SF-36 score improved significantly up to 6 months for physical functioning, role functioning (physical), and bodily pain. Patient expectation and satisfaction also improved significantly. No patient had postoperative infections or rupture. Three patients had delayed wound healing, which resolved after simple dressings.

Conclusion.

Calcaneoplasty and reattachment of the Achilles tendon via a lateral approach for insertional tendinopathy enables early weight bearing and achieves good outcome and pain relief.
Revision Anterior Cruciate Ligament Reconstruction Using Tibial or Hamstring Tendon Allografts
Authors: Reverte-Vinaixa Maria Mercedes , Minguell Joan , Joshi Nayana , Díaz-Ferreiro Eugenio Wenceslao , Duarri Gemma , Carrera Lluís , Castellet Enric
Published: October 2016

Purpose.

To report outcomes of revision anterior cruciate ligament (ACL) reconstruction using tibial or hamstring tendon allografts and to compare with another study using non-irradiated fresh-frozen bone-patellar tendon-bone allografts.

Methods.

Records of 12 men and 7 women aged 18 to 53 (mean, 33) years who underwent revision ACL reconstructions using tibial tendon (n=17) or hamstring tendon (n=2) allografts were retrospectively reviewed. At the time of primary ACL reconstruction, hamstring autografts (n=8) and bone-patellar tendon-bone allografts (n=11) were used. The mean time interval between surgeries was 93 (range, 11–225) months. The causes of failure were traumatic injury (n=7) and technical or biological reasons (n=12). The physical activity level was high in 2 patients, medium in 10, and low in 7. For clinical assessment, the Lysholm test, International Knee Documentation Committee (IKDC) scale, and visual analogue scale (VAS) for pain were used. Patient satisfaction was also assessed.

Results.

Four of the patients had laxity and were dissatisfied or very dissatisfied with the outcome; the failure rate was 21%. The mean IKDC score was 63% (range, 25–100%), and the mean Lysholm score was 74% (range, 30–100%). Comparing our patients with those in another study using bone-patellar-bone allografts, there was no significant difference in terms of the VAS for pain, IKDC score, and Lysholm score. Comparing our patients with and without chondral and/or meniscal lesions, there was significant difference in terms of the Lysholm score only (86±11 vs. 57±28, p=0.043). Comparing patients who had used hamstring tendon autografts at the primary ACL reconstruction with those who had used bone-patellar tendon-bone autografts, there was significant difference in terms of the VAS for pain only (4.4±3.1 vs. 1.6±1.0, p=0.020).

Conclusion.

Revision ACL reconstruction using tibial or hamstring tendon allografts provided acceptable results, similar to those using the bone-patellar tendon-bone allografts.
Disease Activity, Knee Function, and Walking Ability in Patients with Rheumatoid Arthritis 10 Years after Primary Total Knee Arthroplasty
Authors: Nishikawa Masataka , Owaki Hajime , Takahi Koichiro , Fuji Takeshi
Published: October 2016

Purpose.

To evaluate disease activity, knee function, and walking ability of patients with rheumatoid arthritis (RA) over 10 years after total knee arthroplasty (TKA).

Methods.

Four men and 26 women (mean age, 59.9 years) underwent 42 TKAs for RA with a mean duration of 151.3 months and were followed up for a mean of 142.3 months. Preoperatively, disease activity was assessed by C-reactive protein (CRP) level only, and the range of knee motion was recorded. At the final follow-up, tender joint count, swollen joint count, visual analogue scale of RA symptoms, and the Modified Health Assessment Questionnaire (MHAQ) score were assessed. Disease activity was evaluated using CRP, matrix metalloproteinase-3, and Disease Activity Score. Range of motion and Knee Society knee and function scores were also assessed.

Results.

The use of methotrexate increased from 4 patients preoperatively to 20 patients at the final follow-up (p<0.001), and the mean dose increased from 3.9 to 6.3 mg/week (p<0.001). Among the 30 patients, the mean CRP level decreased from 2.63 mg/dl preoperatively to 0.61 mg/dl at the final follow-up (p<0.001). Disease activity was controlled. At the final follow-up, disease activity was in remission in 10 patients, low in 11, and moderate in 9. The mean Knee Society knee score was excellent (91.0), but the mean function score was poor (57.0) and diverse. Severe walking disability (function score, <40) was noted in 8 patients (11 TKAs). Knee and function scores did not correlate.

Conclusion.

Walking ability in patients with RA after TKA was generally poor. Poor function was associated with a history of spinal or lower extremity fracture surgery and the MHAQ score.
Posterior Tension Band Wiring and Instrumentation for Thoracolumbar Flexion-Distraction Injuries
Authors: Hasankhani EG , Omidi-Kashani F
Published: October 2016

Purpose.

To evaluate treatment outcome of tension band wiring followed by posterior spinal fusion and instrumentation for thoracolumbar flexion-distraction injury (FDI).

Methods.

36 men and 12 women aged 21 to 56 (mean, 36) years underwent tension band wiring followed by posterior spinal fusion and instrumentation using pedicular screws for FDI of the thoracolumbar spine. The injured vertebral levels were T11 (n=2), T12 (n=12), T11-T12 (n=1), T12-L1 (n=1), L1 (n=28), and L2 (n=4). Anterior vertebral body height and kyphosis were measured before and after surgery. Neurologic status was assessed using the American Spinal Injury Association (ASIA) scale. The Oswestry Disability Index questionnaire and visual analogue scale for pain were also used.

Results.

The mean follow-up was 38 (range, 26–72) months. At final follow-up, the mean visual analogue scale for pain was 1.7, and the median Oswestry Disability Index was 4% (range, 0–32%). The mean anterior vertebral body height improved from 20.5 to 38.8 mm (p<0.001). The mean kyphosis improved from 20.4° to 1.5° (p<0.001). Four patients had persistent neurologic deficit: ASIA scale C (n=2) and D (n=2); their ASIA scales improved by one grade. All patients returned to their original work at 6 months. There were no intra-operative complications or implant failures.

Conclusion.

Posterior tension band wiring followed by posterior spinal fusion and instrumentation for thoracolumbar FDIs achieved good outcome.
Graft Infection following Arthroscopic Anterior Cruciate Ligament Reconstruction: A Report of Four Cases
Authors: Wee James , Lee Keng Thiam
Published: October 2016

Septic arthritis following arthroscopic anterior cruciate ligament reconstruction (ACL) is a rare complication and associated with severe morbidity. Its risk factors include (1) concomitant procedures during the reconstruction, (2) previous knee surgery, (3) allograft usage, (4) peri-operative wound contamination, and (5) presence of intra-articular foreign bodies. We present a series of 3 men and one woman aged 22 to 35 years who developed septic arthritis following ACL reconstruction. The risk factors identified were local infection (n=2), previous ipsilateral knee surgery (n=2), and the use of an allograft (n=1). All patients underwent emergency knee washout and debridement with graft retention within 24 hours, together with a course of intravenous antibiotic therapy. All the patients achieved eradication of their infections (with intact ACL grafts) and satisfactory functional outcome at a mean follow-up of 32 (range, 25–45) months.
Percutaneous Release of the Al Pulley Using a Modified Kirschner Wire: A Cadaveric Study
Authors: Saengnipanthkul Sukit , Sae-Jung Surachai , Sumananont Chat
Published: October 2016

Purpose.

To evaluate the outcome of percutaneous release of the A1 pulley in 40 cadaveric fingers using a modified Kirschner wire.

Methods.

A 2.5-mm-diameter Kirschner wire measuring >12 cm in length was used. One end of the wire was sharpened into a ‘J’ shape using a grinder. The J-shaped tip featured a blunt, elongated lower tip, a sharp J-shaped curve, and a blunt upper tip. Completeness of A1 pulley release and injuries to the A2 pulley, flexor tendon, and neurovascular structures were evaluated in 40 cadaveric fingers.

Results.

Complete release of the A1 pulley was achieved in 8 index, 7 middle, 8 ring, and 8 little fingers, whereas incomplete release of the distal part was noted in 2 index, 2 middle, 2 ring, and one little fingers; release was missed in one middle and one little fingers. Injury to the A2 pulley was noted in 2 index fingers; the injury was minimal and limited to the proximal 2 mm of the A2 pulley. There was no flexor tendon or digital nerve injury in any finger.
Prognostic Factors Associated with Clear Cell Sarcoma in 14 Chinese Patients
Authors: Lee HL , Ho WY , Lam YL , Ng TP , Li KH , Shek T , Mak KL , Fong ST , So YC , Ngan RKC , Lau PPL , Chan ACL
Published: October 2016

Purpose.

To identify prognostic factors associated with clear cell sarcomas in 14 Chinese patients.

Methods.

Medical records of 7 men and 7 women (mean age, 36 years) with histologically confirmed clear cell sarcoma of tendons and aponeuroses were reviewed. Patient demographics, tumour characteristics, and treatment modalities were retrieved. Prognostic factors associated with favourable 5-year survival were determined.

Results.

The most affected sites were the thigh (n=5) and the foot (n=4); the mean time from symptom onset to diagnosis was 9.5 months. The tumour stage at diagnosis was IIA in 8 patients, IIB in 2, and III in 4. The mean tumour size was 4.5 cm in diameter. One patient was lost to follow-up. For the remaining 13 patients, the mean time to disease-related mortality was 2.5 years. Nine patients had distant metastases; the most common sites were lungs and pleura (n=7), followed by distant lymph nodes (n=4), bone (n=2), pericardium (n=2), and brain (n=1). All patients underwent surgical excision. Three women and one man (mean age, 27 years) attained 5-year disease-free survival. All had stage IIA tumours at diagnosis. Their mean tumour size was 1.75 cm in diameter, which was significantly smaller than that of all patients (4.5 cm). Tumour size of ⩽2.5 cm in diameter (p=0.004) and stage IIA tumour at diagnosis (p=0.04) were significant prognostic factors for 5-year survival.

Conclusion.

Tumour size of ⩽2.5 cm and early stage tumour are associated with 5-year disease-free survival. Early detection is crucial for the prognosis of clear cell sarcomas.
Association of Surgeon Factors with Outcome Scores after Total Knee Arthroplasty
Authors: Tan Sok-Chuen , Chan Yiong-Huak , Chong Hwei-Chi , Chin Pak-Lin , Yew Andy , Chia Shi-Lu , Tay Darren , Lo Ngai-Nung , Yeo Seng-Jin
Published: October 2016

Purpose.

To identify preoperative factors (including surgeon factors) associated with outcome scores after total knee arthroplasty (TKA).

Methods.

Medical records of 2848 patients (3458 knees) who underwent primary TKA by 27 orthopaedic specialists were retrieved. Three specialty knee surgeons who had one-year fellowship in TKA performed 1930 TKAs, and 24 general orthopaedic surgeons performed 1528 TKAs. Four of them (including all 3 specialty knee surgeons) were ultra-high-volume (⩾100 TKAs a year), and 21 of them were senior consultants (⩾5 years post residency). At 2 years, 2922 (85%) of knees had complete follow-up data. Oxford Knee Score, Knee Society knee and function scores, and SF-36 quality-of-life score were assessed by independent physiotherapists before and after surgery. Outcomes were compared in terms of dichotomised specialty, seniority, and surgical volume of surgeons.

Results.

Comparing ultra-high-volume (⩾100 TKAs per year) specialty knee surgeons with general orthopaedic surgeons, the former achieved better outcomes in terms of the Oxford Knee Score at 6 months, Knee Society knee and function scores at 2 years, and SF-36 scores at 6 months and 2 years. Comparing lower-volume (±100 TKAs per year) specialty knee surgeons with general orthopaedic surgeons, the former still achieved better outcome and quality-of-life scores, except for SF-36 Mental Component Score at 2 years.

Conclusion.

Specialty training and clinical research in TKA improved outcome and quality-of-life scores.
Review Article: Open versus Arthroscopic Synovectomy for Pigmented Villonodular Synovitis of the Knee
Authors: Rodriguez-Merchan E Carlos
Published: October 2016

Studies published in MEDLINE between January 2010 and October 2013 were reviewed to compare open with arthroscopic synovectomy for pigmented villonodular synovitis of the knee in terms of rates of recurrence, complication, and osteoarthritis. 10 studies specifically on this topic were analysed; all were retrospective case reports, and thus level of evidence was low. Respectively after open and arthroscopic synovectomy, the overall recurrence rates were 26.7% and 24.6%, the overall complication rates were 5.7% and 3.2%, and the overall osteoarthritis rates were 20% and 17.1%. Arthroscopic and open synovectomy did not differ significantly in terms of rates of recurrence, complication, and osteoarthritis. Prospective randomised studies are needed to confirm the findings.
Combined Volar and Dorsal Plating for Complex Comminuted Distal Radial Fractures
Authors: Farhan MFM , Wong JHK , Sreedharan S , Yong FC , Teoh LC
Published: October 2016

Purpose.

To review outcomes of combined volar and dorsal locked plating for AO type-C3 complex comminuted distal radial fractures.

Methods.

Records of 24 patients aged 17 to 77 (mean, 53.3) years who underwent combined volar and dorsal locked plating for AO type-C3 distal radial fractures with volar and dorsal metaphyseal and intra-articular comminution were reviewed. 21 were closed fractures, and 3 were Gustilo-Anderson type-1 open fractures. Bone union, volar tilt, radial inclination, radial height, range of motion, grip strength, and any complications were assessed by a single hand surgeon.

Results.

After a mean follow-up of 17 (range, 14–25) months, the mean palmar flexion was 49° (range, 30°–80°), dorsiflexion was 52° (range, 30°–80°), supination was 86° (range, 60°–90°), pronation was 77° (range, 30°–90°), radial deviation was 16° (range, 5°–30°), and ulnar deviation was 27° (range, 10°–50°). The mean grip strength of the injured hand was 69.2% of the uninjured side. The mean time to radiological union was 3.9 (range, 2.5–6.0) months; no patient had non-union. At the time of union, the mean volar tilt was 5° (−22°–14°), radial inclination was 18.6° (8°–28°), and radial height was 8.5 mm (5.0 mm–13.6 mm). One patient had collapse of the dorsal fragment resulting in a dorsal tilt of 22° and limited (30°) forearm pronation. The severity of dorsal metaphyseal comminution had not been recognised and bone grafting was not performed. The patient also had minor complications of little finger flexor tendon irritation and carpal tunnel syndrome. She underwent implant removal and carpal tunnel release at 8 months. One patient had implant-related extensor digitorum communis irritation. Another patient had non-specific chronic wrist pain, which was resolved at one year. No patient had infection, tendon rupture, or complex regional pain syndrome. Four patients underwent implant removal, including 2 who had no implant-related problems.

Conclusion.

Combined volar and dorsal plating enables early mobilisation and good outcome for certain complex comminuted distal radial fractures.
Preoperative Warfarin Reversal for Early Hip Fracture Surgery
Authors: Moores Thomas Steven , Beaven Alastair , Cattell Andrew Edwin , Baker Charles , Roberts Philip John
Published: October 2016

Purpose.

To evaluate our hospital protocol of low-dose vitamin K titration for preoperative warfarin reversal for early hip fracture surgery.

Methods.

Records of 16 men and 33 women aged 63 to 93 (mean, 81) years who were taking warfarin for atrial fibrillation (n=40), venous thromboembolism (n=9), cerebrovascular accident (n=3), and prosthetic heart valve (n=3) and underwent surgery for hip fractures were reviewed. The 3 patients with a prosthetic heart valve were deemed high risk for thromboembolism and the remainder low-risk. The international normalised ratio (INR) of patients was checked on admission and 6 hours after administration of vitamin K; an INR of <1.7 was considered safe for surgery.

Results.

No patient developed venous thromboembolism within one year. The 30-day and one-year mortality was 8.2% and 32.6%, respectively. For the 46 low-risk patients, the mean INR on admission was 2.6 (range, 1.1–4.6) and decreased to <1.7 after a mean of 2.2 (range, 0–4) administrations of 2 mg of vitamin K. Their INR was <1.7 within 18 hours (mean, 14 hours). 78% of patients underwent surgery within 36 hours. In the 22% of patients who did not undergo surgery within 36 hours, the delay was due to insufficient operative time or the patient being medically unfit for surgery. The 3 high-risk patients underwent bridging therapy of low-molecular-weight heparin and received no vitamin K; their mean INR on admission was 3.2 (range, 3.1–3.3) and the mean time to surgery was 5.3 (range, 3–8) days. Two low-risk patients and one high-risk patient died within 5 days of surgery.

Conclusion.

The low-dose intravenous vitamin K protocol is safe and effective in reversing warfarin within 18 hours. Hip fracture surgery within 36 to 48 hours of admission improves morbidity and mortality.