bluuebunny/crossref_metadata_2025 huggingface dataset:
DRGs, Orthopedic Surgery, and Age at an Academic Medical Center
Authors: Munoz Eric , Johnson Houston , Margolis Irving , Ratner Lloyd , Mulloy Katherine , Wise Leslie
Published: April 2021

ABSTRACT: The federal Medicare Diagnostic Related Group (DRG) hospital reimbursement system has been on line for 5 years. Hospitals contend that profit margins have dropped to dangerously low levels, due to the federal DRG Prospective Payment System. The authors analyzed all orthopedic surgical admissions to a large academic medical center under DRG reimbursement and characterized patients by age, resource utilization, and outcome. Total costs for the 1,040 orthopedic patients analyzed during a 15-month period added up to $9,718,800. Mean hospital cost per patient, mean hospital length of stay, percent outliers, and mortality generally increased with age. All age categories of patients 65 years of age and above generated financial losses under DRGs. Older orthopedic patients consumed a disproportionately larger share of resources than younger patients, and were more frequent users of the SICU and blood. The current DRG reimbursement scheme may be inequitable in relation to the older orthopedic surgery patient. If these findings are demonstrated at other medical centers, older orthopedic surgical patients could be limited in both their access and quality of care in the future.
Evaluation and Treatment of Chemonucleolysis Failures
Authors: Burkus J Kenneth , Alexander A Herbert , Mitchell John B
Published: April 2021

ABSTRACT; Fifty patients underwent chemonucleolysis for the treatment of lumbar disk herniations unresponsive to conservative therapy. In patients treated with chymopapain, unrelieved sciatica was the most common cause of clinical treatment failure. Eight patients (16%) experienced no relief or only a transient reduction in their radicular symptoms following chymopapain injection. All eight patients were clinically reevaluated and underwent repeat neuroradiographic studies. Computed axial tomography and lumbar myelography demonstrated persistent nerve root compromise at the level of the injected disk space. Open diskectomy was performed in all eight cases. Postoperatively, seven patients noted complete resolution of their radicular symptoms; one patient had intermittent low back and leg pain following surgery.
Traumatic Hip Dislocation in Children Follow Up of 13 Cases
Authors: Hougaard Kjeld , Thomsen Per B
Published: April 2021

ABSTRACT: Thirteen cases of traumatic anterior and posterior hip dislocations in children were treated during a period of 25 years. All of them were available for follow up from 5 to 26 years postinjury. Twelve of the patients had their dislocation reduced within six hours after the injury. None of them developed any complication, and the range of movement was the same as in the noninjured hip. One patient, who had his hip reduced 37 hours after the injury, experienced pain due to osteoarthritis 7 years after the injury at the age of 21 years.
Alternatives in the Treatment of Ipsilateral Fractures of the Hip and Femur
Authors: Eiskjær Søren , Schmidt Steen A , Søjbjerg Jens O , Møller-Larsen Flemming
Published: April 2021

ABSTRACT: Eight cases of ipsílateral femoral neck and shaft fractures were reviewed. The diagnosis of the lemoral neck fracture was delayed in two cases. Seven of the femoral shaft fractures were comminuted. In six cases, both fractures were treated with rigid internal fixation. A combination of traction and internal fixation was used in two cases. Two cases of avascular necrosis of the femoral head were observed. The fracture reduction was insufficient in both cases and the diagnosis of femoral neck fracture was delayed in one case. A radiograph of the pelvis is mandatory in high-velocity trauma victims. Ipsílateral fracures of the femoral neck and shaft should be stabilized by internal fixation as early as possible. Intramedullary locked nailing seems to be an attractive alternative in the treatment of the comm united femoral shaft fracture.
Dislocation of the Elbow: An Experimental Study of the Ligamentous Injuries
Authors: Søjbjerg Jens O , Helmig Peter , Kjærsgaard-Andersen Per
Published: April 2021

ABSTRACT: The stability of human cadaveric elbow specimens was investigated using an experimental apparatus. Posterior dislocation of the elbow could only be produced when a combined valgus and external rotatory torque was applied to the specimen. None of the elbows were dislocated during varus and internal rotatory torque or in the extreme positions. In ten elbow specimens with an experimentally produced posterior dislocation, simultaneous rupture of the anterior part of the medial collateral ligament and the annular ligament were the most frequent findings. A lateral collateral ligament tear was only seen in two cases. Posterior elbow dislocation seems to be due to a combined valgus and external rotatory stress to the semiflexed elbow, resulting in a bilateral ligamentous injury.
Preoperative Crossmatch Guidelines for Total Hip Arthroplasty
Authors: Grzeskiewicz Joseph L , Hall R Alan , Anderson Garth , Mintz Paul D
Published: April 2021

ABSTRACT: The use of crossmatch guidelines has become commonplace as a means of guiding surgeons to efficient preoperative blood ordering. To further refine existing guidelines for a major elective procedure, a number of specific characteristics of 175 patients who underwent 189 total hip arthroplasties were correlated with blood use by univariate and multivariate analyses. The findings of this study demonstrate that for patients with no detectable red cell alloantibody, four units of blood should be crossmatched and reserved preoperatively if the patient is undergoing exchange arthroplasty, or undergoing a transtrochanteric procedure. All other patients with no detectable red cell alloantibody should have two units of blood reserved preoperatively. Proper preoperative crossmatch ordering can result in more labor-efficient and thrifty use of transfusion services, as well as increased effectiveness of autologous predeposit programs.
The Role of Hip Location and Dislocation in the Functional Status of the Myelodysplastic Patient: A Review of 100 Patients
Authors: Crandall Robin C , Birkebak Roland C , Winter Robert B
Published: April 2021

ABSTRACT: One hundred patients 10 years of age or older with myelodysplasia were evaluated to compare located versus dislocated hips with regard to neurologic level, ambulation, hip pain, skin condition, and spinal deformity. Operated and nonoperated individuals were compared. Analysis was carried out to determine what the overall long-time function was in located, dislocated, and "relocated" individuals. Of the 100 patients, 72 presented at follow up with bilateral located hips, 18 with unilateral hip dislocations, and 10 with bilateral dislocations. Twenty patients functioned at T12 levels or above, 30 patients had preservation of anterior thigh musculature, and 25 patients had posterior leg or hip abductor power. Thirteen patients (15 hips) were found to have some degree of pain, 1 patient with bilateral dislocation, 5 with unilateral dislocation, and 7 with bilaterally located hips. Ambulatory function was not affected in any neurologic group by location versus dislocation of the hips. Skin ulcération problems were not increased in patients with hip dislocation. Major spinal deformity in most groups correlated highly with neurologic levels, but not with location versus dislocation of the hips. In one group, an increase in lumbar lordosis was present in unilateral hip dislocations. This study suggests that adolescents and young adults with myelodysplasia have different functional levels related to the neurologic level which are not related to whether the hips are located or dislocated.
Idiopathic Scoliosis: An 11-Year Follow-Up Study of the Role of the Milwaukee Brace in Curve Control and Trunco-Pelvic Alignment
Authors: Andrews George , MacEwen G Dean
Published: April 2021

ABSTRACT: One hundred and fifty-two patients with idiopathic scoliosis were treated at the Alfred I. duPont Institute with the Milwaukee brace between 1961 and 1972. This study includes 94 patients and was undertaken to evaluate the effectiveness of Milwaukee brace treatment in managing various sequelae associated with idiopathic scoliosis, such as degree of curvature and trunco-pelvic alignment, and to assess the degree of spinal stability after treatment. Good results were obtained in patients with curves less 30°; in addition, there was improvement in trunco-pelvic alignment and curve correction. However, results varied considerably among patients and were unpredictable. Double major curve patterns were found to have a poor response to bracing. After bracing is stopped, rate of curve progression appears to decrease with time.
Proximal Humeral Replacement for Tumor: A Preliminary Report
Authors: Riebel Greg , Webster Dwight A
Published: April 2021

ABSTRACT: Five patients who underwent prosthetic proximal humeral replacement for tumor were evaluated postoperatively at an average of 52 months. Four patients were reasonably satisfied with their results: they were relieved of pain which existed preoperatively and had hand and elbow function. Shoulder rotation was recovered satisfactorily. However, elevation and abduction were significantly compromised. No radiographic evidence of prosthetic loosening was identified.
Cementless Total Hip Arthroplasty: Femoral Remodeling and Clinical Experience
Authors: Rosenberg Aaron
Published: April 2021

ABSTRACT: Cementless fixation of arthroplasty components has proved to be viable. The physiology of ingrowth is increasingly understood, and many of the factors influencing this phenomenon have been elucidated. The effect of ingrowth fixation on bone remodeling is less understood. The effects of varying ingrowth surfaces and the distribution of these surfaces influence remodeling and are critical to clinical success. Clinical studies with femoral components of different design show that while both yield good clinical results and exhibit similar remodeling patterns, the degree of remodeling may be influenced by design criteria.
A Quantitative Assessment of Degenerative Changes Acceptable in the Unoperated Compartments of Knees Undergoing Unicompartmental Replacement
Authors: Corpe R Scott , Engh Gerard A
Published: April 2021

ABSTRACT: Thirty-five unicondylar knee arthroplasties were performed on 32 patients. In the unresurfaced compartments, degenerative cartilaginous changes were observed intraoperatively and recorded. The Outerbridge grading scale was used to assess the degree of arthritic change. In addition, the surface area involved was estimated. Grade III and limited grade IV changes in the unresurfaced tibiofemoral compartment and the patellofemoral joint did not preclude excellent results at a follow-up interval of 2 to 4 years.
Synovium Transplantation onto the Cartilage Denuded Patellar Groove of the Sheep Knee Joint
Authors: Rothwell A G
Published: April 2021

ABSTRACT: A macroscopic and histologic study has been made on the changes during a 2-year period in a free composite graft of synovium subsynovial fat and periosteum taken from the medial femoral condyle and placed on the cartilage denuded patellar groove of the knee joint in skeletally mature sheep. The results have been compared to a control group which had the same surgical management except that the graft was discarded. The study demonstrated that following "take" and revascularization, the composite graft had converted to a single layer of vascular fibrobfastic tissue by 6 weeks and over the ensuing year this had been largely replaced by flbrocartilage of variable differentiation. However, over the next year much of this fibrocartilage would appear to have undergone either redifferentiation into disorganized fibrochondroid tissue or developed secondary degenerative changes.

By contrast, the control specimens had profound resorption of the bone plate followed by patchy resurfacing with tissue ranging from a very loose fibrous connective tissue to well differentiated fibrocartilage. The latter had gradually increased in amount over the 2-year period, but secondary degenerative changes had also developed as in the grafted group. Despite some of the drawbacks, particularly the magnitude of the patello-femoral compression force, the technique has now been refined into a reliable animal model for the study of different parameters either in the graft or the graft environment in the hope that a way can be found to increase the life span of the metaplastic cartilage.
Clinical Evaluation of the Rocker Bottom Crutch
Authors: Basford J R , Rhetta H L
Published: April 2021

ABSTRACT: One hundred fifty hospitalized patients referred to a physical therapy department for crutch walking instruction were evaluated in a randomized, controlled crossover study with "rocker bottom" and conventional axillary crutches. A large training effect was observed with each crutch, but no significant differences (all P >.05) of gait speed, stride length, heart rate, stability, or feeling of security were noted between the groups. Thus, rocker bottom crutches, despite potential stability and energy conservation benefits, were found to be no more effective than conventional axillary crutches in this hospital setting.
PRELIMINARY RESULTS OF MILLER-GALANTE UNCEMENTED TOTAL KNEE ARTHROPLASTY
Authors: Joseph James , Kaufman Eugene E
Published: April 2021

ABSTRACT

From July 1984 through February 1986, a total of 46 knees were placed in 42 patients. The average age of all patients was 58 years (range, 32 to 68). Osteoarthritis was the diagnosis in 38 knees, traumatic arthritis in 5, and rheumatoid arthritis in 3. During follow up, averaging 3.6 years (range, 2.0 to 4.5), the total knee score based on a modified Hospital for Special Surgery knee rating scale improved from a preoperative average of 59 to 93 postoperatively. Radiographically, partial radiolucencies (<1 mm) were present in at least one view in 72% of the knees in which the interface was well visualized. No radiolucencies were progressive. Complications occurred mainly in the patellar components, as 17% of metal-backed uncemented patellae required revision to cemented non-metal backed components. There were no deep infections. The authors remain cautiously optimistic while awaiting longterm follow up.
RADIOLOGIC CASE STUDY
Authors: Slawson S Horatio , Arendt Elizabeth , Engebretsen Lars , Everson Lenore I , Griffiths Harry J
Published: April 2021

FROULAR STRESS FRACTURE IN A 20-YEAR-OLD WOMAN
ADAPTATIONS DURING THE STANCE PHASE OF GAIT FOR SIMULATED FLEXION CONTRACTURES AT THE KNEE
Authors: Cerny Kay , Perry Jacquelin , Walker Joan M
Published: April 2021

ABSTRACT

Adaptations in the stance phase of gait to knee flexion contractures simulated by a knee-ankle-foot orthosis were studied in 20 healthy women (mean age: 25 ± 3.6 years). Stride characteristics, jouit postures, floor reactions, and indwelling electromyographic activity of the lower gluteus maximus, vastus Iateralis, long head of the biceps femoris, and soleus muscles were measured during walking with the orthosis, with and without contracture simulation. Simulated knee flexion contracture resulted in decreased stride length and velocity and increased forefoot weight bearing and flexion posture in stance. Increases were also seen in magnitude and/or duration of flexion floor reaction torques and gluteus maximus, vastus Iateralis, and soleus muscle activity. The addition of a restriction of plantar flexion resulted hi a further decrease in velocity and stride length and a small increase in hip extension posture. These results show that knee flexion contractures, simulated in healthy subjects, cause a decrease in gait function with a simultaneous increase in muscular demand.
ENHANCED SPINO-PELVIC FIXATION FOR SEGMENTAL SPINAL INSTRUMENTATION: A PRELIMINARY BIOMECHANICAL EVALUATION
Authors: Thomas Kevin A , King Andrew G S , Zembo Michele M , Solomonow Moshe , Summersgill Louis E , Dabezies E Jean
Published: April 2021

ABSTRACT

A new method for spino-pelvic fixation of Luque rods was developed and biomechanically evaluated on cadaveric specimens. The technique is surgically simpler and fester than the Galveston technique because it does not require the complex three-dimensional bending of rods to conform to the medullary cavity of the iliac wings. Spines were tested in axial compression in both bilateral and unilateral ischial weight bearing in the intact condition, instrumented with the new technique, and instrumented with the Galveston technique. Compared to the intact spine, the technique increased bilateral average stiffness by 131% and unilateral average stiffness by 192%. Compared directly to the Galveston technique, the new method exhibited increased average stiffness of 15% in bflateral and 11% in unilateral ischial weight bearing. The new method combines the advantages of a simpler and faster surgical procedure than the Galveston technique with enhanced spino-pelvic fixation with the potential to decrease migration of rods relative to each other and the pelvis.
LATE MECHANICAL STABILITY OF THE PROXIMAL COATED AML PROSTHESIS
Authors: Sugiyama Hajime , Whiteside Leo A , Engh Charles A , Otani Takuya
Published: April 2021

ABSTRACT

Micromotion of a bone-ingrown anatomic medullary locking (AML) femoral component was evaluated in a specimen retrieved from a 66-year-old man who died 4 years following total hip replacement Radiographic signs suggested bone ingrowth into the proximal porous coating, but a radiolucent line surrounded by a sclerotic line was present around the distal stem. Both torsional and axial loading to physiologic levels elicited minimal micromotion at the proximal boneprosthesis interfaces. However, mediallateral micromotion at the distal tip was found to be as high as 44 µ?? with axial load. An AML femoral component of similar design was inserted into the opposite normal femur using the cementless press-fit technique originally used for the implanted specimen. Micromotion proximally was much greater in the freshly implanted systems in response to both torsional and axial loading than in the bone ingrown specimen. However, distal medial-lateral micromotion was much greater for the bone-ingrown stem. These findings show that bone ingrowth provides rigid fixation of the implant to bone; however, flexibility of the femur causes increased micromotion of the femur around the smooth distal stem despite initial tight distal fit.
RADIOLOGIC CASE STUDY
Authors: Diebner Jeffrey , Sundaram Murali
Published: April 2021

OS ODONTOIDEUM
BIPOLAR HEMIARTHROPLASTY FOR PRIMARY OSTEOARTHRITIS OF THE HIP
Authors: Prieskorn David , Burton Paul , Page Billy Joe , Swienckowski John
Published: April 2021

ABSTRACT

One hundred twenty-five bipolar hemiarthroplasties of the hip were performed at the authors' hospital. Although the procedure was performed for acute femoral neck fractures, rheumatoid arthritis, revision hemiarthroplasty, and primary osteoarthritis, only the latter is the subject of this review. A modified Harris hip score (HHS) was used to evaluate the patients both preoperatively and postoperatively. Radiographs were taken preoperatively as well as postoperatively at 2-, 4-, 6-, and 24-month intervals. A total of 68 patients underwent bipolar hemiarthroplasty for primary hip osteoarthritis. The mean preoperative HHS was 35.5 (SEM = 1.86); the mean postoperative score was 81.2 (SEM = 1.64) with an average improvement of 45.7 (SEM = 2.03). The results of this review were compared to a control group of conventional total hip arthroplasties performed at the same institution. The mean postoperative HHS for the group of conventional arthroplasties was 87.2 (SEM = 1.07). The results of this review indicate a good clinical result from bipolar hemiarthroplasty, but significantly less postoperative function when compared to conventional total hip arthroplasty.
TREATMENT OF COMMINUTED DISTAL RADIUS FRACTURES: AN APPROACH BASED ON PATHOMECHANICS
Authors: Agee John M , Szabo Robert M , Chidgey Larry K , King Francis C , Kerfoot Cynthia
Published: April 2021

ABSTRACT

Following dorsally displaced fractures of the distal radius, the classic position of immobilization is with the wrist flexed and in ulnar deviation. This is not the position of function and entails morbidity in the form of fìnger stiffness, which may require prolonged rehabilitation. We treated 20 consecutive, comminuted, intraarticular distal radial fractures using a new external fixation system with the wrist m a neutral to extended position, thereby promoting metacarpophalangeal joint flexion by relatively relaxing the fìnger extensor tendons. Supplemental pin fixation was used in eight cases. Most patients were performing active digital motion on the day of surgery and 95% maintained functional fìnger motion during treatment. All fractures healed uneventfully. Palmar tilt was restored in 55% of patients in spite of a wrist neutral or extended position. This method of fixing distal radial fractures allows restoration of anatomy while avoiding hand stiffness.
THE DEEP BRANCH OF THE ULNAR NERVE IN GUYON'S CANAL: BRANCHING AND INNERVATION OF THE HYPOTHENAR MUSCLES
Authors: Gonzalez Mark H , Brown Anthony , Goodman David , Black Brian
Published: April 2021

ABSTRACT

Thirty-seven embalmed, unpaired cadaver hands were dissected to delineate and classify the innervation of the hypothenar musculature. The deep branch of the ulnar nerve passed between the abductor digiti minimi and flexor digiti minimi and then pierced the opponens in all specimens. All branching occurred on the ulnar aspect of the deep branch of the ulnar nerve. A classification based on proximity of the different branches is prepared. Five different patterns have been noted.
UNCEMENTED TOTAL KNEE ARTHROPLASTY: REPORT OF 109 TITANIUM KNEES WITH CANCELLOUSSTRUCTURED POROUS COATING
Authors: Baldwin James L , El-Saied M R A , Rubinstein Richard A
Published: April 2021

ABSTRACT

One hundred twenty-three uncemented total knee arthroplasties were performed between Novemher 1986 and November 1989. The implants were pure titanium with porous coating for bony ingrowth. One hundred nine of these knees were followed for 2 to 5 years (average: 31.5 months). Clinical evaluation of the results, using the Hospital for Special Surgery Knee Rating Scale, revealed an increase in the average knee score from 62.9 preoperatively to 92.5 postoperatively, with excellent or good results in 94.5% of the cases. Thirteen knees (12%) had 26 radiolucent lines or areas. There was no complete lucency underneath any implant, and no knees were revised for loosening. One knee required replacement of the tibial insert for instability. While titanium implants were successful in achieving secure fixation and high knee scores in the short term, longer follow up will be necessary for more definitive conclusions, especially in regard to the potential problems with titanium wear debris.
BIOMECHANICAL EFFECTS OF GAMMA IRRADIATION ON FRESH FROZEN ALLOGRAFTS IN VIVO
Authors: Godette George A , Kopta Joseph A , Egle Davis M
Published: April 2021

ABSTRACT

The effect of gamma irradiation on the mechanical properties of allograft in a rabbit model was examined. Tibial allografts were tested in torsion to failure to detennine maximum torque and maximum stress. Statistically significant degradation in the torsional strength of irradiated tibias vs controls was demonstrated. Femoral allografts were orthotopically implanted into experimental rabbits and secured with an intramedullary pin. Rates of incorporation and failure patterns were significantly altered by irradiation. These data suggest that sterilization of fresh-frozen allografts with 2.5 Mrad or greater severely degrades the ability of the graft to resist torsion. The rate of incorporation of freshfrozen allografts also may be dramatically decreased as a result of irradiation.
RESULTS OF THE TOTAL BI-METRIC CEMENTLESS HIP ARTHROPLASTY
Authors: Robertsen Kell , Gaarden Morten , Teichert Gerhardt , Langhoff Otto
Published: April 2021

ABSTRACT

A 2.9-year follow up of 50 primary Bi-Metric System cementless, porous-coated hip arthroplasties (Biomet) is presented. Four patients were operated bilaterally. In two patients, revision arthroplasty was carried out, in one because of infection, in the other because of loosening of the stem. The average Harris hip score was 96 points. The pain level according to d'Aubigné was 5.87. All patients belonged to Jensen's social function group 1. According to Engh's x-ray score, the femoral component achieved an average total of 19 points. Twenty-three patients with heterotopic ossification were graded according to Brooker et al; 18 patients belonged to group ?-?, and 5 patients to group ?1. Discrepancy of leg length was measured in 20 patients, and averaged 0.52 cm (range: 0 cm to 2.5 cm). Four patients complained of thigh pain, but they had no radiographic evidence of loosening of components. The mean age was 63.4 years for women and 58.1 for men. Acceptably high Harris Hip Scores were obtained for the Bi-Metric hip prosthesis at 2-year follow up.
FIBROUS DYSPLASIA
Authors: Stanton Robert P , Montgomery Ben E
Published: April 2021

ABSTRACT

Fibrous dysplasia provides the orthopedic surgeon with tremendous reconstructive challenges. The manifestations of the condition are very diverse and often involve organ systems not routinely cared for by the orthopedic surgeon. We present a concise review of the radiography, histology, clinical manifestations, and complications of this condition, with the main focus on the non-orthopedic management challenges.
Percutaneous vs Modified Phemister Epiphysiodesis of the Lower Extremity
Authors: Scott Allison C , Urquhart Bradford A , Cain Thomas E
Published: April 2021

ABSTRACT

Epiphysiodesis of the lower extremity for limb-length discrepancy has been performed on 24 patients by both the modified Phemister and a percutaneous method. The primary complication of epiphysiodesis by both methods was continued growth of the physeal plate (12% and 15%, respectively). Failure of epiphysiodesis was attributed to young skeletal age at surgery in three of five cases. Closer attention to physeal ablation and close follow up should prevent this complication. No angular deformities resulted in any patient. During 16 proximal fibular procedures, there were no neurologic complications. The percutaneous method is preferred due to ease of surgical procedure, minimaf incisions, limited disability to the normal extremity, and equal results.
Comparison of the Hospital Cost of Primary and Revision Total Knee Arthroplasty After Cost Containment
Authors: Iorio Richard , Healy William L , Richards Julie A
Published: April 2021

ABSTRACT

Revision total knee arthroplasty (TKA) consumes more time, more work, and more supplies than primary TKA. This study compared the hospital cost of primary and revision TKA after the introduction of cost-containment programs (implant standardization, clinical pathway, and competitive bid implant purchasing) at our hospital.

Hospital financial records of 207 primary unilateral TKA operations and 32 revision TKA operations performed from October 1993 through September 1995 were analyzed. A cost-accounting system provided actual hospital cost data for each procedure. Accurate calculation of hospital income or loss was determined for all 239 procedures. The average hospital length of stay was 4.7 days for primary unilateral TKA and 5.1 days for revision TKA. There were 26 three-component revision operations and 6 one- or two-component revision operations. The average hospital cost was $10,421 for primary TKA and $1 1 ,906 for revision TKA. The average net hospital income (hospital revenue - hospital expense) was $3211 for primary TKA and $1853 for revision TKA. The payer mix included indemnity insurance, Medicare, Medicaid, managed care, and workmen's compensation. All payers were profitable except for Medicaid and selected managed care contracts for both primary and revision TKA. As a result of cost-containment programs, revision TKA can be profitable at our institution.
Influence of Tibial Bone Quality on Loosening of the Tibial Component in Total Knee Arthroplasty for Rheumatoid Arthritis: Long-Term Results
Authors: Sugita Takehiko , Umehara Jutaro , Sato Katsumi , Inoue Hisayoshi
Published: April 2021

ABSTRACT

This study examined the relationship between the bone quality of the proximal tibia, which was quantitatively investigated by histomorphometric method at the time of total knee arthroplasty, and the occurrence of loosening of an all-polyethylene tibial component in nine rheumatoid arthritis patients. Despite severe osteoporosis, there was no loosening after 12.8 years. These results suggest that even severe osteoporosis does not influence the occurrence of loosening of a cemented, all-polyethylene tibial component in rheumatoid patients with low activity levels. We recommend the use of all-polyethylene tibial component for low-activity patients.
Intermediate-Term Clinical and Radiographic Results of Synatomic and AGC Knee Prostheses
Authors: Rinta-Kiikka I , Savilahti S , Pajamäki J , Lindholm T S
Published: April 2021

ABSTRACT

This study compared two total knee prostheses to determine whether the clinical and radiographic outcomes were different, focusing primarily on the patellofemoral articulation. The study group was comprised of 75 Synatomic (short-stemmed, anatomic VF type) and 79 AGC 2000 (universal, nonanatomic) prostheses. Patients underwent follow-up for an average of 63 and 50 months, respectively. At latest foilow-up, the mean knee joint score was 84.4 in the Synatomic and 86.5 in the AGC group. Mean knee function scores were 63.5 and 63.4, respectively. No statistically significant difference was noted between the two prostheses.
The Treatment of Symptomatic Os Acromiale
Authors: Ryu Richard K N , Fan Robert S P , Dunbar William H
Published: April 2021

ABSTRACT

Os acromiale is an uncommon condition of the shoulder. When symptomatic, os acromiale may cause impingement pain, rotator cuff tears, or pain through abnormal motion at the unfused apophysis. Treatment of symptomatic os acromiale is controversial. This article reports on four patients with symptomatic mesoacromions who were treated with open reduction and internal fixation. All four patients recovered full function postoperatively with UCLA shoulder rating scores improving from 19 preoperatively to 35 postoperatively. Open reduction and internal fixation of a symptomatic meso-acromion is a reliable and reproducible technique in which the deltoid attachment and lever arm are minimally affected.
Comparison of Bone-Patellar Tendon-Bone Interference Screw Fixation and Hamstring Transfemoral Screw Fixation in Anterior Cruciate Ligament Reconstruction
Authors: Randall R Lor , Wolf Eugene M , Heilmann Moira R , Lotz Jeff
Published: April 2021

ABSTRACT

While bone-patellar tendon-bone (BPTB) interference screw anterior cruciate ligament (ACL) reconstruction is a biomechanically sound construct, alternative techniques have been developed secondary to potential donor site morbidity. This study evaluates a system designed to address this problem that involves a transfemoral screw fixation device and stapling of hamstring tendons. Seven pairs of cadaveric knees underwent ACL reconstruction using either BPTB interference screw technique or semitendinosus gracilis (STG) transfemoral screw fixation and stapling. Tensile testing was performed. There was no significant difference between the two fixation types with regard to stiffness, maximum load to failure, elongation, energy to failure and yield load, displacement, and energy.
Expression of nm23 Protein in Human Osteosarcoma in Relationship With Early Metastasis
Authors: Liao Wei Ming , Chiu Kwong Yuen , Li Fo Bao , Qiu Ju Shi , Han Shi Yin , Chow Shew Ping
Published: April 2021

ABSTRACT

Nm23 protein expression was analyzed by immunohistochemical staining using formalin-fixed, paraffinembedded sections from 39 cases with osteosarcomas and compared with the histologic findings and early metastasis for the purpose of detecting nm23 expression in osteosarcoma and elucidating the clinical significance of its expression. Immunoreactivity of nm23 protein was detected in 48.7% of the total cases. There was no statistical difference between nm23 expression and early metastasis, but there was a trend for cases with nm23 expression to progress to early metastasis within 1 year after operation. The role of nm23 as a tumor metastasis suppressor in osteosarcomas appeared less prominent.
Use of a Siliconized Nylon Sheet to Prevent Pleural Adhesions During Staged Thoracotomy Procedures for Kyphosis
Authors: Ginsburg G M , Mahour G H , Bassett G S
Published: April 2021

To prevent pleural adhesion formation during staged thoracotomies for kyphosis, a siliconized rubber-coated nylon sheet is interposed between freshly dissected pleural surfaces.
Comparison of MRI and Radiographs in the Evaluation of Acromial Morphology
Authors: Wang Jeffrey C , Hatch Joshua D , Shapiro Matthew S
Published: April 2021

ABSTRACT

This study compared the accuracy of magnetic resonance imaging (MRI) grading of acromions using supraspinatus outlet view radiographs. Thirty-two consecutive patients (1 7 men and 1 5 women) treated for shoulder disorders were included in the study. Average patient age was 58.5 years. All patients had both a supraspinatus outlet radiograph and an MRI of the shoulder. Each acromion was graded by three independent observers at separate intervals by radiographs and MRI and the results were compared.

The incidence of the three acromial types determined by radiographs was: type 1=6%, type 11=66%, and type 111=28%. The incidence of the three acromial types determined by MRI was: type 1=6%, type 11=69%, and type 111=25%. There was essentially no difference in the incidence of acromial morphology between the two groups. Magnetic resonance imaging demonstrated the same shape as shown on the plain radiographs in 97% of the patients (95% confidence interval, 0.84-0.99).

Magnetic resonance imaging is similar to supraspinatus outlet radiographs in determining acromial type. Acromial grading by MRI is a valid method of determining acromial morphology.
Tension-Band Technique for Ankle Fusion
Authors: Wu Chi-Chuan , Shih Chun-Hsiung , Chen Wen-Jer , Tai Ching-Lung
Published: April 2021

ABSTRACT

A prospective study was conducted to develop a better technique for ankle fusion. Eleven consecutive patients were treated using the tension-band technique for ankle fusion and underwent follow-up for a minimum of 2 years (range: 2-5 years). All 1 1 patients achieved solid fusion for a fusion rate of 1 00%. Average time to fusion was 3 months (range: 2-6 months). The indication for ankle fusion was intractable aching pain that could not be controlled by conservative methods. Two of 11 patients underwent surgery due to infected arthritis. After ankle fusion, there was no recurrence of infection during a 3-year follow-up period.

The technique included osteotomy of the bimalleoli from the inside out, removal of articular cartilage and preserving wedge space for cancellous bone grafting, with or without staple stabilization, and external immobilization supplementation. The functional outcome in all 1 1 patients improved from unsatisfactory preoperatively to satisfactory at latest follow-up (P<.001). No significant complications were noted. This simple technique proved excellent for ankle fusion with a satisfactory outcome and is recommended for treating severe ankle arthropathies.
Percutaneous Sclerotherapy for Congenital Venous Malformations in the Extremities
Authors: Yao Yuki , Lomis Nick N T , Scott Steven M , Yoon Hyo-Chun , Miller Franklin J
Published: April 2021

ABSTRACT

Between January 1991 and January 1998, a total of 15 patients underwent direct injection sclerotherapy for painful peripheral venous malformations. Duplex ultrasonography or venography was used in all cases for the detection and localization of tortuous venous structures. Direct injection with absolute ethyl alcohol was performed in 12 patients, and Sotradecol or sodium morrhuate was used in 5 patients. Provocative lidocaine testing was used in 2 patients in whom major nerves were in proximity to the malformations. All patients underwent follow-up in the clinic with duplex examination after each sclerotherapy.

Clinical symptoms of all patients improved during average follow-up of 2.5 years (range: 3 months to 6 years.) Duplex examination was useful in detecting the venous component including the size and course of veins, which were often less well seen on magnetic resonance imaging. Duplex study was helpful in follow-up after sclerotherapy in all patients.

Direct injection sclerotherapy is an acceptable treatment modality for venous malformations. Complications are manageable, and regular follow-up with Duplex is helpful.
Assessment of the Endoscopic Semitendinosus/Gracilis Autograft Procedure With Interference Screw Fixation for Reconstruction of the Anterior Cruciate Ligament
Authors: Allen Aaron D , Sitter Michael R , Marchetto Paul , Kelly John D , Mattacola Carl G
Published: April 2021

ABSTRACT

The semitendinosus/gracilis autograft procedure with interference screw fixation was evaluated for clinical effectiveness of anterior cruciate ligament (ACL) reconstruction. Thirty patients underwent the procedure and were evaluated an average of 15 months postoperatively. Results revealed 22 (73%) patients had a standard knee evaluation form score of normal or nearly normal, and 24 (80%) patients returned to strenuous or moderate activity levels. Average Lyshoim outcome score was 89, and bilateral KT-2000 differences were <3 mm at follow-up. Functional knee test symmetry index percentage outcome for the one-legged hop test was 92.6% for distance and 98% for time. Length of time (ie, ≤90 days or ≥91 days) between injury and surgery was independent of outcome. These findings indicate the semitendinosus/gracilis autograft is a viable procedure for reconstruction of the ACL-deficient knee.
Extra-Articular Wide Tumor Resection and Limb Reconstruction in Malignant Bone Tumors at the Proximal Femur
Authors: Nakamura Shinichiro , Kusuzaki Katsuyuki , Murata Hiroaki , Takeshita Hideyuki , Hirata Masazumi , Hashiguchi Shin , Hirasawa Yasusuke
Published: April 2021

To achieve good limb function oñer tumor resection of the hip, triple osteotomy of the pelvis can be performed using the extra-articular wide resection procedure.
Closed-Wedge Tibial Osteotomy: Conventional Technique Versus a New System of Compression-Dynamic Fixation
Authors: Tigani D , Del Baldo A , Trentani P , Trentani F , Marinelli A , Bianchi G
Published: April 2021

Abstract

Two groups of patients treated with different techniques of closed wedge tibial osteotomy were analyzed. Twenty-eight patients underwent the conventional technique and 31 patients underwent a closed-wedge osteotomy using a new osteotomy cutting jig and compression-dynamic fixation. The groups were comparable with respect to age, gender, and deformity. Using the conventional technique, only 68% of knees had an optimal postoperative femorotibial angle between 167° and 175°, compared to 88% using the new device (P=.02). High tibial osteotomy with an osteotomy jig provides a more accurate correction of deformity than the conventional technique.
Complications Related to Postoperative Casting After Surgical Treatment of Subluxed/Dislocated Hips in Patients With Cerebral Palsy
Authors: Lubicky John P , Bernotas Sarunas , Herman Jean E
Published: April 2021

Abstract

Three hundred sixteen subluxed/dislocated hips (222 patients) underwent upper femoral osteotomy. Of these, 286 (90.5%) hips were casted (average patient age: 8.9 years) and 30 (9.5%) were not (average patient age: 13.6 years). Average follow-up was 4.7 years. Complications in the casted/noncasted groups (per hip) were: 43/0 (15%/0%) skin sores; 11/1 (3.8%/3.3%) wound infections; 6/0 (2.1%/0%) instrumentation failures; 22/1 (7.7%/3.3%) reoperations; and 13/1 (4.596/3.3%) rehospitalizations. Differences between the groups were not statistically significant. Casted patients were younger and more neurologically involved.

Casting is useful to ensure healing of osteotomies, prevent instrumentation failure and injury to the operated legs, and allow for ease of handling. Complications that occurred were managed and had no long-term sequelae.
Intraoperative Hemostasis During Spinal Reconstructive Procedures
Authors: Thibodeaux Kerry T , Lorio Morgan P , Block Jon E
Published: April 2021

Abstract

In a consecutive sample of patients undergoing similar spinal reconstructive procedures in the thoracolumbar region, hemostatic effectiveness of a collagen-based composite (CoStasis; Cohesion Technologies, Palo Alto, Calif) (n=10) was compared with standard hemostatic methods (manual compression) (n=9). All patients treated with CoStasis at the operative site(s) demonstrated immediate hemostasis, whereas all cases treated with gauze and sponges showed protracted bleeding (P<.01). The average perioperative blood loss was approximately twice as great among control patients compared to CoStasis patients (1322 mL versus 685 mL; P=.02). Total transfusion requirements and operative duration also were less among CoStasis patients. These findings suggest CoStasis may provide effective hemostasis in spinal reconstructive procedures such as instrumented fusion where blood loss is excessive.
K-Wire Fixation of Displaced Physeal Injuries
Authors: Board T N , Bale R S , Harwin Steven F
Published: April 2021

Kirschner wire fixation, previously described as a treatment for displaced distal radial fractures, is also useful in maintaining fracture reduction of physeal fractures.
The Incidence of Pathology Detected by Magnetic Resonance Imaging of the Knee: Differences Based on the Specialty of the Requesting Physician
Authors: Bernstein Joseph , Cain Eric L , Kneeland J Bruce , Dalinka Murray K
Published: April 2021

Abstract

The usage patterns of magnetic resonance imaging (MRI) by orthopedic and nonorthopedic surgeons were studied. A sample consisting of the radiologist reports from all knee MRIs in a single year at our institution were reviewed. Studies to evaluate tumors or infections were excluded. Reports were classified as normal or demonstrating degenerative joint disease, meniscal tears, cruciate ligament pathology, collateral ligament pathology, focal chondral defects, chondromalacia patella, cysts, extensor mechanism dysfunction, intraosseous edema, or fractures. Six hundred eighteen reports were reviewed. The combined incidence of a normal study or one that found only degenerative joint disease was 45% for nonorthopedic surgeons and 27.6% for orthopedic surgeons (P<.00001). Given the higher incidence of normal findings in studies ordered by nonorthopedic surgeons, these physicians probably use MRI more for screening whereas orthopedic surgeons are more apt to use it for confirmation. Therefore, if clinical guidelines for using MRI are to be established, differences in use as a function of specialty must be acknowledged.
Shoulder Arthroplasty Without a Rotator Cuff
Authors: Walch Gilles
Published: April 2021

Patients with a glenohumeral arthritis and a deficient rotator cuff represent a therapeutic challenge. In 1987, Paul M. C ram mot, MD introduced a new reverse design to treat this patient population.

This reverse design shoulder prosthesis has a cup placed within the proximal humerus and a hemisphere fixated to the glenoid. This prosthetic design relies on the deltoid to provide active elevation.

In this issue, Dr Gilles Walch, a leading international expert in shoulder surgery, shares his views on the reverse design prosthesis. Dr Walch has had vast experience and reports a high success rate with the implant, which is currently under IDE study in the United States.
A Method to Facilitate Open Reduction and Internal Fixation of Surgical Neck Fractures
Authors: Perez-Sanz Jose R , Durudogan Harun
Published: April 2021

Fixation of the tuberosities in proximal humeral fractures can be challenging and frustrating. This method allows easy passage of heavy suture to hold the lesser and greater tuberosities to one another and the shaft fragment
Evaluation and Treatment of Open Calcaneal Fractures: A Retrospective Analysis
Authors: Lawrence Steven J , Grau Gregory F
Published: April 2021

Abstract

The primary evaluation and management of 47 consecutive patients with 48 open calcaneal fractures was retrospectively analyzed. The fractures were treated over a 7year period. Forty-two fractures resulted from blunt trauma, and 6 followed penetrating trauma. The predominant mechanism of injury was a motor vehicle accident.

Initial treatment consisted of emergent irrigation and debridement of the open wound with intravenous antibiotic prophylaxis. Most patients underwent a second debridement. More than two thirds of the wounds were >5 cm in length, degioving-type injuries, associated with a significant neurovascular deficit and/or required a freetissue transfer. Internal fixation of the os calcis was undertaken in 40% of patients. In addition, >40% of patients sustained concomitant foot and ankle fractures. Two patients underwent below-the-knee amputations as primary treatment. Five patients required a free-tissue transfer. Complications included two infections and one below-the-knee amputation. Two deaths occurred due to unrelated causes.

Treatment standards for the optimal management of open calcaneal fractures remain controversial. A better understanding of this complex injury will help determine suitable treatment strategies.
Intercalary Tibial Allografts Following Tumor Resection: The Role of Fibular Centralization
Authors: Mohler David G , Yaszay Burt , Hong Richard , Wera Glenn
Published: April 2021

Abstract

Options to reconstruct intercalary tibial defects include allografts, vascularized bone transfers, autogenous cortical grafts, endoprostheses, and llizarov bone transport. Five patients underwent intercalary bulk allograft reconstruction following en bloc resection of tibial sarcomas. Two patients underwent immediate fibular centralization and iliac crest bone grafting in addition to the allograft. Two patients who underwent fibular centralization during primary reconstruction united uneventfully. The remaining three patients developed nonunion, of which one was successfully salvaged by fibular centralization. A combined allograft transplant and fibular centralization with iliac crest bone grafting is an effective procedure to reconstruct the tibial diaphysis, as well as a salvage procedure for allograft nonunion.
Dynamic Changes in the Contact Area of the Sacroiliac Joint
Authors: Ebraheim Nabil A , Madsen Terry D , Xu Rongming , Mehalik John , Yeasting Richard A
Published: April 2021

Abstract

Thirty adult dry-bone ilium specimens were used in conjunction with computer analysis to determine the average articular contact area between the sacrum and ilium at the sacroiliac joint. Simulating an unstable pelvic injury, the sacroiliac joint was displaced in three directions by moving the ilium posteriorly, superiorly, and posterosuperiorly. After each displacement, the contact area between the sacrum and ilium at the sacroiliac joint was calculated. The data showed that the average articular surface area of the male sacroiliac joint (1138.3 mm
p 2
) was approximately 12.8% greater than the average surface area of the female sacroiliac joint (992.5 mm
p 2
). The average articular contact area between the sacrum and ilium at the sacroiliac joint was lowest with the ilium displaced posterosuperiorly compared to equal displacements superiorly or posteriorly. This study quantitatively illustrated the loss of contact surface area between the sacrum and ilium during various displacements of the ilium, thus indicating the clinical cross-section area available for open reduction and internal fixation or fusion.