bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemi-Resurfacing versus Total Resurfacing for Osteonecrosis of the Femoral Head
Authors: Kabata Tamon , Maeda Toru , Tanaka Kazunori , Yoshida Hironori , Kajino Yoshitomo , Horii Takeshi , Yagishita Shin-Ichi , Tsuchiya Hiroyuki
Published: October 2016

Purpose.

To compare mid-term outcomes of hemi-resurfacing arthroplasty (HRA) and total resurfacing arthroplasty (TRA).

Methods.

Seven men and 5 women (16 hips) aged 33 to 72 (mean, 50) years underwent HRA, whereas 7 men and 3 women (16 hips) aged 23 to 52 (mean, 40) years underwent metal-on-metal TRA; all were for osteonecrosis of the femoral head. In the HRA and TRA groups respectively, 10 and 8 hips were steroid-induced, whereas 6 and 8 hips were related to alcohol abuse. Surgery for 12 and 4 hips entailed the posterolateral approach, whereas 4 and 12 hips entailed the Hardinge approach. Usually, HRA was performed for early stages of the disease, and TRA for more advanced stages. 12 and 6 hips were classified as JOA stages 1 to 3A, whereas 4 and 10 hips as stages 3B to 4. All the hips were JOA types C1 or C2.

Results.

In the HRA and TRA groups respectively, the mean follow-up period were 6.5 and 5.5 years. The mean total JOA hip scores were 57 and 54 preoperatively, 93 and 97 at one year, and 84 and 96 at the final follow-up (p<0.01). The higher score in the TRA patients was mainly attributed to improvement in the pain score. In the HRA group, 12 hips developed groin pain or groin discomfort while walking, though only 4 of them showed apparent joint-space narrowing. Five patients underwent revision surgeries (conversion to total hip arthroplasty) owing to a femoral neck fracture, acetabular protrusio, osteoarthritic change, and severe groin pain. Patients having TRA had no revision surgery and did not complain of groin pain. Implants in both groups were radiographically stable.

Conclusion.

TRA were superior to HRA in terms of pain relief and implant survival, even though the former procedure was used for more advanced cases.
Tarlov Cysts: A Report of Two Cases
Authors: Sen Ramesh Kumar , Goyal Tarun , Tripathy Sujit Kumar , Chakraborty Soumya
Published: October 2016

Perineural cysts are common and usually detected incidentally during magnetic resonance imaging of the lumbosacral spine. Treatment is indicated only when the cyst is symptomatic. We report one such patients presented with cauda equina syndrome and another with low back pain with claudication. They underwent excision and duraplasty; both motor and sensory fibres were carefully separated from the cyst wall using a nerve root retractor and penfield. There was no nerve root damage or neural deficit. Symptoms were relieved postoperatively.
Double Clavicular Fractures Associated with Scapular Neck and Coracoid Process Fractures
Authors: Nanno Mitsuhiko , Sawaizumi Takuya , Ito Hiromoto
Published: October 2016

We report a 38-year-old man with a combination of fractures in his left shoulder involving the middle and distal clavicle, the scapular neck, and the coracoid process, associated with scapulothoracic dissociation and an upper brachial plexus injury. The middle clavicular fracture was fixed with a plate, whereas the distal clavicular fracture was fixed with tension band wiring. Internal fixation for fractures of the scapular neck and coracoid process was not performed, as they were in an acceptable position after fixation of the clavicular fractures. At the 14-month follow-up, the range of motion of the left elbow, the wrist, and all fingers had recovered fully, whereas that of the left shoulder was limited to 35° abduction, 20° flexion, and 20° external rotation. The strength of the left shoulder abduction, flexion, and external rotation was M2. Elbow flexion, wrist extension, and finger extension strength had recovered to normal (M5). Sensation corresponding to the C5-6 dermatome had also improved to almost normal.
Predicting Leg-Length Change after Total Hip Arthroplasty by Measuring Preoperative Hip Flexion under General Anaesthesia
Authors: Fujishiro Takaaki , Nishiyama Takayuki , Hayashi Shinya , Hashimoto Shingo , Kurosaka Masahiro , Kanno Taiki , Masuda Takeshi
Published: October 2016

Purpose.

To measure preoperative hip flexion under general anaesthesia in patients with developmental dysplasia of the hip and analyse its correlation with leg-length change.

Methods.

79 women and 6 men aged 27 to 82 (mean, 59) years underwent 92 total hip arthroplasties for severe developmental dysplasia of the hip of Crowe types II (n=60), III (n=17), and IV (n=15). All such patients had severe pain and/or considerable difficulty in walking and performing daily activities. 16 of the hips were treated with transverse subtrochanteric shortening osteotomy, whereas the remaining 76 had no femoral osteotomy. Preoperative passive hip flexion was measured under general anaesthesia with a goniometer by a single investigator. Its mean value in patients with Crowe type-III deformity was 60.3°. Therefore, >60° of flexion was defined as high. Postoperative leg-length change was measured radiographically. The distraction of the greater trochanter was equal to the leg-length change in patients treated without femoral osteotomy, whereas leg-length change was calculated by subtracting the amount of resection of the femur from the distraction of the greater trochanter in patients treated with femoral osteotomy.

Results.

Of the 16 hips treated with a transverse subtrochanteric shortening femoral osteotomy, 2, 2, and 12 were Crowe types II, III, and IV, respectively. In these 16 hips, hip flexion was high in 10 (mean, 86°) and low in 6 (mean, 36°). Leg-length change was significantly greater in the high than low flexion groups (31 vs. 13 mm, p<0.01). In the 76 hips without osteotomy, hip flexion was high in 54 (mean, 85°) and low in 22 (mean, 40°). Leg-length change was significantly greater in the high than low flexion groups (25 vs. 19 mm, p=0.016). Preoperative hip flexion under general anaesthesia correlated with leg-length change in hips with osteotomy ( r=0.850, p=0.0002) and without osteotomy ( r=0.267, p=0.019).

Conclusion.

Preoperative hip flexion measured under general anaesthesia may predict leg-length change after THA.
Medial Arch Orthosis for Paediatric Flatfoot
Authors: Sinha Shivam , Song Hae Ryong , Kim Hak Jun , Park Man Sik , Yoon Yeoung Chool , Song Sang Heon
Published: October 2016

Purpose.

To evaluate any correlation between various foot angles and their respective American Orthopaedic Foot and Ankle Society (AOFAS) scores for pain, and the effectiveness of a medial arch orthosis.

Methods.

81 children with bilateral symptomatic flatfoot were randomised into orthosis (n=55) and control (n=26) groups. The orthosis group consisted of 33 male and 22 female patients aged 36 to 204 (mean, 99) months and they were given a medial arch support. The control group consisted of 15 male and 11 female patients aged 36 to 192 (mean, 100) months and they were managed with analgesics. Foot angles including anteroposterior (AP) and lateral talocalcaneal (TC) angles, AP and lateral talo–first metatarsal (TFM) angles, calcaneal pitch angle (in lateral plane), and talonavicular (TN) angle were measured, as were AOFAS scores for pain for the forefoot, midfoot, and hindfoot.

Results.

After orthosis treatment, all AOFAS scores and all foot angles (except for the AP-TN angle) improved significantly. In the controls, all AOFAS scores (except for the midfoot score) and only the AP-TFM angle improved significantly. In the orthosis group, the AOFAS hindfoot score correlated positively with the lateral TC angle of the left foot ( r=0.345, p=0.010) and negatively with the calcaneal pitch angle of the right foot ( r=–0.33, p=0.015). In the control group, the lateral TFM angle of the left foot correlated negatively with the AOFAS forefoot ( r=–0.566, p=0.003) and midfoot scores ( r=–0.497, p=0.001), whereas the calcaneal pitch angle of the left foot correlated positively with the AOFAS forefoot score ( r=0.497, p=0.010).

Conclusion.

Medial arch support orthosis significantly improved AOFAS scores and foot angles. Calcaneal pitch angle and lateral TC angle correlated well with AOFAS hindfoot scores.
Calamine Lotion to Reduce Skin Irritation in Children with Cast Immobilisation
Authors: Mak May Fong , Li Wenyun , Mahadev Arjandas
Published: October 2016

Purpose.

To evaluate the effect of calamine lotion in reducing skin irritation in children with cast immobilisation and to identify factors correlating with skin irritation.

Methods.

250 children aged 6 to 15 years who underwent cast immobilisation for limb fractures were assigned into calamine (n=122) and noncalamine (n=128) groups. Data were collected at the time the cast was applied and removed. Potential confounders (gender, age, race, medical history, drug allergy, cast type, duration of casting, and extent of itch prior to casting) were identified. Each patient graded his levels of itch, sweat, and heat using a 5-point scale (with 5 indicating most severe). The on-duty plaster technician recorded the presence and type of skin lesions (blisters, wounds, or others) during cast removal.

Results.

Children in the calamine group were less likely to develop skin lesions (1 vs. 9, odds ratio [OR]=0.115, p=0.009), had less itch during casting (mean difference=0.74, p<0.0001), had a greater decrease in the itch level (mean difference=0.84, p<0.0001), and had lower sweat levels (p=0.048). After adjusting for confounders, the chance of developing skin lesions remained lower in the calamine group (OR=0.063, p=0.003). Being an older child and having shorter duration of casting were associated with presence of skin lesions. The odds for having skin lesions increased by 39.2% per year increase in age (OR=1.392, p=0.04) and decreased by 9.4% per day increase in casting duration (OR=0.906, p=0.03). The decrease in itch level remained significantly greater in the calamine group after adjusting for confounders (p<0.0001).

Conclusion.

Calamine lotion may reduce skin irritation in children with full casts.
A 45-Degree Radiographic Method for Measuring the Neck Shaft Angle and Anteversion of the Femur: A Pilot Study
Authors: Teo Pock Chin , Mohd Kassim Abdul Yazid , Thevarajan K
Published: October 2016

Purpose.

To propose a novel method to measure the neck shaft angle and anteversion of the femur using anteroposterior and 45° oblique radiographs.

Methods.

Three human subjects were used to verify the 45° oblique method. The true neck shaft angle and anteversion of the femur were determined using computed tomography. The true values were compared with the values derived by the 45° oblique method after correcting the distortion using a formula.

Results.

With the true values based on computed tomography as references, the neck shaft angle and anteversion of the 3 subjects deviated +0.82° to +4.66° and −2.14° to +2.55° in lateral 45° oblique radiographs, respectively, whereas the corresponding values in medial 45° oblique radiographs were +0.98° to +5.93° and −10.09° to +1.58°. The lateral 45° oblique method resulted in smaller range of deviation and were more accurate.

Conclusion.

This 45° oblique method is useful in surgical planning, especially for femoral derotational osteotomy in children. This new method enables easy calculation of the true neck shaft angle and anteversion, with low radiation exposure.
Review Article: Anti-Embolism Stockings
Authors: Patel Nimesh , Khakha Raghbir , Gibbs James
Published: October 2016

The National Institute for Health and Clinical Excellence (NICE) guidelines recommend combined mechanical and pharmacological prophylaxis to reduce the risk of venous thromboembolism (VTE) in patients undergoing orthopaedic surgery. There is increasing evidence that anti-embolic stockings (AES) have little effect on reducing such risk. Articles in the MEDLINE, EMBASE, and Cochrane Library were reviewed. Studies on the use of pharmacological prophylaxis recommended in the 2010 NICE guidelines including low-molecular-weight heparin, unfractionated heparin, rivaroxaban, and dabigatran with and without AES in patients undergoing orthopaedic surgery were included. A total of 1171 trauma and elective orthopaedic patients in 4 studies were included; 587 received pharmacological prophylaxis alone, and 584 received a combination of pharmacological prophylaxis and above- or below-knee AES. Of the respective patients, 44 (7.5%) and 31 (5.3%) developed deep vein thrombosis (p=0.1587) and 7 (1.2%) and 9 (1.5%) developed pulmonary embolism (p=0.8493). The overall VTE rates did not differ significantly (p=0.2864). No death from VTE was reported. Addition of AES did not confer significant benefit in terms of reducing the risk of VTE in orthopaedic patients.
Time Required for Effective Action of Phenol against Giant Cell Tumour Cells
Authors: Nithyananth Manasseh , Priscilla Anne Jennifer , Boopalan PVJRC , Titus VTK , Lee Vernon N
Published: October 2016

Purpose.

To evaluate the time required for effective action of phenol against the giant cell tumour (GCT) cells.

Methods.

Fresh GCT cells were harvested from 9 patients with primary GCT of the distal femur (n=4), proximal tibia (n=4), and proximal humerus (n=1), with the Campanacci tumour grades 3 (n=6), 2 (n=2), and 1 (n=1). Specimens were immersed in 80 % phenol for one, 3, 6, and 10 minutes, and were assessed by a single pathologist for irreversible cell death and the depth of phenol penetration.

Results.

Phenol caused consistent GCT cell death in 6 of the 9 specimens after 3 minutes and in all 9 specimens after 6 minutes, compared to none in controls (p<0.0001). The mean depths of phenol penetration were 15 (range, 11–20) and 19 (range, 15–25) cell thickness after 6 and 10 minutes, respectively (p<0.0001).

Conclusion.

GCT cells immersed in 80% phenol for 6 minutes resulted in consistent cell death.
Risk Factors for Recurrence of Giant Cell Tumours of Bone
Authors: Siddiqui Mashfiqul A , Seng Chusheng , Tan Mann Hong
Published: October 2016

Purpose.

To determine the risk factors for recurrence of giant cell tumours (GCTs) of bone.

Methods.

Medical records of 29 men and 29 women (mean age, 34 years) treated for primary (n=53) or recurrent (n=5) GCTs of bone and followed up for a mean of 40.2 months were reviewed. The tumours were located in the distal femur (n=18), proximal tibia (n=10), proximal femur (n=8), distal radius (n=7), proximal fibula (n=4), distal ulna (n=3), calcaneum (n=3), sacrum (n=2), vertebra (n=1), metatarsal (n=1), and distal humerus (n=1). 26 patients had pathological fractures, 12 had cortical break, and 20 had neither. The Campanacci grades of the tumours were I (n=1), II (n=18), and III (n=33); the grades of the remaining 6 tumours were unknown because radiographs were unavailable. The Enneking stages of the tumours were 1 (n=51), 2 (n=6), and 3 (n=1). Treatment included curettage and cementation (n=29), curettage, cementation, and adjuvant treatment with distilled water or liquid nitrogen for bones without fracture (n=18), wide resection for extensive soft tissue involvement (n=9), and amputation (n=2) for a recurrent GCT of the distal femur and a primary GCT of the calcaneus. Reconstruction included cementation (n=27), bone grafting (n=7), cementation/bone grafting with internal fixation (n=14), reconstruction with endoprosthesis (n=3), and none (n=7).

Results.

19 patients had recurrence after a mean of 23.1 months. The overall recurrence-free survival at years 1, 2, and 3 were 86%, 79%, and 72%, respectively. Recurrence did not correlate with patient age (p=0.20), primary or recurrent tumour at presentation (p=0.12), Campanacci grade (p=0.10), Enneking stage (p=0.54), or presence of pathological fracture (p=0.28). Compared to GCTs at other locations, GCTs in the proximal tibia were more likely to recur (27% vs. 60%, p=0.04).

Conclusion.

GCTs of the proximal tibia are more likely to recur than those at other locations.
Multifocal Epithelioid Hemangioendothelioma of the Foot and Ankle: A Case Report
Authors: Bisbinas Ilias , Karabouta Zacharoula , Georgiannos Dimitrios , Lampridis Vasileios , Badekas Athanasios
Published: October 2016

We report on a 41-year-old man with multiple epithelioid hemangioendothelioma of the left foot and ankle. The patient was treated with curettage and fixation with 2 separate plates, but later developed local infection. Owing to the potential for malignancy, below-knee amputation was suggested, but the patient declined and was treated symptomatically with close monitoring. The patient underwent removal of the plates, excision of the distal fourth of the fibula, intralesional curettage of all lesions, and fusion of the ankle and subtalar joints with a retrograde intramedullary nail. After 5.5 years, the patient had recovered well and had no evidence of malignancy. The tumour was considered definitively benign.
Histological Changes and Neural Elements in the Posterior Cruciate Ligament in Osteoarthritic Knees
Authors: Rajgopal Ashok , Vasdev Nandini , Pathak Abhishek , Gautam Dheeraj , Vasdev Attique
Published: October 2016

Purpose.

To evaluate histological changes and neural elements in 100 posterior cruciate ligaments (PCLs) in patients with osteoarthritis.

Methods.

100 PCLs were obtained from a consecutive series of 46 women and 16 men aged 49 to 91 (mean, 67) years who underwent primary PCL-retaining total knee replacement for osteoarthritis. Histology was examined using conventional light microscopy. The PCLs were graded histologically in terms of parallel orientation of collagen fibres, mucoid degeneration, inflammation, and haemosiderin deposition. Histological changes were graded as normal, mild degeneration, moderate degeneration, and severe degeneration. The neural elements were assessed using immunohistochemical staining for S100 protein and neurofilaments. The histopathologist was blinded to the age, gender, and clinical and radiological grades of osteoarthritis.

Results.

One specimen was excluded from analysis owing to inadequate tissue. In the remaining 99 specimens, histology was normal in 72, mildly degenerative in 4, moderately degenerative in 4, and severely degenerative in 15. 76 specimens were positive for S100 protein or neurofilament or both by immunohistochemical staining, indicating the presence of neural elements.

Conclusion.

Most knees with osteoarthritis present with viable PCLs. Retaining the PCL in total knee replacement is a good option for better kinematics, stability, and proprioception.
Comparison of Two Pressurisers for Cementation of the Proximal Femur
Authors: Morishima Takkan , Choy Godwin GH , Crawford Ross W , Wilson Lance J
Published: October 2016

Purpose.

To compare pressures generated by 2 different cement pressurisers at various locations in the proximal femur.

Methods.

Two groups of 5 synthetic femurs were used, and 6 pressure sensors were placed in the femur at 20-mm intervals proximally to distally. Cement was filled into the femoral canal retrogradely using a cement gun with either the half-moon pressuriser or the femoral canal pressuriser. Maximum pressures and pressure time integrals (cumulative pressure over time) of the 2 pressurisers were compared.

Results.

At all sensors, the half-moon pressuriser produced higher maximum pressures and pressure time integrals than the femoral canal pressuriser, but the difference was significant only at sensor 1 (proximal femur). This may result in reduced cement interdigitation in the proximal femur.

Conclusion.

The half-moon pressuriser produced higher maximum cementation pressures and pressure time integrals than the femoral canal pressuriser in the proximal femur region, which is critical for rotational stability of the implant and prevention of implant fracture.
Polarus Nail Fixation for Proximal Humeral Fractures
Authors: Fazal MA , Baloch Irshad , Ashwood N
Published: October 2016

Purpose.

To report the outcomes of Polarus nail fixation for displaced proximal humeral fractures.

Methods.

Medical records of 19 men and 27 women aged 26 to 84 (mean, 63) years who underwent fixation using a standard Polarus nail (n=34) or Polarus plus nail with shaft extension (n=12) for proximal humeral fractures of 2 and 3 parts (n=34) and 2-part with extension to the shaft (n=12) were reviewed. Fracture union, neck shaft angle, and hardware complications were evaluated using radiographs. Outcomes were assessed using the Constant score, the visual analogue scale for pain, and subjective satisfaction. The range of motion, grip strength, and ability to return to work were also recorded.

Results.

The mean follow-up was 20 (range, 15–28) months. The mean humeral neck shaft angle was 137.2°.44 (96%) patients achieved fracture union after a mean of 14 (range, 11–16) weeks. Two patients with 3-part fractures did not unite; one of them underwent hemiarthroplasty and the other consented for nail removal only. Complications included temporary radial nerve palsy (n=2), impingement symptoms caused by the prominent metal work (n=10), and missing of the proximal screws in the nail (n=4). Respectively in patients aged ±60 (n=15) and ⩾60 years (n=31), the mean Constant scores were 79 and 67 (p=0.04). The mean pain score improved from 93 to 15.5 at 12 months. 16 patients were very satisfied, 22 were satisfied, and 8 were not satisfied with the outcome. Of the latter, 3 were aged ±60 years and 5 were aged ⩾60 years.

Conclusion.

Polarus nail fixation for displaced proximal humeral fractures achieved good fracture union and satisfactory functional outcome, particularly in younger patients and those in active employment, but elderly dependent patients tended to have poor functional results. The rates of minor hardware problems and non-union in 3-part fractures were relatively high.
Modified Weaver-Dunn Procedure versus the Use of a Synthetic Ligament for Acromioclavicular Joint Reconstruction
Authors: Kumar Vinod , Garg Sunil , Elzein Lhab , Lawrence Tom , Manning Paul , Wallace W Angus
Published: October 2016

Purpose.

To compare the subjective outcome of acromioclavicular joint (ACJ) reconstruction using the modified Weaver-Dunn procedure versus the Surgilig synthetic ligament.

Methods.

55 patients aged 19 to 72 (mean, 42) years underwent ACJ reconstruction of Rockwood grade 3 (n=38), grade 4 (n=8), and grade 5 (n=9) using the modified Weaver-Dunn procedure (n=31) or the Surgilig synthetic ligament (n=24), based on the surgeon's preference. The mean period from injury to surgical treatment was 39 months. Subjective outcomes were assessed before and after surgery using the Oxford Shoulder score and Nottingham Clavicle score. The time required to return to work and sports was also recorded.

Results.

After a mean follow-up period of 40 months, the mean Oxford Shoulder scores improved from 28 to 42 in the Weaver-Dunn group (p=0.009), and from 26 to 45 in the Surgilig group (p=0.007), whereas the respective mean Nottingham Clavicle scores improved from 53 to 81 (p=0.047) and from 51 to 93 (p=0.023). The Surgilig group achieved significantly better postoperative Oxford Shoulder score (p=0.008) and Nottingham Clavicle score (p=0.007), and could also return to work (14 vs. 6 weeks, p±0.001) and sports (25 vs. 12 weeks, p±0.001) sooner than the Weaver-Dunn group. Three patients in the Weaver-Dunn group and one patient in the Surgilig group had persistent pain and/or functional deficit with evidence of ACJ dislocation.

Conclusion.

Chronic ACJ reconstruction using the Surgilig synthetic ligament achieved better Oxford Shoulder score and Nottingham Clavicle score and earlier return to work and sports, compared with the modified Weaver-Dunn procedure.
Outcome of Fixation for Nonunion of Extremities
Authors: Niikura Takahiro , Lee Sang Yang , Sakai Yoshitada , Nishida Kotaro , Kuroda Ryosuke , Kurosaka Masahiro
Published: October 2016

Purpose.

To review the outcomes of 102 consecutive patients who underwent fixation for nonunion of extremities.

Methods.

Medical records of 71 men and 31 women aged 16 to 82 (mean, 45; standard deviation [SD], 19) years who underwent fixation for nonunion of the upper (n=31) and lower (n=71) extremities were reviewed. The nonunion types included oligotrophic (n=47), hypertrophic (n=22), atrophic (n=17), defect (n=12), and comminuted (n=4). 13 of the nonunions were infected. 10 patients had concomitant injuries of the brain (n=2), abdomen (n=5), chest (n=1), and spine (n=2). 43 patients were smokers, and 19 had diabetes mellitus. 80 patients had had previous surgery, and 3 had undergone previous radiotherapy. The mean time from injury to nonunion surgery was 19 (SD, 25.6; range, 6–180) months. Outcome measures included bone union, ability to return to original work, pain, gait, and loss of range of motion.

Results.

The mean follow-up period was 26.6 (SD, 19.9; range, 8–121) months. 100 patients achieved bone union. 83 of them achieved bone union after a single surgery in a mean of 5.6 (SD, 2.9) months. The remaining 17 patients underwent multiple surgeries, 13 of whom had infected nonunions. Two patients did not achieve bone union. Of 64 patients who had work, 47 returned to their original work and 17 did not. Outcome was unsatisfactory in 5 patients who had persistent pain and/or no improvement in gait.

Conclusion.

Bone union is not necessarily associated with adequate recovery of function.
Late Recurrence of Osteosarcoma: A Report of Two Cases
Authors: Igarashi Kentaro , Yamamoto Norio , Shirai Toshiharu , Nishida Hideji , Hayashi Katsuhiro , Tanzawa Yoshikazu , Kimura Hiroaki , Takeuchi Akihiko , Miwa Shinji , Inatani Hiroyuki , Shimozaki Shingo , Kato Takashi , Tsuchiya Hiroyuki
Published: October 2016

We report 2 cases of late recurrence of osteosarcoma after 6 and 7 years. One patient had pulmonary metastasis, and the other had soft tissue recurrence. Both patients underwent complete resection and chemotherapy. The first patient achieved complete remission and remained disease-free 47 months later and had no limitation in his daily life. The second patient had a re-recurrence and underwent further resection and chemotherapy. He remained disease-free 35 months later and could walk using a T-handled walking cane.
Extraskeletal Myxoid Chondrosarcoma of the Thigh in a Child: A Case Report
Authors: Ibrahim Zainal Abidin , Chan Wai Hoong , Wong Siong Lung , Ong Eng Joe , Narihan M Zulkarnaen A
Published: October 2016

Extraskeletal myxoid chondrosarcoma (EMC) is aggressive in children. The condition in children differs to that in adults and to skeletal myxoid chondrosarcoma. We report on a 9-year-old girl with EMC in her left thigh. She underwent above-knee amputation. Five months later, a small mass was noted at the right lower lobe of the lung. The patient underwent one course of ifosfamide, carboplatin, and etoposide chemotherapy, followed by resection of the mass and 8 more courses of chemotherapy. At the 2-year follow-up, she was in remission radiologically.
Rate of Venous Thromboembolism after Complex Lower-Limb Fracture Surgery without Pharmacological Prophylaxis
Authors: Niikura Takahiro , Sakai Yoshitada , Lee Sang Yang , Iwakura Takashi , Kuroda Ryosuke , Kurosaka Masahiro
Published: October 2016

Purpose.

To evaluate the rate of venous thromboembolism (VTE) after complex lower-limb fracture surgery without pharmacological prophylaxis.

Methods.

Between July 2005 and April 2009, 11 men and 6 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 3 femoral and 20 tibial fractures. Patients were screened for VTE using contrast-enhanced computed tomography (CT) when the D-dimer value was beyond normal range. Between May 2009 and December 2012, 18 men and 4 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 8 femoral and 20 tibial fractures. Patients were routinely screened for deep vein thrombosis (DVT) using ultrasonography and for pulmonary embolism (PE) using contrast-enhanced CT (in high-risk patients with multiple injuries or pelvic and acetabular fractures). In both groups, pharmacological prophylaxis was not used; only mechanical prophylaxis was used.

Results.

The 2 groups were comparable in terms of age, sex, and proportion of bilateral external fixation, open fracture, and associated injury, except that the duration of external fixation was longer in the early group (29.8±28.0 vs. 11.6±4.0 days, p=0.001). Of the 17 patients in the early group, 5 developed VTEs (3 DVTs and 2 PEs) at a mean of 13.6 (range, 6–20) days after injury; 2 of whom developed VTE during the external fixation period. Of the 22 patients in the later period, 10 developed VTEs (10 DVTs and 4 PEs) at a mean of 13 (range, 5–33) days after injury; 7 of whom developed VTE during the external fixation period.

Conclusion.

The rate of VTE was high in patients undergoing complex lower-limb fracture surgery without pharmacological prophylaxis.
Complete Blood Count before and after Total Hip or Knee Arthroplasty
Authors: Jagow Devin M , Yacoubian Shahan V , Yacoubian Stephan V
Published: October 2016

Purpose.

To validate our transfusion protocol based on pre- and post-operative complete blood count (CBC) data in patients undergoing primary total hip or knee arthroplasty (THA or TKA).

Methods.

Records of 113 men and 205 women aged 32 to 94 (mean, 70) years who underwent primary uncemented THA (n=123) or cemented TKA (n=195) for osteoarthritis by 2 senior surgeons were reviewed. A post-surgical drain was used in 29 THA patients and 74 TKA patients, based on the surgeon's preference. CBC was assessed preoperatively, during postanaesthesia care, and at the beginning of postoperative days 1, 2, and 3 to determine their predictive power for transfusion rate. According to our transfusion protocol, blood was transfused when the haemoglobin (Hb) level was <80 g/l, or when hypotension, tachycardia, light-headedness, dizziness, or syncope occurred.

Results.

Respectively in 123 and 195 patients who underwent THA and TKA, the transfusion rates within 3 days were 31.7% (n=39) and 25.6% (n=50). No patient required transfusion during postanaesthesia care; the transfusion rates of all patients during day 1 to day 2 and day 2 to day 3 were 15.1% (n=48) and 12.9% (n=41), respectively. The transfusion rate was higher in women than men (36.6% vs. 12.4%, p<0.001), but did not differ significantly in patients with or without a post-surgical drain (29.1% vs. 27.4%, p=0.754). Respectively for the Hb level of <130 g/l, 130–150 g/l, and >150 g/l, the overall transfusion rates were 48.5%, 22.0%, and 4.3% based on the preoperative level; 32.6%, 7.6%, and 0% based on the postanaesthesia care level; and 28.9%, 8.3%, and 0% based on the day 1 level. The predictive power of the preoperative Hb level was highest, followed by that during postanaesthesia care and the on day 1.

Conclusion.

CBC during postanaesthesia care is no more predictive than preoperative CBC. Preoperative optimisation and close monitoring of the Hb level from day 1 to day 3 is recommended.
Relationship among Cervical, Thoracic, and Lumbopelvic Sagittal Alignment in Healthy Adults
Authors: Endo Kenji , Suzuki Hidekazu , Sawaji Yasunobu , Nishimura Hirosuke , Yorifuji Makiko , Murata Kazuma , Tanaka Hidetoshi , Shishido Takaaki , Yamamoto Kengo
Published: October 2016

Purpose.

To evaluate the association between cervical sagittal alignment and thoracic/lumbopelvic sagittal alignment in healthy Japanese adults.

Methods.

30 male and 22 female healthy adults aged 22 to 50 years were recruited. Spinal parameters were measured on radiographs, including the cervical sagittal vertical axis, sagittal vertical axis, C7 tilt angle, Ishihara index for cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence.

Results.

The C7 tilt angle positively correlated with the Ishihara index ( r=0.52, p<0.0001) and thoracic kyphosis ( r=0.53, p<0.0001). The Ishihara index positively correlated with thoracic kyphosis ( r=0.34, p=0.01) and C7 tilt angle ( r=0.52, p<0.0001). Pelvic incidence positively correlated with sacral slope ( r=0.45, p=0.001), lumbar lordosis ( r=0.26, p=0.07), and pelvic tilt ( r=0.29, p=0.03). Compared with men, women had a smaller Ishihara index (0.07 vs. 0.001, p=0.03), thoracic kyphosis (30.5° vs 24.1°, p=0.02), and C7 tilt angle (23.1° vs. 16.8°, p=0.02). Women had less cervical lordosis and thoracic kyphosis, that is, a straighter cervico-thoracic sagittal alignment.

Conclusion.

In healthy Japanese adults, cervical sagittal alignment is associated with thoracic sagittal alignment but not with lumbopelvic alignment.
Do Economic Evaluations in Primary Care Prevention and the Management of Hypertension Conform to Good Practice Guidelines? A Systematic Review
Authors: Peñaloza Ramos Maria Cristina , Barton Pelham , Jowett Sue , Sutton Andrew John
Published: October 2016

Background: Results of previous research have identified the need for further investigation into the compliance with good practice guidelines for current decision-analytic modeling (DAM). Objective: To identify the extent to which recent model-based economic evaluations of interventions focused on lowering the blood pressure (BP) of patients with hypertension conform to published guidelines for DAM in health care using a five-dimension framework developed to assess compliance to DAM guidelines. Methods: A systematic review of English language articles was undertaken to identify published model-based economic evaluations that examined interventions aimed at lowering BP. The review covered the period January 2000 to March 2015 and included the following electronic bibliographic databases: EMBASE and Medline via Ovid interface and the Centre for Reviews and Dissemination’s (CRD) NHS-EED. Data were extracted based on different components of good practice across five dimensions utilizing a framework to assess compliance to DAM guidelines. Results: Thirteen articles were included in this review. The review found limited compliance to good practice DAM guidelines, which was most frequently justified by the lack of data. Conclusions: The assessment of structural uncertainty cannot yet be considered common practice in primary prevention and management of hypertension, and researchers seem to face difficulties with identifying sources of structural uncertainty and then handling them correctly. Additional guidelines are needed to aid researchers in identifying and managing sources of potential structural uncertainty. Adherence to guidelines is not always possible and it does pose challenges, in particular when there are limitations due to data availability that restrict, for example, a validation process.
Cost-Effectiveness of Treatments for Genotype 1 Hepatitis C Virus Infection in Non-VA and VA Populations
Authors: Liu Shan , Barnett Paul G. , Holodniy Mark , Lo Jeanie , Joyce Vilija R. , Gidwani Risha , Asch Steven M. , Owens Douglas K. , Goldhaber-Fiebert Jeremy D.
Published: October 2016

Background: Chronic hepatitis C viral (HCV) infection affects millions of Americans. Health care systems face complex choices between highly efficacious, costly treatments. This study assessed the cost-effectiveness of treatments for chronic, genotype 1 HCV monoinfected, treatment-naïve individuals in the Department of Veterans Affairs (VA) and general US health care systems. Methods: The study used a decision-analytic Markov model, employing appropriate payer perspectives and time horizons, and discounting benefits and costs at 3% annually. Interventions included the following: sofosbuvir/ledipasvir (SOF-LDV); ombitasvir/paritaprevir/ritonavir/dasabuvir (3D); sofosbuvir/simeprevir (SOF-SMV); sofosbuvir/pegylated interferon/ribavirin (SOF-RBV-PEG); boceprevir/pegylated interferon/ribavirin (BOC-RBV-PEG); and pegylated interferon/ribavirin (PEG-RBV). Outcomes were sustained virologic response (SVR), advanced liver disease, costs, quality adjusted life years (QALYs), and incremental cost-effectiveness. Results: SOF-LDV and 3D achieve high SVR rates, reducing advanced liver disease (>20% relative to no treatment), and increasing QALYs by >2 years per person. For the non-VA population, at current prices ($5040 per week for SOF-LDV; $4796 per week for 3D), SOF-LDV’s lifetime cost ($293,370) is $18,000 lower than 3D’s because of its shorter duration in subgroups. SOF-LDV costs $17,100 per QALY gained relative to no treatment. 3D costs $208,000 per QALY gained relative to SOF-LDV. Both dominate other treatments and are even more cost-effective for the VA, though VA aggregate treatment costs still exceed $4 billion at SOF-LDV prices of $3308 per week. Drug prices strongly determine relative cost-effectiveness for SOF-LDV and 3D; with price reductions of 20% to 30% depending on health system, 3D could be cost-effective relative to SOF-LDV. We currently lack head-to-head regimen effectiveness trials. Conclusions: New HCV treatments are cost-effective in multiple health care systems if trial-estimated efficacy is achieved in practice, though, at current prices, total expenditures could present substantial challenges.
Brief Inventory of Thriving
Authors: Duan Wenjie , Guan Yuan , Gan Fengchun
Published: October 2016

The Brief Inventory of Thriving (BIT) was designed to measure a comprehensive construct of wellbeing beyond the traditional hedonia-versus-eudaimonia framework, highlighting the holism of human flourishing and functioning. This study evaluated the psychometric properties of the BIT in China. A total of 705 community participants and 251 college students completed the BIT, while the student sample also completed the Satisfaction with Life Scale, the Flourishing Scale, the Meaning in Life Questionnaire, the Positive Affect and Negative Affect Schedule, and the Depression Anxiety Stress Scale. Results demonstrated good internal consistency, strong and solid single-factor structure, and good convergent and discriminant validities. Furthermore, the screening role of BIT in mental health status and the incremental validity beyond other wellbeing measures were determined.
Randomised Controlled Trial of Ankle Block Versus Metatarsal Block for First Ray Surgery
Authors: Qasim Sultan N. , Bhatia Maneesh , Roberts Veronica I. , Attwal Manjit , Fombon Felix N.
Published: October 2016

Category:

Bunion

Introduction/Purpose:

First ray arthrodesis or osteotomy is a day surgery procedure performed commonly under general anaesthetic. One of the aims with such procedures is to ensure our patients are discharged on the day of surgery and are relatively pain free on discharge. This is often achieved by the use of local anaesthetic blockades, either as an ankle block or as a metatarsal block. There are studies published on the effectiveness of ankle block for first ray surgery but there is a dearth of studies on metatarsal block. Therefore the aim of this study is to compare the effectiveness of ankle block versus metatarsal block in conjunction to general anaesthetic for first ray surgery.

Methods:

Both local trust board approval and National Research Ethics Committee approval were granted for the study. Statistical analysis to ensure an adequately powered study was performed. Fifty patients undergoing arthrodesis or osteotomy of the first ray were recruited into this study and randomly allocated to the cohort to receive either a metatarsal block or an ankle block. All patients had general anaesthesia. Those patients randomized to ankle block had this performed after induction of general anaesthesia using ultrasonography. Those patients randomized to metatarsal block had this performed at the end of the operative procedure. Patients scored their pain level using a visual analogue scale (0-10) at 2, 6 and 24 hours. A physiotherapist, who was blinded to their treatment arm, assessed patients at hourly intervals from two hours. Patients were contacted by telephone by a research nurse, who was also blinded to their treatment arm, over 24 hours from discharge.

Results:

Forty-eight patients completed the study: 25 in the ankle block treatment arm and 23 in the metatarsal block arm. The majority of the patients were female (44 patients) with an average age of 53 years (range 31-76 years). Analysis of pain scores showed that there was no statistically significant difference between the two groups at any of the measured time periods. Analysis of their analgesic requirement in the first 24 hours after surgery again revealed no striking difference between the two cohorts. Similarly analysis of the time taken to safely mobilise revealed that there was no difference between the two groups. However analysis of the time taken to perform the anaesthesia highlighted a mean addition of eleven minutes when an ultrasound guided ankle block was performed.

Conclusion:

This prospective randomised blinded study demonstrates that metatarsal blocks are just as effective in giving post- operative analgesia as ultrasound guided ankle blocks in patients undergoing first ray surgery under general anaesthetic.
A Prospective Cohort-Study on the Return to Work and Function Two Years After Surgical Treatment of Tibiotalar Arthritis
Authors: Younger Alastair S. , Veljkovic Andrea , Wing Kevin , Penner Murray J. , Gagné Oliver
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Ankle arthritis is a debilitating condition. People who are affected by end stage ankle arthritis are as symptomatic as arthritis in other main articulations of the lower extremity, and often present with concurrent medical conditions and comorbidities. Once these patients cannot perform their job due to disabling arthritic ankle, they leave the workplace and require financial aid. The purpose of this study was to determine the work status before and after surgery for end stage ankle arthritis in the working age population. We hypothesized that middle-age patients at the time of surgery [55 years-old and younger] were able to go back to work within 2 years of their index ankle procedure and not depend on social / subsidized programs.

Methods:

Since 2001, patients treated for end-stage ankle arthritis in three Canadian centers were offered to partake in the Canadian Orthopedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction Database. The modalities of treatment included total ankle replacement and ankle arthrodesis (open and arthroscopic). A survey was given to patients at various points of the study, which included the MODEMS questionnaire from AAOS and SF-36. This study used the pre-operative survey, including the along with the same survey filled by patients 2 years post-operatively. Degenerative osteoarthritis, post-traumatic osteoarthritis and inflammatory arthritis requiring surgical intervention was the main inclusion criteria. Patients over 55 years- old at the time of surgery were excluded.

Results:

This group had 211 patients of age 47±8 and was balanced as far as sex (113 M) and side (102 L). The employment rate for this group should be 79.2 per Statistics Canada. The employment rate prior to surgery was 56% and increased to 63% two years later. The additional 7% were on leave of absence or disability prior to surgery. At the two-year follow-up, 92 patients reported less pain with work, 88 patients reported that the surgery met their expectations and 78 reported minimal interference with their work. With regards to WCB, Disability and Social Security, 115 (56%) were never on any of the above, 41 (20%) were no longer on any two years post-operative and 9 (4%) entered at least one program.

Conclusion:

The two-year follow-up after tibiotalar arthrodesis or arthroplasty in patients younger than 55 years-old shows that more people are able to get back to work than go off work. It also shows that more people are able to get off subsidized programs and that there is an overall satisfaction with regards to pain, inference with work and expectation. After surgery, this patient population still has a lower employment rate than the normal population. More research would be needed to better outline strategies that could reduce the disability within this group and maintain them in the workforce.
Adult Flexible Flatfoot Due to Insufficiency of Posterior Tibial Tendon
Authors: Ceccarini Paolo , Rinonapoli Giuseppe , Gambaracci Giulio , Bisaccia Michele , Ceccarini Alfredo , Caraffa Auro
Published: October 2016

Category:

Hindfoot

Introduction/Purpose:

We postulated that in a flexible adult flatfoot, calcaneo-stop procedure combined with medial tensioning of posterior tibial tendon allowed the resolution of symptoms by correcting the pattern of the gait and avoiding the evolution to a subsequent stage. The purpose of this study was to determine functional, biomechanic, and radiographic results in patients who underwent surgery for flexible flatfoot without osteotomies or arthrodesis.

Methods:

We evaluated clinically and radiographically 29 patients surgically treated for adult flatfoot grade IIa according to Myerson, with a mean age of 46.4 years. Mean follow-up was 34.15 months. For clinical evaluation the AOFAS hindfoot and VAS- FA scores were used. In 10 patients, pre and post-operatively gait analisys was performed.

Results:

Postoperative results showed a significant increase of AOFAS and VAS-FA scores, from 54.7 (range 34 to 78) to 83.1 (range 66-100) and 60.5 (range 35-86) 85 (range 64-100) points, respectively. For the X-ray parameters, in the AP projection, we observed a significant variation of Kite's angle, from 24.2° in the pre-op to 19.2° in the post-op. In lateral view Costa-Bertani angle showed changes from 146.8° to 140.5°. The Meary's angle, showed an average at the post-op of 4.3°. Postoperative satisfaction was excellent-good for 25 patients (86.2%). Postoperative gait analysis showed an improved pattern of the gait.

Conclusion:

The technique of arthroereisis with medial tensioning of PTT is a valid technique for the young adult, up to 50 years and with no signs of osteoarthritis of the midfoot and hindfoot.