bluuebunny/crossref_metadata_2025 huggingface dataset:
Rice-Body Formation and Tenosynovitis of the Wrist: A Case Report
Authors: Tyllianakis M , Kasimatis G , Athanaselis S , Melachrinou M
Published: October 2016

A 61-year-old woman presented with mild pain and swelling on the volar aspect of the wrist, hand, and little finger. Radiography showed a soft-tissue mass shadow, and magnetic resonance imaging showed acute tenosynovitis of the flexor tendons and an inflammatory mass inside the carpal tunnel. Laboratory test results were normal, except for an elevated erythrocyte sedimentation rate (40 mm/h). The patient had an ambiguous Mantoux test result but no history of mycobacterial exposure. Exhaustive investigations for rheumatic disease were negative. Surgical exploration of the lesion revealed rice bodies in the common flexor tendon synovial sheath, extending distally to the tip of the fifth finger. Removal of the rice bodies and thorough excision of the sheath was performed. The patient regained a full and painless range of motion in about 3 months. One-year follow-up revealed no underlying disorder.
Recalcitrant Infection following Total Knee Arthroplasty: A Report of Two Cases
Authors: Zairul-Nizam ZF , Badaruddin BS
Published: October 2016

Infection following total knee arthroplasty can be devastating. Even with established treatment protocols, eradication of the infection may not be feasible. We report 2 patients who required above-knee amputation to eradicate recalcitrant infection.
Complex Regional Pain Syndrome Complicating Total Knee Arthroplasty
Authors: Burns AWR , Parker DA , Coolican MRJ , Rajaratnam K
Published: October 2016

Purpose.

To compare the long-term outcome of patients diagnosed with complex regional pain syndrome–type 1 (CRPS-1) after total knee arthroplasty (TKA) with those of uncomplicated TKA knees and preoperative osteoarthritic knees.

Methods.

Medical records of 1280 patients who underwent TKA for osteoarthritis were retrospectively reviewed; 8 were diagnosed as having symptoms and signs consistent with CRPS after TKA. Patients with primary inflammatory arthritis, signs of component loosening, malpositioning, or of infected arthroplasty were excluded. No patient had signs of CRPS prior to operative intervention. The 8 patients were compared with 2 groups of age- and sex-matched controls: uncomplicated TKA knees and preoperative osteoarthritic knees. Patients were followed up for a mean of 54 (range, 13–111) months and their range of movement, Western Ontario and McMaster Universities Osteoarthritis Index, SF-36 questionnaire scores, and Knee Society scores were assessed and compared.

Results.

After appropriate treatment, most CRPS complicated patients had similar scores on SF-36, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee Society scores when compared with uncomplicated TKA patients. Scores for CRPS complicated patients were significantly improved when compared with preoperative osteoarthritic patients. The incidence of CRPS after TKA was 0.7%.

Conclusion.

When managed early, patients complicated with CRPS after TKA have a similar prognosis to patients with uncomplicated TKA.
Fixation Failure of the Clavicular Hook Plate: A Report of Three Cases
Authors: Charity RM , Haidar SG , Ghosh S , Tillu AB
Published: October 2016

Open reduction and internal fixation for unstable fractures of the lateral end of the clavicle (Neer type II) is not complication-free. Most clavicle fractures can be successfully treated by conservative methods. Neer type II fractures have a reportedly high rate of nonunion, therefore internal fixation is recommended. However, the need for surgical treatment remains controversial as nonunion seldom produces a poor functional outcome. We report 3 cases of fixation failure following treatment with a clavicular hook plate. None of the patients required re-fixation surgery and all achieved bony union with a good functional result.
Congenital Pseudarthrosis of the Clavicle: A Case Report
Authors: Beslikas TA , Dadoukis DJ , Gigis IP , Nenopoulos SP , Christoforides JE
Published: October 2016

Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology. Its pathogenesis is related to the embryology of the clavicle. We present a 6-year-old girl with congenital pseudarthrosis of the right clavicle. A prominence was noticed at birth between the middle and distal ends of the clavicle that increased in size when the right shoulder was actively mobilised. Radiographic examination revealed a hypertrophic pseudarthrosis of the clavicle. The pseudarthrosis was resected and the clavicular segments were fixed with an external fixator for 2 months until union. Clinical results were excellent at the 7-year follow-up: the right shoulder was pain-free and the appearance satisfactory. Surgical treatment of congenital pseudarthrosis of the clavicle in children using an external fixator provides a better cosmetic outcome with smaller postoperative scars and avoids a second surgical procedure to remove the implants.
Crystal Arthropathy of the Lumbar Spine: A Report of 4 Cases
Authors: Lam HY , Cheung KY , Law SW , Fung KY
Published: October 2016

Gout or pseudogout, caused by deposition of crystals, rarely affects the spine. We report 4 cases with gout or pseudogout in the lumbar spine. Two had cauda equina syndrome and another 2 had spinal stenosis. To avoid unnecessary surgery, this should be considered in the differential diagnosis when treating patients with histories of gout or pseudogout for spinal problems.
Neurological Recovery after Occipitocervical Fixation
Authors: Tan KJ , Hee HT
Published: October 2016

Purpose.

To report on 14 consecutive cases of occipitocervical fixation.

Methods.

Records of 8 men and 6 women aged 40 to 81 (mean, 57) years who underwent occipitocervical fixation and were followed up for a minimum of 2 years were retrospectively reviewed. Neurological grading was assessed before and after surgery using the Ranawat grade. Intra-operative somatosensory evoked potentials were monitored.

Results.

The main indications for surgery were rheumatoid arthritis (n=6) and cervical metastasis (n=4). 77% of the patients demonstrated neurological improvement. Four out of the 5 non-ambulatory patients (Ranawat grade IIIB) regained ambulatory status postoperatively. No patient had neurological deterioration or evidence of vertebral artery or spinal cord injury. One endured a superficial wound infection and 2 had implant breakage.

Conclusion.

Although occipitocervical fixation is technically challenging and there are risks of serious neurologic or vascular complications, it remains a viable option with favourable results in patients requiring stabilisation of the craniocervical junction.
Management Outcome and the Role of Manipulation in Slipped Capital Femoral Epiphysis
Authors: Lim YJ , Lam KS , Lim KBL , Mahadev A , Lee EH
Published: October 2016

Purpose.

To examine and compare treatment outcomes for slipped capital femoral epiphysis (SCFE).

Methods.

24 patients with acute or acute-on-chronic SCFE underwent preoperative traction, 13 of them followed by in situ screw fixation (group A), and the remaining 11, manipulation with screw fixation (group B). Their treatment outcomes (according to the Aadalen criteria) and complications were compared.

Results.

There were 2 treatment failures and one poor outcome in patients with acute SCFE (2 had avascular necrosis and one had slight pain with mild limitation of hip movement). The risk of developing avascular necrosis was significantly higher in patients with acute rather than acute-on-chronic or chronic slips. No significant differences were evident between groups A and B with regard to age, sex, ethnicity, outcomes, and preoperative and postoperative changes in the Southwick headshaft angle.

Conclusion.

Patients with acute or acute-on-chronic SCFE can be safely managed with straight-leg traction for up to 6 days, followed by in situ screw fixation without manipulation. Manipulation is not recommended in such slips, due to a higher avascular necrosis risk.
Limb Salvage Surgery Complimented by Customised Mega Prostheses for Malignant Fibrous Histiocytomas of Bone
Authors: Natarajan MV , Mohanlal P , Bose JC
Published: October 2016

Purpose.

To assess functional and oncological outcomes of patients with malignant fibrous histiocytomas of bone, after limb salvage surgery complimented by a customised prosthesis.

Methods.

Between May 1991 and December 2002, 15 men and 5 women (mean age, 42 years) with histologically proven malignant fibrous histiocytoma of bone underwent treatment involving limb salvage surgery complimented by a customised mega prosthesis. Most of the tumours were stage II according to the Enneking system, and located around the knee. Wide resection margins were achieved in 18 patients.

Results.

Following a mean follow-up of 58 months, 4 patients underwent amputation for local recurrence and 5 died of the disease. Two patients had prosthesis fractures; revision of the prosthesis was carried out in one. The functional result was excellent in 5 and good in 9 patients. The Kaplan-Meier 5-year survival rates of the patients treated without chemotherapy and with chemotherapy were 50% and 76%, respectively.

Conclusion.

Limb salvage surgery with chemotherapy is a viable treatment option for patients with malignant fibrous histiocytoma of bone. It achieves higher survival rates than resection alone. Such therapy improves quality of life and provides a useful and functional limb.
Congenital Insensitivity to Pain with Anhydrosis in a Malaysian Family: A Genetic Analysis
Authors: Shalimar A , Sharaf I , Wahida I Farah , Ruszymah BHI
Published: October 2016

A Malaysian family with congenital insensitivity to pain with anhydrosis was diagnosed based on clinical symptoms of chronic ulcers, joint deformities, malunited fractures, anhydrosis, and learning disabilities. We detected a compound heterozygous mutation in exon 16: V709L from the mother and G718S from the father. Two novel mutations were identified: at amino acid 709, a change of G to C at nucleotide 2209 (∼2209G→C) causing a valine to leucine substitution (V709L), and at amino acid 718, a change of G to A at nucleotide 2236 (∼2236G→A) causing a glycine to serine substitution (G718S). Polymorphisms identified were at nucleotides ∼2113G→C and ∼2176T→C.
Gouty Synovitis after Total Knee Arthroplasty: A Casec Report
Authors: Crawford L , Kumar A , Shepard GJ
Published: October 2016

We report a case of acute gouty synovitis after total knee arthroplasty (TKA) in a patient with no history of gout. The diagnosis was confirmed by the presence of urate crystals in the synovial fluid. Acute gouty synovitis, though rare, should be considered in the differential diagnosis of an inflammed knee after TKA to avoid unnecessary surgical revision.
Neurological Deficit and Canal Compromise in Thoracolumbar and Lumbar Burst Fractures
Authors: Mohanty SP , Bhat NS , Abraham R , Keerthi C Ishwara
Published: October 2016

Purpose.

To assess whether canal compromise determines neurological deficit in thoracolumbar and lumbar burst fractures.

Methods.

105 patients aged 17 to 60 (mean, 34) years who had burst fractures in the thoracolumbar (n=82) and lumbar (n=23) regions were included. Fractures were classified according to the Denis classification. The extent of spinal canal compromise was assessed by computed tomography, and the neurological status according to the modified Frankel grading for traumatic paraplegia.

Results.

19 (18%) of the patients had no neurological deficit. Of the remaining 86 (82%) with a deficit, 26 had complete paraplegia. The correlation between the type of the burst fracture and the severity of neurological deficit was not significant (Chi squared=10.57, p=0.835). The mean extent of spinal canal compromise in patients with deficits was 50%, whereas in patients with no deficit it was 36%. The difference between the extent of canal compromise and the severity of neurological deficit at the thoracolumbar and lumbar spine was not significant (p=0.08). Further sub-analysis revealed a significant correlation at T11 and T12 (p=0.007) but not at the L1 (p=0.42) level.

Conclusion.

When studying neurological deficit, T11 and T12 injuries should be analysed separately from L1 injuries.
Sleeve Fracture of the Patella in Children
Authors: Gao GX , Mahadev A , Lee EH
Published: October 2016

Purpose.

To report the diagnosis, treatment, and outcomes of sleeve patellar fractures in children.

Methods.

Records of a consecutive series of patients with sleeve patellar fractures were retrospectively reviewed.

Results.

Of the 11 children (8 boys and 3 girls; mean age, 12 years), 6 had minimally displaced fractures (1–2 mm) and were managed by cylindrical plaster of Paris immobilisation, whereas the other 5 with severely displaced fractures underwent open reduction with tension band wiring. The mean follow-up period was 10 (range, 3–36) months. All patients obtained full extension of the knee except one (with an extension lag of 10 degrees). No patient complained of pain or discomfort of the involved knee.

Conclusion.

Sleeve patellar fractures in children are uncommon. Diagnosis can be missed, especially in those with a very small avulsed bony fragment. For undisplaced fracture, conservative management can achieve good results. For severely displaced fractures, early surgical intervention is effective.
Quality of Life after Infection in Total Joint Replacement
Authors: Cahill JL , Shadbolt B , Scarvell JM , Smith PN
Published: October 2016

Purpose.

To compare the health-related quality of life and functional outcomes of patients with and without periprosthetic infection after total joint replacement (TJR).

Methods.

62 uncomplicated TJRs and 34 TJRs complicated with deep infection were compared using a visual analogue scale for satisfaction, the Western Ontario and McMaster Universities Osteoarthritis Index, Assessment of Quality of Life, and Short Form-36.

Results.

Patients with complicated TJR had significantly poorer satisfaction in outcome (p<0.0001) and disease-specific functional outcomes (p<0.0001). Six of the 8 health-related quality-of-life scores were also significantly poorer (p<0.05). These results persisted after controlling for age, sex, and follow-up period in a multiple regression analysis.

Conclusion.

Infection following TJR reduces patient satisfaction and seriously impairs functional health status and health-related quality of life. When hospitals are balancing the costs of preventative measures with the costs of treating infection in TJR, the effect on patients' quality of life must be considered. Our findings argue strongly for allocation of health care resources to minimise the occurrence of infection after TJR.
Dorsal Dislocation of the Metacarpophalangeal Joint of the Thumb: A Case Report
Authors: Ip KC , Wong LY , Yu SJ
Published: October 2016

Dorsal dislocation of the metacarpophalangeal joint of the thumb is uncommon. We report the case of a 15-year-old patient with a complex dislocation of the left thumb who underwent open reduction after several attempts at closed reduction failed. At 2-month follow-up, full range of movement was regained; strength and pinch grip were comparable to that of the uninjured hand. The patient defaulted subsequent follow-up.
Proximal Femoral Nail Failures in Extracapsular Fractures of the Hip
Authors: Ballal MSG , Emms N , Ramakrishnan M , Thomas G
Published: October 2016

Purpose.

To review patients with proximal femoral nails (PFNs) in our hospital that developed complications and needed revision.

Methods.

Between January 2000 and June 2006, records of 216 patients with PFN fixations for traumatic extracapsular trochanteric fractures (n=160), pathological fractures (n=23), and as a prophylactic measure for metastasis (n=33) were retrospectively reviewed. The injury mechanism, reduction technique and quality, and time to and cause of implant failure were recorded.

Results.

12 PFNs failed: 8 in the trauma group, 3 in the pathological group, and one in the prophylactic nailing group. Two PFNs broke at the proximal lag screw level at a later stage secondary to non-union of the pathological fractures. One broke at the level of the distal locking screw at an early stage, as the locking holes were too close to the fracture.

Conclusion.

Poorly reduced fractures tend to fail early, whereas late failures are due to non-union. Good reduction with minimal dissection, the use of appropriate nail length, and proper positioning of the nail and screws are necessary to avoid failure or revision.
Conventional Muscle-Reflection Approach versus Mini-Incision Muscle-Splitting Approach in Dynamic Hip Screw Fixation
Authors: Leung WY , Tsang WL
Published: October 2016

Purpose.

To compare the short-term results of conventional versus mini-incision approaches to dynamic hip screw (DHS) fixation.

Methods.

41 geriatric patients with either basal femoral neck or intertrochanteric fractures (Kyle types I to III) who underwent closed reduction and DHS fixation by a single surgeon were retrospectively reviewed. From January 2001 to June 2005, 6 men and 19 women aged 60 to 94 (median, 83) years underwent DHS fixation through a conventional muscle-reflection approach with a skin incision of ≥10 cm. From July 2005 to March 2006, 9 men and 7 women aged 67 to 95 (median, 81) years underwent DHS fixation through a mini-incision (4 cm) approach at the lower border of the lesser trochanter. Operating time, drain output and duration of drain placement, decrease in haemoglobin level and receipt of blood transfusions, deterioration in ambulation status, analgesic intake, duration of hospital stay, and bone healing time for the 2 groups were compared. An independent observer retrospectively assessed the fracture pattern, reduction quality, and bone healing time.

Results.

Compared to patients in the conventional group, those in the mini-incision group had shorter operating times (50 vs 43 minutes, p=0.02), a higher proportion whose drain was removed within 24 hours (28% vs 69%, p=0.01), and consumed fewer dosages of oral analgesics within 48 hours (8 vs 5, p=0.001). Classification of the fracture pattern in 21 of 38 patients were consistent between the surgeon and observer. The Kappa value for agreement was 0.32, denoting marginal agreement (p=0.003). Reduction quality (p=0.66) and bone healing time (p=0.73) assessed by the observer were not significantly different between the 2 groups.

Conclusion.

The short-term clinical outcome of mini-incision DHS fixation for geriatric pertrochanteric fractures was favourable.
Open Intramedullary Kirschner Wire versus Screw and Plate Fixation for Unstable Forearm Fractures in Children
Authors: Kose O , Deniz G , Yanik S , Gungor M , Islam NC
Published: October 2016

Purpose.

To compare the outcomes of intramedullary Kirschner wire versus screw and plate fixation for unstable forearm fractures in children aged older than 10 years.

Methods.

Records of 32 children aged 10 to 15 (mean, 12) years with displaced fractures of the radius and ulna were retrospectively reviewed. 17 boys and 4 girls underwent intramedullary Kirschner wiring, whereas 10 boys and one girl underwent plating. All patients had been initially treated with closed reduction and casting. Indications for surgical intervention were fractures with angulation of >10° and total displacement. Patients were followed up for a mean of 24 (range, 13–40) months. Angulation and range of movements of the elbow, wrist, and forearm, as well as clinical and cosmetic results were compared.

Results.

Both treatments achieved excellent clinical outcomes, but intramedullary Kirschner wiring resulted in better cosmesis, shorter operating times, easier hardware removal, and lower implant costs.

Conclusion.

Intramedullary Kirschner wiring is a better option than plating for the treatment of unstable forearm fractures in older children.
The Use of Qualitative Cultures for Detecting Infection in Open Tibial Fractures
Authors: D'Souza A , Rajagopalan N , Amaravati RS
Published: October 2016

Purpose.

To determine the role of qualitative cultures for detecting infection in open tibial fractures.

Methods.

From January 2003 to December 2004, 95 men and 13 women (mean age, 34 years) with open tibial fractures in one or both limbs and without any other sites of infection were prospectively studied. Patients who had been treated with intravenous or oral antibiotics before presentation and/or had undergone debridement or other surgery were excluded.

Results.

Infection was not correlated with age, sex, interval from injury to debridement, and cause of fracture. The association of infection with predebridement cultures was stronger (odds ratio=12.5) than that with postdebridement cultures (odds ratio=4.7).

Conclusion.

Pre- and post-debridement cultures have a role in detecting infection in open tibial fractures. For detecting infection, predebridement cultures have better sensitivity, while postdebridement cultures have better specificity.
Cone Femoral Prosthesis for Osteoarthritis of the Hip with Femoral Dysplasia
Authors: Pak P , de Steiger R
Published: October 2016

Purpose.

To assess the clinical and radiological outcomes of total hip replacement (THR) using the cone femoral prosthesis.

Methods.

Four men and 15 women (26 hips) aged 19 to 78 (mean, 45) years underwent THR for osteoarthritis of the hip with femoral dysplasia using the cone femoral prosthesis. Only 17 patients (24 hips) were available for review. Pain and functional limitation were assessed using the Oxford hip score. Stable fixation by bone ingrowth was defined as no subsidence or radiolucent lines around the prosthesis.

Results.

The mean follow-up duration was 50 (range, 25–92) months. The mean Oxford hip score improved from 44 (range, 32–54) preoperatively to 17 (range, 12–28) at the latest follow-up. Prosthesis survival was 100%. All prostheses showed stable integration with bony ingrowth and no measurable subsidence. 15 hips had excessive anteversion of 25° to 90°. No patient had venous thromboembolism, deep prosthetic infections or dislocations.

Conclusion.

The cone prosthesis is less complex and expensive than the modular prosthesis. The early functional and radiological outcomes were excellent, with marked improvement in pain and function. This constitutes effective treatment for osteoarthritis of the hip with femoral dysplasia.
Anterior versus Modified Combined Instrumentation for Burst Fractures of the Thoracolumbar Spine: A Biomechanical Study in Calves
Authors: Tezeren G , Gumus C , Bulut O , Tukenmez M , Oztemur Z , Sever G
Published: October 2016

Purpose.

To compare stability after anterior instrumentation alone versus modified combined anterior and posterior instrumentation for burst fractures of the thoracolumbar spine in calves.

Methods.

Thoracolumbar spines of 10 calves were used. An axial compression force was applied on each specimen using a material-testing machine, until there was a burst fracture at T12 or L1. Five specimens were fixed with anterior instrumentation alone, using 2 rods connected by 2 screws above and 2 screws below the fractured vertebra plus one tranverse connector. Another 5 were fixed with our modified technique of combined anterior and posterior instrumentation. This entailed one rod connected with one screw above and one screw below the fractured vertebra anteriorly, and another rod connected with one transpedicular screw above and one transpedicular screw below the fractured vertebra posteriorly. After instrumentation, the experiment was conducted again on each specimen and the compressive stiffness and vertebral height loss between the 2 groups compared.

Results.

The mean compressive stiffness was significantly greater after modified combined anterior and posterior instrumentation than anterior instrumentation alone (5508 vs 2888 N, p=0.0256), whereas the respective vertebral height losses were 37 and 33 mm (p=0.3808).

Conclusion.

Our modified technique of combined anterior and posterior instrumentation provides greater stability than traditional anterior instrumentation alone.
Acute Invaginating Docking for Infected Nonunions of the Humerus
Authors: Dhar SA , Kawoosa AA , Butt MF , Ali MF , Mir MR , Halwai MA
Published: October 2016

Purpose.

To assess the efficacy of acute invaginating docking for infected non-unions of the humerus. Methods. Eight men and 3 women aged 17 to 59 years with infected non-unions of the humerus underwent acute invaginating docking with shortening and Ilizarov fixation.

Results.

The mean shortening was 2.9 cm owing to additional debridement. The mean time to external fixator removal was 14.9 (range, 8–28) weeks. The final bone result was excellent in 1, good in 8, and fair in 2. The functional result was excellent in 7 and good in 4.

Conclusion.

This modality enables simultaneous treatment of infected non-unions, axial alignment, vascularity, stability, and function.
Pelvic Ewing's Sarcoma: A Review from Scottish Bone Tumour Registry
Authors: Bhagat S , Sharma H , Pillai DS , Jane MJ
Published: October 2016

Purpose.

To review various treatment modalities on outcome of patients with pelvic Ewing's sarcoma.

Methods.

Between January 1948 and December 2004, 18 male and 15 female patients aged 3 to 48 (mean, 20) years with pelvic Ewing's sarcoma were retrospectively reviewed from the Scottish Bone Tumour Registry. Results. The commonest site involved was the ilium. The main presenting symptom was pain, followed by swelling and restricted hip movements. Treatments included surgery, radiotherapy, chemotherapy, or any of them in combination. Patients who had no metastasis at presentation (p<0.01) and underwent chemotherapy with ifosfamide (p<0.01) had significantly longer survival. Age (p=0.09), gender (p=0.95), delay in presentation (p=0.31), tumour site (p=0.9), surgery (p=0.73), and radiotherapy (p=0.23) were not predictive of survival in the univariate analysis. The 5-year event-free survival rate in patients with no metastasis at presentation was 35%. Conclusion. Intense multi-agent neo-adjuvant chemotherapy including ifosfamide followed by wide excision and postoperative radiation are recommended. Local therapy should not take precedence over or interfere with systemic chemotherapy.
Piriformis Pyomyositis: A Report of Three Cases
Authors: Wong CH , Choi SH , Wong KY
Published: October 2016

Pyomyositis is a subacute infection of skeletal muscles. It can be life-threatening if diagnosis and treatment are delayed. Only 5 cases of isolated piriformis pyomyositis have been reported. We report signs and symptoms of piriformis pyomyositis in 3 women who were treated mainly with antibiotics. Computed tomography is useful in making the diagnosis. Early diagnosis and treatment may avoid surgical treatment and reduce mortality.
Thromboembolic Prophylaxis for Total Knee Arthroplasty in Asian Patients: A Randomised Controlled Trial
Authors: Chin PL , Amin MS , Yang KY , Yeo SJ , Lo NN
Published: October 2016

Purpose.

To compare the efficacy and safety of different modes of thromboembolic prophylaxis for elective total knee arthroplasty (TKA) in Asian patients.

Methods.

440 low-risk patients undergoing TKA were randomised into 4 equal groups: (1) no prophylaxis (control), (2) graduated compression stockings (GCS), (3) intermittent pneumatic compression (IPC), and (4) low-molecular-weight heparin (enoxaparin). Duplex ultrasonography was used as an assessment tool.

Results.

The deep vein thrombosis point prevalence was highest in the control group (22%), which was significantly higher than in patients receiving IPC (8%, p=0.032) or enoxaparin (6%, p=0.001). One patient each in the control and GCS groups developed a non-fatal pulmonary embolism. Patients on enoxaparin received more blood transfusions and 2 of them had major bleeding complications.

Conclusion.

IPC is the preferred method of thromboprophylaxis for TKA in Asian patients.
Review Article: Glucosamine
Authors: Kirkham SG , Samarasinghe RK
Published: October 2016

It has been claimed that glucosamine is able to alleviate pain, slow down losses of, and even restore articular cartilage in patients with damaged or osteoarthritic joints. It is classified as a food additive or nutraceutical; therefore manufacturers do not need to comply with the same regulations that apply for quality assurance within the pharmaceutical industry. Osteoarthritis can be managed by pharmacological and non-pharmacological methods. It is controversial whether glucosamine sulphate is the first structure-modifying drug commercially available. Little evidence suggests that glucosamine is superior to a placebo treatment in restoring articular cartilage.
Spinal Cord Compression Secondary to Brown Tumour in a Patient on Long-Term Haemodialysis: A Case Report
Authors: Mak KC , Wong YW , Luk KDK
Published: October 2016

Brown tumours may occur secondary to hyperparathyroidism in patients with chronic renal failure (CRF). Diagnosing a spinal brown tumour causing cord compression requires a high index of suspicion. We report a 65-year-old woman, who had been on haemodialysis for CRF for over 10 years, who presented with leg weakness and back pain over the thoracolumbar junction. She had a brown tumour at T8 causing subacute spinal cord compression. Ambulation was regained after surgical decompression and stabilisation. Adherence to the National Kidney Foundation guidelines in the management of patients with CRF may prevent renal osteodystrophy. Treatment of spinal brown tumour depends on the severity of the neurological deficit. Remineralisaton is expected after correction of the parathyroid level, thus negating the need for total excision of the parathyroid glands.
Active Unicameral Bone Cysts in the Upper Limb are at Greater Risk of Fracture
Authors: Tey Inn Kuang , Mahadev Arjandas , Lim Kevin Boon Leong , Lee Eng Hin , Nathan Saminathan Suresh
Published: October 2016

Purpose.

To elucidate the natural history of unicameral bone cyst (UBC) and risk factors for pathological fracture.

Methods.

14 males and 8 females (mean age, 9 years) diagnosed with UBC were reviewed. Cyst location, symptoms, and whether there was any fracture or surgery were recorded. Cyst parameters were measured on radiographs, and included (1) the cyst index, (2) the ratio of the widest cyst diameter to the growth plate diameter, and (3) the adjusted distance of the cyst border from the growth plate.

Results.

There were 11 upper- and 11 lower-limb cysts. 13 patients had pathological fractures and 9 did not. 20 patients were treated conservatively with limb immobilisation; 2 underwent curettage and bone grafting (one resolved and one did not). Seven cysts resolved (5 had fractures and 2 did not). The risk of fracture was higher in the upper than lower limbs (100% vs 18%, p<0.001). Fractured cysts were larger than unfractured cysts (mean cyst index, 4.5 vs. 2.2, p=0.07). Active cysts were more likely to fracture.

Conclusion.

Conservative management had a 30% resolution rate. Surgery should be considered for large active cysts in the upper limbs in order to minimise the fracture risk.
Low Back Pain and Cervical Spondylotic Myelopathy
Authors: Kawakita Eiji , Kasai Yuichi , Uchida Atsumasa
Published: October 2016

Purpose.

To determine characteristics responsible for improvement of low back pain after cervical laminoplasty for cervical spondylotic myelopathy.

Methods.

18 men and 10 women aged 38 to 88 (mean, 71) years who had a low back pain visual analogue scale (VAS) score of 5 or more before cervical laminoplasty were included. In 12 patients the VAS score improved to ≤1 after surgery and remained so at 2 years, but in 16 it remained unimproved. Patient characteristics of the 2 groups were compared.

Results.

Preoperatively 11 of the 12 patients with improved VAS score had continuous low back pain all day, compared to 3 of the 16 who remained unimproved (p<0.01).

Conclusion.

In some patients, low back pain may be improved following cervical laminoplasty.
Review Article: Bone Transplantation and Immune Response
Authors: Shegarfi Hamid , Reikeras Olav
Published: October 2016

Bone is the second most common transplant tissue after blood, with the iliac crest autologous graft being most used. Bone transplantation induces osteogenesis to repair bone defects. Despite being the most efficient, autogenous bone requires an additional incision and its supply may be inadequate. Deep-frozen allogeneic bone can be an alternative, but is at risk of microbiological contamination, transmission of unrecognised germs, delayed incorporation, and cellular and humoral immune reactions. Synthetic graft substitutes combine scaffolding properties with biological elements to stimulate cell proliferation and differentiation and eventually osteogenesis. However, they generally lack osteoinductive or osteogenic properties and have various effects on bone healing. We present an overview of bone grafts and graft substitutes in clinical use, and the immune responses to allogeneic bone.
Spontaneous Spinal Epidural Haematomas and the Prognostic Implications of Interval to Surgical Decompression: A Report of Two Cases
Authors: Woon Colin Yi-Loong , Peng Benedict Chan-Wearn , Chen John Li-Tat
Published: October 2016

Spontaneous spinal epidural haematomas (SSEHs) are rare causes of spinal cord compression. We present 2 cases of thoracic SSEHs with similar magnetic resonance imaging (MRI) features. Patient 1 was on long-term oral anticoagulants and patient 2 had uncontrolled hypertension. Patient 1 presented with a dense motor deficit, whereas patient 2 developed progressive lower limb weakness. Decompression laminectomy and haematoma evacuation was performed 51 hours later for patient 1 and 14 hours later for patient 2. Both had recovered their lower limb power, but neurological recovery was greater for patient 2. In patients with bleeding diatheses or uncontrolled hypertension, acute SSEHs must be suspected when they present with atraumatic back pain and signs of spinal cord compression. The interval to surgical decompression greatly influences the prognosis for neurological recovery.
Endoprosthetic Replacement for Giant Cell Tumour of the Proximal Femur
Authors: Khan Shah Alam , Kumar Ashok , Inna Prashanth , Bakhshi Sameer , Rastogi Shishir
Published: October 2016

Purpose.

To evaluate the functional and oncological outcomes of 12 patients with giant cell tumour (GCT) of the proximal femur treated with customised endoprosthesis.

Methods.

Nine men and 3 women aged 26 to 52 (mean, 36) years with Campanacci stage-III GCTs of the proximal femur were included. All underwent a wide excision of the tumour with clear margins and replacement using a customised, bipolar, cemented proximal femoral megaprosthesis. Functional outcomes were evaluated using the Musculoskeletal Tumor Society functional scores.

Results.

The mean follow-up period was 4.8 (range, 4–6) years. There were no instances of recurrence, dislocation, aseptic loosening, deep infection, or death. At the end of 4 years, 8 patients were walking unassisted, 2 used a cane to support during outdoor activities, one used a walking frame at home and outdoors, and one was lost to follow-up. The mean pain relief score was 5.0, the mean functional score was 4.3, the mean emotional acceptance of the procedure and its outcome was 4.7, the mean lower extremity score for support use was 4.7, for walking ability was 4.5, and for gait was 4.3, and the mean total score was 28.3 (out of the maximum of 30).

Conclusion.

Endoprosthetic replacement for Campanacci stage-III GCT of the proximal femur achieves good to excellent functional and oncological outcomes.
Non-Emergency Management of Hip Fractures in Older Patients
Authors: Adie Sam , Harris Ian A , Thorn Lyndall , McEvoy Lynette , Naylor Justine M
Published: October 2016

Purpose.

To evaluate the effects of a policy change from emergency to scheduled management of hip fractures in older patients.

Methods.

91 and 107 patients aged 50 years or older with hip fractures were scheduled for operation on the emergency and orthopaedic lists, respectively. Cancellation rates, consultant supervision rates, after-hour operation rates, 30-day mortality, and preoperative and total length of hospital stay were compared.

Results.

When older patients with hip fractures were scheduled on orthopaedic lists rather than emergency lists, the cancellation rates owing to lack of theatre time (4% vs 54%, p<0.001), the supervision rates (45% vs 24%, p=0.002), and after-hour operation rates (1% vs 25%, p<0.001) were significantly better. The 30-day mortality rates decreased from 4.4% to 1.9% (p=0.3). The median preoperative length of hospital stay significantly increased from 2 to 4 days (p=0.046), but the increase in total length of hospital stay was non-significant (6 to 10 days, p=0.14).

Conclusions.

Non-emergency management of hip fractures in older patients resulted in fewer cancellations and after-hour operations, and increased consultant supervision. Nonetheless, extra time slots for operating theatres are required to avoid an associated increase in preoperative and total length of hospital stay.
Tibiotalocalcaneal Arthrodesis Using a Supracondylar Femoral Nail for Advanced Tuberculous Arthritis of the Ankle
Authors: Gavaskar Ashok S , Chowdary Naveen
Published: October 2016

Purpose.

To review 7 patients with advanced osteoarticular tuberculous arthritis of the ankle who underwent arthrodesis using a supracondylar femoral nail.

Methods.

All patients showed gross destruction of the articular cartilage of the tibiotalar joint with severe periarticular rarefaction on radiographs. Their pre- and one-year post-operative Foot and Ankle Outcome Scores (FAOS) were compared. All patients underwent joint debridement, complete synovial excision, and arthrodesis using a supracondylar femoral nail, followed by multidrug chemotherapy for 12 months (isoniazid, rifampicin, pyrazinamide, and ethambutol for 3 months, and isoniazid and rifampicin for 9 months).

Results.

All patients achieved fusion in a mean of 13 weeks and regained their preoperative level of independence. No patient had a relapse, major complications, or hardware failure. At postoperative year one, the mean FAOS for pain improved to 85 from 26, whereas the mean FAOS for quality of life improved to 60 from 5.

Conclusion.

Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail, combined with debridement and multidrug therapy, enabled a reliable one-stage solution for advanced osteoarticular tuberculosis and early return to function.
Subcapital Femoral Neck Fracture after Fixation of an Intertrochanteric Fracture with a Proximal Femoral Nail: A Report of Two Cases
Authors: Kaneko Haruka , Matsuda Keiji , Kim Sungon , Maeda Kouichi , Ikegami Takashi , Kubota Reiko , Nagayama Masataka , Nozawa Masahiko
Published: October 2016

Subcapital femoral neck fractures are a rare complication after fixation of an intertrochanteric fracture with a proximal femoral nail. We report 2 such cases where the patients had severe osteoporosis, based on Singh's index and pathological findings. In one case there was a technical error leading to a tip-apex distance of more than 20 mm, but osteoporosis appeared to be a more significant cause than any technical problems.
Primary Intra-Osseous Liposarcoma of the Femur: A Case Report
Authors: Macmull Simon , Atkinson Henry Dushan Edward , Saso Srdjan , Tirabosco Roberto , O'Donnell Paul , Skinner John Andrew
Published: October 2016

We report a rare case of an intra-osseous liposarcoma of the proximal femur. A 26-year-old man presented with a 6-month history of left groin pain radiating to the knee and an antalgic gait. Radiology showed a predominantly fatty lesion in the medial aspect of the femoral neck extending toward the lesser trochanter; most of the marrow in the femoral neck had been replaced without evidence of an extra-osseous mass; and the posterior cortex had been destroyed. Histological and immunohistochemical analyses of the tumour after open biopsy were indicative of high-grade liposarcomatous malignancy. After exclusion of any other primary tumour foci or metastases on regional and whole-body magnetic resonance images, the diagnosis of a high-grade intra-osseous primary liposarcoma of the proximal femur was made. The patient received 2 preoperative courses of neoadjuvant doxorubicin, cisplatin and methotrexate. After proximal femoral replacement following en bloc excision of the proximal femur, 4 more cycles of adjuvant ifosfamide and etoposide were given. At the 16-month follow-up, he remained independently ambulatory, with no local or distant recurrence. Tissue diagnosis and multimodal imaging, rather than any single radiological investigation, are important in making the diagnosis.
Discrepancy between Anatomical Axis and Stem Position of Various Femoral Components in Japanese
Authors: Ueno M , Urabe Ken , Fujita Mamou , Aikawa Jun , Kobayashi Akimasa , Itoman M
Published: October 2016

Purpose.

To evaluate the discrepancy between the anatomical axis of the distal femur of Japanese patients and the stem position of 5 types of femoral components.

Methods.

Lateral radiographs of 12 men and 88 women aged 31 to 83 (mean, 59) years with rheumatoid arthritis were evaluated. The discrepancy between the anatomical axis of the distal femur and the stem position of 5 types of femoral components (Nexgen LCCK, Press-Fit Condylar, Scorpio, Total Stabilizer, and Rotating Hinge) was determined by superimposing the template of each model over each lateral radiograph.

Results.

The anatomical axis varied widely among our patients, as did the stem position of the 5 femoral components. Stems of all 5 femoral components tended to be more posterior than the anatomical axis. The discrepancy was smallest in the Nexgen LCCK, followed by the Press-Fit Condylar components. It was >3 mm in the other 3 models. In 35% of the patients, none of the prosthesis could be placed in an appropriate position. Smaller-size prostheses appear necessary for the Japanese.

Conclusion.

The stem position should be an important factor guiding selection of the appropriate model. The currently available femoral components may not be appropriate for the Japanese. Prostheses with appropriately positioned stems for Japanese patients with rheumatoid arthritis should be developed.
Evaluation of Soft-Tissue Balance during Total Knee Arthroplasty
Authors: Sasanuma Hideyuki , Sekiya Hitoshi , Takatoku Kenzo , Takada Hisashi , Sugimoto Naoya
Published: October 2016

Purpose.

To evaluate soft-tissue balance during versus after total knee arthroplasty (TKA).

Methods.

18 men and 75 women aged 52 to 85 (mean, 68) years who had moderate-to-severe varus deformity underwent TKAs using the Scorpio non-restrictive geometry posterior-stabilised system (Stryker Howmedica Osteonics; Allendale, [NJ], USA). All surgeries were performed by a single surgeon using the medial parapatellar approach. After the bony and soft-tissue procedures, soft-tissue balance was measured intra-operatively using a tensor/balancer device. The coronal laxity—angles between the cut surfaces of the femur and tibia—were measured at 0° (in extension) and 90° (in flexion). The central gap was also measured. Immediate postoperative soft-tissue balance was measured using an arthrometer, while anteroposterior stress radiographs were being taken. A valgus or varus force was applied just above the knee on the lateral or medial side, with the knee counter-supported and at 15° flexion.

Results.

Intra-operatively, the mean coronal laxity at 0° (in extension) and 90° (in flexion) was 2.1° and −1.6°, and the mean central gaps were 21.2 and 23.5 mm, respectively. Immediate postoperative mean coronal laxity was 2.9°, indicating that lateral laxity was greater than medial laxity. The postoperative coronal laxity was positively corrected to the intra-operative coronal laxity at 0° ( r=0.304, p=0.003), but not to the intra-operative coronal laxity at 90° ( r= −0.07, p=0.47).

Conclusion.

Slightly greater lateral laxity was observed after TKA, although equal medial-lateral balance was achieved intra-operatively.
Static Progressive Stretching Using a Turnbuckle Orthosis for Elbow Stiffness: A Prospective Study
Authors: Bhat Anil K , Bhaskaranand Kumar , Nair Surej Gopinathan
Published: October 2016

Purpose.

To assess the effectiveness of a turnbuckle orthosis as a means of improving the range of motion in patients with elbow stiffness.

Methods.

17 males and 11 females aged 8 to 68 (mean, 32) years underwent static progressive stretching using a turnbuckle orthosis for elbow stiffness secondary to trauma or surgery. Patients were instructed to wear the orthosis during the daytime for a mean of 15 hours and remove it during sleep as well as at breakfast, lunch, and dinner. One hour of range-of-motion exercise was performed during each break. Patients were followed up every month and the range of motion was recorded with a standard goniometer. The use of orthosis was discontinued when there was no further improvement. Range-of-motion exercise was encouraged thereafter to maintain the results. The extent of flexion contracture and range of motion before and after the treatment were compared.

Results.

The mean duration of orthosis use was 5 (range, 3–8) months. The mean flexion contracture reduced from 59° to 27° and the range of motion improved from 57° to 102°. 19 of the patients achieved a functional range of motion. Improvement in the range of motion was excellent in 6 patients, good in 11, satisfactory in 7; at the end of follow-up (mean, 29 months), the results were maintained or improved further in 20 patients (even in those with long-standing contractures).

Conclusion.

Static progressive stretching using a turnbuckle orthosis is reliable and cost-effective for treating elbow stiffness.
Infection Rate of Percutaneous Kirschner Wire Fixation for Distal Radius Fractures
Authors: Lakshmanan Palaniappan , Dixit Varun , Reed Mike R , Sher Joel Lester
Published: October 2016

Purpose.

To review the infection rate in 43 patients who underwent percutaneous Kirschner wire fixation for distal radius fractures.

Methods.

Records of 13 men and 30 women aged 25 to 86 (mean, 49) years who underwent closed reduction and percutaneous Kirschner wire fixation for unstable distal radius fractures were reviewed. Each fracture was fixed with 2 to 3 wires of 1.6-mm diameter. Kirschner wires were left protruding through the skin for easy removal, with their ends bent outside the skin to prevent migration. Wounds were cleaned and dressed with gauze and a plaster-of-Paris cast was applied. The severity of the pin tract infection was graded according to the modified Oppenheim classification.

Results.

Nine (21%) of the patients developed pin tract infection (3 grade 1, 3 grade 2, 2 grade 3, and one grade 4). Three patients underwent early removal of the Kirschner wires at week 3.

Conclusion.

The infection rate after percutaneous Kirschner wire fixation is unacceptable. Kirschner wires should be buried under the skin to decrease the infection rate.
Idiopathic Hypertrophic Spinal Pachymeningitis: A Case Report
Authors: Takahashi Hiroshi , Wada Akihito , Yokoyama Yuichiro , Ishii Maki , Shibuya Kazutoshi , Suguro Toru
Published: October 2016

A 67-year-old man presented with progressive quadriplegia. Magnetic resonance imaging (MRI) revealed spinal cord compression by a thickened dura ventral to the cord from C3 to C7. The lesion was isointense on both T1- and T2-weighted images, and showed contrast enhancement on T1-weighted gadorinium-enhanced images. A diagnosis of idiopathic hypertrophic spinal pachymeningitis was confirmed histologically after anterior decompression and fusion. Only partial excision was achieved. Marked improvement of the quadriplegia was attained only after steroid therapy. At the 3-month follow-up, the patient was able to walk with a cane. The affected site showed no remission on MRI despite continuous steroid therapy. At the 2-year follow-up, the patient could walk independently.